CAJ | 학술논문

目的通过与传统徒手置钉术的比较,评价一种新的椎弓根螺钉置钉技术,即应用椎弓根球形探针系统置入椎弓根螺钉的准确率.方法自2009年5月至2010年6月,对脊柱侧凸、腰椎滑脱、脊柱骨折等疾病需行颈胸腰椎椎弓根钉内固定的患者,术中应用椎弓根球形探针置入椎弓根螺钉.该探针为医用不锈钢制成,包括一个球端、杆和柄,金属球端的直径分别有1.5、2.5、3.0、3.5 mm四种,其中直径1.5mm的探针具有较强的硬度和一定的弹性.球形探针技术要点:按标准椎弓根螺钉进钉点定位,高速磨钻去除皮质骨,将椎弓根球形探针按直径从小到大依次缓慢敲入椎弓根内直至达到椎体前方骨皮质.术后采用CT扫描评价椎弓根螺钉钉道情况.并与采用传统徒手技术的病例资料进行对比.结果采用球形探针技术共置入312枚椎弓根螺钉,传统徒手技术置入276枚.术后CT扫描显示球形探针技术组颈椎、胸椎、腰椎椎弓根螺钉钉道准确率为100％,无一例穿出椎弓根骨皮质.传统徒手技术组准确率为78％,共有61枚螺钉(22％)位置不良,23枚(8.3％)穿透椎弓根内侧骨皮质,38枚(13.7％)穿透外侧骨皮质.两组置钉准确率的差异具有统计学意义.所有患者术中和术后均未出现神经、血管和内脏损伤等并发症.结论与传统徒手置钉技术相比,椎弓根球形探针置钉技术,可准确地置入椎弓根钉,避免因螺钉误置所导致的术后并发症.
목적 통과여전통도수치정술적비교,평개일충신적추궁근라정치정기술,즉응용추궁근구형탐침계통치입추궁근라정적준학솔.방법 자2009년5월지2010년6월,대척주측철、요추활탈、척주골절등질병수행경흉요추추궁근정내고정적환자,술중응용추궁근구형탐침치입추궁근라정.해탐침위의용불수강제성,포괄일개구단、간화병,금속구단적직경분별유1.5、2.5、3.0、3.5 mm사충,기중직경1.5mm적탐침구유교강적경도화일정적탄성.구형탐침기술요점:안표준추궁근라정진정점정위,고속마찬거제피질골,장추궁근구형탐침안직경종소도대의차완만고입추궁근내직지체도추체전방골피질.술후채용CT소묘평개추궁근라정정도정황.병여채용전통도수기술적병례자료진행대비.결과 채용구형탐침기술공치입312매추궁근라정,전통도수기술치입276매.술후CT소묘현시구형탐침기술조경추、흉추、요추추궁근라정정도준학솔위100％,무일례천출추궁근골피질.전통도수기술조준학솔위78％,공유61매라정(22％)위치불량,23매(8.3％)천투추궁근내측골피질,38매(13.7％)천투외측골피질.량조치정준학솔적차이구유통계학의의.소유환자술중화술후균미출현신경、혈관화내장손상등병발증.결론 여전통도수치정기술상비,추궁근구형탐침치정기술,가준학지치입추궁근정,피면인라정오치소도치적술후병발증.
Objective The aim in this study was to evaluate the efficacy of the ball tip probe technique in placing pedicle screws in patients.Methods From May 2009 to June 2010,we used ball tip probe technique in pedicle screw placement in patients with scoliosis,spondylolisthesis,spinal fractures and other diseases.The ball tip probe consisted of a metal shaft with a metal ball-shaped tip whose size included 1.5,2.5,3.0,3.5 mm in diameter.The ball tip probe with a diameter of 1.5mm owned a high rigidity and certain flexibility.Ball tip probe technique:A high speed bur was used to remove cortical bone and create a starting point,and then the ball tip probes is tapped gently by a hammer for making a guide hole through the pedicle into the vertebral body.The accuracy of the pedicle screw placements was evaluated on postoperative axial CT scanning The pedicle screw placements was compared between the the ball tip probe group and conventional freehand technique group.Results Three hundred and twelve screws were evaluated in the ball tip group and 276 in the conventional freehand group.All the screws (100％) were in the desired pedicle in the ball tip group and 215 (78％) in the conventional group.In the conventional group,23 screws (8.3％) were classified as medial violation; 38 (13.7％) as lateral violation.A significant difference was determined between the 2 groups regarding the pedicle breaches.No vascular,pulmonary,or neurological injuries caused by pedicle screws placement was found in either group.Conclusion This study demonstrates the accuracy and reliability of the ball tip probe technique in pedicle screw placement.This technique can probably reduce the risk of complications of screw misplacements.