Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions
Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions
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DOI：
10.1097/01.brs.0000160846.85397.44
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发表时间：
2005-05-01
期刊：
影响因子：
3
通讯作者：
Puno, RM
中科院分区：
文献类型：
--
作者：
Carreon, LY;Glassman, SD;Puno, RM
研究设计.回顾性队列研究。确定自体髂嵴移植物中加入血小板凝胶对融合的影响。背景资料总结。血小板凝胶是一种通过超浓缩血小板制备的骨诱导材料，含有多种生长因子。专有的商业方法可用于收获自体血小板凝胶浓缩物，用作脊柱融合中的移植物补充剂。方法。我们回顾了76名连续患者，他们接受了混合自体生长因子（AGF）的自体髂嵴骨移植物的后外侧腰椎融合术。对照组从仅行自体骨移植的后外侧腰椎内固定融合术的患者中随机选择。各组在年龄、性别、吸烟史和融合的水平数量方面相匹配。从病历中收集人口统计学、手术和临床数据。骨不连的诊断基于翻修手术中的探查或计算机断层扫描显示的骨不连证据。采用Fisher精确检验比较融合率。在这两组中，平均年龄为50岁，24%是吸烟者。AGF组的骨不连率为25%，对照组为17%。差异无统计学意义（P = 0.18）。血小板凝胶的制备需要从患者身上抽血。这种手术增加了手术的风险和成本。本研究中评价的AGF收获技术提供了市售方法中最高的血小板浓度。尽管如此，我们发现血小板凝胶加入自体移植物中不能提高后外侧脊柱融合术患者的融合率。作者不建议在后外侧脊柱融合术中使用血小板凝胶补充自体植骨。
Study Design. Retrospective cohort study.Objective. To determine the effect on fusion of adding platelet gel to autologous iliac crest graft.Summary of Background Data. Platelet gel is an osteoinductive material prepared by ultra-concentration of platelets and contains multiple growth factors. Proprietary commercial methods are available for harvesting autologous platelet gel concentrates for use as graft supplement in spine fusions.Methods. We reviewed 76 consecutive patients who underwent instrumented posterolateral lumbar fusion with autologous iliac crest bone graft mixed with autologous growth factor (AGF). A control group was randomly selected from patients who underwent instrumented posterolateral lumbar fusion with autologous bone graft alone. The groups were matched for age, sex, smoking history, and number of levels fused. Demographic, surgical, and clinical data were collected from medical records. Diagnosis of nonunion was based on exploration during revision surgery or evidence of nonunion on computerized tomography. The Fisher exact test was used to compare fusion rates.Results. In both groups, mean age was 50 years, and 24% were smokers. The nonunion rate was 25% in the AGF group and 17% in the control group. This difference was not statistically significant ( P = 0.18).Conclusions. Platelet gel preparation requires blood draws from the patient. This procedure adds to the risk and cost of surgery. The technique for AGF harvest evaluated in this study provides the highest concentration of platelets among the commercially available methods. Despite this, we showed that platelet gel failed to enhance fusion rate when added to autograft in patients undergoing instrumented posterolateral spinal fusion. The authors do not recommend the use of platelet gel to supplement autologous bone graft during instrumented posterolateral spinal fusion.