PEEK材料椎弓根内固定与椎间融合修复腰椎管狭窄症:植骨融合率随访评价

Lumbar spinal stenosis treated with polyetheretherketone pedicle screw fixation combined with interbody fusion: a follow-up assessment focusing on bone fusion rate

背景:临床修复腰椎管狭窄症可行减压植骨融合内固定,修复术中可以选择不同的内固定材料。目的:探讨聚醚醚酮材料椎弓根内固定结合椎间融合对腰椎管狭窄症患者植骨融合的影响。方法:回顾性分析63例腰椎管狭窄症行减压植骨融合内固定治疗患者的临床资料,按照所使用的内固定材料分为2组,对照组31例采用钛棒椎弓根内固定系统,观察组32例采用聚醚醚酮棒椎弓根内固定系统,两组均行后路椎管减压植骨融合。观察两组患者治疗前和治疗后4,12,24周的Oswestry功能障碍指数以及治疗后4,12,24周的植骨融合情况,并进行比较。结果与结论:(1)治疗前和治疗后4,12,24周,两组患者Oswestry功能障碍指数均呈现出逐渐下降的趋势,且不同时间两组差异均无显著性意义(P>0.05)。(2)治疗后4,24周,两组植骨融合情况差异均无显著性意义(P>0.05);但治疗后12周观察组的植骨融合情况显著优于对照组(P<0.05)。(3)两组患者修复术中均未出现神经根损伤等情况,治疗后随访,影像随诊未见内固定松动及断裂情况,植骨融合良好,均未出现感染等不良事件。(4)提示对腰椎管狭窄症患者行减压植骨融合内固定的过程中,置入聚醚醚酮棒与钛棒椎弓根内固定系统均可以获得良好的修复效果,但治疗后4-12周期间,聚醚醚酮材料对植骨融合过程具有更好的促进作用。

BACKGROUND： Lumbar spinal stenosis is clinical repaired with decompression, bone fusion and internal fixation, and different internal fixation materials can be chosen during the surgery. OBJECTIVE：To explore the influence of polyetheretherketone（PEEK） pedicle screw fixation combined with interbody fusion on the bone fusion rate of patients with lumbar spinal stenosis. METHODS： A retrospective analysis was performed in 63 cases of lumbar spinal stenosis undergoing decompression and interbody fusion. These patients were divided into control group（titanium internal fixation system, n=31） and experimental group（PEEK pedicle internal fixation system, n=32） according the internal fixation materials followed by posterior spinal decompression with interbody fusion. The Oswestry dysfunction index scores before and 4, 12, 24 weeks postoperatively and bone fusion rates at 4, 12, 24 weeks postoperatively were compared between the two groups. RESULTS AND CONCLUSION： Oswestry dysfunction index scores showed a gradual decline in both two groups before and 4, 12 and 24 weeks after treatment, but there was no difference at different time（P 0.05）. At 4 and 24 weeks after treatment, there was no difference in the bone fusion rates between the two groups（P 0.05）, but at 12 weeks after treatment, the bone fusion rate in the experimental group was better than that in the control group（P 0.05）. During the surgery, no infection and other adverse events occurred in the two groups. These results indicate that both PEEK and titanium internal fixation systems for lumbar tube stenosis have obtained good results, but PEEK material has a better role in the bone fusion at 4-12 weeks after internal fixation.