Accuracy analysis and clinical application of the progressive navigation template system to assist atlas-axial pedicle screw placement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Chao ^1,2 , DENG Jiayan ² ,  TAN Lun ¹ , LIN Xu ¹ , YUAN Dechao ¹

1. Department of Orthopedics, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;
2. Digital Medical Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

TAN Lun, Email: 1098726536@qq.com

Keywords：

Atlas-axis; pedicle screw; three-dimensional printing

DOI：

10.7507/1002-1892.201807129

Video：

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Objective To investigate the accuracy of progressive three-dimensional navigation template system (abbreviated as progressive template) to assist atlas-axial pedicle screw placement. Methods The clinical data of 33 patients with atlas-axial posterior internal fixation surgery between May 2015 and May 2017 were retrospectively analyzed. According to the different methods of auxiliary screw placement, the patients were divided into trial group (19 cases, screw placement assisted by progressive template) and control group (14 cases, screw placement assisted by single navigation template system, abbreviated as initial navigation template). There was no significant difference in gender, age, cause of injury, damage segments, damage types, and preoperative Frankel classification between the two groups (P>0.05). The operation time and intraoperative blood loss of the two groups were compared. The safety of screw placement was evaluated on postoperative CT by using the method from Kawaguchi et al, the deviation of screw insertion point were calculated, the angular deviation of the nailing on coordinate systems XOZ, XOY, YOZ were calculated according to Peng’s method. Results All patients completed the operation successfully; the operation time and intraoperative blood loss in the trial group were significantly less than those in the control group (t=–2.360, P=0.022; t=–3.006, P=0.004). All patients were followed up 12–40 months (mean, 25.3 months). There was no significant vascular injury or nerve injury aggravation. Postoperative immediate X-ray film and CT showed the dislocation was corrected. Postoperative immediate CT showed that all 76 screws were of grade 0 in the trial group, and the safety of screw placement was 100%; 51 screws were of grade 0, 3 of gradeⅠ, and 2 of gradeⅡ in the control group, and the safety of screw placement was 91.1%; there was significant difference in safety of screw placement between the two groups (χ²=7.050, P=0.030). The screw insertion point deviation and angular deviation of the nailing on XOY and YOZ planes in the trial group were significantly less than those in the control group (P<0.05). There was no significant difference in angular deviation of the nailing on XOZ between the two groups (t=1.060, P=0.290). Conclusion Compared with the initial navigation template, the progressive navigation template assisting atlas-axial pedicle screw placement to treat atlas-axial fracture with dislocation, can reduce operation time and intraoperative blood loss, improve the safety of screw placement, and match the preoperative design more accurately.

Citation： WU Chao, DENG Jiayan, TAN Lun, LIN Xu, YUAN Dechao. Accuracy analysis and clinical application of the progressive navigation template system to assist atlas-axial pedicle screw placement. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 212-218. doi: 10.7507/1002-1892.201807129 Copy

1.	Dienst M, Engelke C, Prokop M, et al. Unilateral osseous bridging between the arches of atlas and axis after trauma. Spine (Phila Pa 1976), 1999, 24(20): 2105-2108.
2.	Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888.
3.	Barnes AH, Eguizabal JA, Acosta FL Jr, et al. Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine (Phila Pa 1976), 2009, 34(1): E16-20.
4.	Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976), 2000, 25(8): 962-969.
5.	谭明生, 移平, 王文军, 等. 经寰椎" 椎弓根”螺钉内固定技术的临床应用. 中国脊柱脊髓杂志, 2006, 16(5): 336-340.
6.	张丙磊, 张强, 余枫, 等. 枢椎椎板螺钉固定的解剖学研究. 中国脊柱脊髓杂志, 2006, 16(1): 45-47.
7.	陈其昕, 沈金明, 李方财, 等. 寰椎侧块置钉安全区域的建立及其应用. 中华创伤杂志, 2006, 22(6): 404-407.
8.	覃炜, 权正学, 刘洋, 等. 寰枢椎椎弓根螺钉个体化导向模板的研制与实验研究. 中国修复重建外科杂志, 2010, 24(10): 1168-1173.
9.	Jiang L, Dong L, Tan M, et al. Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg, 2016, 136(11): 1483-1490.
10.	胡勇, 袁振山, 谢辉, 等. 快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析. 中华医学杂志, 2013, 93(33): 2659-2663.
11.	Hu Y, Yuan ZS, Kepler CK, et al. Deviation analysis of atlantoaxial pedicle screws assisted by a drill template. Orthopedics, 2014, 37(5): 420-427.
12.	王飞, 刘志斌, 张建华, 等. 3D 打印导航模板在辅助寰枢椎椎弓根螺钉置入中的应用价值. 中国脊柱脊髓杂志, 2017, 27(1): 61-68.
13.	Kawaguchi Y, Nakano M, Yasuda T, et al. Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine (Phila Pa 1976), 2012, 37(23): 1983-1988.
14.	张美超, 周海涛, 王超, 等. 对寰枢椎侧块螺钉钛板固定装置的力学性能评价. 中国脊柱脊髓杂志, 2006, 16(9): 685-687.
15.	Sugimoto Y, Tanaka M, Nakanishi K, et al. Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report). Arch Orthop Trauma Surg, 2009, 129(1): 25-27.
16.	Li S, Ni B, Xie N, et al. Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C₁-C₂ pedicle fixation. Spine (Phila Pa 1976), 2010, 35(14): E624-632.
17.	郭乃铭, 周跃. 计算机辅助手术导航系统在脊柱外科手术中的应用进展. 中国矫形外科杂志, 2013, 21(8): 787-789.
18.	Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
19.	陈宣煌, 余正希, 吴长福, 等. Quadrant 系统下 3D 打印导航模块辅助腰椎精准植钉的应用研究. 中国修复重建外科杂志, 2017, 31(2): 203-209.
20.	Wang YT, Yang XJ, Yan B, et al. Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders. Chin J Traumatol, 2016, 19(1): 31-34.
21.	Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
22.	Lowry DW, Pollack IF, Clyde B, et al. Upper cervical spine fusion in the pediatric population. J Neurosurg, 1997, 87(5): 671-676.
23.	尤微, 王大平, 张世权, 等. CT 扫描层厚参数对骨组织 3D 打印模型精度影响的研究. 中国数字医学, 2017, 12(9): 85-88.
24.	阳宏奇, 雷青, 蔡立宏, 等. 3D 打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.

