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Anterior cervical discectomy with decompression and implant fusion (ACDF) ʻo ia kekahi o nā ʻano hana maʻamau i hoʻohana ʻia no ka mālama ʻana i ka spinal cord-type a me nerve root-type cervical spondylosis, cervical spine trauma a me nā maʻi ʻē aʻe, a loaʻa iā ia nā mea maikaʻi o ka stabilization mua, kiʻekiʻe fusion rate, hoʻihoʻi i ka convexity mua maʻamau, a me ka ʻole o ka hoʻoponopono ʻana i waho. ka ale ʻana, ka degeneration o nā ʻāpana pili, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, hematoma, maʻi, a me ka 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. ʻO ka mea hoʻohui ponoʻī cervical spine fusion (zero-trace), kahi i hoʻokipa piha ʻia i loko o ka intervertebral space a hoʻemi pono i ka hopena o ka postoperative dysphagia a me ka degeneration ʻāpana pili, ua ʻae nui ʻia.
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 i 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 aʻa, 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 hook he iwi paio ia mai ka hoʻomaka ʻana o ka ʻenehana.
ʻO ka wehewehe mua o ka decompression cervical anterior a me ka hoʻohui 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 i ka osteophyte hui leptokyphotic. 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 iwi kuamoʻo 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 ka paʻa 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 fusion 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 e hoʻokaʻawale ʻia 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, anatomical, ʻo ka paia hope o ka hui leptospondylar ka paia mua o ke aʻa aʻa aʻa, a ʻo ke koena iwi mai ka leptospondylar joint hyperplasia hiki ke alakaʻi i ka intervertebral foraminal stenosis.
I ka hoʻomaʻamaʻa lapaʻau o kēia manawa, ke kākoʻo mau nei ka decompression ma ka excision o ka leptokyphosis i nā poʻe maʻi me ka hoʻopaʻapaʻa koʻikoʻi o ka hyperplasia hui leptokyphotic, i mea e hoʻomaha ai i ke kaomi ʻana o ke aʻalolo a i ʻole ke aʻa vertebral i ka wā hiki.
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 ʻokiʻoki ʻole ma ka mākeke e ka pono e hoʻopaʻa ʻia i 4 screws no ka laka ʻana, 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 ana 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 hiki i 0.2%.SEH i loko o ka plexus venous waiwai o ka epidural, kahi e alakaʻi ai i ka hōʻino ʻana i ka spinal cord inā ʻaʻole mālama ʻia ka hana hematoma i ka manawa. Hiki ke kōkua i ka hoʻihoʻi ʻana o 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 i ʻoi aku ka nui o ka maʻi hematoma ma muli o ka ʻeha nui a me ka nui o nā ʻili o ka iwi; 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 hele ʻana o ka cervical cervical i ka wā perioperative:
A. Pono e hoʻopau ʻia ka nānā ʻana ma mua o ka hana 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 ke kau ʻana 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 abnormality, 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 ākea hou no ka hoʻokomo ʻana i ka screw, hoʻemi ʻia ka ʻoki liʻiliʻi mai 2.5cm a i kahi 2.0cm.
ʻOi aku ka maʻalahi i ka manaʻo o ka hana endoscopic spinal, ʻike iā Endo-ACDF.
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Ma kahi o CZMEDITECH
ʻO Cervical Peek Cage（2 a i ʻole 4 Wili laka ） he mau hoʻonā orthopedic pololei i hoʻomohala pono ʻia e CZMEDITECH i hoʻopaʻa ʻia i ka decompression discectomy cervical anterior a me ka hui implant a alakaʻi ʻia e ka ʻike honua, i hoʻolaʻa ʻia i ka hāʻawi ʻana i nā hopena lapaʻau kūpono, kūpono a me ka uku no nā poʻe maʻi me nā haʻihaʻi paʻakikī a puni ka honua.
Anterior cervical discectomy with decompression and implant fusion (ACDF) ʻo ia kekahi o nā ʻano hana maʻamau i hoʻohana ʻia no ka mālama ʻana i ka spinal cord-type a me nerve root-type cervical spondylosis, cervical spine trauma a me nā maʻi ʻē aʻe, a loaʻa iā ia nā mea maikaʻi o ka stabilization mua, kiʻekiʻe fusion rate, hoʻihoʻi i ka convexity mua maʻamau, a me ka ʻole o ka hoʻoponopono ʻana i waho. ka ale ʻana, ka degeneration o nā ʻāpana pili, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, hematoma, maʻi, a me ka intervertebral implant subsidence etc. ʻO ka nui o ka hopena o nā pilikia postoperative ma kahi o 8%.
