牛骨形成蛋白与异体脱钙骨基质颗粒及骨水泥复合修复椎体骨缺损:3个月效果随访  

Repair of vertebra bone defect by bovine bone morphogenetic protein with decalcified bone matrix and bone cement:A follow-up of the curative effect for 3 months

作　　者：赵廷宝[1] 卢兆桐[1] 张云昌[1] 张晓君[1] 林世德[1] 刘鑫[1] 孟庆溪[1] 焦守凤[1] 

机构地区：[1]解放军济南军区总医院脊髓修复科,山东省济南市250031

出　　处：《中国临床康复》2006年第45期91-93,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:将骨形成蛋白-脱钙骨基质颗粒-骨水泥复合材料用于临床修复椎体骨缺损,观察其临床效果,分析椎体骨缺损的修复与重建方法。方法:以2004-04/2006-02在解放军济南军区总医院脊髓修复科就诊的脊髓损伤患者23例为观察对象,男15例,女8例。提取牛骨形成蛋白,制备异体脱钙骨基质颗粒,将二者按1∶25的质量比复合后,与骨水泥以1∶1的质量比制成复合材料,经充分的动物实验评价后应用到临床。手术方法:所有患者均行气管插管全麻。T10,S1采用后方入路,其余均取前路,前路以CT和(或)MRI示脊髓受压较重的一侧进入。彻底清除对脊髓形成压迫的部分,对局部遗留的空洞清理干净,待骨水泥到拔丝期时将骨形成蛋白-脱钙骨基质颗粒复合物加入混匀复合在一起,复合物固化前植入椎体骨缺损部位,剩余的复合物在台下观察,完全固化后冲洗切口,缝合。为了加强重建椎体的稳定性,同时应用内固定。其中1例因椎体外壳坚硬且完整,复合材料重建后稳定性很好,故未用内固定。术后定时随访,以患者主观感觉和复查时的影象学资料为判定标准。结果:23例患者获得平均9个月的随访。①X射线片示复合材料填充的骨缺损处在术后1个月时可见复合材料与宿主骨边缘模糊,于3,6,9,12,18个月模糊程度缓慢增加,外围骨痂逐渐重新塑建。23例患者无椎体移位,与复合材料相邻的椎体无塌陷,复合材料所在的脊柱节段无侧弯,内固定物无断裂和松动。1例没用内固定的患者,也没有发生椎体移位和脊柱侧弯。②17例获得了3～12个月(平均(9±2)个月)的MRI随访。MRI示术后脊髓减压充分,复合材料处在T1像上呈低信号,复合材料与宿主骨之间没有间隙。在T2像上,复合材料所在部位呈高信号。③患者脊柱无畸形,应用后无不良反应。结论:骨形成蛋白-脱钙骨基质颗粒-骨水泥复合材料是修复椎体骨缺损�AIM： To investigate the methods and curative effect of the repair and reconstruction for the vertebra bone defects by using bovine bone morphogenetic protein （BMP） with decalcified bone matrix （DBM） and bone cement （BC）. METHODS： Totally 23 patients with spinal cord injury including 15 males and 8 females diagnosed in Department of Spinal Cord Injury, General Hospital of Jinan Military Area Command of Chinese PLA between April 2004 and February 2006 were selected as subjects. The bovine BMP was taken to make DBM. After mixed the BMP and DBM together with the proportion of 1：25, then the BC was added with the weight proportion of 1：1, which was applied in clinic after sufficient animal experiments. Operation methods： All the 23 patients were subjected to general anesthesia by tracheal intubation with T10 and S1 from the posterior and other from the anterior with severe compression on spinal cord showed in CT or MRI. The part with compression on spinal cord was completely removed and the cavity with local remnant was cleaned. The BMP-DBM complex was added when the BC in drawing stage, which was implanted into the defect before fixation. The rest complex was observed and the cut was washed and sutured after complete fixation. To strengthen the stability of the reconstructed vertebra, the internal fixation was given to the patients except one ease with solid and complete vertebra coating and good stability. The patients were followed up at different postoperative time with the subjective feeling and the data of X-ray and MRI as the criteria. RESULTS： All the 23 patients were followed up for 9 months averagely. ①X-ray photography showed the boundary between the composite material and the host bone became indistinct at the first month. While the increased of the degree of the indistinctness at the 3^rd, 6^th, 9^th, 12^th and 18^th month, the surrounding callus was gradually reconstructed. No vertebra shifting, collapse of vertebra near the complex material, seoliosis or break or cinch of the i

关 键 词：骨缺损 椎体 修复重建 骨形成蛋白 脱钙骨基质颗粒 骨水泥 

分 类 号：R651.2[医药卫生—外科学]