CAJ | 학술논문

目的探讨在儿童寰枢关节固定或枕颈融合手术中,直径为3.0 mm和3.5 mm螺钉固定儿童枢椎椎弓根、椎板及寰椎侧块的可行性.方法 2008年1月至2010年11月对113例儿童患者行上颈椎CT检查,并对其中85例患者检查资料进行分析,男67例,女18例；年龄2～9岁,平均5.8岁.共获得170个枢椎椎弓根、枢椎椎板及寰椎侧块直径大小数据,比较采用直径为3.0 mm和3.5 mm的螺钉固定的可行性.结果本研究获得儿童枢椎椎弓根、椎板直径及寰椎侧块峡部直径均有170个数据.枢椎椎弓根43.5％ (74/170)可以容纳直径＞3.0 mm螺钉；78.8％ (134/170)可以容纳直径3.0 mm的螺钉,椎弓根和椎板容纳直径＞3.0 mm螺钉的比率比较差异有统计学意义(x2=11.263,P=0.000).椎弓根21.7％ (37/170)可以容纳直径3.5 mm的螺钉,椎板62.9％(107/170)可以容纳直径3.5 mm的螺钉,椎弓根和椎板容纳直径＞3.5mm螺钉的比率比较差异有统计学意义(x2=17.454,P =0.000).儿童寰椎侧块92.9％能容纳直径3.5 mm的螺钉,100％能容纳直径3.0mm螺钉,差异无统计学意义(x2=9.216,P=0.095).结论根据CT评估,儿童枢椎选择直径3.0 mm的椎板螺钉较椎弓根螺钉较少受到解剖学限制.在儿童寰枢关节固定或枕颈融合手术中,枢椎椎板螺钉固定可以作为一个可靠的固定选择.
목적 탐토재인동환추관절고정혹침경융합수술중,직경위3.0 mm화3.5 mm라정고정인동추추추궁근、추판급환추측괴적가행성.방법 2008년1월지2010년11월대113례인동환자행상경추CT검사,병대기중85례환자검사자료진행분석,남67례,녀18례；년령2～9세,평균5.8세.공획득170개추추추궁근、추추추판급환추측괴직경대소수거,비교채용직경위3.0 mm화3.5 mm적라정고정적가행성.결과 본연구획득인동추추추궁근、추판직경급환추측괴협부직경균유170개수거.추추추궁근43.5％ (74/170)가이용납직경＞3.0 mm라정；78.8％ (134/170)가이용납직경3.0 mm적라정,추궁근화추판용납직경＞3.0 mm라정적비솔비교차이유통계학의의(x2=11.263,P=0.000).추궁근21.7％ (37/170)가이용납직경3.5 mm적라정,추판62.9％(107/170)가이용납직경3.5 mm적라정,추궁근화추판용납직경＞3.5mm라정적비솔비교차이유통계학의의(x2=17.454,P =0.000).인동환추측괴92.9％능용납직경3.5 mm적라정,100％능용납직경3.0mm라정,차이무통계학의의(x2=9.216,P=0.095).결론 근거CT평고,인동추추선택직경3.0 mm적추판라정교추궁근라정교소수도해부학한제.재인동환추관절고정혹침경융합수술중,추추추판라정고정가이작위일개가고적고정선택.
Objective To determine the feasibilities of placing screws of 3.0 mm and 3.5 mm in diameter into the C2 laminae and pediclcs in a C1-C2 or craniocervical arthrodesis.Methods The CT data of 85 children patients were reviewed fir this study who had undergone CT scans of the superior cervica vertebrae from January 2008 to November 2010 in our hospital.They were 67 boys and 18 girls,aged from 2 to 9 years (average,5.8 years).A set of 170 diameter data were obtained respectively of C2 laminae and pedicles,as well as C1 lateral masses.The chi-square test was used to determine the feasibilities of fixation with screws of 3.0 mm and 3.5 mm in diameter.Results Three sets of 170 diameter data were obtained,respectively of C2 laminae,C2 pedicles and C1 lateral masses.In this group,3.5 mm screw placement was feasible in 21.7％ (37/170) of the C2 pedicles and 62.9％ (107/170) of the C2 laminae,with a significant difference(x2=ll.263,P=0.000); 3.0-mm screw placement was feasible in 43.5％ (74/170) oftheC2 pedicles,significantly lower than in the C2 laminae (78.8％,134/170) (x2 =17.454,P =0.000).Of the C1lateral masses,92.9％ were suitable for 3.5 mm screw placement and 100％ were suitable for 3.0 mm screw placement,with no significant difference(x2=9.216,P=0.095).Conclusions 3.0 mm screw placement for laminae requires the least anatomic restriction than that for pedicles in children.C2 laminae represent a viable fixation point in a C1-C2 or craniocervical arthrodesis in children.