Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery

Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery Xiao-feng Zhao, Xiang-dong Lu, Yi-bo Zhao, De-tai Qi, Wen-xuan Wang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-15465/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND To observed and evaluated the clinical efficacy of a new type cervical anterior screw plate system development for anterior cervical surgery. Methods 27 patients with cervical spine disease treated with new PRUNUS nail plate internal fixation were selected as observation group, and 29 patients treated with conventional cervical anterior screw fixation were selected as the control group. Cervical stability, internal fixation position and bone graft fusion were evaluated according to imaging data. The operative time, intraoperative blood loss, cervical Cobb angle, VAS scores, and JOA scores were compared between the two groups. Spinal function scores and neurological improvement rates were used to evaluate the clinical efficacy of the new PRUNUS spine plate. Results There were statistical differences in operation time and blood loss between the two groups (P<0.05). The difference in Cobb angle, JOA score and improvement rate, VAS score before and after surgery in two groups were statistically significant (P0.05). Conclusion The new PRUNUS spine plate system can be applied to the anterior cervical spine surgery, and its clinical efficacy was similar to the traditional cervical anterior plate. But PRUNUS simplified the operation process, especially for the osteoporosis patients. Orthopedic Surgery PRUNUS Spine Plate System Anterior Cervical Spine Surgery Clinical Efficacy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background With the transformation of people's living habits and working methods, cervical-vertebral-related diseases such as cervical spondylosis and cervical trauma fractures have gradually become common clinical diseases. Surgical treatment is recommended as the therapeutic choice for patients with cervical spondylotic myelopathy who were unresponsive to regular conservative treatment. Since Bohler [1] first used the screw-plate system for anterior cervical fixation, and so the anterior cervical plate system has been improved in research and application in the following years. Although the application of the screw-plate system for anterior cervical fixation showed good clinical results [2-3], other postoperative complications may occur, including spinal injury, plate displacement, screw loosening and plate or screw fracture. Hence, the revision of the surgeries has been increased [4-5]. To solve the technical issues associated with plate displacement and screw loosening, scientific research has provided a new type of PRUNUS screw-plate system that is used for the anterior cervical vertebral surgery. Our study aimed to observe its clinical efficacy and explore the clinical application of the PRUNUS screw-plate system and its advantages. Methods Clinical materials 27 patients with cervical spine disease treated with anterior cervical decompression, cage or titanium mesh graft fusion, and new PRUNUS nail plate internal fixation were selected (observation group) from the Department of Orthopedics in our hospital from June 2016 to October 2017. Of these, 15 were male and 12 were female, with a mean age of 63.6 years, range 42-82 years. Nine patients had cervical spine fracture or dislocation (Frankel grade A 4 cases, B grade 2 cases, and D grade 4 cases), 11 patients had cervical spondylosis, 5 patients had postoperative revision surgery and 2 patients had a cervical vertebral metastatic tumour. The disease duration ranged from 2 days to 19 years with an average of 39.37 months. At the same time, 29 patients with cervical spine disease treated with cervical anterior decompression, cage or titanium mesh graft fusion, and conventional cervical anterior screw fixation were selected as the control group. Of these, 17 were male and 12 were female, with an average age of 65.9 years, range 39-85 years old. Eight patients had cervical spine fracture or dislocation (Frankel grade A 2 cases, B grade 2 cases, and D grade 4 cases), 19 patients had cervical spondylosis, 1 patient had postoperative revision surgery and 1 patient had cervical tuberculosis. The duration of the disease ranged from 3 days to 21 years with an average of 25.32 months. The inclusion criteria were as follows: (1) patients met the symptoms and signs of cervical spondylosis, cervical fracture, cervical disc herniation, cervical spondylitis or brucellosis, confirmed by imaging and neurophysiological examinations. (2) patients treated with anterior cervical surgery using the conventional cervical- and new PRUNUS nail plates. (3) patients who completed preoperative and postoperative imaging examinations and follow-up. (4) the main evaluation indicators included operation time, intraoperative blood loss, cervical vertebra Cobb angles, VAS scores， and the Japanese Orthopedic Association (JOA) scores. (5) a retrospective comparative study. The exclusion criteria were as follows: (1) patients with heart, brain, kidney, and other important organ diseases. (2) Cervical diseases caused by infection or tumour. (3) patients unable to cooperate with surgical treatment. Surgical method The patient was placed in supine position, and a transverse incision was made in front of the right neck. Followed by the incision of the skin, subcutaneous tissues, platysma and superficial cervical fascia to bluntly separate till the target vertebral body, and determine the vertebral body clearance of the lesion, and confirm the segment under the C-arm X-ray. Using the distractor, the adjacent vertebral body of the surgical lesion intervertebral space was distracted, and then the intervertebral disc or vertebral body subtotal excision of the intervertebral space was scraped. After decompression, the spinal cord should be inspected for no pressure, handle the cartilage endplate, and put it into a suitable size cage or a suitable length of titanium mesh. The C-arm perspective determines the position of the cage or titanium mesh accurately and well. The appropriate size of the new type of open dynamic nail plate that was close to the front edge of the vertebral body was selected, and locked in place after a good position. Rinse, place a negative pressure drainage tube after complete hemostasis, sew up the layers, and close the surgical incision. Drainage tube was indwelled for 1~3 days according to the drainage condition. After 3 days of operation, proper function exercise was allowed to get out of bed and under the brake. Efficacy evaluation Fifty-six patients were reviewed postoperatively, and routine cervical X-ray and MRI examinations were performed. The stability of the cervical spine, the position of the internal fixation, and the fusion of the bone graft were observed according to the imaging data. The cervical Cobb angle, visual analogue scores of pain (VAS) and Japanese Orthopedic Association (JOA) scores[6], neurological recovery rate [ recovery rate = (final follow-up score - preoperative score) / (17-preoperative score ) × 100%], the neurological function of patients before and after surgery was evaluated using Frankel grading were recorded to comprehensively evaluate the clinical efficacy of the new type of three-leaf reinforced cervical anterior screw-plate system. Statistical analysis The data were analyzed using SPSS, version21.0 for windows. The measured values were presented as means (±). A paired-sample t-test was performed for comparing