后路椎弓根螺钉固定联合rhBMP-2治疗退变性腰椎滑脱疗效观察
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摘要
目的探讨后路椎弓根螺钉固定系统联合重组人骨形态发生蛋白-2(rhBMP-2)在椎间植骨融合治疗退变性腰椎滑脱中的疗效。方法选择2015年3月至2016年3月我院收治的60例退变性腰椎滑脱患者为研究对象,根据治疗方法的不同分为观察组和对照组,各30例。观察组采用后路椎弓根螺钉固定系统联合rhBMP-2椎间融合治疗,对照组采用单纯后路椎弓根螺钉固定系统椎间融合治疗。应用Prolo腰椎功能评分、奥斯沃斯特里功能障碍指数(ODI)、视觉疼痛模拟评分(VAS)评估并对比2组患者腰椎功能、腰椎障碍程度、疼痛情况,术后定期复查,对比2组患者植骨融合率、滑脱角、椎体滑移度、椎间盘高度、滑脱率的差异。结果 2组患者Prolo评分均升高,ODI评分、VAS评分均降低,其中观察组患者术后Prolo评分为(7. 72±1. 69)分,ODI评分为(10. 94±3. 27)分、VAS评分为(1. 93±0. 34)分,对照组患者术后Prolo评分为(6. 21±1. 05)分,ODI评分为(15. 27±5. 93)分、VAS评分为(2. 52±0. 98)分,2组比较差异有统计学意义(P <0. 05)。术后2组患者滑脱角、椎体滑移度、滑脱率均明显降低,椎间盘高度明显升高,其中观察组患者术后滑脱角、椎体滑移度、椎间盘高度及滑脱率分别为(12. 72±3. 69)°、(7. 94±3. 15) mm、(15. 93±4. 34) mm和(14. 35±3. 19)%,对照组术后滑脱角、椎体滑移度、椎间盘高度及滑脱率分别为(14. 79±4. 05)°、(10. 27±3. 33) mm、(13. 19±3. 85) mm和(22. 53±6. 25)%,差异有统计学意义(P <0. 05)。观察组术后3、6个月腰椎植骨融合率分别为83. 33%和96. 67%,均高于对照组的60. 00%和80. 00%,差异有统计学意义(P <0. 05)。结论后路椎弓根螺钉固定系统联合rhBMP-2椎间融合治疗术可促进退变性腰椎滑脱患者植骨融合,降低椎体滑脱程度、腰椎障碍程度和疼痛程度,近期疗效好。
Objective To investigate the efficacy of posterior pedicle screw fixation combined with rh BMP-2 in the treatment of degenerative lumbar spondylolisthesis. Methods A total of 60 cases with degenerative lumbar spondylolisthesis admitted into our hospital from March 2015 to March 2016 were divided into observation group and control group,30 cases in each group. The observation group was treated with posterior pedicle screw fixation combined with rh BMP-2 intervertebral fusion. The control group was treated with posterior pedicle screw fixation system. Prolo lumbar function score,ODI and VAS were used to evaluate and compare the lumbar function,the degree of lumbar vertebral dysfunction and pain between the two groups. The patients were regularly reviewed after operation. The differences of fusion rate,slippage angle,degree of vertebral slippage,disc height and slippage rate between the two groups were compared. Results Prolo score increased,ODI score and VAS score decreased in both groups. The Prolo score,ODI score and VAS score of the observation group were( 7. 72 ± 1. 69),( 10. 94 ± 3. 27),( 1. 93 ± 0. 34),respectively. The Prolo score,ODI score and VAS score of the control group were( 6. 21 ± 1. 05),( 15. 27 ± 5. 93),( 2. 52 ± 0. 98),respectively. There was significant difference between the two groups( P < 0. 05). The slippage angle,degree of vertebral slippage and rate of spondylolisthesis in both groups were significantly decreased,and the height of intervertebral disc was significantly increased. The slippage angle,vertebral slippage,slippage rate and intervertebral disc height in the observation group were( 12. 72 ± 3. 69) °,( 7. 94 ± 3. 15) mm,( 15. 93 ± 4. 34) mm and( 14. 35 ± 3. 19) %,respectively. The slippage angle,vertebral slippage,slippage rate and intervertebral disc height of the control group were( 14. 79 ± 4. 05) °,( 10. 27 ± 3. 33) mm,( 13. 19 ± 3. 85) mm and( 22. 53 ±6. 25) %,respectively,with significant difference( P < 0. 05). The fusion rates of lumbar vertebrae in observation group were 83. 33% and 96. 67% respectively at 3 and 6 months after operation,which was higher than 60. 00% and 80. 00% of the control group,the differences were significant( P < 0. 05). Conclusion Posterior pedicle screw fixation combined with rh BMP-2 interbody fusion can promote bone graft fusion in patients with degenerative lumbar spondylolisthesis,decrease the degree of spondylolisthesis,lumbar vertebral disorder and pain,with good short-term effect.
