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Anterior cervical discectomy with decompression and implant fusion (ACDF) yɛ oprehyɛn akwan a wɔtaa fa so sa akyi berɛmo ne ntini ntini-type cervical spondylosis, cervical spine trauma ne ɔhaw afoforo no mu biako, na ɛwɔ mfaso horow a ɛne sɛ mfiase no ɛyɛ den, fusion rate a ɛkɔ soro, anterior convexity a ɛfata san ba, ne external a enni hɔ fixation, ne nea ɛkeka ho The oprehyɛn akyi nsɛnnennen a ɛtaa ba te sɛ ɛyɛ den sɛ wɔbɛmene, afã horow a ɛbɛn no a ɛsɛe, ntini a ɛsan kɔ anom no mu a ɛyɛ mmerɛw, amemene mu nsu a ɛtwetwe, mogya a ɛtɔ, ɔyare mmoawa, ne akyi berɛmo ntam nsɛnnennen a ɛkɔ fam ne nea ɛkeka ho Oprehyɛn akyi nsɛnnennen a ɛba nyinaa bɛyɛ 8%.
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Wɔ atifi hɔ ɔhaw ahorow no ho mmuaema mu no, adesuafo no reyɛ adwuma bere nyinaa wɔ mfiridwuma mu nkɔso, adwene mu nkɔso, ne nipadua a wɔde yɛ nipadua no a wɔbɛma ayɛ yiye ho. Wɔagye afiri a ɛma awotwaa mu akyi berɛmo a ɛka bom a ɛma ne ho yɛ den (zero-trace), a ɛwɔ akyi berɛmo ntam ahunmu koraa na ɛtew asiane a ɛwɔ hɔ sɛ oprehyɛn akyi aduan a ɛyɛ den ne ɔfã a ɛbɛn hɔ a ɛbɛsɛe no so yiye no atom kɛse.
Wɔaka oprehyɛn akyi nsɛnnennen a ɛbata nipadua a wɔde yɛ nipadua no ho asɛm wɔ ase ha ——
1.Akyinnyegye a ɛfa sɛ ebia wobetwa akyi berɛmo nkwaa a wɔde hama abɔ no anaasɛ wɔrentwa no ho
Mfonini 1 Schematic diagram a ɛkyerɛ sɛnea conotruncus, vertebral artery, ne akyi berɛmo ne ntini ntini no nhyehyɛe.
bi. Abusuabɔ a ɛda concha no articular eminence ne vertebral artery ntam.
b. Wɔ nhoma no mu no, woyi articular eminence no mfinimfini ano, na wɔkora akyi ano no so sɛnea ɛfata na amma akyi berɛmo no mu ntini no ansɛe.
![2_upscayl_2x_realesrgan-x4plus na ɛyɛ adwuma wɔ ɔkwan a ɛyɛ nwonwa so]( "2_upscayl_2x_realesrgan-x4plus")
Mfonini 2 Schematic diagram a ɛkyerɛ ntini ntini a ɛhyɛ ne decompression denam hyperplastic conical nkwaa a wɔtrɛw mu no so.
bi. Nnompe a enyin ne akyi berɛmo a ɛyɛ conical joints no brɛ intervertebral foramina no fã a ɛtrɛw no ase, na ɛnam so mia ntini ntini no.
b. Intervertebral fusion device/implant betumi abue intervertebral space no ama intervertebral foramen no fã no ayɛ kɛse na ɛne ntini ntini a ɛhyɛ no adi nkitaho, na bere koro no ara mu no, asan ayɛ akyi berɛmo no gyinabea a ɛyɛ den no foforo.
