椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术中的应用

目的 分析椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术(Anterior cervical discectomy and fu-sion,ACDF)中的应用效果.方法 回顾性分析自2015-01-2018-12采用ACDF治疗的184例退行性颈椎病,104例采用椎体原位骨屑植骨技术进行椎间融合(原位骨屑组),...     

Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders

Anterior cervical discectomy and fusion (ACDF) with cage alone (ACDF-C) is associated with a significant incidence of subsidence, local kyphosis, and migration. The use of concurrent plate augmentation may decrease the incidence of these complications while improving the fusion rate. The purpose of the study is to present our results with ACDF with cage and plate augmentation (ACDF-CPA) and to compare these results to previous reports of outcomes following ACDF-C. We evaluated the radiologic and clinical parameters of 83 patients (266 fusion sites) who had an ACDF-CPA between March 2002 and May 2006. Radiologic parameters included fusion rate, fusion time, fusion type, site of pseudoarthrosis and rate and degree of subsidence. Clinical parameters included complications and overall outcomes assessed with Robinson’s criteria; 79 of 83 patients showed bony fusion (95.1%) at last follow-up postoperatively, and there was no significant difference in fusion rate between the number of fusion levels. Type I (pseudoarthrosis) was noticed in 9 patients (12 fusion sites), type II in 14 (19 fusion sites), and type III in 60 (235 fusion sites). Five type I and all type II fusions converged into type III by the last follow-up; 76 of 83 patients (91.6%) experienced good clinical outcomes. Pseudoarthrosis occurred more commonly in more proximal locations, and the subsidence rate was significantly greater in two-level fusions when compared with single-level fusions (P = 0.046). There were four metal-related complications. Plate augmentation in one- or two-level anterior cervical fusions for degenerative cervical spine disorders may improve fusion rates and reduce subsidence and complication rates, resulting in improved clinical outcomes.     

自体骨、同种异体骨和人工骨应用于颈前路椎间盘切除融合术的效果比较

目的：比较自体髂骨、同种异体骨和羟基磷灰石（hydroxyapatite,HA）人工骨在前路颈椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）应用的临床效果和影像学结果。方法：回顾性分析2015年1月～2019年12月于南方医科大学第三附属医院接受ACDF患者的临床资料。共纳入107例患者、164节段。根据使用的植骨材料不同分为自体髂骨组（37例、53个节段）、同种异体骨组（46例、70个节段）和HA人工骨组（24例、41个节段）。术前和末次随访时采用疼痛视觉模拟量表（visual analogue scale,VAS）评分、颈椎功能障碍指数（neck disability index,NDI）、日本骨科协会（Japanese Orthopedic Association,JOA）评分评估患者颈椎疼痛和功能情况。在颈椎矢状面X线片测量手术节段高度和矢状面参数[C2-C7矢状面轴向距离（SVA）和C2-C7 Cobb角],评估融合器下沉情况。根据Odom标准进行满意程度评估,采用Brantigan评分评估颈椎椎间融合状态,采用多...     

Bone graft substitutes in anterior cervical discectomy and fusion

Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor- and cell-based technologies.     

Complications of anterior cervical discectomy without fusion in 450 consecutive patients

Summary The complications of anterior discectomy without fusion were analyzed on the basis of 450 consecutive cases treated surgically for degenerative disc disease. There was no death related to the procedure. The most common complication was a worsening of the preexisting myelopathy. This occurred in 3.3%, including one case with severe medullary contusion. Wound infection developed in 1.6%. Additional radicular symptoms and wound haematoma, respectively, occurred in 1.3%; recurrent nerve palsy, Horner's syndrome, and respiratory insufficiency, respectively, in 1.1% of the cases. Epidural haematoma and instability of the cervical spine, respectively, occurred in 0.9%, nerve root lesion and aseptic spondylodiscitis, respectively, in 0.4%. There was one case each (0.2%) with a pharyngeal lesion, meningitis due to dural perforation, transient additional myelopathy, and epidural abscess.The results and the management of complications are discussed in relation to numerous previously published reports, including posterior procedures and anterior fusion techniques. Precise knowledge of all potential accidents and pitfalls related to the surgical procedure and of their aetiology may contribute to preventing failures. The rate of complications in this series has been reduced in the past years by better patient selection, by paying more attention to correct positioning of the patient during the operation, and by meticulous removal of all offending structures. Discectomy without interbody fusion is now considered to be a reasonably safe procedure with an acceptable operative morbidity and lack of mortality.     

