脱矿骨纤维植入融合术治疗腰椎退行性疾病
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摘要
[目的]探讨脱矿骨纤维(DBF)作为椎间融合器填充材料应用于下腰椎退行性疾病后路切开减压植骨融合内固定手术的临床疗效。[方法]回顾性分析2013年1月～2017年12月本院应用椎弓根钉内固定系统与椎间融合器技术治疗腰椎退行性疾病的患者69例。其中,28例使用DBF作为椎间融合器填充材料,41例完全采用自体骨填充。采用日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评价临床疗效,影像学检查评价植骨融合效果。[结果]两组患者均顺利手术,无严重并发症。DBF组27例患者术后未见过敏反应、感染或中毒症状,无皮疹、高热。两组患者术后平均随访(21.82±6.43)个月。两组术后JOA评分与ODI指数均较术著改善,差异有统计学意义(P<0.05),术后第3、6个月DBF组JOA评分低于自体骨组,差异有统计学意义(P<0.05),术后6个月,两组ODI指数差异无统计学意义(P>0.05)。末次随访时两组间JOA和ODI评分差异均无统计学意义(P>0.05)。影像学方面,术后3、6个月DBF组融合率低于自体骨组,差异有统计学意义(P<0.05),但末次随访时,两组间融合率的差异无统计学意义(P>0.05)。[结论]脱矿骨纤维作为植骨融合材料用于下腰椎退行性疾病手术治疗疗效满意,但较自体骨融合时间延长。
[Objective] To explore the reliability and validity of demineralized bone fiber(DBF) used as graft in posterior instrumented fusion for lumbar degenerative diseases. [Methods] A retrospective study was conducted on 69 patients who underwent instrumented fusion for lumbar degenerative diseases from January 2013 to December 2017. Among them, 27 patients had the intervertebral spaced implanted with DBF, while the other 42 patients with autogenous bone graft. The Japanese Orthopedics Association(JOA) score and Oswestry disability index(ODI) were used for evaluation of clinical consequences and radiographic examinations for assessment of intervertebral fusion. [Results] The patients in both groups had operation performed smoothly without serious complication. All the 27 patients in the DBF group did not have reject reaction, infection, intoxication,rash and abnormal fever. The follow-up lasted for(21.82±6.43) months on average. Both JOA and ODI scores in the two groups significantly improved after operation compared with those before operation(P<0.05). Although the DBF group got significantly lower JOA score, whereas higher ODI score than the autograft group at 3 and 6 months postoperatively(P<0.05), no statistically significant differences were proved between them at the latest follow up(P>0.05). Consistently, the fusion rate revealed by radiographs in the DBF group was significantly inferior to the autograft group at 3 and 6 months postoperatively(P<0.05), however that became not statistically significant at the latest follow up between the two groups(P>0.05). [Conclusion] The demineralized bone fiber is safe and feasible alternative for bone autograft in instrumented fusion for treatment of lumbar degenerative diseases, although it has the fusion time delayed compared the bone autograft.
[Objective] To explore the reliability and validity of demineralized bone fiber(DBF) used as graft in posterior instrumented fusion for lumbar degenerative diseases. [Methods] A retrospective study was conducted on 69 patients who underwent instrumented fusion for lumbar degenerative diseases from January 2013 to December 2017. Among them, 27 patients had the intervertebral spaced implanted with DBF, while the other 42 patients with autogenous bone graft. The Japanese Orthopedics Association(JOA) score and Oswestry disability index(ODI) were used for evaluation of clinical consequences and radiographic examinations for assessment of intervertebral fusion. [Results] The patients in both groups had operation performed smoothly without serious complication. All the 27 patients in the DBF group did not have reject reaction, infection, intoxication,rash and abnormal fever. The follow-up lasted for(21.82±6.43) months on average. Both JOA and ODI scores in the two groups significantly improved after operation compared with those before operation(P<0.05). Although the DBF group got significantly lower JOA score, whereas higher ODI score than the autograft group at 3 and 6 months postoperatively(P<0.05), no statistically significant differences were proved between them at the latest follow up(P>0.05). Consistently, the fusion rate revealed by radiographs in the DBF group was significantly inferior to the autograft group at 3 and 6 months postoperatively(P<0.05), however that became not statistically significant at the latest follow up between the two groups(P>0.05). [Conclusion] The demineralized bone fiber is safe and feasible alternative for bone autograft in instrumented fusion for treatment of lumbar degenerative diseases, although it has the fusion time delayed compared the bone autograft.
