背景:在椎间手术中,早期融合至关重要,以最大程度地减少因延迟愈合而导致的机械性并发症,尤其是骨质疏松症患者。骨形态发生蛋白(BMPs)用于脊柱融合术;然而,关于BMP使用的融合时间存在有限的评估,特别是骨质疏松症患者。
目的:根据骨密度评估重组人骨形态发生蛋白-2(rhBMP-2)使用组和未使用组单水平经椎间孔腰椎椎间融合术(TLIF)术后融合时间的差异。
方法:回顾性单中心队列研究患者样本:本研究纳入132名患者(平均年龄,65.25±8.66;男性患者,40.9%)在2012年2月至2021年12月期间接受了退行性疾病的单水平TLIF,并进行了术前和术后计算机断层扫描(CT)。
方法:每年获取术后CT扫描的椎间融合量和植骨状态,并记录每位患者的融合时间.
方法:根据在椎间融合过程中使用rhBMP-2将患者分为两组。患者进一步分为骨质疏松症,骨质减少,和正常组基于术前L1椎体衰减值,使用90和120Hounsfield单位的截止值。严格定义,当形成小梁骨桥时,融合被认为是完全的,因此,融合时间以年为单位.BMP组和非BMP组的融合时间进行统计学比较,然后根据骨密度进一步比较。
结果:BMP组和非BMP组之间的融合时间差异显着,BMP组有一半患者在2.5年内实现融合,而非BMP组则为4年(p<0.001)。融合率根据骨密度而变化,在骨质疏松组中观察到的最大差异,BMP组有一半患者在3年内实现融合,而非BMP组则为5年(p<0.001)。进行亚组分析,揭示融合时间与已知影响融合过程的因素之间没有显着关联,包括年龄,性别,病史,吸烟和饮酒,用药史,除了rh-BMP2使用和骨密度。
结论:使用RhBMP-2显著缩短了单水平TLIF的融合时间,尤其是骨质疏松症患者。
方法:三级。
BACKGROUND: Early fusion is crucial in interbody procedures to minimize mechanical complications resulting from delayed union, especially for patients with osteoporosis. Bone morphogenetic proteins (BMPs) are used in spinal fusion procedures; however, limited evaluation exists regarding time-to-fusion for BMP use, particularly in patients with osteoporosis.
OBJECTIVE: To evaluate the difference in time-to-fusion after single-level transforaminal lumbar interbody fusion (TLIF) surgery between recombinant human bone morphogenetic protein-2 (rhBMP-2) usage and nonusage groups according to bone density.
METHODS: Retrospective single-center cohort study.
METHODS: This study enrolled 132 patients (mean age, 65.25±8.66; male patients, 40.9%) who underwent single-level TLIF for degenerative disorders between February 2012 and December 2021, with pre and postoperative computed tomography (CT).
METHODS: The interbody fusion mass and bone graft status on postoperative CT scans was obtained annually, and time-to-fusion was recorded for each patient.
METHODS: The patients were divided into 2 groups based on rhBMP-2 use during the interbody fusion procedure. Patients were further divided into osteoporosis, osteopenia, and normal groups based on preoperative L1 vertebral body attenuation values, using cutoffs of 90 and 120 Hounsfield units. It was strictly defined that fusion is considered complete when a trabecular bone bridge was formed, and therefore, the time-to-fusion was measured in years. Time-to-fusion was statistically compared between BMP group and non-BMP groups, followed by further comparison according to bone density.
RESULTS: The time-to-fusion differed significantly between BMP and non-BMP groups, with half of the patients achieving fusion within 2.5 years in the BMP group compared with 4 years in the non-BMP group (p<.001). The fusion rate varied based on bone density, with the maximum difference observed in the osteoporosis group, when half of the patients achieved fusion within 3 years in the BMP group compared to 5 years in the non-BMP group (p<.001). Subgroup analysis was conducted, revealing no significant associations between time-to-fusion and factors known to influence the fusion process, including age, gender, medical history, smoking and alcohol use, and medication history, except for rh-BMP2 use and bone density.
CONCLUSIONS: RhBMP-2 usage significantly reduced time-to-fusion in single-level TLIF, especially in patients with osteoporosis.
METHODS: Level III.