The application of Z-Plate plate system in anterior thoracolumbar spine surgery Zeng Shixing Ma Yuanchen Wang Yisheng Zhou Liangan Z-Plate plate fixation. Compared with previous surgical methods, 6-15 patients were followed up to observe the fusion of bone graft. Results: Two patients with metastatic spinal tumors had died. The remaining patients had good bone graft growth, and there was no loose plate or Screw breakage. Conclusion: The application of Z-Plate plate in anterior thoracolumbar spine surgery is a simple and reliable method with high fixation rate of bone graft.
Thoracic and lumbar anterior bone graft fusion often requires internal fixation. In February of this year, our department applied Z-Plate steel plate system fixation to 26 patients with anterior bone graft, and achieved good results. The report is as follows.
1 Materials and methods 1.1 General information In this group, there are 12 males and 14 females, with a maximum age of 69 years, a minimum age of 32 years, and an average age of 48 years. Preoperative diagnosis: 11 cases of thoracolumbar fracture, 5 cases of thoracolumbar spine tuberculosis, 5 cases of metastatic cancer, 4 cases of lumbar spondylolisthesis, and 1 case of intervertebral discitis. There were 12 cases of inter-vertebral body fixation, 14 cases of adjacent vertebral body fixation, 24 cases of autogenous iliac bone grafting, and 2 cases of deep hypothermic bone grafting.
1.2 Observation indicators The operation time and bleeding volume required for each case were recorded intraoperatively, and postoperative follow-up was performed to observe the healing of bone graft.
1.3 Statistical methods Randomly select the previous 11 cases of Kandea internal fixation due to thoracolumbar fractures and the 11 cases of Z-Plate internal fixation in this group for statistical processing. Compare the intraoperative blood loss and the time required for the operation. The standard deviation (± s) of the mean means that the t test is used for comparison between the two groups.
1.4 Surgical method The patient is placed in a general anesthesia lateral position. The surgical approach depends on the need for the removal of the lesion. If necessary, the chest is opened, and the C-arm X-ray machine is positioned to expose the anterior side of the spine. The lesion is removed. If necessary, the pressure-forming tissue located in front of the posterior longitudinal ligament must be completely removed. The first bolt should be placed at the posterior and inferior edge of the lower fixed vertebral body, drill holes in a direction inclined forward 10 * parallel to the lower endplate, and screw in the bolts of appropriate length so that the bolts just pass through the cortex on the opposite side of the vertebral body. The bottom of the bolt is close to the vertebral body.
The second bolt should be placed on the posterior superior edge of the upper fixed vertebrae, driven in parallel with the upper end plate and inclined forward 10 *, and screw in the bolt of the appropriate length.
Take iliac bone graft or deep-temperature hypoallergenic bone graft, place a Z-Plate steel plate of appropriate length, press the bone graft with special compression forceps, tighten the nuts of the first and second bolts, the two on the front side The screws are located in front of the upper and lower vertebrae and the upper and lower vertebrae. The screws need to pass through the screw holes on the washer, about 10 * 1.5 times the central axis. Antituberculosis treatment for 1 year. After the wound is removed, the brace or plaster is used for external fixation. If the patient is in good condition, he can get out of bed.
2 Results All cases had no complications during the operation. The blood loss was followed up for 6-18 months after 300. Two patients with metastatic cancer died due to the further deterioration of the tumor. One patient with intervertebral discitis had serious psychiatric symptoms for unknown reasons. Now undergoing treatment by a psychiatrist, the bone graft is growing well. The remaining bone grafts are fused within 3-9 months. There is no bone graft non-healing or plate and screw fracture, and no obvious kyphosis and scoliosis deformities occur. . Compared with the previous cases of Kaneda internal fixation, 11 cases of fractures in this group had significant differences in bleeding volume and time required for surgery ("0.01", see Table 1. Table 1 Bleeding volume comparison (x * s) t value P value operation time (min) bleeding volume (ml) 3 Discussion 3.1 Reasonable design of Z-Plate steel plate spinal trauma or tuberculosis caused spinal cord or cauda equina compression, anterior surgery decompression implant Bone effect is superior to posterior surgery has been accepted by most scholars. Anterior internal fixation not only benefits bone graft growth and nerve function recovery, but also plays an important role in preventing postoperative kyphosis. The application of Z-Plate steel plate in anterior surgery provides an additional method for the selection of internal fixation of anterior surgical instruments; the steel plate is designed to be curved to adapt to the shape of the vertebral body, ensuring that the steel plate adheres to the side of the vertebral body after being placed. It can reduce the possibility of low back pain caused by the compression of the paravertebral tissue after the operation of the plate, and it is difficult to avoid this phenomenon with the conventional internal fixation equipment.
At the upper end of the steel plate, the screw is fixed through the slotted hole of the steel plate, and the bone graft compression can be completed by one press with the compression forceps, which significantly shortens the operation time. Z-Plate steel plate system titanium alloy has good compatibility with human body, which is convenient for postoperative MRI examination.
3.2 The biomechanical characteristics of the Z-Plate system The Z-Plate system is mainly composed of titanium steel plates and four cancellous bone screws. The screws pass through the bone cortex on the left and right sides of the vertebral body and are fixed to the upper and lower vertebrae of the bone graft. The vertebral bodies at both ends are tightly connected to form a fixed system, which has good stability. Dick has made a biomechanical comparison of the thoracolumbar spinal anterior internal fixation system. The results show that under axial pressure load, its stability is from strong to weak. The three systems are ATLP, Z-Plate, and Kane. Good stability, no statistically significant difference, but TSRH stability is poor. In terms of fatigue life testing, ATLP, Z-Plate life is much longer than KanedaTSRH.
3.3 The importance and possibility of internal fixation of Z-Plate system after spine infection The key to integration. However, different scholars have different views on whether to use internal fixation, because some scholars worry that the application of internal fixation in infected lesions will produce a foreign body reaction, which is not conducive to the treatment of infection. The traditional method is to remove the lesion and absolute bed rest after bone grafting. From 3 to 6 months, there are many disadvantages: (1) External fixation or bed rest cannot achieve the absolute braking of the bone graft segment, especially for young or old patients who need to turn over frequently. (2) Spinal infections, especially tuberculosis patients, are often of poor physique. Long-term bed rest is not conducive to disease recovery, and is prone to more complications. Recently, there are many scholars in China: 34 proposed that the application of internal fixation in the treatment of active tuberculosis lesions is feasible, and has a positive significance for the treatment of tuberculosis. Because internal fixation can stabilize the spine firmly, effectively prevent the displacement, collapse and absorption of the bone graft, it plays an important role in maintaining the height of the anterior column of the spine and avoiding kyphosis deformity. Of patients underwent postoperative Z-Plate plate fixation, and the good results obtained also showed that internal fixation can be applied after spinal infection and bone graft removal.
The application of Z-Plae steel plate in anterior spinal fixation is a novel and simple method, which can be applied to the internal fixation of the short anterior thoracolumbar spine, but because the steel plate and operating tools are imported, the price is relatively Expensive, if you can reduce the price or localization, it will be beneficial to the promotion and use of the system in the country.
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