원위 요골 골절에서 나사못 돌출 확인을 위한 Skyline View와 수술 중 시행한 컴퓨터 단층 촬영의 비교 = Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures

다국어 초록 (Multilingual Abstract)

Purpose: The aim of our study was to compare and analyze intraoperative fluoroscopy (skyline view) and mobile cone-beam computed tomography (CBCT) for detecting protruded screws in volar locked plating used for distal radius frac-tures.Methods: We carried out a prospective analysis of 35 patients who had undergone both intraoperative fluoroscopy and mobile CBCT. The patients had all undergone volar locking plate fixation for a distal radial fracture at our institution between January and May 2017. Skyline view and mobile CBCT were carried out and protruded screws were replaced. Screw tip cortex distance (STCD) was measured using skyline view and mobile CBCT and compared with each area of the distal radius.Results: Three screws were found to be protruding after skyline view, and further seven screws were found to be protrud-ing after computed tomography (CT) scan. The mean STCD for each compartment was 3.8±0.6 mm, 3.5±1.8 mm, 2.2±1.3 mm, 3.7±1.6 mm, and 3.9±1.4 mm in the skyline view, respectively, and 3.5±0.7 mm, 0.8±1.6 mm, 0.9±1.1 mm, 2.1±1.6 mm, and 3.7±1.9 mm in the CT scan, respectively (p<0.05). The mean STCD of all screws was 1.2 mm longer in the sky-line view than in the CT scan. Conclusion: The skyline view showed approximately 1-2 mm difference compared to CBCT; therefore, it would be better to insert the screw 2 mm shorter than seen in the skyline view.

국문 초록 (Abstract)

목적: 수장부 잠김 금속판을 이용한 원위 요골 골절 수술 후 돌출된 나사못을 발견하는 데 있어 skyline view의 정확성을 수술 중 촬영한 cone-beam computed tomography (CBCT)와 비교하여 분석하고자 한다.방법: 원위 요골 골절에 대하여 수장판 잠김 금속판 고정술을 시행 후 수술 중에 skyline view와 CBCT를 모두 촬영한 35명의 환자를 대상하였다. Skyline view를 촬영한 뒤 돌출된 나사못을 교체한 후 CBCT를 촬영하여 추가로 돌출된 나사못을 교체하였다. 수술 후 요골의 배측을 5개의 영역으로 나누어 나사못의 돌출 정도(screw tip cor-tex distance, STCD)를 측정하여 비교하였다.결과: 나사못 돌출은 skyline view에서 3개가 확인되었으며, computed tomography (CT) 촬영 후에는 추가로 7개가 확인되어 교체되었다. STCD는 skyline view에서 각 영역에서 3.8 mm, 3.5 mm, 2.2 mm, 3.7 mm, 3.9 mm이었고, CT에서는 3.5 mm, 0.8 mm, 0.9 mm, 2.1 mm, 3.7 mm로 측정되어 2, 3, 4번 영역에서 통계적으로 유의한 차이를 보였다.결론: Skyline view는 수술 중 CT와 약 1-2 mm가량의 오차를 보여 skyline view에서 보이는 것보다 2 mm가량 짧게 나사못을 삽입하는 것이 좋을 것으로 생각된다.

참고문헌 (Reference)

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