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Discectomy na baya na mahaifa tare da lalatawa da haɗin gwiwa (ACDF) yana ɗaya daga cikin hanyoyin da ake amfani da su na tiyata don maganin cututtuka na kashin baya-nau'i da nau'in jijiya irin nau'in mahaifa, ciwon mahaifa da sauran cututtuka, kuma yana da fa'idodi na daidaitawa na farko, babban haɗin kai, farfadowa na yau da kullum, rashin daidaituwa na al'ada da dai sauransu. matsalolin da suka biyo bayan aiki kamar wahalar haɗiye, ɓarnawar sassan da ke kusa da su, gurɓataccen jijiyar maƙogwaro, zubar da ruwa na cerebrospinal, haematoma, kamuwa da cuta, da raguwar shiga tsakani da dai sauransu. Gabaɗayan abin da ya faru na rikice-rikicen bayan tiyata shine kusan 8%.
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Dangane da matsalolin da ke sama, al'ummar ilimi suna aiki akai-akai akan inganta fasaha, abubuwan da suka dace, da inganta aikin gyaran kafa. Na'urar haɗin gwiwar mahaifa ta kai tsaye (sifili-trace), wanda ke da cikakkiyar matsuguni a cikin sararin intervertebral kuma yadda ya kamata ya rage haɗarin dysphagia na baya-bayan nan da ɓarnawar yanki kusa, an yarda da shi sosai.
Abubuwan da ke tattare da aikin prostheses an tattauna su a ƙasa --
1. Rikici kan ko za a sake gyara haɗin gwiwa na kashin baya ko a'a
Hoto 1 Tsarin tsari na tsarin conotruncus, jijiyar vertebral, da kashin baya da tushen jijiya.
a. Dangantakar da ke tsakanin mahimmin mahimmanci na articular na concha da jijiyoyin vertebral.
b. A cikin littafin, an cire matsakaicin tsaka-tsakin maɗaukakin maɗaukaki, kuma an kiyaye gefen gefen da kyau don kauce wa lalacewa ga jijiyar vertebral.
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Hoto na 2 Tsarin tsari na tushen jijiya da kuma raguwa ta hanyar yada sassan conical hyperplastic.
a. Ci gaban kasusuwa da raguwar kashin baya na haɗin gwiwar conical suna rage ɓangaren giciye na intervertebral foramina, don haka matsawa tushen jijiya.
b. Intervertebral fusion na'urar / dasa na iya bude sararin intervertebral don kara girman yanki na intervertebral foramen da tuntuɓar tushen jijiya, kuma a lokaci guda, sake gyara kwanciyar hankali na kashin baya.
Wajabcin tiyatar kashin baya na mahaifa don cire haɗin gwiwa na ƙugiya ya kasance ƙashi na jayayya tun farkon fasahar.
An ba da bayanin farko na ɓarnawar mahaifa na baya da haɗin gwiwa tare da gyaran ciki da Robinson da Smith suka bayar a cikin 1955 inda ya bayyana hanyar da ba ta buƙatar cire haɗin gwiwa na leptokyphotic osteophyte. Cloward, wani wanda ya kafa ACDF, ya jaddada cewa ya kamata a cire duk matsawa, kuma cirewar leptokyphosis na hyperplastic yana da mahimmanci don ragewa, yayin da Robinson ya amsa cewa leptokyphosis za a iya sake dawo da shi yayin da aka tabbatar da kwanciyar hankali na kashin baya kuma yayin da ƙananan kayan aikin injiniya suka ɓace, kuma ana tunanin waɗannan matsalolin suna da alaka da samuwar leptokyphosis.
Masu kiyayewa suna jayayya cewa haɗin gwiwar ƙugiya yana ba da gudummawar 48% zuwa 60% na kwanciyar hankali na kowane sashi kuma yana ba da mafi girman kwanciyar hankali a cikin ɓangaren baya na kashin mahaifa, kuma daidaitaccen ƙwayar mahaifa na foraminotomy decompression yana lalata yanayin baya na haɗin ƙugiya da na gaba na gaba na haɗin gwiwa na neuraxial mafi yawan abin da aka cire, yayin da mafi yawan abin da ake iya cirewa daga canal neuraxial. ƙaurawar matsayi na sakawa yana rage nasarar haɗuwa.
