CAJ | 학술논문

目的：比较“漏斗法”和解剖标记法在颈椎弓根螺钉置入中的准确性和安全性。方法选取10具新鲜成人尸体标本截取颈椎节段（C3-C7），供体年龄51-75岁，平均62.5岁，每例标本术前采用双源CT薄层扫描（1mm∕层）测量C3-C7的椎弓根形态，包括椎弓根的宽度、椎弓根的内偏角、矢状角度。所有标本随机分为两组，实验组采用“漏斗法”置钉技术，对照组采用传统置钉法（解剖标记法）植入椎弓根螺钉，术中不借助任何影像设备，术后检测螺钉植入结果，根据是否造成邻近组织损伤分为一般破损和严重破损，对两种方法的成功率和皮质破损率进行统计学比较。结果术前CT检查发现有5个椎弓根因太小不宜置钉，共计95个椎弓根植入螺钉纳入试验。漏斗法植入颈椎椎弓根钉50枚，其中41枚(82%)完全在椎弓根内，穿破椎弓根皮质9枚(18％)，其中一般破损7枚(14%)，关键破损2枚(4%)，解剖标记法置入螺钉45枚，其中28枚(62.2%)完全在椎弓根内，穿破椎弓根皮质17枚(37.8％)，其中一般破损11枚(24.4%)，关键破损6枚(13.4%)，两种方法的成功率和皮质破损率比较，差异有统计学意义。结论“漏斗法”植入技术植入颈椎椎弓根螺钉安全性和准确率均较高，优于解剖标记置钉法。
목적：비교“루두법”화해부표기법재경추궁근라정치입중적준학성화안전성。방법선취10구신선성인시체표본절취경추절단（C3-C7），공체년령51-75세，평균62.5세，매례표본술전채용쌍원CT박층소묘（1mm∕층）측량C3-C7적추궁근형태，포괄추궁근적관도、추궁근적내편각、시상각도。소유표본수궤분위량조，실험조채용“루두법”치정기술，대조조채용전통치정법（해부표기법）식입추궁근라정，술중불차조임하영상설비，술후검측라정식입결과，근거시부조성린근조직손상분위일반파손화엄중파손，대량충방법적성공솔화피질파손솔진행통계학비교。결과술전CT검사발현유5개추궁근인태소불의치정，공계95개추궁근식입라정납입시험。루두법식입경추추궁근정50매，기중41매(82%)완전재추궁근내，천파추궁근피질9매(18％)，기중일반파손7매(14%)，관건파손2매(4%)，해부표기법치입라정45매，기중28매(62.2%)완전재추궁근내，천파추궁근피질17매(37.8％)，기중일반파손11매(24.4%)，관건파손6매(13.4%)，량충방법적성공솔화피질파손솔비교，차이유통계학의의。결론“루두법”식입기술식입경추추궁근라정안전성화준학솔균교고，우우해부표기치정법。
Objective To evaluate accuracy of cervical pedicle screws placement using funnel technique and topographic landmarks surgical technique. Methods Ten fresh frozen cervical spines(C3-C7)were used(100 pedicles,20 pedicles per level). The average specimen age was 62.5 years (range 51-75);Pedicle width,Sagital angle and transverse angle were measured on preopera-tive axial computed tomography (1-mm slices)for every pedicle. All the specimens were randomly divided into two groups. The pedicles (C3-C7)of experimental group were instrumented with 3.5-mm screws with the funnel technique and the control group with the Topographic landmarks surgical Technique. No intraoperative uoroscopy or radiographic control was used during any part of the entire procedure. Critical perforations (documented contact of a screw with,or an injury to,a spinal cord,nerve root,or vertebral artery)and noncritical perforations(a perforation with no critical contact)were recorded. Results In five pedicles(5%) the procedure was aborted because of a small or nonexistent pedicle medullary canal. In group I(funnel technique) ,82%of screws were placed in the pedicle correctly,7 pedicles(18%) had noncritical breaches and 2 pedicles(4%) had critical perforations. In group II(topograph-ic landmarks surgical technique),62.2%of screws were placed in the pedicle correctly,whereas 11 pedicles(24.4%) had noncritical perforations and 6 pedicles(13.3%) had critical perforations. Statistically significant differences were demonstrated between the two groups(P<0.05). Conclusion Funnel technique can enhance accuracy and further improve the safety of transpedicularscrew place-ment comparing with topographic landmarks surgical technique.