骨形态发生蛋白在腰椎融合术中的应用  

Application of bone morphogenetic protein in the lumbar spinal fusion

作　　者：林二虎[1,2] 镇万新 高国勇[1,2] 马乐群 杨大志[1,2] 彭松林 刘俊良[1,2] 

机构地区：[1]暨南大学第二附属医院 [2]深圳市人民医院脊柱外科,广东深圳518020

出　　处：《新乡医学院学报》2015年第6期557-560,共4页Journal of Xinxiang Medical University

摘　　要：目的探讨骨形态发生蛋白（BMP）结合椎间融合器在腰椎植骨融合术中的应用效果。方法选择2013年3月至2014年10月深圳市人民医院脊柱外科收治的56例行腰椎融合术治疗患者为观察组,其中腰椎滑脱23例,腰椎管狭窄症21例,腰椎间盘突出症12例,均采用BMP结合椎间融合器自体骨植骨融合及椎弓根系统治疗。2012年3月至2013年2月在本科室行椎间融合器自体骨植骨融合及椎弓根系统治疗的72例患者为对照组,其中腰椎滑脱28例,腰椎管狭窄症26例,腰椎间盘突出症18例。观察2组患者术后3、6、12个月时的疗效、腰椎融合率及并发症。结果术后随访12-16个月,2组患者均无融合器塌陷、松动、移位,椎间高度无明显丢失。按Nakai评分标准,术后3、6、12个月时,观察组患者优良率分别为89.3%、91.1%、94.6%,融合率分别为0.0%、71.4%及94.6%;对照组患者优良率分别为87.5%、88.9%、90.3%,融合率分别为0.0%、37.5%和79.2%;术后12个月时观察组患者的优良率显著高于对照组（P〈0.05）;术后6、12个月时观察组患者的融合率显著高于对照组（P〈0.05）。对照组患者术后6-12个月出现断棒3例、断钉1例（5.6%）,临近椎体退变滑脱1例通过2次手术治疗。观察组患者术后12-16个月无断钉断棒病例。结论在腰椎融合术中应用BMP能有效提高临床疗效和腰椎融合率,减少断钉、断棒及临近椎体退变等并发症。Objective To explore the clinical effect of the bone morphogenetic protein（ BMP） combined with cage in lumbar spine fusion. Methods A total of 56 patients who had lumbar spinal fusion from March 2013 to October 2014 in the Department of Spinal Surgery of Shenzhen People＇s Hospital were selected as observation group,with 23 cases of lumbar olisthe,21 cases of lumbar spinal stenosis disease and 12 cases of lumbar disc prolapse. BMP combined with intervertebral fusion of autologous bone graft fusion and pedicle screw were adopted in the patients. Seventy-two cases who had interbody fusion with autograft bone fusion and pedicle screw fixation from March 2012 to February 2013 were selected as control group,with 28 cases of include lumbar olisthe,26 cases of lumbar spinal stenosis disease and 18 cases of lumbar disc prolapse. The curative effect,fusion rate and complication at postoperative 3,6 and 12 months were observed. Results All the patients had no fusion device subsidence,loose,displacement and their intervertebral height had no a loss. According to Nakai evaluation criterion,the optimal rate and the fusion rate of the observation group at postoperative 3,6 and 12 months were 89. 3%,91. 1%,94. 6% and0. 0%,71. 4%,94. 6%,which in the control group were 87. 5%,88. 9%,90. 3% and 0. 0%,37. 5%,79. 2%. The optimal rate in observation group was higher significantly than that in the control group at postoperative 12 months（ P〈0. 05） and the fusion rate in observation group was higher significantly than those in the control group at postoperative 6 and 12 months（ P〈0. 05）. There were three cases of broken bars,one case of screw breakage（5. 6%）,adjacent vertebral spondylolisthesis in one case by secondary surgery in the control group during the 6- 12 months after operation while the study group had no cases with broken nail or broken rod. Conclusion Application of BMP in the lumbar fusion can effectively improve the clinical curative effect and lumbar fusion rate,reduce complications such as broken na

关 键 词：骨形态发生蛋白 椎间融合器 腰椎融合 

分 类 号：R683.2[医药卫生—骨科学]