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.	譚明生, 移平, 王文軍, 等. 經寰椎" 椎弓根”螺釘內固定技術的臨床應用. 中國脊柱脊髓雜志, 2006, 16(5): 336-340.
6.	張丙磊, 張強, 余楓, 等. 樞椎椎板螺釘固定的解剖學研究. 中國脊柱脊髓雜志, 2006, 16(1): 45-47.
7.	陳其昕, 沈金明, 李方財, 等. 寰椎側塊置釘安全區域的建立及其應用. 中華創傷雜志, 2006, 22(6): 404-407.
8.	覃煒, 權正學, 劉洋, 等. 寰樞椎椎弓根螺釘個體化導向模板的研制與實驗研究. 中國修復重建外科雜志, 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, 謝輝, 等. 快速成型導向模板輔助下寰樞椎椎弓根螺釘置釘的偏差因素分析. 中華醫學雜志, 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.	王飛, 劉志斌, 張建華, 等. 3D 打印導航模板在輔助寰樞椎椎弓根螺釘置入中的應用價值. 中國脊柱脊髓雜志, 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.	張美超, 周海濤, 王超, 等. 對寰樞椎側塊螺釘鈦板固定裝置的力學性能評價. 中國脊柱脊髓雜志, 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.	郭乃銘, 周躍. 計算機輔助手術導航系統在脊柱外科手術中的應用進展. 中國矯形外科雜志, 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.	陳宣煌, 余正希, 吳長福, 等. Quadrant 系統下 3D 打印導航模塊輔助腰椎精準植釘的應用研究. 中國修復重建外科雜志, 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, 張世權, 等. CT 掃描層厚參數對骨組織 3D 打印模型精度影響的研究. 中國數字醫學, 2017, 12(9): 85-88.
24.	陽宏奇, 雷青, 蔡立宏, 等. 3D 打印導板輔助空心螺釘內固定治療不穩定性骨盆骨折. 中國修復重建外科雜志, 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. 譚明生, 移平, 王文軍, 等. 經寰椎" 椎弓根”螺釘內固定技術的臨床應用. 中國脊柱脊髓雜志, 2006, 16(5): 336-340.
6. 張丙磊, 張強, 余楓, 等. 樞椎椎板螺釘固定的解剖學研究. 中國脊柱脊髓雜志, 2006, 16(1): 45-47.
7. 陳其昕, 沈金明, 李方財, 等. 寰椎側塊置釘安全區域的建立及其應用. 中華創傷雜志, 2006, 22(6): 404-407.
8. 覃煒, 權正學, 劉洋, 等. 寰樞椎椎弓根螺釘個體化導向模板的研制與實驗研究. 中國修復重建外科雜志, 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, 謝輝, 等. 快速成型導向模板輔助下寰樞椎椎弓根螺釘置釘的偏差因素分析. 中華醫學雜志, 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. 王飛, 劉志斌, 張建華, 等. 3D 打印導航模板在輔助寰樞椎椎弓根螺釘置入中的應用價值. 中國脊柱脊髓雜志, 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. 張美超, 周海濤, 王超, 等. 對寰樞椎側塊螺釘鈦板固定裝置的力學性能評價. 中國脊柱脊髓雜志, 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. 郭乃銘, 周躍. 計算機輔助手術導航系統在脊柱外科手術中的應用進展. 中國矯形外科雜志, 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. 陳宣煌, 余正希, 吳長福, 等. Quadrant 系統下 3D 打印導航模塊輔助腰椎精準植釘的應用研究. 中國修復重建外科雜志, 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, 張世權, 等. CT 掃描層厚參數對骨組織 3D 打印模型精度影響的研究. 中國數字醫學, 2017, 12(9): 85-88.
24. 陽宏奇, 雷青, 蔡立宏, 等. 3D 打印導板輔助空心螺釘內固定治療不穩定性骨盆骨折. 中國修復重建外科雜志, 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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