硫酸钙/脱钙骨基质和同种异体骨在颈椎前路椎间盘切除减压融合中的疗效对比

Clinical efficacy of calcium sulphate/demineralized bone matrix versus bone allograft in anterior cervical discectomy and fusion

背景:不同的骨移植替代物被广泛应用于临床骨修复及组织重建中,但目前对于哪种骨移植材料可获得良好的骨融合业界并没有明确的定论。目的:对比在Zero-P融合器内填充不同骨移植物行单节段颈椎前路椎间盘切除减压融合治疗脊神经根型颈椎病的临床疗效。方法:选择2017年1月至2019年1月山西医科大学第二医院收治的77例脊神经根型颈椎病患者,均进行单节段颈椎前路椎间盘切除减压融合手术,依据植骨材料分为硫酸钙/脱钙骨基质组(n=27)、同种异体骨组(n=24)及自体骨组(n=26)。术后随访1年,评估颈脊髓损伤JOA评分、目测类比评分及颈椎残障功能指数评分,影像学观察植骨融合及颈椎曲度、椎间隙高度变化。试验获得山西医科大学第二医院伦理委员会批准。结果与结论:①3组术后1年的颈脊髓损伤JOA评分、目测类比评分及颈椎残障功能指数评分均较术前改善(P <0.05),但3组间比较差异均无显著性意义(P> 0.05);②3组术后1年的颈椎曲度、椎间隙高度均较术前增加(P <0.05),但3组间比较差异均无显著性意义(P> 0.05);③3组在术后第6个月均实现了骨性融合,硫酸钙/脱钙骨基质组骨融合程度接近自体骨组(P> 0.05),同种异体骨组骨融合程度弱于自体骨组(P <0.05);④结果表明,使用硫酸钙/脱钙骨基质行颈椎前路椎间盘切除减压融合可获得良好的骨性融合,且与自体骨相当,优于同种异体骨。

BACKGROUND:Different bone graft substitutes are widely used in clinical bone repair and tissue reconstruction.However,it remains unclear what bone graft substitute can acquire good bone fusion.OBJECTIVE:To investigate the clinical efficacy of different bone grafts filled in Zero-P cage for single-segment anterior cervical discectomy and fusion to treat cervical radiculopathy.METHODS:Seventy-seven patients with cervical radiculopathy who received treatment in the Second Hospital of Shanxi Medical University between January 2017 and January 2019 were included in this study.All included patients underwent single-segment anterior cervical discectomy and fusion and were divided into three groups according to bone graft materials:calcium sulphate/demineralized bone matrix group(n=27),allogeneic bone group(n=24),and autologous bone group(n=26).After surgery,1-year follow up was performed.The Japanese Orthopedic Association(JOA)score,Visual Analog Scale(VAS)score,and Neck Disability Index(NDI)were evaluated.Changes in bone fusion,cervical curvature,and the height of intervertebral space were observed by imaging examination.This study was approved by the Hospital Ethics Committee,Second Hospital of Shanxi Medical University,China.RESULTS AND CONCLUSION:(1)Compared with before surgery,JOA score was significantly increased,VAS score,and NDI were significantly decreased in each group at 1 year after surgery(P<0.05).There were no significant differences in JOA score,VAS score,and NDI among three groups at 1 year after surgery(P>0.05).(2)Compared with before surgery,cervical curvature and the height of intervertebral space were significantly increased in each group at 1 year after surgery(P<0.05).There were no significant differences in cervical curvature and the height of intervertebral space between groups(P>0.05).(3)At 6 months after surgery,bone fusion was observed in each group,and the degree of bone fusion in the calcium sulphate/demineralized bone matrix group was similar to that in the autologous bone group(P>0.05),and the degree of bone fusion in the allogeneic bone group was lower than that in the autologous bone group(P<0.05).(4)These results suggest that calcium sulphate/demineralized bone matrix for anterior cervical discectomy and fusion can acquire good bone fusion,and the clinical efficacy of calcium sulphate/demineralized bone matrix is similar to that of autologous bone and superior to that of allogenic bone.