ABSTRACT
Objective To validate the safety and accuracy of a rapid prototyping drill template (RPDT) for posterior atlantoaxial transarticular screw placement and analyze factors for screw deviation.Methods Twelve normal cadaveric cervical spines were examined using 64 slice CT with 1-mm thick scan and data in Dicom format were recorded.After data was processed using software Mimics 10.01 for three-dimensional (3-D) model reconstruction,computer-assisted design of optimum trajactory for atlantoaxial transarticular screw placement was worked out and made into a drill template,where the surface was created as the inverse of axial posterior surface.The drill template was materialized in a rapid prototyping machine and used to place the screws.After surgery,the position of posterior atlantoaxial transarticular screw was evaluated by X-ray and CT scan.Screw entry point,angle and orientation of the optimal and actual trajactory were determined after fitting the position of the pre-operative and post-operative specimen in computer software and the redefining the 3-D coordinate axis.Results Twenty-four screws were implanted with no cortex perforation.Depth of the optimum save screw trajectory for atlantoaxial transarticular fixation was (37.34 ± 2.31) mm on the left side and (37.11 ± 2.21) mm on the right side.Introversion angles of the optimum save screw trajectory was 0° in both sides,but the actual angle was (0.15 ±0.58)°on the left side and (0.11 ±0.46)°on the right side.Elevation angle of the optimum save screw trajectory was (49.35 ± 1.62) °on the left side and (48.83 ± 1.83) ° on the right side,but the actual angle was (49.29 ± 1.68) °and (49.10 ± 1.45) °respectively.Average displacement of screw entry point in the x,y and z axis was respective (0.21 ±0.65) mm,(0.69 ± 1.48) mm and (0.39 ±0.11) mm on the right side,while (0.19 ± 0.66) mm,(0.53 ± 1.45) mm and (0.38 ± 0.13) mm on the left side.There were no statistically significant differences in deviation levels of entry point and orientation between the optimum and actual screw trajectory (P ＞ 0.05).Conclusions Causes for deviation in RPDT-assisted placement of atlantoaxial transarticular screw are mainly intrinsic factors of the hardware and software and human factors in the operation.RPDT is easy in operation and has individualized design,which greatly improves the accuracy of screw placement and reduces screw deviation.RPDT can be widely used in clinical practice.