Osteogenic protein versus autologous interbody arthrodesis in the sheep thoracic spine -: A comparative endoscopic study using the Bagby and Kuslich interbody fusion device
Osteogenic protein versus autologous interbody arthrodesis in the sheep thoracic spine -: A comparative endoscopic study using the Bagby and Kuslich interbody fusion device
复制标题
DOI：
10.1097/00007632-199903150-00002
复制
发表时间：
1999-03-15
期刊：
影响因子：
3
通讯作者：
McAfee, PC
中科院分区：
文献类型：
--
作者：
Cunningham, BW;Kanayama, M;McAfee, PC
研究设计。采用体内体间关节融合术模型，评价了重组人成骨蛋白-1 （rhOP-1）填充Bagby and Kuslich （BAK）装置的疗效。比较成骨蛋白与自体移植物在椎体间融合术中的疗效，结合生物力学、组织学和影像学分析，观察融合成功的情况。背景资料摘要。重组人骨形态发生蛋白（rhBMPs）作为骨诱导移植物替代品或扩张剂的使用最近获得了相当大的研究兴趣，特别是在后外关节融合术中的应用。然而，这些结果是否可以推断为成功的椎间融合术仍不确定。12只羊经胸腔镜入路行多节段胸椎减压术。制备3个不连续的失稳位点（T5-T6、T7-T8、T9-T10），随机处理如下。对照组采用非手术、单纯失稳和空BAK治疗。实验组分别采用自体移植物、自体移植物填充的BAK装置或rhOP-1填充的BAK装置。术后4个月，通过生物力学测试、计算机断层扫描、显微x线摄影和组织形态学测量来量化体间融合状态。生物力学分析结果显示，与对照组和实验组相比，5种测试方法中的4种测试方法的节段刚度水平具有统计学意义（P < 0.05）。计算机断层扫描和显微放射照相表征不稳定仅为在六种制剂中产生一种融合；空的BAK，六分之二；仅自体移植，8人中有4人；自体骨移植，5 / 8；与rhOP-1组的BAK， 8人中有6人，所有证据都是由编织的小梁骨跨越融合部位。组织形态学分析显示，实验组与对照组相比，融合部位骨小梁形成明显增多（P < 0.05）。采用rhOP-1实现了与自体融合具有生物力学和组织形态学等效性的椎间融合。BAK/rhOP-1复合体的功能单元稳定性和组织学骨整合证据表明，这种体间关节融合术是替代传统自体髂骨的可行方法，从而避免了对髂骨供体部位的需要和相关的患者发病率。
Study Design. Using an in vivo interbody arthrodesis model, the efficacy of the Bagby and Kuslich (BAK) device packed with recombinant human osteogenic protein-1 (rhOP-1) was evaluated.Objectives. To compare the efficacy of osterogenic protein with that of autograft for interbody arthrodesis, with fusion success based on biomechanical, histologic, and radiographic analyses.Summary of Background Data. The use of recombinant human bone morphogenetic proteins (rhBMPs) as osteoinductive bone graft substitutes or expanders has recently gained considerable research interest, particularly when applied in posterolateral arthrodesis. However, whether these results can be extrapolated to a successful interbody spinal arthrodesis remains uncertain.Methods. Twelve sheep underwent a multilevel thoracic spinal decompression by thoracoscopic approach. Three noncontiguous destabilization sites (T5-T6, T7-T8, T9-T10) were prepared and randomly treated as follows. Control group treatments were nonsurgical, destabilization alone, and empty BAK. Experimental groups were treated with autograft alone, BAK device packed with autograft, or BAK device packed with rhOP-1. Four months after surgery, interbody fusion status was quantified by biomechanical testing, computed tomography, microradiography and histomorphometry.Results. Results of biomechanical analysis showed statistically higher segmental stiffness levels when comparing the control and experimental groups with four of the five testing methods (P < 0.05). Computed tomography and microradiography characterized destabilization alone as producing one fusion in six preparations; the empty BAK, two in six; autograft alone, four in eight; BAK with autograft, five in eight; and BAK with rhOP-1 group, six in eight-all evidence by woven trabecular bone spanning the fusion sites. Histomorphometry yielded significantly more trabecular bone formation at the fusion sites in the three experimental groups than in the two control groups (P , 0.05).Conclusions. Interbody spinal fusions showing biomechanical and histomorphometric equivalency to autologous fusions have been achieved with rhOP-1. The functional unit stability and histologic osteointegration evidence by the BAK/rhOP-1 complex shows this interbody arthrodesis technique to be a viable alternative to-conventional autologous iliac crest, thereby obviating the need for an iliac crest donor site and associated patient morbidity.