the preoperative and the postoperative results, and the control group with the observation group. The test level was α=0.05. The statistical significance was considered as P<0.05. Results The observation group demonstrated an average operative time of 98.4±9.2 minutes (range 80-160minutes), while the mean intraoperative blood loss was 65.3±10.6ml (rang 50-100ml). The control group showed an average operative time of 109.7±9.4 minutes (range 70-170minutes), while the mean intraoperative blood loss was 72.9±15.6ml (rang 50-130ml). The difference in operative time and intraoperative blood loss between the two groups was statistically significant(P<0.05). In the two groups, the preoperative, one week postoperative, and the last follow-up of cervical cobb angle, JOA scores and VAS are shown in Table. The recovery rate in the control group was 89.74%±6.12%, and the recovery rate in the observation group was 88.69%±7.33%. The last follow-up cervical cobb angle, JOA scores and VAS scores in the control group and the observation group showed significant differences from their respective preoperative cervical cobb angle, JOA scores and VAS scores. But the values showed no statistical significance between the two groups (P>0.05) (Table 1-4; Fig 1-3). Postoperative drainage volume was less than 30ml and then the drainage tube was removed. On the second day after surgery, the patients with a cervical collar were moved down to the ground. In the control group, there were 9 patients with the complaint of hoarseness and 6 patients with dysphagia after surgery. In the observation group, 11 patients suffered from postoperative hoarseness, and 5 patients suffered dysphagia and began to relieve at 3 days after surgery and disappeared within one month. The average follow-up time was 7.33 months (5-18 months). In the control group, 4 patients with cervical spine fracture and dislocation in Frankel A and B demonstrated no sense and movement, while other patients were relieved of the symptoms. After one month, 2 of them began to recover from sensation and movement. During the last follow-up, the body movement function of these 4 patients had different degrees of recovery. In the observation group, 5 patients with cervical spine fracture and dislocation had no sense and movement, while other patients were relieved of the symptoms. Two of them began to recover from sensation and movement at 7 days after surgery, and 2 of them had a recovery of sensation and movement after one month. During the last follow-up, the body movement function of these 4 patients showed different degrees of recovery, and only one patient had dyskinesia in double limbs. No loosening, fracture, and break out of the plate and screws occurred in both the groups. Discussion Development and limitations of traditional cervical anterior plate In 1952, Abbott [7] has first proposed anterior cervical surgery. Later on, Robinson [8] and Smith [9] improved the technique in 1958 and proposed that anterior cervical discectomy and fusion with bone grafting using autologous bone grafting can promote the fusion rate. The surgery can directly remove the compressive elements, and ensure adequate decompression of the spinal cord. This subsequently improved the patient's symptoms. But this anterior decompression with bone grafting alone, without using plate and screw fixation can easily cause cervical instability. This instability also caused serious problems such as non-fusion of bone grafting and prolapse of bone grafting. So, Bohler [1] proposed the use of steel plate and screws in the anterior cervical surgery in 1964. In the following years, a variety of cervical anterior plate systems were developed, including non-locking non-robust type, locking firm type, variable angle semi-restricted type, and slip semi-limited type [10]. During the process of anterior cervical surgery, it is necessary to select an appropriate vertebral fixation device due to different bone qualities of the patient. After the surgery is completed, the implant is under a micro-motion state in the patient body, which causes displacement of the steel plate, loosening and fracture of the screw in the long-term micro-motion state. This finally fails the internal implant. Especially in patients with osteoporosis, there is a higher risk of plate displacement and screw loosening. Severe plate displacement and screw loosening can stress the blood vessels, trachea or oesophagus, and even cause vascular damage, trachea or oesophagal damage. Due to low bone mass, the bone microstructure is destroyed in patients with osteoporosis, causing increased bone fragility and easy fracture. It is more difficult to locate the steel plate in patients undergoing anterior cervical spine surgery for osteoporosis. Clinically, when patients with osteoporosis had accepted anterior cervical surgery, the incidence of internal fixation plates revision surgery was significantly increased. Design and advantages of the new PRUNUS nail plate system The PRUNUS nail plate system is made of medical titanium alloy, including titanium plate, fixing screws and locked plates. Titanium plate had a width of 17mm, length ranging 25-75mm, and increment of 3mm. Screw length ranged 25-75mm, and diameter of 4mm. The two ends of the titanium plate are designed as a curved surface, which can fix the surface of the actual anatomical bone. This, in turn, makes it suitable for the physiological curvature of the cervical spine, avoids the problem of uneven stress load effectively, and there are three screw holes are arranged in an isosceles triangle at the two ends. After the screws are fixed, they are fixed triangularly, and the screw nails cross each other, significantly enhancing the anti-rotation ability of the titanium plate system, and also reducing the risk of screw backing and screw fracture. A locked plate is provided in the middle of the screw hole to prevent screw loosening effectively. The middle part of the titanium place is provided with a large perspective window to facilitate bone grafting and the observation during and after surgery. The screws are designed with self-tapping screws, which reduces the usage of wiretapping. The screw diameters and colors can be distinguished, and at the same time, can be divided into fixed angles and adjustable angles, which are used for different indications (figure 5). Based on the recent biomechanical studies on the stability, fatigue life and pull-out strength, the PRUNUS plate system demonstrated good biomechanical properties, effective stability on the cervical spine and maintained the acute stability of the cervical spine, while it has a better anti-pull out strength and figure resistance. At the same time, through a biomechanical test and practical application in clinical surgery, we believed that the new PRUNUS nail plate system can achieve the fixation of cervical vertebrae more effectively, especially in patients with osteoporosis and multilevel cervical fusion. It can also reduce the risk of revision surgery due to screw loosening and plate displacement. Otherwise, it is particularly suitable for revision surgery. In the revision surgery, screws holes have already been drilled in the cervical vertebrae. Therefore, if the screws are placed in the original hole, the screws can be easily loosened and the plate can be displaced. If the new PRUNUS nail plate was used in the revision surgery, it affords a new position for the screws and disperses the screw force significantly. The geometrical principle of the three-point stable can be used to enhance the holding force of the plate, achieving