同种异体骨移植材料在脊柱融合中的应用  

Application of allograft bone materials in spinal fusion

作　　者：蔡元庆 刘谟震[1] 李忠海[1] Cai Yuanqing;Liu Mozhen;Li Zhonghai(Department of Orthopedics,First Affiliated Hospital of Dalian Medical University,Dalian 116600,Liaoning Province,China)

机构地区：[1]大连医科大学附属第一医院骨科,辽宁省大连市116600

出　　处：《中国组织工程研究》2023年第16期2571-2579,共9页Chinese Journal of Tissue Engineering Research

基　　金：大连市科技创新基金科技惠民项目(2020JJ27SN070);项目负责人:李忠海。

摘　　要：背景:脊柱融合术中选择有效的植骨材料十分有必要,自体骨移植被视为脊柱融合术的“金标准”,但其存在取骨区疼痛等并发症。同种异体骨供骨量充足、可避免取骨区并发症,不同的同种异体骨材料在不同部位的脊柱融合中展现了良好的成骨能力。目的:综述近年来同种异体骨移植材料在脊柱融合术中的应用现状。方法:检索1990-2022年间,在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词:“fresh frozen bone,autograft,allograft,freeze-dried bone,demineralized bone matrix,allograft spacer,spinal fusion”;中文检索词:“新鲜冰冻骨,自体骨,同种异体骨,冷冻干燥骨,脱矿骨基质,同种异体骨椎间融合器,脊柱融合”,经筛选后最终纳入95篇文献进行综述。结果与结论:新鲜冰冻骨由于其存在免疫排斥、传播疾病等风险临床运用较少;冷冻干燥骨移植虽然存在延迟愈合,但是其最终融合效果与自体骨相似;脱钙骨基质常作为自体骨填充剂或用于填充椎间融合器而最大发挥其融合能力,与硫酸钙或羟磷灰石等载体的联用使其可塑性和成骨活性提升明显;新型解剖型同种异体椎间融合器成骨活性好、临床融合率高、可有效维持椎间隙高度和椎间孔的正常形状。现有的大量临床研究结果表明同种异体骨材料在脊柱融合术中能达到与自体骨一样的融合效率,并且和自体骨一样安全,是外科医生良好的选择,在临床中得到了大量应用。BACKGROUND:It is necessary to select an effective bone graft material in spinal fusion.Autograft was considered as the"gold standard"of spinal fusion,but there are complications such as donor site morbidity.Allograft can avoid complications associated with harvesting and donor’s volume is sufficient.Different allograft bone materials exhibit its excellent osteogenic ability when using at different sites of spine in spinal fusion.OBJECTIVE:To review the application status quo of allograft mate rial in spinal fusion in recent years.METHODS:Relevant articles in Chinese and English published in PubMed,Web of Science and CNKI Database from 1990 to 2022 were retrieved.Search terms were"fresh frozen bone,autograft,allograft,freeze-dried bone,demineralized bone matrix,allograft spacer,spinal fusion"in English and Chinese,separately.After screening,95 articles were included and reviewed.RESULTS AND CONCLUSION:Fresh frozen allograft is less used clinically due to its risk of immune rejection and transmission of disease.The fusion effect of freeze-dried bone is similar to autograft bone despite its delayed union in the end.Demineralized bone matrix is a useful graft mate rial when it is used as a graft extender in combination with autograft or to fill the cages to play its biggest fusion ability.The combination with a carrier such as calcium sulfate or hydroxyapatite results in a significant increase in its plasticity and osteogenic activity.The new anatomic allograft spacer has good osteogenic activity,high clinical fusion rate and is effective in maintaining the interve rtebral space height and the normal shape of interve rtebral foramen.A la rge number of existing clinical studies have shown that allograft bone mate rial can achieve the same fusion efficiency as autograft bone in spinal fusion,and is as safe and effective as autograft bone.It is a good choice for surgeons and has been widely used in clinical practice.

关 键 词：脊柱融合 自体骨 同种异体骨 冷冻干燥骨 脱钙骨基质 椎间融合器 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.3