不同植骨材料在退变性腰椎病脊柱融合术中的应用与疗效比较  

COMPARISON OF THREE DIFFERENT BONE GRAFTS FOR SPINAL FUSION OF DEGENERATIVE LUMBAR DISEASE

作　　者：殷鹏[1] 刘秀珍[1] 吴延平[1] 孙英华[1] 

机构地区：[1]潍坊医学院附属青州中心医院骨科,山东青州262500

出　　处：《中国修复重建外科杂志》2012年第7期778-782,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较自体骨、同种异体骨、BMP复合骨应用于退变性腰椎病椎间植骨融合术中的临床疗效。方法 2005年1月-2010年1月采用脊柱植骨融合术治疗102例退变性腰椎病患者,根据植骨材料不同,将患者随机分为自体骨组(A组,35例)、同种异体骨组(B组,33例)、BMP复合骨组(C组,34例)。3组患者性别、年龄、病程、病变节段、Meyerding分级、术前椎间隙高度及日本骨科学会(JOA)评分等比较差异无统计学意义(P>0.05),具有可比性。比较不同时间点3组椎间隙高度、植骨融合率及JOA评分等情况。结果 3组患者均获随访,随访时间2～5年,平均3.2年。术后6～24个月各组椎间隙高度均较术前显著提高(P<0.05);A、C组术后6、12、18、24个月椎间隙高度显著大于B组(P<0.05),A、C组间差异无统计学意义(P>0.05)。A、C组植骨术后6个月出现融合患者,至24个月A、C组植骨融合率均为100%;B组于术后12个月出现融合患者,至24个月植骨融合率为87.88%,与A、C组比较差异有统计学意义(P<0.05)。术后12、24个月,各组JOA评分均较术前显著提高(P<0.05);A、C组JOA评分及改善优良率显著高于B组(P<0.05),A、C组间差异无统计学意义(P>0.05)。结论 BMP复合骨在退变性腰椎病手术椎间植骨中与自体骨基本等效,并优于同种异体骨,且移植骨量充足,无需有创取材,具有融合快、成功率高等特点。Objective To compare the effectiveness of three different bone grafts [autogenous bone, allogeneic bone, and bone morphogenetic protein （BMP） composite bone] combined with screw system for spinal fusion of degenerative lumbar disease. Methods Between January 2005 and January 2010, 102 cases of degenerative lumbar disease were randomly treated with autogenous bone （group A, n=35）, allogeneic bone （group B, n=33）, and BMP composite bone （group C, n=34）. There was no significant difference in sex, age, disease duration, affected segments, Meyerding grade, preoperative intervertebral space height, and the Japanese Orthopaedic Association （JOA） score among 3 groups （P 〉 0.05）. The intervertebral space height, bone fusion rate, and JOA score were compared among 3 groups at different time points. Results All patients of 3 groups were followed up 2 to 5 years, with an average of 3.2 years. At 6 to 24 months after operation, the intervertebral space height significantly increased when compared with preoperative value in 3 groups （P 〈 0.05）; the intervertebral space height of groups A and C was significantly greater than that of group B at 6, 12, 18, and 24 months after operation （P 〈 0.05）, but no significant difference was found between groups A and C （P 〉 0.05）. Bone graft fusion was observed at 6 months in groups A and C and at 12 months in group B; at 24 months, the rate of bone graft fusion was 100% in groups A and C, and 87.88% in group B, showing significant difference （P 〈 0.05）. There was significant difference in IOA score between preoperation and postoperative 12th and 24th months （P 〈 0.05）; at 12 and 24 months after operation, JOA socre and improving rate of groups A and C were significantly higher than those of group B （P 〈 0.05）, but no significant difference was found between groups A and C （P 〉 0.05）. Conclusion The effect of BMP composite bone is equivalent to that of autogenons bone graft in treating spinal fusion of degenerative lumbar

关 键 词：脊柱融合 退变性腰椎病 BMP复合骨 植骨 

分 类 号：R687.3[医药卫生—骨科学]