零切迹椎间融合固定器与传统颈前路钢板Cage融合内固定治疗双节段颈椎病的比较

文题释义：零切迹椎间融合固定器：放入椎间隙内的融合器带斜向螺钉孔，通过孔置入螺钉可固定相邻椎体，且螺钉尾部沉入融合器内，椎体前方无内植物外露。传统颈椎前路钢板及Cage：前路行手术治疗减压患者椎间隙后，处理上下终板，于椎间隙内放入预填充骨块的Cage，于椎体前方安放钢板螺钉固定相邻椎体。背景：颈前路减压植骨融合是治疗颈椎病的一种经典手术方式，目前可选择零切迹椎间融合固定器与传统颈前路钢板、Cage作为内固定融合材料。与传统颈前路钢板固定系统相比，零切迹椎间融合固定器具有术后对食管干扰小、降低术后吞咽困难发生率、避免钢板过长或位置不佳损伤临近节段椎间盘等优势。目的：比较零切迹椎间融合固定器Zero-P与传统颈前路钢板Cage融合内固定治疗双节段颈椎病的安全性和有效性。方法：回顾性分析成都市第三人民医院2016年5月至2018年5月行颈椎前路减压植骨治疗的60例双节段颈椎病患者的临床资料，根据融合方式分为2组，Zero-P组采用Zero-P融合固定，钢板组采用颈椎前路钢板固定联合Cage置入，每组30例。2组患者对治疗方案均知情同意，且得到医院伦理委员会批准。采用日本骨科学会评分、颈部功能障碍指数、Bazaz吞咽功能评分评估临床疗效；行颈椎X射线、颈椎CT检查，测量颈椎曲度，观察植骨融合情况以及内植物移位、松动及断裂等并发症发生情况。结果与结论：①60例患者均顺利完成手术，术后伤口均Ⅰ期愈合，无神经损伤、食管瘘、脑脊液漏等严重并发症发生；②在术后随访中，2组患者颈部功能障碍指数及日本骨科学会评分、植骨融合率差异均无显著性意义(P > 0.05)；③Zero-P组患者吞咽困难发生率和严重程度在术后各随访时间点均低于钢板组(P均< 0.05)；④术后6个月及末次随访，钢板组患者在颈椎整体曲度和手术节段曲度方面均优于Zero-P(P < 0.05)；⑤提示双节段Zero-P椎间融合是一种安全有效的治疗方式，在手术时间、出血量、透视次数、术后吞咽困难发生率方面均优于传统颈椎前路钢板固定系统，但在颈椎曲度方面不如传统颈前路钢板系统。术前颈椎曲度明显异常的患者不推荐使用Zero-P椎间融合固定器作为内固定器械。ORCID: 0000-0003-3584-5276(余彬)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Comparison between anterior cervical discectomy and fusion using Zero-P and traditional anterior cervical plate plus cage for treating two-level cervical spondylosis

BACKGROUND:Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis.At present,we can use a Zero-P interbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material.The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation.Besides,the Zero-P could avoid the risk of excessively long or poorly placed plate injury to adjacent segmental intervertebral discs.OBJECTIVE:To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage.METHODS:Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People’s Hospital from May 2016 to May 2018 were retrospectively analyzed.The patients were divided into Zero-P group(Zero-P fusion,n=30) and plate group(anterior cervical plate fixation combined with cage implantation,n=30).All patients in the two groups had informed consent to the treatment plan.This study was approved by the hospital ethics committee.The Japanese orthopedic association score,neck disability index score and Bazaz swallowing function score were used to evaluate the clinical efficacy.Cervical X-ray and cervical CT scans were performed to assess cervical curvature,observe bone graft fusion,and implant displacement,loosening and breakage.RESULTS AND CONCLUSION:(1) All surgeries were successfully completed in 60 patients.The wounds healed in stage I after operation.There were no serious complications such as nerve injury,esophageal fistula,and cerebrospinal fluid leakage.(2) During the follow-up,there was no significant difference in neck disability index,Japanese orthopedic association score and bone graft fusion rates between the two groups(P> 0.05).(3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation(all P <0.05).(4) The overall curvature and operative segments curvature were better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up(P <0.05).(5) Two-level anterior cervical discectomy and fusion using Zero-P is a safe and effective operative method.The operation time,bleeding volume,number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system,but it is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine.Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation.