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Anterior cervical discectomy with decompression and implant fusion (ACDF) is one of the most commonly surgical method 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 stabilization, high fusion rate, restoration of normal anterior convexity, and the absence of external postoperative fixation. ka ale ʻana, ka degeneration o nā ʻāpana pili, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, hematoma, maʻi, a me intervertebral implant subsidence etc. ʻO ka nui o ka hopena o nā pilikia postoperative ma kahi o 8%.
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I ka pane ʻana i nā pilikia i luna, ke hana mau nei ke kaiāulu hoʻonaʻauao i nā hoʻomaikaʻi ʻenehana, nā holomua manaʻo, a me ka hoʻomaikaʻi ʻana i ka prosthesis. Ua ʻae nui ʻia ka mea hoʻohui ponoʻī o ka cervical spine fusion (zero-trace), kahi i hoʻokomo piha ʻia i loko o ka intervertebral space a hoʻemi pono i ka hopena o ka postoperative dysphagia a me ka degeneration ʻāpana pili.
ʻO nā pilikia postoperative e pili ana me nā prostheses e kūkākūkā ʻia ma lalo nei -—
1. Hoʻopaʻapaʻa no ka wehe ʻana i ka hui vertebral hooked
Fig. 1 Schematic diagram of the structure of the conotruncus, vertebral artery, and spinal cord and nerve roots.
a. ʻO ka pilina ma waena o ke kiʻekiʻe articular o ka concha a me ke aʻa vertebral.
b. I loko o ka puke, ua wehe ʻia ka ʻaoʻao waena o ka eminence articular, a mālama pono ʻia ka ʻaoʻao ʻaoʻao e pale i ka pōʻino o ke aʻa vertebral.
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Fig. 2 Diagram Schematic o ka hoʻopaʻa ʻana a me ka decompression o ke aʻa aʻa ma ka hohola ʻana i nā hui conical hyperplastic.
a. ʻO ka ulu ʻana o ka iwi a me ka hoʻohaʻahaʻa ʻana o ka spinal o nā hui conical e hoʻemi i ka ʻāpana cross-sectional o ka foramina intervertebral, no laila e hoʻopiʻi i nā aʻa aʻalolo.
b. Hiki ke wehe i ka intervertebral fusion device / implant e hoʻonui i ka wahi o ka intervertebral foramen a hoʻopili i ke aʻa aʻa aʻalolo, a ma ka manawa like, hoʻoponopono hou i ka paʻa o ka spine.
ʻO ka pono o ka ʻoki ʻana o ka spine cervical mua e wehe i ka hui vertebral makau he iwi paio ia mai ka hoʻomaka ʻana o ka ʻenehana.
ʻO ka wehewehe mua o ka decompression cervical anterior a me ka hui implant me ka hoʻoponopono kūloko i hāʻawi ʻia e Robinson lāua ʻo Smith ma 1955 i wehewehe ʻo ia i ke kaʻina hana ʻaʻole pono e wehe ʻia ka leptokyphotic joint osteophyte. Ua ʻōlelo ʻo Cloward, kekahi mea nāna i hoʻokumu i ka ACDF, e hoʻoneʻe ʻia nā mea paʻa a pau, a ʻo ka wehe pololei ʻana i ka leptokyphosis hyperplastic he mea nui ia no ka decompression, ʻoiai ua pane ʻo Robinson e hiki ke hoʻihoʻi ʻia ka leptokyphosis i ka wā i hoʻokumu ʻia ai ka paʻa o ka spine a i ka nalowale ʻana o nā mana mechanical abnormal, a ua manaʻo ʻia ua pili kēia mau instabilities i ka hoʻokumu ʻana o ka leptokyphosis.
Hoʻopaʻapaʻa ka poʻe mālama i ka hāʻawi ʻana o ka hui hook i ka 48% a i ka 60% o ka paʻa o kēlā me kēia māhele a hāʻawi i ke kūpaʻa nui loa ma ka ʻaoʻao hope o ka spine cervical, a ʻo ka decompression foraminotomy cervical maʻamau e hoʻohaʻahaʻa i ka ʻaoʻao hope o ka ami makau a me ka ʻaoʻao mua o ka canal neuraxial, akā ʻo ka ʻoiaʻiʻo, ʻo ka ʻaoʻao paʻa loa a me ka hoʻohemo ʻana o ka hui. hoemi ke kulana i ka holomua o ka hui.