rhBMP-2对骨骼肌卫星细胞增殖与粘附的影响

目的探讨人重组骨形态发生蛋白(rhBMP)-2对骨骼肌卫星细胞增殖与粘附的影响.方法体外分离与培养骨骼肌卫星细胞,分别用0、50、100、500、1000 ng/ml的rhBMP-2诱导培养基培养48h.利用MTT法测定细胞增殖能力的变化,通过荧光法测定接种后1h的粘附细胞率.结果rhBMP-2可促进骨骼肌卫星细胞的增殖,这种作用从BMP浓度为500ng/ml即可表现出来,并随着浓度的增加而越发明显.在rhBMP-2作用下骨骼肌卫星细胞的粘附率增高,在500ng/ml的浓度时达最高,但当BMP浓度进一步增大时,细胞粘附率却不再增加.结论rhBMP-2可促进骨骼肌卫星细胞的增殖,增强其粘附特性.     

骨形态发生蛋白-2/胶原/掺锶羟基磷灰石材料修复颅骨缺损

目的 制备骨形态发生蛋白-2( BMP-2)/胶原/掺锶羟基磷灰石材料并探讨其修复大鼠颅骨缺损的可行性和有效性.方法 扫描电镜观察Ⅰ型胶原制备单纯胶原、胶原/羟基磷灰石、胶原/掺锶羟基磷灰石、BMP-2/胶原/掺锶羟基磷灰石4组骨修复材料表面结构.用BMP-2/胶原/掺锶羟基磷灰石材料浸提液进行细胞毒性试验和体外溶血试验评价其生物相容性.在大鼠头颅制备颅骨极限骨缺损模型,分别植入4种骨修复材料.术后12周CT扫描观察骨缺损修复影像学.苏木素-伊红(HE)和Masson染色观察骨缺损组织学变化,并在骨缺损及其周围新生骨部位行骨桥蛋白( OPN)和β-连环蛋白(β-catenin)免疫组织化学染色.结果 在扫描电镜下观察发现单纯的胶原材料为交织样物质结构,胶原/羟基磷灰石材料为交织晶体板状结构胶原/掺锶羟基磷灰石和BMP-2/胶原/掺锶羟基磷灰石材料晶体结构为单晶体交织状.BMP-2/胶原/掺锶羟基磷灰石材料浸提液对细胞相对增殖率(RGR)无显著影响(P＞0.05),材料的细胞毒性为1级.骨缺损CT扫描平均CT值分别为(98.5±10.2)、(208.4±19.5)、(418.4±27.1)、(476.8±30.5)hu,BMP-2/胶原/掺锶羟基磷灰石材料缺损部位CT值最高.HE和Masson染色见BMP-2/胶原/掺锶羟基磷灰石组骨质愈合完全,原骨缺损处多为红色成熟骨.胶原/掺锶羟基磷灰石组植入区内蓝色的新生骨较多.胶原/羟基磷灰石材料组,植入区在植入材料边缘新生骨形成,界限仍然清晰.单纯胶原组骨质未愈合,骨缺损处为淡蓝色条索状结构,中间未见骨形成.对比其他3组,BMP-2/胶原/掺锶羟基磷灰石组存在大量棕色的OPN和β-catenin染色阳性新生骨组织,差异有统计学意义(P＜0.05).结论 BMP-2/胶原/掺锶羟基磷灰石材料促进骨修复能力强于单纯胶原、胶原/羟基磷灰石、胶原/掺锶羟基磷灰石材料.     

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom’s criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara’s index at 1 year. Group 1 had a mean age 46.2 years (range 35–60 years). Group 2 had a mean age 50.1 years (range 35–70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.     

Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone

Background  

In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease.     

