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  

Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery

作　　者：刘涛[1,3] 俞兴[2] 关健斌[1] 杨永栋 赵赫[2] 杨济洲[2] 曲弋[2] 王逢贤[2] 赵丁岩[2] 赵子义 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(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Orthopaedics,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东直门医院骨科,北京100070 [3]西安交通大学附属红会医院脊柱病医院,陕西西安710054

出　　处：《中国骨伤》2024年第7期676-683,共8页China Journal of Orthopaedics and Traumatology

基　　金：潍坊奥精仿生骨多中心临床研究项目(编号:HX-02M-2018010)。

摘　　要：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,ODI);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±

关 键 词：腰椎退行性疾病 聚醚醚酮棒 非融合 临床疗效 

分 类 号：R681.55[医药卫生—骨科学]