Hanyar jeri dunƙule pedicle
1. Wurin shiga: wuyansa, kirji da kugu sun bambanta;
2. Ɗauki kusurwar jirgin sama na kwance (TSA) da sagittal jirgin sama (SSA) na shigar da dunƙule: Za a iya auna kusurwar TSA daga fim din CT. SSA tana da ƙayyadaddun dangantaka tare da matsayi na jiki, kuma ana iya sarrafa shi tare da C-arm yayin aiki.
3. Zurfin: Tsawon dunƙule ya kai kashi 80% na tsayin axis ɗin pedicle don samun isasshen ƙarfin biomechanical, kuma yana da sauƙin shiga cikin kashin cortical kuma yana lalata hanyoyin jini idan ya yi tsayi da yawa.
4. Tsawon: daga wurin saka allura zuwa 83% na jimlar tsayin cortex na gaba na jikin kashin baya.
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Kashin mahaifa
Hanyar shigar dunƙule bakin mahaifa
Hanyar shigar allura
A halin yanzu, manyan hanyoyin shigar allura sune: Hanyar Abumi, Hanyar sanya alamar ƙasa, hanyar saka hoto ta hanyar kwamfuta, da dai sauransu.
wurin shiga kashin mahaifa
A tsaka-tsakin 5mm da ke ƙasa da layin kwance na gefen babba na lamina na C2 axis da 7mm a waje da tsaka-tsakin tsakiya na canal na kashin baya.
C3-C6 Matsakaicin tsakiyar tsakiyar 1/4 a kwance layin da tsakiyar waje 1/4 a tsaye a kan baya na shingen gefe.
C7 Matsakaicin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsaki na gefe da kuma babban layin 1/4 na kwance yana sama.
kusurwar jujjuyawar mahaifar mahaifa
C2 karkata 20-25° karkata 10-15°
C3-C6 karkata 40-45°, jirgin sama na kwance yana layi daya da faranti na sama da na ƙasa.
C7 karkata 30-40 °, jirgin sama a kwance yana daidai da manyan faranti na sama da na ƙasa.
Ciwon baya na mahaifa
Idan tsayin baka na baya na atlas bai wuce 4mm ba, ana canza shi zuwa dunƙule taro na gefe.
Idan tsawo ko nisa na pedicle na axis bai wuce 5mm ba, ana bada shawara don canzawa zuwa gyaran gyare-gyare na gefe.
Wurin dunƙule dunƙulewa na gefen mahaifa
Hanyar Magerl : Wurin shigar da dunƙule yana 1-2mm sama da tsakiyar bangon bangon baya na taro na gefe; Hanyar shigar da dunƙule 25-30 ° a kaikaice karkata, kuma kai yana karkatar da 30 ° (daidai da saman articular na sama), kuma an haƙa cortex mai rikitarwa; zurfin ma'aunin Bayan dunƙule a cikin 3.5mm cortical kashi sukurori.
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Hanyar Roy-Camille : wurin shigar da dunƙule yana tsakiyar tsakiyar baya na taro na gefe; Hanyar shigar da dunƙule yana da 10 ° a gefe, an yi amfani da cortex na baya na tsaye, kuma an yi amfani da cortex mai sabani; bayan an yi sauti, an zana dunƙule kashi na cortical 3.5mm a ciki.
Hanyar Anderson : Wurin shigar da dunƙule yana 1mm a cikin tsakiyar tsakiya na gefe, hanyar shigar da dunƙule yana da 20 ° a gefe, kuma an karkatar da kai 20 ° zuwa 30 ° don haƙa ramin, kuma an haƙa cortex mai rikitarwa.
Ƙwarewar taƙaitawa
(1) Ya kamata a biya kulawa ta musamman ga amincin dasa shuki. Ya kamata likitan fiɗa ya zaɓi hanyar da ta dace bisa ga ƙwararrun ilimin mahaifa da fasaha na dunƙulewa.
(2) Ƙaƙwalwar ƙira ta gefe a cikin sashin C3-C6 ya fi sauƙi kuma mafi aminci fiye da gyaran gyare-gyaren dunƙule na pedicle.
