| 引用本文: | 韩旭,曾建成,谢天航,王贤帝,罗川,胡骁,彭星瑞.明胶海绵- rhBMP-2复合活性骨修复材料“三明治”封装植骨技术在斜外侧腰椎间融合术中的临床疗效[J].中国临床新医学,0,():-. |
| hanxu,xietainhang,wangxiandi,luochuan,huxiao,pengxingrui.明胶海绵- rhBMP-2复合活性骨修复材料“三明治”封装植骨技术在斜外侧腰椎间融合术中的临床疗效[J].中国临床新医学,0,():-. |
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| 明胶海绵- rhBMP-2复合活性骨修复材料“三明治”封装植骨技术在斜外侧腰椎间融合术中的临床疗效 |
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韩旭, 曾建成, 谢天航, 王贤帝, 罗川, 胡骁, 彭星瑞
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四川大学华西医院
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| 摘要: |
| 目的 探讨在斜外侧腰椎椎间融合术(OLIF)中,应用明胶海绵覆盖并缝线捆绑椎间融合器的 “三明治”技术,在防止活性骨修复材料漏出及维持临床疗效方面的安全性与有效性。 方法 回顾性分析我院脊柱外科自2017年11月至2018年11月收治的92例行单节段OLIF手术的腰椎退行性疾病患者的临床资料。其中男41例,女51例,平均年龄(59.9±10.6)岁。记录手术时间、术中出血量及住院时间。临床疗效评估采用视觉模拟评分法(VAS)及Oswestry功能障碍指数(ODI)。影像学评估包括术前、术后1天及术后12个月的椎间隙高度(DH),术后12个月的椎间融合及融合器沉降情况。采用Marchi百分比分级系统评估融合器沉降程度,采用Bridwell分级标准评估椎间融合情况。结果 本组92例患者手术均顺利完成,未发生植骨材料移位、漏出或相关神经压迫并发症。平均手术时间为(88.3±12.0)min,术中出血量为(35.9±9.5)ml,中位住院时间[4(3,4)]天。术后随访至少12个月。患者ODI指数由术前(37.8±5.5)分显著降至(12.7±3.0)分(P<0.05)；腰痛VAS评分由(7.0±1.1)分降至(2.1±0.6)分(P<0.05),腿痛VAS评分由(6.6±1.4)分降至(1.7±0.8)分(P<0.05)。术后影像显示,手术节段椎间隙高度在术后1天恢复,术后1年维持良好。术后12个月影像学融合率为93.5%(Bridwell I-II级),沉降率为18.5%。结论 在OLIF术中应用rhBMP-2 复合活性骨修复材料“三明治”封装植骨技术显示出良好的安全性与可行性,具有操作简便、手术时间短、并发症少等优势,在保证微创手术效率的同时,获得了满意的临床及影像学疗效。 |
| 关键词: 斜外侧腰椎间融合术 融合器沉降 前路内固定 人工骨漏出 明胶海绵 腰椎退行性疾病 |
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| 基金项目:中华人民共和国科学技术部重点研发项目(编号：2023YFC3604405) |
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| Clinical Efficacy of Gelatin Sponge-rhBMP-2 Composite Bioactive Material via |
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hanxu, xietainhang, wangxiandi, luochuan, huxiao, pengxingrui
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west china hosipital
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| Abstract: |
| Objective To evaluate the safety and effectiveness of the “sandwich” technique—using a gelatin sponge wrapped and secured with absorbable sutures to cover the cage—during oblique lumbar interbody fusion (OLIF) in preventing graft leakage and maintaining clinical outcomes. Methods A retrospective analysis was conducted on 92 patients with lumbar degenerative diseases who underwent single-level OLIF at our institution from November 2017 to November 2018. The cohort included 41 males and 51 females, with a mean age of (59.9 ± 10.6)years. Operative time, intraoperative blood loss, and length of hospital stay were recorded. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI). Radiological evaluations included disc height (DH) measured preoperatively, postoperative day 1, and 12 months after surgery, as well as fusion status and cage subsidence at 12 months. Cage subsidence was graded using the Marchi percentage-based system, and interbody fusion was assessed according to the Bridwell grading criteria. Results All 92 procedures were completed successfully without artificial bone migration, leakage, or neurological complications. The mean operative time was (88.3 ± 12.0) minutes, intraoperative blood loss was (35.9 ± 9.5) mL, and median hospital stay was [4 (3, 4)] days. All patients were followed for at least 12 months. ODI scores improved significantly from (37.8 ± 5.5) preoperatively to (12.7 ± 3.0) at the final follow-up (P < 0.05). Low-back pain VAS scores decreased from (7.0 ± 1.1) to (2.1 ± 0.6) (P < 0.05), and leg pain VAS scores decreased from (6.6 ± 1.4) to (1.7 ± 0.8) (P < 0.05). Postoperative imaging demonstrated restoration of DH at postoperative day 1 with sustained maintenance at 12 months. The fusion rate was 93.5%, and the cage subsidence rate was 18.5%. Conclusion Intraoperative use of a rhBMP-2–composited bioactive bone graft substitute with a “sandwich” encapsulation technique during OLIF demonstrated favorable safety and feasibility. This approach is simple to perform, time-efficient, and associated with a low complication profile. While preserving the efficiency of minimally invasive surgery, it achieved satisfactory clinical outcomes and radiographic results. |
| Key words: Oblique lumbar interbody fusion (OLIF) cage subsidence anterior internal fixation artificial bone graft leakage gelatin sponge lumbar degenerative diseases |
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