CAJ | 학술논문

目的观察区域法枢椎椎弓根钉植入技术的临床治疗效果.方法自2004年4月至2010年6月共收治创伤性寰枢椎不稳患者23例,男19例,女4例,平均年龄45.8岁.术前给予颈椎牵引复位良好后进行手术治疗.寰枢椎椎弓根螺钉固定14例,枕颈融合5例,颈1-3椎弓根钉固定4例.术中采用区域法植入枢椎椎弓根螺钉,即进钉点在枢椎下关节突内上1/4象限,进钉角度参照枢椎峡部上壁和内壁走行方向确定内倾角和头倾角.术后进行颈椎X线和CT检查,评价螺钉位置.结果共置入枢椎弓根螺钉46枚,枢椎弓根螺钉长22～26 mm,平均24 mm,术中未发生椎动脉、脊髓损伤,患者术后神经症状无加重,有神经功能障碍者均获得不同程度改善.复查颈椎X线示复位良好,内固定位置良好.颈椎CT对枢椎弓根钉位置进行评价:1级者占82.6％ (38/46),2级者占15.2％ (7/46),3级者占2.2％ (1/46).结论区域法枢椎椎弓根钉植入技术考虑到了患者的个体化差异,不需要记忆复杂的进钉点和进钉角度参数,不需要术中寻找难以辨认的解剖标志,便于操作,安全性高.
목적 관찰구역법추추추궁근정식입기술적림상치료효과.방법 자2004년4월지2010년6월공수치창상성환추추불은환자23례,남19례,녀4례,평균년령45.8세.술전급여경추견인복위량호후진행수술치료.환추추추궁근라정고정14례,침경융합5례,경1-3추궁근정고정4례.술중채용구역법식입추추추궁근라정,즉진정점재추추하관절돌내상1/4상한,진정각도삼조추추협부상벽화내벽주행방향학정내경각화두경각.술후진행경추X선화CT검사,평개라정위치.결과 공치입추추궁근라정46매,추추궁근라정장22～26 mm,평균24 mm,술중미발생추동맥、척수손상,환자술후신경증상무가중,유신경공능장애자균획득불동정도개선.복사경추X선시복위량호,내고정위치량호.경추CT대추추궁근정위치진행평개:1급자점82.6％ (38/46),2급자점15.2％ (7/46),3급자점2.2％ (1/46).결론 구역법추추추궁근정식입기술고필도료환자적개체화차이,불수요기억복잡적진정점화진정각도삼수,불수요술중심조난이변인적해부표지,편우조작,안전성고.
Objective To explore the clinical efficacies and outcomes of regional method axis pedicle screw insertion technique.Methods During the period of April 2004 to June 2010,a total of 23 cases with traumatic instability of upper cervical vertebrae were recruited.There were 19 males and 4 females with a mean age of 45.8 years.They underwent surgical operations after an excellent traction reduction of cervical vertebrae.The entry points were drawn on axial facet joint and all of them distributed in the region of upper inner 1/4 of lower articular process. So the regional method was employed to determine the entry point.All subjects underwent the reconstruction of posterior stability.Axial pedicle screws were inserted by the insertion technique of axial pedicle screw via the “regional method”.The entry region was in the upper inner 1/4 area of lower articular process.The entry angle,medial inclination and superior inclination were determined by the direction of inner wall and upper wall of isthmus.Postoperative cervical radiography and CT examination were performed to confirm the screw position.Results Forty-six axial pedicle screws were implanted.No significant complications occurred. All screws stayed in excellent positions without the invasion of vertebral artery and spinal canal.Conclusion The “regional method” insertion technique of axial pedicle screw require no memory of complex entry points and entry angle parameters.And there is no need of identifying the anatomical landmarks.Thus this approach is accurate,safe and suitable for most patients.