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

张少甫，胡凡琦，杨晓清，王 尧，张智发，张雪松

解放军总医院 骨科，北京 100853

Abstract: 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.

Keywords: polyetheretherketone; thoracolumbar kyphosis; ankylosing spondylitis; spinal instrumentation; spinal fractures

强直性脊柱炎(ankylosing spondylitis，AS)是一 种主要累及中轴关节，以关节韧带骨化为特征的慢性炎症性疾病，晚期易伴发矢状面屈曲畸形[1-2]，易发生经椎体或椎间盘破坏性病变，即Andersson损害(Andersson Lesion)[2]，AS胸腰段后凸畸形合并Andersson损害患者脊柱区域出现Andersson骨折通常以累及三柱的贯通性骨折为主要损伤，且Andersson骨折常位于应力较为集中的胸腰段顶锥区域，假关节易形成而引起活动相关疼痛、肌肉疲劳，同时关节突及黄韧带易骨化会造成椎管狭窄及椎间孔狭窄引起神经压迫症状[3-4]。经保守治疗无效的AS胸腰段后凸畸形合并Andersson骨折患者，外科手术是主要治疗方法[5]。手术目的是重建和改善矢状位平衡，恢复脊柱对线和水平视野，获得满意的外观及疗效[6]。目前治疗AS胸腰段后凸畸形合并Andersson骨折的手术入路主要有脊柱前路、后路以及后前路联合[7]。单纯前路手术融合效果好但矫形效果较差，单纯后路手术融合效果较差易产生断钉断棒的风险，后前路联合手术复杂且创伤较大[8-9]。另外张宏其等[10]报道了单存后柱短缩截骨的优点，包括创伤小、难度较低同时矫形效果良好，但后柱短缩有硬脊膜和脊髓皱缩的潜在风险[11]。植骨融合术治疗脊柱退行性疾病的疗效已经获得国内外认可[12]。植骨融合材料在术中应用对于保障和提高手术的疗效及安全性起着重要作用，然而目前其应用于脊柱畸形后路截骨手术的临床疗效报道较少。……