引文
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[10]覃建朴,王翀,张朋云,等.不同植骨融合材料在腰椎椎体间脊柱融合中的应用[J].中国组织工程研究,2016,20(25):3693-3698.
[11]邓子文,黄东.同种异体骨移植修复骨缺损的应用进展[J].山东医药,2017,57(32):98-100.
[12]郜德龙,方忠,孙允龙,等.同种异体骨Cage在经椎间孔腰椎椎间融合手术中的应用[J].中国修复重建外科杂志,2018,(7):1-7.
[13]Rodriguez RU,Kemper N,Breathwaite E,et al.Demineralized bone matrix fibers formable as general and custom 3D printed mold-based implants for promoting bone regeneration[J].Biofabrication,2016,8(3):035007.
[14]Iijima H,Ito A,Nagai M,et al.Physiological exercise loading suppresses post-traumatic osteoarthritis progression via an increase in bone morphogenetic proteins expression in an experimental rat knee model[J].Osteoarthritis Cartilage,2017,25(6):964-975.
[15]钟南哲,严望军,魏海峰,等.骨水泥强化椎弓根螺钉技术应用于脊柱肿瘤外科治疗的临床疗效探究[J].中国骨与关节杂志,2016,5(8):632-637.
[2]Ding F,Jia Z,Zhao Z,et al.Total disc replacement versus fusion for lumbar degenerative disc disease:a systematic review of overlapping meta-analyses[J].Eur Spine J,2017,26(3):806-815.
[3]Jain S,Eltorai AE,Ruttiman R,et al.Advances in spinal interbody cages[J].Orthop Surg,2016,8(3):278-284.
[4]Thangarajah T,Sanghani-Kerai A,Henshaw F,et al.Application of a demineralized cortical bone matrix and bone marrow-derived mesenchymal stem cells in a model of chronic rotator cuff degeneration[J].Am J Sports Med,2018,46(1):98-108.
[5]席焱海,王洋,余将明,等.应用皮质骨轨迹螺钉联合椎弓根螺钉内固定技术治疗老年骨质疏松腰椎退变性疾病的临床疗效[J].第二军医大学学报,2016,37(7):879-883.
[6]许鹏,史建刚,叶晓健,等.经椎间孔椎体间融合术与后路椎体间融合术治疗多节段腰椎管狭窄症的疗效比较[J].中华解剖与临床杂志,2016,21(3):226-230.
[7]Fujimori T,Okuda S,Iwasaki M,et al.Validity of the japanese orthopedic association scoring system based on patient-reported improvement after posterior lumbar interbody fusion[J].Spine J,2016,16(6):728-736.
[8]方贤聪,程继伟,盛锡华.Oswestry功能障碍指数评定腰椎滑脱症患者的反应度和最小有意义变化研究[J].中国现代医生,2017,55(28):16-20.
[9]赵勃然,郑修军,马金荣.椎间融合器及其材料的研究与进展[J].中国组织工程研究,2017,21(2):315-321.
[10]覃建朴,王翀,张朋云,等.不同植骨融合材料在腰椎椎体间脊柱融合中的应用[J].中国组织工程研究,2016,20(25):3693-3698.
[11]邓子文,黄东.同种异体骨移植修复骨缺损的应用进展[J].山东医药,2017,57(32):98-100.
[12]郜德龙,方忠,孙允龙,等.同种异体骨Cage在经椎间孔腰椎椎间融合手术中的应用[J].中国修复重建外科杂志,2018,(7):1-7.
[13]Rodriguez RU,Kemper N,Breathwaite E,et al.Demineralized bone matrix fibers formable as general and custom 3D printed mold-based implants for promoting bone regeneration[J].Biofabrication,2016,8(3):035007.
[14]Iijima H,Ito A,Nagai M,et al.Physiological exercise loading suppresses post-traumatic osteoarthritis progression via an increase in bone morphogenetic proteins expression in an experimental rat knee model[J].Osteoarthritis Cartilage,2017,25(6):964-975.
[15]钟南哲,严望军,魏海峰,等.骨水泥强化椎弓根螺钉技术应用于脊柱肿瘤外科治疗的临床疗效探究[J].中国骨与关节杂志,2016,5(8):632-637.