Heard Jeremy C, Lee Yunsoo, Lambrechts Mark J, Berthiaume Emily, D'Antonio Nicholas D, Bodnar John, Paulik John, Mangan John J, Canseco Jose A, Kurd Mark F, Kaye I David, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D, Hilibrand Alan S
Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
J Craniovertebr Junction Spine. 2023 Apr-Jun;14(2):194-200. doi: 10.4103/jcvjs.jcvjs_45_23. Epub 2023 Jun 13.
The objectives of our study were to compare the fusion rates and surgical outcomes of lumbar fusion surgery based on the (1) type of demineralized bone matrix (DBM) carrier allograft, (2) the presence/absence of a carrier, and (3) the presence of bone fibers in DBM.
Patients >18 years of age who underwent single-level posterolateral decompression and fusion (PLDF) between L3 and L5 between 2014 and 2021 were retrospectively identified. We assessed bone grafts based on carrier type (no carrier, sodium hyaluronate carrier, and glycerol carrier) and the presence of bone fibers. Fusion status was determined based on a radiographic assessment of bony bridging, screw loosening, or change in segmental lordosis >5°. Analyses were performed to assess fusion rates and surgical outcomes.
Fifty-four patients were given DBM with a hyaluronate carrier, 75 had a glycerol carrier, and 94 patients were given DBM without a carrier. DBM carrier type, bone fibers, and carrier presence had no impact on 90-day readmission rates ( = 0.195, = 0.099, and = 1.000, respectively) or surgical readmissions ( = 0.562, = 0.248, and = 0.640, respectively). Multivariable logistic regression analysis found that type of carrier, presence of fibers (odds ratio [OR] = 1.106 [0.524-2.456], = 0.797), and presence of a carrier (OR = 0.701 [0.370-1.327], = 0.274) were also not significantly associated with successful fusion likelihood.
Our study found no significant differences between DBM containing glycerol, sodium hyaluronate, or no carrier regarding fusion rates or surgical outcomes after single-level PLDF. Bone particulates versus bone fibers also had no significant differences regarding the likelihood of bony fusion.
我们研究的目的是比较基于以下因素的腰椎融合手术的融合率和手术结果：（1）脱矿骨基质（DBM）载体同种异体骨的类型；（2）载体的有无；（3）DBM中骨纤维的存在情况。
回顾性确定2014年至2021年间接受L3至L5单节段后外侧减压融合术（PLDF）且年龄大于18岁的患者。我们根据载体类型（无载体、透明质酸钠载体和甘油载体）和骨纤维的存在情况评估骨移植。根据骨桥接、螺钉松动或节段性前凸改变>5°的影像学评估确定融合状态。进行分析以评估融合率和手术结果。
54例患者接受含透明质酸钠载体的DBM，75例有甘油载体，94例患者接受无载体的DBM。DBM载体类型、骨纤维和载体的存在对90天再入院率（分别为=0.195、=0.099和=1.000）或手术再入院率（分别为=0.562、=0.248和=0.640）均无影响。多变量逻辑回归分析发现，载体类型、纤维的存在（优势比[OR]=1.106[0.524 - 2.456]，=0.797）和载体的存在（OR=0.701[0.370 - 1.327]，=0.274）也与成功融合的可能性无显著相关性。
我们的研究发现，在单节段PLDF术后，含甘油、透明质酸钠或无载体的DBM在融合率或手术结果方面无显著差异。骨颗粒与骨纤维在骨融合可能性方面也无显著差异。