1. Dienst M, Engelke C, Prokop M, et al. Unilateral osseous bridging between the arches of atlas and axis after trauma. Spine (Phila Pa 1976), 1999, 24(20): 2105-2108.
2. Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888.
3. Barnes AH, Eguizabal JA, Acosta FL Jr, et al. Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine (Phila Pa 1976), 2009, 34(1): E16-20.
4. Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976), 2000, 25(8): 962-969.
5. 谭明生, 移平, 王文军, 等. 经寰椎" 椎弓根”螺钉内固定技术的临床应用. 中国脊柱脊髓杂志, 2006, 16(5): 336-340.
6. 张丙磊, 张强, 余枫, 等. 枢椎椎板螺钉固定的解剖学研究. 中国脊柱脊髓杂志, 2006, 16(1): 45-47.
7. 陈其昕, 沈金明, 李方财, 等. 寰椎侧块置钉安全区域的建立及其应用. 中华创伤杂志, 2006, 22(6): 404-407.
8. 覃炜, 权正学, 刘洋, 等. 寰枢椎椎弓根螺钉个体化导向模板的研制与实验研究. 中国修复重建外科杂志, 2010, 24(10): 1168-1173.
9. Jiang L, Dong L, Tan M, et al. Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg, 2016, 136(11): 1483-1490.
10. 胡勇, 袁振山, 谢辉, 等. 快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析. 中华医学杂志, 2013, 93(33): 2659-2663.
11. Hu Y, Yuan ZS, Kepler CK, et al. Deviation analysis of atlantoaxial pedicle screws assisted by a drill template. Orthopedics, 2014, 37(5): 420-427.
12. 王飞, 刘志斌, 张建华, 等. 3D 打印导航模板在辅助寰枢椎椎弓根螺钉置入中的应用价值. 中国脊柱脊髓杂志, 2017, 27(1): 61-68.
13. Kawaguchi Y, Nakano M, Yasuda T, et al. Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine (Phila Pa 1976), 2012, 37(23): 1983-1988.
14. 张美超, 周海涛, 王超, 等. 对寰枢椎侧块螺钉钛板固定装置的力学性能评价. 中国脊柱脊髓杂志, 2006, 16(9): 685-687.
15. Sugimoto Y, Tanaka M, Nakanishi K, et al. Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report). Arch Orthop Trauma Surg, 2009, 129(1): 25-27.
16. Li S, Ni B, Xie N, et al. Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C₁-C₂ pedicle fixation. Spine (Phila Pa 1976), 2010, 35(14): E624-632.
17. 郭乃铭, 周跃. 计算机辅助手术导航系统在脊柱外科手术中的应用进展. 中国矫形外科杂志, 2013, 21(8): 787-789.
18. Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
19. 陈宣煌, 余正希, 吴长福, 等. Quadrant 系统下 3D 打印导航模块辅助腰椎精准植钉的应用研究. 中国修复重建外科杂志, 2017, 31(2): 203-209.
20. Wang YT, Yang XJ, Yan B, et al. Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders. Chin J Traumatol, 2016, 19(1): 31-34.
21. Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
22. Lowry DW, Pollack IF, Clyde B, et al. Upper cervical spine fusion in the pediatric population. J Neurosurg, 1997, 87(5): 671-676.
23. 尤微, 王大平, 张世权, 等. CT 扫描层厚参数对骨组织 3D 打印模型精度影响的研究. 中国数字医学, 2017, 12(9): 85-88.
24. 阳宏奇, 雷青, 蔡立宏, 等. 3D 打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.

Chinese Journal of Reparative and Reconstructive Surgery

Accuracy analysis and clinical application of the progressive navigation template system to assist atlas-axial pedicle screw placement

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