PEEK融合器在强直性脊柱炎胸腰段后凸畸形合并Andersson骨折手术中的应用
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摘要
目的分析并评价强直性脊柱炎(ankylosing spondylitis,AS)胸腰段后凸畸形合并Andersson骨折患者通过脊柱后路经骨折线截骨手术应用PEEK(polyetheretherketone)融合器的疗效。方法回顾性分析2013年1月-2015年1月在我科应用PEEK融合器行脊柱后路经骨折线截骨手术治疗的27例AS胸腰段后凸畸形合并Andersson骨折患者临床资料,随访时间24~28(26.25±1.45)个月。收集患者手术前后正侧位X线片及CT检查图像,测量患者截骨平面高度及脊柱整体后凸角以评价手术效果,观察植骨融合情况,采用SRS-22量表评价术前及术后生活质量改善情况。结果 27例患者均顺利完成手术。术后1周、3个月、6个月、1年、2年截骨平面高度(level height,LH)均较术前无显著变化(P均>0.05),术后较术前后柱未见过度短缩。术后1周、3个月、6个月、1年、2年脊柱矢状面Cobb角矢状位平衡测量数据较术前显著改善(P均<0.05),术后各时间点间比较无明显差异(P>0.05)。术后3个月截骨处植骨融合率为77.8%,术后6个月为96.3%,术后1年为100%。术后6个月SRS-22各项得分均较术前明显增高,症状得到改善。随访期间,截骨矫形植骨融合部位X线复查未发现融合器移位、塌陷等情况。结论行脊柱后路经骨折线截骨矫形手术的AS胸腰段后凸畸形合并Andersson骨折患者术中应用Peek融合器安全有效,能够有效维持截骨部位高度及弧度,避免后柱过度短缩造成的硬脊膜和脊髓皱缩,长期随访临床效果满意。
Objective To evaluate the clinical outcomes of PEEK(Polyetheretherketone) cage for surgical treatment of thoracolumbar kyphosis deformity in ankylosing spondylitis patients with andersson fracture. Methods Clinical data about 27 patients who were diagnosed with ankylosing spondylitis thoracolumbar kyphosis with andersson fracture and treated by posterior osteotomy using PEEK cage in our hospital from January 2013 to January 2015 were retrospectively analyzed. All the patients were followed up for 24-28(26.25±1.45) months. Preoperative and postoperative radiographic data were recorded. The level height in osteotomy region(LH) and sagittal Cobb angle in globe kyphosis(GK) of the whole spine were measured on X-ray image and body fusion was evaluated. Scoliosis Research Society-22(SRS-22) was obtained to evaluate postoperative quality of life improvement. Results All surgeries were performed successfully without severe complications. There was no significant difference between preoperative and postoperative LH(all P >0.05). Compared with before operation, the sagittal Cobb angle in globe kyphosis of the whole spine(GK) improved significantly after operation(P <0.05), while no significant difference was found among each time point after operation(all P >0.05). The fusion rate was 77.8% at 3 months after operation, 96.3% at 6 months and 100% at 1 year. The SRS-22 score increased significantly at 6 months after operation(P <0.05). No cage displacement or collapse was found during follow-up. Conclusion Posterior osteotomy through fracture line with PEEK cage is an effective method for treatment of thoracolumbar kyphotic deformity in ankylosing spondylitis patients with andersson fracture and it can avoid potential spinal cord kinking or curving. PEEK cage maintains segmental height and restoration of lordosis angle effectively during long-term follow-up with high fusion rate.
