Summers Lori E, Kouri Joshua G, Yang Mu, Patrick Jacob R
Department of Neurological Surgery, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
J Spinal Disord Tech. 2008 Feb;21(1):45-8. doi: 10.1097/BSD.0b013e31805777da.
We describe the use of isocentric 3-dimensional fluoroscopy to place odontoid screws in 9 patients.
We wanted to show the benefits of using isocentric 3-dimensional fluroscopy in odontoid screw placement.
Odontoid screw fixation for treatment of type II odontoid fractures has gained popularity since its introduction in the early 1980s. During the last several years, a multitude of new techniques have improved the ease of odontoid screw placement, including biplanar fluoroscopy, cannulated screw systems, and beveled bedside-fixed retractor systems. The use of isocentric C-arm fluoroscopy can improve the ease and facilitate placement of odontoid screws.
Nine patients, ranging in ages from 30 to 89 years, presented with type II odontoid fractures. All fractures were either nondisplaced or minimally displaced (<4 mm) and occurred as a result of acute trauma. No patient had evidence of transverse atlantal ligament disruption.
Isocentric 3-dimensional fluoroscopy, in conjunction with image-guided navigational software, was used to place 1 or 2 odontoid screws in each patient. Three-dimensional images were acquired intraoperatively, which were then reconstructed and uploaded to the navigational workstation. Screw trajectory was planned and performed with the use of tracked instruments.
Successful screw placement, as judged by intraoperative computerized tomography, was attained in all 9 patients.
Isocentric 3-dimensional fluoroscopy, in conjunction with an image-guided navigational software system, obviates the need for cumbersome biplanar fluoroscopy, allows for intraoperative image acquisition after surgical exposure, reduces intraoperative registration time, reduces both surgeon and patient radiation exposure, and allows immediate computerized tomographic imaging in the operating room to verify screw position.
我们描述了使用等中心三维透视法为9例患者置入齿突螺钉的情况。
我们想展示在齿突螺钉置入中使用等中心三维透视法的益处。
自20世纪80年代初引入以来，齿突螺钉固定术治疗Ⅱ型齿突骨折已得到广泛应用。在过去几年中，多种新技术提高了齿突螺钉置入的便利性，包括双平面透视法、空心螺钉系统和床边固定斜角牵开器系统。使用等中心C形臂透视法可提高齿突螺钉置入的便利性并便于操作。
9例患者，年龄在30至89岁之间，均为Ⅱ型齿突骨折。所有骨折均无移位或轻度移位（<4毫米），由急性创伤引起。所有患者均无寰椎横韧带断裂的证据。
使用等中心三维透视法结合图像引导导航软件，为每位患者置入1枚或2枚齿突螺钉。术中采集三维图像，然后重建并上传至导航工作站。使用跟踪器械规划并执行螺钉轨迹。
根据术中计算机断层扫描判断，所有9例患者螺钉均成功置入。
等中心三维透视法结合图像引导导航软件系统，无需繁琐的双平面透视法，允许在手术暴露后进行术中图像采集，减少术中配准时间，减少术者和患者的辐射暴露，并允许在手术室立即进行计算机断层扫描成像以验证螺钉位置。