Effects of bone morphogenetic protein-2 on human tumor cell growth and differentiation: a preliminary report

The effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) on cell growth were studied in three human osteosarcoma cell lines, NOS-1, HuO9, and HuO-3N1; one human prostate cancer cell line, PC-3; and one human breast cancer cell line, OCUB-1M. The growth of these cell lines was not promoted by rhBMP-2 at con-centrations of 50, 100, 250, and 500 ng/ml, as evaluated by colorimetric 3 (4,5-dimethyl-thiazol-2-yl)-2,5 diphenyl tetrazolium bromide (MTT) assay. Furthermore, the protein induced osteogenic differentiation, characterized by increased alkaline phosphatase activity, and increased production of type I collagen and γ-carboxylated osteocalcin in NOS-1 cells. The results of this study may suggest the feasibility of using rhBMP-2 for the reconstruction of bone defects caused by malignant tumors, although the data are still preliminary and require further investigation. Received: March 29, 2000 / Accepted: July 26, 2000     

The short-term therapeutic effect of recombinant human bone morphogenetic protein-2 on collagenase-induced lumbar facet joint osteoarthritis in rats

OBJECTIVE: To determine whether an intra-articular injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) alleviates cartilage degradation in a rat model of osteoarthritis (OA) of the lumbar facet joint. METHOD: The right-side facet joint OA model was created by an intra-articular injection of collagenase (type II) 2 weeks before treatment. The OA rats were divided into four groups: (1) no treatment, or intra-articular injection of either (2) saline, (3) rhBMP-2 10 ng, or (4) rhBMP-2 100 ng. The left-side facet joint served as the normal control. At 3 and 6 weeks after treatment, histological analyses were performed on the cartilage, synovium, subchondral bone and bone marrow. The cartilage and synovium were graded using a modified Mankin score and a synovium score system. Extracellular type II collagen was evaluated by immunohistochemistry. RESULTS: Intra-articular injection of collagenase causes OA-like changes in the facet joint. OA rats treated with rhBMP-2 at both dosages tested showed reduced severity of their cartilage lesions compared with untreated and saline-treated groups. There was a statistically significant difference in the modified Mankin score compared to the untreated and saline-treated groups. However, some rhBMP-2-treated rats at the higher dose (100 ng) showed, as a side effect, joint space obliteration caused by cartilage overgrowth. Also OA rats treated with 100 ng of rhBMP-2 displayed a significant synovium reaction at 3 weeks compared with that in other groups. Immunohistochemical analysis showed that treatment with rhBMP-2 significantly increased the content of type II collagen. CONCLUSION: This study demonstrates the potential efficacy of rhBMP-2 in the alleviation of arthritic changes in a rat model of OA of the lumbar facet joint. However, treatment with a high dosage of rhBMP-2 caused adverse side effects in some animals.     

颈椎前路手术后吞咽困难的原因分析

目的：探讨颈椎前路手术后发生吞咽困难的相关因素。方法：随访2002年10月～2004年10月间颈椎前路手术患者490例。其巾男306例，女184例；年龄12～76岁，平均47．2岁；诊断为颈椎病415例，颈椎骨折脱位43例．颈椎间盘突出症22例，颈椎椎体肿瘤8例．颈椎结核2例。观察患者手术后是否存在吞咽困难；对于存在吞咽困难的患者均静脉应用地塞米松及对症治疗。结果：共有96例（19．6％）患者出现不同程度吞咽困难，持续时间3周～24个月。男42例，女54例，年龄38～63岁，平均57．6岁。96例吞咽困难患者巾，使用钛板内同定89例．使用颈椎椎间融合器7例：颈椎融合术未加内固定者及颈椎人工间盘置换者均未出现吞咽困难病例。女性、高龄及使用钛板内植物等因素与吞咽困难之间存在相关性。96例患者平均随访14．2个月，90例（93．7％）吞咽困难的症状消失或减轻，6例（6.3％）症状无改善。结论：吞咽困难是颈椎前路手术后常见的并发症；其发生可能与多种因素有关。临床医生应给予相应重视和采取相应措施以减少其发生。     

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Purpose

We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).

Methods

A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.

Results

Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.

Conclusions

Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.     

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

Background The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature.Methods Seventy-nine consecutive patients were operated on using the Smith–Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years.Results The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one- and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and non-smokers in the rate or course of fusion as previously reported.     

丝素蛋白增强型磷酸钙复合rhBMP-2用于绵羊腰椎椎体间融合的实验研究

目的 评价可注射丝素蛋白增强型磷酸钙(silk fibroin/calcium phosphate cement,SF/CPC)复合人重组骨形态发生蛋白-2(recombinant human bone morphogenetic protein-2,rhBMP-2)应用于绵羊腰椎椎体间融合的效果.方法 24只绵羊均建立L1.2、L3.4和L5.6前路椎体间融合模型.每只绵羊的3个腰椎间隙随机植入SF/CPC、CPC/rhBMP-2、SF/CPC/rhBMP-2和自体髂骨中的3种.分别于术后6个月和12个月各处死12只绵羊.每个时段均获得36个腰椎手术节段,每种材料9个节段.通过大体观察、手触检测、CT扫描、非破坏性生物力学测试和组织学观察分析脊柱融合状况.结果 术后6个月时,手触检测SF/CPC、CPC/rhBMP-2、SF/CPC/rhBMP-2以及髂骨的融合率分别为0、33.33%(3/9)、55.56%(5/9)和77.78%(7/9);12个月时为11.11%(1/9)、44.44%(4/9)、77.78%(7/9)和77.78%(7/9).生物力学显示6个月时,前屈、后伸、左屈和右屈的融合刚度:髂骨＞SF/CPC/rhBMP-2＞CPC/rhBMP-2＞SF/CPC;12个月时SF/CPC/rhBMP-2刚度与髂骨相近,SF/CPC最小.组织学定量表明:6个月时,髂骨新生骨量＞SF/CPC/rhBMP-2＞CPC/rhBMP-2＞SF/CPC;而钙磷残留量依次增多;12个月时,SF/CPC/rhBMP-2新生骨量与髂骨相近;SF/CPC最少;钙磷残留量依次增多.结论 SF/CPC/rhBMP-2人工骨具有骨传导和骨诱导性,降解与成骨能力匹配,是一种理想的脊柱融合材料.     

骨形态发生蛋白-2对椎间盘细胞软骨特异性基因 mRNA的调节作用

目的探讨骨形态发生蛋白(BMP)-2对椎间盘细胞软骨特异性基因Sox9、Ⅱ型胶原和蛋白聚糖基因的调控作用.方法应用逆转录-聚合酶链反应(RT-PCR)技术检测BMP-2对培养的人椎间盘细胞中Sox9、Ⅱ型胶原和蛋白聚糖基因 mRNA表达的调控作用.结果在BMP-2浓度为100 μg/L(0.149±0.006,P<0.05)和1 000 μg/L(0.163±0.006,P<0.01)时,其对椎间盘细胞中Sox9基因 mRNA可起到显著的正向调控作用;在此浓度下,它也可以对Ⅱ型胶原和蛋白聚糖基因mRNA起到正向调控作用.结论 BMP-2可以按照剂量依赖方式正向调控椎间盘细胞中Sox9、Ⅱ型胶原和蛋白聚糖基因的表达.     

重组人骨形态发生蛋白-2缓释微球对成骨细胞的作用

目的　探讨甲基丙烯酸缩水甘油酯右旋糖酐 (dex GMA)重组人骨形态发生蛋白(rhBMP 2 )凝胶微球 (rhBMP2 dex HM )对成骨细胞的生物学作用。方法　将单纯rhBMP 2 (A组 )、空白dex GMA凝胶微球dex HM (B组 )和rhBMP2 dex HM (C组 )加入成骨细胞培养液中 ,用细胞计数法、噻唑蓝比色法 (MTT法 )、流式细胞仪观察细胞增殖情况 ,并检测成骨细胞上清液中骨钙素 (BGP)含量。结果　培养 1～ 2d后 ,3组细胞计数、吸光度 (A)值差异无统计学意义 (P >0 .0 5 ) ;4～ 6d时A、C组细胞计数和A值开始高于B组 ,但A、C组间差异无统计学意义 (P >0 .0 5 ) ;培养 6～ 8d后 ,C组明显高于其他组 ,差异有统计学意义 (P <0 .0 1)。14d后 ,A、B、C 3组细胞数分别为 (2 2 .97± 0 .2 3 )、(13 .89± 0 .5 7)和 (3 2 .46± 0 .67)× 10 4个细胞 /ml,差异有统计学意义(P <0 .0 1)。流式细胞仪检测结果显示 ,培养 2d后 ,A组的G2 /M +S期百分数最高 ;6～ 8d后 ,C组的G2 /M +S期百分数最高。成骨细胞上清液中BGP含量 ,C微球组最高 ,其次为A组。结论　rhBMP 2 dex HM可以较长时间持续释放活性rhBMP 2 ,作为rhBMP 2的缓释载体 ,可以明显促进成骨细胞增殖和分化。     

