聚醚醚酮棒与钛棒椎弓根钉固定腰椎退行性病的比较

Polyetheretherketone versus titanium rods used in pedicle screw fixation for lumbar degenerative diseases

摘要:

［目的］比较聚醚醚酮（polyetheretherketone, PEEK）棒与钛棒椎弓根螺钉内固定系统治疗腰椎退行性疾病的临床疗效。［方法］ 2019 年 8 月—2020 年 11 月对 60 例腰椎退行性疾病患者行减压椎弓根固定术。根据医患沟通结果，30 例采用 PEEK 棒，30 例采用钛棒。比较两组围手术期、随访及影像结果。［结果］ 两组均顺利完成手术，无严重并发症。两组手术时间、切口长度、术中失血量、透视次数、切口愈合等级、住院时间、下地行走时间的差异均无统计学意义 （P>0.05）。两组恢复完全负重活动时间的差异无统计学意义 （P>0.05）。随访 12 个月以上，随时间推移，两组患者术后腰部疼痛 VAS 和 ODI 评分均显著减少 （P<0.05），术后 2 周 PEEK 组的 VAS 评分显著优于钛棒组 （P<0.05），但术后 12 个月时两组间差异无统计学意义（P>0.05）。术后各时间点两组 ODI 指数差异均无统计学意义（P>0.05）。影像方面，术后 12 个月 PEEK 组固定节段 ROM 显著大于钛棒组 （P<0.05），相应时间点，两组间固定节段、上邻节段和下邻节段的 Pfirrmann 分级的差异均无统计学意义 （P> 0.05）。［结论］ 两种材质的内固定系统均能明显改善腰椎退行性疾病的临床症状，PEEK 组患者术后早期腰痛程度更轻，并保持更好的腰部活动度。

Abstract:

[Objective] To compare the clinical efficacy of polyetheretherketone (PEEK) rod versus titanium rod used in pedicle screw fixation for lumbar degenerative diseases. [Methods] From August 2019 to November 2020, a total of 60 patients received decompression and pedicle screw fixation for lumbar degenerative diseases. According to doctor- patient communication results, 30 patients had PEEK rods used, while the other 30 patients had titanium rod used. The perioperative, follow-up and imaging results were compared between the two groups. [Results] All patients in both groups were operated on successfully without serious complications. There were no significant dif- ferences in terms of operative time, incision length, intraoperative blood loss, times of fluoroscopy, incision healing grades, hospital stay and postoperative walking time between the two groups (P＞0.05) . In addition, there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . As time went during the follow-up period lasted for more than 12 months, both VAS and ODI scores significantly decreased in the two groups (P＜0.05) . The PEEK group proved significantly superior to the titanium group in VAS score at 2 weeks after surgery (P＜0.05) , whereas which became not statistically significant between the two groups 12 months postoperatively (P＞0.05) . However, there was no significant difference in ODI score between the two groups at any matching time points (P＞0.05) . Radiographically, the PEEK group had significantly greater range of motion (ROM) of the fixed segment measured on imag- es than titanium group at 12 months after surgery (P＜0.05) , whereas there were no statistically significant differences in term of Pfirrmann classification of fixed segment, upper adjacent segment and lower adjacent segment between the two groups at any corresponding time points (P＞0.05) . [Conclusion] Both PEEK and titanium rods used for pedicle screw fixation do significantlly improve the clinical symp- toms of lumbar degenerative diseases, by comparison, PEEK group has less chance of early postoperative low back pain, with better lumbar mobility maintained.