PEEK棒与钛棒治疗腰椎管狭窄症的疗效对比

PEEK versus Titanium rods for lumbar canal stenosis

[目的]比较应用PEEK棒半刚性固定系统与钛棒刚性固定系统治疗腰椎管狭窄症的临床疗效。[方法]对2015年1月~2016年1月腰椎管狭窄症手术治疗患者38例进行回顾性分析,根据术中采用内固定材质的不同,将其随机分为PEEK棒组(18例)和钛棒组(20例),比较两组手术时间、术中出血量、JOA评分和手术节段活动范围(ROM)。[结果]所有患者均顺利手术,无严重术中并发症。PEEK棒组手术时间和术中出血量均小于钛棒组,差异有统计学意义(P≤0.05)。患者术后获24~36个月,平均26.2个月的随访。末次随访时两组JOA评分均较术前显著进步,差异有统计学意义(P<0.05);但两组间手术前后各时间点的JOA评分差异均无统计学意义(P>0.05)。手术前两组患者节段ROM组间比较差异无统计学意义(P>0.05),但PEEK棒组手术后各时间点的节段ROM均明显大于钛棒组,差异均有统计学意义(P<0.05);末次随访时钛棒节段ROM较术前显著降低,差异有统计学意义(P<0.05),而PEEK组较术前比较差异无统计学意义(P>0.05)。术后随访期间均无感染,PEEK棒组患者未出现内固定松动断裂情况,钛棒组有1例患者出现螺钉松动。[结论]PEEK棒半刚性固定系统与钛棒刚性固定系统术后均可明显改善腰椎管狭窄症患者的临床症状,疗效满意。PEEK棒半刚性固定系统在稳定脊柱的前提下可保留更多的腰椎活动范围。

[Objective] To compare the clinical outcomes of PEEK （polyetheretherketone） rod semi-rigid fixation system versus titanium rod rigid fixation system for lumbar canal stenosis. [Methods] A retrospective study was performed on 38 patients who were surgically treated for lumbar canal stenosis from January 2015 to January 2016. In term of the instrument implanted, the patients were randomly divided into PEEK rod group （n=18） and titanium rod group （n=20） . The operative time, blood loss, JOA scores and ROM were compared between the two groups. [Results] All patients received a successful operation without serious complications. The PEEK rod group proved significantly shorter operation time and less blood loss than the titanium rod group （P〈0.05） . The patients were followed up for 24 to 36 months with a mean of 26.2 months. Although the JOA scores significantly increased at the last follow-up compared with those before operation in both groups （P〈0.05）, no statistical differences in JOA scores between the two groups were noticed at any corresponding time points （P〉0.05） . In addition, the PEEK rod group had significant greater segment ROM than the titanium group at each time point postoperatively （P〈0.05）, despite the fact that no a statistical difference in the segment ROM was proved between them before operation （P〉0.05）. At the latest follow up, the ROM in the titanium rod group was statistically less than that before operation （P〈0.05）, whereas the ROM in the PEEK rod group had no significant changed between the two time points （P〉0.05）. During the follow up period, no infection happened in anyone of both groups, no loosening or fracture of implants occurred in anyone of the PEEK group, whereas 1 patient in the titanium rod group got screw loosening. [Conclusion] Both the PEEK rod semi-rigid fixation system and Titanium rod rigid fixation system do improve clinical symptom obviously and achieve excellent functional outcomes for lumbar canal stenosis. In contrast, the PEEK rod semi-rigid fixation system does retain some mobility in the operated segment as stabilizing the spine.