Relationship Between Screw Trajectory of C1 Lateral Mass Screw and Internal Carotid Artery
Relationship Between Screw Trajectory of C1 Lateral Mass Screw and Internal Carotid Artery
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DOI：
10.1097/brs.0b013e318186b2fd
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发表时间：
2008-11-15
期刊：
影响因子：
3
通讯作者：
Otsuka, Takanobu
中科院分区：
文献类型：
--
作者：
Murakami, Satona;Mizutani, Jun;Otsuka, Takanobu
研究设计。对诊断影像的评价。从避免颈内动脉(ICA)损伤的角度，了解颈内动脉(ICA)与双皮质置入C1侧块螺钉的解剖关系。尽管先前的研究表明，位于寰椎侧块前表面的螺钉尖端可能会损伤颈内动脉，但尚未有研究评估与其位置有关的避免颈内动脉损伤的寰椎侧块螺钉的安全轨迹。从177幅人体三维CT重建图像中的149幅图像中，测量了6个与枢椎和颈内动脉有关的距离参数和2个角度参数。此外，还检查了螺钉插入时偏离预期轨迹的误差角。颈内动脉位于颈1侧块前方占64.4%，面朝颈1侧块外侧1/3者占54.6%。无一例位于C1侧块内侧1/3前方。违反ICA的最大向内螺钉轨迹为8.6度。术前C_1/2旋转角和与预定轨迹的平均误差角分别约为5度。通过正确地将螺钉向内插入10度，可以排除ICA损伤的可能性。尽管具有足够内侧角度的双皮质置入物可能足够安全，但我们必须记住在双皮质置入物中违反ICA的可能性，因为预期的螺钉轨迹永远不能确定。
Study Design. Evaluation of diagnostic imaging.Objective. To comprehend anatomic relationships between the internal carotid artery (ICA) and bicortical purchase of C1 lateral mass screws from the perspective of avoiding ICA injury.Summary of Background Data. No studies have evaluated safety trajectory of atlantal lateral mass screw that would avoid the ICA injury in relation to its location, although previous studies have indicated concern about ICA injury by the screw tip at the anterior surface of the lateral mass of the atlas.Methods. From 149 of 177 human 3-dimensional computed tomography reconstruction images, 6 distance and 2 angle parameters related to both atlas and ICA were measured on the plane 15 degrees cephalad to the transverse plane. In addition, angle of error during screw insertion from intended trajectory was checked.Results. The ICA was located in front of the C1 lateral mass in 64.4% of cases and faced the lateral one third of the C1 lateral mass in 54.6% of cases. None were located in front of the medial one third of the C1 lateral mass. The maximum inward screw trajectory that would violate the ICA was 8.6 degrees. Mean angle of preoperative C1/2 rotation and angle of error from intended trajectory was about 5 degrees, respectively.Conclusion. The possibility of ICA injury can be excluded by correct insertion of the screw 10 degrees inward. Although bicortical purchase with adequately medially angulated trajectory might be safe enough, we must remember the possibility to violate the ICA in bicortical purchase, because the intended screw trajectory never be assured.