성인 척추변형 환자에서 척추골반부 고정시 장골나사못과 관련된 합병증 - 척추골반부 고정 시 장골나사못의 합병증 -

김환정,지용주,강종원,박건영,구제윤,권원조,최원식 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.3

Study Design: Retrospective study. Objectives: To evaluate clinical & radiologic significance about complications of spinopelvic fixation with iliac screw in patients with adult spinal deformity. Summary of Literature Review: Complications of iliac screw fixation in adult spinal deformity patients was obscure in spite of the good results of iliac screw fixation. Material and Methods: We analyzed 27 patients, followed over 1-year, with adult spinal deformity (lumbar degenerative kyphosis,degenerative lumbar scoliosis, flat back syndrome). The study was done for complications of iliac screw fixation by clinical and radiological evaluations. Results: Post-operative iliac screw prominence were 15 cases (55.5%) , iliac screw breakage was 1 case (3.7%), bursitis was 1 case (3.7%), sacroiliac joint pain were 5 cases (18.5%), halo sign around iliac screw were 23 cases (85.1%), and 3 cases (11.1%) were performed reoperation. There was no significance between halo sign and sacroiliac joint pain. Conclusions: Iliac screw fixation is a very useful operative method without severe complications on spinopelvic fixation. There are some complications of iliac screw fixation and iliac screw prominence is a most common problem, but few counterplan exits. So, further studies about reducing complication method, management protocols of iliac screw complication were needed. 연구계획: 후향적 연구. 목적: 성인척추변형으로 장골 나사를 이용하여 척추골반부 고정을 시행한 환자에서 발생한 합병증들에 대하여 알아보고, 임상적 및 방사선학적 의의를평가하고자 하였다. 선행문헌의 요약: 성인척추변형환자에서 장골나사못을 이용하여 척추골반부 고정이 시행되고 좋은 결과를 발표하고 있으나 장골나사못을 이용한 척추골반부 고정의 합병증에 대한 연구는 부족한 실정이다. 대상 및 방법: 성인척추변형환자(요추변성후만증, 시상면 불균형이 동반된 퇴행성 요추부 측만증, 편평배부증후군)로 본원에서 장골나사못을 이용하여수술을 받은 환자 중 1년 이상 추시된 27례를 대상으로 하였다. 추후 발생한 합병증들에 대하여 방사선학적 및 임상적으로 나누어 평가를 하였다. 결과: 장골나사못 돌출15례(55.5%), 장골나사 파단1례(3.7%), 점액낭염 1례(3.7%)가 있었으며 halo sign은 23례(85.1%), 천장관절 동통 5례(18.5%) 등이 있었으며 3례에서 재수술을 시행 받았다. 그러나 halo sign과 천장관절 동통의 통계학적인 의의는 없었다. 결론: 장골나사못을 이용한 척추골반부 고정은 심각한 합병증이 없는 유용한 수술이다. 그렇지만 일부 합병증들이 동반되며 그 중 장골나사못 돌출이가장 흔히 발생할 수 있지만, 그 대책은 미비하다. 따라서 추후 합병증들을 감소 방안과 관리 방법에 대한 추가적인 연구가 필요할 것으로 사료된다.

축추 교수형 골절의 수술적 치료 - 내고정 방법들과 적응증 검토 -

정재윤,서형연,이재준,김현종,조상권 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.4

척추경 나사못을 이용한 흉요추부 방출형 골절의 치료

이규열,손성근,김달희 동아대학교의과대학 1997 동아의대학술지 Vol.9 No.2

Posterior Atlantoaxial Fixation with a Combination of Pedicle Screws and a Laminar Screw in the Axis for a Unilateral High-riding Vertebral Artery

Kim, Sei-Yoon,Jang, Jee-Soo,Lee, Sang-Ho The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.2