a good fixed effect greatly and improving the success rate of revision surgery. The efficacy analysis of the new PRUNUS screw-plate system Through the follow-up data of the control and the observation groups, we found that the operative time and blood loss of the observation group were higher than the control group, but the differences between the two groups showed no statistical significance. Nevertheless, 5 patients are undergoing anterior cervical revision surgery in the observation group. The operations of these patients were generally more complex, had longer operation time and more bleeding. The use of the new type of PRUNUS screw-plate system can reduce the operative time and the amount of bleeding compared to conventional anterior cervical surgery. Meanwhile, it can also simplify the surgical procedures, reduce operative time and blood loss to enhance surgical safety. One week after postoperatively and the last follow-up demonstrated that the cervical cobb angle, JOA scores and VAS scores in the control group and the observation group was significantly differed from their respective preoperative cervical cobb angle, JOA scores and VAS scores. But there was no statistically significant difference between the two groups. These data indicated that the new PRUNUS nail plate system can maintain the stability and restore the physiological curvature of the cervical spine, significantly improving the patient's symptoms, and achieving similar clinical results compared with the traditional cervical spine plate. The new PRUNUS screw-plate system can simplify the surgical procedures, reduce operating time and surgical risk, particularly in cases of cervical fractures, cervical revision surgery, and osteoporosis. It also can reduce the patient's physical and mental pain and economic burden. The indications and deficiencies of the new PRUNUS screw-plate system Indications of the new PRUNUS screw-plate system include 1. degenerative conditions of cervical spine, such as cervical spondylosis, posterior longitudinal ligament ossification, etc.; 2. cervical traumatic injuries such as cervical spine fracture and dislocation, cervical instability; 3. a variety of benign, malignant cervical tumours and thoracic vertebral body (T1, T2) tumours; 4. patients who require revision surgery after anterior cervical surgery; 5. cervical vertebral infections (tuberculosis, brucellosis); 6. osteoporosis with cervical spine-related diseases. Although recent clinical efficacy analysis showed that the new PRUNUS screw-plate system has short-term effect in the anterior cervical surgery, due to short clinical application time, no abundant case data, short follow-up time, long-term complications and efficacy requires further follow-up to study and improve. Conclusion Overall, the short-term efficacy of the new PRUNUS screw-plate system in anterior cervical surgery remained satisfactory. It is particularly applicable for patients undergoing anterior cervical surgery and osteoporosis. The operation is simple and convenient, safe and effective, and worthy of clinical promotion. List of Abbreviations PRUNUS: CT: Computed tomography; MRI: Magnetic resonance imaging; JOA: Japanese Orthopaedic Association Scores. VAS: Visual Analogue Scale/Score Declarations Ethics approval and consent to participate The study design was approved by the Ethical Committee of the second affiliated hospital of Shanxi medical university. All of the participants provided written informed consent. Consent for publication Not Applicable. Availability of data and material All data generated or analyzed during this study are included in this published article and its additional files. Competing interest The authors declare that they have no competing interests Funding No funding was obtained for this section. Authors’ contributions ZZF and ZB were in charge and contributed to all stages of the present study. WWX and QDT were responsible for the original data collection. LXD and ZYB contributed to interpreting the data and writing the final manuscript. ZRT, JYZ and WXN contributed to reviewing the accuracy of the data. All authors read and approved the final manuscript. Acknowledgements Not Applicable. Authors’ Information Affiliations Department of Orthopaedics, the Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, Shanxi, China (all authors use the same address) Corresponding author Correspondence to Zhao Bin. References [1] Böhler J, Gaudernak T. Anterior plate stabilization for fracture-dislocations of lower cervical spine. J Trauma. 1980 Mar;20(3):203-5. [2] Aryan HE, Lu DC, Acosta FL Jr, Hartl R, McCormick PW, Ames CP. Bioabsorbable anterior cervical plating: initial multicenter clinical and radiographic experience. Spine (Phila Pa 1976). 2007 May 1;32(10):1084-8. [3] Mobbs RJ, Rao P, Chandran NK. Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating. J Clin Neurosci. 2007 Jul;14(7):639-42. [4] Kepler CK, Rihn JA, Bennett JD, Anderson DG, Vaccaro AR, Albert TJ, Hilibrand AS.Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis. Spine J. 2012 Aug;12(8):639-44. [5] Hofstetter CP, Kesavabhotla K, Boockvar JA. Zero-profile anchored spacer reduces rate of dysphagia compared to ACDF with anterior plating. J Spinal Disord Tech. 2015 Jun;28(5):E284-90. [6] Japanese orthopaedic association. Criteria for the treatment of cervical myelopathy [J]. Journal of the Japanese society of orthopaedics,1975,(99):1-2. [7] Vaccaro AR, Balderston RA. Anterior plate instrumentation for disorders of the subaxial cervical spine. Clin Orthop Relat Res. 1997 Feb;(335):112-21. [8] Robinson RA, Smith GW. Anterolateral cervical disk removing and interbody fusion for cervical disk syndrome. Bull John Hopkins Hospital.1955,96:223-224. [9] SMITH GW, ROBINSON RA.The treatment of cervical spine disorders by anterior removal of the intervertebral disc and interbody fudion. J Bone Joint Surg Am. 1958 Jun;40-A(3):607-24. [10] Haid RW, Foley KT, Rodts GE, Barnes B.The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 2002 Jan 15;12(1):E15. Tables Table 1. Operation time and blood loss in the control group and observation group ( ± ) operation time blood loss control group 109.7±9.4 72.9±15.6 observation group 98.4±9.2 65.3±10.6 t value 2.77 2.07 p value 0.01 0.04 Note: In the two groups, the operation time and blood loss were compared ( P < 0.05). Table 2. Preoperative and postoperative cobb angles in the control group and observation group ( ± ) preoperative postoperative one week Last follow-up t value p value control group 4.89°±1.03° 11.47°± 1.12° 10.74°± 2.58° 20.2 0.00 observation group 5.36°±1.51° 12.15°±0.84° 11.39°±1.02° 26.28 0.00 t value 1.92 1.99 1.94 p value 0.06 0.05 0.06 Note: In the two groups, the improvement in Cobb angle before surgery and last follow-up ( P 0.05). Table 3. Preoperative and postoperative JOA scores in the control group and observation group ( ± ) preoperative postoperative one week Last follow-up t value p value control group 8.43±1.26 14.21±1.09 15.17±0.89 36.34 0.00 observation group 8.14±1.16 13.63±0.97 14.72±1.17 26.25 0.00 t value 1.45 1.93 1.96 p value 0.15 0.06 0.06 Note: In the two groups, the improvement in JOA scores before surgery and last follow-up ( P 0.05). Table4. Preoperative and postoperative VAS scores in the control group and observation group ( ± ) preoperative postoperative one week Last follow-up t value p value control group 5.13±0.72 1.69±0.62 1.57±0.71 23.59 0.00 observation group 5.42±0.84 1.51±0.72 1.33±0.71 23.34 0.00 t value 1.51 1.44 1.82 p value 0.14 0.16 0.08 Note: In the two groups, the improvement in VAS scores before surgery and last follow-up ( P 0.05). 