中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
43期
6889-6895
,共7页
许运%金耀%史勇%姜为民%唐天驷
許運%金耀%史勇%薑為民%唐天駟
허운%금요%사용%강위민%당천사
生物材料%骨生物材料%颈椎%前路减压融合%骨形态发生蛋白2
生物材料%骨生物材料%頸椎%前路減壓融閤%骨形態髮生蛋白2
생물재료%골생물재료%경추%전로감압융합%골형태발생단백2
bone morphogenetic proteins%cervical vertebrae%spinal fusion
背景：颈椎前路椎间盘切除减压自体髂骨植骨融合是治疗颈椎病的标准术式，但取自体髂骨存在较多供骨区并发症，寻找合适的骨修复替代材料应用于颈椎前路手术一直是研究的热点。
<br> 目的：分析含骨形态发生蛋白2骨修复材料在颈椎前路减压融合中的临床效果。
<br> 方法：回顾性分析行颈前路减压植骨融合治疗40例患者的临床资料，其中试验组21例将含骨形态发生蛋白2的骨修复材料(载体为药用明胶、注射用大豆卵磷脂、羟基磷灰石等)及自体骨赘植入PEEK cage融合器，对照组19例将自体骼骨植入PEEK cage融合器。随访12个月，比较两组融合节段Cobb角、融合节段椎体前缘高度、椎间高度、并发症、融合率、JOA评分和目测类比评分等指标。
<br> 结果与结论：经过治疗后，两组均获得了即刻的颈椎稳定，颈椎前凸、融合节段椎体前缘高度及椎间高度均较治疗前明显增加(P<0.05)。随访12个月时，试验组Cobb角明显大于对照组(P<0.05)，两组融合节段椎间隙前缘高度与融合节段椎间高度、椎间融合率、颈部与上肢目测类比评分、JOA评分比较差异无显著性意义，均获得骨性愈合。表明含骨形态发生蛋白2的骨修复材料结合自体骨赘植骨应用于颈椎前路减压融合可有效恢复并维持颈椎前凸、融合节段的高度，在改善临床症状方面与自体髂骨疗效相当。
揹景：頸椎前路椎間盤切除減壓自體髂骨植骨融閤是治療頸椎病的標準術式，但取自體髂骨存在較多供骨區併髮癥，尋找閤適的骨脩複替代材料應用于頸椎前路手術一直是研究的熱點。
<br> 目的：分析含骨形態髮生蛋白2骨脩複材料在頸椎前路減壓融閤中的臨床效果。
<br> 方法：迴顧性分析行頸前路減壓植骨融閤治療40例患者的臨床資料，其中試驗組21例將含骨形態髮生蛋白2的骨脩複材料(載體為藥用明膠、註射用大豆卵燐脂、羥基燐灰石等)及自體骨贅植入PEEK cage融閤器，對照組19例將自體骼骨植入PEEK cage融閤器。隨訪12箇月，比較兩組融閤節段Cobb角、融閤節段椎體前緣高度、椎間高度、併髮癥、融閤率、JOA評分和目測類比評分等指標。
<br> 結果與結論：經過治療後，兩組均穫得瞭即刻的頸椎穩定，頸椎前凸、融閤節段椎體前緣高度及椎間高度均較治療前明顯增加(P<0.05)。隨訪12箇月時，試驗組Cobb角明顯大于對照組(P<0.05)，兩組融閤節段椎間隙前緣高度與融閤節段椎間高度、椎間融閤率、頸部與上肢目測類比評分、JOA評分比較差異無顯著性意義，均穫得骨性愈閤。錶明含骨形態髮生蛋白2的骨脩複材料結閤自體骨贅植骨應用于頸椎前路減壓融閤可有效恢複併維持頸椎前凸、融閤節段的高度，在改善臨床癥狀方麵與自體髂骨療效相噹。
배경：경추전로추간반절제감압자체가골식골융합시치료경추병적표준술식，단취자체가골존재교다공골구병발증，심조합괄적골수복체대재료응용우경추전로수술일직시연구적열점。
<br> 목적：분석함골형태발생단백2골수복재료재경추전로감압융합중적림상효과。
<br> 방법：회고성분석행경전로감압식골융합치료40례환자적림상자료，기중시험조21례장함골형태발생단백2적골수복재료(재체위약용명효、주사용대두란린지、간기린회석등)급자체골췌식입PEEK cage융합기，대조조19례장자체격골식입PEEK cage융합기。수방12개월，비교량조융합절단Cobb각、융합절단추체전연고도、추간고도、병발증、융합솔、JOA평분화목측류비평분등지표。
<br> 결과여결론：경과치료후，량조균획득료즉각적경추은정，경추전철、융합절단추체전연고도급추간고도균교치료전명현증가(P<0.05)。수방12개월시，시험조Cobb각명현대우대조조(P<0.05)，량조융합절단추간극전연고도여융합절단추간고도、추간융합솔、경부여상지목측류비평분、JOA평분비교차이무현저성의의，균획득골성유합。표명함골형태발생단백2적골수복재료결합자체골췌식골응용우경추전로감압융합가유효회복병유지경추전철、융합절단적고도，재개선림상증상방면여자체가골료효상당。
BACKGROUND:The anterior cervical discectomy and fusion with autologous bone is the standard surgical treatment for cervical spondylosis, but there are more complications occurring during the harvesting of autologous iliac bone. To find suitable alternative materials used in bone repair surgery has been a research focus.
<br> OBJECTIVE:To analyze the clinical and radiographic outcomes in patients undergoing anterior cervical discectomy with fusion using polyetheretherketone cages packed with bone repair material containing recombinant human bone morphogenetic protein-2.
<br> METHODS:A total of 40 consecutive patients with cervical spinal degenerative disease who underwent anterior cervical discectomy and fusion were enrol ed. We retrospectively reviewed anterior cervical discectomy with fusion using polyetheretherketone cages packed with bone repair material containing recombinant human bone morphogenetic protein-2 and autologous osteophyte in 21 cases and with autologous iliac crest in 19 cases. These patients had sequential radiographs before and after surgery, and at 1 year. The anterior disc height, interbody height, segmental Cobb angle, complication, and fusion rate were assessed based on radiographs including flexion/extension radiographs and CT scan. The neurologic outcomes were evaluated using the visual analog scale score for neck and arm pain and the Japanese Orthopedic Association scoring system for myelopathy.
<br> RESULTS AND CONCLUSION:At the last fol ow-up, solid fusion appeared to have been achieved in patients of both groups. Lordosis was increased significantly in both groups after surgery (P<0.05), and was maintained up until 1 year without a difference between groups. Both the anterior disc height and interbody height were significantly increased after surgery (P<0.05), without a significant difference between groups. At the last fol ow-up, the Cobb angle in the test group was significantly higher than that in the control group (P<0.05), but there was no significant difference in both the visual analog scale score and the Japanese Orthopedic Association scores between the two groups at the last fol ow-up. Bone repair materials containing recombinant human bone morphogenetic protein-2 can achieve higher fusion rates, restore and maintain up of lordosis and disc space height. Therefore, the ongoing use of the polyetheretherketone cage packed with bone repair material containing recombinant human bone morphogenetic protein-2 and autologous osteophyte in anterior cervical discectomy with fusion is a safe and effective alternative to the gold standard of autologous iliac bone grafts.