A vertebral arte [VA] injury presents a difficult problem in atlantoaxial fixation. Recent technical reports described posterior C2 fixation using bilateral, crossing C2 laminar screws. The translaminar screw technique has the advantages of producing little risk of VA injury and the unconstrained screw placement. In addition, biomechanical studies have demonstrated the potential of the translaminar screw technique to provide a firmer construct that is equivalent to methods currently used. We report the successful treatment of C1-2 instability with a left-side high-riding VA. Because of the potential risk of VA injury, we performed a posterior C1-2 fixation with a combination of pedicle screws and a laminar screw in C2. We first placed bilateral C1 lateral mass screws and a right-side C2 pedicle screw. However, placement of the left- side C2 pedicle screw was technically difficult due to a narrow isthmus and pedicle. A laminar screw was inserted instead and authors believe that this posterior C1-C2 fixation with a combination of pedicle screws and a laminar screw in C2 can be a useful alternative technique for the treatment of C1-C2 instability in the presence of a unilateral high-riding VA.

척추-골반부의 고정

유창훈,양재준,장봉순 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.4

Lumbosacral fixation or spinopelvic fixation is frequently required for the surgical treatment of neuromuscular scoliosis and degenerative lesions, trauma and tumor in the lumbosacral vertebrae. However, the establishment of stable fixation with these procedures is difficult due to the anatomic characteristics of the sacrum and this is even more problematic for the cases with long segmental fixation, severe instability and bone defects. Although the emergence of pedicle screws makes spinal fixation easier and more rigid, S1 pedicle screws alone do not provide enough stability for lumbosacral fixation. For the purposes of reinforcing lumbosacral fixation, procedures using rods or screws can be used: the procedures using rods include the Galveston method, the McCarthy S-rod and the Jackson intrasacral rod, and the procedures using screws include sacral alar screws, transdiscal screws and iliac screws. The purpose of this study was to ascertain the proper fixation methods, according to each indication, for spinopelvic fixation and we analyzed the advantages and drawbacks of each fixation method. In addition, the fixation method of iliac screws, which has recently become more popular, is presented in detail to enhance the availability and reduce the complication of this technique. 신경근육성 척추측만증, 요천추부의 각종 퇴행성 병변, 외상 및 종양 등에서 요추-천추부 고정, 나아가서는 척추-골 반부의 고정을 요하는 경우가 많으나, 천골의 해부학적 특성상 안정된 고정을 얻기가 힘들다. 특히 장 분절 고정, 심 한 불안정성, 골 결손이 있는 경우에는 더욱 그렇다. 척추경 나사가 개발되고 대부분의 척추 고정이 한결 쉽고 견고 하게 되었지만, 천추에서는 제1 천추 척추경 나사만으로는 부족한 경우가 많다. 이를 보강하는 방법으로는 Galveston 방법, McCarthy S-강봉, Jackson 천추내 강봉 등과 같이 강봉을 이용한 방법들과, 천골 익 나사, 경추간판 나사, 장골 나사 등과 같이 나사를 이용하는 방법들로 대별될 수 있다. 이 논문에서는 각 적응증에 따른 고정 방법의 변화를 알 아보고 장단점을 분석하였다. 또한 최근 사용이 증가하고 있는 장골 나사 사용 방법을 자세히 소개하여 활용할 수 있 도록 하고, 합병증을 줄이고자 하였다.

Impact of Screw Diameter and Length on Pedicle Screw Fixation Strength in Osteoporotic Vertebrae: A Finite Element Analysis

Matsukawa Keitaro,Yato Yoshiyuki,Imabayashi Hideaki 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

