![Nɔnɔmetata (1) .]( "image (1)")
Anterior cervical discectomy with decompression and implant fusion (ACDF) is one of the most commonly used surgical methods for the treatment of spinal cord-type and nerve root-type cervical spondylosis, cervical spine trauma and other disorders, and it has the advantages of initial stabilisation, high fusion rate, restoration of normal anterior convexity, and the absence of external fixation, etc. The common postoperative Kuxiwo abe nu mimi ƒe sesẽ, akpa siwo te ɖe wo nɔewo ŋu ƒe gbegblẽ, lãkusi ƒe lãmetutudɔ gbugbɔgawɔ, ahɔhɔ̃mekawo me tsi ƒe sisi, ʋu ƒe sisi, dɔlékuiwo, kple ʋukawo dome lãkusiwo ƒe dodo kple bubuawo ene.
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Le kuxi siwo le etame la ta la, agbalẽnyalagãwo le dɔ wɔm ɣesiaɣi tso mɔ̃ɖaŋununya ƒe ŋgɔyiyi, nukpɔsusu ƒe ŋgɔyiyi, kple ametia ƒe akpa aɖewo ƒe nyonyo ŋu. Wolɔ̃ ɖe ɖokuitɔdidi ƒe vidzidɔ ƒe akɔta ƒe ʋuʋu ƒe mɔ̃ (zero-trace), si woxɔna bliboe le akɔta dome teƒe eye wòɖea afɔku si le dɔwɔwɔ vɔ megbe ƒe dɔmawɔmawɔ nyuie kple akpa si te ɖe eŋu ƒe gbegblẽ dzi kpɔtɔna nyuie la dzi le afisiafi.
Woƒo nu tso dɔwɔwɔ vɔ megbe kuxi siwo do ƒome kple ametia ƒe akpa aɖewo ŋu le ete ——
1.Nyaʋiʋliwo le nenye be woaɖe asi le vertebral joint si wotsɔ kɔsɔkɔsɔ wɔe ŋu alo womaɖee ɖa o .
Fig. 1 Conotruncus ƒe wɔwɔme, akɔta ƒe ʋuka, kple aklã ƒe ka kple lãmeka ƒe kewo ƒe nɔnɔmetata si wowɔ ɖe ɖoɖo nu.
a. Ƒomedodo si le concha ƒe articular eminence kple vertebral artery dome.
b. Le agbalẽa me la, woɖea ƒunukpeƒea ƒe akpa si le titina la ɖa, eye wodzraa axadzi ƒe nugbɔ ɖo nyuie be woaƒo asa na nusiwo gblẽ le akɔta ƒe ʋuka ŋu.
![2_USCAYL_2X_REALESRGAN-X4PLUS]( "2_upscayl_2x_realesrgan-x4plus")
Fig. 2 lãmeka ƒe ke ƒe tete kple decompression ƒe nɔnɔmetata si wowɔ ɖe ɖoɖo nu to hyperplastic conical joints kaka me.
a. Ƒu ƒe tsitsi kple akɔta ƒe ƒunukpeƒewo ƒe gbagbã ɖea akɔta ƒe akpa si le lãkusia ƒe akpa si wotso la dzi kpɔtɔna, si wɔnɛ be lãmekawo ƒe kewo ƒoa ƒu.
b. Intervertebral fusion device/implant ateŋu aʋu intervertebral space la be woadzi intervertebral foramen ƒe teƒe ɖe edzi eye wòate ɖe nerve root compression ŋu, eye le ɣeyiɣi ma ke me la, remodeling the stability of the spine.
Anterior cervical spine surgery ƒe hiahiã be woaɖe hook vertebral joint ɖa nye nyaʋiʋli ƒe ƒu tso esime wodze aɖaŋua gɔme .
