Department of Orthopedics, The Sixth Medical Center, General Hospital of Chinese PLA, Beijing, 100048, China.
Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China.
BMC Musculoskelet Disord. 2023 Jan 18;24(1):37. doi: 10.1186/s12891-023-06156-9.
To compare the clinical and radiologic outcomes after anterior cervical dynamic or static plate fixation for short segment cervical degenerative disc diseases (DDD) for more than 5 years.
Sixty-four patients who underwent anterior cervical one level discectomy or corpectomy with an anterior cervical plate system were followed for an average of 6.8 years for clinical and radiographic outcomes. Among the sixty-four patients, thirty-eight patients were fixed with a static plate (ORION and CSLP plate system) and the other twenty-six patients were fixed with a dynamic plate (ABC plate). Radiographic data were collected included the global sagittal alignment of the cervical spine (C2-C7), the local height and angle of the operated level pre-operatively, postoperatively and at last follow-up. A clinical assessment was performed at pre-operatively, three months postoperatively and final follow-up using the Japanese Orthopedic Association (JOA) /Visual Analogue Score(VAS)/ Neck Disablility Index(NDI) scoring system.
The mean follow-up time was 6.8 years. At final review, there were two cases of suspicious pseudarthrosis which were from ABC plate fixation group while the other cases all gained solid fusion. The height of fusion segment gained significantly improvement for both dynamic and static plate group post-operation, and all groups demonstrated a significant loss in height postoperatively. Generally, for the one level ACDF group, the height decrease was 0.5 mm for static plate and 1.6 mm for dynamic group which was significantly different(p < 0.05). And for one level ACCF group, this type of difference was not seen in which decreasing was 1.7 mm for static group and 1.8 mm for dynamic group. Segmental lordosis of the fusion segments was increased significantly both post-operation and final follow-up than before-operation for both one and two segments fusion. Global cervical lordosis from C2-C7 was increased in the early postoperative period in all groups, and at final follow-up the total lordosis was still getting better compared with early postoperative period, but this increase was not statistically significant. Clinical assessment of JOA/NDI showed that there was significantly improvement 3-month post-operation compared with pre-operation, and the score could get a slight further improvement at the final follow-up.
Our study demonstrated a statistically similar fusion rate between dynamic and static cervical plate fixation. However, the height gained with static plate fixation for single segment disease was maintained better than with dynamic plate fixation and there was no difference between JOA outcome scores between groups. Despite the reported improved biomechanics of dynamic plate fixation, further research needs to be done to show the clinical advantage of dynamic plate fixation.
比较前路颈椎动态或静态板固定治疗短节段颈椎退行性椎间盘疾病（DDD）超过 5 年的临床和影像学结果。
对 64 例行前路颈椎单节段椎间盘切除术或椎体切除术并采用前路颈椎板系统的患者进行平均 6.8 年的临床和影像学随访。64 例患者中，38 例行静态板固定（ORION 和 CSLP 板系统），26 例行动态板固定（ABC 板）。收集的影像学资料包括颈椎（C2-C7）的整体矢状位排列、术前、术后和末次随访时手术节段的局部高度和角度。采用日本矫形协会（JOA）/视觉模拟评分（VAS）/颈部残疾指数（NDI）评分系统分别在术前、术后 3 个月和末次随访时进行临床评估。
平均随访时间为 6.8 年。末次随访时，有 2 例可疑假关节，均来自 ABC 板固定组，其余病例均获得牢固融合。术后动态和静态板组融合节段高度均显著改善，所有组术后高度均显著下降。一般来说，对于单节段 ACDF 组，静态板的高度下降为 0.5mm，动态板组为 1.6mm，差异有统计学意义（p<0.05）。而对于单节段 ACCF 组，静态组下降 1.7mm，动态组下降 1.8mm，两组之间没有这种差异。融合节段的节段前凸在术后和末次随访时均显著增加，均高于术前。所有组术后颈椎 C2-C7 的整体前凸均增加，末次随访时与术后早期相比，总前凸仍有改善，但无统计学意义。JOA/NDI 的临床评估显示，术后 3 个月与术前相比有显著改善，末次随访时评分略有进一步改善。
我们的研究表明，动态和静态颈椎板固定的融合率在统计学上相似。然而，对于单节段疾病，静态板固定获得的高度保持优于动态板固定，两组间 JOA 结果评分无差异。尽管有报道称动态板固定的生物力学性能有所改善，但仍需要进一步研究以显示动态板固定的临床优势。
