CAJ | 학술논문

目的：探讨儿童枢椎椎弓根及椎板螺钉内固定的可行性。方法收集2009年至2012年广州军区广州总医院儿童颈椎薄层CT影像资料32套，其中年龄2～5岁（幼龄组）及5～10岁（学龄组）各16套32侧。测量枢椎椎弓根虚拟钉道宽度、长度、内倾角，椎板虚拟钉道峡部宽度、长度及外展角数据。结果幼龄组椎弓根虚拟钉道宽度＞3.5 mm为15侧、学龄组为26侧；幼龄组椎板虚拟钉道峡部宽度＞3.5 mm为24侧、学龄组为31侧。两组比较，差异均有统计学意义（P＜0.05）。幼龄组和学龄组椎弓根虚拟钉道平均宽度、平均长度，椎板虚拟钉道峡部平均宽度、平均长度比较，差异均有统计学意义（P＜0.05）；两组椎弓根虚拟钉道内倾角、椎板虚拟钉道外展角比较，差异无统计学意义（P＞0.05）。结论对于5～10岁的学龄期儿童，可根据情况选用枢椎椎弓根螺钉或椎板螺钉内固定方式；而对于年龄＜5岁的低龄患儿，术前需基于患儿颈椎薄层CT扫描螺钉内固定相关解剖参数的精确测量和评估，合理选择枢椎椎弓根螺钉、椎板螺钉或混搭式固定，以保证手术的安全性和内固定的可靠性。
목적：탐토인동추추추궁근급추판라정내고정적가행성。방법수집2009년지2012년엄주군구엄주총의원인동경추박층CT영상자료32투，기중년령2～5세（유령조）급5～10세（학령조）각16투32측。측량추추추궁근허의정도관도、장도、내경각，추판허의정도협부관도、장도급외전각수거。결과유령조추궁근허의정도관도＞3.5 mm위15측、학령조위26측；유령조추판허의정도협부관도＞3.5 mm위24측、학령조위31측。량조비교，차이균유통계학의의（P＜0.05）。유령조화학령조추궁근허의정도평균관도、평균장도，추판허의정도협부평균관도、평균장도비교，차이균유통계학의의（P＜0.05）；량조추궁근허의정도내경각、추판허의정도외전각비교，차이무통계학의의（P＞0.05）。결론대우5～10세적학령기인동，가근거정황선용추추추궁근라정혹추판라정내고정방식；이대우년령＜5세적저령환인，술전수기우환인경추박층CT소묘라정내고정상관해부삼수적정학측량화평고，합리선택추추추궁근라정、추판라정혹혼탑식고정，이보증수술적안전성화내고정적가고성。
Objective To investigate the feasibility for internal fixation of pedicle screw and laminar screw in the axis of children. Methods Thirty-two sets of cervical CT scan images of children (age range from 2 to 10 years old) treated in Guangzhou General Hospital of Guangzhou Military Command from 2009 to 2012 were slected, in which there were 16 sets (32 sides) in play age group (age range from 2 to 5 years old ) and other 16 sets (32 sides) in primary school-age group (age range from 5 to 10 years old). The axial pedicle width, length and introvert angle of pedicle screw trajectory, as well as the isthmus width of lamina, length and outward angle of laminar screw trajectory were measured by PACS tools respectively. Results There were 15 sides where pedicle width of pedicle screw trajectory > 3.5 mm in play age group and 26 sides in primary school-age group;while 24 sides where isthmus width of laminar screw trajectory > 3.5 mm in play age group and 31 sides in primary school-age group. Differences of average width, length of pedicle and larmina all showed statistical significance between 2 groups (P <0.05), as for introvert angle of pedicle screw trajectory and outward angle of laminar screw trajectory, there had no statistical differences between 2 groups (P >0.05). Conclusions It is mostly feasible for axis pedicle screw and laminar screw implant for primary school-age children. For the play age children, based on preoperative accurate measurement and evaluation of relative screw implant anatomic parameters through thin slice cervical CT scan images, laminar or pedicle screw or mixed internal fixation should be chosen reasonably so as to provide safe and efficient fixation.