| 聚醚醚酮棒半刚性椎弓根钉内固定在腰椎非融合术中的应用 |
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Received:January 18, 2022
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| 作者 | Author | 单位 | Unit | E-Mail |
| 刘涛 |
LIU Tao |
北京中医药大学, 北京 100029 |
Beijing University of Chinese Medicine, Beijing 100029, China |
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| 俞兴 |
YU Xing |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
yuxing34@sina.com |
| 关健斌 |
GUAN Jian-bin |
北京中医药大学, 北京 100029 |
Beijing University of Chinese Medicine, Beijing 100029, China |
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| 杨永栋 |
YANG Yong-dong |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 赵赫 |
ZHAO He |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 杨济洲 |
YANG Ji-zhou |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 曲弋 |
QU Yi |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 王逢贤 |
WANG Feng-xian |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 赵丁岩 |
ZHAO Ding-yan |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 赵子义 |
ZHAO Zi-yi |
北京中医药大学东直门医院骨科, 北京 100070 |
Department of Orthopaedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China |
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| 期刊信息：《中国骨伤》2024年37卷，第7期，第676-683页 |
| DOI：10.12200/j.issn.1003-0034.20220707 |
| 基金项目:潍坊奥精仿生骨多中心临床研究项目(编号:HX-02M-2018010) |
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目的：探讨聚醚醚酮(polyetheretherketone,PEEK)棒半刚性椎弓根钉内固定系统在腰椎非融合手术中的疗效。
方法：将 2017 年 3 月至 2019 年 12 月接受手术治疗的双节段腰椎退行性疾病 74 例患者按手术方式分为 PEEK棒组和钛棒组。其中 PEEK 棒组 34 例,男 13 例,女 21 例,年龄 51~79(62.4±6.8)岁;L1-L3 节段 1 例,L2-L4 节段 7 例,L3-L5 节段 20 例,L4-S1 节段 6 例。钛棒组 40 例,男 17 例,女 23 例,年龄 52~81(65.2±7.3)岁;L1-L3 节段 3 例,L2-L4 节段 11 例,L3-L5 节段 19 例,L4-S1 节段 7 例。分别记录两组手术时间、术中出血量、术后引流量;比较两组术前及术后 3、12 个月及末次随访时视觉模拟评分(visual analogue scale,VAS)和 Oswestry 功能障碍指数(Oswestry disability index,O-DI);通过腰椎过伸过屈 X 线观察椎间活动度(range-of-motion,ROM)变化情况。
结果：所有患者顺利完成手术,随访时间 22~34(26.8±5.6)个月。PEEK 棒组手术时间(142.2±44.7) min 和术中出血量(166.5±67.4) ml,低于钛棒组的(160.7±57.3) min 和(212.8±85.4) ml(P<0.05),两组术后引流量差异无统计学意义(P>0.05)。末次随访时,PEEK 棒组和钛棒组患者腰痛 VAS[(0.8±0.4)分 vs (1.0±0.5)分]、腿痛 VAS[(0.7±0.4)分 vs (0.8±0.5)分]和 ODI[(9.8±1.6)% vs (12.1±1.5)%],与术前[(5.8±1.1)分 vs (6.0±1.1)分]、[(7.2±1.7)分 vs (7.0±1.6)分]、[(68.5±8.9)% vs (66.3±8.2)%]比较,差异有统计学意义(P<0.05),两组术后各时间点 VAS 评分比较差异无统计学意义(P>0.05)。术后 3 个月,两组 ODI 比较差异无统计学意义 (P>0.05);PEEK 棒组和钛棒组术后 12 个月 ODI[(15.5±2.1)% vs (18.4±2.4)%]及末次随访[(9.8±1.6)% vs (12.1±1.5)%]比较,差异有统计学意义(P<0.05)。两组腰椎整体活动度术后均有下降,术后 12 个月及末次随访时 PEEK 棒组腰椎整体活动度与同时期钛棒组相比,差异有统计学意义(P<0.05)。两组术后固定节段活动度均有下降,PEEK 棒组固定节段活动度由术前(9.5±4.6)°降至末次随访时的(4.1±1.9)°,钛棒组固定节段活动度由术前(9.8±4.3)°降至末次随访时的(0.9±0.5)°,差异均有统计学意义(P<0.05)。两组术后上位椎间活动度均有增加,术后 12 个月及末次随访时,两组上位椎间活动度比较,差异无统计学意义(P>0.05)。随访周期内两组均无螺钉松动断裂。
结论：PEEK 棒半刚性椎弓根钉内固定用于腰椎非融合手术,可保留固定节段部分活动度,近期临床疗效不劣于同期钛棒融合,是治疗腰椎退行性疾病的可行选择,长期疗效有待进一步随访观察。 |
| [关键词]:腰椎退行性疾病 聚醚醚酮棒 非融合 临床疗效 |
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| Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery |
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Abstract:
Objective To investigate the effect of Polyetheretherketone (PEEK) rod semi-rigid pedicle screw fixation system in lumbar spine non-fusion surgery.