Robinson kple Smith ye gblɔ ŋgɔgbe ƒe vidzidɔ ƒe dɔmawɔmawɔ nyuie kple lãkusi ƒe fusion kple implant fusion kple implant fusion gbãtɔ le ƒe 1955 me si me wògblɔ le be ɖoɖoa bia be woaɖe leptokyphotic joint osteophyte la ɖa. Cloward, si nye ACDF ƒe gɔmeɖoanyila bubu, te gbe ɖe edzi be ele be woaɖe nutetewo katã ɖa, eye be hyperplastic leptokyphosis ɖeɖe ɖa tẽ le vevie na decompression, esime Robinson ɖo eŋu be woate ŋu agbugbɔ leptokyphosis la aɖo anyi abe alesi woli ke le leptokyphosis me ene eye be mɔ̃ siwo me gblẽ la bu.
The preservationists argue that the hook joint contributes 48% to 60% of the stability of each segment and provides the greatest stability in the posterior aspect of the cervical spine, and that standard cervical foraminotomy decompression decompresses the posterior aspect of the hook joint and the anterior aspect of the neuraxial canal, whereas in reality the most stable part of the joint is removed, and instability as well as displacement of the implant position ɖea fusion la ƒe dzidzedzekpɔkpɔ dzi kpɔtɔna.
Ne woate ŋu akpɔ dɔdamɔnu me tsonu siwo sɔ kple wo nɔewo evɔ womeɖe hook vertebral joint la ɖa o la, hook vertebral joint takpɔkpɔ ate ŋu ana nɔnɔme si sɔ wu na fusion rates siwo kɔkɔ wu le nukpɔsusu nu. Tsɔ kpe ɖe eŋu la, hook vertebral joint takpɔkpɔ kpena ɖe ame ŋu be woaɖe mɔnukpɔkpɔ siwo li be woawɔ dɔ le dɔwɔwɔ vɔ megbe ƒe akɔta ƒe akpa si nye subluxation dzi akpɔtɔ, eye wode dzesii be ne woɖe hook vertebral joint ƒe akpa si wu 38% la, interbody fusion subluxation ƒe agbɔsɔsɔme adzi ɖe edzi ŋutɔ.
![3_UpScayl_2x_nu ŋutɔŋutɔwoRgan-X4Plus .]( "3_upscayl_2x_realesrgan-x4plus")
Nukpɔkpɔ si ɖea nu le ame ŋu .
Le Resection School of Thought ƒe nya nu la, le ŋutilã ƒe wɔwɔme nu la, leptospondylar ƒunukpeƒea ƒe megbegli nye lãmeka ƒe ke ƒe ŋgɔgbegli, eye ƒu si susɔ tso leptospondylar ƒunukpeƒe ƒe hyperplasia me ate ŋu ahe intervertebral foraminal stenosis vɛ.
Le atikewɔmɔnu si li fifia me la, wogahea tete ɖe anyi to leptokyphosis ɖeɖe ɖa me le dɔnɔ siwo ŋu leptokyphotic joint hyperplasia ƒe nutete sesẽ le me, be woaɖe lãmeka alo akɔta ƒe ʋuka ƒe tete dzi akpɔtɔ kaba ale si woate ŋui.
Le nusianu me la, nyaʋiʋliwo nɔ anyi ɣesiaɣi, gake tiatia si nye be woakpɔ hook spondylolisthesis la ta, akpɔ eƒe akpa aɖe ta, alo aɖee ɖa keŋkeŋ le dɔnɔa ƒe nɔnɔme nu la va zu nusi dzi woda asi ɖo le dɔdaƒe vovovowo. Gake atikewɔwɔmɔnu si wowɔ na ame ɖekaɖekawo la biaa nu geɖe tso ametia ƒe lolome ŋu.
![4_UpScayl_2x_nu ŋutɔŋutɔwoRgan-X4Plus .]( "4_upscayl_2x_realesrgan-x4plus")
zero-cut trace siwo bɔ ɖe asi me la se ɖe afi aɖe le esi wòhiã be woatsɔ gavi 4 aƒo gavi 4 nu, eye woƒe kekeme hiã be wòanye milimeta 17.5, si nye lolome gã aɖe na dukɔmevi aɖewo, eye zi geɖe la, ebia be woaxe mɔ ɖe kɔsɔkɔsɔa ƒe ƒunukpeƒe ƒe akpa aɖe nu hena fusion ƒe ƒoƒo ɖe teƒe si le akɔta dome.
