CAJ | 학술논문

目的探讨前路经寰枢关节螺钉内固定术钉道安全性及临床疗效评估.方法对21例创伤性寰枢椎不稳定患者行前路经寰枢关节螺钉内固定术并随访,术后行X线及CTA检查,应用三维CT血管造影(3D-CTA)及AW三维测量软件测量螺钉置入的角度、螺钉在不同平面与椎动脉及椎管的距离,所得数据进行统计学分析.结果全部病例置钉范围均在矢状面上外偏(9°～22°)平均17°,冠状面上后倾(12°～29°)平均21°,螺钉长度(19～30 mm)平均24.5 mm,直径3.5 mm,术中均未发生椎动脉与脊髓损伤；20例获得随访,时间5个月～9年,平均20个月,术后复查示螺钉位置良好,无松动及断钉,寰枢关节植骨融合率为95.0％,术后临床症状均不同程度改善,恢复良好.螺钉与椎动脉间最小距离位于椎动脉入寰椎横突孔平面,数值为(2.2 ～10.2mm),平均5.71 mm,螺钉与椎管间最小距离位于椎动脉出寰椎横突孔平面,数值为(3.8～13.2mm),平均7.36mm.结论研究表明前路经寰枢关节螺钉内固定术是安全有效的.
목적 탐토전로경환추관절라정내고정술정도안전성급림상료효평고.방법 대21례창상성환추추불은정환자행전로경환추관절라정내고정술병수방,술후행X선급CTA검사,응용삼유CT혈관조영(3D-CTA)급AW삼유측량연건측량라정치입적각도、라정재불동평면여추동맥급추관적거리,소득수거진행통계학분석.결과 전부병례치정범위균재시상면상외편(9°～22°)평균17°,관상면상후경(12°～29°)평균21°,라정장도(19～30 mm)평균24.5 mm,직경3.5 mm,술중균미발생추동맥여척수손상；20례획득수방,시간5개월～9년,평균20개월,술후복사시라정위치량호,무송동급단정,환추관절식골융합솔위95.0％,술후림상증상균불동정도개선,회복량호.라정여추동맥간최소거리위우추동맥입환추횡돌공평면,수치위(2.2 ～10.2mm),평균5.71 mm,라정여추관간최소거리위우추동맥출환추횡돌공평면,수치위(3.8～13.2mm),평균7.36mm.결론 연구표명전로경환추관절라정내고정술시안전유효적.
Objective To investigate screw path safety and clinical efficacy assessment of anterior C1-C2 transarticular screw fixation.Methods 21 cases of traumatic atlantoaxial instability were treated by anterior C1-C2 transarticular screw fixation and followed up,After operation,X-ray and CTA are examed.With the application of 3D-CTA and the AW three-dimensional measurement software,the measurement of the angle of the screw placement and the distance between the screw and the vertebral artery as well as spinal canal at different plane is accessible and used for statistical analysis.Results All the cases with the placement of the cancellous bone screw of which the length is froml9 to 30 mm and diameter is 3.5 mm with the lateral angulation to the sagittal plane ranged from 9 ° to 22 °and the posterior angulation to the coronal plane from 12° to 29° had no trauma on vertebral artery and cervical cord during their cervical operations;20 cases were followed up for about 5 months to 9 years with an average of 20 months.Screw position after operation review showed well with no loosening or breakage and Atlantoaxial synostosis rate was 95％.The clinical symptoms were improved to different levels and patients recovered well.The minimum distance between the screw and the vertebral artery is located inside the plane of transverse foramen of atlas with an average of 5.71 mm(2.2-10.2 mm).The minimum distance between the screw and the spinal canal is located outside the plane of transverse foramen of atlas with an average of 7.36 mm(3.8-13.2 mm).Conclusion Our Research have indicated that anterior C1-C2 transarticular screw fixation is safe and effective.