脱钙骨基质在脊柱融合中的临床应用进展

Progress in clinical application of DBM for spinal fusion

脊柱融合是脊柱外科中最常用的手术方式之一,在术中选择合适的植骨材料具有十分重要的意义。一种良好的骨移植材料需同时具备骨传导性、骨诱导性和成骨性三大特性。目前,临床上应用最广泛的骨移植材料为同种异体骨,包括新鲜冰冻骨、冻干骨和脱钙骨基质(demineralized bone matrix,DBM)三类,新鲜冰冻骨具有最高的机械稳定性,但存在免疫反应和疾病传播的危险性;冻干骨在其制备过程中,水分的丢失和辐照的电离破坏了其力学性能;DBM是一种由胶原蛋白(主要为Ⅰ型、Ⅳ型)、非胶原蛋白、生长因子、少量磷酸钙和细胞碎片等组成的天然骨移植材料,具有良好的骨诱导性及一定的骨传导性。目前,随着骨移植替代材料研究深入,DBM显示出了相当大的优势,同时在脊柱融合中发挥了重要作用。

Spinal fusion is one of the most common operations in spinal surgery,choosing a proper bone material for the fusion makes a significant sense.The excellent bone grafting material should be characterized by osteoconduction,osteoinduction,and osteogenesis.At present,one of most widely used bone grafting material in clinical setting is bone allograft,including fresh frozen bone,freeze-dried bone and demineralized bone matrix(DBM).Of them,fresh frozen bone possesses the highest mechanical strength,whereas the highest risks immunorejection and disease spreading at the same time.During the preparation of freeze-dried bone,loss of water and ionization by irradiation damage its mechanical property.The DBM consisting of typeⅠand typeⅣcollagen,non-collagenous protein and growth factors,such as bone morphogenetic protein,as well as a small amount of calcium phosphate and cell debris is a kind of natural bone grafting material with good osteoinduction.With the researches on bone grafting materials going further,DBM demonstrates huge superiority,and plays a significant role in spinal fusion.