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the control group and observation group.","description":"","filename":"Fig.2.tif","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/Fig.2.tif"},{"id":570808,"identity":"22d0912d-345b-46c3-b3bf-cf5a7d653c88","added_by":"auto","created_at":"2020-02-28 22:02:43","extension":"tif","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":81660,"visible":true,"origin":"","legend":"Preoperative and postoperative VAS scores in the control group and observation group.","description":"","filename":"Fig.3.tif","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/Fig.3.tif"},{"id":570809,"identity":"7592c259-cdf0-44e7-848c-f31599f18788","added_by":"auto","created_at":"2020-02-28 22:02:43","extension":"tif","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":649243,"visible":true,"origin":"","legend":"A 63-year-old female patient with previous ankylosing spondylitis was treated with anterior cervical ACDF for cervical fracture and dislocation of 6 vertebrae with incomplete paralysis caused by fall. \nFig.4（A-C）X-ray and CT examination after the first operation, which showed that two screws in the upper position of titanium plate were placed into the intervertebral space of C5-6. （D-G） X-ray and CT examination before revision, which showed that the bone graft of C5-6 was not fused. （H-J）X-ray examination after revision operation with new trefoil enhanced nail plate system, which showed that the position of implant was good and the fixation was firm.","description":"","filename":"Fig.4.tif","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/Fig.4.tif"},{"id":570810,"identity":"1f66bca4-11cb-4827-9b94-0f430573f78e","added_by":"auto","created_at":"2020-02-28 22:02:43","extension":"tif","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":536134,"visible":true,"origin":"","legend":"A variety of new type of PRUNUS titanium plates. Three screw holes are arranged in an isosceles triangle at the two ends， screws are fixed triangularly, and the screw nails cross each other, significantly enhancing the anti-rotation ability of the titanium plate system; A large perspective window is easy to facilitate bone grafting and the observation during and after surgery; The locking elastic pieces are arranged above the nail holes at both ends of the titanium plate to effectively prevent the loosening of screws.","description":"","filename":"Fig.5.tif","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/Fig.5.tif"},{"id":13491332,"identity":"f944ec90-cf64-4012-acc5-cb21abbf3563","added_by":"auto","created_at":"2021-09-16 22:27:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1925775,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/356654d4-176b-462b-80bf-848de6d7abe7.pdf"},{"id":570805,"identity":"3d5661af-0deb-4152-a61a-c88c9f6b4543","added_by":"auto","created_at":"2020-02-28 22:02:43","extension":"xls","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37888,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialThedateofallthepatientsl.xls","url":"https://assets-eu.researchsquare.com/files/rs-15465/v1/Supplementary Material(The date of all the patientsl).xls"}],"financialInterests":"","formattedTitle":"Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the transformation of people's living habits and working methods, cervical-vertebral-related diseases such as cervical spondylosis and cervical trauma fractures have gradually become common clinical diseases. Surgical treatment is recommended as the therapeutic choice for patients with cervical spondylotic myelopathy who were unresponsive to regular conservative treatment. Since Bohler [1] first used the screw-plate system for anterior cervical fixation, and so the anterior cervical plate system has been improved in research and application in the following years.\u003c/p\u003e\n\u003cp\u003eAlthough the application of the screw-plate system for anterior cervical fixation showed good clinical results [2-3], other postoperative complications may occur, including spinal injury, plate displacement, screw loosening and plate or screw fracture. Hence, the revision of the surgeries has been increased [4-5]. To solve the technical issues associated with plate displacement and screw loosening, scientific research has provided a new type of PRUNUS screw-plate system that is used for the anterior cervical vertebral surgery. Our study aimed to observe its clinical efficacy and explore the clinical application of the PRUNUS screw-plate system and its advantages.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eClinical materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e27 patients with cervical spine disease treated with anterior cervical decompression, cage or titanium mesh graft fusion, and new PRUNUS nail plate internal fixation were selected (observation group) from the Department of Orthopedics in our hospital from June 2016 to October 2017. Of these, 15 were male and 12 were female, with a mean age of 63.6 years, range 42-82 years. Nine patients had cervical spine fracture or dislocation (Frankel grade A 4 cases, B grade 2 cases, and D grade 4 cases), 11 patients had cervical spondylosis, 5 patients had postoperative revision surgery and 2 patients had a cervical vertebral metastatic tumour. The disease duration ranged from 2 days to 19 years with an average of 39.37 months. At the same time, 29 patients with cervical spine disease treated with cervical anterior decompression, cage or titanium mesh graft fusion, and conventional cervical anterior screw fixation were selected as the control group. Of these, 17 were male and 12 were female, with an average age of 65.9 years, range 39-85 years old. Eight patients had cervical spine fracture or dislocation (Frankel grade A 2 cases, B grade 2 cases, and D grade 4 cases), 19 patients had cervical spondylosis, 1 patient had postoperative revision surgery and 1 patient had cervical tuberculosis. The duration of the disease ranged from 3 days to 21 years with an average of 25.32 months. The inclusion criteria were as follows: (1) patients met the symptoms and signs of cervical spondylosis, cervical fracture, cervical disc herniation, cervical spondylitis or brucellosis, confirmed by imaging and neurophysiological examinations. (2) patients treated with anterior cervical surgery using the conventional cervical- and new PRUNUS nail plates. (3) patients who completed preoperative and postoperative imaging examinations and follow-up. (4) the main evaluation indicators included\u0026nbsp;operation time, intraoperative blood loss, cervical vertebra Cobb angles, VAS scores， and the Japanese Orthopedic Association (JOA) scores. (5) a retrospective comparative study. The exclusion criteria were as follows: (1) patients with heart, brain, kidney, and other important organ diseases. (2) Cervical diseases caused by infection or tumour. (3) patients unable to cooperate with surgical treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was placed in supine position, and a transverse incision was made in front of the right neck. Followed by the incision of the skin, subcutaneous tissues, platysma and superficial cervical fascia to bluntly separate till the target vertebral body, and determine the vertebral body clearance of the lesion, and confirm the segment under the C-arm X-ray. Using the distractor, the adjacent vertebral body of the surgical lesion intervertebral space was distracted, and then the intervertebral disc or vertebral body subtotal excision of the intervertebral space was scraped. After decompression, the spinal cord should be inspected for no pressure, handle the cartilage endplate, and put it into a suitable size cage or a suitable length of titanium mesh. The C-arm perspective determines the position of the cage or titanium mesh accurately and well. The appropriate size of the new type of open dynamic nail plate that was close to the front edge of the vertebral body was selected, and locked in place after a good position. Rinse, place a negative pressure drainage tube after complete hemostasis, sew up the layers, and close the surgical incision. Drainage tube was indwelled for 1~3 days according to the drainage condition. After 3 days of operation, proper function exercise was allowed to get out of bed and under the brake.