Goldberg Grigory, Albert Todd J, Vaccaro Alexander R, Hilibrand Alan S, Anderson D Greg, Wharton Nicholas
Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA 19107, USA.
Spine (Phila Pa 1976). 2007 Jun 1;32(13):E371-5. doi: 10.1097/BRS.0b013e318060cca9.
This study is a retrospective review of fusion rates for cervical plates, analyzed by means of computerized analysis.
This study compares the fusion rates for two-level anterior cervical discectomy and fusion between patients with static versus dynamic plates.
Anterior cervical plating has been shown to decrease the pseudarthrosis rate. However, static plates, which have been successful in reducing nonunion rates, may be "too rigid" in certain situations, leading to pseudarthrosis in some patients. Recently, some surgeons have begun using dynamic plate constructs to avoid this problem.
A retrospective review was performed of patients having a two-level anterior cervical discectomy and fusion performed either with a static or dynamic plate. A computerized method for evaluating the presence of a solid fusion was used with a criterion of <2 degrees of motion considered a solid fusion.
The follow-up time period averaged 10 months (range, 5.8-13 months) for the static plate group and 9.5 months (range, 5.8-13 months) for the dynamic plate group. Based on a motion threshold of 2 degrees, the rate of fusion per level for patients in the static plate/autograft group was 87.8%, resulting in an overall fusion rate of 76.2%. The rate for fusion per level for patients treated with a dynamic plate and allograft was 89.8%, with an overall fusion rate of 81.8%. There was no statistically significant difference between the two groups (P = 0.469). The fusion rate increased during the follow-up period: In the 6- to 9-month interval, the static plate/autograft group had a 62.5% fusion rate, versus 75% for the dynamic plate/allograft group. In the 10- to 13-month interval, the fusion rate had increased to 84.7% for the static plate/autograft group and 90% for the dynamic plate/allograft group.
Computerized evaluation of digitized films can improve the accuracy and reproducibility of the analysis of anterior cervical fusion. An angular threshold of 2 degrees was selected for this purpose. This study showed that the rate of fusion with a dynamic plate was similar to that of the static plate despite the use of allograft bone with the dynamic plate. In addition, this study found that successful fusions continued to evolve throughout the first year following surgery.
本研究是一项对颈椎钢板融合率的回顾性分析，采用计算机化分析方法。
本研究比较了静态钢板与动态钢板在双节段颈椎前路椎间盘切除融合术患者中的融合率。
颈椎前路钢板固定已被证明可降低假关节形成率。然而，成功降低骨不连发生率的静态钢板在某些情况下可能“过于僵硬”，导致部分患者出现假关节。最近，一些外科医生开始使用动态钢板结构来避免这一问题。
对接受双节段颈椎前路椎间盘切除融合术并使用静态或动态钢板的患者进行回顾性分析。采用一种计算机化方法评估是否存在牢固融合，以运动度<2°作为牢固融合的标准。
静态钢板组的平均随访时间为10个月（范围5.8 - 13个月），动态钢板组为9.5个月（范围5.8 - 13个月）。基于2°的运动阈值，静态钢板/自体骨移植组患者每节段的融合率为87.8%，总体融合率为76.2%。使用动态钢板和异体骨移植治疗的患者每节段融合率为89.8%，总体融合率为81.8%。两组之间无统计学显著差异（P = 0.469）。随访期间融合率有所增加：在6至9个月时，静态钢板/自体骨移植组的融合率为62.5%，动态钢板/异体骨移植组为75%。在10至13个月时，静态钢板/自体骨移植组的融合率增至84.7%，动态钢板/异体骨移植组为90%。
数字化影像的计算机化评估可提高颈椎前路融合分析的准确性和可重复性。为此选择了2°的角度阈值。本研究表明，尽管动态钢板使用了异体骨，但动态钢板的融合率与静态钢板相似。此外，本研究发现术后第一年成功融合仍在持续发展。
