215 …… Experience exchange Application of 0rion locking anterior cervical spine plate in anterior cervical surgery Shao Qingdong, Xiao Jianru 2, Jiang Feng 1, Jiang Lunfa 1 (1. Department of Orthopedics, the 455th Hospital of the PLA, Shanghai 2000522. Shanghai Changzheng Hospital Orthopedics, Shanghai 200003) ACLPS) Value and role in anterior cervical surgery. Methods 15 patients with cervical spondylosis were treated with subtotal cervical resection + bone grafting and ACLPS internal fixation. Results 12 of 15 cases were followed up for> 6 months. In all cases, the bone grafts healed completely, and no cases of complications such as loosening and fracture of plate screws occurred, and the patients' symptoms improved to varying degrees. Conclusion ACLPS is easy to operate and firmly fixed, and is especially suitable for the application in anterior cervical surgery.
With the advancement of technology, various anterior cervical spine fixation equipments have been continuously introduced into the clinic, such as Caspar (1989), Aebi (1991) AO blunt titanium locking steel plate, etc., our hospital from October 1997 to April 2000 in Anterior cervical locking plate system (ACLPS) was used to treat 15 patients with cervical disease during anterior cervical surgery, and satisfactory results were obtained. 1 Clinical data 1.1 15 patients in this group, 12 males, 3 females, and 3 years old 52 years old, average 44 years old. Among them, there were 4 cases of cervical spondylosis, 3 cases of cervical disc herniation, 6 cases of cervical fracture, dislocation with paraplegia, 1 case of cervical tumor, 1 case of cervical posterior longitudinal ligament ossification (0PLL) (Franke classification was used to evaluate neurological function, of which 2 cases were grade A , 3 cases of grade B, 4 cases of grade C, 4 cases of grade D, and 2 cases of grade E.) All patients underwent standard X-ray radiography and CT or MRI before operation to determine the extent of the lesion and the extent of involvement. There are 11 cases of two intervertebral spaces in the vertebral body, and 4 cases involving three intervertebral spaces of the two vertebral bodies.
1.2 The internal fixation material is the Orion locking cervical spine anterior steel plate system provided by Sofamor Danek company. The length of the plate is 25 ~ 90mm, during which it is delivered every 2.5mm, the plate is 18mm wide and 2mm thick; There are three types of cortical bone fixation screws and locking screws. The cancellous bone fixation screw has a diameter of 4mm and a length of 10 ~ 24mm, with 1.0mm in between; the locking screw is 2mm long, and one locking screw can lock a pair of cancellous bone screws to prevent the screw from retreating. The surface of the pre-bent steel plate was designed with radians with intermittent diagonally collapsing grooves for screws to be placed in any suitable position. 1.3 Surgical method Supine, neck neutral position, general anesthesia, research direction: spinal surgery.
Conventionally, without a towel, make a 4-6 cm long oblique incision on the front right side of the neck to reveal the diseased vertebral body or segment and its adjacent upper and lower vertebral bodies. Removal of the 1/3 bone at the edge of the diseased intervertebral disc and its adjacent upper and lower vertebral bodies. For tumors or burst fractures of the vertebral body, subtotal vertebral body decompression should be performed to remove the hardened tissue pressed on the surface of the dura mater. After the decompression of the injured spinal cord is completed, hemostasis is completed, and a piece of iliac bone is repaired into a corresponding shape. The bone defect after implantation of decompression is placed under the "C * arm X-ray TV monitor. Select a plate of appropriate length to be placed in front of the vertebrae. , Drill holes in sequence, tap, screw in 4 cancellous bone screws, and finally screw the two locking screws between the upper and lower pairs of cancellous bone screws respectively 1.4 Postoperative treatment General postoperative cervical neck protection In February, 1 week after operation, the patient could go to the ground or get out of bed. 1.5 Results There were no intraoperative complications in this group. The operation time was 80 to 130 minutes. There were 4 cases of sore throat and dysphagia after operation, 1 case of hiccup, and hoarse voice 2 The cases were all caused by surgical traction. After symptomatic treatment, they were relieved within 3 to 5 days after surgery. There were 2 cases of redness and swelling around the incision. No deep infection was found. All cases were taken at 2 weeks, 8 weeks, and 12 weeks. , All bone grafts reached clinical healing after 12 weeks. Cervical spine physiological curvature was maintained well, without plate Breaking screw, slippage, and other complications loose but four cases of complete paralysis, 2 patients restricted neck flexion, the remaining neck were normal, without dysphagia patients and foreign body sensation.