Study Design: Biomechanical study. Purpose: To quantitatively investigate the effect of screw size on screw fixation in osteoporotic vertebrae with finite element analysis (FEA) Overview of Literature: Osteoporosis poses a challenge in spinal instrumentation; however, the selection of screw size is directly related to fixation and is closely dependent on each surgeon’s experience and preference. Methods: Total 1,200 nonlinear FEA with various screw diameters (4.5–7.5 mm) and lengths (30–50 mm) were performed on 25 patients (seven men and 18 women; mean age, 75.2±10.8 years) with osteoporosis. The axial pullout strength, and the vertebral fixation strength of a paired-screw construct against flexion, extension, lateral bending, and axial rotation were examined. Thereafter, we calculated the equivalent stress of the bone-screw interface during nondestructive loading. Then, using diameter parameters (screw diameter or screw fitness in the pedicle [%fill]), and length parameters (screw length or screw depth in the vertebral body [%length]), multiple regression analyses were performed in order to evaluate the factors affecting various fixations. Results: Larger diameter and longer screws significantly increased the pullout strength and vertebral fixation strength; further, they decreased the equivalent stress around the screws. Multiple regression analyses showed that the actual screw diameter and %length were factors that had a stronger effect on the fixation strength than %fill and the actual screw length. Screw diameter had a greater effect on the resistance to screw pullout and flexion and extension loading (β=0.38–0.43, p<0.01); while the %length had a greater effect on resistance to lateral bending and axial rotation loading (β=0.25–0.36, p<0.01) as well as mechanical stress of the bone-screw interface (β=−0.42, p<0.01). Conclusions: The screw size should be determined based on the biomechanical behavior of the screws, type of mechanical force applied on the corresponding vertebra, and anatomical limitations.

C7 Posterior Fixation Using Intralaminar Screws : Early Clinical and Radiographic Outcome

Jang, Sang-Hoon,Hong, Jae-Taek,Kim, Il-Sup,Yeo, In-Sung,Son, Byung-Chul,Lee, Sang-Won The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.2

Objective : The use of segmental instrumentation technique using pedicle screw has been increasingly popular in recent years owing to its biomechanical stability. Recently, intralaminar screws have been used as a potentially safer alternative to traditional fusion constructs involving fixation of C2 and the cervicothoracic junction including C7. However, to date, there have been few clinical series of C7 laminar screw fixation in the literature. Thus, the purpose of this study is to report our clinical experiences using C7 laminar screw and the early clinical outcome of this rather new fixation technique. Methods : Thirteen patients underwent C7 intralaminar fixation to treat lesions from trauma or degenerative disease. Seventeen intralaminar screws were placed at C7. The patients were assessed both clinically and radiographically with postoperative computed tomographic scans. Results : There was no violation of the screw into the spinal canal during the procedure and no neurological worsening or vascular injury from screw placement. The mean clinical and radiographic follow up was about 19 months, at which time there were no cases of screw pull-out, screw fracture or non-union. Complications included two cases of dorsal breech of intralaminar screw and one case of postoperative infection. Conclusion : Intralaminar screws can be potentially safe alternative technique for C7 fixation. Even though this technique cannot be used in the cases of C7 laminar fracture, large margin of safety and the ease of screw placement create a niche for this technique in the armamentarium of spine surgeons.

The Feasibility of Multiple Fixation Points in C2

Ngoc Quyen Nguyen,Riew K. Daniel,Lee So Min,Park Sang-Min,Kim Ho-Joong,장봉순,Lee Sang-Hun,Lee Jae Chul,Yeom Jin S. 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.5

Study Design: Analysis using three-dimensional simulation software for spinal screw placement and computed tomographic scan images.Purpose: To assess the feasibility of achieving multiple (three or four) screw fixation points in C2 vertebra by using a combination of pedicle and laminar screws.Overview of Literature: Secure C2 fixation using multiple screws is required or beneficial in some unique cases. However, to the best of our knowledge, there have been no reports analyzing the feasibility of multiple screw fixation in C2.Methods: We used 1.0-mm interval computed tomographic scan images of 100 patients (50 men and 50 women) and screw trajectory simulation software. The diameter of all screws was set at 3.5 mm, considering its common usage in real surgery. The anatomical feasibility of placing both pedicle and laminar screws on the same side was evaluated. For all feasible sides, the three-dimensional distance between the screw entry points was measured.Results: In 85% of cases, both pedicle and laminar screws could be placed on both sides, allowing for the insertion of 4 screws. In 11% of cases, 2 screws could be placed on one side, while only 1 screw was feasible on the other side, resulting in the placement of 3 screws. In all 181 sides where both types of screws could be inserted, the distance between their entry points exceeded 16.1 mm, which was sufficient to prevent the collision between the screw heads.Conclusions: C2 vertebra can accommodate three (11%) or four (85%) screws in 96% of cases.