Inā hiki ke hoʻokō ʻia nā hopena lapaʻau like me ka ʻole o ka wehe ʻana i ka hui vertebral hook, hiki i ka mālama ʻana i ka hui vertebral hook ke hāʻawi i ka hoʻonohonoho kūpono loa no nā helu hui kiʻekiʻe. Eia kekahi, ʻo ka mālama ʻana i ka hui vertebral hook e kōkua i ka hōʻemi ʻana i ka manawa o ka subluxation vertebral postoperative, a ua ʻike ʻia i ka wā i hoʻokaʻawale ʻia ai ka wahi o ka hui vertebral hook e oi aku ma mua o 38%, e piʻi nui ka nui o ka interbody fusion subluxation.
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Wahi a ke kula resection o ka noʻonoʻo, anatomically, ʻo ka paia hope o ka hui leptospondylar ka paia mua o ke aʻa aʻa aʻalolo, a ʻo ke koena iwi mai ka leptospondylar joint hyperplasia hiki ke alakaʻi i ka intervertebral foraminal stenosis.
Ma ka hana lapaʻau o kēia manawa, ʻōlelo ʻia ka decompression ma ka excision o ka leptokyphosis i nā poʻe maʻi me ka hoʻoemi koʻikoʻi o ka hyperplasia hui leptokyphotic, i mea e hōʻoluʻolu ai i ka hoʻopiʻi ʻana o ke aʻalolo a i ʻole ke aʻa vertebral i ka hiki wawe.
ʻO ka holoʻokoʻa, ua mau ka hoʻopaʻapaʻa, akā ʻo ke koho ʻana i ka mālama ʻana, mālama hapa, a i ʻole ka wehe loa ʻana i ka spondylolisthesis hook e like me ke kūlana o ka mea maʻi, ua lilo ia i mea ʻae i nā hana lapaʻau like ʻole. ʻO ka papahana lapaʻau hoʻokahi, akā, kau i nā koi kiʻekiʻe i ka nui o ka prosthesis.
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Hoʻopili ʻia nā ʻāpana ʻoki ʻole ma ka mākeke e ka pono e hoʻopaʻa ʻia i ka 4 screws no ka laka, a ʻo ko lākou laulā he 17.5 mm, ʻo ia ka nui nui no kekahi mau lāhui, a koi pinepine i ka occlusion hapa o ka ami makau no ka fusion implantation ma ka intervertebral space.
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ʻO ka SAGI 2-nail locking zero incision ua hoʻemi ʻia i 14.8 mm ka laulā, me ka noʻonoʻo ʻana i nā anana anatomical o ka heluna Kina, a hāʻawi i ka mea hoʻohana i kahi hoʻomaʻamaʻa intraoperative hou aku o ka hui hook, e ʻae ai i ka mālama ʻana i ka hui hook e koho ʻia e like me ke kūlana maoli o ka mea maʻi, ʻoiai e hōʻoia ana i ka paʻa mua a me ka hui lōʻihi.
ʻO ka hematoma epidural spinal postoperative
ʻO ka spinal epidural hematoma (SEH) he pilikia koʻikoʻi a koʻikoʻi ma hope o ka hele ʻana o ka cervical cervical, me kahi maʻi ma kahi o 0.1% a 0.2%.SEH i loko o ka plexus venous waiwai o ka epidural, kahi e alakaʻi ai i ka hōʻino ʻana o ka spinal cord inā ʻaʻole mālama ʻia ka hana hematoma i ka manawa. Hiki ke kōkua i ka hoʻihoʻi ʻana i ka hana neurological ma hope o ka hōʻoia ʻana o SEH.
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Hoʻolālā SEH postoperative o ACCF
Hiki ke loaʻa nā hematoma epidural spinal ma hope o ka ACDF a me ka ACCF, me ka ACCF he ʻoi aku ka nui o ka maʻi hematomas ma muli o ka ʻeha nui a me nā ʻili o ka iwi oozing; akā naʻe, ʻoi aku ka nui o ka leo holoʻokoʻa o ke kaʻina hana ACDF, me ka nui o nā SEH e puka mai ana.
