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Discectomy na baya na mahaifa tare da decompression da fusion implant (ACDF) yana daya 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 daidaitawar farko, babban haɗin kai, farfadowa na al'ada na yau da kullum 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 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 haɗaɗɗun kashin baya na mahaifa (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 matsakaicin maɗaukakin maɗaukaki, kuma ana kiyaye gefen gefen daidai yadda ya kamata don kauce wa lalacewar 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 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.
Bayanin farko na lalatawar mahaifa na baya da kuma haɗawar dasawa tare da gyaran ciki an ba su Robinson da Smith 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 kafa kwanciyar hankali na kashin baya kuma yayin da ƙananan injiniyoyi suka ɓace, kuma ana tunanin cewa waɗannan rashin daidaituwa 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 kuma yanayin gaba na haɗin gwiwa na neuraxial mafi yawan abin da aka cire, yayin da mafi yawan abin da aka cire a cikin haɗin gwiwa na 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 gwiwa mafi girma. Bugu da ƙari, adana ƙugiya na ƙugiya na ƙugiya yana taimakawa wajen rage damar da za a iya samu na subluxation na vertebral 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 matsa lamba na hyperplasia na haɗin gwiwa na leptokyphotic, don sauƙaƙe matsawar jijiya ko jijiyar vertebral da wuri-wuri.
Gabaɗaya, rigima ta 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 haɓakar 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 barin jiyya na ƙugiya da za a zaba bisa ga ainihin yanayin majiyyaci, tare da tabbatar da kwanciyar hankali na farko da kuma dogon lokaci Fusion.
Bayan aiki na kashin baya epidural hematoma
Kashin baya 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 venous na epidural, wanda zai haifar da rashin aiki mai tsanani 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 yana yiwuwa bayan duka ACDF da ACCF, tare da ACCF suna da haɗarin haematomas mafi girma saboda rauni mai girma da ƙarin filayen kashi; duk da haka, jimlar adadin tsarin ACDF ya fi girma, tare da mafi girman adadin SEH da ke faruwa.
Rigakafin SEH bayan tsarin mahaifa na gaba ya kamata ya ci gaba a duk tsawon lokacin aikin:
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 juzu'i na jikin kashin baya, yakamata a shafa 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-gyaren ligament na baya na tsawon lokaci na ɓangaren da aka yi aiki, da kuma adana ƙananan ƙananan ligament na baya a ɓangarorin 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 ƙwanƙwasawa 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 murɗa na tsakiya 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 dunƙule, 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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Game da CZMEDITECH
Cervical Peek Cage (2 ko 4 Kulle sukurori ) daidaitattun hanyoyin magance orthopedic ne a hankali sun haɓaka ta CZMEDITECH ya dogara ne akan ƙaddamar da ƙwaƙwalwar ƙwayar cuta ta mahaifa da kuma haɗakarwa ta hanyar hangen nesa na duniya, wanda aka keɓe don samar da ingantaccen, dacewa da farashi mai mahimmanci na maganin jiyya ga marasa lafiya tare da raguwa masu rikitarwa a duniya.
Discectomy na baya na mahaifa tare da decompression da fusion implant (ACDF) yana daya 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 daidaitawar farko, babban haɗin kai, farfadowa na al'ada na yau da kullum 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 sauransu. Gabaɗayan abin da ya faru na rikice-rikicen bayan tiyata shine kusan 8%.
