Koban Orkun, Öğrenci Ahmet, Akar Ezgi Ayçiçek, Uyanık Ahmet Sadık, Yılmaz Mesut, Dalbayrak Sedat
Okan University, Department of Neurosurgery, Istanbul, Turkey.
Okan University, Department of Neurosurgery, Istanbul, Turkey.
J Orthop Sci. 2021 May;26(3):369-374. doi: 10.1016/j.jos.2020.05.011. Epub 2020 Jun 27.
It is extremely difficult to treat spine disorders with stabilization in patients with rheumatoid arthritis. Because revision rates are significantly higher in rigid stabilization. To date, there is no data about patients with rheumatoid arthritis treated with dynamic stabilization. Our aim was to compare the radiological and clinical results of patients with rheumatoid arthritis who underwent lumbar rigid stabilization or dynamic stabilization with Polyetheretherketone rod (PEEK).
Patients with degenerative lumbar spine disease with rheumatoid arthritis who underwent dynamic stabilization between 2013 and 2015 and rigid stabilization between 2010 and 2012 were evaluated radiologically for adjacent segment disease, proximal junctional kyphosis, system problem (nonunion, screw loosening, instrumentation failure, pull out). It was also compared according to both the revision rates and the Visual Analog Scale and Oswestry Disability Index scores at the 12th month and 24th month.
The difference of decrease in Visual Analog Scale and Oswestry Disability Index scores from preoperative to 12th month between patients who underwent dynamic stabilization and rigid stabilization was statistically insignificant. However, there was a significant difference of increase in Visual Analog Scale and Oswestry Disability Index scores between the 12th month and 24th month of patients who underwent rigid stabilization, compared with patients with dynamic stabilization. In patients with dynamic stabilization, the problems of instrumentation were seen less frequently. Revision rates were high in patients with rigid stabilization when compared the patients with dynamic stabilization.
Radiological and clinical outcomes in patients with rheumatoid arthritis operated with dynamic stabilization are more significant when compared to rigid stabilization. These patients have lower pain and disability scores in their follow up periods. Revision rates are lower in patients with dynamic stabilization.
在类风湿关节炎患者中，采用稳定术治疗脊柱疾病极其困难。因为在刚性稳定术中翻修率显著更高。迄今为止，尚无关于采用动态稳定术治疗类风湿关节炎患者的数据。我们的目的是比较接受腰椎刚性稳定术或聚醚醚酮棒（PEEK）动态稳定术的类风湿关节炎患者的影像学和临床结果。
对2013年至2015年间接受动态稳定术以及2010年至2012年间接受刚性稳定术的患有退行性腰椎疾病的类风湿关节炎患者进行影像学评估，以检查相邻节段疾病、近端交界性后凸、系统问题（骨不连、螺钉松动、器械故障、拔出）。还根据翻修率以及第12个月和第24个月时的视觉模拟量表和奥斯威斯利功能障碍指数评分进行了比较。
接受动态稳定术和刚性稳定术的患者从术前到第12个月视觉模拟量表和奥斯威斯利功能障碍指数评分下降的差异无统计学意义。然而，与接受动态稳定术的患者相比，接受刚性稳定术的患者在第12个月至第24个月期间视觉模拟量表和奥斯威斯利功能障碍指数评分增加存在显著差异。在接受动态稳定术的患者中，器械问题出现的频率较低。与接受动态稳定术的患者相比，接受刚性稳定术的患者翻修率较高。
与刚性稳定术相比，采用动态稳定术治疗的类风湿关节炎患者的影像学和临床结果更显著。这些患者在随访期间疼痛和功能障碍评分更低。接受动态稳定术的患者翻修率更低。
