Treatment of thoracolumbar burst fractures with short-segment pedicle instrumentation and recombinant human bone morphogenetic protein 2 and allogeneic bone grafting in injured vertebra_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YIN Fei ,  SUN Zhenzhong , YIN Qudong , SONG Sheng , GU Sanjun , RUI Yongjun

Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University, the Ninth People’s Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China;

Corresponding?author：

SUN Zhenzhong, Email: szzwuxi@163.com

Keywords：

Thoracolumbar burst fracture; allogeneic bone; recombinant human bone morphogenetic protein 2; bone grafting

DOI：

10.7507/1002-1892.201703065

Video：

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Objective To investigate the effect of preventing the loss of correction and vertebral defects after thoracolumbar burst fractures treated with recombinant human bone morphogenetic protein 2 (rhBMP-2) and allogeneic bone grafting in injured vertebra uniting short-segment pedicle instrumentation. Methods A prospective randomized controlled study was performed in 48 patients with thoracolumbar fracture who were assigned into 2 groups between June 2013 and June 2015. Control group (n=24) received treatment with short-segment pedicle screw instrumentation with allogeneic bone implanting in injured vertebra; intervention group (n=24) received treatment with short-segment pedicle screw instrumentation combining with rhBMP-2 and allogeneic bone grafting in injured vertebra. There was no significant difference in gender, age, injury cause, affected segment, vertebral compression degree, the thoracolumbar injury severity score (TLICS), Frankel grading for neurological symptoms, Cobb angle, compression rate of anterior verterbral height between 2 groups before operation (P>0.05). The Cobb angle, compression rate of anterior vertebral height, intervertebral height changes, and defects in injured vertebra at last follow-up were compared between 2 groups. Results All the patients were followed up 21-45 months (mean, 31.3 months). Bone healing was achieved in 2 groups, and there was no significant difference in healing time of fracture between intervention group [(7.6±0.8) months] and control group [(7.5±0.8) months] (t=0.336, P=0.740). The Frankel grading of all patients were reached grade E at last follow-up. The Cobb angle and compression rate of anterior verterbral height at 1 week after operation and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference in Cobb angle and compression rate of anterior verterbral height between 2 groups at 1 week after operation (P>0.05), but the above indexes in intervention group were better than those in control group at last follow-up (P<0.05). At last follow-up, there was no significant difference of intervertebral height changes of internal fixation adjacent upper position, injured vertebra adjacent upper position, injured vertebra adjacent lower position, and internal fixation adjacent lower position between 2 groups (P>0.05). Defects in injured vertebra happened in 18 cases (75.0%) in control group and 5 cases (20.8%) in intervention group, showing significant difference (χ²=14.108, P=0.000); and in patients with defects in injured vertebra, bone defect degree was 7.50%±3.61% in control group, and was 2.70%±0.66% in intervention group, showing significant difference (t=6.026, P=0.000). Conclusion Treating thoracolumbar fractures with short-segment pedicle screw instrumentation with rhBMP-2 and allogeneic bone grafting in injured vertebra can prevent the loss of correction and vertebral defects.

Citation： YIN Fei, SUN Zhenzhong, YIN Qudong, SONG Sheng, GU Sanjun, RUI Yongjun. Treatment of thoracolumbar burst fractures with short-segment pedicle instrumentation and recombinant human bone morphogenetic protein 2 and allogeneic bone grafting in injured vertebra. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1080-1085. doi: 10.7507/1002-1892.201703065 Copy

