聚醚醚酮棒杂交手术预防成人脊柱畸形术后近端交界处失败的效果研究

Efficacy of polyetheretherketone rod hybrid surgery in preventing proximal junctional failure after adult spinal deformity surgery

目的探讨聚醚醚酮(PEEK)棒杂交手术治疗成人脊柱畸形的临床效果及其对长节段融合术后近端交界处失败(PJF)的预防作用。方法回顾性分析2017年1月至2021年12月于北京大学第一医院骨科诊断为退行性脊柱侧、后凸畸形行长节段减压融合手术的75例患者的临床资料。男性14例,女性61例,年龄(67.2±6.8)岁(范围:55~84岁)。使用PEEK棒杂交手术治疗20例,使用传统钛棒治疗55例。采集患者的一般信息,测量患者术前、术后1个月及末次随访时脊柱的影像学冠状位及矢状位参数,临床疗效使用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估。记录患者随访过程中是否发生近端交界性后凸(PJK)和PJF,及其出现的时间。组间比较采用独立样本t检验、Mann-Whitney U检验χ^(2)检验或Fisher确切概率法。同组治疗前后指标比较采用配对样本t检验或Wilcoxon检验。结果两组患者的年龄、性别、体重指数、骨密度、远端固定椎、手术节段、截骨方式、手术时间、术中出血等资料的差异均无统计学意义(P值均>0.05)。PEEK棒组随访时间较短[M(IQR)][16.5(4.8)个月比25.0(12.0)个月,Z=-4.230,P<0.01]。两组患者术前的脊柱冠状位、矢状位参数、VAS、ODI差异均无统计学意义(P值均>0.05),术后冠状位Cobb角、骨盆投射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸、胸椎后凸、矢状垂直轴(SVA)、VAS、ODI均获得明显改善(P值均<0.05)。末次随访PEEK棒杂交组的SVA为(3.74±2.40)cm,低于钛棒组的(6.28±4.06)cm(t′=-3.318,P=0.002)。末次随访PEEK棒杂交组的ODI为30.7±6.1,优于钛棒组的39.3±17.2(t=-3.203,P=0.046)。PEEK棒杂交组有2例(10.0%)患者出现PJK,未观察到PJF。钛棒组有18例(32.7%)患者出现PJK,11例(20.0%)患者出现PJF。PEEK棒杂交组与钛棒组的PJF发生率有差异(P=0.031)。结论PEEK棒杂交手术治疗成人脊柱畸形临床效果良好,可改善患者临床功能评分,较传统钛棒矫形手术术后PJF的发生率低。

Objective To investigate the clinical outcome and preventive effect of polyetheretherketone(PEEK)rod hybrid surgery on proximal junction failure(PJF)after long-segment fusion of adult spinal deformity.Methods A retrospective study was conducted to analyze patients with degenerative scoliosis/kyphosis who underwent long-segment decompression and fusion surgery at Department of Orthopedics,Peking University First Hospital from January 2017 to December 2021.A total of 75 patients were included in the study,including 14 males and 61 females,aged(67.2±6.8)years(range:55 to 84 years).According to the operation method chosen by the patients,the patients were divided into PEEK rod hybrid group(20 cases)and traditional titanium rod group(55 cases).The general information of the patients was collected,and the coronal and sagittal parameters of the spine were measured before operation,at 1 month after operation,and at the last follow-up.The clinical effect of surgery was judged by the visual analogue scale(VAS)and Oswestry disability index(ODI).Whether proximal junctional kyphosis(PJK)and PJF occurred during the follow-up and the time of occurrence were recorded.Comparisons between groups were performed using independent sample t test,Mann-Whitney U test,χ^(2)test and Fisher′s exact probability method.The data before and after surgery in the same group were compared using the paired sample t test and the Wilcoxon test.Results There were no significant differences in age,gender,body mass index,bone mineral density,distal instrumented vertebrae,surgical segments,osteotomy method,operation time,and intraoperative bleeding between the two groups(all P>0.05).The follow-up time of the PEEK rod group was shorter(M(IQR)16.5(4.8)vs.25.0(12.0),Z=-4.230,P<0.01).There were no significant differences in coronal,sagittal parameters,VAS and ODI between the two groups before operation(all P>0.05).Postoperative coronal Cobb angle,pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,sagittal vertical axis(SVA),VAS and ODI were significantly improved in both groups(all P<0.05).At the last follow-up,the SVA of the PEEK rod hybrid group was(3.74±2.40)cm,which was significantly lower than that of the titanium rod group(6.28±4.06)cm(t′=-3.318,P=0.002).At the last follow-up,the ODI of the PEEK rod hybrid group was 30.7±6.1,significantly better than the titanium rod group 39.3±17.2(t=-3.203,P=0.046).PJK occurred in 2 patients(10.0%)in the PEEK rod hybrid group,and no PJF phenomenon was observed.In the titanium rod group,18 patients(32.7%)developed PJK,and 11 patients(20.0%)developed PJF.There was a statistically significant difference in the incidence of PJF between the PEEK rod hybrid group and the titanium rod group(P=0.031).Conclusions PEEK rod hybrid surgery can achieve good clinical results in the treatment of adult spinal deformities.Compared with traditional titanium rod surgery,it can significantly reduce the incidence of postoperative PJF and improve the clinical function of patients.