Department of Neurosurgery, Al Azhar University, Cairo, Egypt.
Global Spine J. 2013 Jun;3(2):63-8. doi: 10.1055/s-0033-1345035. Epub 2013 May 23.
We sought to determine the optimal placement and screw length for C2 pedicle screw fixation to compare with recommendations in literature. Nine patients were included in this study and underwent C2 pedicle instrumentation either for a hangman's fracture as part of C2 pedicle-C3 lateral mass fixation or for C2-C3 subluxation. All nine patients had good postoperative improvement with satisfactory fracture consolidation. Mediolateral and rostrocaudal angulations of the inserted screws were not consistent with the traditional angulations of 20 degrees in each plane due to the fracture lines and the anatomical variations. Because the frequent observation of the bony anatomical variations and the lines of fractures brought about by trauma, a shift from the classic 20 degrees of angulation in both trajectories has been concluded. But still fixed angles of angulations cannot be generalized. As a consequence, accurate preoperative planning can be obtained by computed tomography with three-dimensional images so that it gives the surgeon a good prediction of the best length of utilized screws in the procedure and the best angulations for safety of the neighboring neurovascular structures.
我们试图确定 C2 椎弓根螺钉固定的最佳位置和螺钉长度，以与文献中的建议进行比较。本研究纳入 9 例患者，其中 5 例因Hangman 骨折行 C2 椎弓根-C3 侧块固定，4 例因 C2-C3 半脱位行 C2 椎弓根螺钉内固定。所有患者术后均有良好的改善，骨折愈合满意。由于骨折线和解剖变异，插入螺钉的内外侧和前后倾斜角与传统的每个平面 20 度的角度不一致。由于经常观察到由创伤引起的骨解剖变异和骨折线，因此得出结论，在两条轨迹中从经典的 20 度角度偏移。但是仍然不能将固定角度普遍化。因此，可以通过三维 CT 图像进行精确的术前规划，从而使外科医生能够很好地预测手术中使用的螺钉的最佳长度和相邻神经血管结构的安全性的最佳角度。