Idan za'a iya samun daidaitattun sakamakon asibiti ba tare da an gyara haɗin haɗin gwiwa na ƙugiya ba, adana haɗin gwiwa na ƙugiya zai iya samar da wuri mafi dacewa don ƙimar haɗin kai. Bugu da ƙari, adana ƙugiya na ƙugiya na kashin baya yana taimakawa wajen rage damar da za a iya samu na subluxation na baya bayan aiki, kuma an lura cewa lokacin da yankin ƙugiya na ƙugiya ya rabu da fiye da 38%, ƙimar haɗin haɗin gwiwa zai karu sosai.
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Bisa ga makarantar resection, anatomically, bangon baya na haɗin gwiwa na leptospondylar shine bangon baya na tushen jijiya, kuma ragowar kashi daga hyperplasia na haɗin gwiwa na leptospondylar zai iya haifar da intervertebral foraminal stenosis.
A cikin aikin asibiti na yanzu, raguwa ta hanyar cirewar leptokyphosis har yanzu ana ba da shawarar ga marasa lafiya tare da matsananciyar matsawa na hyperplasia na haɗin gwiwa na leptokyphotic, don sauƙaƙe matsawa na jijiyoyi ko jijiyoyi na vertebral da wuri-wuri.
Gabaɗaya, rikice-rikice ya kasance koyaushe, amma zaɓin adanawa, adana wani yanki, ko cire gaba ɗaya ƙugiya spondylolisthesis bisa ga yanayin haƙuri ya zama yarjejeniya a cikin ayyukan asibiti daban-daban. Dabarun jiyya na mutum ɗaya, duk da haka, yana sanya buƙatu masu yawa akan girman prosthesis.
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Alamun sifili na yau da kullun akan kasuwa yana iyakance ta buƙatar dunƙule a cikin screws 4 don kullewa, kuma faɗin su yana buƙatar zama 17.5 mm, wanda shine babban girman ga wasu 'yan ƙasa, kuma galibi yana buƙatar ɓoyayyiyar ƙugiya ta ƙugiya don shigar da fusion a cikin sararin intervertebral.
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Sagi 2-ƙulle sifili incision an rage zuwa 14.8 mm a fadin, la'akari da yanayin jiki na jama'ar kasar Sin, da kuma samar da ma'aikacin da wani ƙarin keɓaɓɓen magani na ciki na ƙugiya hadin gwiwa, da damar da magani na ƙugiya hadin gwiwa da za a zaba bisa ga ainihin yanayin majiyyaci, tare da tabbatar da kwanciyar hankali na farko da kuma dogon lokaci Fusion.
Bayan aikin kashin baya epidural hematoma
Kashin baya na epidural hematoma (SEH) wani abu ne mai wuyar gaske kuma mai tsanani bayan tsarin mahaifa na gaba, tare da abin da ya faru na kimanin 0.1% zuwa 0.2% .SEH yana faruwa a cikin ma'auni mai yalwar jini na epidural, wanda zai haifar da mummunan aiki na kashin baya idan ba a kula da samuwar hematoma cikin lokaci ba. Yin tiyata na gaggawa bayan ganewar asali na SEH zai iya taimakawa wajen dawo da aikin neurological.
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Bayanan aikin SEH na ACCF
Ciwon hematoma na kashin baya na iya yiwuwa bayan duka ACDF da ACCF, tare da ACCF suna da haɗarin haematomas mafi girma saboda rauni mai girma da kuma filayen kashi; duk da haka, yawan adadin tsarin ACDF ya fi girma, tare da adadin SEH mafi girma yana faruwa.
