人重组骨形态蛋白-2预防腰椎内固定植骨融合术后复发的评价  

Effect of rhBMP-2 on preventing the recurrence of lumbar degenerative spondylolisthesis after lumbar internal fixation and bone graft fusion surgery

作　　者：朱燕生[1] 黄凯[1] 盛红枫 俞华军[1] ZHU Yan-sheng;HUANG Kai;SHENG Hong-feng;YU Hua-jun(Department of Bone Injury Repair and Reconstruction,Litongde Hospital,Hangzhou,Zhejiang 310012,China)

机构地区：[1]浙江省立同德医院骨伤修复重建外科,浙江杭州310012

出　　处：《中国预防医学杂志》2020年第10期1129-1133,共5页Chinese Preventive Medicine

基　　金：浙江省医药卫生科技计划基金资助项目(2015KYB078)。

摘　　要：目的研究人重组骨形态发生蛋白-2(rhBMP-2)预防腰椎退变性滑脱患者腰椎内固定植骨融合术后复发的效果。方法选取2017年1月~2018年11月收治的112例需行腰椎内固定植骨融合术的腰椎退变性滑脱患者进行研究,按照随机数字表法,随机分为研究组和对照组,每组56例。对照组应用椎弓根螺钉双侧内固定,研究组应用rhBMP-2骨修复材料填埋和椎弓根螺钉双侧内固定。观察并比较两组患者Prolo评分、滑脱率情况、SF-36评分、VAS评分、ODI指数变化情况以及术后融合率。结果术后研究组患者Prolo评分为(7.56±1.67)分,较术前(3.12±0.33)分显著上升;滑脱率为(14.55±6.26)%较术前(43.27±5.17)%显著下降;对照组患者Prolo评分为(6.81±1.45)分,较术前(3.21±0.52)分显著上升;滑脱率为(22.58±4.31)%较术前(43.39±5.38)%显著下降;研究组较对照组变化有统计学意义(P<0.05)。研究组术后6个月SF-36评分为(63.47±3.86)分、ODI指数(23.48±5.27)均较术前分别为(70.56±5.78)分和(47.94±5.58)显著下降;术后12个月SF-36评分为(44.91±6.26)分,腿痛VAS评分为(2.13±0.74)分、腰痛(2.07±0.73)分、ODI指数(21.46±4.97)均较术前为(70.56±5.78)分和(6.54±1.03)分、(5.85±1.24)分、(47.94±5.58)显著下降。对照组术后6个月SF-36评分(67.89±3.92)分、ODI指数(28.44±3.13)均较术前(70.23±5.22)分、(45.85±6.27);术后12个月SF-36评分(49.39±5.68)分、VAS评分腿痛(2.95±0.63)分、腰痛(2.81±0.67)分及ODI指数(25.67±11.25)均较术前显著下降(70.23±5.22)分、(6.37±0.95)分、(5.93±1.05)分、(45.85±6.27)显著下降;且研究组较对照组下降更为显著(P<0.05)。研究组术后6个月融合率28.57%、12个月融合率76.79%,均高于对照组10.71%、51.79%,差异有统计学意义(P<0.05)。结论腰椎内固定植骨融合术中应用rhBMP-2骨修复材料可提高临床治疗效果,增加椎间植骨融合率,降低术后腰椎滑脱,预防复发。Objective To observe the effect of rhBMP-2 on preventing the recurrence of lumbar degenerative spongylolisthesis after lumbar internal fixation and bone graft fusion surgery. Methods A total of 112 patients with lumbar degenerative spongylolisthesis who underwent lumbar internal fixation and bone graft fusion surgery from January 2017 to November 2018 were enrolled and were evenly divided into observation group and control group according to the random number table method.All patients underwent pedicle screw bilateral internal fixation surgery,while those in the observation group also received treatment with rhBMP-2 bone repair material graft fusion.The Prolo score,slip rate,SF-36 score,VAS score,ODI index change and postoperative fusion rate were compared between the two groups. Results After the surgery,,the Prolo score increased from 3.12±0.33 to 7.56±1.67 in the observation group and from 3.21±0.52 to 6.81±1.45 in the control group,while the slip rate decreased from 43.27±5.17%to 14.55±6.26%in the observation group and from43.39±5.38%to 22.58±4.31%in the control group,the postoperative Prolo score was higher while the postoperative slip rate was lower in the observation group compared to those in the control group,the differences were statistically significant(P<0.05).After the surgery,even though the SF-36 score and ODI index at 6 month and SF-36 score,leg pain VAS score,lower back pain VAS score and ODI index at 12 month all decreased in both groups,the changes were more significant in the observation group than that in the control group(P<0.05).The fusion rates at 6 months and 12 month after the surgery were higher in the observation group than those in the control group(28.57% vs 10.71%,76.79% vs 51.79%),the differences were also statistically significant(P<0.05). Conclusions The use of rhBMP-2 bone repair material in lumbar internal fixation and bone graft fusion can improve the clinical outcome of patients by increasing the fusion rate of the graft,reducing the occurrence of postoperative lumbar

关 键 词：自体骨移植 人重组骨形态发生蛋白-2 退变性腰椎滑脱 腰椎退变性疾病 植骨融合 经后路腰椎体间融合术 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学]