1.	謝學義, 李金生, 吉趙勇, 等. 后路短節段固定結合椎弓根植骨治療胸腰段骨折. 中華創傷骨科雜志, 2012, 14(4): 357-358.
2.	朱立帆, 曾金才, 朱曉東, 等. 胸腰椎骨折三種不同內固定方式的療效比較. 中國脊柱脊髓雜志, 2016, 26(10): 893-898.
3.	唐一村, 林本丹, 林慰光, 等. X 線片和 CT 影像對胸腰椎后方韌帶復合體損傷的診斷意義. 中國脊柱脊髓雜志, 2016, 26(9): 801-806.
4.	呂游, 張大明, 李瑞, 等. 三種胸腰段骨折分類法的可信度和可重復性研究. 中國脊柱脊髓雜志, 2011, 21(7): 566-568.
5.	印飛, 孫振中, 殷渠東, 等. 傷椎植骨植釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究. 中國修復重建外科雜志, 2014, 28(2): 227-232.
6.	印飛, 孫振中, 殷渠東, 等. 同種異體骨與硫酸鈣傷椎內植入治療 Denis B 型胸腰椎爆裂骨折療效觀察. 中華全科醫師雜志, 2014, 13(6): 478-480.
7.	肖斌, 李健, 蔡厚洪, 等. 跨骨折椎體固定聯合單側傷椎植釘治療胸腰椎爆裂骨折的生物力學研究. 中國修復重建外科雜志, 2016, 30(5): 580-584.
8.	劉中浩, 彭國棟, 林勇, 等. 肌間隙入路并傷椎植骨內固定治療胸腰椎骨折. 中華創傷雜志, 2013, 29(6): 503-506.
9.	王飛, 何軒, 楊博文. 后路經傷椎椎弓根椎體內植骨治療腰椎骨折. 中華創傷雜志, 2011, 27(12): 1066-1067.
10.	劉團江, 郝定均, 王曉東, 等. 胸腰段骨折椎弓根釘復位固定術后骨缺損的 CT 研究. 中國矯形外科雜志, 2003, 11(10): 678-679.
11.	印飛, 張紹東, 吳小濤, 等. 短節段椎弓根螺釘復位固定傷椎內植骨治療 Denis B 型胸腰椎骨折的影像學觀察. 中國脊柱脊髓雜志, 2014, 23(4): 341-346.
12.	伍紅樺, 施建國, 屈波, 等. 經傷椎椎弓根螺釘加強內固定+植骨治療胸腰段椎體骨折. 中華創傷雜志, 2013, 29(12): 1190-1194.
13.	劉潮堅, 蔡拉加, 石昭宏, 等. 傷椎置釘與不置釘短節段內固定治療胸腰椎爆裂骨折的比較. 中國矯形外科雜志, 2016, 24(6): 531-535.
14.	李利, 史亞民, 侯樹勛, 等. 經椎弓根椎體內植骨與后外側植骨治療胸腰椎爆裂骨折的影像學研究. 中華外科雜志, 2011, 49(2): 140-144.
15.	陳林, 覃建樸, 伍富俊, 等. 微創通道下開窗減壓椎體內植骨經皮椎弓根螺釘內固定治療 Denis B 型胸腰椎爆裂骨折. 中國修復重建外科雜志, 2016, 30(8): 985-991.
16.	梁昌詳, 鄭曉青, 梁國彥, 等. 胸腰椎爆裂性骨折中椎間盤完整性對手術療效的影響. 中國脊柱脊髓雜志, 2016, 26(6): 502-509.
17.	Wang Y, Ho CC, Bang E, et al. Bone morphogenetic protein 2 stimulates noncanonical SMAD2/3 signaling via the BMP type 1A receptor in gonadotrope-like cells: implications for FSH synthesis. Endocrinology, 2014, 155(5): 1970-1981.
18.	李想, 洪毅, 張軍, 等. 側入路微創椎間融合結合后路短節段固定治療胸腰段骨折的初步臨床療效. 中國脊柱脊髓雜志, 2014, 24(5): 400-406.
19.	郝林, 王濤, 徐海榮, 等. 大段異體骨移植后骨端不愈合的外科治療. 中華外科雜志, 2009, 47(11): 837-841.

