内置物Zero-P与传统椎间融合器加钛板修复神经根颈椎病：2年随访疗效及影像学比较

背景：虽然经前路椎体融合应用于颈椎退行性疾病的治疗超过50年,但至今对其技术的标准化仍然存在争议.单独使用椎间融合器最主要的缺点是即时稳定性欠佳和融合器下沉;椎间融合器配合前路钛板最主要的缺点是术后钛板区域吞咽困难及手术间盘周围异位骨化.目的：对比新的内置物Zero-P和传统椎间融合器加钛板治疗神经根颈椎病的临床疗效及影射学结果.方法：回顾性分析56例行颈椎前路减压植骨融合内固定神经根型颈椎病患者的临床资料,根据内固定方案分为两组：Zero-P组患者25例共31个节段,传统组（传统椎间融合器＋锁定钛板）患者31例共40个节段,两组患者年龄、性别及手术节段位置差异均无显著性意义;比较两组患者的颈椎功能障碍指数、吞咽困难发生率、Cobb C角、Cobb S角、椎体高度、椎体稳定性及异位骨化程度.结果与结论：两组患者内固定后24个月时的颈椎功能障碍指数明显低于内固前（P＜0.05）,内固定后患者症状明显好转.Zero-P有1例内固定后早期发生吞咽困难,24个月随访时症状消失;传统组2例内固定后发生吞咽困难,两组吞咽闲难发生率差异无显著性意义（P＞0.05）.两组Cobb C角及手术节段椎体高度在内固前与内固定后比较差异无显著性意义（P＞0.05）.Cobb S角Zero-P组患者在内固前至内固定后（即手术过程时间）呈明显增加趋势,最大值出现在内固定后第1次复查时;而传统组内固前至内固定后6周时Cobb S角呈缓慢增加趋势,内固定后6周左右Cobb S角达到最大值.Zero-P组融合节段均获得牢固骨性融合,而传统组31例患者中有30例均牢固骨性融合,稳定率达到97％.内固定后24个月随访发现,Zero-P组异位骨化发生率为25％,传统组异位骨化发生率为44％,Zero-P组内固定后24个月时的异位骨化率显著低于传统组（P＜0.05）.提示与传统钉板系统相比,Zero-P?

Zero-P implant versus traditional interbody fusion with titanium plate in the repair of nerve root cervical spondylosis： 2-year follow-up of efficacy and imaging

BACKGROUND： Anterior interbody fusion has been used to treat cervical degenerative diseases for more than 50 years, but the standardization of its technique remains controversial. The major disadvantages of alone use of interbody fusion cage are instant poor stability and fusion subsidence. The main disadvantages of interbody fusion with anterior titanium plate are dysphagia in the plate region and heterotopic ossification around the operated intervertebral disc side.
OBJECTIVE： To compare clinical and radiological efficacies of new implant Zero-P and traditional fusion with titanium plate for treatment of nerve root cervical spondylosis.
METHODS： We retrospectively analyzed clinical data of 56 patients with nerve root type cervical spondylosis undergoing anterior cervical decompression and fusion fixation. They were divided into two groups according to fixation scheme. Zero-P group contained 25 patients with 31 segments. Traditional group （traditional intervertebral fusion device ＋ locking titanium plate） contained 31 patients with 40 segments. There were no significant differences in age, gender and operated regions between above two groups. Cervical dysfunction index, the incidence of dysphagia, Cobb C angle, Cobb S angle, vertebral height, vertebral stability and heterotopic ossification degree were compared between the two groups.
RESULTS AND CONCLUSION： Cervical dysfunction index was significantly lower at 24 months after fixation than before fixation in both groups （P 〈 0.05）. Patient’s symptoms were obviously improved after fixation. One patient affected dysphagia in early stage after fixation in the Zero-P group. Symptoms disappeared during 24-month follow-up. Two patients experienced dysphagia in the traditional group after fixation. No significant difference in the incidence of dysphagia was detected between the two groups （P 〉 0.05）. No significant differences in Cobb C angle and vertebral height of surgical segment were detectable before and after fixation in the tw