不同植骨材料及骨质疏松对腰后路椎间植骨成功率的影响

背景：对于骨质疏松性腰椎疾病患者，在实施后路腰椎间融合治疗时受骨密度等因素的影响会降低植骨融合率，但关于不同植骨材料及骨质疏松对后路腰椎间融合的影响，目前尚无全面的报道。目的：分析不同植骨材料及骨质疏松对腰后路椎间植骨成功率的影响。方法：回顾性分析227例行腰椎后路椎间融合治疗患者的临床资料，按照植骨材料的不同分为自体髂骨组(n=121)和融合器联合自体髂骨组(n=65)、同种异体骨组(n=41)，3组中骨质疏松患者分别有20，22，6例，治疗后随访24个月，对比3组植骨融合情况、融合时间、椎间高度变化及内固定失败等不良事件的发生情况。结果与结论：同种异体骨组内固定失败率、植骨融合时间、椎间高度丢失高于自体髂骨组和融合器联合自体髂骨组(P < 0.05)，植骨融合率低于自体髂骨组和融合器联合自体髂骨组(P < 0.05)，自体髂骨组和融合器联合自体髂骨组各指标比较差异无显著性意义。在骨质疏松患者中，同种异体骨组内固定失败率、植骨融合时间高于自体髂骨组和融合器联合自体松质骨组(P < 0.05)，椎间高度丢失及植骨融合率低于自体髂骨组和融合器联合自体髂骨组(P < 0.05)；自体髂骨组融合时间短于融合器联合自体髂骨组(P < 0.05)，融合率高于融合器联合自体髂骨组(P < 0.05)。表明在后路腰椎椎间融合过程中，使用自体髂骨或融合器联合自体髂骨均可以获得较高的植骨融合率，内固定失败情况较少；对于合并骨质疏松患者，予以自体髂骨块植骨可以获得更好的融合效果。中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Effects of different bone graft materials and osteoporosis on the success rate of posterior lumbar interbody fusion

BACKGROUND:For patients with osteoporosis, bone mineral density and other factors can lower the success rate of posterior lumbar interbody fusion. But there is no comprehensive report on the effects of different bone graft materials and osteoporosis on the posterior lumbar interbody fusion. OBJECTIVE:To explore the influence of different bone graft materials and osteoporosis on the success rate of posterior lumbar interbody fusion.METHODS:Clinical data of 227 patients undergoing posterior lumbar interbody fusion were retrospectively analyzed, and these patients were assigned into autogenous iliac bone group (n=121), fusion cage combined with autogenous cancellous bone group (combined group, n=65) and allograft group (n=41) according to different bone graft materials. There were 20, 22, 6 patients with osteoporosis in the three groups, respectively. All the patients were followed up for 24 months, and postoperative bone fusion, fusion time, intervertebral height and internal fixation failure and other adverse events were recorded and compared among three groups.RESULTS AND CONCLUSION:The failure rate of internal fixation, fusion time and loss of intervertebral height were higher, but the fusion rate was lower in the allograft group than the other two groups (P < 0.05). In addition, there was no difference between the autogenous iliac bone group and combined group. For the osteoporosis  patients, the failure rate of internal fixation and fusion time were higher, while the loss of intervertebral height and fusion ratewere lower in the allograft group than the other two groups (P < 0.05); compared with the autogenous iliac bone group, the combined group had longer fusion time and higher fusion rate (P < 0.05). These findings indicate that autogenous iliac bone graft combined with or without fusion cage can achieve higher fusion rate and less internal fixation failure in the posterior lumbar interbody fusion; however, for osteoporosis patient, the autogenous iliac bone graft can obtain better fusion effects.