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Woɖe SAGI 2-nail locking zero incision dzi kpɔtɔ va ɖo 14.8 mm le kekeme me, eye wobu Chinatɔwo ƒe ameha la ƒe ŋutilã ƒe lolome ŋu, eye wòna dɔwɔla la kpɔa dɔwɔwɔ me atikewɔwɔ si wowɔ na ame ŋutɔ wu le kɔsɔkɔsɔa ƒe ƒunukpeƒea ŋu, si wɔnɛ be woate ŋu atia hook joint la ƒe nɔnɔme ŋutɔŋutɔ kple ɣeyiɣi didi ƒe nɔnɔme, esime wòle be woatiae le gɔmedzedzea me le nɔnɔme ŋutɔŋutɔ me.
Dɔwɔwɔ vɔ megbe ƒe aklã ƒe ʋuka me ʋu ƒe sisi .
Spinal epidural hematoma (SEH) nye kuxi si mebɔ kura o eye wònye kuxi sesẽ aɖe le anterior cervical approach megbe, kple dzɔdzɔ abe 0.1% va ɖo 0.2%.Seh dzɔna le venous plexus si me ke le le epidural me, si ana woawɔ dɔ na spinal cord ƒe dɔwɔwɔ ƒe gbɔdzɔgbɔdzɔ sesẽ aɖeke o. Amekoko kpata le SEH ƒe dzesiwo nyanya vɔ megbe ate ŋu akpe ɖe ame ŋu be ahɔhɔ̃mekawo ƒe dɔwɔwɔ nahaya.
![Nɔnɔmetata (2) .]( "image (2)")
SEH ƒe ɖoɖowɔɖi si wowɔ le dɔwɔwɔ vɔ megbe le ACCF .
ACDF kple ACCF siaa ate ŋu adzɔ le aklã me ʋu ƒe sisi le aklã me ŋu, eye ACCF ƒe ʋu ƒe sisi ƒe afɔku lolo wu le nuveviwɔame geɖe wu kple ƒu siwo le dodom wu ta; Gake ACDF ƒe dɔwɔwɔ ƒe agbɔsɔsɔ bliboa lolo wu, eye SEH ƒe xexlẽme si sɔ gbɔ wu la dzɔna.
Ele be mɔxexe ɖe SEH nu le ŋgɔgbe ƒe vidzidɔ ƒe mɔnu megbe Ele be woayi edzi le dɔwɔwɔ na ame ƒe ɣeyiɣi bliboa me:
A. Ele be woawu dodokpɔ si wowɔ do ŋgɔ na dɔwɔwɔ nɛ nu, eye woabia nya tsitotsito tso nenye be dɔléle aɖewo le ʋumenugbagbeviɣidɔ ŋu hã, kple nenye be atamanono kple ahatsunono ɣeyiɣi didi ƒe ŋutinya li; Ne amewo le atike siwo tsia ʋumenugbagbeviɣidɔ nu zãm la, ele be woadzudzɔ wo nono kwasiɖa ɖeka do ŋgɔ na dɔwɔwɔ na wo;
B. Ʋu ƒe ʋuʋu nyuie le dɔwɔwɔ me, ʋu ƒe sisi si mede blibo o to elektrikŋusẽ ƒe hɛ dzi ate ŋu ana ʋu yeye nado, woɖo aɖaŋu be woazã bipolar electrocoagulation forceps; Le akɔta ƒe ŋutilã ƒe akpa si nye subtotal resection ƒe ɖoɖoa me la, ele be woatsɔ ƒumeŋuɖui aƒoe be woaƒo asa na ʋu ƒe sisi fũ akpa tso ƒu ƒe gowo dzi; Haemostatic atikewo, abe tranexamic acid dodo, kple bubuawo ene, zazã be woatsɔ aɖe ʋu si dona le dɔwɔwɔ me dzi akpɔtɔ; Mehiã be woadi be woaɖe megbeƒuƒu ƒe akpa si wowɔ dɔ na ƒe megbeƒuƒu ƒe akpa si wowɔ dɔ le la ɖa keŋkeŋ o, eye megbe didime ƒe lãkusi sue aɖe takpɔkpɔ le akpa eveawo hã ate ŋu akpɔ decompression ƒe ŋusẽkpɔɖeamedzi o; Ele be ametia ƒe akpa si wowɔ la nagblẽ teƒe si sɔ ɖe ɖusime kple miame. Ne wole ametia ƒe akpa si wowɔ la dam ɖe eme la, ele be woagblẽ teƒe si sɔ ɖe miame kple ɖusime ale be ʋu si le epidural la nate ŋu atso akɔta ƒe ŋgɔgbe eye woaɖee to tsiɖɔɖɔɖɔƒe ƒe mɔ̃ si me tsi mele o me;
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C. Le dɔwɔwɔ vɔ megbe la, lé ŋku ɖe dzesi veviawo ŋu nyuie; Na tsidzɔƒea nanɔ blɔ; Zã atike siwo wua ʋumenugbagbeviɣidɔ tsɔ ƒo asa na ʋuka me ʋu ƒe sisi; Lé ŋku ɖe lãmekawo ƒe dɔwɔwɔ ŋu nyuie; Ne nusi mesɔ o aɖe li la, ke wɔ nu ɖe eŋu le ɣeyiɣi aɖe megbe.
