骨形态发生蛋白结合后外侧融合在腰椎退行性疾病手术中的应用  

Application of bone morphogenetic protein combined with posterolateral fusion in the treatment of lumbar degenerative diseases

作　　者：夏海鹏 郑燕平 周超 殷军 丛伟 XIA Haipeng;ZHENG Yanping;ZHOU Chao;YIN Jun;CONG Wei(Department of Orthopedics, Qilu Hospital of Shandong University(Qingdao), Qingdao 266035, Shandong, China)

机构地区：[1]山东大学齐鲁医院(青岛)脊柱外科

出　　处：《山东大学学报（医学版）》2019年第5期62-66,共5页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81572215)

摘　　要：目的评价骨形态发生蛋白(BMP)结合后外侧融合术(PLF)治疗腰椎退行性疾病的临床疗效。方法回顾2014年1月至2017年11月在山东大学齐鲁医院(青岛)因腰椎退行性疾病行后外侧融合术(PLF)患者66例,其中男34例,女32例, 36~79岁,平均(54.5±14.2)岁。单节段、双节段、三节段患者分别为26例、28例、12例;腰椎管狭窄症45例,腰椎滑脱症(I°)11例,腰椎间盘突出症(极外侧)10例。主要临床表现为腰痛、下肢疼痛和下肢麻木。行经微创通道Wiltse入路减压,磨钻制备植骨床,后外侧植骨,钉棒系统固定。单纯自体骨植骨23侧,自体骨+同种异体骨33侧,自体骨+BMP 32侧,同种异体骨+BMP 19侧,自体骨+同种异体骨+BMP 25侧,常规左侧应用BMP,其中有13例双侧均应用BMP。临床疗效评估采用Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS);参照Suk标准评估融合情况。结果随访时间12~24个月,平均(14.7±3.2)个月。术后1年VAS评分、ODI均有改善,未发生临床并发症。随着术后随访时间延长,不同植骨材料组融合率均逐渐增高,术后3、6个月,1年融合率,单纯自体骨侧分别为52%、65%、96%,自体骨+同种异体骨侧52%、64%、94%,自体骨+BMP侧分别为84%、88%、94%,同种异体骨+BMP侧为84%、89%、95%,自体骨+同种异体骨+BMP侧分别为84%、88%、96%。结论 PLF治疗腰椎退行性疾病融合率高、组织损伤小,是腰椎融合方式的一个选择及补充。BMP可提高PLF近期随访的融合率,但远期随访时融合率无明显差别。Objective To evaluate the clinical efficacy of bone morphogenetic protein(BMP) combined with posterolateral fusion(PLF) in the treatment of lumbar degenerative diseases. Methods The clinical data of 66 patients with lumbar degenerative diseases who underwent PLF during Jan. 2014 and Nov. 2017 were retrospectively analyzed, including 34 males and 32 females, aged 36-79 years, average(54.5±14.2) years. The disease involved single segment, double segments and three segments in 26, 28 and 12 cases, respectively. Lumbar spinal stenosis, lumbar spondylolisthesis(I°) and far lateral lumber disc herniation occurred in 45, 11 and 10 cases, respectively. The main clinical manifestations were low back pain, lower extremity pain and anesthesia. After decompression through the minimally invasive Wiltse approach, bone grafting bed was prepared by high-speed burr. PLF was performed on 23 sides with autologous bone alone, 33 sides with autologous and allogeneic bone, 32 sides with autologous bone and BMP, 19 sides with allogeneic bone and BMP, and 25 sides with autologous and allogeneic bone and BMP. BMP was routinely used in the left side, and used in both sides in 13 patients. The clinical efficacy was evaluated with Oswestry disability index(ODI) and visual analogue scale(VAS), and the fusion rate was evaluated with Suk. Results The patients were followed up for 12-24 months, average(14.7±3.2) months. One year after surgery, VAS score and ODI were significantly improved, and no clinical complications occurred. As the postoperative follow-up prolonged, the fusion rate 3 months, 6 months and 1 year after surgery for the autologous bone sides was 52%, 65% and 96%, for the autologous bone + allogeneic bone sides was 52%, 64%, 94%, for the autologous bone + BMP sides was 84%, 88% and 94%, for the allogeneic bone + BMP sides was 84%, 89%, 95%, and for the autologous bone + allogeneic bone + BMP sides was 84%, 88% and 96%, respectively. Conclusion PLF is safe, effective and minimal invasive in the treatment of lumbar degenerative

关 键 词：骨形态发生蛋白 后外侧融合 腰椎退行性疾病 Wiltse入路 

分 类 号：R681.5[医药卫生—骨科学]