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Discectomy nke ihu cervical na decompression na implant fusion (ACDF) bụ otu n'ime ụzọ ịwa ahụ a na-ejikarị eme ihe maka ọgwụgwọ nke ọkpụkpụ azụ-ụdị na irighiri mgbọrọgwụ-ụdị cervical spondylosis, cervical spine trauma na ọrịa ndị ọzọ, na ọ nwere uru nke mmalite nkwụsi ike, ọnụ ọgụgụ dị elu nke mgbagwoju anya, mweghachi nke nkịtị, nkwụsị nke nkịtị na ihe ndị ọzọ. nsogbu postoperative dị ka ihe isi ike na ilo, degeneration nke n'akụkụ akụkụ, laryngeal reentrant akwara mkpọnwụ, cerebrospinal fluid leakage, hematoma, ọrịa, na intervertebral implant subsidence wdg. N'ozuzu omume nke postoperative mgbagwoju bụ banyere 8%.
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Na nzaghachi nye nsogbu ndị a dị n'elu, obodo agụmakwụkwọ na-arụ ọrụ mgbe niile na nkwalite teknụzụ, ihe nhụsianya echiche, na nkwalite prosthesis. Ngwa eji ejikọta cervical cervical na-ejide onwe ya (zero-trace), bụ nke a na-anabata nke ọma na oghere intervertebral ma na-ebelata ihe ize ndụ nke dysphagia postoperative na n'akụkụ akụkụ degeneration, anabatala nke ọma.
A na-atụle nsogbu ndị metụtara prostheses mgbe ịwachara ahụ n'okpuru --
1.Arụrịta ụka banyere ma ọ ga-emezigharị nkwonkwo vertebral kpara akpa
Fig. 1 Eserese atụmatụ nke nhazi nke conotruncus, akwara vertebral, na ọkpụkpụ azụ na mgbọrọgwụ akwara.
a. Mmekọrịta dị n'etiti amanence articular nke concha na akwara vertebral.
b. N'ime akwụkwọ ahụ, a na-ewepụ akụkụ etiti nke ihe ngosi nke articular, a na-echekwa akụkụ dị n'akụkụ nke ọma iji zere mmebi nke akwara vertebral.
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Fig. 2 Eserese atụmatụ nke mkpakọ mgbọrọgwụ akwara na mgbakasị ahụ site na ịgbasa nkwonkwo conical hyperplastic.
a. Ọkpụkpụ ọkpụkpụ na mmebi ọkpụkpụ azụ nke nkwonkwo conical na-ebelata mpaghara cross-section nke intervertebral foramina, si otú ahụ na-agbanye mgbọrọgwụ akwara.
b. Ngwa ngwaọrụ / ntinye nke intervertebral nwere ike imeghe oghere intervertebral iji mee ka mpaghara nke oghere intervertebral gbasaa ma kpọtụrụ mkpakọ mgbọrọgwụ mgbọrọgwụ akwara, na n'otu oge ahụ, na-emezi nkwụsi ike nke ọkpụkpụ azụ.
Mkpa ọ dị ịwa ahụ nke azụ cervical azụ iji wepụ nko vertebral nkwonkwo bụ ọkpụkpụ nke esemokwu kemgbe mmalite nke usoro ahụ.
Robinson na Smith nyere nkọwa mbụ nke nhụsianya cervical ihu na ntinye ntinye na ntinye nke ime n'ime ya bụ Robinson na Smith na 1955 bụ nke ọ kọwara usoro dị ka ọ dịghị achọ iwepụ leptokyphotic nkwonkwo osteophyte. Cloward, onye ọzọ guzobere ACDF, kwusiri ike na ekwesịrị iwepụ mkpakọ niile, yana na mwepụ nke hyperplastic leptokyphosis ozugbo dị mkpa maka ịda mbà n'obi, ebe Robinson zara na leptokyphosis nwere ike ịmaliteghachi dị ka nkwụsi ike nke ọkpụkpụ azụ na dị ka ihe ndị na-adịghị ahụkebe na-apụ n'anya, nakwa na a na-eche na nsogbu ndị a nwere njikọ na nhazi nke leptokyphosis.
Ndị na-echekwa nchekwa na-arụ ụka na nkwonkwo nko na-enye aka 48% na 60% nke nkwụsi ike nke akụkụ nke ọ bụla ma na-enye nkwụsi ike kachasị na akụkụ azụ nke spine cervical, na ọkọlọtọ cervical foraminotomy decompression decompresses na azụ akụkụ nke nko nkwonkwo na ihu ihu nke neuraxial ọwa mmiri na-ewepụsị nke ọma dị ka akụkụ nke neuraxial n'ezie na-wepụrụ na akụkụ nke ọma dị ka nke ọma dị ka akụkụ nke nkwụsi ike. Ntughari nke ọnọdụ ntinye na-ebelata ihe ịga nke ọma nke ngwakọta.