2 Discussion Cloward (1961) and others reported that the anterior decompression and bone graft fusion has been widely used since the procedure has also caused many problems, such as fracture and dislocation patients, the fracture of the cervical longitudinal ligament does not provide sufficient stability. Bone mass slipped and bone grafts did not fuse to form a pseudo-joint, resulting in instability and deformity of the cervical spine in the future, and also added postoperative rehabilitation and nursing time. This brings forward the use of internal fixation technology for anterior cervical decompression and bone grafting. Qina currently uses the vertebral screw fusion (TFC) AO anterior cervical plate, etc., but in practice we found that the Orion anterior cervical plate seems to The vertebral Orion plate, which is more suitable for the Chinese, is easy to operate and reliable. The system has a variety of different specifications of the plate, which can be selected during the operation according to the different vertebral body thickness needs of different patients. The plate also has a locking device designed by A locking screw locks a pair of cancellous bone screws to effectively prevent the screws from slipping and loosening, so that the steel plate, screws and vertebral bone grafts are firmly connected into one body, which is conducive to the fusion of bone grafts. The operation of this system is not complicated, the key It is the accurate placement of the internal fixation. 1 First, make sure that at least two sides of the iliac block of the appropriate size are cortical bone. 2 It is best to use a cervical distraction device. Especially in patients with cervical fractures, the normal physiological height disappears and the distraction device can be restored. The cervical spine height 3 steel plate should be pre-bent before placement to ensure that the steel plate matches the curvature of the vertebral body after insertion. 4 The cancellous bone screw must be screwed in the vertebral body, not in In the intervertebral space, otherwise the steel plate is easy to slip off and damage the esophagus, so intraoperative C-arm X-ray machine monitoring is essential. The advantages of Orion blunt titanium steel plate: (1) patients with high internal stability can get out of bed early (2) Appropriate pre-bending of the steel plate allows it to absorb more tension, reduce the movement of the bone graft and the upper and lower vertebral body plates, and make it easier to merge (3) The Orion steel plate is fixed internally and does not require strong external fixation. It only needs to be protected by the neck brace. The patient is easy to accept. (4) The operation is simple and the complications are few. Because the cancellous bone screw does not have to penetrate the posterior margin of the vertebral cortex, the risk of damaging the spinal cord is avoided. (5) The pure titanium plate does not affect the postoperative MRI observation, which is convenient for understanding the decompression effect and the evaluation of the postoperative effect. The neurological symptoms of 15 patients have improved to varying degrees after surgery, especially in patients with cervical disc herniation. Patients with fractures and paraplegia have poor recovery of nerve function due to compression of the spinal cord, but internal fixation can play a role in stabilizing the spine, and can prevent the symptoms from further aggravating, so there is still a need for surgical treatment. As for the grasp of surgical indications, we It is considered that there is obvious spinal cord compression and neurological symptoms, and this method can be used when the cervical spine is in an unstable state. Of course, due to the small number of our surgical cases, some places still need to be further explored and explored as a newer surgical method. Orion self-locking steel plate is one of the best solutions in line with the basic principles of modern anterior cervical surgery The price is expensive, and there are certain plate and screw complications that limit its wide application. Since our follow-up time is not long, the effect on cervical spine movement after multi-segment vertebral fusion remains to be further observed
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