多孔钛合金与聚醚醚酮笼架腰椎后路椎间融合比较△

Posterior lumbar interbody fusion with porous titanium cage versus polyether ether ketone cage

摘要:

[目的]比较 3D 打印工艺生产的多孔钛合金笼架与聚醚醚酮（poly-ether-ether-ketone, PEEK）笼架行腰椎后路椎间融合术（posterior lumbar interbody fusion, PLIF） 的疗效。[方法]2020 年 12 月—2023 年 5 月 62 例诊断为Ⅰ度或Ⅱ度退变性腰椎滑脱或椎弓峡部裂性腰椎滑脱，拟行 PLIF 的患者纳入本研究。采用随机数字表法将患者分为两组，31 例使用多孔钛笼架 （钛组），31 例使用 PEEK 笼架（PEEK 组）。比较两组围手术期、随访、影像资料。[结果]两组手术均顺利完成，两组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、切口愈合等级、住院天数及并发症发生率的差异均无统计学意义 （P＞0.05）。随访时间平均 （14.7±3.3） 个月。两组恢复完全负重活动时间的差异无统计学意义 （P＞0.05），与术前相比，术后 3 个月和末次随访两组患者腰痛 VAS、腿痛 VAS、ODI、 QBPDS 评分均显著减少（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后各时间点两组滑脱程度显著改善（P＜0.05）、滑脱率显著减少 （P＜0.05）、腰椎前凸角度显著增加 （P＜0.05），与术后 3 个月相比，术后 6 个月及末次随访时，椎间隙高度丢失率显著增加 （P＜0.05）。术后 3 个月 [(4.4±2.4)% vs ( 7.6±3.4)%, P＜0.001]、6 个月 [(6.0±2.3)% vs ( 10.4±2.9)%, P＜0.001]、12 个月 [(7.1±3.1)% vs (12.4±3.6)%, P＜0.001] 钛组的椎间隙高度丢失率显著小于 PEEK 组，两组滑脱程度、滑脱率、腰椎前凸角、椎间融合评级的差异均无统计学意义 （P＞0.05）。[结论] 多孔钛笼架与 PEEK 笼架用于 PLIF 均可有效治疗低度腰椎滑脱症。相比之下，微孔钛笼架可显著减少术后椎体间隙沉降。

Abstract:

[Objective] To compare the clinical efficacy of posterior lumbar interbody fusion (PLIF) with porous titanium cage produced by 3D printing versus poly-ether-ether-ketone (PEEK) cage for the low-extent spondylolisthesis. [Methods] From December 2020 to May 2023, a total of 62 patients who were undergoing PLIF for gradeⅠorⅡdegenerative or isthmic lumbar spondylolisthesis were included in this study, and divided into two groups by random number table method. Of them, 32 patients had PLIF performed with porous titanium cage (titanium group), while the other 32 patients were with PEEK cage (PEEK group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had PLIF performed successfully, without statistically significant differences in operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, ambulation time, incision healing grade, hospital stay and complication rate between the two groups (P＞0.05). The average followup time was of (14.7±3.3) months, and there was no a statistically significant difference between the two groups in the time to return to full weightbearing activities (P＞0.05). Compared with those preoperatively, lower back pain VAS, leg pain VAS, ODI and QBPDS scores were significantly reduced at 3 months after surgery and the last follow-up in both groups (P＜0.05). At any corresponding time points, there were no statistically significant differences in the above indexes between the two groups (P＞0.05). As for imaging, compared with those preoperatively, the degree of spondylolisthesis, slippage percentage, lumbar lordotic angle were significantly improved in both groups at each time point after surgery (P＜0.05). Compared with that 3 months postoperatively, the vertebral space height loss rate was significantly increased 6 months after surgery and at the last follow-up (P＜0.05). The titanium group proved significantly less vertebral space height loss rate than the PEEK group [(4.4±2.4)% vs (7.6±3.4)%, P＜0.001] 3 months, [(6.0±2.3)% vs (10.4±2.9)%, P＜0.001] 6 months, and [(7.1±3.1)% vs (12.4±3.6)%, P＜0.001] 12 months after operation, despite of the fact that no statistically significant differences were noted in terms of the degree of spondylolisthesis, slippage percentage, lumbar lordotic angle and interbody fusion rate between the two groups (P＞0.05). [Conclusion] PLIFs with both porous titanium cage and PEEK cage do effectively treat lowgrade lumbar spondylolisthesis. In contrast, the porous titanium cages significantly reduced postoperative vertebral space subsidence.