Xi LIN, Fu-Zhi AI, Qing-Shui YIN, Hong XIA, Zeng-Hui WU, Xiang-Yang MA

Application of three-dimensional model in the management of irreducible atlanto-axial dislocation

Amaç:Bu çalışmanın amacı, redükte edilemeyen atlantoaksiyel çıkık tedavisinde vida yerleştirilmesi uygulamasının doğruluğunu geliştirmek için kullanılan gerçek boyutlu hızlı prototipleme (HP) 3-boyutlu model uygulamasını tarif etmekti. Çalışma planı: Çalışmaya redükte edilemeyen atlantoaksiyel çıkık bulunan 10 hasta dahil edildi. Tüm hastalar Japon Ortopedik Derneği (Japanese Orthopedic Association, JOA) skoru kullanılarak değerlendirildi. Cerrahi işlem sırasında ve sonrasında grafiler, MRG ve BT çekildi. Her hasta için 3 boyutlu bir HP modeli yaratıldı. Model, her pedikül hakkında detaylı bilgi elde etmek amacıyla ve ameliyat sırasında bir referans olarak kullanıldı. Model yardımıyla, tüm olgularda transoral atlantoaksiyel redüksiyon plakası ile tespit yapıldı. Bulgular: Ortalama operasyon süresi 145 (dağılım: 90-180) dakika ve ortalama kan kaybı 120 (dağılım: 60-250) ml idi. Cerrahi sonrası JOA skorlarının daha iyi olduğu görüldü. Kırk transoral pedikül/lateral mass vidasının tamamı ciddi bir komplikasyon veya internal tespit yetmezliği gelişmeden yerleştirildi. Ameliyat sonrası grafiler ve BT taraması, 38 transoral pedikül/lateral mass vidasının pedikül yollarında bulunduğunu teyit etti. Vidaların %95’inde tatmin edici bir redüksiyon elde edildi. İki vida son derece dar bir pedikül vakasında C2 pedikülünün yan duvarını deldi. Hastanın takibinde hiçbir nörolojik sekel veya vertebral arter yaralanmasına rastlanmadı. Çıkarımlar: Hızlı prototipleme redükte edilemeyen atlantoaksiyel çıkık ameliyatı sırasında, özellikle anormal anatomik olgularda, doğru ve güvenli vida yerleştirilmesi açısından etkili ve güvenilir bir tekniktir.

Redükte edilemeyen atlantoaksiyel çıkık tedavisinde üç boyutlu model uygulaması

Objective:The aim of this study was to describe the application of the rapid prototyping (RP) life-size 3-dimensional model used to improve accuracy of screw insertion in irreducible atlanto-axial dislocation (IAD). Methods: The study included 10 patients with IAD. All patients were assessed using the Japanese Orthopedic Association (JOA) score. Radiographs, MRI and CT were conducted during the preoperative and postoperative procedure. A 3D RP model was created for each patient. The model was used to obtain detailed information of each pedicle and used as an intraoperative reference. Assisted by the model, transoral atlanto-axial reduction plate fixation was performed in each case. Results: The average operation time was 145 (range: 90 to 180) minutes and average blood loss was 120 (range: 60 to 250) ml. JOA scores improved after surgery. All 40 transoral pedicle/lateral mass screws were placed without serious complications or internal fixation failure. Postoperative radiographs and CT scan showed 38 transoral pedicle/lateral mass screws located in the pedicle tracts. Satisfactory reduction was achieved in 95% of screws. Two screws perforated the lateral wall of the C2 pedicles in an extremely narrow pedicle case. No neurologic sequelae or vertebral artery injury were detected. Conclusion: The RP technique is effective and reliable in achieving an accurate and safe screw insertion during IAD surgery, especially in anatomically abnormal cases.

___

1. Facanha-Filho FA, Winter RB, Lonstein JE, Koop S, No- vacheck T, L’Heureux EA Jr, et al. Measurement accuracy in congenital scoliosis. J Bone Joint Surg Am 2001;83- A:42-5.
2. Izatt MT, Thorpe PL, Thompson RG, D’Urso PS, Adam CJ, Earwaker JW, et al. The use of physical biomodelling in complex spinal surgery. Eur Spine J 2007;16:1507-18.
3. Lu S, Xu YQ, Lu WW, Ni GX, Li YB, Shi JH, et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine 2009;34:E959-66. CrossRef
4. Zhang K, Xu J, Wang Q, Wang G, Wu Z, Xia H, Yin QS. Treatment of dens fractures with posterior atlantoaxial dislocation with transoral atlantoaxial reduction plate sur- gery: case report and introduction of a novel treatment op- tion. Spine 2012;37:E451-5. CrossRef
5. Ai FZ, Yin QS, Xu DC, Xia H, Wu ZH, Mai XH. Tran- soral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of c2 for the treatment of irreducible atlantoaxial dislocation: two case reports. Spine 2011;36:E556-62. CrossRef
6. Mavili ME, Canter HI, Saglam-Aydinatay B, Kamaci S, Kocadereli I. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery. J Craniofac Surg 2007;18:740-7. CrossRef
7. Wagner JD, Baack B, Brown GA, Kelly J. Rapid 3-di- mensional prototyping for surgical repair of maxillo- facial fractures: a technical note. J Oral Maxillofac Surg 2004;62:898-901. CrossRef
8. Yang S, Leong KF, Du Z, Chua CK. The design of scaf folds for use in tissue engineering. Part II. Rapid prototyp- ing techniques. Tissue Eng 2002;8:1-11. CrossRef
9. Wiria FE, Leong KF, Chua CK, Liu Y. Poly-epsilon- caprolactone/hydroxyapatite for tissue engineering scaf- fold fabrication via selective laser sintering. Acta Biomater 2007;3:1-12. CrossRef
10. Yang JC, Ma XY, Lin J, Wu ZH, Zhang K, Yin QS. Per- sonalised modified osteotomy using computer-aided de- sign-rapid prototyping to correct thoracic deformities. Int Orthop 2011;35:1827-32. CrossRef
11. Guarino J, Tennyson S, McCain G, Bond L, Shea K, King H. Rapid prototyping technology for surgeries of the pe- diatric spine and pelvis: benefits analysis. J Pediatr Orthop 2007;27:955-60. CrossRef
12. Hurson C, Tansey A, O’Donnchadha B, Nicholson P, Rice J, McElwain J. Rapid prototyping in the assessment, classi- fication and preoperative planning of acetabular fractures. Injury 2007;38:1158-62. CrossRef
13. Tauchi R, Imagama S, Ito Z, Ando K, Hirano K, Mura- moto A, et al. Complications and outcomes of posterior fusion in children with atlantoaxial instability. Eur Spine J 2012;21:1346-52. CrossRef
14. Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine 2008;33:779- 85. CrossRef
15. Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neuro- surg 1998;88:634-40. CrossRef
16. Suzuki M, Ogawa Y, Kawano A, Hagiwara A, Yamagu- chi H, Ono H. Rapid prototyping of temporal bone for surgical training and medical education. Acta Otolaryngol 2004;124:400-2. CrossRef
17. Kim MS, Hansgen AR, Carroll JD. Use of rapid proto- typing in the care of patients with structural heart disease. Trends Cardiovasc Med 2008;18:210-6. CrossRef