1. 謝學義, 李金生, 吉趙勇, 等. 后路短節段固定結合椎弓根植骨治療胸腰段骨折. 中華創傷骨科雜志, 2012, 14(4): 357-358.
2. 朱立帆, 曾金才, 朱曉東, 等. 胸腰椎骨折三種不同內固定方式的療效比較. 中國脊柱脊髓雜志, 2016, 26(10): 893-898.
3. 唐一村, 林本丹, 林慰光, 等. X 線片和 CT 影像對胸腰椎后方韌帶復合體損傷的診斷意義. 中國脊柱脊髓雜志, 2016, 26(9): 801-806.
4. 呂游, 張大明, 李瑞, 等. 三種胸腰段骨折分類法的可信度和可重復性研究. 中國脊柱脊髓雜志, 2011, 21(7): 566-568.
5. 印飛, 孫振中, 殷渠東, 等. 傷椎植骨植釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究. 中國修復重建外科雜志, 2014, 28(2): 227-232.
6. 印飛, 孫振中, 殷渠東, 等. 同種異體骨與硫酸鈣傷椎內植入治療 Denis B 型胸腰椎爆裂骨折療效觀察. 中華全科醫師雜志, 2014, 13(6): 478-480.
7. 肖斌, 李健, 蔡厚洪, 等. 跨骨折椎體固定聯合單側傷椎植釘治療胸腰椎爆裂骨折的生物力學研究. 中國修復重建外科雜志, 2016, 30(5): 580-584.
8. 劉中浩, 彭國棟, 林勇, 等. 肌間隙入路并傷椎植骨內固定治療胸腰椎骨折. 中華創傷雜志, 2013, 29(6): 503-506.
9. 王飛, 何軒, 楊博文. 后路經傷椎椎弓根椎體內植骨治療腰椎骨折. 中華創傷雜志, 2011, 27(12): 1066-1067.
10. 劉團江, 郝定均, 王曉東, 等. 胸腰段骨折椎弓根釘復位固定術后骨缺損的 CT 研究. 中國矯形外科雜志, 2003, 11(10): 678-679.
11. 印飛, 張紹東, 吳小濤, 等. 短節段椎弓根螺釘復位固定傷椎內植骨治療 Denis B 型胸腰椎骨折的影像學觀察. 中國脊柱脊髓雜志, 2014, 23(4): 341-346.
12. 伍紅樺, 施建國, 屈波, 等. 經傷椎椎弓根螺釘加強內固定+植骨治療胸腰段椎體骨折. 中華創傷雜志, 2013, 29(12): 1190-1194.
13. 劉潮堅, 蔡拉加, 石昭宏, 等. 傷椎置釘與不置釘短節段內固定治療胸腰椎爆裂骨折的比較. 中國矯形外科雜志, 2016, 24(6): 531-535.
14. 李利, 史亞民, 侯樹勛, 等. 經椎弓根椎體內植骨與后外側植骨治療胸腰椎爆裂骨折的影像學研究. 中華外科雜志, 2011, 49(2): 140-144.
15. 陳林, 覃建樸, 伍富俊, 等. 微創通道下開窗減壓椎體內植骨經皮椎弓根螺釘內固定治療 Denis B 型胸腰椎爆裂骨折. 中國修復重建外科雜志, 2016, 30(8): 985-991.
16. 梁昌詳, 鄭曉青, 梁國彥, 等. 胸腰椎爆裂性骨折中椎間盤完整性對手術療效的影響. 中國脊柱脊髓雜志, 2016, 26(6): 502-509.
17. Wang Y, Ho CC, Bang E, et al. Bone morphogenetic protein 2 stimulates noncanonical SMAD2/3 signaling via the BMP type 1A receptor in gonadotrope-like cells: implications for FSH synthesis. Endocrinology, 2014, 155(5): 1970-1981.
18. 李想, 洪毅, 張軍, 等. 側入路微創椎間融合結合后路短節段固定治療胸腰段骨折的初步臨床療效. 中國脊柱脊髓雜志, 2014, 24(5): 400-406.
19. 郝林, 王濤, 徐海榮, 等. 大段異體骨移植后骨端不愈合的外科治療. 中華外科雜志, 2009, 47(11): 837-841.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of thoracolumbar burst fractures with short-segment pedicle instrumentation and recombinant human bone morphogenetic protein 2 and allogeneic bone grafting in injured vertebra

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