聚醚醚酮棒椎弓根螺钉系统在多节段腰椎退行性疾病治疗中的应用

Clinical outcome of polyetheretherketone rods for multiple levels lumbar degenerative diseases

目的探讨聚醚醚酮(PEEK)棒椎弓根螺钉内固定系统在多节段腰椎退行性疾病中的应用价值。方法回顾性分析2014年9月至2015年5月应用PEEK棒椎弓根螺钉内固定系统治疗的多节段腰椎退行性疾病患者,共11例,所有患者随访资料均完整。其中男5例,女6例,平均年龄60.4±8.7岁。其中9例患者固定4个节段,5例患者固定范围为L_3-S_1,4例患者固定范围为L_2-L_5,2例患者固定5个节段,均固定至L_2-S_1。根据病变的情况在固定节段内选择性行椎间融合,其中2例患者融合了2个节段,7例患者融合了1个节段,2例患者未行椎间融合。通过术前、术后3月、6月、1年及2年的Oswestry功能障碍指数(Oswestry Disfunctional Index)和视觉模拟评分(Visual Analogue Scale,VAS),评估临床疗效。通过腰椎侧位X线观察融合节段的椎间高度指数(DHI),腰椎过伸过屈X线观察椎间活动度(Range of Motion,ROM)变化情况,术后2年CT二维重建观察椎间融合情况,术后2年CT三维重建观察有无PEEK棒断裂或变形。结果 11例患者平均随访24.6±1.7(22~28)月。平均手术时152±25(120~210)分钟,平均术中失血518±248(300~1000)mL。ODI评分术前49.6±12.2,末次随访15.5±3.7,同术前相比差异有统计学意义(P=0.000);VAS评分术前8.1±0.8,末次随访时1.7±0.6,同术前相比差异有统计学意义(P=0.000)。融合节段的DHI术前0.343±0.091,末次随访DHI 0.321±0.069,差异无统计学意义(P=0.070)。在24个非融合节段中,ROM术前平均9.3°±1.5°,末次随访2.3°±0.5°,术前术后变化差异有统计学意义(P=0.000)。行椎间融合的11个节段在术后2年随访时共8例患者获得骨性融合,融合率为72.7%。术后2年随访时无PEEK棒断裂,变形情况出现。结论 PEEK棒椎弓根螺钉内固定系统治疗多节段腰椎退行性病变安全有效,但长期疗效有待进一步随访观察。

Objective To explore the clinical feasibility and validity of polyetheretherketone rods for multiple levels lumbar degenerative diseases. Methods Eleven patients treated by polyetheretherketone rods pedicle screw system for multiple level lumbar degenerative diseases from Sep 2014 to May 2015 were studied retrospectively. There were five males and six females with a mean age of 60.4±8.7 years. Among them, nine patients had fixed four segments, five patients had a fixed range of L3-S1, and four patients had a fixed range of L2-L5. The other two patients had a fixed range of L2-S1.Interbody fusion was selective, two patients were fused with two segments, seven patients fused one segment, two patients had no intervertebral fusion. Clinical outcomes were calculated by Oswestry Disfunctional Index and Visual Analogue Scale preoperatively, 3 months, 6 months, 12 months and 24 months postoperatively. Disc height index was measured on lateral lumbar radiograph. Intervertebral range of motion was calculated by extension and flexion lumbar radiographs. Intervertebral fusion was determined by CT reconstructions and PEEK rods were observed by three dimensional reconstruction. Results The mean follow-up was 24.6±1.7（22 ～ 28）. The mean operation time was 152±25（120 ～210） minutes and the mean blood loss was 518±248（300 ～ 1000） mL. The ODI score decreased from preoperative49.6±12.2 to 15.5±3.7 at final follow-up with statistical significance, while the VAS decreased from preoperative 8.1±0.8 to 1.7±0.6 at final follow-up with statistical significance. The DHI decreased from 0.343±0.091 preoperatively to0.321±0.069 at final follow-up without statistical significance. The ROM decreased from 9.3°±1.5° preoperatively to 2.3°±0.5° at final follow-up with no statistical significance. Eight out of eleven segments received interbody fusion procedure acquired successful bony fusion. Deformation and breakage were not observed during the follow-up. Conclusion PEEK rods pedicle screw system is effective procedure for multiple level lumbar degenerative diseases. The long-term outcome needs to be evaluated further.