![详情页8.]( "详情页8")
Wotrɔ asi le eŋu be wòawɔ ɖe dukɔa ƒe ŋutilã ƒe wɔwɔme ƒe didime dzi .
1. naa atikewɔnyawo gbɔkpɔnu si wowɔ na ame ŋutɔ hena akɔta ƒe ƒunukpeƒe si wotsɔ kɔsɔkɔsɔ ƒo ƒui la dzi kpɔkpɔ.
2. Ðe mɔnukpɔkpɔ si li be akɔta ƒe akpa si le akɔta naɖiɖi la dzi akpɔtɔ .
3. Ðe afɔku si le aklã ƒe ʋuka me ʋu ƒe sisi me dzi kpɔtɔ .
Angle angle screw design hena dɔwɔwɔ bɔbɔe .
![8]( "8")
Screw siwo ƒe dzogoe nye -1.5°11.5° kple cephalad swing angle si nye 36°44° hena ɖaƒoƒo le dɔwɔwɔ me bɔbɔe wu .
Nusi mewɔa nu ɖe ame ŋu boo o .
Mehiã be woadzra teƒe bubu ɖo na screw insertion o, woɖea nu suetɔ kekeake si woɖe tso eme la dzi kpɔtɔna tso 2.5cm va ɖo abe 2.0cm ene.
Woate ŋu atrɔ asi le eŋu wu ɖe aklãdɔlékui ƒe dɔwɔwɔ ƒe nukpɔsusua nu, si nye endo-acdf ƒe dzedzeme.
![7]( "7")
Le CzmediTech ŋu la, .
cervical peek cage(2 alo 4 locking screws) nye ƒumeŋuɖui ƒe kuxiwo gbɔ kpɔnu pɛpɛpɛ to . CzmediTech si ku ɖe ŋgɔgbe ƒe vidzidɔ me discectomy decompression kple implant fusion ŋu eye xexeame katã ƒe ŋutega ʋãe, si woɖo be wòana atikewɔwɔ ƒe kuxiwo gbɔ kpɔnu siwo me kɔ nyuie, siwo sɔ eye womexɔa ga geɖe o na dɔnɔ siwo ƒe gbagbã sesẽ le xexeame godoo.
Anterior cervical discectomy with decompression and implant fusion (ACDF) is one of the most commonly used surgical methods for the treatment of spinal cord-type and nerve root-type cervical spondylosis, cervical spine trauma and other disorders, and it has the advantages of initial stabilisation, high fusion rate, restoration of normal anterior convexity, and the absence of external fixation, etc. The common postoperative Kuxiwo abe nu mimi ƒe sesẽ, akpa siwo te ɖe wo nɔewo ŋu ƒe gbegblẽ, lãkusi ƒe lãmetutudɔ gbugbɔgawɔ, ahɔhɔ̃mekawo me tsi ƒe sisi, ʋu ƒe sisi, dɔlékuiwo, kple ʋukawo dome lãkusiwo ƒe dodo kple bubuawo ene.