Ọ bụrụ na enwere ike nweta nsonaazụ ụlọ ọgwụ na-enweghị nhazi nke nkwonkwo nko vertebral, ichekwa nkwonkwo nko vertebral nwere ike na-enye usoro kachasị mma maka ọnụ ọgụgụ njikọ dị elu. Tụkwasị na nke ahụ, nchekwa nke nko vertebral nkwonkwo na-enyere aka belata ohere nke vertebral subluxation postoperative, na achọpụtara na mgbe mpaghara nke nko vertebral nkwonkwo na-agbaji karịa 38%, ọnụego nke interbody fusion subluxation ga-abawanye nke ukwuu.
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Dị ka ụlọ akwụkwọ echiche nke resection si kwuo, anatomically, mgbidi dị n'azụ nke nkwonkwo leptospondylar bụ mgbidi dị n'ihu nke akwara mgbọrọgwụ akwara, na ihe fọdụrụ n'ọkpụkpụ sitere na hyperplasia nkwonkwo leptospondylar nwere ike iduga intervertebral foraminal stenosis.
Na omume ụlọ ọgwụ ugbu a, a ka na-akwado mwepu site na mwepu nke leptokyphosis na ndị ọrịa nwere oke mkpakọ nke hyperplasia nkwonkwo leptokyphotic, iji belata mkpakọ nke akwara ma ọ bụ akwara vertebral ozugbo enwere ike.
N'ozuzu, esemokwu na-adị adị mgbe niile, ma nhọrọ nke ichekwa, ichekwa akụkụ, ma ọ bụ wepụ nko spondylolisthesis kpamkpam dịka ọnọdụ onye ọrịa ahụ aghọwo nkwenye na usoro ọgwụgwọ dị iche iche. Otú ọ dị, usoro ọgwụgwọ nke onwe onye na-etinye ihe dị elu na nha nke prosthesis.
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The nkịtị efu-cut traces na ahịa na-ejedebeghị na mkpa ịghasa na 4 kposara maka kpochidoro, na obosara ha kwesịrị ịbụ 17.5 mm, nke bụ a nnukwu size maka ụfọdụ mba, na-achọkarị akụkụ nke occlusion nke nko nkwonkwo maka fusion implantation na intervertebral ohere.
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SAGI 2-nail locking zero incision na-ebelata ka ọ bụrụ 14.8 mm n'obosara, na-eburu n'uche akụkụ ahụ nke ndị China, ma na-enye onye ọrụ ahụ ọgwụgwọ intraoperative ahaziri nkeonwe nke nkwonkwo nko, na-ekwe ka a họrọ ọgwụgwọ nke nkwonkwo nko dị ka ọnọdụ onye ọrịa siri dị, na-eme ka nkwụsi ike mbụ na ogologo oge.
hematoma spinal epidural hematoma mgbe arụ ọrụ gasịrị
Ọkpụkpụ epidural hematoma (SEH) bụ ihe mgbagwoju anya na-adịghị ahụkebe na mgbagwoju anya mgbe ihu ihu cervical, na-enwe ihe dị ka 0.1% ruo 0.2% SEH na-eme na venous plexus bara ụba nke epidural, nke ga-eduga n'ịrụ ọrụ ọkpụkpụ azụ siri ike ma ọ bụrụ na a naghị agwọta hematoma n'oge. Ịwa ahụ mberede mgbe nchọpụta nke SEH nwere ike inyere aka mgbake nke ọrụ akwara ozi.
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Atụmatụ SEH postoperative nke ACCF
Ọkpụkpụ heematomas nke spinal ga-ekwe omume mgbe ma ACDF na ACCF, ebe ACCF nwere nnukwu ihe ize ndụ nke hematoma n'ihi nnukwu trauma na ọkpụkpụ na-esiwanye ike; Otú ọ dị, ọnụ ọgụgụ zuru ezu nke usoro ACDF dị ukwuu, na ọnụ ọgụgụ dị elu nke SEH na-eme.
