지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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초록· 키워드
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Objective : When the pedicle screw insertion technique is failed or not applicable, C7 intralaminar screw insertion method has been used as an alternative or salvage fixation method recently. However, profound understanding of anatomy is required for safe application of the bilaterally crossing laminar screw at C7 in clinic. In this cadaveric study, we evaluated the anatomic feasibility of the bilateral crossing intralaminar screw insertion and especially focused on determination of proper screw entry point. Methods : The C7 vertebrae from 18 adult specimens were studied. Morphometric measurements of the mid-laminar height, the minimum laminar thickness, the maximal screw length, and spino-laminar angle were performed and cross-sectioned vertically at the screw entry point (spino-laminar junction). The sectioned surface was equally divided into 3 parts and maximal thickness and surface area of the parts were measured. All measurements were obtained bilaterally. Results : The mean mid-laminar height was 13.7 mm, mean minimal laminar thickness was 6.6 mm, mean maximal screw length was 24.6 mm, and mean spinolaminar angle was $50.8{\pm}4.7^{\circ}$. Based on the measured laminar thickness, the feasibility of 3.5 mm diameter intralaminar screw application was 83.3% (30 sides laminae out of total 36) when assuming a tolerance of 1 mm on each side. Cross-sectional measurement results showed that the mean maximal thickness of upper, middle, and lower thirds was 5.0 mm, 7.5 mm, and 7.3 mm, respectively, and mean surface area for each part was $21.2mm^2$, $46.8mm^2$, and $34.7mm^2$, respectively. Fourteen (38.9%) sides of laminae would be feasible for 3.5 mm intralaminar screw insertion when upper thirds of C7 spino-laminar junction is the screw entry point. In case of middle and lower thirds of C7 spino-laminar junction, 32 (88.9%) and 28 (77.8%) sides of laminae were feasible for 3.5 mm screw insertion, respectively. Conclusion : The vertical cross-sectioned area of middle thirds at C7 spinolaminar junction was the largest area and 3.5 mm screw can be accommodated with 77.8 % of feasibility when lower thirds were the screw entry point. Thus, selection of middle and lower thirds for each side of screw entry point in spino-laminar junction would be the safest way to place bilateral crossing laminar screw within the entire lamina. This anatomic study result will help surgeons to place the screw safely and accurately.
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참고문헌 (16)
참고문헌 신청
Abumi K / 1994 / Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine : description of the techniques and preliminary report / J Spinal Disord 7:19~28
An HS / 1991 / Anatomic considerations for plate-screw fixation of the cervical spine / Spine (Phila Pa 1976) 16(10 Suppl):S548~S551
Bozkus H / 2005 / Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine / Spine (Phila Pa 1976) 30:915~922
Harris BM / 2001 / A comparison of three screw types for unicortical fixation in the lateral mass of the cervical spine / Spine (Phila Pa 1976) 26:2427~2431
Hong JT / 2008 / Significance of laminar screw fixation in the subaxial cervical spine / Spine (Phila Pa 1976) 33:1739~1743
An HS / 1991 / Anatomic considerations for plate-screw fixation of the cervical spine / Spine (Phila Pa 1976) 16(10 Suppl):S548~S551
Bozkus H / 2005 / Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine / Spine (Phila Pa 1976) 30:915~922
Harris BM / 2001 / A comparison of three screw types for unicortical fixation in the lateral mass of the cervical spine / Spine (Phila Pa 1976) 26:2427~2431
Hong JT / 2008 / Significance of laminar screw fixation in the subaxial cervical spine / Spine (Phila Pa 1976) 33:1739~1743
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