Objective To investigate the efficacy of posterior pedicle screw fixation combined with rh BMP-2 in the treatment of degenerative lumbar spondylolisthesis. Methods A total of 60 cases with degenerative lumbar spondylolisthesis admitted into our hospital from March 2015 to March 2016 were divided into observation group and control group,30 cases in each group. The observation group was treated with posterior pedicle screw fixation combined with rh BMP-2 intervertebral fusion. The control group was treated with posterior pedicle screw fixation system. Prolo lumbar function score,ODI and VAS were used to evaluate and compare the lumbar function,the degree of lumbar vertebral dysfunction and pain between the two groups. The patients were regularly reviewed after operation. The differences of fusion rate,slippage angle,degree of vertebral slippage,disc height and slippage rate between the two groups were compared. Results Prolo score increased,ODI score and VAS score decreased in both groups. The Prolo score,ODI score and VAS score of the observation group were( 7. 72 ± 1. 69),( 10. 94 ± 3. 27),( 1. 93 ± 0. 34),respectively. The Prolo score,ODI score and VAS score of the control group were( 6. 21 ± 1. 05),( 15. 27 ± 5. 93),( 2. 52 ± 0. 98),respectively. There was significant difference between the two groups( P < 0. 05). The slippage angle,degree of vertebral slippage and rate of spondylolisthesis in both groups were significantly decreased,and the height of intervertebral disc was significantly increased. The slippage angle,vertebral slippage,slippage rate and intervertebral disc height in the observation group were( 12. 72 ± 3. 69) °,( 7. 94 ± 3. 15) mm,( 15. 93 ± 4. 34) mm and( 14. 35 ± 3. 19) %,respectively. The slippage angle,vertebral slippage,slippage rate and intervertebral disc height of the control group were( 14. 79 ± 4. 05) °,( 10. 27 ± 3. 33) mm,( 13. 19 ± 3. 85) mm and( 22. 53 ±6. 25) %,respectively,with significant difference( P < 0. 05). The fusion rates of lumbar vertebrae in observation group were 83. 33% and 96. 67% respectively at 3 and 6 months after operation,which was higher than 60. 00% and 80. 00% of the control group,the differences were significant( P < 0. 05). Conclusion Posterior pedicle screw fixation combined with rh BMP-2 interbody fusion can promote bone graft fusion in patients with degenerative lumbar spondylolisthesis,decrease the degree of spondylolisthesis,lumbar vertebral disorder and pain,with good short-term effect.
引文
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[4]刘玉增,海涌,关立,等.手术治疗老年人退变性腰椎滑脱症对骨盆参数及脊柱矢状面平衡的影响[J].中华老年医学杂志,2015,34(11):1182-1185.doi:10.3760/cma.j.issn.0254-9026.2015.11.009.