Mgbochi nke SEH mgbe ụzọ ihu cervical ihu ga-aga n'ihu n'ime oge niile:
A. Ekwesịrị imecha nyocha tupu ịwa ahụ, a ga-ajụkwa ajụjụ zuru oke maka ma enwere ọrịa coagulation ọ bụla, yana ma enwere akụkọ ihe mere eme nke ise siga ogologo oge na ịṅụ mmanya; ọ bụrụ na e nwere ndị na-aṅụ ọgwụ mgbochi ọbara, ha kwesịrị ịkwụsị ịṅụ ya otu izu tupu ịwa ahụ;
B. Hemostasis intraoperative nke ọma, hemostasis na-ezughị ezu site na mma electrocoagulation nwere ike iduga ọbara ọgbụgba ọhụrụ, a na-atụ aro ka ị jiri ike electrocoagulation bipolar; na usoro nke vertebral ahụ subtotal resection, ọkpụkpụ wax ka a ga-etinye n'ọrụ iji zere oke ọbara seepage si n'elu ọkpụkpụ; itinye ọgwụ hemostatic dị ka ịgba ọgwụ tranexamic acid, wdg, iji belata ọbara ọgbụgba n'ime ime; ọ dịghị mkpa ka a na-achọ maka nchịkọta zuru ezu nke ọkpụkpụ azụ ogologo oge nke akụkụ a na-arụ ọrụ, na ichekwa obere ihe nkedo ogologo oge n'akụkụ abụọ nwekwara ike nweta mmetụta nke nkwụsịtụ; ntinye nke prosthesis kwesịrị ịhapụ ohere zuru oke n'akụkụ aka nri na aka ekpe. Mgbe ị na-etinye prosthesis ahụ, a ga-ahapụ ohere zuru ezu n'akụkụ aka ekpe na aka nri ka ọbara ọgbụgba epidural wee na-asọba n'ihu vertebrae wee wepụ ya site na tube drainage na-adịghị mma;
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C. Mgbe arụchara ọrụ ahụ, lelee akara ngosi dị mkpa nke ọma; mee ka drainage ahụ dị nro; na-eji ọgwụ na-eme ihe na-eme ka ọ ghara ime ihe n'ụzọ ziri ezi iji zere thrombosis; nyochaa nke ọma ọrụ nke usoro ụjọ ahụ; ọ bụrụ na enwere ihe na-adịghị mma, dozie ya n'oge.
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Ezubere iji zute akụkụ anatomical nke mba
1. Na-enye ihe ngwọta ụlọ ọgwụ ahaziri iche maka njikwa nke nkwonkwo vertebral hooked.
2. Belata ohere nke vertebral ahu subsidered
3. Belata ihe ize ndụ nke hematoma spinal epidural hematoma
Ntugharị skru nke akụkụ dị iche iche maka ịrụ ọrụ dị mfe
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Kpọsara nwere akụkụ swing coronal nke -1.5°11.5° yana akụkụ cephalad swing nke 36°44° maka itinye ntu ntu ntu dị mfe.
Ọ dịghị mkpa idobe ohere ọzọ maka ntinye ịghasa, nke kacha nta na-ebelata site na 2.5cm ruo ihe dịka 2.0cm.
Enwere ike ime mgbanwe na echiche nke ọrụ endoscopic spinal, na-aghọta Endo-ACDF.
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Ihe gbasara CZMEDITECH
Cervical Peek Cage (2 ma ọ bụ 4 akpọchi screws) bụ ngwọta orthopedic ziri ezi nke ejiri nlezianya mepụta ya. CZMEDITECH gbadoro ụkwụ na mgbawa discectomy cervical na ntinye ntinye na nke ọhụụ zuru ụwa ọnụ na-eduzi, raara onwe ya nye inye ọgwụgwọ zuru oke nke ọma, dị mma na ọnụ ahịa maka ndị ọrịa nwere mgbaji gbajiri agbaji gburugburu ụwa.
Discectomy nke ihu cervical na decompression na implant fusion (ACDF) bụ otu n'ime ụzọ ịwa ahụ a na-ejikarị eme ihe maka ọgwụgwọ nke ọkpụkpụ azụ-ụdị na irighiri mgbọrọgwụ-ụdị cervical spondylosis, cervical spine trauma na ọrịa ndị ọzọ, na ọ nwere uru nke mmalite nkwụsi ike, ọnụ ọgụgụ dị elu nke mgbagwoju anya, mweghachi nke nkịtị, nkwụsị nke nkịtị na ihe ndị ọzọ. nsogbu postoperative dị ka ihe isi ike na ilo, degeneration nke n'akụkụ akụkụ, laryngeal reentrant akwara mkpọnwụ, cerebrospinal fluid leakage, hematoma, ọrịa, na intervertebral implant subsidence wdg. N'ozuzu omume nke postoperative mgbagwoju bụ banyere 8%.
