CAJ | 학술논문

目的：观测脊柱侧弯患者胸椎椎弓根及周围重要结构的形态学特征，评价经椎弓根-肋骨复合体螺钉内固定技术在脊柱侧弯矫形中的可行性。方法11例脊柱侧弯患者的术前矫形内固定节段椎体CT，观察椎弓根、椎弓根-肋骨复合体、脊髓等的形态及解剖位置。并在导航下行后路椎弓根螺钉内固定矫形植骨融合术，术后相同节段再行CT扫描，评价螺钉植入位置。结果椎弓根横径凹侧较凸侧为细，最细者1.2mm，椎弓根在凸侧呈弧形改变，椎体偏离凹侧。凹侧脊髓紧贴椎弓根，凸侧脊髓偏离椎弓根。126枚椎弓根螺钉，有25（19.8％）枚螺钉完全偏出椎弓根行椎弓根-肋骨复合体固定，但术后所有病例均无神经血管的损伤发生，并且均维持了牢靠的内固定。结论导航技术应用于脊柱侧弯椎弓根螺钉植入时，可提高螺钉植入的准确率，畸形严重时螺钉可行椎弓根-肋骨复合体内固定。
목적：관측척주측만환자흉추추궁근급주위중요결구적형태학특정，평개경추궁근-륵골복합체라정내고정기술재척주측만교형중적가행성。방법11례척주측만환자적술전교형내고정절단추체CT，관찰추궁근、추궁근-륵골복합체、척수등적형태급해부위치。병재도항하행후로추궁근라정내고정교형식골융합술，술후상동절단재행CT소묘，평개라정식입위치。결과추궁근횡경요측교철측위세，최세자1.2mm，추궁근재철측정호형개변，추체편리요측。요측척수긴첩추궁근，철측척수편리추궁근。126매추궁근라정，유25（19.8％）매라정완전편출추궁근행추궁근-륵골복합체고정，단술후소유병례균무신경혈관적손상발생，병차균유지료뢰고적내고정。결론도항기술응용우척주측만추궁근라정식입시，가제고라정식입적준학솔，기형엄중시라정가행추궁근-륵골복합체내고정。
Objective To observe the morphological characteristics of thoracic pedicle and surrounding important structures of patients with scoliosis, and to evaluate the feasibility of pedicle rib unit with pedicle screw fixation used in scoliosis orthopedic. Methods 11 cases of scoliosis patients were preoperatively examined vertebral of orthopedic internal fixation by CT. The anatomic position and morphology of pedicle, pedicle rib unit, and the spinal cord were observed. In the navigation, the patients were treated with posterior pedicle screw internal fixation and bone grafting fusion. After the operation, the same segment was again performed CT scanning, and screw implant position was evaluated. Results The convex side of pedicle transverse diameter concave side was thin, of which the thinnest was 1.2mm. The convex side of pedicle was arc change, and the vertebral body was deviated from the concave side. The concave side of spinal was close to pedicle, and The convex side is deviated from the spinal pedicle. There were 25 (19.8%) screws completely partial out of pedicle in 126 pedicle screws, those were fixed with pedicle rib unit, but after the operation there were no neurovascular injury, and all cases maintained stable internal fixation. Conclusion Computer-assisted navigation with pedicle screw implantation used in scoliosis can improve the accuracy of screw placement. In severe deformity, screw can be body fixed by pedicle rib unit.