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.	谢学义, 李金生, 吉赵勇, 等. 后路短节段固定结合椎弓根植骨治疗胸腰段骨折. 中华创伤骨科杂志, 2012, 14(4): 357-358.
2.	朱立帆, 曾金才, 朱晓东, 等. 胸腰椎骨折三种不同内固定方式的疗效比较. 中国脊柱脊髓杂志, 2016, 26(10): 893-898.
3.	唐一村, 林本丹, 林慰光, 等. X 线片和 CT 影像对胸腰椎后方韧带复合体损伤的诊断意义. 中国脊柱脊髓杂志, 2016, 26(9): 801-806.
4.	吕游, 张大明, 李瑞, 等. 三种胸腰段骨折分类法的可信度和可重复性研究. 中国脊柱脊髓杂志, 2011, 21(7): 566-568.
5.	印飞, 孙振中, 殷渠东, 等. 伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究. 中国修复重建外科杂志, 2014, 28(2): 227-232.
6.	印飞, 孙振中, 殷渠东, 等. 同种异体骨与硫酸钙伤椎内植入治疗 Denis B 型胸腰椎爆裂骨折疗效观察. 中华全科医师杂志, 2014, 13(6): 478-480.
7.	肖斌, 李健, 蔡厚洪, 等. 跨骨折椎体固定联合单侧伤椎植钉治疗胸腰椎爆裂骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(5): 580-584.
8.	刘中浩, 彭国栋, 林勇, 等. 肌间隙入路并伤椎植骨内固定治疗胸腰椎骨折. 中华创伤杂志, 2013, 29(6): 503-506.
9.	王飞, 何轩, 杨博文. 后路经伤椎椎弓根椎体内植骨治疗腰椎骨折. 中华创伤杂志, 2011, 27(12): 1066-1067.
10.	刘团江, 郝定均, 王晓东, 等. 胸腰段骨折椎弓根钉复位固定术后骨缺损的 CT 研究. 中国矫形外科杂志, 2003, 11(10): 678-679.
11.	印飞, 张绍东, 吴小涛, 等. 短节段椎弓根螺钉复位固定伤椎内植骨治疗 Denis B 型胸腰椎骨折的影像学观察. 中国脊柱脊髓杂志, 2014, 23(4): 341-346.
12.	伍红桦, 施建国, 屈波, 等. 经伤椎椎弓根螺钉加强内固定+植骨治疗胸腰段椎体骨折. 中华创伤杂志, 2013, 29(12): 1190-1194.
13.	刘潮坚, 蔡拉加, 石昭宏, 等. 伤椎置钉与不置钉短节段内固定治疗胸腰椎爆裂骨折的比较. 中国矫形外科杂志, 2016, 24(6): 531-535.
14.	李利, 史亚民, 侯树勋, 等. 经椎弓根椎体内植骨与后外侧植骨治疗胸腰椎爆裂骨折的影像学研究. 中华外科杂志, 2011, 49(2): 140-144.
15.	陈林, 覃建朴, 伍富俊, 等. 微创通道下开窗减压椎体内植骨经皮椎弓根螺钉内固定治疗 Denis B 型胸腰椎爆裂骨折. 中国修复重建外科杂志, 2016, 30(8): 985-991.
16.	梁昌详, 郑晓青, 梁国彦, 等. 胸腰椎爆裂性骨折中椎间盘完整性对手术疗效的影响. 中国脊柱脊髓杂志, 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, 张军, 等. 侧入路微创椎间融合结合后路短节段固定治疗胸腰段骨折的初步临床疗效. 中国脊柱脊髓杂志, 2014, 24(5): 400-406.
19.	郝林, 王涛, 徐海荣, 等. 大段异体骨移植后骨端不愈合的外科治疗. 中华外科杂志, 2009, 47(11): 837-841.

1. 谢学义, 李金生, 吉赵勇, 等. 后路短节段固定结合椎弓根植骨治疗胸腰段骨折. 中华创伤骨科杂志, 2012, 14(4): 357-358.
2. 朱立帆, 曾金才, 朱晓东, 等. 胸腰椎骨折三种不同内固定方式的疗效比较. 中国脊柱脊髓杂志, 2016, 26(10): 893-898.
3. 唐一村, 林本丹, 林慰光, 等. X 线片和 CT 影像对胸腰椎后方韧带复合体损伤的诊断意义. 中国脊柱脊髓杂志, 2016, 26(9): 801-806.
4. 吕游, 张大明, 李瑞, 等. 三种胸腰段骨折分类法的可信度和可重复性研究. 中国脊柱脊髓杂志, 2011, 21(7): 566-568.
5. 印飞, 孙振中, 殷渠东, 等. 伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究. 中国修复重建外科杂志, 2014, 28(2): 227-232.
6. 印飞, 孙振中, 殷渠东, 等. 同种异体骨与硫酸钙伤椎内植入治疗 Denis B 型胸腰椎爆裂骨折疗效观察. 中华全科医师杂志, 2014, 13(6): 478-480.
7. 肖斌, 李健, 蔡厚洪, 等. 跨骨折椎体固定联合单侧伤椎植钉治疗胸腰椎爆裂骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(5): 580-584.
8. 刘中浩, 彭国栋, 林勇, 等. 肌间隙入路并伤椎植骨内固定治疗胸腰椎骨折. 中华创伤杂志, 2013, 29(6): 503-506.
9. 王飞, 何轩, 杨博文. 后路经伤椎椎弓根椎体内植骨治疗腰椎骨折. 中华创伤杂志, 2011, 27(12): 1066-1067.
10. 刘团江, 郝定均, 王晓东, 等. 胸腰段骨折椎弓根钉复位固定术后骨缺损的 CT 研究. 中国矫形外科杂志, 2003, 11(10): 678-679.
11. 印飞, 张绍东, 吴小涛, 等. 短节段椎弓根螺钉复位固定伤椎内植骨治疗 Denis B 型胸腰椎骨折的影像学观察. 中国脊柱脊髓杂志, 2014, 23(4): 341-346.
12. 伍红桦, 施建国, 屈波, 等. 经伤椎椎弓根螺钉加强内固定+植骨治疗胸腰段椎体骨折. 中华创伤杂志, 2013, 29(12): 1190-1194.
13. 刘潮坚, 蔡拉加, 石昭宏, 等. 伤椎置钉与不置钉短节段内固定治疗胸腰椎爆裂骨折的比较. 中国矫形外科杂志, 2016, 24(6): 531-535.
14. 李利, 史亚民, 侯树勋, 等. 经椎弓根椎体内植骨与后外侧植骨治疗胸腰椎爆裂骨折的影像学研究. 中华外科杂志, 2011, 49(2): 140-144.
15. 陈林, 覃建朴, 伍富俊, 等. 微创通道下开窗减压椎体内植骨经皮椎弓根螺钉内固定治疗 Denis B 型胸腰椎爆裂骨折. 中国修复重建外科杂志, 2016, 30(8): 985-991.
16. 梁昌详, 郑晓青, 梁国彦, 等. 胸腰椎爆裂性骨折中椎间盘完整性对手术疗效的影响. 中国脊柱脊髓杂志, 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, 张军, 等. 侧入路微创椎间融合结合后路短节段固定治疗胸腰段骨折的初步临床疗效. 中国脊柱脊髓杂志, 2014, 24(5): 400-406.
19. 郝林, 王涛, 徐海荣, 等. 大段异体骨移植后骨端不愈合的外科治疗. 中华外科杂志, 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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