Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2012 Dec 15;37(26):2145-50. doi: 10.1097/BRS.0b013e3182685684.
A technical note and a retrospective review of cervical osteotomy using an innovative reduction technique.
To present the clinical and radiological outcomes and effectiveness of the sterile-freehand reduction technique for cervical osteotomy. SUMMARY OF BACKGROUD DATA: For a successful osteotomy, controlled reduction of deformity after complete release of bony deformity is the most critical step. Conventional "unscrubbed-scrubbed" manual reduction techniques necessitate multiple releases and retightening of the clamp and are inconvenient for the surgeon to control the force and monitor the surgical field closely.
A total of 7 consecutive patients (5 male and 2 female; mean age, 52.6 yr) who underwent corrective osteotomy of the fixed cervical kyphosis by a single surgeon were enrolled. Radiographically, C2-C7 sagittal and coronal angle, and the chin-brow vertical angle were measured. In the prone position, the entire head and the Gardner-Wells tong were included in the surgical field, and a sterile rope was connected to a weight through a hole made in the surgical drape. After complete release of bony element and fixation of the caudal part of osteotomy with a prebent lordotic rod, the operator held the tong with right hand and gradually reduced the deformity to place the rod within the screw heads on the cranial part of osteotomy under close visual observation, with the support of the caudal part with left hand. RESULTS.: The type of osteotomy performed was pedicle-subtraction osteotomy in 5 cases and anterior-release-posterior osteotomy in 2 cases. The mean correction angle was 39.7° (28°-63°) on the sagittal plane and 9.3° (0°-16°) on the coronal plane. The mean correction of the chin-brow vertical angle was 37.1° (18°-61°). There was no neurovascular complication.
Using the sterile-freehand reduction technique, the operator can obtain a safe, controlled reduction with close monitoring of the surgical field. The technique is potentially a simple and effective method to provide stable, 3-dimensional reduction for corrective osteotomies of the cervical spine.
创新性减压技术下颈椎截骨术的技术说明和回顾性研究。
介绍颈椎截骨术无菌徒手减压技术的临床和影像学结果及有效性。
对于成功的截骨术，在完全解除骨畸形后，对畸形的控制性减压是最关键的步骤。传统的“未消毒-消毒”手动减压技术需要多次释放和重新拧紧夹具，并且不方便外科医生控制力量并密切监测手术区域。
共纳入 7 例连续患者（5 名男性，2 名女性；平均年龄 52.6 岁），均由同一位外科医生行颈椎固定性后凸畸形矫正截骨术。影像学上，测量 C2-C7 矢状面和冠状面角以及颏眉垂直角。患者取俯卧位，整个头部和 Gardner-Wells 口外牵引弓都包含在手术野内，无菌绳索通过手术巾上的一个孔连接到一个重物上。在完全释放骨元素并使用预弯的前凸杆固定截骨术的尾部后，术者用右手握住口外牵引弓，逐渐减少畸形，在密切的视觉观察下将杆放置在截骨术头部的螺钉头内，同时用左手支撑尾部。
5 例患者行椎弓根切除截骨术，2 例患者行前路松解后路截骨术。矢状面平均矫正角度为 39.7°（28°-63°），冠状面平均矫正角度为 9.3°（0°-16°）。颏眉垂直角的平均矫正角度为 37.1°（18°-61°）。无神经血管并发症。
使用无菌徒手减压技术，术者可以在密切监测手术野的情况下获得安全、可控的减压。该技术是一种简单有效的方法，可为颈椎矫正截骨术提供稳定的三维复位。