Rigakafin SEH bayan tsarin mahaifa na gaba ya kamata ya ci gaba a duk tsawon lokacin aiki:
A. Ya kamata a kammala bincike kafin a yi aiki, kuma a yi cikakken bincike game da ko akwai wasu cututtukan da suka shafi jini, da kuma ko akwai tarihin shan taba da barasa na dogon lokaci; idan akwai masu shan magungunan kashe jini, to su daina shansu har tsawon mako guda kafin a yi aikin;
B. Cikakken haemostasis na ciki, rashin cikawar haemostasis ta hanyar wuka na lantarki na iya haifar da sabon zub da jini, ana ba da shawarar yin amfani da karfi na electrocoagulation na bipolar; a cikin aikin jujjuyawar jikin kashin baya, yakamata a yi amfani da kakin kakin kashi don gujewa zubar jini da yawa daga saman kashi; amfani da magungunan haemostatic, irin su allurar tranexamic acid, da sauransu, don rage zubar jini na ciki; ba lallai ba ne a nemi cikakken gyare-gyare na ligament na baya na tsawon lokaci na ɓangaren da aka yi aiki, da kuma adana ƙananan ƙananan ligament na baya a bangarorin biyu kuma zai iya cimma tasirin raguwa; sanyawa na prosthesis ya kamata ya bar isasshen sarari a gefen dama da hagu. Lokacin sanya prosthesis, ya kamata a bar isasshen sarari a gefen hagu da dama don zubar da jini na epidural zai iya gudana zuwa gaban kashin baya kuma a fitar da shi ta hanyar bututun magudanar magudanar ruwa;
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C. Bayan aikin, kula da mahimman alamun; kiyaye magudanar ruwa da santsi; yi amfani da magungunan kashe qwari a hankali don guje wa thrombosis; saka idanu sosai akan aikin tsarin juyayi; idan akwai wani rashin daidaituwa, magance shi cikin lokaci.
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An ƙirƙira don saduwa da ma'aunin jiki na ƙasa
1. Yana ba da wani keɓaɓɓen bayani na asibiti don kula da haɗin gwiwa na kashin baya.
2. Rage damar samun kwanciyar hankali na vertebral
3. Rage haɗarin hematoma na kashin baya
Maɓallin maɓalli mai canzawa don aiki mai sauƙi
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Screws tare da kusurwar juzu'i na -1.5°11.5° da cephalad swing 36°44° don sauƙin sanya ƙusa na ciki.
Babu buƙatar yin ajiyar ƙarin sarari don shigar da dunƙulewa, an rage mafi ƙarancin inci daga 2.5cm zuwa kusan 2.0cm.
Mai daidaitawa ga manufar aikin endoscopic na kashin baya, fahimtar Endo-ACDF.
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Abubuwan da aka bayar na CZMEDITECH
Cervical Peek Cage (2 ko 4 Locking Screws) daidaitattun hanyoyin magance orthopedic ne a hankali sun haɓaka ta CZMEDITECH ya ta'allaka ne akan lalatawar discectomy na baya na mahaifa da haɗakarwa da haɓakawa ta hanyar hangen nesa na duniya, sadaukar da kai don samar da ingantaccen, dacewa da ingantaccen hanyoyin magance hanyoyin magani ga marasa lafiya tare da ɓarna masu rikitarwa a duniya.
Discectomy na baya na mahaifa tare da lalatawa da haɗin gwiwa (ACDF) yana ɗaya daga cikin hanyoyin da ake amfani da su na tiyata don maganin cututtuka na kashin baya-nau'i da nau'in jijiya irin nau'in mahaifa, ciwon mahaifa da sauran cututtuka, kuma yana da fa'idodi na daidaitawa na farko, babban haɗin kai, farfadowa na yau da kullum, rashin daidaituwa na al'ada da dai sauransu. matsalolin da suka biyo bayan aiki kamar wahalar haɗiye, ɓarnawar sassan da ke kusa da su, gurɓataccen jijiyar maƙogwaro, zubar da ruwa na cerebrospinal, haematoma, kamuwa da cuta, da raguwar shiga tsakani da dai sauransu. Gabaɗayan abin da ya faru na rikice-rikicen bayan tiyata shine kusan 8%.
