背景:先前的分析表明,根据种族,颈椎管形态存在差异,可能部分是由于后部元素的变化。这些变化影响仪器放置的可能性是不确定的。这项研究的目的是报告在新西兰队列中插入C2椎板螺钉的可行性,包括对毛利人的分析,新西兰的土著人民。
方法:访问创伤计算机断层扫描数据库以识别合适的图像。在轴向图像上,地峡最宽的地方,测量层的外径(OD)和内径(ID)。从建议的入口点到椎板和侧块的对侧接合处测量螺钉长度。测量spinolaminar角度为螺钉轨迹和中矢面所对的角度。5.5mmOD被认为是椎板螺钉放置可行性的阈值。
结果:评估了一百八十七个图像:115个新西兰欧洲人和72个毛利人。该队列的平均年龄为41.9岁(SD19.6),大多数患者(64%)是男性。对于整个队列,左右平均OD分别为6.6和6.8mm,分别;平均内径为3.5和3.8毫米;平均螺钉长度为31.5和31.5毫米;平均spinolaminar角为46.0°和46.1°。在大多数患者中,C2椎板螺钉的放置是可行的。只考虑到毛利人,男性在96%的右层和94%的左层中放置是可行的,而女性在72%的右层和72%的左层中放置是可行的。
结论:在大多数患者中,C2椎板螺钉的放置是可行的。然而,术前必须仔细评估高级影像学检查,因为数据表明,毛利女性可能不一定具有最佳解剖结构.临床相关性在评估和计划不同种族的手术住院患者时需要采取Care,因为C2后部元素的形态可能存在差异,从而导致最佳固定策略的差异。证据水平3。
BACKGROUND: Previous analyses have suggested variations in cervical spine canal morphology according to ethnicity, possibly in part due to variations in the posterior elements. The potential for these variations to affect the placement of instrumentation is uncertain. The aim of this study was to report on the feasibility of C2
lamina screw insertion in a New Zealand cohort including analysis of Māori, the indigenous people of New Zealand.
METHODS: A trauma computed tomography database was accessed to identify suitable images. On axial images, where the isthmus was at its widest, the outer diameter (OD) and inner diameter (ID) of the lamina were measured. Screw length was measured from a proposed entry point to the contralateral junction of the
lamina and lateral mass. The spinolaminar angle was measured as the angle subtended by the screw trajectory and midsagittal plane. A 5.5-mm OD was accepted as a threshold for the feasibility of
lamina screw placement.
RESULTS: One hundred eighty-seven images were assessed: 115 New Zealand European and 72 Māori. The mean age of the cohort was 41.9 years (SD 19.6), and most patients (64%) were men. For the entire cohort, mean OD was 6.6 and 6.8 mm on the right and left, respectively; the mean inner diameter was 3.5 and 3.8 mm; mean screw length was 31.5 and 31.5 mm; and mean spinolaminar angle was 46.0° and 46.1°. C2
lamina screw placement was feasible in a majority of patients. Considering only Māori patients, placement was feasible in 96% of right and 94% of left laminae in men but 72% of right and 72% of left laminae in women.
CONCLUSIONS: In a majority of patients, C2
lamina screw placement is feasible. However, advanced imaging must be carefully assessed preoperatively because data suggest that Māori women may not necessarily have optimal anatomy.Clinical RelevanceCare needs to be taken when assessing and planning surgery inpatients of different ethnicities because variations may exist in the morphology of the posterior elements of C2, leading to variation in optimal fixation strategy.Level of Evidence3.