关键词: 聚醚醚酮, 前后入路, 前柱重建, 胸腰段骨折, 骨质疏松

Abstract:

Objective To assess the mid-term clinical prognosis and radiological outcomes of a novel expandable PEEK（polyetheretherketone） vertebral replacement device used for anterior and middle column reconstruction in the thoracolumbar spine of osteoporotic patients. Methods A retrospective analysis was performed on 52 patients with single-segment osteoporotic thoracolumbar fractures who underwent vertebral body replacement surgery between January 2020 and December 2023. The surgical procedures included either a thoracoscopic or minimally invasive anterior approach， combined with posterior short-segment cement-augmented screw fixation. According to the type of replacement material used， patients were categorized into two groups： the novel PEEK group and the titanium Mesh cage group. Data on surgical time， intraoperative blood loss， and postoperative complications were collected. The Visual Analogue Score （VAS）， Oswestry Disability Index （ODI）， local kyphotic angle （LKA）， fusion segment height （D-line）， anterior vertebral body height （AVBH）， and posterior vertebral body height （PVBH） were assessed at three stages： preoperatively， immediately postoperatively， and during the final follow-up. Results All patients were successfully discharged. In the PEEK group， the average operative time was （235.28 ± 58.69） minutes， and intraoperative blood loss was （680.00 ± 163.30） mL. The mean follow-up duration was （14.12 ± 2.44） months. The VAS score decreased significantly from （7.44 ± 0.87） preoperatively to （2.24 ± 0.93） at the final follow-up， and the ODI score also decreased significantly from （42.64 ± 4.86） preoperatively to （11.84 ± 3.73） at the final follow-up， indicating substantial improvement in symptoms and function （P < 0.05）. At the final follow-up， LKA， D-line， and AVBH exhibited partial loss compared to immediate postoperative values （P > 0.05）， but they remained significantly improved compared to preoperative values （P < 0.05）. The postoperative complication rate was 12.00% （3/25）， and the fusion rate at the final follow-up was 100.00%. Similarly， the Mesh group effectively improved patient symptoms， function， and vertebral height （P < 0.05）. However， at the final follow-up， the PEEK group demonstrated significantly better LKA， D-line， and AVBH values compared to the Mesh group （P < 0.05）. Conclusion The short-segment cement-augmented internal fixation in combination with the novel expandable PEEK replacement device represents a viable solution for anterior column reconstruction in osteoporotic thoracolumbar fractures， as evidenced by its mid-term outcomes of effective pain relief， significant functional improvement， sustained maintenance of vertebral height， and successful deformity correction.

Key words: polyetheretherketone, anterior-posterior approach, anterior column reconstruction, thoracolumbar fracture, osteoporosis