重组人骨形态发生蛋白2联合自体骨行椎间植骨融合治疗胸腰椎结核

Recombinant human bone morphogenetic protein-2 combined with autologous bone grafting and fusion in the treatment of thoracolumbar tuberculosis

背景:重组人骨形态发生蛋白2(recombinant human bone morphogenetic protein-2,rhBMP-2)联合自体骨行椎间植骨融合术治疗腰椎滑脱、椎管狭窄、椎间盘突出等脊柱退行性变疾病的疗效和安全性已经得到认可,但对于治疗脊柱结核等脊柱感染性疾病的疗效和安全性少有临床研究。目的:评价rhBMP-2联合自体骨行椎间植骨融合术对脊柱结核的临床疗效及其安全性。方法:回顾性分析2010年11月至2018年5月广州中医药大学第一附属医院收治的胸腰椎结核患者的临床资料,所有患者均采用后路经椎弓根螺钉内固定+植骨融合术,根据植骨时是否使用rhBMP-2将其分为2组,试验组33例采用1 mg rhBMP-2联合自体骨植入大小适宜的支撑体中,对照组35例单纯用自体骨植入支撑体。术后随访1年以上,并对术前、术后疼痛目测类比评分、脊髓损伤ASIA分级、围术期并发症以及融合率进行统计学分析。研究通过广州中医药大学第一附属医院伦理委员会的批准,患者对治疗方案均知情同意。结果与结论:①所有患者均完成1年以上的随访,随访中未发现内固定断裂移动和椎体的明显塌陷;②两组手术时间、术中出血量、住院时间、围术期并发症比例差异无显著性意义(P>0.05);③两组术后1周和术后1年的目测类比评分、ASIA分级与术前相比,有显著改善(P<0.05),但两组之间对比差异无显著性意义(P>0.05);④在融合率方面,试验组术后6个月的融合率明显高于对照组(P<0.05),然而,两组术后1年的融合率比较却无统计学差异(P>0.05)。提示:rhBMP-2联合自体骨行植骨融合术治疗胸腰椎结核能在短期内加快骨性融合,具有良好的疗效和安全性。

BACKGROUND:The efficacy and safety of recombinant human bone morphogenetic protein-2(rhBMP-2)combined with autologous bone grafting for the treatment of spinal degenerative diseases such as lumbar spondylolisthesis,spinal canal stenosis and intervertebral disc herniation have been recognized,but few clinical studies have been conducted on the efficacy and safety in the treatment of spinal infectious diseases such as spinal tuberculosis.OBJECTIVE:To evaluate the clinical efficacy and safety of rhBMP-2 combined with autologous bone grafting for spinal tuberculosis.METHODS:Clinical data of thoracolumbar tuberculosis admitted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from November 2010 to May 2018 were retrospectively analyzed.All patients underwent posterior pedicle screw fixation plus bone graft for spinal fusion,with(experimental group)or without(control group)the use of rhBMP-2.In the experimental group,33 patients were treated with posterior pedicle fixation and autologous bone graft for spinal fusion combined with rhBMP-2(1 mg).In the control group,35 patients underwent posterior pedicle fixation and autologous bone graft.Visual analogue scale,the American Spinal Injury Association(ASIA),perioperative complications and fusion rate were statistically analyzed.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital,Guangzhou University of Chinese Medicine.Informed consent was obtained from each patient.RESULTS AND CONCLUSION:All patients were followed up for more than 1 year.During the follow-up period,no fracture or movement of the internal fixation or distinct collapse of the vertebral body were found.There was no significant difference between the two groups in terms of operative time,intraoperative blood loss,length of stay,and proportion of perioperative complications(P>0.05).There was a significant improvement in visual analogue scale scores and ASIA grades in the two groups at 1 week and 1 year after operation(P<0.05).However,there were no statistically significant differences between the experimental and control groups(P>0.05).The fusion rate in the experimental group was significantly higher than that in the control group at 6 months after operation(P<0.05),but there was no statistically significant difference between the two groups at 1 year after operation(P>0.05).These findings indicate that rhBMP-2 combined with autologous bone for the treatment of thoracolumbar tuberculosis can accelerate bone fusion with favorable efficacy and safety in a short time.