[5]苏锴,郭营,汤嘉军,等.微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响[J].中国脊柱脊髓杂志,2014,24(3):204-210.doi:10.3969/j.issn.1004-406X.2014.03.03.
[6]Kim HS,Park JC,Yun PY,et al.Evaluation of bone healing using rhBMP-2 soaked hydroxyapatite in ridge augmentation:a prospective observational study[J].Maxillofac Plast Reconstr Surg,2017,39(1):40.doi:10.1186/s40902-017-0138-9.
[7]戈浩,吕建军.PLIF与TLIF治疗老年退变性腰椎滑脱合并腰椎管狭窄症的疗效比较[J].湖南师范大学学报(医学版),2016,13(6):41-44.doi:10.3969/j.issn.1673-016X.2016.06.014.
[8]Cooper GS,Kou TD.Risk of cancer following lumbar fusion surgery with recombinant human bone morphogenic protein-2(rhBMP-2):an analysis using a commercially insured patient population[J].Int J Spine Surg,2018,12(2):260-268.doi:10.14444/50323.
[9]Mehta S,Blagg R,Willcockson J,et al.Cost-Effectiveness analysis of demineralized bone matrix and rhBMP-2 versus autologous iliac crest bone grafting in alveolar cleft patients[J].Plast Reconstr Surg,2018,142(3):737-743.doi:10.1097/PRS.0000000000004646.
[10]董盼锋,何欣雨,胡庆磊,等.rh BMP-2联合同种异体骨植骨手术治疗动脉瘤样骨囊肿[J].中国骨与关节损伤杂志,2018,33(9):994-996.doi:10.7531/j.issn.1672-9935.2018.09.035.
[11]高松森,曹云,陶晖,等.经椎间孔椎体间融合术与经后路椎体间融合术治疗轻、中度退变性腰椎滑脱症临床疗效及安全性的Meta分析[J].中国脊柱脊髓杂志,2018,28(1):16-24.doi:10.3969/j.issn.1004-406X.2018.01.03.
[12]秦超,熊健,文文,等.微创经椎间孔腰椎椎体间融合术两种入路方式治疗单节段退变性腰椎滑脱的疗效比较[J].重庆医学,2018,47(8):1117-1120.doi:10.3969/j.issn.1671-8348.2018.08.035.
[13]Lingner M,Seidling R,Lehmann LJ,et al.Osseointegrative effect of rhBMP-2 covalently bound on a titan-plasma-spray-surface after modification with chromosulfuric acid in a large animal bone gap-healing model with the G9ttingen minipig[J].J Orthop Surg Res,2018,13(1):219.doi:10.1186/s13018-018-0915-x.
[14]邓梦娟,邝磊,王冰,等.前外侧腰椎间融合术与后路经椎间孔腰椎间融合术治疗L4/5Ⅰ度退变性腰椎滑脱的疗效比较[J].中国脊柱脊髓杂志,2018,28(5):389-396.doi:10.3969/j.issn.1004-406X.2018.05.02.
[15]Arzeno A,Wang T,Huddleston JI.Abundant heterotopic bone formation following use of rhBMP-2 in the treatment of acetabular bone defects during revision hip arthroplasty[J].Arthroplast Today,2018,4(2):162-168.doi:10.1016/j.artd.2017.12.004.
[16]Koerner JD,Markova DZ,Schroeder GD,et al.The local cytokine and growth factor response to recombinant human bone morphogenetic protein-2(rh BMP-2)after spinal fusion[J].Spine J,2018,18(8):1424-1433.doi:10.1016/j.spinee.2018.03.006.
[17]朱德志.重组人骨形态发生蛋白-2结合纳米晶胶原基骨材料治疗腰椎不稳症的临床效果及安全性评价[J].中国综合临床,2016,32(4):358-361.doi:10.3760/cma.j.issn.1008-6315.2016.04.021.
