London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada.
London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, London, Canada.
World Neurosurg. 2022 Jun;162:e225-e234. doi: 10.1016/j.wneu.2022.02.126. Epub 2022 Mar 6.
We sought to evaluate the accuracy of using patient-specific drill guides to place bilateral laminar screws in C1 and C2.
Nine cervical specimens (8 males; mean age: 66.6 [56-73]) with the occiput attached (C0-C3) were used in this study. Preoperative computed tomography (CT) scans were used to create digital anatomic models for templating and guide creation. A total of 36 screws were placed with the aid of 3-dimensional printed, patient-specific guides (2 screws at C1 and C2). Postoperative CT scans were performed following screw insertion. The planned and actual trajectories were compared using preoperative and postoperative imaging based on the angular and entry point deviation. After screw placement and postoperative imaging, each specimen was dissected and performed a visual inspection for breaches.
No breaches or violations were observed on postprocedural CT and visual inspection. The average variation of the entry point in the X, Y, and Z axes was 0.3 ± 0.28, 0.41 ± 0.38, and 0.29 ± 0.24, respectively. No statistically significant difference (P > 0.05) was observed between the planned and obtained entry points. There was no significant difference (P > 0.05) in the deviation analysis between the planned and obtained angles in the axial and coronal planes.
The study demonstrates that patient-specific drill guides allow for accurate C1 and C2 bilateral laminar screw placement, with a low risk of cortical breach.
我们旨在评估使用患者特异性钻导板在 C1 和 C2 中放置双侧椎板螺钉的准确性。
本研究使用了 9 个附有枕骨（C0-C3）的颈椎标本（8 名男性；平均年龄：66.6 [56-73]）。术前计算机断层扫描（CT）用于创建模板和导板制作的数字解剖模型。共使用 3 个三维打印的患者特异性导板（C1 和 C2 各 2 个螺钉）辅助放置 36 个螺钉。插入螺钉后进行术后 CT 扫描。基于角度和进入点偏差，使用术前和术后影像学比较计划和实际轨迹。螺钉放置和术后成像后，每个标本均进行解剖并进行目视检查以检查穿孔。
术后 CT 和目视检查均未观察到穿孔或侵犯。X、Y 和 Z 轴上进入点的平均变化分别为 0.3±0.28、0.41±0.38 和 0.29±0.24。计划和获得的进入点之间没有统计学上的显著差异（P＞0.05）。在轴状和冠状平面上，计划和获得的角度之间的偏差分析没有显著差异（P＞0.05）。
该研究表明，患者特异性钻导板允许准确放置 C1 和 C2 双侧椎板螺钉，皮质穿孔的风险较低。
