陈海岳,李洪安,杨文东,阿 海,关炳瑜

颈椎前路椎间盘切除融合术（Anterior Cervical Discectomy and Fusion，ACDF）长期以来被视为治疗多种退行性颈椎疾病（如神经根型颈椎病、脊髓型颈椎病、颈椎间盘突出症等）的金标准手术方式。传统ACDF术中，在椎间放置融合器（Cage）后，通常需要在椎体前方附加一块钛板并用螺钉固定在相邻椎体上，以提供术后的即刻稳定性和促进融合。然而，这种“Cage+钛板”的组合存在一个显著的缺点：钛板及螺钉头对覆盖其上的食管、气管等前纵韧带前方软组织形成机械性突起（即“切迹”），成为术后吞咽困难（Dysphagia）发生的重要危险因素之一，其发生率可达30%以上，部分患者症状迁延不愈，显著影响术后生活质量。为克服这一局限，零切迹椎间融合器（Zero-Profile Cage，ZP-Cage）应运而生。本文旨在系统综述零切迹椎间融合器在颈椎疾病领域中的应用现状，结合近十年的关键研究进展，评估其临床效果、优势、局限性及未来发展方向。

零切迹椎间融合器；颈椎疾病；应用

[1] Lu,V.M.,et al.(2024).A Multicenter Randomized Controlled Trial Comparing Zero-Profile Devices versus Traditional Cage-Plate Constructs in Single-Level Anterior Cervical Discectomy and Fusion:Five-Year Clinical and Radiographic Outcomes.Spine Journal, 24(3),421–430. [2] Wu,T.,et al.(2021).Zero-profile implant versus conventional cage–plate construct in anterior cervical discectomy and fusion for the treatment of symptomatic cervical spondylosis:a meta-analysis of randomized controlled trials.Journal of Orthopaedic Surgery and Research,16(1),208. [3] Scholz,M.,et al.(2014).A new zero-profile implant for stand-alone anterior cervical interbody fusion.Clinical Orthopaedics and Related Research,472(2),546–553. [4] Li,Z.,et al.(2019).Adjacent segment degeneration after single-level anterior cervical discectomy and fusion:a comparison between zero-profile implant and cage with plate.European Spine Journal,28(9),2101–2110. [5] Park,J.H.,et al.(2016).Early complications and outcomes of zero-profile devices versus conventional plate devices in single-level anterior cervical discectomy and fusion.Journal of Clinical Neuroscience,34,242–246. [6] Chen,Y.,et al.(2020).Does Zero-Profile Anchored Cage Implant Reduce the Incidence of Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion Surgery?A Minimum 5-Year Follow-up Study.Orthopaedic Surgery,12(2),510–518. [7] Shi,S.,et al.(2019).Comparison of Standalone Zero-Profile Devices versus Cage-Plate Constructs in Three-Level Anterior Cervical Discectomy and Fusion:A Minimum 2-Year Follow-Up Study.World Neurosurgery,131,e390–e397. [8] Yang,J.S.,et al.(2020).Subsidence and Nonunion After Anterior Cervical Discectomy and Fusion With a Zero-Profile Integrated Plate and Spacer Device.Global Spine Journal,10(7),848–855. [9] Liu,Y.,et al.(2018).Zero-profile anchored spacer versus conventional plate-cage construct in anterior cervical discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy:a comparative study.BMC Musculoskeletal Disorders,19(1),119. [10] Wang,B.,et al.(2017).Comparison of Zero-Profile Device versus Plate-and-Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Fusion:A Minimum 2-Year Follow-up Study.World Neurosurgery,108,836–843. [11] Yao,Y.,et al.(2022).The Effect of Zero-profile Implants on Cervical Sagittal Alignment in Single-level Anterior Cervical Discectomy and Fusion:A Comparative Study with Traditional Cage-Plate Constructs.Journal of Orthopaedic Science,27(1),92–98. [12] Xu,R.,et al.(2021).Does the Zero-Profile Device Truly Reduce the Incidence of Postoperative Dysphagia Compared with the Traditional Plate?A Systematic Review and Meta-Analysis of Radiologic and Functional Outcomes.Clinical Spine Surgery,34(8), E435–E442. [13] Zhou,J.,et al.(2019).Risk factors for subsidence of zero-profile devices following single-level anterior cervical discectomy and fusion.Journal of Orthopaedic Surgery,27(3),1–6. [14] Zhang,L.,et al.(2023).Application of 3D-Printed Patient-Specific Zero-Profile Titanium Cage in Complex Anterior Cervical Reconstruction:Technical Note and Early Outcomes.Neurosurgical Focus:Video,8(1),V8. [15] Burkus,J.K.,et al.(2016).Clinical and radiographic outcomes of anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device:two-year results from a prospective,multicenter study.Spine,41(Suppl 8),S111–S112. [16] Lu,T.,et al.(2015).Comparison of Zero-profile device versus plate-cage construct in treatment of cervical spondylotic myelopathy:a meta-analysis.European Journal of Orthopaedic Surgery&Traumatology,25(Suppl 1),S183–S190. [17] Lee,D.H.,et al.(2017).Radiologic Changes of Zero-profile Device(Zero-P)and Conventional Cage-Plate Construct After Single-level Anterior Cervical Discectomy and Fusion:Comparative Study.Korean Journal of Spine,14(4),125–130. [18] Chen,C.M.,et al.(2020).Surface Modification of Titanium Alloy Zero-Profile Cage with Hydroxyapatite/Chitosan Composite Coating Promotes Osteointegration in a Canine Model.ACS Biomaterials Science&Engineering,6(4),2270–2279. [19] Liu,X.,et al.(2021).Biomechanical comparison of a novel zero-profile,self-locking stand-alone cage versus traditional cage-plate constructs in single-level ACDF:a finite element analysis.Computer Methods in Biomechanics and Biomedical Engineering, 24(9),1003–1015.

点击下载PDF