Experimental Spinal Fusion With Recombinant Human Bone Morphogenetic Protein-2 Without Decortication of Osseous Elements
Experimental Spinal Fusion With Recombinant Human Bone Morphogenetic Protein-2 Without Decortication of Osseous Elements
复制标题
重组人骨形态发生蛋白 2 不去骨元件的实验性脊柱融合
作者：
H. Sandhu;L. Kanim;J. Toth;J. Kabo;David Liu;R. Delamarter;E. Dawson
研究设计.用58 μg、230 μg或920 μg重组人骨形态发生蛋白-2在20只狗中产生L4-L5横突间融合。11例患者在植入植入物前进行了传统的后部结构去皮质术。9人未被剥皮。术后3个月对所有动物进行评价。目标.确定在骨诱导蛋白（如骨形态发生蛋白-2）存在下，去皮质是否是成功融合的先决条件。背景数据总结。重组骨诱导蛋白可以在没有骨髓成分的情况下在异位软组织部位重新诱导成骨。实现脊柱融合的传统方法依赖于通过去皮质术暴露骨髓以促进成骨。假设植入的骨诱导蛋白的存在消除了暴露和释放宿主诱导因子的需要。方法.重组人骨形态发生蛋白-2诱导的横突间融合分别在皮质剥除和不剥除的情况下进行。通过计算机断层扫描成像、高分辨率X线摄影、手动测试、机械测试和组织学分析对融合部位进行评价。结果100%的去皮质脊柱和89%的未去皮质脊柱在3个月时临床融合。91%的去皮质标本和78%的未去皮质标本显示双侧横突骨性桥接。唯一未能实现牢固双侧关节融合的脊柱位于最低剂量组。在较高的两个剂量下，在融合块和未去皮质的横突之间存在骨连续性的组织学证据。结论.去皮质和未去皮质部位的临床和影像学融合率无统计学差异。使用更高剂量的重组人骨形态发生蛋白-2，去皮质与未去皮质脊柱融合之间几乎没有组织学差异。
Study Design. L4-L5 intertransverse process fusions were produced with 58 μg, 230 μg, or 920 μg of recombinant human bone morphogenetic protein-2 in 20 dogs. Eleven had traditional decortication of posterior elements before insertion of the implant. Nine were left undecorticated. All animals were evaluated 3 months after surgery. Objectives. To determine whether decortication is a prerequisite for successful fusion in the presence of osteoinductive proteins such as bone morphogenetic protein-2. Summary of Background Data. Recombinant osteoinductive proteins can induce de novo bone in ectopic soft-tissue sites in the absence of bone marrow elements. Traditional methods for achieving spinal fusion rely on exposure of bone marrow through decortication to facilitate osteogenesis. It is hypothesized that the presence of an implanted osteoinductive protein obviates the need for exposure and release of host inductive factors. Methods. Recombinant human bone morphogenetic protein-2-induced intertransverse process fusions were performed with and without decortication. Fusion sites were evaluated by computed tomography imaging, high-resolution radiography, manual testing, mechanical testing, and histologic analysis. Results. One hundred percent of decorticated spines and 89% of undecorticated spines were clinically fused by 3 months. Ninety-one percent of decorticated spines and 78% of undecorticated specimens exhibited bilateral transverse process osseous bridging. The only spines that failed to achieve solid bilateral arthrodesis were in the lowest dose group. With the higher two doses, there was histologic evidence of osseous continuity between the fusion mass and undecorticated transverse processes. Conclusions. There were no statistical differences in clinical and radiographic fusion rates between decorticated and undecorticated sites. With higher doses of recombinant human bone morphogenetic protein-2, there was little histologic distinction between fusions in decorticated versus undecorticated spines.