Orthopedics Center of Zigong Fourth People's Hospital, Zigong, China.
Digital Medical Center of Zigong Fourth People's Hospital, Zigong,China.
Neurol Res. 2021 Dec;43(12):961-969. doi: 10.1080/01616412.2021.1948741. Epub 2021 Jul 6.
To explore the corridor for atlas pedicle screw placement perpendicular to the coronal plane and to develop patient-specific navigation templates for pedicle screw placement.
This study is a retrospective analysis. A total of 71 patients (41 males and 30 females) were involved in this study from June 2016 to June 2018, and they were divided into a template group (39 patients) and a conventional group (32 patients). The CT-based 3D reconstruction models were analyzed in the template group. From the perspective of the 3D atlas in a coronal view, the pedicle corridor was obtained. Taking the center of the tangential circle of the pedicle as the entry point, we simulated screw placement perpendicular to the coronal plane. Then, the individual navigation template was designed and used in surgery. In the conventional group, free-hand pedicle screw placement was performed perpendicular to the coronal plane. The diameter of the maximum tangential circle and screw length of the pedicle corridor were measured in the template group. The surgical time, radiation exposure time, screw grading criteria and so on were evaluated and compared between the two groups after surgery.
;The diameter of the maximum tangential circle and the distance between the entry point and posterior tubercle were significantly greater in males than in females. The operation was successfully completed in all patients, without aggravation of nerve injury, and the follow-up was 12-20 months, with an average of 15.6 months. A total of 78 screws were inserted in the template group, and 64 screws were inserted in the conventional group. The surgical times in the template group and conventional group were 76.47±24.44 min and 125.63±36.41 min, respectively. The radiation exposure times in the template group and conventional group were 3.51±1.77 and 10.15±4.95, respectively, and there was a significant difference between the two groups. In the template group, the deviation in the screw entry point and screw angle were 1.92±1.67 mm and 2.08±1.98°, respectively. The medial angle deviation between the left and right sides was 2.71±1.88° in the template group, which was significantly less than the deviation of 3.76±2.22° in the conventional group.
A pedicle screw trajectory perpendicular to the coronal plane can be quickly obtained based on the perspective of 3D models. The technique of screw placement perpendicular to the coronal plane assisted by navigation templates has a shorter operative time, lessintraoperative fluoroscopy and a higher safety of screw placement than traditional surgery.
探索与冠状面垂直的寰枢椎椎弓根螺钉进钉通道，并为置钉设计个体化导航模板。
本研究为回顾性分析。2016 年 6 月至 2018 年 6 月共纳入 71 例患者（男 41 例，女 30 例），分为模板组（39 例）和常规组（32 例）。在模板组中对基于 CT 的三维重建模型进行分析。从寰椎冠状位三维视角获取椎弓根通道，以椎弓根切线圆的圆心为进钉点，模拟置钉方向垂直于冠状面。然后，设计个体化导航模板并应用于手术。常规组采用徒手置钉方法，置钉方向垂直于冠状面。测量模板组中椎弓根通道最大切线圆直径和螺钉长度。术后对两组患者的手术时间、射线暴露时间、螺钉置钉分级标准等进行评价和比较。
男性患者的最大切线圆直径和进钉点至后结节距离均大于女性（P<0.05）。所有患者均顺利完成手术，无神经损伤加重，随访 12~20 个月，平均 15.6 个月。模板组共置入 78 枚螺钉，常规组共置入 64 枚螺钉。模板组和常规组的手术时间分别为 76.47±24.44 min 和 125.63±36.41 min，射线暴露时间分别为 3.51±1.77 和 10.15±4.95，两组比较差异均有统计学意义（P<0.05）。模板组螺钉进钉点和螺钉角度偏差分别为 1.92±1.67 mm 和 2.08±1.98°，左右两侧内倾角度偏差为 2.71±1.88°，均小于常规组的 3.76±2.22°。
基于三维模型的冠状面垂直置钉通道可以快速获得，导航模板辅助下的冠状面垂直置钉技术与传统手术相比，手术时间更短，术中射线暴露更少，螺钉置钉安全性更高。
