摘要
目的探讨聚醚醚酮（polyetheretherketone，PEEK）棒椎弓根螺钉内固定系统在下腰椎退行性疾病治疗中的价值。方法2012年9月至2013年3月应用PEEK棒椎弓根螺钉内固定系统治疗腰椎退行性疾病患者63例，男23例，女40例；年龄35~75岁，平均（56．2±5．1）岁。按手术方式分为融合组10例，L3-4 2例、L4-5 5例、L5S1 3例；非融合组17例，L3,4 4例、L4.5 10例、L5S1 3例；混合手术组36例，L4.5融合＋L3.4非融合22例、L3．4融合＋L4.5非融合2例、L5S1融合＋L4.5非融合12例。以术后3、6、24个月日本骨科学会（JapaneseOrthopedicAssociation，JOA）评分和Oswestry功能障碍指数（Oswestrydisfunc．tionindex，ODI）评价疗效。测量术后3、6、24个月侧位x线片上手术节段椎间高度指数，过伸过屈位x线片上手术节段椎间活动度。术后2年行CT扫描及三维重建评价有无内固定断裂及松动。结果63例患者随访18~30个月，平均（23．4±3．3）个月。融合组手术时间（110±17）min，术中失血（270±85）ml；非融合组手术时间（98±22）min，术中失血（255±72）ml；混合手术组手术时间（121＋25）min，术中失血（316±80）ml。融合组JOA评分由术前（10．5±2．6）分提高至末次随访的（24．0±3．1）分，非融合组由（10．3±2．2）分提高至（24．3±3．4）分，混合手术组由（11．1±2．3）分提高至（23．9±3．3）分（P〈0．05）。融合组ODI由术前51．8％±10．3％降至末次随访的14．1％±3．7％，非融合组由52．2％±11．1％降至13．2％±3．2％，混合手术组由53．4％±9．2％降至13．8％±2．5％（P〈0．05）。术后3、6个月及末次随访时融合组、非融合组、混合手术组非融合节段及融合节段的椎间高度指数与术前比较差异均无统计学意义。非融合节段椎间活动度由术前8．8°±1．8°减小至末次随访的2．2°±0．3°（P〈0．05）。1例出现椎间融合器向背侧滑脱移位，无螺钉松动断裂及PEEK棒断裂。结论对腰椎退行性疾病采用PEEK棒椎弓根螺钉内固定系统行融合、非融合及混合术式均可取得较为满意的疗效，钉棒系统松动、断裂的发生率较低。
Objective To explore the reliability and validity of poly ether ether ketone （PEEK） rods and pedicle screw system for lumbar degenerative diseases. Methods Sixty-three patients, including 23 men and 40 women with the mean age of 56.2°5.1 years （range,35-75 years）, treated by PEEK rods pedicle screw system from September 2012 to March 2013 were retrospectively recruited. Fusion procedure were performed in 10 patients, with 2 cases at L3,4, 5 cases at L.5, 3 cases at L5S1; non- fusion procedure were performed in 17 patients, with 4 cases at L3, 4, 10 cases at L, 5, 3 cases at L5S1; hybrid procedure were per- formed in 36 patients, with 22 case fusion at L4,5 and nonfusion at L.4, with 2 cases fusion at L3,4 and nonfusion at L4,5, with 12 cas- es fusion at LsS, and nonfusion at L4. 5. Clinical effects were evaluated via Japanese Orthopedics Association （JOA） score and Os- westry disfunction index （ODI） at 3 months, 6 months and 24 months postoperatively. Disc heights were measured by disc height index on lateral lumbar radiograph. Range of motion （ROM） was measured by extension-flexion lumbar X-ray. Three-dimensional CT reconstruction was achieved to observe the integrity of PEEK rods at the final follow-up. Results The mean follow-up were 23.4±3.3 months. The mean operation time were 110±17 min in the fusion group, 98±22 min in the non-fusion group and 121± 25 min in the hybrid group. The mean blood loss were 270±85 ml in the fusion group, 255±72 ml in the non-fusion group and 316±80 ml in the hybrid group. The JOA score improved from 10.5±2.6 preoperatively to 24.0±3.1 at the final follow-up in the fusion group, from 10.3±2.2 to 24.3±3.4 in the non-fusion group and from 11.1±2.3 to 23.9±3.3 in the hybrid group （P〈0.05）. The ODI decreased from 51.8%±10.3% preoperatively to 14.1%±3.7% at the final follow-up in the fusion group, from 52.2%±11.1% to 13.2%±3.2% in the non-fusion group and from 53.4%±9.2% to 13.8%±2.5% in the hybrid group. There was no sig- nificantly statistical difference in the dise height index at 3 months, 6 months and 24 months postoperatively compared with that at preoperative. The ROM decreased from 8.8°±1.8° preoperatively to 2.2°±0.3° at the final follow-up （P〈0.05）. One ease demonstrated cage migration at one month follow-up, bony fusion in situ at 3 months follow-up, and the patient had no related symptoms during the follow-up. No screw loosening or breakage and rods breakage was observed during the follow-up. Conclu- sion PEEK rods and pediele serew system for lumbar degenerative diseases by fusion, non- fusion and hybrid proeedure can achieve eonsiderable elinical outeome with low eomplieation rate.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第12期761-769,共9页
Chinese Journal of Orthopaedics
关键词
腰椎
椎间盘退行性变
椎管狭窄
脊柱融合术
内固定器
Lumbar vertebrae
Intervertebral disc degeneration
Spinal stenosis
Spinal fusion
Internal fixators
