CAJ | 학술논문

目的探讨"漏斗技术"在胸椎椎弓根螺钉置入中的准确性,并对该技术的实验和临床应用一致性进行比较.方法回顾性分析2006年8月-2008年7月至少有1枚螺钉置于T1～T12的3具人类尸体标本和11例患者的资料.由一位缺乏胸椎弓根螺钉置钉经验的年轻脊柱外科医师采用"漏斗技术"完成全部螺钉的置入.根据术后薄层CT扫描评估置钉准确性及各种并发症.结果平均随访时间23.1个月,未见医源性血管、神经或内脏损伤等并发症;置钉失败率在标本和患者分别为14%(10/72)和15%(8/55);标本和患者危险性穿破分别为2枚(3%)和1枚(2%);置钉准确性在标本和患者之间差异无统计学意义;11例患者中,6枚(11%)螺钉穿破椎弓根外侧壁,1枚(2%)螺钉穿破椎弓根内侧壁,1枚(2%)螺钉穿破椎弓根上壁,未见椎弓根下壁和前壁穿破;患者置钉准确性比较:T1～T4比T5～T8(P＞0.05)、T1～T4比T9～T12(P＞0.05)、T1～T8比T9～T12(P＞0.05).在所有患者中,仅1枚螺钉需要重置.年轻脊柱外科医师在第1、第2、第3具标本上发生置钉失败数分别为6枚、3枚和1枚.结论 "漏斗技术"是一种简单、安全、准确和经济的椎弓根螺钉置入方法.实验研究与临床应用一致,通过该技术使年轻医师迅速安全、准确置入胸椎弓根螺钉成为可能.
목적 탐토"루두기술"재흉추추궁근라정치입중적준학성,병대해기술적실험화림상응용일치성진행비교.방법 회고성분석2006년8월-2008년7월지소유1매라정치우T1～T12적3구인류시체표본화11례환자적자료.유일위결핍흉추궁근라정치정경험적년경척주외과의사채용"루두기술"완성전부라정적치입.근거술후박층CT소묘평고치정준학성급각충병발증.결과 평균수방시간23.1개월,미견의원성혈관、신경혹내장손상등병발증;치정실패솔재표본화환자분별위14%(10/72)화15%(8/55);표본화환자위험성천파분별위2매(3%)화1매(2%);치정준학성재표본화환자지간차이무통계학의의;11례환자중,6매(11%)라정천파추궁근외측벽,1매(2%)라정천파추궁근내측벽,1매(2%)라정천파추궁근상벽,미견추궁근하벽화전벽천파;환자치정준학성비교:T1～T4비T5～T8(P＞0.05)、T1～T4비T9～T12(P＞0.05)、T1～T8비T9～T12(P＞0.05).재소유환자중,부1매라정수요중치.년경척주외과의사재제1、제2、제3구표본상발생치정실패수분별위6매、3매화1매.결론 "루두기술"시일충간단、안전、준학화경제적추궁근라정치입방법.실험연구여림상응용일치,통과해기술사년경의사신속안전、준학치입흉추궁근라정성위가능.
Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.