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

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。

Abstract:

[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.