Kể từ cuối những năm 1950, giảm mở và cố định nội bộ đã được ủng hộ để khôi phục lại giải phẫu xương và cho phép huy động đầu. Cách tiếp cận này thường đòi hỏi phải bóc tách rộng và devitalization mô, tạo ra một môi trường thuận lợi cho công đoàn gãy xương và nhiều hơn nữa dễ bị nhiễm trùng xương. | Perspectives on Modern Orthopaedics The Role of Human Bone Morphogenetic Proteins in Spinal Fusion Dan A. Zlotolow MD Alexander R. Vaccaro MD Michael L. Salamon and Todd J. Albert MD Abstract The attainment of a stable arthrodesis is critical to the successful management of some types of spinal disorders. Autologous iliac-crest bone graft has been the most commonly utilized substance associated with predictable healing in spinal fusion applications. Although alternative graft substances exist these have not been shown to be as uniformly effective in achieving spinal fusion. Because of the morbidity associated with bone autograft harvest there is increasing interest in alternative graft substances and especially in the osteoinductive abilities of bone morphogenetic proteins BMPs . Several animal models have demonstrated that BMP-containing allograft or synthetic carrier medium is as effective as or superior to autograft bone in promoting spinal fusion. Furthermore the limited number of human trials utilizing BMPs to treat nonunions in the appendicular skeleton indicate that the results found in animal models will be reproducible in the clinical setting. J Am Acad Orthop Surg 2000 8 3-9 Of the various bone-graft materials available autologous bone graft is the standard for arthrodesis of the spine. The relative superiority of autologous bone grafting is due to its osteoinductive as well as its osteoconductive and osteogenic properties. Autologous bone graft is thought to contain growth factors such as bone morphogenetic proteins BMPs .1 These proteins have been shown to induce bone formation through endochondral mechanisms leading to their possible use in isolated form to achieve spinal fusion and to repair long-bone 3 In 1979 Urist et al4 first showed that proteins with bone morphogenetic properties could be extracted from animal cortical bone by digestion of the demineralized cortical bone matrix with bacterial collagenase and solubilization of the .