颈前路减压零切迹椎间植骨融合内固定系统治疗颈椎病的早期疗效分析

目的:分析颈前路减压零切迹椎间植骨融合内固定系统(Zero-P)治疗颈椎病的早期疗效。方法 :2010年6月~10月39例颈椎病患者接受颈前路减压Zero-P植骨内固定手术,患者年龄33~71岁,平均50.3岁。神经根型颈椎病8例,脊髓型31例;单间隙14例,2个间隙18例,3个间隙7例。共置入Zero-P 71枚,C3/4、C4/5、C5/6、C6/7椎间隙置入Zero-P分别为8、19、30、14枚。术前、术后2个月及12个月对神经根型颈椎病患者行VAS评分、脊髓型颈椎病患者行JOA评分,在颈椎中立侧位X线片上测量颈椎Cobb角(C2和C7椎体后缘切线的夹角),观察术后吞咽不适的发生率以及症状持续时间。根据术后伸屈侧位X线片观察手术间隙有无异常活动。结果:手术时间48~130min,平均86min;术中出血量40~310ml,平均110ml。14例患者术后1周内出现吞咽不适,其中13例术后2个月内症状消失,1例(2.6%)症状持续至术后4个月消失。随访12~16个月,平均14.6个月。神经根型颈椎病患者术后2个月、12个月时的VAS评分分别为1.5±0.8分、1.3±0.9分,均低于术前的7.3±1.3分(P<0.05)。脊髓型颈椎病患者术后2个月、12个月时的JOA评分分别为14.6±1.1分、15.0±1.2分,均高于术前的9.7±1.7分(P<0.05)。术后2个月及12个月颈椎Cobb角分别为18.4°±9.6°、17.8°±9.2°,大于术前的9.0°±10.0°(P<0.05)。术后12个月时的VAS评分、JOA评分和颈椎Cobb角与术后2个月比较无显著性差异(P>0.05)。随访期间手术间隙无异常活动,内置物无移位。结论:颈前路减压Zero-P植骨内固定治疗颈椎病的早期疗效满意,稳定性可靠,可重建颈椎曲度,术后慢性吞咽不适发生率低。     

应用AdEasy腺病毒载体系统构建人骨形成蛋白2基因重组腺病毒

目的利用AdEasy腺病毒载体系统构建人骨形成蛋白2(BMP2)基因重组腺病毒并在293E细胞中扩增制备重组病毒。方法自人骨形成蛋白2真核表达载体pcDNA3-hBMP2中酶切出hBMP2基因，插入pAdtrackCMV中构建成腺病毒穿梭质粒pAdtrackCMV—hBMP2，经酶切线性化后，采用电穿孔转化到事先电转化腺病毒骨架质粒pAdEasy的BJ5183大肠杆菌电感受态细菌中，挑选同源重组质粒，酶切线性化重组质粒并转染293E细胞包装成重组病毒颗粒，荧光显微镜观察绿色荧光表达。重组病毒上清感染293细胞，荧光显微镜观察绿色荧光表达。结果经限制性内切酶检测和GFP表达证实成功地构建了携带hBMP2基因的重组腺病毒载体并制备出高滴度重组病毒。结论成功地构建了携带hBMP2基因的重组腺病毒载体，为进一步研究rBMP2基因治疗奠定了基础。     

Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2

Introduction

Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2.

Methods

Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months.

Results

Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred.

Conclusion

The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.