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEfficacy evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifty-six patients were reviewed postoperatively, and routine cervical X-ray and MRI examinations were performed. The stability of the cervical spine, the position of the internal fixation, and the fusion of the bone graft were observed according to the imaging data. The cervical Cobb angle, visual analogue scores of pain (VAS) and Japanese Orthopedic Association (JOA) scores[6], neurological recovery rate [ recovery rate = (final follow-up score - preoperative score) / (17-preoperative score ) \u0026times; 100%], the neurological function of patients before and after surgery was evaluated using Frankel grading were recorded to comprehensively evaluate the clinical efficacy of the new type of three-leaf reinforced cervical anterior screw-plate system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using SPSS, version21.0 for windows. The measured values were presented as means (\u0026plusmn;). A paired-sample t-test was performed for comparing the preoperative and the postoperative results, and the control group with the observation group. The test level was \u0026alpha;=0.05. The statistical significance was considered as P\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe observation group demonstrated an average operative time of 98.4\u0026plusmn;9.2 minutes (range 80-160minutes), while the mean intraoperative blood loss was 65.3\u0026plusmn;10.6ml (rang 50-100ml). The control group showed an average operative time of 109.7\u0026plusmn;9.4 minutes (range 70-170minutes), while the mean intraoperative blood loss was 72.9\u0026plusmn;15.6ml (rang 50-130ml). The difference in operative time and intraoperative blood loss between the two groups was statistically significant(P\u0026lt;0.05). In the two groups, the preoperative, one week postoperative, and the last follow-up of cervical cobb angle, JOA scores and VAS are shown in Table. The recovery rate in the control group was 89.74%\u0026plusmn;6.12%, and the recovery rate in the observation group was 88.69%\u0026plusmn;7.33%. The last follow-up cervical cobb angle, JOA scores and VAS scores in the control group and the observation group showed significant differences from their respective preoperative cervical cobb angle, JOA scores and VAS scores. But the values showed no statistical significance between the two groups (P\u0026gt;0.05) (Table 1-4; Fig 1-3).\u003c/p\u003e\n\u003cp\u003ePostoperative drainage volume was less than 30ml and then the drainage tube was removed. On the second day after surgery, the patients with a cervical collar were moved down to the ground. In the control group, there were 9 patients with the complaint of hoarseness and 6 patients with dysphagia after surgery. In the observation group, 11 patients suffered from postoperative hoarseness, and 5 patients suffered dysphagia and began to relieve at 3 days after surgery and disappeared within one month. The average follow-up time was 7.33 months (5-18 months). In the control group, 4 patients with cervical spine fracture and dislocation in Frankel A and B demonstrated no sense and movement, while other patients were relieved of the symptoms. After one month, 2 of them began to recover from sensation and movement. During the last follow-up, the body movement function of these 4 patients had different degrees of recovery. In the observation group, 5 patients with cervical spine fracture and dislocation had no sense and movement, while other patients were relieved of the symptoms. Two of them began to recover from sensation and movement at 7 days after surgery, and 2 of them had a recovery of sensation and movement after one month. During the last follow-up, the body movement function of these 4 patients showed different degrees of recovery, and only one patient had dyskinesia in double limbs. No loosening, fracture, and break out of the plate and screws occurred in both the groups.\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003e\u003cstrong\u003eDevelopment and limitations of traditional cervical anterior plate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 1952, Abbott [7] has first proposed anterior cervical surgery. Later on, Robinson [8] and Smith [9] improved the technique in 1958 and proposed that anterior cervical discectomy and fusion with bone grafting using autologous bone grafting can promote the fusion rate. The surgery can directly remove the compressive elements, and ensure adequate decompression of the spinal cord. This subsequently improved the patient's symptoms. But this anterior decompression with bone grafting alone, without using plate and screw fixation can easily cause cervical instability. This instability also caused serious problems such as non-fusion of bone grafting and prolapse of bone grafting. So, Bohler [1] proposed the use of steel plate and screws in the anterior cervical surgery in 1964. In the following years, a variety of cervical anterior plate systems were developed, including non-locking non-robust type, locking firm type, variable angle semi-restricted type, and slip semi-limited type [10].\u003c/p\u003e\n\u003cp\u003eDuring the process of anterior cervical surgery, it is necessary to select an appropriate vertebral fixation device due to different bone qualities of the patient. After the surgery is completed, the implant is under a micro-motion state in the patient body, which causes displacement of the steel plate, loosening and fracture of the screw in the long-term micro-motion state. This finally fails the internal implant. Especially in patients with osteoporosis, there is a higher risk of plate displacement and screw loosening. Severe plate displacement and screw loosening can stress the blood vessels, trachea or oesophagus, and even cause vascular damage, trachea or oesophagal damage. Due to low bone mass, the bone microstructure is destroyed in patients with osteoporosis, causing increased bone fragility and easy fracture. It is more difficult to locate the steel plate in patients undergoing anterior cervical spine surgery for osteoporosis. Clinically, when patients with osteoporosis had accepted anterior cervical surgery, the incidence of internal fixation plates revision surgery was significantly increased.