Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation
Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation
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DOI：
10.1097/brs.0000000000001807
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发表时间：
2017-03-15
期刊：
影响因子：
3
通讯作者：
Sumi, Masatoshi
中科院分区：
文献类型：
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作者：
Sugawara, Taku;Higashiyama, Naoki;Sumi, Masatoshi
研究设计。利用患者特异性螺钉导向模板技术进行后 C1-C2 固定螺钉插入方法的前瞻性临床试验。目的。评估该方法插入 C1 侧块螺钉 (LMS)、C2 椎弓根螺钉 (PS) 和 C2 板层螺钉 (LS) 的效果。背景数据摘要。后路C1LMS和C2PS固定，也称为Goel-Harms法，可以实现立即刚性固定和高融合率，但螺钉插入存在神经元和血管结构损伤的风险。解剖静脉丛和 C2 神经根以确定 C1LMS 的插入点也可能会引起问题。我们开发了一种使用患者特定层流模板的术中螺钉引导方法。方法。使用三维 (3D)/多平面成像软件分析术前计算机断层扫描 (CT) 骨图像，以规划螺钉的轨迹。使用 3D 设计和打印技术为每个椎板创建带有螺杆引导结构的塑料模板。三种类型的模板用于精确的多步引导，所有模板都经过专门设计，可在手术过程中贴合并锁定椎板。使用该患者专用螺钉导向模板系统进行手术，并在术后使用 CT 评估螺钉的放置。结果。 12 名 C1-C2 不稳定患者接受了总共 48 颗螺钉的治疗（24 颗 C1LMS、20 颗 C2PS、4 颗 C2LS）。术中，每个模板都精确贴合并锁定在椎板上，并且成功完成螺钉插入，无需解剖静脉丛和 C2 神经根。术后 CT 显示螺钉没有侵犯皮质，螺钉与计划轨迹的平均偏差为 0.70 +/- 0.42 mm。结论。多步、针对患者的螺钉导向模板系统对于后 C1-C2 固定的术中螺钉导航非常有用。这种简单、经济的方法可以提高螺钉插入的准确性，并减少后路C1-C2固定手术的手术时间和辐射暴露。
Study Design. Prospective clinical trial of the screw insertion method for posterior C1-C2 fixation utilizing the patient-specific screw guide template technique.Objective. To evaluate the efficacy of this method for insertion of C1 lateral mass screws (LMS), C2 pedicle screws (PS), and C2 laminar screws (LS).Summary of Background Data. Posterior C1LMS and C2PS fixation, also known as the Goel-Harms method, can achieve immediate rigid fixation and high fusion rate, but the screw insertion carries the risk of injury to neuronal and vascular structures. Dissection of venous plexus and C2 nerve root to confirm the insertion point of the C1LMS may also cause problems. We have developed an intraoperative screw guiding method using patient-specific laminar templates.Methods. Preoperative bone images of computed tomography (CT) were analyzed using three-dimensional (3D)/multiplanar imaging software to plan the trajectories of the screws. Plastic templates with screw guiding structures were created for each lamina using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all templates were specially designed to fit and lock on the lamina during the procedure. Surgery was performed using this patient-specific screw guide template system, and placement of the screws was postoperatively evaluated using CT.Results. Twelve patients with C1-C2 instability were treated with a total of 48 screws (24 C1LMS, 20 C2PS, 4 C2LS). Intraoperatively, each template was found to exactly fit and lock on the lamina and screw insertion was completed successfully without dissection of the venous plexus and C2 nerve root. Postoperative CT showed no cortical violation by the screws, and mean deviation of the screws from the planned trajectories was 0.70 +/- 0.42 mm.Conclusion. The multistep, patient-specific screw guide template system is useful for intraoperative screw navigation in posterior C1-C2 fixation. This simple and economical method can improve the accuracy of screw insertion, and reduce operation time and radiation exposure of posterior C1-C2 fixation surgery.