Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-ku, Sungnam 463-707, Republic of Korea.
Spine J. 2013 Nov;13(11):1455-63. doi: 10.1016/j.spinee.2013.05.036. Epub 2013 Jul 10.
Anterior transarticular screw (ATAS) fixation has been suggested as a viable alternative to posterior stabilization. However, we are not aware of previous reports attempting to establish the usefulness of specific fluoroscopic landmark-guided trajectories in the use of ATAS, and we could find no reference to it in a computerized search using MEDLINE.
To determine the anatomic feasibility of ATAS placement using defined fluoroscopic landmarks to guide screw trajectory.
Evaluation using three-dimensional screw insertion simulation software and 1.0-mm-interval computed tomographic scans.
Computed tomographic scans of 100 patients including 50 men and 50 women.
Incidence of violation of the vertebral artery groove of C1 and C2, the spinal canal, and the atlanto-occipital joint and screw lengths and lengths of C1 and C2 purchase.
Four screw trajectories were determined: promontory screw (PS), single central facet (CF) screw, and medial (MF) and lateral (LF) double facet screws. Placement of a 4.0-mm screw was simulated using defined fluoroscopic landmarks for each trajectory. The previously mentioned outcome measures were evaluated and compared for the four trajectories. This study was not supported by any financial sources, and there is no topic-specific potential conflict of interest with this study.
No violation of the C1 or C2 vertebral artery groove or of the spinal canal was observed for any of the screw types. Screw lengths and the length of C2 purchase were by far the longest for PS (40.4±2.8 and 25.7±2.1 mm, respectively; p<.001 in all post hoc comparisons). The length of C1 purchase was longer for CF (16.4±2.3 mm) and LF (15.8±1.6 mm) than PS (14.7±2.0 mm) and MF (14.6±2.4 mm) (p≤.001, respectively). There was no atlanto-occipital joint violation if the length of C1 purchase was set at 12 mm for CF and LF and at 10 mm for PS and MF.
Our results suggest that it may be possible to place ATASs without violating the vertebral artery groove, spinal canal, or the atlanto-occipital joint by using the described entry points, trajectories, and fluoroscopic landmarks.
经关节突螺钉（ATAS）固定已被提议作为一种可行的替代后稳定方法。然而，我们不知道以前有尝试建立特定的透视引导标志轨迹在 ATAS 使用中的有用性的报告，并且我们在使用 MEDLINE 的计算机搜索中也没有找到相关内容。
使用定义的透视引导标志来确定 ATAS 放置的解剖可行性，以指导螺钉轨迹。
使用三维螺钉插入模拟软件和 1.0-mm 间隔的计算机断层扫描进行评估。
包括 50 名男性和 50 名女性在内的 100 名患者的计算机断层扫描。
违反 C1 和 C2 椎动脉沟、椎管和寰枕关节以及螺钉长度和 C1 和 C2 购买长度的发生率。
确定了四种螺钉轨迹：穹窿螺钉（PS）、单一中央关节突螺钉（CF）、内侧（MF）和外侧（LF）双关节突螺钉。为每个轨迹使用定义的透视引导标志模拟 4.0-mm 螺钉的放置。评估并比较了四种轨迹的上述测量结果。本研究没有得到任何资金的支持，并且与本研究没有特定主题的潜在利益冲突。
对于任何类型的螺钉，都没有观察到 C1 或 C2 椎动脉沟或椎管的侵犯。螺钉长度和 C2 购买长度最长的是 PS（分别为 40.4±2.8 和 25.7±2.1mm;p<.001 在所有事后比较中）。CF（16.4±2.3mm）和 LF（15.8±1.6mm）的 C1 购买长度均长于 PS（14.7±2.0mm）和 MF（14.6±2.4mm）（p≤.001，分别）。如果 CF 和 LF 的 C1 购买长度设置为 12mm，PS 和 MF 的 C1 购买长度设置为 10mm，则不会侵犯寰枕关节。
我们的结果表明，通过使用描述的入口点、轨迹和透视引导标志，可能可以在不侵犯椎动脉沟、椎管或寰枕关节的情况下放置 ATASs。
