重组人类骨形成蛋白-2在腰椎椎间融合中应用的临床研究

Clinical study on the application of recombinant human bone morphogenetic protein-2 in lumbar interbody fusion

目的探究重组人类骨形成蛋白-2(recombinant human bone morphogenetic protein-2,rhBMP-2)在腰椎椎间融合中应用的临床疗效。方法选取本院2018年1月至2019年6月收治的60例行腰椎退变性疾病后路减压融合术患者,按照治疗方法的不同分为A组和B组,每组30例。A组采用rhBMP-2和自体骨复合植骨治疗,B组采用传统自体骨植骨与椎间融合器治疗,比较两组不同时间点椎间隙高度、腰腿部疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、植骨融合及并发症发生率。结果术后,两组各时间点VAS、ODI评分均低于术前,椎间隙高度均高于术前(P<0.05),但组间比较差异无统计学意义;术后3个月,A组植骨融合率高于B组(P<0.05),术后6、12个月,两组植骨融合率比较差异无统计学意义。两组无一例术后出现相关并发症。结论rhBMP-2应用于退变性腰椎疾病椎间融合中可提高近期随访融合率,减少手术融合失败率,远期疗效与自体骨相当,应用rhBMP-2骨诱导效果好、融合快、成功率高,且可避免有创取材,具有较高的临床应用价值。

Objective To evaluate the clinical efficacy of recombinant human bone morphogenetic protein-2(rhBMP-2)in lumbar interbody fu-sion.Methods 60 patients admitted to our hospital from January 2018 to June 2019 who underwent posterior decompression and fusion for lumbar degenerative diseases were selected and they were divided into group A and group B according to different treatment methods,with 30 cases in each group.Group A was treated with rhBMP-2 combined with autologous bone graft.Group B was treated with traditional autologous bone graft in inter-body fusion apparatus.The intervertebral space height,visual analog scale(VAS)and Ostry disability index(ODI)scores of lumbar and leg pain,bone graft fusion and complications were compared between the two groups at different time points.Results After surgery,VAS and ODI scores at each time point in the two groups were lower than those before surgery,and intervertebral space height was higher than that before surgery(P<0.05),but there was no statistically significant difference between the two groups.At 3 months after surgery,the fusion rate of bone graft in group A was higher than that in group B(P<0.05).At 6 months and 12 months after surgery,there was no statistically significant difference in the fusion rate of bone graft between the two groups.No postoperative complications occurred in the two groups.Conclusion RhBMP-2 in the surgical fusion of degenerative lumbar diseases can improve the fusion rate in recent follow-up,reduce the rate of failure of surgical fusion,long-term efficacy is basi-cally the same as autologous bone,the application of rhBMP-2 bone induction effect is good with fast fusion and high success rate,can avoid inva-sive materials,reflecting a higher clinical value.