환축추 불안정성에 대한 환축추 유합술의 방사선학적 분석 - 후방 강선, 경관절 나사, 후방 나사-강봉 고정술의 비교 - = Radiographic Analysis of Atlantoaxial Fusion for Atlantoaxial Instability -Comparison of Posterior wiring, Transarticular screw, Posterior screw-rod fixation -

국문 초록 (Abstract)

연구 계획: 후향적 연구목적: 환축추 불안정성에 대하여 후방 강선 고정술, 경관절 나사 고정술, 후방 나사-강봉 고정술을 통한 환축추 유합 위치와 축추하 경추 배열 변화와 재전위의 연관성을 알아보고자 하였다.
선행문헌의 요약: 환축추 유합술에서 환축추 고정위치와 유합술 후 발생하는 축추하 경추 배열 변화와 재전위에 관한 문헌들은 드물다.
대상 및 방법: 1986년부터 2008년까지 환축추 불안정성으로 후방 유합술을 시행하였던 35예를 대상으로 하였고, 평균 추시 기간은 59.5개월이었다.
후방강선 고정술 군 17예, 경관절 나사 고정술 군 10예, 후방 나사-강봉 고정술 군 8예였고, 불안정성의 원인질환은 횡인대 파열 12예, 류마티스 관절염11예, 치상돌기 불유합 6예, Os odontoideum 6예였다. 방사선학적으로 환추-치돌기간 간격과 환추 후궁 및 축추 추궁판각, 인접분절의 정렬 변화 및 유합 시기를 조사하였다.
결과: 전 예에서 골유합은 평균 3.5개월 (3-5개월)에 이루어졌다. 최종 추시상 후방 강선 고정술 군에서는 5예에서 재전위되었고, 축추하 후만 변형은 3예에서 발생했다. 경관절 나사 고정술 군에서는 재전위 및 후만 변형은 없었으며, 후방 나사-강봉 고정술군은 모든 예에서 재전위는 없었고, 1예에서 후만 변형이 발생하였다. 재전위 및 분절간 후만 변형이 일어난 경우는 후궁-추궁판각이 수술 전후로 10도이상 차이나는 군이었으며 통계학적으로 의의가 있었다.
결론: 환축추 불안정성에 대한 수술적 치료 방법에 있어 환축추 유합 위치가 수술 후 축추하 배열 변화에 관련이 있으며, 수술 전 환축추의 전만 유지는수술 후 축추하 배열의 변화를 예방할 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

Study Design: This is a retrospective study.
Objectives: We wanted to clarify the association between the position of the atlantoaxial fusion angle and the change of the subaxial cervical spine alignment (SCA) and the reduction loss after atlantoaxial fusion (AAF) using the posterior wiring technique (PWT),transarticular screw fixation (TAF) and posterior screw-rod fixation (PSR) for treating atlantoaxial instability (AAI).
Summary of the Literature Review: There are not many studies on the change of the SCA and the reduction loss after AAF.
Material and Methods: Thirty five patients underwent AAF for AAI from 1986 to 2008. The mean follow-up period was 59.5 months.
The surgical techniques were divided into three groups, that is, PWT: 17 patients, TAS: 10 and PSR: 8. The causes of instability were transverse ligament rupture in 12 patients, rheumatoid arthritis in 11, Os odontoideum in 6 and nonunion of an odontoid fracture in 6.
Plain radiographs were used to assess the atlanto-dental interval, the posterior arch-lamina angle, the change of the SCA and the time of fusion.
Results: Fusion was achieved in all the patients within 3.5 months (range: 3-5 months). The radiologic findings in the 5 PWT patients showed a reduction loss and 3 patients showed subaxial cervical kyphosis (SCK). The TAS group had no reduction loss or SCK. The PSR group had no reduction loss and one patient showed SCK. A statistically significant reduction loss and SCK occurred in the group in which there was a posterior arch-laminar angle greater than 10 degrees before and after surgery.
Conclusions: For the treatment of AAI, the position of the AAF is associated with the change of the postoperative SCA. The preoperative lodortic position of C1-2 should be maintained to prevent the change of the SCA

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