Hia a ɛho hia sɛ wɔyɛ awotwaa no akyi oprehyɛn wɔ anim de yi hook vertebral joint no ayɛ dompe a wɔde gye akyinnye fi bere a wofii ase yɛɛ ɔkwan no
Robinson ne Smith de nkyerɛkyerɛmu a edi kan a ɛfa anterior cervical decompression ne implant fusion with internal fixation ho mae wɔ 1955 mu a ɔkaa ɔkwan a wɔfa so yɛ no ho asɛm sɛ enhia sɛ woyi leptokyphotic joint osteophyte no fi hɔ. Cloward, obi foforo a ɔhyehyɛɛ ACDF no sii so dua sɛ ɛsɛ sɛ woyi nhyɛso nyinaa fi hɔ, na ɛho hia sɛ woyi hyperplastic leptokyphosis no fi hɔ tẽẽ ma decompression, bere a Robinson buae sɛ wobetumi asan agye leptokyphosis no bere a wɔde akyi berɛmo no gyina pintinn na bere a mfiri tumi ahorow a ɛnyɛ ne kwan so no yera no, na wosusuwii sɛ saa nneɛma a entumi nnyina pintinn yi wɔ abusuabɔ leptokyphosis a ɛma obi nya ɔyare mmoawa.
Wɔn a wɔkora nneɛma so no ka sɛ hama nkwaa no boa 48% kosi 60% ma ɔfã biara gyina pintinn na ɛma ɛyɛ den kɛse wɔ awotwaa no akyi fã a ɛwɔ akyi no mu, na standard cervical foraminotomy decompresses decompresses akyi fã a ɛwɔ hook nkwaa no mu ne anim fã a ɛwɔ neuraxial canal no mu, bere a nokwarem no, nkwaa no fã a ɛyɛ den sen biara no yɛ wɔayi afi hɔ, ne nea entumi nnyina ne sɛnea gyinabea a wɔde hyɛ nipadua no mu a wɔdan kɔ baabi foforo no ma fusion no nkonimdi so tew.
Sɛ wobetumi anya ayaresabea mu nsunsuanso a ɛyɛ pɛ a wontwa hook vertebral joint no a, hook vertebral joint no a wɔbɛkora so no betumi ama wɔ nsusuwii mu ama tebea a ɛfata sen biara ama fusion dodow a ɛkɔ soro. Bio nso, hook vertebral joint no a wɔkora so no boa ma hokwan a ɛwɔ hɔ sɛ oprehyɛn akyi vertebral subluxation no so tew, na wɔahyɛ no nsow sɛ sɛ wotwa hook vertebral joint no fã no bɛboro 38% a, interbody fusion subluxation no dodow bɛkɔ soro kɛse.
![3_upscayl_2x_realesrgan-x4plus na ɛyɛ adwuma wɔ ɔkwan a ɛyɛ nwonwa so]( "3_upscayl_2x_realesrgan-x4plus")
Adwene a ɛfa excisionist ho no
Sɛnea resection sukuu no kyerɛ no, wɔ nipadua mu no, leptospondylar nkwaa no akyi ɔfasu no ne ntini ntini no anim fasu, na nnompe nkae a efi leptospondylar nkwaa no hyperplasia mu no betumi ama intervertebral foraminal stenosis aba.
Wɔ mprempren ayaresabea adwumayɛ mu no, wɔda so ara kamfo decompression denam leptokyphosis a wotwa so kyerɛ wɔ ayarefo a wɔhyɛ leptokyphotic nkwaa hyperplasia no mu denneennen no ho, sɛnea ɛbɛyɛ a wɔbɛma ntini anaa akyi berɛmo mu ntini no nhyɛso no afi hɔ ntɛm ara sɛnea wobetumi.
Sɛ yɛka ne nyinaa bom a, akyinnyegye wɔ hɔ bere nyinaa, nanso paw a wɔpaw sɛ wɔbɛkora hama spondylolisthesis no so, wɔbɛkora so fã bi, anaasɛ wobeyi afi hɔ koraa sɛnea ɔyarefo no tebea te no abɛyɛ nea adwene hyia wɔ ayaresabea nneyɛe ahorow mu. Nanso, ayaresa kwan a wɔfa so yɛ ankorankoro de no hwehwɛ sɛnea wɔde afiri a wɔde yɛ nipadua no kɛse no hwehwɛ kɛse.
![4_upscayl_2x_realesrgan-x4plus, na ɛyɛ adwuma wɔ ɔkwan a ɛyɛ nwonwa so]( "4_upscayl_2x_realesrgan-x4plus")
Zero-cut traces a ɛtaa ba wɔ gua so no anohyeto wɔ hia a ehia sɛ wɔde screws 4 screws mu ma locking, na wɔn trɛw hia 17.5 mm, a ɛyɛ kɛse kɛse ma ɔman mma binom, na mpɛn pii no ɛhwehwɛ sɛ occlusion fã bi hook joint ma fusion implantation wɔ intervertebral space.
