• 作者： 吳興盛; 梁鉑鈴; 白偉民; 赦曼冠; 林柳池
• 作者服務機構： 國防醫學院骨科學科; 三軍總醫院骨科部
• 中文摘要： 脊椎經椎莖固定術有愈來愈廣泛使用的趨勢。在解決脊椎短節數脊椎病變時，如骨折、假性關節(Pseudoarthaosis)、腫瘤或脊椎滑脫症，最好只固定病變脊椎上、下一節，以減少正常脊椎節的固定。脊椎經椎莖固定術即有只需固定短節數的好處。而且其穩定性在生物力學(Biomechanical)測試上，證實比傳統 Harrington 及 Luque 的固定術來得更穩定。但脊椎經椎莖固定術施行時有潛在的危險。經椎莖鋼釘太偏內會傷到脊髓太偏外時則可能傷到神經根。所以如何使經椎鋼釘的植入又深又完全，在臨床施行上是很重要的。作者經解剖、分析多具屍體脊椎後，設計了一個導引器，可使經椎莖鋼釘的植入又深又完全。導引器原型完成後，先在屍體脊椎上測試，其結果經電腦斷層攝影證實，鋼釘在椎莖中間又深又完全。在臨床上的施行，早期亦證實其完全性及實用性。
• 英文摘要： Spinal transpedicular fixation has gained widespread popularity in the past 5 years. Inbiomechanical studies, the deeply-inserted transpedicular screws withstood the largest number of cyclesin the cephalad-caudad and medial-lateral direction before failure. However, in clinical practice, the riskof screw placement which is too far medially or too far laterally do exist. The optimization of increasingscrew depth to avoid complication is of significant clinical importance. A Spinal Pedicle Finder (S.P.F)has been designed for transpedicular screws and a prototype has been completed. It is composed of anI-shaped body with a pair of front rails and a pair of rear rails. The front rail comprises two positioningarms that fit against the laminal bony crest, and the rear rail comprises two guiding bases that providethe transpedicular pin inserted with a specific angle. Both positioning arms and both guiding bases can beadjusted synchronously, and the specific angle over the guiding bases can be pre-set preoperatively accord-ing to the angle of pedicle axis. To date, in 7 cases (5 fracture and 2 spondylolisthesis) transpedicular screwfixation has been applied by aid of the S.P.F. Two-level fixation was applied in a fracture group and three-level fixation was applied in a spondylolisthesis group. The position of the transpedicular screw has beenchecked by CT scan postoperatively. A total of 32 transpedicular screws were inserted and all were in thepedicle and vertebral body except in one instances. One transpedicular screw was malpositioned on oneside, partially lateral to the pedicle. However, this malposition did not cause any neurologic problem, suchas dural tear, nerve root injury or other. Clinical experience has demonstrated its efficacy and safety.
• 中文關鍵字： transpedicular fixation; spinal fracture; spondylolisthesis; spinal pedicle finder
• 英文關鍵字： --