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改良枕髁螺钉:一项定量解剖学研究,探讨一种用于颅颈融合的新型器械固定技术的可行性。

The modified occipital condyle screw: A quantitative anatomic study investigating the feasibility of a novel instrumented fixation technique for craniocervical fusion.

作者信息

Dietz Nicholas, Gruter Basil Erwin, Haegler Joshua, Cho Samuel K, Tubbs R Shane, Spiessberger Alexander

机构信息

Department of Neurosurgery, University of Louisville, Louisville, KY, USA.

Department of Neurosurgery, Cantonal Hospital Aarau, Tellstrasse, 5001 Aarau, Switzerland.

出版信息

J Craniovertebr Junction Spine. 2023 Apr-Jun;14(2):175-180. doi: 10.4103/jcvjs.jcvjs_27_23. Epub 2023 Jun 13.


DOI:10.4103/jcvjs.jcvjs_27_23
PMID:37448506
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10336899/
Abstract

STUDY DESIGN: Prospective human anatomical study. OBJECTIVE: Occipitocervical fusion with occipital plate or condyle screws has shown higher failure rates in those with skeletal dysplasia. The modified occipital condyle screw connects the occipital condyle to the pars basilaris of the occipital bone that may achieve fortified bony purchase and serve as a more rigid fixation point. We evaluate anatomical feasibility of a novel cranial fixation technique designed to decrease risk of pseudarthrosis. MATERIALS AND METHODS: Occipital condyles were analyzed morphologically using multiplanar three-dimensional reconstructed, ultra-thin section computed tomography. The following parameters were obtained: occipital condyle length, maximal cross section, location of hypoglossal canal, axial and sagittal orientation of the long axis, occipital condyle pedicle (OCP) diameter, maximal length of OCP screw, and entry point. RESULTS: Forty patients with total of 80 occipital condyles were analyzed and the following measurements were obtained: occipital condyle length 24.1 mm (20.5-27.7, standard deviation [SD]: 2.2); condyle maximum axial cross-section 12.6 mm (9-15.8, SD: 1.9); length of OCP screw 38.9 mm (29.3-44, SD: 5.7); diameter of OCP 3.4 mm (3.2-3.6, SD: 0.2); clearance below hypoglossal canal 4.5 mm (3.4-7, SD: 1.1); and distance of screw entry point from condylar foramen 2 mm (range 0-4, SD 1.6). CONCLUSION: The modified occipital condyle screw connects the condyle with the clivus through the pars basilaris and represents a safe and technically feasible approach to achieve craniocervical fusion in skeletally mature individuals. This cephalad anchor point serves as an alternate fixation point of the occipitocervical junction with increased strength of construct and decreased risk of hardware failure or pseudarthrosis given cortical bone purchase and longer screw instrumentation.

摘要

研究设计:前瞻性人体解剖学研究。 目的:在骨骼发育异常患者中,使用枕骨板或髁螺钉进行枕颈融合术的失败率较高。改良枕髁螺钉将枕髁与枕骨基底部分相连,可实现更稳固的骨质锚固,并作为更坚固的固定点。我们评估一种旨在降低假关节风险的新型颅骨固定技术的解剖学可行性。 材料与方法:使用多平面三维重建、超薄层计算机断层扫描对枕髁进行形态学分析。获取以下参数:枕髁长度、最大横截面积、舌下神经管位置、长轴的轴向和矢状方向、枕髁椎弓根(OCP)直径、OCP螺钉的最大长度以及进针点。 结果:对40例患者共80个枕髁进行分析,获得以下测量值:枕髁长度24.1毫米(20.5 - 27.7,标准差[SD]:2.2);髁最大轴向横截面积12.6毫米(9 - 15.8,SD:1.9);OCP螺钉长度38.9毫米(29.3 - 44,SD:5.7);OCP直径3.4毫米(3.2 - 3.6,SD:0.2);舌下神经管下方间隙4.5毫米(3.4 - 7,SD:1.1);螺钉进针点距髁孔的距离2毫米(范围0 - 4,SD 1.6)。 结论:改良枕髁螺钉通过枕骨基底部分将髁与斜坡相连,是在骨骼成熟个体中实现颅颈融合的一种安全且技术上可行的方法。这个头端锚固点作为枕颈交界处的另一种固定点,由于皮质骨锚固和更长的螺钉植入,可增强结构强度并降低硬件故障或假关节的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/220a7587bc97/JCVJS-14-175-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/da598f7ff1e4/JCVJS-14-175-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/8fc6673e5959/JCVJS-14-175-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/db51b5432b19/JCVJS-14-175-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/8e55b93ec9b1/JCVJS-14-175-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/44b76960d390/JCVJS-14-175-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/220a7587bc97/JCVJS-14-175-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/da598f7ff1e4/JCVJS-14-175-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/8fc6673e5959/JCVJS-14-175-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/db51b5432b19/JCVJS-14-175-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/8e55b93ec9b1/JCVJS-14-175-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/44b76960d390/JCVJS-14-175-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4923/10336899/220a7587bc97/JCVJS-14-175-g006.jpg

相似文献

[1]
The modified occipital condyle screw: A quantitative anatomic study investigating the feasibility of a novel instrumented fixation technique for craniocervical fusion.

J Craniovertebr Junction Spine. 2023

[2]
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J Spinal Disord Tech. 2008-12

[3]
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[4]
[Digital and anatomical study of posterior atlantooccipital joint-occipital condyle-clivus screw technique].

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[5]
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[6]
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[7]
Computed Tomography-Based Occipital Condyle Morphometry in an Indian Population to Assess the Feasibility of Condylar Screws for Occipitocervical Fusion.

Asian Spine J. 2017-12

[8]
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[9]
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Spine (Phila Pa 1976). 2010-4-20

[10]
[Feasibility of screw placement on posterior occipital condyle assisted by occipital tangent angulation].

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本文引用的文献

[1]
Ehlers-Danlos syndrome-associated craniocervical instability with cervicomedullary syndrome: Comparing outcome of craniocervical fusion with occipital bone versus occipital condyle fixation.

J Craniovertebr Junction Spine. 2020

[2]
Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans.

Global Spine J. 2022-9

[3]
Impact of Screw Diameter and Length on Pedicle Screw Fixation Strength in Osteoporotic Vertebrae: A Finite Element Analysis.

Asian Spine J. 2021-10

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Occipital condyle screws: indications and technique.

J Spine Surg. 2020-3

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Oper Neurosurg (Hagerstown). 2020-9-1

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Oper Neurosurg (Hagerstown). 2018-11-1

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Clin Anat. 2018-5

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Biomechanical evaluation of fixation strength among different sizes of pedicle screws using the cortical bone trajectory: what is the ideal screw size for optimal fixation?

Acta Neurochir (Wien). 2016-3

[9]
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Childs Nerv Syst. 2015-12

[10]
The efficacy of routine use of recombinant human bone morphogenetic protein-2 in occipitocervical and atlantoaxial fusions of the pediatric spine: a minimum of 12 months' follow-up with computed tomography.

J Neurosurg Pediatr. 2015-7

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