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Anterior cervical discectomy with decompression and implant fusion (ACDF) yog ib qho kev phais feem ntau siv rau kev kho tus txha caj qaum-hom thiab paj hlwb-hom cervical spondylosis, cervical spine trauma thiab lwm yam kab mob, thiab nws muaj qhov zoo ntawm qhov pib fusion stabilisation, zoo li qub, thiab kev ua kom zoo dua qub. qhov tsis muaj kev kho sab nraud, thiab lwm yam. Cov teeb meem tom qab kev phais xws li nyuaj rau nqos, degeneration ntawm cov ntu uas nyob ib sab, laryngeal reentrant paj hlwb tuag tes tuag taw, cerebrospinal kua to, haematoma, kis kab mob, thiab intervertebral implant subsidence thiab lwm yam. Tag nrho cov xwm txheej ntawm postoperative yog 8%.
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Nyob rau hauv teb rau cov teeb meem saum toj no, lub zej zog kev kawm yog tas li ua hauj lwm rau kev txhim kho kev txawj ntse, lub tswv yim breakthroughs, thiab prosthesis optimisation. Tus kheej-stabilizing ncauj tsev menyuam nqaj qaum fusion ntaus ntawv (zero-trace), uas yog tag nrho nyob rau hauv lub intervertebral qhov chaw thiab zoo txo qhov kev pheej hmoo ntawm postoperative dysphagia thiab nyob ib sab ntu degeneration, tau txais dav dav.
Cov teeb meem postoperative cuam tshuam nrog prostheses tau tham hauv qab no ——
1.Kev tsis sib haum xeeb txog seb puas yuav rov kho qhov sib koom ua ke vertebral
Fig. 1 Schematic daim duab ntawm cov qauv ntawm cov conotruncus, vertebral artery, thiab qaum qaum thiab cov paj hlwb.
a. Kev sib raug zoo ntawm articular eminence ntawm concha thiab vertebral hlab ntsha.
b. Hauv phau ntawv, qhov nruab nrab ntawm ntug ntawm articular eminence raug tshem tawm, thiab cov ntug sab nraud yog khaws cia kom tsim nyog kom tsis txhob muaj kev puas tsuaj rau cov hlab ntsha vertebral.
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Daim duab 2 Schematic daim duab ntawm cov hlab ntsha hauv paus compression thiab decompression los ntawm kev nthuav tawm cov hyperplastic conical pob qij txha.
a. Cov pob txha loj hlob thiab tus txha caj qaum degeneration ntawm cov pob qij txha conical txo qhov ntu ntu ntawm intervertebral foramina, yog li compressing cov paj hlwb.
b. Intervertebral fusion ntaus ntawv / cog tuaj yeem qhib qhov chaw intervertebral kom nthuav dav thaj tsam ntawm intervertebral foramen thiab tiv tauj cov hlab ntsha hauv paus compression, thiab tib lub sijhawm, kho qhov ruaj khov ntawm tus txha nraub qaum.
Qhov tsim nyog ntawm anterior cervical spine phais kom tshem tawm qhov sib txuas vertebral sib koom ua ke yog cov pob txha ntawm kev sib cav txij thaum pib ntawm cov txheej txheem.
Thawj qhov kev piav qhia ntawm anterior cervical decompression thiab implant fusion nrog kev kho sab hauv yog muab los ntawm Robinson thiab Smith hauv 1955 uas nws tau piav qhia txog cov txheej txheem tsis tas yuav tsum tau tshem tawm ntawm leptokyphotic leeg osteophyte. Cloward, lwm tus tsim ntawm ACDF, hais tias txhua qhov compression yuav tsum tau muab tshem tawm, thiab qhov kev tshem tawm ncaj qha ntawm hyperplastic leptokyphosis yog qhov tseem ceeb rau kev decompression, thaum Robinson teb tias leptokyphosis tuaj yeem kho tau raws li kev ruaj ntseg ntawm tus txha nraub qaum tau tsim thiab raws li qhov txawv txav tsis zoo ntawm cov tshuab ua kom ploj mus, thiab cov kev tsis sib haum xeeb no tau xav txog qhov tsim ntawm leptokyphosis.
Cov preservationists sib cav hais tias qhov sib txuas sib txuas txhawb nqa 48% mus rau 60% ntawm kev ruaj ntseg ntawm txhua ntu thiab muab kev ruaj ntseg zoo tshaj plaws nyob rau hauv lub posterior nam ntawm lub ncauj tsev menyuam nqaj qaum, thiab tus qauv ntawm lub ncauj tsev menyuam foraminotomy decompression decompresses lub posterior nam ntawm tus nuv sib koom ua ke thiab lub anterior nam ntawm qhov sib koom ua ke ntawm qhov tseeb, qhov tseeb ntawm qhov sib koom ua ke yog qhov tseeb. tshem tawm, thiab instability nrog rau kev hloov chaw ntawm qhov chaw cog khoom txo qhov kev vam meej ntawm fusion.
