rhBMP-2骨修复材料在后路腰椎内固定植骨融合术中应用  

Application of bone repair material containing recombinant human bone morphogenetic protein-2 in instrumented posterior lumbar interbody fusion

作　　者：雷建平 徐昊 张克良 

机构地区：[1]武汉普爱医院,湖北武汉430033

出　　处：《中国矫形外科杂志》2018年第5期390-394,共5页Orthopedic Journal of China

摘　　要：[目的]探讨rhBMP-2骨修复材料在腰椎内固定植骨融合术中应用的临床疗效。[方法]2015年1月～2016年4月在本院骨科收治的行后路腰椎体间融合术的腰椎退变性疾病患者73例,根据植骨融合材料分为两组。rhBMP-2组35例,采用rhBMP-2骨修复材料填埋Cage+椎弓根螺钉双侧内固定;自体骨组38例,采用自体骨骨质填埋Cage+椎弓根螺钉双侧内固定。比较两组患者手术时间、术中出血量、术后螺钉位置不良率、Cage位置移位率、相对椎间隙丢失高度、椎间融合率以及治疗前后JOA评分及Oswestry指数(ODI)评估。[结果]两组间手术时间、术中出血量的差异无统计学意义(P>0.05),两组术前、术后ODI和JOA评分差异无统计学意义(P>0.05)。rhBMP-2组第12周螺钉位置不良率(7.14%)和Cage位置移位率(8.11%)分别显著高于自体骨组的3.29%和2.56%,差异具有统计学意义(P<0.05),而第24周,rh BMP-2组螺钉位置不良率(9.29%)和Cage位置移位率(8.11%)与自体骨组的10.53%和7.69%相当,差异无统计学意义(P>0.05);rhBMP-2组术后椎间隙高度丢失(0.32±0.06)mm显著低于自体骨组的(1.41±0.40)mm,差异具有统计学意义(P<0.05);rhBMP-2组第12周椎间融合率为54.05%,低于同期自体骨组的79.49%,差异具有统计学意义(P<0.05),而第24周两组椎间融合率均为100%,差异无统计学意义(P>0.05)。[结论]rhBMP-2骨修复材料应用于腰椎内固定植骨融合术中的起效时间晚于自体骨,但最终疗效与自体骨相当,但在恢复椎间高度上的作用优于自体骨,可以在临床上替代自体骨用于脊柱融合术中。[Objective] To investigate the clinical outcomes of applying bone repair material containing recombinant human bone morphogenetic protein-2 （rhBMP-2） in instrumented posterior lumbar interbody fusion. [Methods] Form January 2015 to April 2016, 73 patients with lumbar degenerative diseases were surgically treated with instrumented posterior lumbar interbody fusion in our hospital. According to the materials implanted into the cages for posterior lumbar interbody fusion combined with bilateral pedicle screw-rod fixation, the 73 patients were divided into two groups ： the rhBMP-2 group had the bone repair ma- terial containing rhBMP-2 filled in the interbody cage in 35 patients, whereas the bone autograft group had autogenous bone was packed in the cage in 38 patients. The operative time, intraoperative blood loss, ODI, JOA and radiological assessments, such as the screw malposition, loss of intervertebral height, cage displacement as well as intervertebral fusion, were compared between the two groups. [Results] There were no statistical differences in the operative time, intraoperative blood loss, ODI and JOA between the two groups （P 〉 0.05）. The rhBMP-2 group was significantly inferior to the bone autograft group at 12 weeks after operation with higher rate of the screw malposition （7.14% versus 2.29% ） and higher rate of the cage displacement （8.11% versus 2.56%） （P 〈 0.05）, however, which turned to be statistically indistinguishable at 24 weeks postoperatively （9.29% versus 10.53% and 8.11% versus 7.69%） （P 〉 0.05）. Conversely, the rhBMP-2 group got significantly less intervertebral height lossthan the bone autograft group [（0.32±0.06） mm versus （1.41±0.40） ram, P 〈 0.05] . In term of the intervertebral fusion rate, the rhBMP-2 group was statistically inferior to the bone autograft group at 12 weeks after operation（54.05% versus 79.49%, P〈0.05） , although both groups achieved 100% of the fusion at 24 weeks after operation （P〉 0.05） . [Conclusion] The o

关 键 词：人重组骨形态发生蛋白-2 自体骨移植 腰椎后路椎体间融合术 

分 类 号：R318[医药卫生—生物医学工程]