Biomechanical Analysis of Fusion Segment Rigidity Upon Stress at Both the Fusion and Adjacent Segments -A Comparison between Unilateral and Bilateral Pedicle Screw Fixation-

김호중,염진섭,강경탁,장봉순,이춘기,김장우 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: The purpose of this study was to investigate the effects of unilateral pediclescrew fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models. Materials and Methods: Four L3--4 fusion models were simulated according to the extent of decompressionand the method of pedicle screws fixation in L3--4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3--4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motionat the L2--3 and L3--4 segments were analyzed under flexion, extension, lateral bending, and torsional moments. Results: Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment,but larger motions were noted at the fusion segment (L3--4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superioradjacent L2--3 segments and fusion segment. Conclusion: The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely,in the case of hemi-laminectomy, unilateral fixation could be an alternative option,which also has potential benefit to reduce the stress of the adjacent segment.

중수골 골절에 대한 최소 침습적 고정 방법

권기연 ( Ki Youn Kwon ),오진록 ( Jin Rok Oh ),곽지웅 ( Ji Woong Kwak ) 대한골절학회 2022 대한골절학회지 Vol.35 No.1

목적: 이 연구의 목적은 최소 침습적인 고정 방법인 K-강선 고정술 또는 골수강내 무두나사 고정술을 시행한 중수골 골절 환자에 대해 영상학적, 임상적 결과를 비교분석하는 데 있다. 대상 및 방법: 중수골 중위 및 원위간부 또는 경부 단순 골절에 대해 K-강선 또는 무두나사를 이용해 내고정을 하여 치료하였던 18세에서 55세 사이의 환자들 중 최소 6개월 이상 추시가 가능했던 환자들 52예(남자 46예, 여자 6예)에 대해 영상학적 평가(각변형, 단축), 수부 기능 평가(TAM, 악력, 환자의 주관적 기능 평가), 일상 및 직장으로의 복귀 시간, 합병증의 발생 빈도 등의 요소에 대해 비교분석하였다. 결과: 영상학적 평가, 수부 기능 평가, 합병증의 발생빈도의 측면에서 K-강선 고정군과 골수강내 무두나사 고정군 간 통계적인 차이는 없었으나(p>0.05), 일상 및 직장으로의 복귀는 골수강내 고정군이 빨랐다(p<0.05). 결론: 6개월 이상의 추시에서 중수골 골절에 대한 최소 침습적 치료법인 경피적 K-강선 고정술 및 골수강내 무두나사 고정술은 임상적 결과의 측면에서 차이가 없으나, 일상 및 업무로의 조기 복귀라는 측면에서는 골수강내 무두나사 고정술의 선택을 고려해 볼 만하다. Purpose: This study compared the radiologic and clinical outcomes of metacarpal fractures treated with two minimally invasive surgical techniques: Kirschner wire (K-wire) fixation and headless screw fixation. Materials and Methods: This study included 52 patients (46 males and 6 females; age 18-55 years) with distal metacarpal fractures (middle and distal shaft, including the neck) who had undergone K-wire fixation or headless screw fixation. All subjects were followed up for at least six months. The radiologic assessments were performed to evaluate the angular deformity and shortenings. The total active motion (TAM), grip strength, and patients’ subjective functional assessment were measured to evaluate the hand function. The time taken to return to work (RTW) and adverse events were analyzed. Results: Of the 52 cases, metacarpal fractures treated with headless screw fixation and K-wire fixation showed a significant difference associated with early RTW (p< 0.05). There were no significant differences between the subjects treated with K-wire fixation and those with headless screw fixation in terms of the radiologic measurement, hand function examinations, complications, and adverse events (p >0.05). Conclusion: After a six-month follow-up, minimally invasive K-wire fixation and headless screw fixation produced similar clinical and radiologic outcomes in subjects with metacarpal fractures. Compared to K-wire fixation, however, headless screw fixation led to earlier functional recovery and might be a better option for treating metacarpal fractures in this regard.