聚醚醚酮棒脊柱动态内固定系统在腰椎退行性疾病中的临床对比研究

doi:10.3877/cma.j.issn.1674-0785.2019.11.011

目的

对比研究聚醚醚酮（PEEK）棒脊柱动态内固定系统与传统刚性内固定在治疗腰椎退行性病变中的临床疗效。

方法

回顾性分析2014年6月至2017年6月47例腰椎退行性病变患者的临床资料。根据内固定材料的不同，将47例患者分为PEEK棒组（21例）和钛棒组（26例）。比较两组病例的手术时间、术中出血量、住院时间、下床活动时间、手术并发症及Oswestry功能障碍指数（ODI）评分、疼痛视觉模拟评分（VAS）等的差异。

结果

患者术后获得18~36个月［（24.4±6.5）个月］随访。PEEK棒组与钛棒组在手术时间、术中出血量、下床活动时间、住院时间差异无统计学意义（P>0.05）。术后1、3个月ODI评分、VAS差异无统计学意义（P>0.05），但末次随访ODI评分、VAS评分PEEK棒组优于钛棒组，差异具有统计学意义［ODI评分：（14.3±2.4）分vs（21.8±5.2）分，t=2.45，P<0.05；VAS评分：（6.32±0.81）分vs （5.15±1.02）分，t=3.43，P=0.021］。并发症方面，PEEK棒组随访期间未出现邻近节段退变，钛棒组出现2例患者3个节段退变，伴有轻度坐骨神经痛症状，予以保守治疗，部分缓解。2组患者在随访期间均无内固定断裂、松动发生。

结论

PEEK棒动态内固定系统治疗腰椎退行性病变可获得较好的临床疗效，并发症少。

关键词: 腰椎退行性病变, 聚醚醚酮棒, 半刚性, 动态固定, 脊柱融合术

Objective

To compare the clinical effects between the polyetheretherketone (PEEK) rod-based dynamic internal fixation system and traditional rigid internal fixation in the treatment of lumbar degenerative disease.

Methods

From June 2014 to June 2017, a retrospective analysis was performed on 47 patients with lumbar degenerative disease. According to the internal fixation materials used, the patients was divided into either a PEEK rod-based internal fixation group (21 cases) or titanium rod-based rigid internal fixation group (26 cases). The operation time, intraoperative blood loss, surgical complications, time to ambulation, and hospitalization time were compared between the two groups. The Oswestry Disability Index (ODI) score and Visual Analogue Scale (VAS) score were also compared.

Results

The patients were followed for 18 to 36 months, with a mean follow-up period of (24.4±6.5) months. There was no significant difference between the two groups in operation time, intraoperative blood loss, hospital stay, or time to ambulation (P>0.05). There was also no significant difference in ODI score or VAS score at 1 and 3 months after operation, although the scores were significantly better in the PEEK rod-based internal fixation group than in the titanium rod-based rigid internal fixation group at the last follow-up (ODI: 14.3±2.4 vs 21.8±5.2, t=2.45, P<0.05; VAS: 6.32±0.81 vs 5.15±1.02, t=3.43, P=0.021). In terms of complications, there was no degeneration of adjacent segments during the follow-up period in the PEEK rod group, while two patients in the titanium rod fixation group had degeneration of three segments accompanied by sciatica symptoms, which were conservatively treated and partially relieved. There were no internal fixation fractures or loosening during the follow-up period.

Conclusion

In the treatment of lumbar degenerative diseases, PEEK rod-based dynamic internal fixation system can obtain better long-term clinical efficacy and less complications than the traditional internal fixation system.

Key words: Lumbar degenerative disease, PEEK rod, Semi-rigid, Dynamic fixation, Spinal fusion

图1 患者女性，57岁，L_4~5椎间盘突出并椎管狭窄，行椎板切除减压，PEEK棒内固定

图2 患者男性，62岁，L_4~5，L₅~S₁椎间盘突出并椎管狭窄，行椎板切除减压，PEEK棒内固定

表1 PEEK棒组与钛棒组围手术期指标比较（±s）

分组	例数	手术时间（min）	术中出血量（ml）	住院时间（d）	下床活动时间（d）
PEEK棒组	21	141±17	542±45	8.20±1.91	4.72±0.81
钛棒组	26	136±14	510±57	8.54±1.62	5.05±1.02
t值	?	0.402	0.751	0.189	0.433
P值	?	0.713	0.675	0.812	0.727

表1 PEEK棒组与钛棒组围手术期指标比较（±s）

分组	例数	手术时间（min）	术中出血量（ml）	住院时间（d）	下床活动时间（d）
PEEK棒组	21	141±17	542±45	8.20±1.91	4.72±0.81
钛棒组	26	136±14	510±57	8.54±1.62	5.05±1.02
t值	?	0.402	0.751	0.189	0.433
P值	?	0.713	0.675	0.812	0.727

表2 2组患者术前、术后及末次随访ODI、VAS评分比较（±s）

组别	例数	VAS评分
组别	例数	术前	术后1个月	术后3个月	末次随访
PEEK棒组	21	2.32±0.31	5.32±0.81	5.79±1.11	6.32±0.81
钛棒固定组	26	2.15±0.42	5.05±1.02	5.17±0.92	5.15±1.02
t值	?	0.202	0.351	0.289	3.43
P值	?	0.813	0.675	0.712	0.021
组别	例数	ODI评分
组别	例数	术前	术后1个月	术后3个月	末次随访
PEEK棒组	21	69.5±11..4	27.2±6.3	21.7±7.1	14.3±2.4
钛棒固定组	26	70.9±9.7	29.1±8.4	23.2±5.8	21.8±5.2
t值	?	1.21	1.82	1.74	2.45
P值	?	0.50	0.10	0.10	0.025

表2 2组患者术前、术后及末次随访ODI、VAS评分比较（±s）

组别	例数	VAS评分
组别	例数	术前	术后1个月	术后3个月	末次随访
PEEK棒组	21	2.32±0.31	5.32±0.81	5.79±1.11	6.32±0.81
钛棒固定组	26	2.15±0.42	5.05±1.02	5.17±0.92	5.15±1.02
t值	?	0.202	0.351	0.289	3.43
P值	?	0.813	0.675	0.712	0.021
组别	例数	ODI评分
组别	例数	术前	术后1个月	术后3个月	末次随访
PEEK棒组	21	69.5±11..4	27.2±6.3	21.7±7.1	14.3±2.4
钛棒固定组	26	70.9±9.7	29.1±8.4	23.2±5.8	21.8±5.2
t值	?	1.21	1.82	1.74	2.45
P值	?	0.50	0.10	0.10	0.025

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Therapeutic effects of polyetheretherketone rod-based dynamic spine internal fixation system versus traditional rigid internal fixation on lumbar degenerative diseases

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Therapeutic effects of polyetheretherketone rod-based dynamic spine internal fixation system versus traditional rigid internal fixation on lumbar degenerative diseases