聚醚醚酮棒与钛棒椎弓根钉对腰椎退行性疾病的疗效比较
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1.北京中医药大学;2.首都医科大学附属北京中医医院骨科

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Comparison of effect of Polyetheretherketone rod and titanium rod pedicle screw for lumbar degenerative diseases
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1.Beijing University of Chinese Medicine;2.Department of Orthopedics, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University

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    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]对2019年8月至2020年11月首都医科大学附属北京中医医院骨科手术治疗的60例腰椎退行性疾病患者进行回顾性分析,根据术中采用内固定材质的不同,将其分为PEEK组(30例)和钛棒组(30例),比较两组围手术期一般情况:包括术中并发症,手术时间,切口长度,术中失血量,术后引流量,住院时间,切口愈合时间,下地行走时间,术后早期并发症;随访情况:包括完全负重活动时间、腰部疼痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(oswestry disability index, ODI)评分;影像学结果:包括动力位活动度(range of motion, ROM)、Pfirrmann退变分级。[结果]所有患者均顺利完成手术,围手术期一般情况差异均无统计学意义。随访情况中完全负重活动时间,术前、术后12月的腰部疼痛VAS评分差异均无统计学意义,而术后2周VAS评分两组存在显著性差异(P<0.05)。各时间段的ODI评分均无明显差异。ROM比较存在显著性差异(P<0.05)。钛棒组术后12月与术前相比有统计学意义(P<0.05),而PEEK组术后12月与术前比较无统计学意义(P>0.05)。在Pfirrmann退变分级方面,PEEK棒能一定程度减少邻近节段退变(Adjacent segment degeneration,ASD)的发生,但该差异不显著(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,疗效满意。PEEK组患者术后早期腰痛程度更轻,并发症更少,腰部活动度更好。同时,PEEK棒能一定程度减少ASD的发生,但该差异不具有统计学意义。

    Abstract:

    [Objective] To compare the clinical effect of Polyetheretherketone (PEEK) rod and titanium rod pedicle screw fixation system in the treatment of lumbar degenerative diseases. [Methods] 60 cases of lumbar degenerative disease patients were retrospectively analyzed in Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from August 2019 to November 2020. According to the intraoperative use of different internal fixation material, these patients can be divided into PEEK group (30 cases) and titanium rod group (30 cases). Comparing two groups of surgery perioperative general situation including intraoperative complications, operative time, incision length, intraoperative blood loss, postoperative drainage, length of hospital stay, incision healing time, time of start walking on the ground and postoperative early complications. Comparing two groups of follow-up situation including time of walking on the ground without weight-bearing, visual analogue scale (VAS) and oswestry disability index(ODI) score. Comparing two groups of imaging results including Range of Motion (ROM) and Pfirrmann degeneration grading. [Results] All patients successfully completed surgery, and there was no significant difference in general situation during perioperative period. As to follow-up situation, there was no statistical significance in time of walking on the ground without weight-bearing, VAS scores of before surgery and 12 months after surgery, but VAS scores of 2 weeks after surgery were significantly different between the two groups (P < 0.05). There was no significant difference in ODI score in each time period. There was significant difference in ROM between the two groups (P < 0.05). In the titanium rod group, there was statistical significance between 12 months after surgery and before operation(P < 0.05), while in the PEEK group, there was no statistical significance between 12 months after surgery and before operation(P > 0.05). In the aspect of Pfirrmann degeneration grading, PEEK rod could reduce the occurrence of adjacent segment degeneration to a certain extent, but the difference was not significant (P > 0.05). [Conclusion] The two kinds of internal fixation systems can obviously improve the clinical symptoms of lumbar degenerative disease, and the effect is satisfactory. The PEEK group had less early postoperative low back pain, fewer complications, and better waist mobility. Meanwhile, PEEK could reduce the degeneration of adjacent segments to a certain extent, but the difference was not statistically significant.

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  • 收稿日期:2021-07-04
  • 最后修改日期:2021-10-31
  • 录用日期:2022-01-27
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