Objective To evaluate the clinical outcomes of PEEK(Polyetheretherketone) cage for surgical treatment of thoracolumbar kyphosis deformity in ankylosing spondylitis patients with andersson fracture. Methods Clinical data about 27 patients who were diagnosed with ankylosing spondylitis thoracolumbar kyphosis with andersson fracture and treated by posterior osteotomy using PEEK cage in our hospital from January 2013 to January 2015 were retrospectively analyzed. All the patients were followed up for 24-28(26.25±1.45) months. Preoperative and postoperative radiographic data were recorded. The level height in osteotomy region(LH) and sagittal Cobb angle in globe kyphosis(GK) of the whole spine were measured on X-ray image and body fusion was evaluated. Scoliosis Research Society-22(SRS-22) was obtained to evaluate postoperative quality of life improvement. Results All surgeries were performed successfully without severe complications. There was no significant difference between preoperative and postoperative LH(all P >0.05). Compared with before operation, the sagittal Cobb angle in globe kyphosis of the whole spine(GK) improved significantly after operation(P <0.05), while no significant difference was found among each time point after operation(all P >0.05). The fusion rate was 77.8% at 3 months after operation, 96.3% at 6 months and 100% at 1 year. The SRS-22 score increased significantly at 6 months after operation(P <0.05). No cage displacement or collapse was found during follow-up. Conclusion Posterior osteotomy through fracture line with PEEK cage is an effective method for treatment of thoracolumbar kyphotic deformity in ankylosing spondylitis patients with andersson fracture and it can avoid potential spinal cord kinking or curving. PEEK cage maintains segmental height and restoration of lordosis angle effectively during long-term follow-up with high fusion rate.
引文
1 Liu H,Yang C,Zheng Z,et al.Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2015,40(8):570-579.
2 Russo VM,Casey AT.Andersson lesion in ankylosing spondylitis[J].Spine J,2014,14(7):1357.
3 郑国权,张永刚,王岩,等.强直性脊柱炎后凸畸形的301分型[J].中国脊柱脊髓杂志,2015,25(9):769-774.
4 Kim SK,Shin K,Song Y,et al.Andersson lesions of whole spine magnetic resonance imaging compared with plain radiography in ankylosing spondylitis[J].Rheumatol Int,2016,36(12):1663-1670.
5 Park YS,Kim JH,Ryu JA,et al.The Andersson lesion in ankylosing spondylitis:distinguishing between the inflammatory and traumatic subtypes[J].J Bone Joint Surg Br,2011,93(7):961-966.
6 Zhang X,Wang Y,Wu B,et al.Treatment of Andersson lesioncomplicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy,a retrospective study[J].Eur Spine J,2016,25(8):2587-2595.
7 Wang G,Sun J,Jiang Z,et al.The surgical treatment of Andersson lesions associated with ankylosing spondylitis[J].Orthopedics,2011,34(7):e302-e306.
8 Dave BR,Ram H,Krishnan A.Andersson lesion:are we misdiagnosing it?A retrospective study of clinico-radiological features and outcome of short segment fixation[J].Eur Spine J,2011,20(9):1503-1509.
9 Zhang X,Zhang Z,Wang J,et al.Vertebral column decancellation:a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis[J].Bone Joint J,2016,98-B(5):672-678.
10 张宏其,周振海,郭超峰,等.单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折[J].中国矫形外科杂志,2016,24(21):1921-1926.
11 Savage JW,Patel AA.Fixed sagittal plane imbalance[J].Global Spine J,2014,4(4):287-296.
12 Cheng X,Zhang F,Zhang K,et al.Effect of Single-Level Transforaminal Lumbar Interbody Fusion on Segmental and Overall Lumbar Lordosis in Patients with Lumbar Degenerative Disease[J].World Neurosurg,2018,109:e244-e251.
13 Brantigan JW,Steffee AD.A carbon fiber implant to aid interbody lumbar fusion.Two-year clinical results in the first 26 patients[J].Spine(Phila Pa 1976),1993,18(14):2106-2107.
14 胡凡琦,胡文浩,张智发,等.简体中文版脊柱侧凸研究学会22项问卷量表各维度得分与成人脊柱侧凸患者手术治疗满意度的相关性研究[J].解放军医学院学报,2016,37(10):1075-1078.
15 Alsiddiky A,Aloqayli A,Ahmed A,et al.Scoliosis Surgical Treatment Outcomes with relevance of Quality of Life(Qo L),through SRS22;Clinical recovery,Psycho–social status and management satisfaction[J].Int J Sci Res,2016,5(3):191-194.
16 成俊遥,宋凯,郑国权,等.强直性脊柱炎重度胸腰段后凸畸形患者的双节段截骨设计[J].脊柱外科杂志,2017,15(3):141-145.