[18]陈泽鹏,夏远军,韩冷,等.硫酸葡聚糖/重组入骨形态发生蛋白-2/壳聚糖纳米微球联合珊瑚羟基磷灰石修复大段骨缺损的成骨化研究[J].中华创伤骨科杂志,2017,19(12):1074-1080.doi:10.3760/cma.j.issn.1671-7600.2017.12.012.
[19]谢纪宝,郑永茂,李云飞,等.肱骨近端良性骨肿瘤刮除后用β-磷酸三钙人工骨联合重组人骨形态发生蛋白-2植入的治疗效果[J].临床骨科杂志,2018,21(2):245.doi:10.3969/j.issn.1008-0287.2018.02.046.
[20]鲍玉成,王勇,张文龙,等.不同粒径重组人骨形态发生蛋白2/聚乳酸-聚羟基乙酸共聚物微球制备及体内外释放性能比较[J].中国组织工程研究,2018,22(2):210-215.doi:10.3969/j.issn.2095-4344.0008.
[21]Hirata A,Ueno T,Moy PK.Newly formed bone induced by recombinant human bone morphogenetic protein-2:a histological observation[J].Implant Dentistry,2017,26(2):173-177.doi:10.1097/ID.0000000000000564.
[22]唐勇,叶记超,胡旭民,等.基因重组人骨形态发生蛋白-2联合自体骨椎间打压植骨在腰椎融合术中的应用研究[J].中华骨与关节外科杂志,2018,11(9):664-667.doi:10.3969/j.issn.2095-9958.2018.09.005.
[2]李军,王云,鲍小明,等.rhBMP-2体外诱导骨质疏松大鼠BM-SCs成骨及VEGF表达的研究[J].中国骨伤,2015,28(5):446-449.doi:10.3969/j.issn.1003-0034.2015.05.013.
[3]Toth JM,Wang M,Patel CK,et al.Early term effects of rhBMP-2 on pedicle screw fixation in a sheep model:histomorphometric and biomechanical analyses[J].J Spine Surg,2018,4(3):534-545.doi:10.21037/jss.2018.06.19.
[4]刘玉增,海涌,关立,等.手术治疗老年人退变性腰椎滑脱症对骨盆参数及脊柱矢状面平衡的影响[J].中华老年医学杂志,2015,34(11):1182-1185.doi:10.3760/cma.j.issn.0254-9026.2015.11.009.
[5]苏锴,郭营,汤嘉军,等.微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响[J].中国脊柱脊髓杂志,2014,24(3):204-210.doi:10.3969/j.issn.1004-406X.2014.03.03.
[6]Kim HS,Park JC,Yun PY,et al.Evaluation of bone healing using rhBMP-2 soaked hydroxyapatite in ridge augmentation:a prospective observational study[J].Maxillofac Plast Reconstr Surg,2017,39(1):40.doi:10.1186/s40902-017-0138-9.
[7]戈浩,吕建军.PLIF与TLIF治疗老年退变性腰椎滑脱合并腰椎管狭窄症的疗效比较[J].湖南师范大学学报(医学版),2016,13(6):41-44.doi:10.3969/j.issn.1673-016X.2016.06.014.
[8]Cooper GS,Kou TD.Risk of cancer following lumbar fusion surgery with recombinant human bone morphogenic protein-2(rhBMP-2):an analysis using a commercially insured patient population[J].Int J Spine Surg,2018,12(2):260-268.doi:10.14444/50323.
[9]Mehta S,Blagg R,Willcockson J,et al.Cost-Effectiveness analysis of demineralized bone matrix and rhBMP-2 versus autologous iliac crest bone grafting in alveolar cleft patients[J].Plast Reconstr Surg,2018,142(3):737-743.doi:10.1097/PRS.0000000000004646.
[10]董盼锋,何欣雨,胡庆磊,等.rh BMP-2联合同种异体骨植骨手术治疗动脉瘤样骨囊肿[J].中国骨与关节损伤杂志,2018,33(9):994-996.doi:10.7531/j.issn.1672-9935.2018.09.035.
