重组骨形成蛋白-2对后路腰椎间融合影响  

Effect of recombinant bone morphogenetic protein-2 on posterior lumbar interbody fusion

作　　者：蔡卓延 莫凌[1] 杨策凯 伍子贤 崔健超[1] 唐福宇[2] 梁德[1] 姚珍松[1] CAI Zhuo-yan;MO Ling;YANG Ce-kai;WU Zi-xian;CUI Jian-chao;TANG Fu-yu;LIANG De;YAO Zhen-song(Guangzhou University of Traditional Chinese Medicine,Guangzhou510405,China;Liuzhou Traditional Chinese Medicine Hospital,Liuzhou545001,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]柳州市中医院,广西柳州545001

出　　处：《中国矫形外科杂志》2022年第19期1738-1743,共6页Orthopedic Journal of China

基　　金：广西自然科学基金项目(编号:2019JJA140167)。

摘　　要：[目的]比较单纯自体骨与自体骨混合重组人骨形态发生蛋白-2(recombinant human bone morphogenetic protein,rh⁃BMP-2)对后路腰椎椎间融合的影响。[方法]回顾性分析2015年1月—2019年8月因腰椎退行性疾病行后路腰椎融合75例患者的临床资料。依据术前医患沟通结果,43例椎间融合采用rhBMP-2,32例仅采用单纯自体骨。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,术中无严重并发症。两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。随访(13.87±1.30)个月,随时间推移,两组患者VAS、ODI、JOA评分均显著改善(P<0.05)。术后6个月时,BMP组JOA评分显著优于自体骨组(P<0.05)。影像方面,随时间推移,两组患者椎间隙高度均呈显著曲线变化(P<0.05);两组融合Lenke评级均显著改善(P<0.05);两组Marchi评级笼架沉降均有所加重,但差异无统计学意义(P>0.05)。术后3、6个月时BMP组椎间隙高度大于自体骨组(P<0.05);术后6个月及末次随访时,BMP组融合Lenke评级均显著优于自体骨组(P<0.05);末次随访时,BMP组笼架沉降Marchi评级轻于自体骨组,差异有统计学意义(P<0.05)。[结论]后路椎间融合采用自体骨复合rhBMP-2可以有效减少椎间不融合和笼架沉降,改进临床效果。[Objective]To compare the effects of bone autograft composited with recombinant human bone morphogenetic protein-2(rh⁃BMP-2)versus bone autograft only on posterior lumbar interbody fusion(PLIF).[Methods]A retrospective study was conducted on 75 pa⁃tients who underwent PLIF for degenerative lumbar diseases in our department from January 2015 to August 2019.According to preopera⁃tive doctor-patient communication,43 patients had PLIF performed with rhBMP-2 used(the BMP group),while the remaining 32 patients were with bone autograft only(the BA group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups were operated on successfully without serious complications.There was no significant difference in the time to resume full weight-bearing activity between the two groups(P>0.05).As time went during followed up lasted for(13.87±1.30)months,VAS,ODI and JOA scores in both groups significantly improved(P<0.05).At 6 months postoperatively,the BMP group proved significantly superior to the BA group in JOA score(P<0.05).Radiographically,the height of intervertebral space showed significant curve-like changes(P<0.05);the Lenke grade for interbody fusion significantly improved in both groups(P<0.05);whereas cage subsidence in term of Marchi's criteria slightly increased in both groups regardless of no statistically significant differences among time points(P>0.05).At 3 months and 6 months the BMP group was significantly superior to the BA group in term of the height of intervertebral space(P<0.05).At 6 months and the last follow-up,the BMP group was significantly superior to the BA group in term of the Lenke grade of fusion(P<0.05),additionally,the former proved significantly superior to the latter in Marchi's scale for cage subsidence at the last follow-up(P<0.05).[Conclusion]Bone autograft composited with rhBMP-2 does effectively reduce interbody non-fusion and cage subsidence in PLIF,and improve its clini⁃cal efficacy.

关 键 词：重组人骨形态发生蛋白-2 自体骨移植 后路腰椎椎体间融合术 融合笼架 沉降 

分 类 号：R318[医药卫生—生物医学工程]