17 宋凯,张永刚.强直性脊柱炎胸腰段后凸畸形矫形设计概述[J].解放军医学院学报,2015,36(5):521-524.
18 Jain S,Eltorai AE,Ruttiman R,et al.Advances in Spinal Interbody Cages[J].Orthop Surg,2016,8(3):278-284.
19 Chastain CA,Eck JC,Hodges SD,et al.Transforaminal lumbar interbody fusion:a retrospective study of long-term pain relief and fusion outcomes[J].Orthopedics,2007,30(5):389-392.
20 Hou Y,Shi J,Sun J,et al.Transvertebral Bone Graft and Augmentation Versus Posterior Spinal Instrumentation in the Treatment of Simple Thoracolumbar Compression Fractures[J/OL].https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30273-0.
21 Kinaci A,Neuhaus V,Ring DC.Trends in bone graft use in the United States[J].Orthopedics,2014,37(9):e783-e788.
22 Tuchman A,Brodke DS,Youssef JA,et al.Autograft versus Allograft for Cervical Spinal Fusion:A Systematic Review[J].Global Spine J,2017,7(1):59-70.
23 Niu CC,Liao JC,Chen WJ,et al.Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion:titanium cages versus polyetheretherketone(PEEK)cages[J].J Spinal Disord Tech,2010,23(5):310-316.
24 Derman PB,Albert TJ.Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis[J].Curr Rev Musculoskelet Med,2017,10(4):530-538.
25 Panayotov IV,Orti V,Cuisinier F,et al.Polyetheretherketone(PEEK)for medical applications[J].J Mater Sci Mater Med,2016,27(7):118.
26 Zhou L,Qian Y,Zhu Y,et al.The effect of different surface treatments on the bond strength of PEEK composite materials[J].Dent Mater,2014,30(8):e209-e215.
27 Faraj SSA,Van Hooff ML,Holewijn RM,et al.Measuring outcomes in adult spinal deformity surgery:a systematic review to identify current strengths,weaknesses and gaps in patient-reported outcome measures[J].Eur Spine J,2017,26(8):2084-2093.
28 Wang Y,Zhang Y,Zhang X,et al.Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity[J].Eur Spine J,2009,18(10):1436-1441.
29 杨全中,张雪松,杨晓清,等.脊柱后路去松质骨截骨术用于脊柱畸形翻修手术的安全性和有效性[J].中国脊柱脊髓杂志,2016,26(8):715-722.
30 Shibuya N,Jupiter DC.Bone graft substitute:allograft and xenograft[J].Clin Podiatr Med Surg,2015,32(1):21-34.
2 Russo VM,Casey AT.Andersson lesion in ankylosing spondylitis[J].Spine J,2014,14(7):1357.
3 郑国权,张永刚,王岩,等.强直性脊柱炎后凸畸形的301分型[J].中国脊柱脊髓杂志,2015,25(9):769-774.
4 Kim SK,Shin K,Song Y,et al.Andersson lesions of whole spine magnetic resonance imaging compared with plain radiography in ankylosing spondylitis[J].Rheumatol Int,2016,36(12):1663-1670.
5 Park YS,Kim JH,Ryu JA,et al.The Andersson lesion in ankylosing spondylitis:distinguishing between the inflammatory and traumatic subtypes[J].J Bone Joint Surg Br,2011,93(7):961-966.
6 Zhang X,Wang Y,Wu B,et al.Treatment of Andersson lesioncomplicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy,a retrospective study[J].Eur Spine J,2016,25(8):2587-2595.
7 Wang G,Sun J,Jiang Z,et al.The surgical treatment of Andersson lesions associated with ankylosing spondylitis[J].Orthopedics,2011,34(7):e302-e306.
8 Dave BR,Ram H,Krishnan A.Andersson lesion:are we misdiagnosing it?A retrospective study of clinico-radiological features and outcome of short segment fixation[J].Eur Spine J,2011,20(9):1503-1509.
9 Zhang X,Zhang Z,Wang J,et al.Vertebral column decancellation:a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis[J].Bone Joint J,2016,98-B(5):672-678.
