Patient-specific drill template for C2 transoral pedicle insertion in complete reduction of atlantoaxial dislocation: cadaveric efficacy and accuracy assessments

Journal of Orthopaedic Surgery and Research

Peng Peng¹  Jianyi Li²  Lijun Lin³  Meisong Zhu³  Xiaoqi Zhou³  Xintao Zhang⁴ 

[1] 0000 0000 8877 7471, grid.284723.8, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China;0000 0000 8877 7471, grid.284723.8, Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China;0000 0000 8877 7471, grid.284723.8, Nanhai Hospital, Southern Medical University, 28 Liguan Road, Lishui Town, Nanhai District, Foshan, Guangdong, China;0000 0000 8877 7471, grid.284723.8, Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China;0000 0000 8877 7471, grid.284723.8, Department of Radiology, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshandadao Xi, Tianhe District, Guangzhou, Guangdong, China;

关键词: Patient-specific drill template;    Transoral atlantoaxial reduction plate;    Atlantoaxial dislocation;    Pedicle fixation;   

DOI  :  10.1186/s13018-019-1189-7

来源: publisher

【 摘 要 】

BackgroundThe transoral atlantoaxial reduction plate (TARP) is an effective advance in the treatment of atlantoaxial dislocation (AAD) and can enable the performance of anterior atlantoaxial release, reduction, decompression, and internal fixation in a one-stage operation. However, accurate transoral C2 pedicle insertion (C2TOPI) remains a challenge. The aim of this study is to develop a grouped patient-specific drill template (PDT) specifically for AAD with complete reduction and, furthermore, to compare its efficacy and accuracy in facilitating C2TOPI.MethodsAfter CT scanning, ten cadaveric C2 specimens were randomly assigned to two groups (the PDT and freehand group). A grouped PDT specifically for AAD with complete reduction was designed and manufactured. C2TOPI was performed using the PDT or the fluoroscopy-guided freehand technique. Postoperative CT scans were subsequently performed to analyze the deviations at the centroid of the cross section at the midpoint of the pedicle. Screw position grades were also assessed in both groups.ResultsCompared to the freehand group, the PDT group had a significantly shorter surgery time (p < 0.001). Significant differences between the two groups were observed in the absolute value of the deviations at the centroid of the pedicle on either the axial or sagittal planes (p < 0.05). No significant difference was found in the screw positions between the two groups (p > 0.05); however, two unacceptable breaches (20%) occurred in the freehand group.ConclusionA specifically designed PDT could provide an accurate and easy-to-apply method for C2TOPI in AAD with complete reduction.

【 授权许可】

CC BY