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign and advantages of the new PRUNUS nail plate system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PRUNUS nail plate system is made of medical titanium alloy, including titanium plate, fixing screws and locked plates. Titanium plate had a width of 17mm, length ranging 25-75mm, and increment of 3mm. Screw length ranged 25-75mm, and diameter of 4mm. The two ends of the titanium plate are designed as a curved surface, which can fix the surface of the actual anatomical bone. This, in turn, makes it suitable for the physiological curvature of the cervical spine, avoids the problem of uneven stress load effectively, and there are three screw holes are arranged in an isosceles triangle at the two ends. After the screws are fixed, they are fixed triangularly, and the screw nails cross each other, significantly enhancing the anti-rotation ability of the titanium plate system, and also reducing the risk of screw backing and screw fracture. A locked plate is provided in the middle of the screw hole to prevent screw loosening effectively. The middle part of the titanium place is provided with a large perspective window to facilitate bone grafting and the observation during and after surgery. The screws are designed with self-tapping screws, which reduces the usage of wiretapping. The screw diameters and colors can be distinguished, and at the same time, can be divided into fixed angles and adjustable angles, which are used for different indications (figure 5).\u003c/p\u003e\n\u003cp\u003eBased on the recent biomechanical studies on the stability, fatigue life and pull-out strength, the PRUNUS plate system demonstrated good biomechanical properties, effective stability on the cervical spine and maintained the acute stability of the cervical spine, while it has a better anti-pull out strength and figure resistance. At the same time, through a biomechanical test and practical application in clinical surgery, we believed that the new PRUNUS nail plate system can achieve the fixation of cervical vertebrae more effectively, especially in patients with osteoporosis and multilevel cervical fusion. It can also reduce the risk of revision surgery due to screw loosening and plate displacement. Otherwise, it is particularly suitable for revision surgery. In the revision surgery, screws holes have already been drilled in the cervical vertebrae. Therefore, if the screws are placed in the original hole, the screws can be easily loosened and the plate can be displaced. If the new PRUNUS nail plate was used in the revision surgery, it affords a new position for the screws and disperses the screw force significantly. The geometrical principle of the three-point stable can be used to enhance the holding force of the plate, achieving a good fixed effect greatly and improving the success rate of revision surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe efficacy analysis of the new PRUNUS screw-plate system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough the follow-up data of the control and the observation groups, we found that the operative time and blood loss of the observation group were higher than the control group, but the differences between the two groups showed no statistical significance. Nevertheless, 5 patients are undergoing anterior cervical revision surgery in the observation group. The operations of these patients were generally more complex, had longer operation time and more bleeding. The use of the new type of PRUNUS screw-plate system can reduce the operative time and the amount of bleeding compared to conventional anterior cervical surgery. Meanwhile, it can also simplify the surgical procedures, reduce operative time and blood loss to enhance surgical safety. One week after postoperatively and the last follow-up demonstrated that the cervical cobb angle, JOA scores and VAS scores in the control group and the observation group was significantly differed from their respective preoperative cervical cobb angle, JOA scores and VAS scores. But there was no statistically significant difference between the two groups. These data indicated that the new PRUNUS nail plate system can maintain the stability and restore the physiological curvature of the cervical spine, significantly improving the patient's symptoms, and achieving similar clinical results compared with the traditional cervical spine plate. The new PRUNUS screw-plate system can simplify the surgical procedures, reduce operating time and surgical risk, particularly in cases of cervical fractures, cervical revision surgery, and osteoporosis. It also can reduce the patient's physical and mental pain and economic burden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe\u003c/strong\u003e\u003cstrong\u003e indications and deficiencies\u003c/strong\u003e\u003cstrong\u003e of\u003c/strong\u003e\u003cstrong\u003e the new PRUNUS \u003c/strong\u003e\u003cstrong\u003escrew-plate\u003c/strong\u003e\u003cstrong\u003e system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndications of the new PRUNUS screw-plate system include 1. degenerative conditions of cervical spine, such as cervical spondylosis, posterior longitudinal ligament ossification, etc.; 2. cervical traumatic injuries such as cervical spine fracture and dislocation, cervical instability; 3. a variety of benign, malignant cervical tumours and thoracic vertebral body (T1, T2) tumours; 4. patients who require revision surgery after anterior cervical surgery; 5. cervical vertebral infections (tuberculosis, brucellosis); 6. osteoporosis with cervical spine-related diseases.\u003c/p\u003e\n\u003cp\u003eAlthough recent clinical efficacy analysis showed that the new PRUNUS screw-plate system has short-term effect in the anterior cervical surgery, due to short clinical application time, no abundant case data, short follow-up time, long-term complications and efficacy requires further follow-up to study and improve.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eOverall, the short-term efficacy of the new PRUNUS screw-plate system in anterior cervical surgery remained satisfactory. It is particularly applicable for patients undergoing anterior cervical surgery and osteoporosis. The operation is simple and convenient, safe and effective, and worthy of clinical promotion.\u003c/p\u003e "},{"header":"List of Abbreviations","content":"\u003cp\u003ePRUNUS: CT: Computed tomography; MRI: Magnetic resonance imaging; JOA: Japanese Orthopaedic Association Scores. VAS: Visual Analogue Scale/Score\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design was approved by the Ethical Committee of the second affiliated hospital of Shanxi medical university. All of the participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its additional files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZZF and ZB were in charge and contributed to all stages of the present study. WWX and QDT were responsible for the original data collection. LXD and ZYB contributed to interpreting the data and writing the final manuscript. ZRT, JYZ and WXN contributed to reviewing the accuracy of the data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Orthopaedics, the Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, Shanxi, China (all authors use the same address)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u0026nbsp;Zhao Bin.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e[1] B\u0026ouml;hler J, Gaudernak T. Anterior plate stabilization for fracture-dislocations of lower cervical spine. J Trauma. 1980 Mar;20(3):203-5.\u003c/p\u003e\n\u003cp\u003e[2] Aryan HE, Lu DC, Acosta FL Jr, Hartl R, McCormick PW, Ames CP. Bioabsorbable anterior cervical plating: initial multicenter clinical and radiographic experience. Spine (Phila Pa 1976). 2007 May 1;32(10):1084-8.\u003c/p\u003e\n\u003cp\u003e[3] Mobbs RJ, Rao P, Chandran NK. Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating. J Clin Neurosci. 2007 Jul;14(7):639-42.\u003c/p\u003e\n\u003cp\u003e[4] Kepler CK, Rihn JA, Bennett JD, Anderson DG, Vaccaro AR, Albert TJ, Hilibrand AS.Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis. Spine J. 2012 Aug;12(8):639-44.\u003c/p\u003e\n\u003cp\u003e[5] Hofstetter CP, Kesavabhotla K, Boockvar JA. Zero-profile anchored spacer reduces rate of dysphagia compared to ACDF with anterior plating. J Spinal Disord Tech. 2015 Jun;28(5):E284-90.\u003c/p\u003e\n\u003cp\u003e[6] Japanese orthopaedic association. Criteria for the treatment of cervical myelopathy [J]. Journal of the Japanese society of orthopaedics,1975,(99):1-2.\u003c/p\u003e\n\u003cp\u003e[7] Vaccaro AR, Balderston RA. Anterior plate instrumentation for disorders of the subaxial cervical spine. Clin Orthop Relat Res. 1997 Feb;(335):112-21.\u003c/p\u003e\n\u003cp\u003e[8] Robinson RA, Smith GW. Anterolateral cervical disk removing and interbody fusion for cervical disk syndrome. Bull John Hopkins Hospital.1955,96:223-224.\u003c/p\u003e\n\u003cp\u003e[9] SMITH GW, ROBINSON RA.The treatment of cervical spine disorders by anterior removal of the intervertebral disc and interbody fudion. J Bone Joint Surg Am. 1958 Jun;40-A(3):607-24.\u003c/p\u003e\n\u003cp\u003e[10] Haid RW, Foley KT, Rodts GE, Barnes B.The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 2002 Jan 15;12(1):E15.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003eTable 1. Operation time and blood loss\u003c/span\u003e \u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003ein the control group and observation group\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e (\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\" width=\"441\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 16.45pt;\"\u003e\n\u003ctd style=\"width: 103.25pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"138\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003eoperation time\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 141.9pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"189\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003eblood loss\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 103.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"138\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003econtrol group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003e109.7\u0026plusmn;9.4 \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 141.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"189\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003e72.9\u0026plusmn;15.6\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 103.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"138\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eobservation group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003e98.4\u0026plusmn;9.2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 141.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"189\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;65.3\u0026plusmn;10.6\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 103.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"138\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e2.77\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 141.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"189\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e2.07\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 103.25pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"138\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.01\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 141.9pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"189\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.04\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cem\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003eNote:\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e In the two groups, the \u003c/span\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003eoperation time\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e and \u003c/span\u003e\u003cspan style=\"font-size: 10.0pt; font-family: 'Times New Roman',serif;\"\u003eblood loss \u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003ewere compared (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003eTable 2. Preoperative and postoperative cobb angles in the control group and observation group\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e (\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\" width=\"649\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 16.45pt;\"\u003e\n\u003ctd style=\"width: 74.4pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"99\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epreoperative\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epostoperative one week\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eLast follow-up\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70.9pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 74.4pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"99\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003econtrol group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e4.89\u0026deg;\u0026plusmn;1.03\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e11.47\u0026deg;\u0026plusmn; 1.12\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e10.74\u0026deg;\u0026plusmn; 2.58\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e20.2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.00\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 74.4pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"99\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eobservation group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e5.36\u0026deg;\u0026plusmn;1.51\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e12.15\u0026deg;\u0026plusmn;0.84\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e11.39\u0026deg;\u0026plusmn;1.02\u0026deg;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e26.28\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.00\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 74.4pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"99\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.92\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.99\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.94\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 74.4pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"99\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.06\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.05\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.06\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70.9pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cem\u003e\u003cspan style=\"font-family: 'Times New Roman', serif;\"\u003eNote:\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e In the two groups, the improvement in \u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eCobb angle\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e before surgery and last follow-up (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), and the improvement in \u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eCobb angle\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e between the two groups were compared (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003eTable 3. Preoperative and postoperative JOA scores in the control group and observation group\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e(\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\" width=\"657\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 16.45pt;\"\u003e\n\u003ctd style=\"width: 79.25pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epreoperative\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epostoperative one week\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eLast follow-up\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 79.