Yog tias qhov sib npaug ntawm cov txiaj ntsig kev kho mob tuaj yeem ua tiav yam tsis muaj kev txiav tawm ntawm qhov sib txuas vertebral sib koom ua ke, kev khaws cia ntawm qhov sib txuas vertebral sib koom ua ke tuaj yeem muab qhov tsim nyog tshaj plaws rau kev sib tw ntau dua. Tsis tas li ntawd, kev khaws cia ntawm qhov sib txuas vertebral sib koom ua ke pab txo cov kev pheej hmoo ntawm postoperative vertebral subluxation, thiab nws tau raug sau tseg tias thaum thaj tsam ntawm tus nuv vertebral sib koom ua ke yog resected los ntawm ntau dua 38%, tus nqi ntawm interbody fusion subluxation yuav nce ntau.
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Raws li lub tsev kawm resection ntawm kev xav, anatomically, cov phab ntsa tom qab ntawm leptospondylar sib koom ua ke yog cov phab ntsa ntawm cov hlab ntsha hauv paus kwj dej, thiab cov pob txha residue los ntawm leptospondylar sib koom ua ke hyperplasia tuaj yeem ua rau intervertebral foraminal stenosis.
Hauv kev xyaum kho mob tam sim no, decompression los ntawm kev txiav tawm ntawm leptokyphosis tseem tawm tswv yim rau cov neeg mob uas muaj kev sib koom ua ke ntawm leptokyphotic sib koom ua ke hyperplasia, txhawm rau txo qis cov hlab ntsha lossis cov hlab ntsha vertebral sai li sai tau.
Zuag qhia tag nrho, kev tsis sib haum xeeb yeej ib txwm muaj, tab sis kev xaiv ntawm kev khaws cia, ib feem khaws cia, lossis tshem tawm tag nrho cov nuv spondylolisthesis raws li tus neeg mob tus mob tau dhau los ua kev pom zoo hauv ntau yam kev kho mob. Txawm li cas los xij, txoj kev kho tus kheej ntawm tus kheej, txawm li cas los xij, muab qhov xav tau siab ntawm qhov loj ntawm prosthesis.
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Cov kev xoom-txiav ib qho ntawm kev ua lag luam raug txwv los ntawm qhov yuav tsum tau muab ntsia hlau rau hauv 4 lub taub hau rau kev xauv, thiab lawv qhov dav yuav tsum yog 17.5 hli, uas yog qhov loj me me rau qee lub teb chaws, thiab feem ntau xav tau ib feem ntawm qhov sib txuas sib txuas rau fusion implantation hauv qhov chaw intervertebral.
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SAGI 2-nail locking zero incision tau raug txo mus rau 14.8 mm dav, suav nrog qhov ntev ntawm anatomical ntawm Suav pej xeem, thiab muab tus neeg teb xov tooj nrog kev kho tus kheej ntau dua ntawm kev sib koom tes sib txuas, tso cai rau kev kho mob ntawm tus nuv sib koom ua ke los xaiv raws li tus neeg mob qhov xwm txheej, thaum ua kom muaj kev ruaj ntseg thiab lub sij hawm ntev.
Postoperative spinal epidural hematoma
Spinal epidural hematoma (SEH) yog ib qho teeb meem uas tsis tshua muaj thiab loj heev tom qab lub ncauj tsev menyuam txoj hauv kev, nrog rau qhov tshwm sim ntawm 0.1% mus rau 0.2%. Kev phais mob xwm txheej ceev tom qab kuaj pom ntawm SEH tuaj yeem pab rov qab ua haujlwm ntawm cov hlab ntsha.
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Postoperative SEH schematic ntawm ACCF
Spinal epidural haematomas muaj peev xwm ua tau tom qab ob qho tib si ACDF thiab ACCF, nrog ACCF muaj kev pheej hmoo siab ntawm hematomas vim kev raug mob ntau dua thiab ntau dua oozing pob txha; Txawm li cas los xij, tag nrho cov ntim ntawm ACDF txheej txheem yog ntau dua, nrog rau ntau dua ntawm SEHs tshwm sim.
