骨形态发生蛋白－2对腰椎椎间融合的效果分析

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摘要目的探讨骨形态发生蛋白-2（BMP-2）对腰椎患者椎间融合的效果。方法收集2011年7月～2016年1月我院骨科收治的106例腰椎退行性疾病患者，根据修复方式的不同分为BMP-2融合组（采用BMP-2骨修复材料填埋于Cage中植入椎间隙，n=57）和传统融合组（采用剪碎的自体骨填埋于Cage中并植入椎间隙，n=49）。比较两组患者平均耗时及术中平均出血量，比较两组术后第1、4、6、8、12、24周螺钉位置不良率、Cage移位率、相对椎间隙高度丢失，JOA评分及Oswestry指数（ODI）评估及治疗前后影像学结果。结果两组患者平均耗时和术中平均出血量比较，差异无统计学意义（P＞0.05）。术后第1周传统融合组螺钉位置不良率为1.53%，BMP-2融合组未出现螺钉位置偏移；截止术后第24周，传统融合组螺钉位置不良率达15.30%，BMP-2融合组仅3.51%，差异有统计学意义（P＜0.05）。术后第4周传统融合组Cage移位率为4.08%，BMP-2融合组未出现Cage移位；术后第6周BMP-2融合组Cage移位率为1.75%；截止术后第24周，传统融合组Cage移位率高达20.41%，BMP-2融合组则为7.02%，差异有统计学意义（P＜0.05）。术前与术后第24周比较，传统融合组相对椎间隙高度为（2.11± 0.40）mm，BMP-2融合组为（0.52±0.60）mm，差异有统计学意义（P＜0.05）；术前传统融合组、BMP-2融合组JOA评分分别为（13.03±3.45）、（14.56±2.17）分，术后第24周分别为（22.01±3.41）、（28.42±1.22）分，差异有统计学意义（P＜0.05）；两组ODI术前评分分别为（40.55±10.35）、（39.32±9.63）分，术后第24周分别为（17.2±8.4）、（7.5±3.3）分，差异有统计学意义（P＜0.05）。结论采用BMP-2骨修复材料替代自体骨进行腰椎后路钉棒内固定植骨间融合术疗效显著，不仅能够提供即刻的生物学稳定，达到有效的结构性支撑作用，而且还能促进患者椎间隙前后缘高度的恢复和明显改善患者的疼痛症状。

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	镇万源
	晏艳祥
	熊昌军
	王冠清
	吴睿

关键词 ：骨形态发生蛋白-2, 椎间融合, 椎弓根螺钉固定, 生物学稳定

Abstract：ObjectiveTo observe the therapeutic effect of BMP-2 on lumbar interbody fusion.Methods106 patients with lumbar degenerative disease in Department of Orthopedics of our hospital form July 2011 to January 2016 were selected and divided into BMP-2 interbody fusion group (the bone repairmaterial of BMP-2 were filled in Cage,n=57) and traditional fusion group(autogenous boneswere filled in Cage,n=49)according to the differentways of repair.Average time during the operation and average intraoperative blood losswere compared between two groups,the rate of screw malposition and Cage shift loss and value of relative intervertebral height loss after operation for the firstweek,4th,6th,8th, 12th,24thweek,ODIand JOA before operation and after operation for the 24thweek and radiographic results were compared between two groups.ResultsAverage time during the operation and average intraoperative blood losswere no signiflcant difference between two groups (P＞0.05).After the firstweek of operation,the rate of screw malposition in traditional fusion group was 1.53%and without screw malposition in BMP-2 interbody fusion group;after operation for the 24thweek,the rate of screw malposition in traditional fusion group was 15.30%and 3.51%in BMP-2 interbody fusion group,and the difference between two groups was statistically significant(P＜0.05).The rate of Cage shift in traditional fusion group was 4.08%after operation for the 4thweek and without Cage shift in BMP-2 interbody fusion group;one Cage (1.75%)shifted in BMP-2 interbody fusion group until the 6thweek of postoperation;after operation for the 24thweek,the rate of Cage shift in traditional fusion group and BMP-2 interbody fusion group was respectively 20.41%and 7.02%,there was significant difference between two groups(P＜0.05).Relative intervertebral height in the traditional fu-sion group and BMP-2 interbody fusion group was(2.11±0.40)mm and(0.52±0.60)mm,and the difference was statistically significant (P＜0.05).The preoperative ODI score and JOA score in traditional fusion group was respectively (40.55±10.35)scores,(13.03±3.45)scores,and(39.32±9.63)scores,(14.56±2.17)scores in BMP-2 interbody fusion group, while after operation for the 24thweek,ODIscore and JOA score in the two groups was respectively (17.2±8.4)scores, (22.01±3.41)scores and (7.5±3.3)scores,(28.42±1.22)scores,therewas statistical difference (P＜0.05).ConclusionThe lumbar interbody fusion surgery using BMP-2 bone repairmaterials which replaces autologous bone not only can provide immediate biological stability,achieve effective structural support,but also can promote the recovery intervertebral disc height of patients and obviously improve the patient′spain symptoms.

Key words： Bonemorphogenetic protein-2 Interbogy fusion Pedicle screw fixation Biological stability

引用本文:

镇万源；晏艳祥；熊昌军；王冠清；吴睿. 骨形态发生蛋白－2对腰椎椎间融合的效果分析[J]. 中国当代医药, 2016, 23(34): 59-62转88.
ZHENWan-yuan； YAN Yan-xiang ；XIONG Chang-jun； WANGGuan-qing ；WU Rui. Effect analysis of bone morphogenetic protein－2 on lumbar interbody fusion. 中国当代医药, 2016, 23(34): 59-62转88.

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