rhBMP-2在脊柱化脓性感染手术治疗中的临床结果、安全性和成本考虑:重点综述。

IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY
European Spine Journal Pub Date : 2025-10-01 Epub Date: 2025-06-12 DOI:10.1007/s00586-025-08993-9
Hassan Mahfouz, Hamza Mahfouz, Humaid Al Farii
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引用次数: 0

摘要

背景:化脓性脊柱炎和椎体骨髓炎仍然是具有挑战性的临床实体,特别是当需要手术干预时。虽然重组人骨形态发生蛋白-2 (rhBMP-2)在退行性脊柱融合中得到了很好的证实,但它在活动性或先前治疗过的脊柱感染中的作用仍然存在争议。本综述评估了rhBMP-2在化脓性椎间盘炎和椎体骨髓炎手术治疗中的临床结果、安全性和成本考虑。方法:对文献进行了重点回顾,以确定在化脓性脊柱炎和椎体骨髓炎脊柱融合术患者中使用rhBMP-2的研究报告。数据包括患者人口统计学、rhBMP-2剂量、融合率、并发症概况、感染复发、神经预后和成本相关指标。结果:纳入了6项回顾性研究,包括346例接受rhBMP-2治疗的患者。融合率从95%到100%不等,在所有报道的研究中,加权平均值为97.84%。感染复发率很低,为1.54%,没有研究将再感染归因于使用rhBMP-2。并发症发生率平均为18.49%,仅有1例短暂性rhBMP-2相关事件(神经根炎)报道。68.0%的患者神经系统改善。成本数据虽然有限,但表明rhBMP-2治疗患者的长期医疗保健利用率降低,可能抵消初始植入成本。结论:根据目前可获得的回顾性数据,rhBMP-2似乎是化脓性脊柱炎和椎体骨髓炎手术治疗中潜在安全的辅助药物。当有选择地使用时,它具有高融合率和可接受的安全性。这些发现支持前瞻性对照试验的需要,以进一步确定其在化脓性脊柱炎和椎体骨髓炎手术治疗中的最佳作用、剂量策略和成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical outcomes, safety, and cost considerations of rhBMP-2 in the surgical management of pyogenic spinal infections: a focused review.

Background: Pyogenic spondylodiscitis and vertebral osteomyelitis remain challenging clinical entities, particularly when surgical intervention is required. While recombinant human bone morphogenetic protein-2 (rhBMP-2) is well established in degenerative spinal fusion, its role in the context of active or previously treated spinal infection remains controversial. This focused review evaluates the clinical outcomes, safety profile, and cost considerations of rhBMP-2 in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis.

Methods: A focused literature review was conducted to identify studies reporting on the use of rhBMP-2 in patients undergoing spinal fusion for pyogenic spondylodiscitis and vertebral osteomyelitis. Data were extracted on patient demographics, rhBMP-2 dose, fusion rates, complication profiles, infection recurrence, neurological outcomes, and cost-related metrics.

Results: Six retrospective studies encompassing 346 patients treated with rhBMP-2 were included. Fusion rates ranged from 95 to 100%, with a weighted average of 97.84% across reported studies. Infection recurrence was low at 1.54%, and no study attributed reinfection to rhBMP-2 use. The complication rate averaged 18.49%, with only one transient rhBMP-2 related event (radiculitis) reported. Neurological improvement was observed in 68.0% of patients. Cost data, though limited, suggest reduced long-term healthcare utilisation in rhBMP-2 treated patients, potentially offsetting initial implant costs.

Conclusion: Based on currently available retrospective data, rhBMP-2 appears to be a potentially safe adjunct in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis. When used selectively, it has been associated with high fusion rates and an acceptable safety profile. These findings support the need for prospective, controlled trials to further define its optimal role, dosing strategies, and cost-effectiveness in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis.

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来源期刊
European Spine Journal
European Spine Journal 医学-临床神经学
CiteScore
4.80
自引率
10.70%
发文量
373
审稿时长
2-4 weeks
期刊介绍: "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe
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