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Wɔatew SAGI 2-nail locking zero incision no trɛw so akodu mm 14.8 wɔ ne tɛtrɛtɛ mu, a wosusuw Chinafo dodow no nipadua mu nsusuwii ho, na ɛma nea ɔyɛ oprehyɛn no nya hook nkwaa no ayaresa a ɛfata kɛse wɔ oprehyɛn no mu, na ɛma wotumi paw hook nkwaa no ayaresa sɛnea ɔyarefo no tebea ankasa te, bere a wɔhwɛ hu sɛ mfiase no gyina pintinn na wɔde bere tenten afrafra no.
Oprehyɛn akyi akyi berɛmo mu epidural hematoma
Spinal epidural hematoma (SEH) yɛ ɔhaw a ɛntaa nsi na ɛyɛ aniberesɛm wɔ anim cervical approach akyi, na ɛba bɛyɛ 0.1% kosi 0.2%.SEH ba wɔ epidural no venous plexus a ɛyɛ den no mu, a ɛbɛma akyi berɛmo no dwumadi asɛe kɛse sɛ wɔansa hematoma a ɛba no bere ano a. Oprehyɛn a wɔyɛ no ntɛm bere a wɔahu sɛ ɔwɔ SEH akyi no betumi aboa ma ntini mu dwumadi asan ayɛ yiye.
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Oprehyɛn akyi SEH nhyehyɛe a ɛfa ACCF ho
Akyi berɛmo mu mogya a ɛba akyi berɛmo mu no betumi aba wɔ ACDF ne ACCF nyinaa akyi, na ACCF wɔ asiane kɛse sɛ wobenya mogya esiane ahodwiriw kɛse ne nnompe ani a ɛsen pii nti; nanso, ACDF nhyehyɛe no nyinaa dodow yɛ kɛse, na SEH dodow a ɛkɔ soro na ɛba.
Ɛsɛ sɛ SEH a wosiw ano bere a wɔabɛn awotwaa no anim akyi no kɔ so wɔ oprehyɛn no bere nyinaa mu:
A. Ɛsɛ sɛ wowie nhwehwɛmu a wɔyɛ ansa na wɔayɛ oprehyɛn no, na ɛsɛ sɛ wobisabisa nsɛm kɔ akyiri sɛ ebia nyarewa bi wɔ hɔ a ɛma mogya tu, ne sɛ ebia abakɔsɛm bi wɔ hɔ a ɛkyerɛ sɛ wɔanom sigaret bere tenten na wɔanom nsa; sɛ nnipa bi wɔ hɔ a wɔnom nnuru a ekum mogya a ɛtwetwe mogya a, ɛsɛ sɛ wogyae nom dapɛn biako ansa na wɔayɛ oprehyɛn no;
B. Mogya a wɔde siw mogya a ɛkɔ oprehyɛn mu yiye, mogya a wɔde siw ano a enni mũ denam sekan a wɔde twetwe mogya no betumi ama mogya foforo aba, wɔkamfo kyerɛ sɛ wɔmfa bipolar electrocoagulation forceps nni dwuma; wɔ vertebral body subtotal resection nhyehyɛe no mu no, ɛsɛ sɛ wɔde bone wax gu so na amma mogya pii ankɔ dompe no ani; nnuru a wɔde siw mogya ano, te sɛ tranexamic acid a wɔde twitwiw nipadua mu, ne nea ɛkeka ho a wɔde bedi dwuma sɛnea ɛbɛyɛ a mogya a ɛba wɔ oprehyɛn mu no so bɛtew; ɛho nhia sɛ wɔhwehwɛ sɛ wobetwa akyi ntini tenten a ɛwɔ ɔfã a wɔayɛ no oprehyɛn no mu koraa, na akyi ntini tenten kakraa bi a wɔbɛkora so wɔ afã abien no nso betumi anya nkɛntɛnso a ɛwɔ decompression so ɛsɛ sɛ afiri a wɔde yɛ nipadua no a wɔde besi hɔ no ma baabi a ɛdɔɔso wɔ nifa ne benkum so. Sɛ wɔde afiri a wɔde yɛ nipadua no reto hɔ a, ɛsɛ sɛ wogyaw baabi a ɛdɔɔso wɔ benkum ne nifa so sɛnea ɛbɛyɛ a mogya a ɛretu wɔ akyi berɛmo no mu no betumi asen akɔ akyi berɛmo no anim na afa nhyɛso bɔne a ɛma nsu fi mu no mu;
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C. Sɛ wɔyɛ oprehyɛn no wie a, hwɛ nsɛnkyerɛnne a ɛho hia no yiye; ma nsu a ɛkɔ mu no nyɛ mmerɛw; fa nnuru a ekum mogya a ɛtwetwe mogya di dwuma wɔ ntease mu na ama woakwati thrombosis; hwɛ sɛnea ntini ahorow no yɛ adwuma yiye; sɛ biribi a ɛnteɛ wɔ hɔ a, di ho dwuma wɔ bere ano.
