限制性与非限制性滑动钛板在颈椎前路手术中的应用

Anterior cervical plate fixation:a clinical study of the effects of rigid and dynamic plate

目的:对比分析限制性与新型非限制型滑动钛板在颈椎前路手术中的疗效及优缺点。方法:2000年3月￣2004年12月连续诊治的58例颈椎伤病患者,其中应用限制性钛板27例,新型非限制性滑动钛板31例。对比分析两组患者的临床疗效、并发症、植骨融合率、椎体间高度及活动度变化。结果:平均随访28个月,两组患者术前、术后与随访时临床功能JOA评分均无显著性差异。影像学观察与测量非限制性钛板组1例假关节形成,1例可疑假关节形成,其余56例均达骨融合。术后两种内固定的单节段和双节段融合椎间高度均较术前有显著改善(P<0.05);随访显示在单节段融合,限制与非限制性内固定组椎间高度降低分别为0.5mm和1.6mm(P<0.05),而双节段融合,则分别为1.7mm和1.8mm(P>0.05)。结论:在单节段融合时,限制性钛板在维持椎体间高度方面优于非限制性钛板;本研究尚不能得出新型非限制性滑动钛板临床疗效优于限制性钛板的结论。

Objective：To compare the clinical outcomes between the rigid and dynamic anterior cervical plating system.Method：58 patients who underwent anterior cervical procedure with anterior cervical plating system were collected between March 2000 and December 2004.Patients ranged in age from 24 to 74 years （average 52 years）.Of these patients,27 were involved in rigid plates（Orion,CLSP） with 11 in single-level and 16 in two-level,31 in dynamic plates （ABC,Zephir） with 10 in single-level and 21 in two-level.Discectomy was used in 21 patients and single-level corpectomy was used in remaining 37 patients.Autografi illac crest bone was used in all of patients.Clinical outcomes was evaluated by Japanese Orthopaedic Association Scoring System（JOA score） and radiographs.Settling,Cobb angle and segment height were measured by plain X-ray at post-operation,3,6 and 12 months.Fusion was defined as the appearance of bridging trabecular bone and absence of motion in flexion-extension films.Result：The mean follow-up period was 28 months （range 12-65 months ）.Successful fusion was observed in 56 patients （96.6%）.There was no significant difference of JOA scores between the patients with rigid and dynamic anterior cervical plates. Settling occurred in most patients with ABC plate,mainly in first three months post-operatively.In single-level fusion patients,the average setting were 0.5mm and 1.6mm by using rigid and dynamic plates,respectively （P〈0.05）.But in two-level fusion patients,settling were 1.7mm and 1.8 mm,respectively（P〉0.05）.Lordosis was increased post-operative significantly in single-level fusion patients both in rigid and dynamic plate patients （P〈0.05）,but there was no significant improvement in two-level fusion patients （P〉0.05）.Conclusion：For single-level fusion,rigid plate is better in preservation of segment height than dynamic plate.There is no evidence to show dynamic anterior cervical plate has superior outcomes than rigid anterior cervical plate from present data.