CAJ | 학술논문

目的探讨颈椎前路椎弓根螺钉(anterior pedicle screw,APS)内固定技术临床应用的可行性和安全性. 方法应用下颈椎APS内固定技术治疗下颈椎损伤患者10例.术前皆行颈椎CT扫描,Mimics软件重建三维模型,测量置钉参数(进钉点、置钉角度和螺钉长度与直径).采用常规颈前方入路术,显露椎体前壁致两侧外缘,辨清固定椎体上下终板.在X线透视引导下,严格按照术前的置钉参数置钉.术后复查颈椎正、侧位X线片、CT平扫和三维重建及MRI,由放射科医师与非术者骨科医师共同评价.术后1,3,6,12个月随访,并进行评价. 结果术中除1枚C4和l枚C7螺钉未能成功置入外,共计置入C3～C7螺钉24枚.术后CT示4枚损伤椎弓根外侧壁.术后1例1周后死于急性心肌梗死,余9例均获随访.按Frankel分级,3例创伤患者中1例A级患者无恢复,但无加重,另2例有2～3级恢复；6例非创伤患者脊髓功能日本骨科学会(JOA)评分平均提高到13.4分,按Hirabayashi法计算,改善率为60.7％.所有受访患者,除2例发生吞咽困难外,余均无并发症发生.各例早期均有骨融合出现. 结论下颈椎APS内固定技术可行.置钉成功的关键在于术前个体化置钉参数的测定及术中X线透视技术的运用.
목적 탐토경추전로추궁근라정(anterior pedicle screw,APS)내고정기술림상응용적가행성화안전성. 방법 응용하경추APS내고정기술치료하경추손상환자10례.술전개행경추CT소묘,Mimics연건중건삼유모형,측량치정삼수(진정점、치정각도화라정장도여직경).채용상규경전방입로술,현로추체전벽치량측외연,변청고정추체상하종판.재X선투시인도하,엄격안조술전적치정삼수치정.술후복사경추정、측위X선편、CT평소화삼유중건급MRI,유방사과의사여비술자골과의사공동평개.술후1,3,6,12개월수방,병진행평개. 결과 술중제1매C4화l매C7라정미능성공치입외,공계치입C3～C7라정24매.술후CT시4매손상추궁근외측벽.술후1례1주후사우급성심기경사,여9례균획수방.안Frankel분급,3례창상환자중1례A급환자무회복,단무가중,령2례유2～3급회복；6례비창상환자척수공능일본골과학회(JOA)평분평균제고도13.4분,안Hirabayashi법계산,개선솔위60.7％.소유수방환자,제2례발생탄인곤난외,여균무병발증발생.각례조기균유골융합출현. 결론 하경추APS내고정기술가행.치정성공적관건재우술전개체화치정삼수적측정급술중X선투시기술적운용.
Objective To discuss the feasibility and safety of anterior pedicle screw (APS) fixation in treatment of lower cervical spine injuries. Methods A total of 10 patients with lower cervical spine injuries were treated with APS fixation.All the patients received preoperative cervical CT scans,and then three-dimensional model was reconstructed by using Mimics software to measure the screw placement parameters (insertion point,screw placement angle,screw length and diameter).All APS fixations were performed through anterior cervical approach,and then centrums antetheca and bilateral outer edges were exposed to distinguish the vertebral end plates.Screw insertion was strictly operated under the fluoroscopic assistance and preoperative screw placement parameters.The postoperative efficacy of APS fixation was evaluated by radiologist and other orthopedist via anteroposterior and lateral radiation,CT scan,three-dimensional model reconstruction and MRI.A follow-up was carried out at 1,3,6 and 12 months after operation. Results Except for one screw for C4 and one for C7,another 24 crews for C3-C7 were successfully inserted.Postoperative CT scan demonstrated four screws breaking the outer vertebral wall.Except for one patient suddenly died from acute myocardial infarction one week after operation,the other nine patients received follow-up.Of three trauma patients,one patient at Grade A did not get improvement but with no aggravation and two achieved improvement for 2-3 grades according to Frankel grade.Among six non-trauma patients,spinal function score by JOA was averagely elevated to 13.4 points,with improvement rate of 60.7％ according to Hirabayashi method.There were no serious complications except for two patients of dysphagia among the patients who were followed up. Conclusions APS fixation is feasible for lower cervical spine injuries.The keys to successful screw insertion are preoperative measurement of individualized screw insertion parameters and appropriate application of intraoperative fluoroscope technique.