Abstract：
OBJECTIVE: The unclear clinical outcomes of two different zero-profile implants with different number of screws in hybrid surgery restricts the choice of patient-specific implants. This study aims to compare two different implants on its postoperative subsidence, motion stabilization and clinical outcomes. It also provides references to the most reasonable implant choice in fusion surgery.
METHODS: This was a retrospective study. From February 2014 to March 2022, 173 patients who underwent hybrid surgery were included. Among them, 122 received surgery with a four screw implant, while 51 received a two screw implant. We analyzed the significance of patient-specific factors, radiographic factors and clinical outcomes. The Wilcoxon rank sum test, t tests/analysis of variance (ANOVA) test and stepwise multivariate logistic regression were adopted for statistical analysis.
RESULTS: No statistically significant difference was observed between the two screw and four screw groups in terms of immediate, middle, and long-term stability and fusion rate (p > 0.05). However, the two screws group had higher FSU height subsidence at 3, 6, and 12 months postoperatively and higher rates of significant subsidence at three and 6 months postoperatively (p < 0.05). Both groups showed significant clinical improvements at the final follow-up.
CONCLUSIONS: Two screw and four screw implants provide comparable stability, fusion rates and clinical outcomes. However, the two screw implant was inferior to the four screw implant in subsidence prevention. Therefore, the two-screw implant is non-inferior to the four-screw implant in most patients. It can be used as the priority choice in the fusion segment by its easy manageability. However, the patients with a high risk of subsidence such as multilevel surgery, the elderly, lower BMD, bad cervical alignment should receive a four screw implant rather than a two screw implant.
METHODS: This was a retrospective study. From February 2014 to March 2022, 173 patients who underwent hybrid surgery were included. Among them, 122 received surgery with a four screw implant, while 51 received a two screw implant. We analyzed the significance of patient-specific factors, radiographic factors and clinical outcomes. The Wilcoxon rank sum test, t tests/analysis of variance (ANOVA) test and stepwise multivariate logistic regression were adopted for statistical analysis.
RESULTS: No statistically significant difference was observed between the two screw and four screw groups in terms of immediate, middle, and long-term stability and fusion rate (p > 0.05). However, the two screws group had higher FSU height subsidence at 3, 6, and 12 months postoperatively and higher rates of significant subsidence at three and 6 months postoperatively (p < 0.05). Both groups showed significant clinical improvements at the final follow-up.
CONCLUSIONS: Two screw and four screw implants provide comparable stability, fusion rates and clinical outcomes. However, the two screw implant was inferior to the four screw implant in subsidence prevention. Therefore, the two-screw implant is non-inferior to the four-screw implant in most patients. It can be used as the priority choice in the fusion segment by its easy manageability. However, the patients with a high risk of subsidence such as multilevel surgery, the elderly, lower BMD, bad cervical alignment should receive a four screw implant rather than a two screw implant.
摘要：
目的：混合手术中两种具有不同螺钉数量的不同零轮廓植入物的临床结局不明确，限制了患者特定植入物的选择。本研究旨在比较两种不同的植入物对其术后沉降的影响,运动稳定和临床结果。这也为融合手术中最合理的植入物选择提供了参考。
方法：这是一项回顾性研究。从2014年2月至2022年3月，纳入了173例接受混合手术的患者。其中,122接受了四螺钉植入物的手术，而51接受了两个螺钉植入物。我们分析了患者特定因素的意义，影像学因素和临床结果。Wilcoxon秩和检验,采用t检验/方差分析（ANOVA）检验和逐步多变量逻辑回归进行统计分析。
结果：两个螺钉组和四个螺钉组之间在即刻，中间,和长期稳定性和融合率(p>0.05)。然而,两个螺钉组术后3,6和12个月时FSU高度沉降较高,术后3和6个月时显著沉降的发生率较高(p<0.05).两组在最后的随访中均显示出明显的临床改善。
结论：两个螺钉和四个螺钉植入物提供了相当的稳定性，融合率和临床结果。然而,在防止沉降方面，两螺钉植入物不如四螺钉植入物。因此,在大多数患者中，双螺钉植入物不劣于四螺钉植入物。由于其易于管理，可以用作融合段的优先级选择。然而,具有高沉降风险的患者，如多级手术，老年人,较低的BMD,不良的子宫颈排列应该接受四螺钉植入物，而不是两螺钉植入物。
方法：这是一项回顾性研究。从2014年2月至2022年3月，纳入了173例接受混合手术的患者。其中,122接受了四螺钉植入物的手术，而51接受了两个螺钉植入物。我们分析了患者特定因素的意义，影像学因素和临床结果。Wilcoxon秩和检验,采用t检验/方差分析（ANOVA）检验和逐步多变量逻辑回归进行统计分析。
结果：两个螺钉组和四个螺钉组之间在即刻，中间,和长期稳定性和融合率(p>0.05)。然而,两个螺钉组术后3,6和12个月时FSU高度沉降较高,术后3和6个月时显著沉降的发生率较高(p<0.05).两组在最后的随访中均显示出明显的临床改善。
结论：两个螺钉和四个螺钉植入物提供了相当的稳定性，融合率和临床结果。然而,在防止沉降方面，两螺钉植入物不如四螺钉植入物。因此,在大多数患者中，双螺钉植入物不劣于四螺钉植入物。由于其易于管理，可以用作融合段的优先级选择。然而,具有高沉降风险的患者，如多级手术，老年人,较低的BMD,不良的子宫颈排列应该接受四螺钉植入物，而不是两螺钉植入物。
