后路寰枢椎脱位复位钢板:尸体测试与形态轨迹分析。

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis.

机构信息

Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.

Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China.

出版信息

Orthop Surg. 2022 Mar;14(3):522-529. doi: 10.1111/os.13217. Epub 2022 Jan 30.

DOI:10.1111/os.13217

PMID:35098677

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8927024/

Abstract

OBJECTIVE

To evaluate the placement feasibility and safety of the newly designed retropharyngeal reduction plate by cadaveric test and to perform morphometric trajectory analysis.

METHODS

The five cadaveric specimens with intact atlantoaxial joint were enrolled in this study. They were used for simulating the placement process and evaluating the placement feasibility of the retropharyngeal reduction plate. The atlantoaxial dislocation (AAD) of five cadaveric specimens were obtained by proper external force after dissecting ligaments. The retropharyngeal reduction plate was placed on atlantoaxial joint of cadaveric specimens. The X-ray and three-dimensional (3D) spiral CT were used for evaluating the placement safety of retropharyngeal reduction plate. The DICOM data was obtained after 3D spiral CT scanning for the morphometric trajectory analysis.

RESULTS

The reduction plates were successfully placed on the atlantoaxial joint of five cadaveric specimens through the retropharyngeal approach, respectively. The X-ray and 3D spiral CT showed the accurate screw implantation and satisfying plate placement. The length of the left/right atlas screw trajectory (L/RAT) was, respectively, 1.73 ± 0.01 cm (LAT) and 1.71 ± 0.02 cm (RAT). The length of odontoid screw trajectory (OST) was 1.38 ± 0.02 cm. The length of the left/right axis screw trajectory (L/RAXT) was, respectively, 1.67 ± 0.02 cm (LAXT) and 1.67 ± 0.01 cm (RAXT). There was no statistical significance between left side and right side in terms of AT and AXT (P > 0.05). The angles of atlas screw trajectory angle (ASTA), axis screw trajectory angle (AXSTA), and odontoid screw trajectory angle (OSTA) were 38.04° ± 2.03°, 56.92° ± 2.66°, and 34.78° ± 2.87°, respectively.

CONCLUSION

The cadaveric test showed that the retropharyngeal reduction plate is feasible to place on the atlantoaxial joint, which is also a safe treatment choice for atlantoaxial dislocation. The meticulous preoperative planning of screw trajectory based on individual differences was also vital to using this technique.

摘要

目的

通过尸体试验评估新设计的咽后复位板的放置可行性和安全性，并进行形态测量轨迹分析。

方法

本研究纳入了 5 具完整寰枢关节的尸体标本，用于模拟放置过程并评估咽后复位板的放置可行性。通过解剖韧带后施加适当的外力，获得 5 具尸体标本的寰枢关节脱位（AAD）。将咽后复位板放置在尸体标本的寰枢关节上。X 射线和三维（3D）螺旋 CT 用于评估咽后复位板的放置安全性。3D 螺旋 CT 扫描后获得 DICOM 数据进行形态测量轨迹分析。

结果

通过咽后入路，5 具尸体标本的复位板均成功放置在寰枢关节上。X 射线和 3D 螺旋 CT 显示螺钉植入准确，钢板放置满意。左侧/右侧寰椎螺钉轨迹（L/RAT）的长度分别为 1.73±0.01cm（LAT）和 1.71±0.02cm（RAT）。齿状突螺钉轨迹（OST）的长度为 1.38±0.02cm。左侧/右侧枢椎螺钉轨迹（L/RAXT）的长度分别为 1.67±0.02cm（LAXT）和 1.67±0.01cm（RAXT）。左右两侧 AT 和 AXT 之间无统计学差异（P＞0.05）。寰椎螺钉轨迹角（ASTA）、枢椎螺钉轨迹角（AXSTA）和齿状突螺钉轨迹角（OSTA）分别为 38.04°±2.03°、56.92°±2.66°和 34.78°±2.87°。