Methods A total of 74 patients with tow level lumbar degenerative diseases who underwent surgery from March 2017 to December 2019 were divided into PEEK rod group and titanium rod group. In the PEEK rod group,there were 34 patients,including 13 males and 21 females,aged from 51 to 79 years old with an average of (62.4± 6.8) years old;There were 1 patient of L1-L3 segments,7 patients of L2-L4 segments,20 patients of L3-L5 segments and 6 patients of L4-S1 segments. In the titanium rod group,there were 40 patients,including 17 males and 23 females,aged from 52 to 81 years old with an average of (65.2±7.3) years old;There were 3 patient of L1-L3 segments,11 patients of L2-L4 segments, 19 patients of L3-L5 segments and 7 patients of L4-S1 segments. The general conditions of operation,such as operation time, intraoperative blood loss,postoperative drainage was recorded. The visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI) were compared in preoperatively and postoperatively (3 months,12 months and last follow-up) between two groups. The change of range-of-motion (ROM) was observed by flexion and extension x ray of lumbar
Results All patients successfully completed the operation. The follow-up time ranged from 22 to 34 months with an average of (26.8±5.6) months. The operative time (142.2±44.7) min and intraoperative blood loss (166.5±67.4)ml in PEEK group were lower than those in titanium group[(160.7±57.3) min、(212.8±85.4) ml](P<0.05). There was no significant differences in postoperative drainage between the two groups (P>0.05). At the final follow-up visit,in PEEK group and titanium group VAS of low back pain[(0.8±0.4) points vs (1.0±0.5) points],VAS for leg pain[(0.7±0.4) points vs (0.8±0.5) points] and ODI[(9.8±1.6)% vs (12.1±1.5)%] were compared with preoperative[(5.8±1.1) points vs (6.0±1.1)points],[(7.2±1.7) points vs (7.0±1.6) points],[(68.5±8.9)% vs (66.3±8.2)%] were significantly different (P<0.05). There was no significant difference in VAS scores between the two groups at each postoperative time point (P>0.05). At 3 months after surgery,there was no difference in ODI between the two groups (P>0.05). There were significant differences in ODI between PEEK group and titanium rod group at 12 months[(15.5±2.1)% vs (18.4±2.4)%] and at the last follow-up[(9.8±1.6)% vs (12.1±1.5)%] (P<0.05). The total range-of-motion (ROM) of lumbar decreased in both groups after surgery. At 12 months after surgery and the last follow-up,the PEEK group compared with the titanium rod group,the total range-of-motion of lumbar was statistically significant (P<0.05). The range-of-motion (ROM) of the fixed segments decreased in both groups after surgery. The ROM of the fixed segments in PEEK group decreased from (9.5±4.6)° to (4.1±1.9)° at the last follow-up (P<0.05),which in the titanium rod group was decreased from (9.8±4.3)°to (0.9±0.5)° at the last follow-up (P<0.05). The range-of-motion (ROM) of upper adjacent segment increased in both groups,there was statistical significance in the ROM of upper adjacent segment between the two groups at 12 months after surgery and the last follow-up,(P<0.05). There was no screw loosening and broken rods in both groups during the follow-up period.
Conclusion The PEEK rod semi-rigid pedicle screw internal fixation system used in lumbar non-fusion surgery can retain part of the mobility of the fixed segment,showing comparable short term clinical efficacy to titanium rod fusion. PEEK rod semi-rigid pedicle screw internal fixation system is a feasible choice for the treatment of lumbar spine degenerative diseases,and its long term efficacy needs further follow-up observation. |
| KEYWORDS:Lumbar degenerative disease Polyetheretherketone rods Non fusion Clinical efficacy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘涛,俞兴,关健斌,杨永栋,赵赫,杨济洲,曲弋,王逢贤,赵丁岩,赵子义.聚醚醚酮棒半刚性椎弓根钉内固定在腰椎非融合术中的应用[J].中国骨伤,2024,37(7):676~683 |
| 英文格式: | LIU Tao,YU Xing,GUAN Jian-bin,YANG Yong-dong,ZHAO He,YANG Ji-zhou,QU Yi,WANG Feng-xian,ZHAO Ding-yan,ZHAO Zi-yi.Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(7):676~683 |
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