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Spine:脊柱融合术中应用BMP并发症发生率

2013-10-09 佚名 丁香园

本文是Spine杂志近期在线发表的一篇系统评价文章,由美国芝加哥拉什大学医学院的学者Kern Singh等人完成。 【原文下载】 Kern等人经过严格制定研究纳入和排除标准,对Medline等在线数据库的全面系统搜索,共检索和BMP并发症相关系统文献29篇,其中7篇报道颈椎前路融合手术系统并发症,3篇报道颈椎后路融合手术并发症,4片报道腰椎前路融合术(ALIF),9篇报道后路/经椎间孔椎间融合术

本文是Spine杂志近期在线发表的一篇系统评价文章,由美国芝加哥拉什大学医学院的学者Kern Singh等人完成。 【原文下载】

Kern等人经过严格制定研究纳入和排除标准,对Medline等在线数据库的全面系统搜索,共检索和BMP并发症相关系统文献29篇,其中7篇报道颈椎前路融合手术系统并发症,3篇报道颈椎后路融合手术并发症,4片报道腰椎前路融合术(ALIF),9篇报道后路/经椎间孔椎间融合术(PLIF/TLIF),6篇报道后外侧腰椎融合术。

按照系统评价方法论的相关方法,对纳入的文献进行质量评价并进行数据提取和统计学数据合并分析。

颈椎前路:7篇报道颈椎前路手术BMP应用的文献中只有两篇文章为前瞻性对照研究,共记录867例患者,其中BMP组592例,对照组(ICBG)275例。数据统计分析发现,颈椎前路融合术应用BMP最为常见的并发症为颈部软组织水肿导致的术后吞咽困难或呼吸困难。

在接受BMP治疗的ALIF患者中软组织水肿发生率约在20.1%,而对照组的软组织肿胀发生率约在15.6%,两者统计学差异趋向明显的趋势(p=0.07);而少数研究报道了其他相关并发症,如BMP组手术切口感染率为1/281(0.66%),对照组感染率为5/86(5.8%),P=0.003。在BMP组,除手术感染之外的其余切口并发症发生率为5.3%。一个非常重要的指标,BMP组假关节形成率为1.2%,而对照组则为10.0%,组间比较有显著差异(p=0.01)。

颈椎后路:3篇报道后路颈椎融合术的文献,共纳入189例患者,86例BMP,在报道的并发症中比较,没有发现组间有统计学差异。最常见的手术并发症为切口并发症,在两组患者间比较没有统计学差异(p=0.08)。BMP组假关节形成率为10.3%,对照组没有报道该数据。

腰椎前路(ALIF):4篇报道BMP在腰椎前路的应用,其中1篇为前瞻性对照研究。有两篇研究报道了脊柱融合率,使用BMP的假关节形成率为4.0%,其中一篇文章报道对照组假关节形成率为11.0%,较BMP显著增高。其他两篇文章报道了男性逆行性射精的发生率,BMP组显著增高(7.3% VS 2.3%)。

后路/经椎间孔腰椎融合术(PLIF/TLIF):9篇文献报道。其中两篇为前瞻性对照研究,共纳入630例患者,其中457例患者接受BMP治疗。4篇文献报道BMP组骨溶解的总体发生率为15.7%(31/197),而对照组在文献中并未报道该并发症;3篇文章报道了异位骨化发生率,其中BMP组6.5%(9/139),对照组2.3%(1/43),p=0.27。后路最为多见的手术并发症是神经功能损伤,但BMP组和对照组组间比较无显著差异。BMP组在假关节形成率方面要低(6.3% VS 18.2%,p=0.07)。

后外侧融合:6篇文献报道了BMP在腰椎后外侧入路融合中的应用,其中两篇为前瞻性研究。共2762例患者,其中BMP组2220例。两组患者在假关节形成率(BMP 5.9% VS 对照组15.1%)和其他医疗并发症方面(BMP 8.2% VS 21.8%)有显著差异。

总结:文献报道BMP的并发症发生率从0.66%到21.8%不等,BMP组唯一发生率显著增高的并发症事件是前路手术时的男性患者逆行性射精(7.3%),总体而言BMP目前的手术并发症发生率仍处于较低水平。但研究受限与纳入研究的质量问题,仍需要进一步对相关问题进行系统的评价和研究。

原文检索

Singh K, Ahmadinia K, Park D, Nandyala SV, Marquez-Lara A, Patel AA, Fineberg SJ.Complications of Spinal Fusion With Utilization of Bone Morphogenetic Protein: A Systematic Review of the Literature.Spine (Phila Pa 1976). 2013 Sep 10.【原文下载】

 

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    2014-07-18 mgqwxj
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    2013-10-19 HNYYM
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    2013-12-17 丁鹏鹏
  5. [GetPortalCommentsPageByObjectIdResponse(id=1699267, encodeId=68c2169926eb5, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Fri Jul 18 02:46:00 CST 2014, time=2014-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633996, encodeId=73db16339967f, content=<a href='/topic/show?id=596635e549' target=_blank style='color:#2F92EE;'>#BMP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3575, encryptionId=596635e549, topicName=BMP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d95322064897, createdName=HNYYM, createdTime=Sat Oct 19 03:46:00 CST 2013, time=2013-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826236, encodeId=30f218262364d, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Wed Mar 05 10:46:00 CST 2014, time=2014-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757582, encodeId=ac761e575820b, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Tue Dec 17 06:46:00 CST 2013, time=2013-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525377, encodeId=2cfa15253e7eb, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Fri Oct 11 02:46:00 CST 2013, time=2013-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546176, encodeId=c95015461e650, content=<a href='/topic/show?id=807a8886416' target=_blank style='color:#2F92EE;'>#融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88864, encryptionId=807a8886416, topicName=融合术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e99213890117, createdName=12498cb5m17暂无昵称, createdTime=Fri Oct 11 02:46:00 CST 2013, time=2013-10-11, status=1, ipAttribution=)]
    2013-10-11 licz0427
  6. [GetPortalCommentsPageByObjectIdResponse(id=1699267, encodeId=68c2169926eb5, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Fri Jul 18 02:46:00 CST 2014, time=2014-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633996, encodeId=73db16339967f, content=<a href='/topic/show?id=596635e549' target=_blank style='color:#2F92EE;'>#BMP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3575, encryptionId=596635e549, topicName=BMP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d95322064897, createdName=HNYYM, createdTime=Sat Oct 19 03:46:00 CST 2013, time=2013-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826236, encodeId=30f218262364d, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Wed Mar 05 10:46:00 CST 2014, time=2014-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757582, encodeId=ac761e575820b, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Tue Dec 17 06:46:00 CST 2013, time=2013-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525377, encodeId=2cfa15253e7eb, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Fri Oct 11 02:46:00 CST 2013, time=2013-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546176, encodeId=c95015461e650, content=<a href='/topic/show?id=807a8886416' target=_blank style='color:#2F92EE;'>#融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88864, encryptionId=807a8886416, topicName=融合术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e99213890117, createdName=12498cb5m17暂无昵称, createdTime=Fri Oct 11 02:46:00 CST 2013, time=2013-10-11, status=1, ipAttribution=)]

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