颈椎后路单开门术中微型钛板联合侧块螺钉内固定的影像学测量及可行性分析

Imaging measurement and feasibility analysis of micro-titanium plate combined with lateral mass screw internal fixation in posterior cervical single-door surgery

目的 基于影像归档和通信系统(PACS)测量颈椎侧块相关影像学参数,比较微型钛板与侧块螺钉位置关系对微型钛板联合侧块螺钉内固定术中置钉成功率的影响。方法 收集2021年9月—2021年12月在北部战区总医院骨科门诊行颈椎CT检查的116例患者的颈椎CT数据,并传输至PACS,测量C_(3~7)侧块后表面长度(PSL)和下极角(LPA)。模拟微型钛板联合4种侧块螺钉置钉技术(Roy-Camille、Magerl、Riew和Cheng技术),在不破坏关节突的前提下计算所需最小PSL,若计算值小于实际PSL则定义为置钉成功,反之为置钉失败。根据微型钛板与侧块螺钉位置关系分为上组(微型钛板位于侧块螺钉上方)和下组(微型钛板位于侧块螺钉下方),并比较置钉成功率的组间差异。计算不同置钉技术中置钉成功率较高组所需最小PSL。结果 Magerl上组置钉成功率为17.4%,下组置钉成功率为0.2%;Camille上组置钉成功率为60.5%,下组置钉成功率为0.2%;Riew上组置钉成功率为69.3%,下组置钉成功率为0;Cheng上组置钉成功率为85.2%,下组置钉成功率为0;上组整体置钉成功率为58.1%,下组整体置钉成功率为0.1%;不同置钉技术上组置钉成功率均高于下组,差异具有统计学意义(P < 0.05)。Magerl上组所需最小PSL为15.6 mm、Camille上组为13.1 mm、Riew上组为12.5 mm、Cheng上组为11.5 mm。结论 在微型钛板联合侧块螺钉置钉技术中,微型钛板放置于侧块螺钉上方时置钉成功率较高。其中,Riew上组和Cheng上组有更高的置钉成功率,为颈椎后路单开门微型钛板联合侧块螺钉内固定术安全、可行的策略。若颈椎侧块PSL < 11.5 mm,则不建议行联合手术。

Objective To measure the imaging parameters related to cervical lateral mass using the picture archiving and communication system(PACS),and compare the effect of the position relationship between micro-titanium plates and lateral mass screws on the success rate of screw placement in micro-titanium plate combined with lateral mass screw internal fixation surgery.Methods From September 2021 to December 2021,the cervical CT data of 116 patients who underwent cervical CT examination at the orthopedic outpatient department of the General Hospital of Northern Theater Command were collected and transmitted to PACS.The posterior surface length(PSL)and lower pole angle(LPA)of the C_(3-7) lateral masses were measured.The micro-titanium plate combined with 4 types of lateral mass screw placement techniques(Roy-Camille,Magerl,Riew and Cheng techniques)were simulated,and the minimum required PSL without damaging the articular process was calculated.If the calculated value was less than the actual PSL,it was defined as successful screw placement;otherwise,it was defined as failed screw placement.According to the position relationship between the micro-titanium plate and the lateral mass screw,the patients were divided into upper group(the micro-titanium plate was located above the lateral mass screw)and lower group(the micro-titanium plate was located below the lateral mass screw),and the differences in the success rate of screw placement between the groups were compared.The minimum required PSL for the groups with higher success rates of screw placement in the different screw placement techniques was calculated.ResultsThe success rate of screw placement was 17.4%in the Magerl upper group and 0.2%in the Magerl lower group.The success rate of screw placement was 60.5%in the Camille upper group and 0.2%in the Camille lower group.The success rate of screw placement was 69.3%in the Riew upper group and Oin the Riew lower group.The success rate of screw placement was 85.2%in the Cheng upper group and O in the Cheng lower group.The overall success rate of screw placement of upper groups was 58.1%,and the overall success rate of screw placement of lover group was O.1%.Overall,the successrate of screw placement in the upper group was higher than that in the lower group in different screw placement techniques,and the difference was statistically significant(P<0.05).The minimum required PSL for Magerl upper group was 15.6 mm,Camile upper group 13.1 mm,Riew technical upper group 12.5 mm,and Cheng upper group 11.5 mm.Conclusions Among the micro-titanium plates combined with lateral mass screw placement techniques,the success rate of screw placement was higher when the micro-titanium plate was placed over the lateral mass screws.Among them,the Riew upper group and the Cheng upper group both have a higher success rate of screw placement,which suggest that the micro-titanium plate located above the lateral mass is a feasible and relatively safe strategy in posterior cervical single-door plate-screw internal fixation.However,it is not recommended to perform combined surgery if the PSL of the cervical lateral mass less than 11.5 mm.