Gu Jiyong, Lei Weiwei, Xin Zong, Wu Yi, Peng Lin, Li Zhibin, Feng Zize, Zhao Minchan, Qi Songtao, Lu Yuntao
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China; Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China.
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China.
Clin Neurol Neurosurg. 2018 Jun;169:49-54. doi: 10.1016/j.clineuro.2018.04.005. Epub 2018 Apr 3.
Fixation with the axis vertebra (C2) using pedicle screws is commonly used to treat an unstable occipitocervical junction; however, it is accompanied by a risk of vertebral artery injury. The occiput-C2 (OC2) crossing translaminar screw fixation technique may avoid this risk, but rod implantation is difficult. Offset connectors can help facilitate this construct. This study aimed to evaluate the stability of a technique for OC2 crossing translaminar screw fixation using offset connectors (C2LAM + OF) in comparison with other methods.
Six fresh-frozen human cadaveric occipital-cervical spines were tested intact under flexion, extension, lateral bending, and axial rotation. These were then made into a type II odontoid fracture model, instrumented with an occipital plate, and tested in the following modes: C2 bilateral pedicle screws (C2P), a single C2 pedicle screw and bilateral C3 lateral mass screws (C2P + C3M), C2 crossing translaminar screws (C2LAM), and C2LAM + OF. The OC2 range of motion (ROM) for each construct was obtained and compared using a repeated-measures analysis.
The ROM of the C2LAM + OF construct was found not to be significantly different from that of the C2P and C2P + C3M fixations in every direction (p > 0.05). However, the C2LAM + OF construct was superior to the C2LAM construct in axial rotation (p < 0.05).
OC2 crossing translaminar screw fixation using offset connectors offers similar stability to C2 pedicle screw fixation and is an effective alternative method for treating an unstable occipitocervical junction.
使用椎弓根螺钉固定枢椎（C2）常用于治疗不稳定的枕颈交界区；然而，它伴随着椎动脉损伤的风险。枕骨-C2（OC2）跨椎板螺钉固定技术可避免这种风险，但棒植入困难。偏置连接器有助于促进这种结构。本研究旨在评估使用偏置连接器的OC2跨椎板螺钉固定技术（C2LAM + OF）与其他方法相比的稳定性。
对6个新鲜冷冻的人体尸体枕颈脊柱进行完整的屈伸、侧弯和轴向旋转测试。然后将其制成II型齿状突骨折模型，安装枕骨板，并在以下模式下进行测试：C2双侧椎弓根螺钉（C2P）、单个C2椎弓根螺钉和双侧C3侧块螺钉（C2P + C3M）、C2跨椎板螺钉（C2LAM）和C2LAM + OF。获得每种结构的OC2活动范围（ROM），并使用重复测量分析进行比较。
发现C2LAM + OF结构在各个方向上的ROM与C2P和C2P + C3M固定的ROM无显著差异（p > 0.05）。然而，C2LAM + OF结构在轴向旋转方面优于C2LAM结构（p < 0.05）。
使用偏置连接器的OC2跨椎板螺钉固定提供了与C2椎弓根螺钉固定相似的稳定性，是治疗不稳定枕颈交界区的一种有效替代方法。
