Department of Spinal Surgery, the Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, Wenzhou, People's Republic of China.
Spine J. 2012 Aug;12(8):656-62. doi: 10.1016/j.spinee.2012.05.010. Epub 2012 Jun 23.
As a minimally invasive spine surgery, percutaneous atlantoaxial fixation techniques using anterior transarticular screw (ATS) and posterior transarticular screw (PTS) have promising clinical results. However, transarticular screw fixation is technically demanding and carries a potential risk of iatrogenic vertebral artery (VA) injury. There were no available data comparing the anatomic risk of VA injury associated with these screws.
To evaluate the trajectories of percutaneous atlantoaxial ATS and PTS through three-dimensional (3D) computerized tomography.
To compare the anatomic risk of VA injury between percutaneous ATS and PTS.
Sixty patients ranged in age from 19 to 75 years (mean, 45.08 years) and included 35 men and 25 women.
Image measurement of C2 isthmus height and C2 isthmus width and the distance between the medial-most superior articular facet to the medial-most edge of the VA groove of the C2 (D).
Sixty consecutive patients (in total) with lower cervical lesions were evaluated through 3D images reconstructed by a rapid 3D system. The maximum possible diameters of the percutaneous atlantoaxial ATS and PTS trajectories were compared and examined. Mean, range, and standard deviations for each type of screw, for left and right trajectories, and for men and women were calculated from 120 percutaneous atlantoaxial ATS and PTS measurements through SPSS.
The maximum mean diameter differed significantly between the trajectories of 120 percutaneous atlantoaxial ATS and PTS. For screw trajectories ≤3.5 mm in diameter, 19.2% of the PTS trajectories were judged as risky, whereas all the anterior ones were judged as safe.
From an anatomic perspective, percutaneous ATS fixation poses less anatomic risk of VA injury than percutaneous PTS fixation. As an alternative surgical therapy for atlantoaxial subluxation, percutaneous ATS fixation may play a more important role in the future.
经皮寰枢椎固定技术，包括前路经关节螺钉（ATS）和后路经关节螺钉（PTS），作为一种微创脊柱手术，具有良好的临床效果。然而，经关节螺钉固定技术要求高，存在医源性椎动脉（VA）损伤的潜在风险。目前尚无比较这些螺钉相关 VA 损伤解剖风险的可用数据。
通过三维（3D）计算机断层扫描评估经皮寰枢椎 ATS 和 PTS 的轨迹。
比较经皮 ATS 和 PTS 与 VA 损伤的解剖风险。
60 例患者年龄 19-75 岁（平均 45.08 岁），其中男 35 例，女 25 例。
C2 峡部高度和 C2 峡部宽度以及 C2 最内侧关节突到 VA 沟最内侧缘的距离（D）的影像学测量。
通过快速 3D 系统重建 60 例连续下颈椎病变患者的 3D 图像。比较并检查经皮寰枢椎 ATS 和 PTS 轨迹的最大可能直径。通过 SPSS 计算了 120 个经皮寰枢椎 ATS 和 PTS 测量值的每种螺钉的平均值、范围和标准差，以及左右轨迹和男女的平均值、范围和标准差。
120 个经皮寰枢椎 ATS 和 PTS 轨迹的最大平均直径差异有统计学意义。对于直径≤3.5mm 的螺钉轨迹，19.2%的 PTS 轨迹被认为有风险，而所有前侧的螺钉轨迹均被认为是安全的。
从解剖学角度来看，经皮 ATS 固定比经皮 PTS 固定造成 VA 损伤的解剖风险更小。作为寰枢关节半脱位的替代手术治疗方法，经皮 ATS 固定在未来可能发挥更重要的作用。