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Wɔayɛ no sɛnea ɛbɛyɛ a ebehyia ɔman no nipadua mu nneɛma a ɛwɔ nipadua mu no
1. Ɛde ayaresabea ano aduru a wɔayɛ ama obiara ma akyi berɛmo nkwaa a wɔde hama abɔ no sohwɛ.
2. Tew hokwan a ɛwɔ hɔ sɛ akyi berɛmo nipadua no bɛkɔ fam no so
3. Tew asiane a ɛwɔ hɔ sɛ obi benya spinal epidural hematoma no so
Variable angle screw nhyehyɛe ma ɛyɛ mmerɛw sɛ wode bɛyɛ adwuma
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Screws a coronal swing angle yɛ -1.5°11.5° ne cephalad swing angle a ɛyɛ 36°44° ma ɛnyɛ den sɛ wɔde nnadewa bɛto oprehyɛn no mu
Ɛho nhia sɛ wode baabi foforo sie ma skru a wɔde bɛhyɛ mu, wɔtew ntwitwiridii a ɛba fam koraa no so fi 2.5cm kosi bɛyɛ 2.0cm.
Ɛyɛ nea ɛyɛ mmerɛw kɛse ma ɛne adwene a ɛne sɛ wɔyɛ akyi berɛmo mu oprehyɛn no hyia, na wohu Endo-ACDF.
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Ɛfa CZMEDITECH ho
Cervical Peek Cage(2 anaa 4 Locking Screws) yɛ nnompe ano aduru a ɛyɛ pɛpɛɛpɛ a wɔde ahwɛyiye ayɛ denam CZMEDITECH twee adwene sii anterior cervical discectomy decompression ne implant fusion so na wiase nyinaa anisoadehu na ɛkanyan no, a wɔatu wɔn ho ama sɛ wɔde ayaresa ano aduru a edi mũ a etu mpɔn, ɛyɛ mmerɛw na ɛho ka sua bɛma ayarefo a wɔn akisikuru a ɛyɛ den wɔ wiase nyinaa.
Anterior cervical discectomy with decompression and implant fusion (ACDF) yɛ oprehyɛn akwan a wɔtaa fa so sa akyi berɛmo ne ntini ntini-type cervical spondylosis, cervical spine trauma ne ɔhaw afoforo no mu biako, na ɛwɔ mfaso horow a ɛne sɛ mfiase no ɛyɛ den, fusion rate a ɛkɔ soro, anterior convexity a ɛfata san ba, ne external a enni hɔ fixation, ne nea ɛkeka ho The oprehyɛn akyi nsɛnnennen a ɛtaa ba te sɛ ɛyɛ den sɛ wɔbɛmene, afã horow a ɛbɛn no a ɛsɛe, ntini a ɛsan kɔ anom no mu a ɛyɛ mmerɛw, amemene mu nsu a ɛtwetwe, mogya a ɛtɔ, ɔyare mmoawa, ne akyi berɛmo ntam nsɛnnennen a ɛkɔ fam ne nea ɛkeka ho Oprehyɛn akyi nsɛnnennen a ɛba nyinaa bɛyɛ 8%.
