Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Scoliosis Correction with Thoracic Pedicle Screws: Posteroanterior C-arm Rotation Method

측만증 교정술에서 흉추경 나사못의 삽입 술기: 후전방 C형 투시 장치 회전 방법

Hwang, Chang-Ju;Ahn, Young-Joon;Kang, Seok-Joong;Kim, Ji-Hyo;Jeong, Kyeong-Il;Kim, Yung-Tae;Lee, Dong-Ho;Lee, Choon-Sung
황창주;안영준;강석중;김지효;정경일;김영태;이동호;이춘성

  • Published : 20070200
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Abstract

Purpose : This study evaluated a practical, safe and accurate method of thoracic pedicle screw insertion for the surgical treatment of scoliosis using the posteroanterior C-arm fluoroscopy rotation method. Materials and Methods: A total of 611 thoracic pedicle screws were inserted in 45 patients using the posteroanterior (PA) C-arm rotation method. CT scans were taken postoperatively in the transverse and sagittal sections to evaluate the pedicle screw placement. Results : A mean preoperative curve of 57.7˚ was corrected to 17.1˚ (range, 3˚-45˚) in the coronal plane. The postoperative CT scans revealed that 10 screws (1.6%) had penetrated the medial cortex by a mean distance of 3.0 mm and 56 screws (9.2%) penetrated the lateral cortex by a mean distance of 3.5 mm. No screw penetrated the inferior or superior cortex in the sagittal plane. However, 21 screws (3.4%) penetrated the anterior cortex. No neurological or vascular complications were encountered, and none of the screws required replacement. Conclusion : Thoracic pedicle screw insertion in scoliosis patients using the posteroanterior C-arm rotation method is a practical, simple and safe technique that allows the en face visualization of both pedicles by rotating the C-arm to compensate for the rotational deformity.

목적: 후전방 C형 투시 장치 회전 방법을 이용한 척추 측만증의 수술적 치료에서 흉추 척추경 나사못 삽입의 실용적이고 안전하며 정확한 방법을 알아보고 소개하고자 하였다. 대상 및 방법: 한 명의 숙련된 척추외과 의사가 후전방 C형 투시 장치 회전 방법을 이용하여 45명의 흉추부 만곡이 주만곡인 측만증 환자에서 611개의 흉추 척추경 나사못을 삽입하였다. 흉추 척추경 나사못의 정확한 위치를 알기 위해 술후 컴퓨터 단층 촬영을 시행하였다. 결과: 삽입된 611개의 나사못 중 10개의 나사못(1.6%)이 내측 피질을 천공하였고, 56개의 나사못(9.2%)이 외측 피질을 천공하였다. 21개의 나사못(3.4%)이 추체의 전방 피질을 관통하였고, 시상면 상에서 척추경의 상하 피질을 천공한 경우는 없었다. 신경 혈관계의 합병증이나 나사못을 재삽입해야 하는 경우도 없었다. 결론: 척추 측만증 환자에서 후전방 C형 투시 장치 회전 방법을 이용한 흉추 척추경 나사못 삽입 방법은 회전 변형이 있는 추체에서 회전 변형에 맞춰 C형 투시 장치를 회전시켜 양측 척추경이 대칭으로 보이는 진성 전후면 영상에서 나사못을 삽입하기 때문에 배우기 쉽고, 간편하게 적용할 수 있으며, 안정성이 높은 방법이라고 판단된다.

Keywords

References

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