Kev tiv thaiv ntawm SEH tom qab anterior cervical mus kom ze yuav tsum txuas ntxiv mus rau lub sijhawm perioperative:
A. Kev kuaj xyuas ua ntej yuav tsum ua kom tiav, thiab cov lus nug ntxaws yuav tsum tau ua kom paub seb puas muaj cov kab mob coagulation, thiab seb puas muaj keeb kwm ntawm kev haus luam yeeb ntev ntev thiab haus cawv; yog tias muaj cov neeg noj tshuaj anticoagulant, lawv yuav tsum tsis txhob noj lawv rau ib lub lis piam ua ntej kev ua haujlwm;
B. Tag nrho intraoperative haemostasis, tsis tiav haemostasis los ntawm electrocoagulation riam yuav ua rau cov los ntshav tshiab, nws yog pom zoo kom siv bipolar electrocoagulation forceps; nyob rau hauv tus txheej txheem ntawm vertebral lub cev subtotal resection, pob txha siv quav ciab yuav tsum tau thov kom tsis txhob muaj ntshav ntau dhau los ntawm cov pob txha nto; daim ntawv thov ntawm cov tshuaj hemostatic, xws li tranexamic acid txhaj, thiab lwm yam, thiaj li yuav txo tau cov ntshav intraoperative; Nws tsis yog qhov tsim nyog los nrhiav kev ua kom tiav ntawm qhov kev txiav txim siab ntawm lub sijhawm ntev ntawm lub sijhawm ua haujlwm, thiab kev khaws cia ntawm qhov me me ntawm cov ligament posterior longitudinal ligament ntawm ob sab kuj tuaj yeem ua tiav cov txiaj ntsig ntawm decompression; qhov kev tso kawm ntawm prosthesis yuav tsum tso qhov chaw txaus ntawm sab xis thiab sab laug. Thaum muab cov prosthesis, qhov chaw txaus yuav tsum tau muab tso rau ntawm sab laug thiab sab xis kom cov ntshav epidural tuaj yeem ntws mus rau pem hauv ntej ntawm lub vertebrae thiab raug tso tawm los ntawm qhov tsis zoo ntawm lub raj xa dej;
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C. Tom qab ua haujlwm, ua tib zoo saib cov cim tseem ceeb; khaws cov kua dej kom du; siv cov tshuaj anticoagulant tsim nyog kom tsis txhob muaj thrombosis; ua tib zoo saib xyuas kev ua haujlwm ntawm lub paj hlwb; yog tias muaj qhov txawv txav, nrog rau lub sijhawm.
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Tsim kom tau raws li lub teb chaws anatomical qhov ntev
1. Muab kev kho mob tus kheej rau kev tswj hwm ntawm qhov sib koom ua ke vertebral.
2. Txo txoj hauv kev ntawm lub cev vertebral
3. Txo qhov kev pheej hmoo ntawm tus txha caj qaum epidural hematoma
Variable angle screw tsim rau kev ua haujlwm yooj yim
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Screws nrog lub coronal viav vias lub kaum sab xis ntawm -1.5 ° 11.5 ° thiab cephalad viav vias lub kaum sab xis ntawm 36 ° 44 ° kom yooj yim intraoperative ntsia thawv tso.
Tsis tas yuav tsum tau tshwj tseg qhov chaw ntxiv rau cov ntsia hlau ntxig, qhov tsawg kawg nkaus yog txo los ntawm 2.5cm mus txog 2.0cm.
Ntau yoog tau rau lub tswv yim ntawm kev ua haujlwm ntawm tus txha caj qaum endoscopic, paub txog Endo-ACDF.
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Hais txog CZMEDITECH
Cervical Peek Cage (2 lossis 4 Locking Screws) yog cov kev daws teeb meem orthopedic ua tib zoo tsim los ntawm CZMEDITECH yog lub hauv paus rau anterior cervical discectomy decompression thiab implant fusion thiab tsav los ntawm lub zeem muag thoob ntiaj teb, mob siab rau muab cov kev kho mob zoo, yooj yim thiab raug nqi zoo rau cov neeg mob uas muaj kev puas tsuaj ntau thoob ntiaj teb.
Anterior cervical discectomy with decompression and implant fusion (ACDF) yog ib qho kev phais feem ntau siv rau kev kho tus txha caj qaum-hom thiab paj hlwb-hom cervical spondylosis, cervical spine trauma thiab lwm yam kab mob, thiab nws muaj qhov zoo ntawm qhov pib fusion stabilisation, zoo li qub, thiab kev ua kom zoo dua qub. qhov tsis muaj kev kho sab nraud, thiab lwm yam. Cov teeb meem tom qab kev phais xws li nyuaj rau nqos, degeneration ntawm cov ntu uas nyob ib sab, laryngeal reentrant paj hlwb tuag tes tuag taw, cerebrospinal kua to, haematoma, kis kab mob, thiab intervertebral implant subsidence thiab lwm yam. Tag nrho cov xwm txheej ntawm postoperative yog 8%.