[11]高松森,曹云,陶晖,等.经椎间孔椎体间融合术与经后路椎体间融合术治疗轻、中度退变性腰椎滑脱症临床疗效及安全性的Meta分析[J].中国脊柱脊髓杂志,2018,28(1):16-24.doi:10.3969/j.issn.1004-406X.2018.01.03.
[12]秦超,熊健,文文,等.微创经椎间孔腰椎椎体间融合术两种入路方式治疗单节段退变性腰椎滑脱的疗效比较[J].重庆医学,2018,47(8):1117-1120.doi:10.3969/j.issn.1671-8348.2018.08.035.
[13]Lingner M,Seidling R,Lehmann LJ,et al.Osseointegrative effect of rhBMP-2 covalently bound on a titan-plasma-spray-surface after modification with chromosulfuric acid in a large animal bone gap-healing model with the G9ttingen minipig[J].J Orthop Surg Res,2018,13(1):219.doi:10.1186/s13018-018-0915-x.
[14]邓梦娟,邝磊,王冰,等.前外侧腰椎间融合术与后路经椎间孔腰椎间融合术治疗L4/5Ⅰ度退变性腰椎滑脱的疗效比较[J].中国脊柱脊髓杂志,2018,28(5):389-396.doi:10.3969/j.issn.1004-406X.2018.05.02.
[15]Arzeno A,Wang T,Huddleston JI.Abundant heterotopic bone formation following use of rhBMP-2 in the treatment of acetabular bone defects during revision hip arthroplasty[J].Arthroplast Today,2018,4(2):162-168.doi:10.1016/j.artd.2017.12.004.
[16]Koerner JD,Markova DZ,Schroeder GD,et al.The local cytokine and growth factor response to recombinant human bone morphogenetic protein-2(rh BMP-2)after spinal fusion[J].Spine J,2018,18(8):1424-1433.doi:10.1016/j.spinee.2018.03.006.
[17]朱德志.重组人骨形态发生蛋白-2结合纳米晶胶原基骨材料治疗腰椎不稳症的临床效果及安全性评价[J].中国综合临床,2016,32(4):358-361.doi:10.3760/cma.j.issn.1008-6315.2016.04.021.
[18]陈泽鹏,夏远军,韩冷,等.硫酸葡聚糖/重组入骨形态发生蛋白-2/壳聚糖纳米微球联合珊瑚羟基磷灰石修复大段骨缺损的成骨化研究[J].中华创伤骨科杂志,2017,19(12):1074-1080.doi:10.3760/cma.j.issn.1671-7600.2017.12.012.
[19]谢纪宝,郑永茂,李云飞,等.肱骨近端良性骨肿瘤刮除后用β-磷酸三钙人工骨联合重组人骨形态发生蛋白-2植入的治疗效果[J].临床骨科杂志,2018,21(2):245.doi:10.3969/j.issn.1008-0287.2018.02.046.
[20]鲍玉成,王勇,张文龙,等.不同粒径重组人骨形态发生蛋白2/聚乳酸-聚羟基乙酸共聚物微球制备及体内外释放性能比较[J].中国组织工程研究,2018,22(2):210-215.doi:10.3969/j.issn.2095-4344.0008.
[21]Hirata A,Ueno T,Moy PK.Newly formed bone induced by recombinant human bone morphogenetic protein-2:a histological observation[J].Implant Dentistry,2017,26(2):173-177.doi:10.1097/ID.0000000000000564.
[22]唐勇,叶记超,胡旭民,等.基因重组人骨形态发生蛋白-2联合自体骨椎间打压植骨在腰椎融合术中的应用研究[J].中华骨与关节外科杂志,2018,11(9):664-667.doi:10.3969/j.issn.2095-9958.2018.09.005.