微创经椎间孔入路椎间融合术治疗腰椎退行性病变中两种植骨材料的疗效比较

Effect comparison of two bone grafting materials in minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases

目的比较微创经椎间孔入路椎间融合术(MIS-TLIF)治疗腰椎退行性病变中两种植骨材料的疗效。方法将采用MIS-TLIF治疗的169例腰椎退行性病变患者按照使用植骨材料不同分为BMP组[采用局部自体髂骨粒混合重组人骨形态发生蛋白-2(BMP-2)椎间植骨,83例]和LABG组(采用局部单纯自体髂骨粒椎间植骨,86例)。比较两组手术情况、手术并发症及MIS-TLIF相关并发症发生情况、影像学结果。采用疼痛VAS评分、ODI评分评价临床疗效。结果患者均获得随访,时间24~75(42.6±15.8)个月。(1)手术情况、手术并发症发生率:两组比较差异均无统计学意义(P>0.05)。(2)MIS-TLIF相关并发症发生率:BMP组明显高于LABG组(P=0.025)。(3)疼痛VAS评分、ODI评分、椎间隙高度:两组术后各时间段均明显优于术前(P<0.05),且随时间延长逐步降低,差异均有统计学意义(P<0.05)。术后各时间点两组比较差异均无统计学意义(P>0.05)。(4)骨性融合率:BMP组明显高于LABG组(P<0.05)。结论自体髂骨联合BMP-2移植进行MIS-TLIF治疗腰椎退行性病变与局部单纯自体髂骨粒椎间植骨相比,自体髂骨移植可限制和控制BMP-2向外渗透,从而能降低使用BMP-2引起的并发症风险,且能相对有效地实现骨性融合,并能明显缓解疼痛、恢复椎体高度、改善患者生活质量,但需注意有可能增加脊神经根炎和血清肿发生的风险。

Objective To compare the efficacy of two bone grafting materials in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for lumbar degenerative diseases.Methods The total of 169 patients with lumbar degenerative diseases treated with MIS-TLIF were divided into two groups:BMP group[local autogenous iliac bone particles mixed with recombinant human bone morphogenetic protein-2(BMP-2)for intervertebral bone graft,83cases]and LABG group(local simple autogenous iliac bone particles for intervertebral bone graft,86 cases).The surgical situation,surgical complications,MIS-TLIF related complications and imaging results were compared between the two groups.Pain VAS and ODI score were used to evaluate the clinical efficacy.Results All patients were followed up for 24~75(42.6±15.8)months.(1)Surgical situation and total incidence rate of surgical complications:there were no statistical differences between two groups(P>0.05).(2)The incidence rate of MIS-TLIF related complications was significantly higher in BMP group than that in LABG group(P=0.025).(3)Pain VAS,ODI score and intervertebral space height:both groups were significantly better than those before surgery at each time period after surgery(P<0.05),and which was gradually decreased with time prolonging(P<0.05),but there was no statistical significance between the two groups at each postoperative time point(P>0.05).(4)Bone fusion rate:BMP group was significantly higher than LABG group(P<0.05).Conclusions Compared with local autogenous iliac bone graft alone,autogenous iliac bone combined with BMP-2 graft for MIS-TLIF are used to treat lumbar degenerative disease,can obviously relieve pain,restore vertebral height and improve patients′quality of life,and can limit and control the external infiltration of BMP-2,thus reducing the risk of complications caused by BMP-2 use and achieving bone fusion effectively.However,it should be noted that there is risk of possibly increasing the occurrence of radiculopathy and seroma.