目标:随着过去20年生物技术的进步,已经引入了许多促进骨骼愈合的新疗法。特别是在脊柱外科领域,更多前所未有的生物疗法可用于提高脊柱融合成功率以及先进的仪器方法。然而,为了改善临床实践,外科医生可能还没有充分了解他们的安全性和有效性。因此,有必要总结证据并将最新进展带给外科医生,以便为患者提供更好的临床服务。
方法:我们综述了近二十年来发表的关于促进脊柱融合的生物疗法的文献。
结果:自体骨由于其良好的骨传导性,仍然是脊柱融合术中植骨的金标准,骨诱导性,和成骨能力。越来越多的证据表明,添加rhBMPs结合自体移植物可有效促进融合率并改善手术结果。然而,其他生长因子对脊柱融合的刺激作用,包括PDGF,VEGF,TGF-β,FGF,没有说服力,而Nell-1和活化素A表现出初步疗效。就全身治疗方法而言,骨质疏松药物特立帕肽在促进脊柱手术后骨愈合方面发挥了积极作用,而新的药物如denosumab和硬化蛋白抗体仍需进一步验证。目前,其他治疗,如控释制剂和载体,正在研究更好的释放曲线和活性成分的给药便利性。
结论:随着世界人口的老龄化,由于脊柱退行性疾病(SDD)的手术需求增加,脊柱融合病例的数量大幅增加。最近,促进脊柱融合的生物疗法的关键进步为患者带来了更好的临床结果。随着更高层次证据的积累,目前和新兴产品的安全性和有效性越来越明显。这些新兴的疗法将改变围手术期治疗的格局,以增强脊柱融合。
OBJECTIVE: With the advances in biological technologies over the past 20 years, a number of new therapies to promote bone healing have been introduced. Particularly in the spinal surgery field, more unprecedented biological therapeutics become available to enhance spinal fusion success rate along with advanced instrumentation approaches. Yet surgeons may not have been well informed about their safety and efficacy profiles in order to improve clinical practices. Therefore there is a need to summarize the evidence and bring the latest progress to surgeons for better clinical services for patients.
METHODS: We comprehensively reviewed the literatures in regard to the biological therapeutics for enhancement of spinal fusion published in the last two decades.
RESULTS: Autograft bone is still the gold standard for bone grafting in spinal fusion surgery due to its good osteoconductive, osteoinductive, and osteogenic abilities. Accumulating evidence suggests that adding rhBMPs in combination with autograft effectively promotes the fusion rate and improves surgical outcomes. However, the stimulating effect on spinal fusion of other growth factors, including PDGF, VEGF, TGF-beta, and FGF, is not convincing, while Nell-1 and activin A exhibited preliminary efficacy. In terms of systemic therapeutic approaches, the osteoporosis drug Teriparatide has played a positive role in promoting bone healing after spinal surgery, while new medications such as denosumab and sclerostin antibodies still need further validation. Currently, other treatment, such as controlled-release formulations and carriers, are being studied for better releasing profile and the administration convenience of the active ingredients.
CONCLUSIONS: As the world\'s population continues to grow older, the number of spinal fusion cases grows substantially due to increased surgical needs for spinal degenerative disease (SDD). Critical advancements in biological therapeutics that promote spinal fusion have brought better clinical outcomes to patients lately. With the accumulation of higher-level evidence, the safety and efficacy of present and emerging products are becoming more evident. These emerging therapeutics will shift the landscape of perioperative therapy for the enhancement of spinal fusion.