同种异体骨移植在颈椎前路融合手术中的应用

Application of allogeneic bone transplantation in anterior cervical corpectomy

学术背景:目前自体骨移植在临床应用广泛且效果良好,但其存在严重缺点并制约其临床应用。目的:综合分析近年来国内外同种异体骨移植在颈椎前路融合手术中的应用现状及进展。检索策略:由第一作者应用EndNote9软件检索美国PUBMED数据库、中国生物医学文献数据库和中国期刊全文数据库公开发表截止到2007-05有关同种异体骨移植在颈椎前路融合手术中应用的文献,英文检索词"bone allograft;allograft;cervical spine;cervical vertebra;anterior cervical corpectomy";中文检索词"同种异体骨;骨移植;同种异体骨移植;颈椎;颈椎前路融合术"。检索到英文文献256篇,中文113篇,其中动物实验和临床研究167篇,综述、述评、讲座类文献76篇。纳入标准:①同种异体骨移植的基础研究。②同种异体骨移植在颈椎前路融合术中的应用研究。③不限定对照及盲法。排除标准:①自体骨移植及异种骨移植。②同一领域重复研究和综述文献。文献评价:①文献来源情况:随机对照试验、循证医学系统综述、汇总分析、个例报道及经验交流。②评价人:第一作者。资料综合:自体骨移植是目前骨科应用最多、效果最好的骨移植,但是存在严重不足:①自体骨取骨量不能满足大量骨缺损的需要。②自体骨移植手术切口增多,手术时间延长,出血增多。③供骨区正常结构遭到破坏,并发症多。针对自体移植骨的缺点,同种异体骨的研究及临床应用得到了广泛的重视并取得了良好的效果,其中同种异体骨移植在颈椎前路融合手术中的应用近年来得到广泛发展,大量研究表明同种异体骨移植在颈椎前路手术中的融合率高,免疫排斥反应低,但是移植骨下沉、塌陷的机率相对较高,植骨融合结合坚强内固定以及骨笼、骨圈等移植骨材料的改进有利于减少上述并发症。结论:随着同种异体骨处理技术的不断提高及移植骨材料的不断改进,以及重组人骨形态发生蛋白的成功应用,同种异体骨移植在颈椎前路手术中的融合率将进一步提高,并发症将明显减少。

BACKGROUND： Although autograft is considered as the most effective bone material and is widely used in clinic. Its disadvantage is obvious, so its application is limited. OBJECTIVE： To review the research progress of bone allograft and its application in anterior cervical corpectomy in recent years. RETRIEVE STRATEGY： Computer-based search was conducted in PUBMED, CBMdisc and China Journal Full-text Database （CJFD） for articles related to bone allograft and anterior cervical corpectomy published before May 2007 with the key words of ＂bone allograft, allograft, cervical spine, cervical vertebra, anterior cervical corpectomy＂ in English, and ＂bone allograft, bone transplantation, allograft, cervical vertebra, anterior cervical corpectomy＂ in Chinese by the first author with EndNote 9 software. There were 256 English articles and 113 Chinese articles, including 167 literatures of animal experiment and clinical research, 76 literatures of review, summary and lecture. Inclusive criteria included （1）basic studies of allogeneic bone transplantation, （2） application of allogeneic bone transplantation in anterior cervical corpectomy, and （3）no limits for control and blind method. Exclusive criteria included articles of （1）autogenous bone graft and xenogeneic bone transplantation, and （2）repeated studies and reviews in the same field. LITERATURE EVALUATION： （1）Literature source included RCT, evidence-based medicine, summary analysis, case report, symposium. （2）Estimate person was the first author. DATA SYNTHESIS： Autograft is considered as the most effective substitute and is presently the most common graft substance in spinal surgery. However, the amount of available autograft for transplantation is insufficient. （1）The amount of available autograft is insufficient for a great quantity of bone defect. （2）lncreasing operative time and blood loss and associated with considerable donor site morbidity are disadvantages of it. （3）Normal structure was destroy in donor region combined with many complications. According to the disadvantages of autograft, allograft is considered as the ideal bone graft substitute and has been popular applied to the spinal surgery. AIIogeneil graft has been widely utilized in anterior cervical corpectomy recently. Many researches revealed that the fusion rate of allograft bone fusion was evident and had low immunological rejection. However, the rates of collapse and subsidence were relatively high. The complication of bone allograft can be reduced combined with the stable instrument and the application of new bone materials such as bone cage, bone ring and so on. CONCLUSION： With the application of new bone materials and human bone morphogenetic protein and the high technology, the fusion rate of bone allograft in the spinal surgery will be elevated and the complication will be less.