10 张宏其,周振海,郭超峰,等.单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折[J].中国矫形外科杂志,2016,24(21):1921-1926.
11 Savage JW,Patel AA.Fixed sagittal plane imbalance[J].Global Spine J,2014,4(4):287-296.
12 Cheng X,Zhang F,Zhang K,et al.Effect of Single-Level Transforaminal Lumbar Interbody Fusion on Segmental and Overall Lumbar Lordosis in Patients with Lumbar Degenerative Disease[J].World Neurosurg,2018,109:e244-e251.
13 Brantigan JW,Steffee AD.A carbon fiber implant to aid interbody lumbar fusion.Two-year clinical results in the first 26 patients[J].Spine(Phila Pa 1976),1993,18(14):2106-2107.
14 胡凡琦,胡文浩,张智发,等.简体中文版脊柱侧凸研究学会22项问卷量表各维度得分与成人脊柱侧凸患者手术治疗满意度的相关性研究[J].解放军医学院学报,2016,37(10):1075-1078.
15 Alsiddiky A,Aloqayli A,Ahmed A,et al.Scoliosis Surgical Treatment Outcomes with relevance of Quality of Life(Qo L),through SRS22;Clinical recovery,Psycho–social status and management satisfaction[J].Int J Sci Res,2016,5(3):191-194.
16 成俊遥,宋凯,郑国权,等.强直性脊柱炎重度胸腰段后凸畸形患者的双节段截骨设计[J].脊柱外科杂志,2017,15(3):141-145.
17 宋凯,张永刚.强直性脊柱炎胸腰段后凸畸形矫形设计概述[J].解放军医学院学报,2015,36(5):521-524.
18 Jain S,Eltorai AE,Ruttiman R,et al.Advances in Spinal Interbody Cages[J].Orthop Surg,2016,8(3):278-284.
19 Chastain CA,Eck JC,Hodges SD,et al.Transforaminal lumbar interbody fusion:a retrospective study of long-term pain relief and fusion outcomes[J].Orthopedics,2007,30(5):389-392.
20 Hou Y,Shi J,Sun J,et al.Transvertebral Bone Graft and Augmentation Versus Posterior Spinal Instrumentation in the Treatment of Simple Thoracolumbar Compression Fractures[J/OL].https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30273-0.
21 Kinaci A,Neuhaus V,Ring DC.Trends in bone graft use in the United States[J].Orthopedics,2014,37(9):e783-e788.
22 Tuchman A,Brodke DS,Youssef JA,et al.Autograft versus Allograft for Cervical Spinal Fusion:A Systematic Review[J].Global Spine J,2017,7(1):59-70.
23 Niu CC,Liao JC,Chen WJ,et al.Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion:titanium cages versus polyetheretherketone(PEEK)cages[J].J Spinal Disord Tech,2010,23(5):310-316.
24 Derman PB,Albert TJ.Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis[J].Curr Rev Musculoskelet Med,2017,10(4):530-538.
25 Panayotov IV,Orti V,Cuisinier F,et al.Polyetheretherketone(PEEK)for medical applications[J].J Mater Sci Mater Med,2016,27(7):118.
26 Zhou L,Qian Y,Zhu Y,et al.The effect of different surface treatments on the bond strength of PEEK composite materials[J].Dent Mater,2014,30(8):e209-e215.
27 Faraj SSA,Van Hooff ML,Holewijn RM,et al.Measuring outcomes in adult spinal deformity surgery:a systematic review to identify current strengths,weaknesses and gaps in patient-reported outcome measures[J].Eur Spine J,2017,26(8):2084-2093.
28 Wang Y,Zhang Y,Zhang X,et al.Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity[J].Eur Spine J,2009,18(10):1436-1441.
29 杨全中,张雪松,杨晓清,等.脊柱后路去松质骨截骨术用于脊柱畸形翻修手术的安全性和有效性[J].中国脊柱脊髓杂志,2016,26(8):715-722.
30 Shibuya N,Jupiter DC.Bone graft substitute:allograft and xenograft[J].Clin Podiatr Med Surg,2015,32(1):21-34.