(3) Kayan aiki ba zai iya shiga bangon waje na pedicle ba, in ba haka ba zai lalata jijiyoyi da jini na kusa.
(4) Matsakaicin saka dunƙule ya kamata ya bambanta tare da kusurwar baka na kashin baya.
(5) Ya kamata a guji shiga cikin kashin cortical a gaban jikin kashin baya.
(6) Intraoperative fluoroscopy iya daidai gano wuri na vertebral jiki da intervertebral sarari, da kuma daidai dasa sukurori don hana dunƙulewa a cikin intervertebral sarari da kuma kashin baya canal.
Thoracic
Wurin shigar allura:
1. Margel da Roy Camille sun ɗauki tsaka-tsakin layi na kwance na tsakiyar tsakiya na tsarin maɗaukaki da kuma layi na tsaye na gefen waje na babban aikin articular a matsayin wurin shigarwa.
2. Ebraheim ya ba da shawarar cewa tsakiyar pedicle na T1-T2 yana cikin 7-8 mm a cikin gefen waje na babban aikin articular, da kuma 3-4 mm akan tsakiyar layi na tsari mai juyawa. ~8mm.
3. Zana layi na tsaye 3 mm a waje da tsakiyar tsakiya na ƙananan haɗin gwiwa, kuma zana layi a kwance daga saman 1/3 na tushe na tsari mai jujjuyawa, kuma tsaka-tsakin layin biyu shine wurin shigar ƙusa.
4. A kan tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsayin daka na tsarin aiki na ƙananan ƙananan da kuma layin kwance na tsakiya na tushen tsarin mai juyayi, 1 mm a ƙasa da facet;
5. A cikin lokuta masu rikitarwa, zaɓi ne mai aminci don cire ɓangaren lamina da sanya sukurori na pedicle a ƙarƙashin hangen nesa kai tsaye.
kusurwar saka kashin baya na thoracic
Jirgin sama na Sagittal : Ragewa a cikin karkata daga T1 zuwa T12. T1: 25 °; T2: 20 °; T3: 15°; T4-9: 10 °; T10: 5°; T11-12: 0°.
Gilashin ƙwanƙwasa na ƙwanƙwasa na thoracic na sama ya kamata su sami kusurwar karkatarwa na 10-20 ° tare da jirgin sama na sagittal, kuma ƙuƙuka na tsakiya da ƙananan thoracic vertebrae ya kamata su kasance da kusurwar 0-10 ° tare da jirgin sama na sagittal. Ebraheim ya ba da shawarar cewa T1 da T2 pedicle sukurori ya zama 30-40 ° karkata tare da sagittal jirgin sama, T3-T11 ya zama 20-25 °, kuma T12 ya zama 10 °.
Jirgin sama na kwance : yakamata ya kasance daidai da faranti na sama da na ƙasa.
Zabin kashin baya na thoracic
T1～T5 yana buƙatar diamita dunƙule 3.5 ~ 4.0mm
T6～T10 yana buƙatar 4.0-5.0mm
T11, T12 suna buƙatar 5.5mm
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Ga manya, diamita na dunƙule na thoracic pedicle bai wuce 5mm ba, kuma akwai haɗarin fashewar dunƙule. A yawancin lokuta na kashin baya na tsakiya, ba za a iya sanya sukurori fiye da 5 mm a diamita ba, wanda zai iya haifar da fashewar pedile cikin sauƙi.
Wasu malaman suna amfani da sanyawa a gefe na pedicle, wanda ke magance wannan matsala sosai. Danna tip na tsarin jujjuya don shigar da fil, kuma tsakiyar layin tsarin yana kwance. Juya ƙaramin rami da farko, kuma shugabanci na awl yana haɗuwa tare da gefen gefen gefen facet na vertebra. The kwana tare da sagittal jirgin sama ne 25-40 digiri, da kuma a hankali matakin ya karu daga T12 zuwa sama.
