Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: A prospective randomized controlled trial
Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: A prospective randomized controlled trial
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DOI：
10.1016/j.spinee.2017.07.167
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发表时间：
2019-02-01
期刊：
影响因子：
4.5
通讯作者：
Ohtori, Seiji
中科院分区：
文献类型：
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作者：
Kubota, Go;Kamoda, Hiroto;Ohtori, Seiji
背景：富血小板血浆（PRP）在啮齿类动物脊柱融合术模型中加速骨愈合。然而，PRP对脊柱术后骨愈合的影响尚不清楚。目的：本研究的目的是评估PRP在腰椎后外侧融合（PLF）手术后的疗效。研究设计/设置：单中心前瞻性随机对照临床试验，随访2年。患者样本：患者样本共包括62例患者（PRP组31例，对照组31例）。结果测量：结果测量包括骨融合率、骨融合块面积、骨融合持续时间和使用视觉模拟评分（VAS）的临床评分。材料和方法：我们将62例接受一级或二级固定PLF治疗伴有不稳定性的腰椎退行性颈椎病的患者随机分为PRP组（31例）和对照组（31例）。富血小板血浆治疗的患者使用自体骨芯片（局部骨）进行手术，并在手术前立即从患者血液样本中制备PRP；对照组患者行PLF治疗，不加PRP治疗。我们在术前立即准备的PRP中评估血小板计数和生长因子浓度。术后每3个月用x线平片评估骨愈合时间、术后骨融合率和融合块面积，12或24个月用计算机断层扫描评估。采用VAS评估术前、术后3、6、12、24个月的骨融合时间及腰痛、腿痛、腿麻的临床评分。结果：纳入了50例资料完整的患者。PRP组最终随访时骨愈合率（94%）明显高于对照组（74%）（p= 0.002）。PRP组融合块面积（572 mm(2)）明显高于对照组（367 mm(2)） （p= 0.02）。PRP组平均愈合时间为7.8个月，对照组为9.8个月（p= 0.013）。PRP中血小板计数比血浆高7.7倍，生长因子浓度比血浆高50倍（p < 0.05）。结论：与未接受PRP治疗的患者相比，接受PRP治疗的患者脊柱融合术后的融合率更高，融合质量更大，骨愈合更快。(C) 2017年Elsevier Inc.出版。
BACKGROUND CONTEXT: Platelet-rich plasma (PRP) accelerates bone union in vivo in a rodent model of spinal fusion surgery. However, PRP's effect on bone union after spinal surgery remains unclear.PURPOSE: The objective of this study was to evaluate the efficacy of PRP after posterolateral lumbar fusion (PLF) surgery.STUDY DESIGN/SETTING: Single-center prospective randomized controlled clinical trial with 2-year follow-up.PATIENT SAMPLE: The patient sample included a total 62 patients (31 patients in the PRP group or 31 patients in the control group).OUTCOME MEASURES: The outcome measures included the bone fusion rate, the area of bone fusion mass, the duration of bone fusion, and the clinical score using the visual analog scale (VAS).MATERIALS AND METHODS: We randomized 62 patients who underwent one- or two-level instrumented PLF for lumbar degenerative spondylosis with instability to either the PRP (31 patients) or the control (31 patients) groups. Platelet-rich plasma-treated patients underwent surgery using an autograft bone chip (local bone), and PRP was prepared from patient blood samples immediately before surgery; patients from the control group underwent PLF without PRP treatment. We assessed platelet counts and growth factor concentrations in PRP prepared immediately before surgery. The duration of bone union, the postoperative bone fusion rate, and the area of fusion mass were assessed using plain radiography every 3 months after surgery and by computed tomography at 12 or 24 months. The duration of bone fusion and the clinical scores for low back pain, leg pain, and leg numbness before and 3, 6, 12, and 24 months after surgery were evaluated using VAS.RESULTS: Data from 50 patients with complete data were included. The bone union rate at the final follow-up was significantly higher in the PRP group (94%) than in the control group (74%) (p=.002). The area of fusion mass was significantly higher in the PRP group (572 mm(2) ) than in the control group (367 mm(2) ) (p=.02). The mean period necessary for union was 7.8 months in the PRP group and 9.8 months in the control group (p=.013). In the PRP, the platelet count was 7.7 times higher and the growth factor concentrations were 50 times higher than those found in plasma (p.05).CONCLUSIONS: Patients treated with PRP showed a higher fusion rate, greater fusion mass, and more rapid bone union after spinal fusion surgery than patients not treated with PRP. (C) 2017 Published by Elsevier Inc.