Pono e hoʻomau ka pale ʻana i ka SEH ma hope o ka hoʻokokoke ʻana o ka cervical i ka wā perioperative:
A. Pono e hoʻopau ʻia ka hoʻokolokolo mua ʻana, a pono e nīnau ʻia inā he mau maʻi coagulation paha, a inā he moʻolelo o ka puhi ʻana a me ka inu ʻawaʻawa lōʻihi; inā aia kekahi poʻe e lawe ana i nā lāʻau anticoagulant, pono lākou e hoʻōki i ka lawe ʻana iā lākou no hoʻokahi pule ma mua o ka hana;
B. ʻO ka hemostasis intraoperative holoʻokoʻa, hemostasis piha ʻole me ka pahi electrocoagulation hiki ke alakaʻi i ke koko hou, pono e hoʻohana i nā forceps electrocoagulation bipolar; i ke kaʻina hana o ke kino vertebral subtotal resection, pono e hoʻopili ʻia ka ʻili iwi e pale i ka nui o ke kahe koko mai ka ʻili o ka iwi; ka hoʻohana ʻana i nā lāʻau hemostatic, e like me ka tranexamic acid injection, etc., i mea e hōʻemi ai i ke koko intraoperative; ʻaʻole pono eʻimi i ka hoʻopau pihaʻana o ka ligament longitudinal hope o ka māhele i hanaʻia, aʻo ka mālamaʻana i kahi liʻiliʻi liʻiliʻi o ka ligament longitudinal hope ma nāʻaoʻaoʻelua hiki ke hoʻokō i ka hopena o ka decompression; ʻo ka waiho ʻana o ka prosthesis pono e waiho i kahi ākea ma ka ʻaoʻao ʻākau a hema. I ka wā e kau ai i ka prosthesis, pono e waiho ʻia ka nui ma ka ʻaoʻao hema a me ka ʻaoʻao ʻākau i hiki ai i ke koko epidural ke kahe i mua o ka vertebrae a hoʻokuʻu ʻia ma o ka paipu hoʻoheheʻe ʻino;
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C. Ma hope o ka hana, e nānā pono i nā hōʻailona koʻikoʻi; e mālama pono i ka wai hoʻokahe; e hoʻohana pono i nā lāʻau anticoagulant e pale i ka thrombosis; e nānā pono i ka hana o ka ʻōnaehana nerve; inā loaʻa kekahi mea ʻino, e hoʻoponopono i ka manawa.
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Hoʻolālā ʻia e hoʻokō i nā ana anatomical aupuni
1. Hāʻawi i kahi hopena lapaʻau pilikino no ka hoʻokele ʻana i ka hui vertebral hooked.
2. E ho'ēmi i ka manawa o ke kino vertebral subsidence
3. E ho'ēmi i ka pilikia o ka spinal epidural hematoma
ʻO ka hoʻolālā ʻokoʻa kihi ʻokoʻa no ka hana maʻalahi
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ʻO nā wili me kahi kihi koʻi coronal o -1.5°11.5° a me kahi kihi koʻi cephalad o 36°44° no ka maʻalahi o ka hoʻokomo ʻana i nā kui intraoperative.
ʻAʻole pono e mālama i kahi keu no ka hoʻokomo ʻana i ka screw, hoʻemi ʻia ka liʻiliʻi liʻiliʻi mai 2.5cm a ma kahi o 2.0cm.
ʻOi aku ka maʻalahi i ka manaʻo o ka hana endoscopic spinal, ʻike iā Endo-ACDF.
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E pili ana iā CZMEDITECH
ʻO Cervical Peek Cage (2 a i ʻole 4 Locking Screws) he mau hoʻonā orthopedic pololei i hoʻomohala ʻia e Hoʻokumu ʻia ʻo CZMEDITECH i ka decompression discectomy cervical anterior a me ka hui ʻana o ka implant a alakaʻi ʻia e ka ʻike honua, i hoʻolaʻa ʻia i ka hāʻawi ʻana i nā hopena lapaʻau kūpono, kūpono a me ke kumu kūʻai no nā poʻe maʻi me nā haʻihaʻi paʻakikī a puni ka honua.
Anterior cervical discectomy with decompression and implant fusion (ACDF) is one of the most commonly surgical method 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 stabilization, high fusion rate, restoration of normal anterior convexity, and the absence of external postoperative fixation. ka ale ʻana, ka degeneration o nā ʻāpana pili, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, hematoma, maʻi, a me intervertebral implant subsidence etc. ʻO ka nui o ka hopena o nā pilikia postoperative ma kahi o 8%.