Ƙunƙarar da aka saka za ta wuce ta hanyar juzu'i, wani ɓangare na tsarin costotransverse, haɗin gwiwar costovertebral, da bangon gefe na jikin vertebral. Tun da hanyar shigar da dunƙule yana waje da haɗin gwiwa facet, ba shi yiwuwa a shigar da canal na kashin baya, wanda ya fi aminci. Bugu da ƙari, haɓakar kusurwar ƙaddamarwa yana sa kullun ya fi tsayi. , mai kauri, ƙarfin gyare-gyare yana ƙara girma, girman kusurwar shigarwa yana da girma, za a iya samun screws a cikin layi, kuma taron ya fi dacewa.
Lumbar kashin baya
Lumbar shigarwa wurin
1. Hanyar shigar da allura a koli na herringbone ridge (maganin taro na m tsari ridge a kan posterolateral gefen tushen mafi girma articular tsari da kuma isthmus ridge), da bambancin da wannan matsayi ne karami (layin da ya faru ne 98%), da kuma m tsari cizon ta hanyar sakawa.
2. Hanyar tsaka-tsakin: tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsari da kuma tsayin daka mai tsayi a waje da haɗin gwiwa na facet, ko kuma gefen waje na babban aikin articular,
3. A cikin lokuta masu rikitarwa, zaɓi ne mai aminci don cire ɓangaren lamina da sanya sukurori na pedicle a ƙarƙashin hangen nesa kai tsaye.
Lumbar dunƙule kusurwa
Sagittal jirgin sama kwana : L1-L3 da 5-10 digiri na juyi, L4-L5 da 10-15 digiri na juyi.
Hannun jirgin sama na kwance : L1-4: daidai da farantin karfe; L5: 10 digiri na karkata zuwa ƙasa (L5 jikin kashin baya baya).
Lumbar zaɓin zaɓin kashin baya
Kariyar Tiyata
1. Kafin tiyata, dole ne a sami ra'ayi na gaba da na gefe na kashin baya na lumbar. Duban baya yana nuna matsayi na dunƙule a cikin madaidaiciyar hanya, kuma ra'ayi na gefe zai iya nuna matsayi na dunƙule a cikin matsayi na tsaye.
2. Matsayin shigarwa ya kamata ya zama daidai kuma ya haɓaka da kyau, kuma za'a iya cire kashin cortical a wurin anga ta hanyar buɗe dala triangular ko rongeur.
3. Bayan kayyade jagorar gabaɗaya, yi amfani da ƙarfin da ya dace don buɗe kewaye a hankali. Binciken baƙar fata bai kamata ya gamu da juriya ba a lokacin shigar da allura. Kada a sami ma'anar ' gazawa' ko tsayin daka. Lokacin da aka fuskanci juriya a farkon 5 ~ 15mm, ya kamata ya zama lokaci. Daidaita wurin shigar allura da kusurwa. Idan kun ci karo da juriya mai ƙarfi, ana ba da shawarar ku fita da farko kuma ku sake zaɓar hanyar da za ku shiga. Tabbatar ku bi hanyar pedicle. Ciki na pedicle shine kashi mai sokewa kuma waje shine kashin cortical, wanda za'a iya shiryar da shi ta atomatik, muddin wurin shigarwa daidai ne kuma ya girma sosai; Matsa 10-15 ° zuwa tsakiyar layi, kula da jirgin sama daidai da gefen babba na jikin kashin baya, kuma ku fahimci zurfin kusan 3cm. Ji yana da mahimmanci.
4. Yana da matukar muhimmanci a yi amfani da binciken pedicle don bincika bangon hudu, musamman bangon ciki, ƙasa da ƙasa.
5. Lokacin da bambancin jikin jiki tsakanin ƙananan thoracic da lumbar vertebrae ba a sani ba, ciji tsarin kayan haɗi da ƙananan tsarin articular, sa'an nan kuma ciji wani ɓangare na tsarin haɗin gwiwa na sama, da kuma duba kai tsaye ga bangon ciki na pedicle da ƙofar pedicle.
6. Gara fita waje da ciki, ka hau kada ka gangara; juyawa shine babban abu, kuma gaba shine kari; yayin ci gaba da bincike, tsayawa lokacin da kuke gani da ƙarfi, daidaita cikin lokaci, yi amfani da ƙarfin yatsa kawai, kar a karkatar da ƙarfi.
7. Diamita na dunƙule bai kamata ya wuce 83% na diamita na waje ba na pedicle.
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