A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures
A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures
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齿状突骨折前路螺钉固定后三维颈椎节段运动特性的体内研究技术
DOI：
10.1097/brs.0000000000003818
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发表时间：
2021
期刊：
影响因子：
3
通讯作者：
Wan Zongmiao
中科院分区：
文献类型：
--
作者：
Zhong Yanlong;Yao Haoqun;Tang Benyu;Song Quanwei;Shaobai Wang;Li Guoan;Wan Zongmiao
研究设计。采用锥形束计算机断层扫描（CBCT）结合三维到三维（3D-3D）配准技术对前齿状突螺钉固定（AOSF）术后患者的颈椎运动学进行研究。目的：探讨前齿状突螺钉固定（AOSF）术后患者的体内三维颈椎运动特征。背景资料摘要。AOSF手术是治疗齿状突骨折的经典手术方法，但其对颈椎体内生物力学影响的研究较少。术后寰枢关节（C1-C2）和尾侧邻近节段（C2-C3）的生物力学特征尚不清楚。方法：本研究纳入14例采用拉力螺钉固定AOSF的患者。受试者与14名健康对照配对。所有受试者在7个功能体位下对颈椎进行CBCT扫描。在每个功能位置对每个椎体进行3D-3D配准以计算节段运动特征。结果AOSF组C1-C2、C2-C3和C1-C7整体颈椎在屈伸体位（7.0 vs. 11.0）、C2-C3 （3.7 vs. 6.7）和C1-C7 （43.3 vs. 54.4）的ROMs均显著小于对照组（P< 0.05）。AOSF组C1-C2的扭转ROM为39.3，对照组为65.7 (P< 0.05)； AOSF组C2-C3的弯曲ROM为2.8，对照组为8.9 （P< 0.05）。AOSF组C1-C7节段扭转ROM为63.2，健康对照组为98.1 （P< 0.05）。与对照组相比，虽然AOSF手术降低了所有研究脊柱节段的屈伸ROM，但也降低了C1-C2和C1-C7的扭转ROM，但仅降低了C2-C3的侧屈ROM。这些数据表明，AOSF手术会导致寰枢节段和尾侧邻近节段不同的生物力学变化。为了评估AOSF术后患者的临床结果，有必要对更大的患者群体进行长期随访研究。证据水平：3本研究的目的是利用锥束计算机断层扫描图像结合3D-3D配准技术，研究接受前齿状突螺钉固定手术患者的体内三维（3D）颈椎运动特征。精确评估寰枢关节及其相邻节段C2-C3的6个自由度运动学以及下颈椎的代偿运动。
Study Design.Kinematics of the cervical spine was investigated using cone beam computed tomography (CBCT) images combined with three dimensions to three dimensions (3D-3D) registration technology in patients after anterior odontoid screw fixation (AOSF) surgery.Objective.The aim of this study was to investigate in vivo 3D cervical motion characteristics of patients who had undergone AOSF surgeries.Summary of Background Data.AOSF surgery is a classic surgical method for the treatment of odontoid fracture, but there are few studies that investigated its effect on in vivo biomechanics of the cervical spine. Postoperative biomechanical characters of the atlantoaxial joint (C1-C2) and the caudal adjacent segment (C2–C3) have yet to be clarified.Methods.The study involved 14 patients subjected to a procedure of AOSF with lag screw. Subjects were matched with 14 healthy controls. All subjects underwent CBCT scanning of the cervical spine under seven functional positions. A 3D-3D registration was performed for each vertebra at each functional position to calculate the segmental motion characteristics. The ranges of motion (ROMs) of the C1-C2, C2–C3, and the overall cervical spine (C1-C7) for each of the functional positions were determined.Results.The ROMs of the AOSF group were significantly (P< 0.05) smaller than the control group in flexion-extension positions for the C1-C2 (7.0 vs. 11.0), C2-C3 (3.7 vs. 6.7) and C1-C7 (43.3 vs. 54.4). The twisting ROM of the C1-C2 was 39.3 in the AOSF group and 65.7 in the control (P< 0.05), the bending ROM of the C2-C3 was 2.8 in the AOSF group and 8.9 in the control (P< 0.05). The twisting ROM of C1-C7 segment was 63.2 for the AOSF and 98.1 for the healthy control groups (P< 0.05).Conclusion.Although AOSF surgery reduced the flexion-extension ROMs of all investigated spinal segments, additionally, it reduced twisting ROMs of C1-C2 and C1-C7, but only lateral bending ROM of C2-C3, when compared with the control group. The data implied that the AOSF surgery would result in different biomechanics changes in the atlantoaxial segment and caudal adjacent segment. Longer-term follow-up studies of larger patient cohorts are necessary to evaluate the clinical outcomes of patients after the AOSF surgery.Level of Evidence: 3The aim of this study was to investigate in vivo three dimensions (3D) cervical motion characteristics of patents who had undergone anterior odontoid screw fixation surgery using cone beam computed tomography images combined with 3D-3D registration technology. The 6 degrees-of-freedom kinematics of atlantoaxial joint and the adjacent segment C2-C3 as well as compensatory movements of subaxial cervical spine were precisely evaluated.