PEEK棒椎弓根螺钉系统治疗老年腰椎退行性疾病的疗效分析

Clinical outcome of PEEK rod pedicle screw system for senile lumbar degenerative disease

目的观察聚醚醚酮树脂(PEEK)棒椎弓根螺钉内固定系统治疗老年腰椎退行性疾病的可行性和有效性。方法前瞻性收集2013年7月至2014年3月济南军区总医院符合纳入排除标准的老年腰椎退行性疾病患者41例,根据两组患者术中采用椎弓根螺钉材质的不同,将其随机分为PEEK棒组(n=21)和钛棒组(n=20)。术前所有患者行X线腰椎正侧位、过伸过屈位、CT、MRI检查,随访并观察术前、术后3个月、6个月及1年的欧氏功能障碍指数(ODI)、日本骨科学会评分(JOA)、螺钉松动、断裂及假关节形成情况,术后1年行CT平扫加三维重建,评估内固定及融合情况。结果 41例患者均获得成功随访,随访时间为10~15个月,平均(12.7±1.4)个月。两组患者手术前后各时间点的ODI及JOA评分组间比较差异均无统计学意义。PEEK棒组患者末次随访时的ODI评分由术前(46.8±8.3)分降至(15.9±3.1)分,钛棒组患者末次随访时的ODI评分由术前(45.2±7.4)分降至(16.6±3.5)分,差异均具有统计学意义(F=14.235,F=12.361,P<0.05),PEEK棒组JOA评分由术前(12.2±2.6)分提高至(22.4±3.9)分,钛棒组JOA评分由术前(12.8±2.4)分提高至(22.3±3.6)分,差异均具有统计学意义(F=20.186,F=17.015,P<0.05)。PEEK棒组所有患者未出现螺钉松动断裂及PEEK棒断裂情况,钛棒组有2例患者出现螺钉松动。PEEK棒组患者(12/15)椎间骨性融合率与钛棒组(15/20)无统计学差异(x^2=9.012,P=0.527)。结论 PEEK棒椎弓根螺钉内固定系统术后可明显改善老年腰椎退行性疾病患者的临床症状,疗效较为满意。

Objective To evaluate the feasibility and validity of polyetheretherketone(PEEK) rod pedicle screw internal fixation system for senile lumbar degenerative disease(LDD). Methods A perspective study was performed in 41 senile LDD from July 2013 to March 2014. They were divided into PEEK group(n=21) and titanium rod group(n=20) randomly according to different materials of pedicle screw in each group. All patients got front and lateral, hyperextension and hyperflexion X- ray films, CT scan, MRI before surgery. The oswestry dysfunctional index(ODI), Japanese orthopedics association(JOA),pseudarthrosis, screw loosening and rupture at 3 months, 6 months and 12 months were followed- up after surgery. 12 months after surgery, a three- dimensional CT reconstructions were achieved to observe the integrity of PEEK rods. Results All 41 patients received an average 12.7±1.4 months follow-up(range,10-15 m). There was no statistically significant difference of ODI and JOA between two groups before and after operation. At the last follow-up visit, the ODI score decreased to 15.9±3.1 from preoperative 46.8±8.3in PEEK group, the ODI score decreased to 16.6±3.5 from preoperative 45.2±7.4 in titanium rod group withstatistical significance(F=14.235, F=12.361, P<0.05), the JOA score increased to 22.4±3.9 from preoperative12.2±2.6 in PEEK group, the JOA score increased to 22.3±3.6 from preoperative 12.8±2.4 in titanium rod group with statistical significance(F=20.186, F=17.015, P<0.05). No screw loosening, screw and rods breakage occurred in PEEK group, while 2 cases in titanium rod group showed screw loosening. There was no statistically significant difference(x^2=9.012, P=0.527) of fusion rate between PEEK group(12/15) and titanium rod group(15/20). Conclusion PEEK rod pedicle screw internal fixation system can improve clinical symptom obviously and achieve excellent functional outcomes in elderly LDD.