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: left; text-indent: 4.5pt;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003econtrol group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e8.43\u0026plusmn;1.26\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e14.21\u0026plusmn;1.09\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e15.17\u0026plusmn;0.89\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e36.34\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.00\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 79.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;observation group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e8.14\u0026plusmn;1.16\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e13.63\u0026plusmn;0.97\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e14.72\u0026plusmn;1.17\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e26.25\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.00\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 79.25pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.45\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.93\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.96\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 79.25pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.15\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.06\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.06\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cem\u003e\u003cspan style=\"font-family: 'Times New Roman', serif;\"\u003eNote:\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e In the two groups, the improvement in \u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eJOA scores\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e before surgery and last follow-up (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), and the improvement in\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e JOA scores\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e between the two groups were compared (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; layout-grid-mode: char;\"\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003eTable4. Preoperative and postoperative VAS scores in the control group and observation group\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e(\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: 'Times New Roman',serif;\"\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\" width=\"661\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 16.45pt;\"\u003e\n\u003ctd style=\"width: 73.8pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"98\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epreoperative\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003epostoperative one week\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003eLast follow-up\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003et value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 80.2pt; border-top: solid windowtext 1.5pt; border-left: none; border-bottom: solid windowtext 1.5pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 16.45pt;\" width=\"107\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003ep value\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 73.8pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"98\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003econtrol group \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e5.13\u0026plusmn;0.72\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.69\u0026plusmn;0.62\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e1.57\u0026plusmn;0.71\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; 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padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e0.08\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85.35pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"114\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 80.2pt; border: none; border-bottom: solid windowtext 1.5pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"107\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 9.0pt; font-family: 'Times New Roman',serif;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center; text-indent: 10.5pt;\"\u003e\u003cem\u003e\u003cspan style=\"font-family: 'Times New Roman', serif;\"\u003eNote:\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e In the two groups, the improvement in \u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003eVAS scores \u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003ebefore surgery and last follow-up (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), and the improvement in\u003c/span\u003e \u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003eVAS scores\u003c/span\u003e\u003cspan style=\"font-family: 'Times New Roman',serif;\"\u003e between the two groups were compared (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PRUNUS Spine Plate System, Anterior Cervical Spine Surgery, Clinical Efficacy","lastPublishedDoi":"10.21203/rs.3.rs-15465/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-15465/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBACKGROUND To observed and evaluated the clinical efficacy of a new type cervical anterior screw plate system development for anterior cervical surgery. \u003c/p\u003e\u003cp\u003eMethods 27 patients with cervical spine disease treated with new PRUNUS nail plate internal fixation were selected as observation group, and 29 patients treated with conventional cervical anterior screw fixation were selected as the control group. Cervical stability, internal fixation position and bone graft fusion were evaluated according to imaging data. The operative time, intraoperative blood loss, cervical Cobb angle, VAS scores, and JOA scores were compared between the two groups. Spinal function scores and neurological improvement rates were used to evaluate the clinical efficacy of the new PRUNUS spine plate. \u003c/p\u003e\u003cp\u003eResults There were statistical differences in operation time and blood loss between the two groups (P\u0026lt;0.05). The difference in Cobb angle, JOA score and improvement rate, VAS score before and after surgery in two groups were statistically significant (P\u0026lt;0.05), but no significant differences between two groups (P\u0026gt;0.05). \u003c/p\u003e\u003cp\u003eConclusion The new PRUNUS spine plate system can be applied to the anterior cervical spine surgery, and its clinical efficacy was similar to the traditional cervical anterior plate. But PRUNUS simplified the operation process, especially for the osteoporosis patients.\u003c/p\u003e","manuscriptTitle":"Clinical efficacy analysis of the new PRUNUS spine plate system for anterior cervical spine surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-02-28 22:02:42","doi":"10.21203/rs.3.rs-15465/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bcd78a66-0f39-4891-9944-5542d30be763","owner":[],"postedDate":"February 28th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63902,"name":"Orthopedic Surgery"}],"tags":[],"updatedAt":"2020-06-19T12:02:17+00:00","versionOfRecord":[],"versionCreatedAt":"2020-02-28 22:02:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-15465","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-15465","identity":"rs-15465","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}