| 摘要: |
| ［摘要］ 目的 观察在斜外侧腰椎椎间融合术（OLIF）中应用明胶海绵-重组人骨形态发生蛋白-2（rhBMP-2）复合活性骨修复材料“三明治”封装植骨技术，在防止活性骨修复材料漏出及促进骨融合方面的安全性与有效性。方法 回顾性分析2017年11月至2023年7月四川大学华西医院收治的834例行L4-5节段OLIF的腰椎退行性疾病患者的临床资料。其中男380例（45.6%），女454例（54.4%），年龄23～89（63.3±11.8）岁。记录手术时间、术中出血量及住院时间。采用视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）评估临床疗效。于术前、术后1 d、术后12个月及术后24个月通过矢状位腰椎三维CT测量椎间隙高度（DH）。采用Marchi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 所有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（87.2±11.8）min，平均术中出血量为（33.3±7.4）mL，平均住院时间为（5.3±1.5）d。术后随访24～90个月，中位随访时间为28(24，43)个月。与术前相比，术后3个月、12个月及24个月的腰痛与腿痛VAS评分以及ODI均持续显著改善，差异有统计学意义（P<0.05）。术后影像学测量显示，手术节段DH在术后1 d恢复，术后12个月维持良好。术后24个月影像学融合率为93.8%（Bridwell Ⅰ～Ⅱ级），融合器沉降率为22.9%。结论 在OLIF中应用明胶海绵-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和可行性，具有操作简便、手术时间短、并发症少等优点，在保证微创手术效率的同时，获得了良好的临床疗效。 |
| 关键词: “三明治”封装植骨技术 重组人骨形态发生蛋白-2 斜外侧腰椎椎间融合术 融合器沉降 前外侧钉棒固定 人工骨漏出 明胶海绵 腰椎退行性疾病 |
| DOI：10.3969/j.issn.1674-3806.2026.02.06 |
| 分类号:R 681.5 |
| 基金项目:国家自然科学基金项目（编号：82372439）；国家重点研发计划课题（编号：2023YFC3604405） |
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| Observation on the clinical efficacy of “sandwich” bone graft encapsulation technique using gelatin sponge-rhBMP-2 composite bioactive material in oblique lumbar interbody fusion |
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HAN Xu, ZENG Jiancheng, XIE Tianhang, WANG Xiandi, LUO Chuan, HU Xiao, PENG Xingrui
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Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
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| Abstract: |
| ［Abstract］ Objective To observe the safety and effectiveness of “sandwich” bone graft encapsulation technique using gelatin sponge-recombinant human bone morphogenetic protein-2(rhBMP-2) composite bioactive material in preventing graft-related leakage and promoting osseous fusion in oblique lumbar interbody fusion(OLIF). Methods A retrospective analysis was performed on the clinical data of 834 patients with lumbar degenerative diseases who underwent L4-5 segment OLIF in West China Hospital, Sichuan University from November 2017 to July 2023. The patients included 380 males(45.6%) and 454 females(54.4%), aged 23-89(63.3±11.8)years. The operation time, intraoperative blood loss and hospital stay of the patients were recorded. The clinical efficacy was evaluated by using Visual Analogue Scale(VAS) scores and Oswestry Disability Index(ODI). Sagittal lumbar three-dimensional computed tomography(3D-CT) was used to measure the disc height(DH) before the operation and 1 day, 12 months and 24 months after the operation. Cage subsidence was graded by using Marchi classification system, and interbody fusion status was assessed according to Bridwell grading criteria. Results All the patients were operated successfully without any complications such as graft migration, graft leakage or graft-related neurological compression. The average operation time was (87.2±11.8)min. The average intraoperative blood loss was (33.3±7.4)mL, and the average hospital stay was (5.3±1.5)days. The postoperative follow-up duration ranged from 24 to 90 months, with a median follow-up duration of 28(24, 43)months. Compared with those before the operation, the VAS scores for assessing low back pain and leg pain as well as the ODI of the patients at 3 months, 12 months and 24 months after the operation continued to improve significantly, and the differences were statistically significant(P<0.05). Postoperative imaging measurement demonstrated a restoration of DH in the operated lumber vertebra segments at 1 day after the operation, with favorable maintenance at 12 months after the operation. At 24 months after the operation, the imaging fusion rate reached 93.8%(Bridwell grades Ⅰ-Ⅱ), and the incidence of cage subsidence was 22.9%. Conclusion The application of “sandwich” bone graft encapsulation technique using gelatin sponge-rhBMP-2 composite bioactive material in OLIF shows good safety and feasibility. It has the advantages of simple operation, short operation time and low complication rate. While ensuring the efficiency of minimally invasive surgery, it achieves good clinical efficacy. |
| Key words: “Sandwich” bone graft encapsulation technique Recombinant human bone morphogenetic protein-2(rhBMP-2) Oblique lumbar interbody fusion(OLIF) Cage subsidence Anterolateral screw fixation Artificial bone graft leakage Gelatin sponge Lumbar degenerative diseases |
