Sikulufu za pedicle ziyingizibwa zitya?

Enkola y’okuteeka sikulaapu ya pedicle

1. Ekifo we bayingira: ensingo, ekifuba n’ekiwato bya njawulo;

2. Kwata enkoona y’ennyonyi empanvu (TSA) ne enkoona y’ennyonyi eya sagittal (SSA) ey’okuyingira kwa sikulaapu: Enkoona ya TSA esobola okupimibwa okuva mu firimu ya CT. SSA erina enkolagana ezimu n’embeera y’omubiri, era esobola okufugibwa n’omukono gwa C mu kiseera ky’okulongoosebwa.

3. Obuziba: Obuwanvu bwa sikulaapu butuuka ku bitundu 80% ku buwanvu bwa pedicle axis okufuna amaanyi agamala aga biomechanical, era kyangu okuyingira mu ggumba ly’omubiri (cortical bone) n’okwonoona emisuwa singa eba mpanvu nnyo.

4. Obuwanvu: okuva ku kifo we bateeka empiso okutuuka ku bitundu 83% ku buwanvu bwonna obw’ekitundu ky’omubiri eky’omu maaso eky’omubiri gw’omugongo.

Omugongo gw’omumwa gwa nnabaana

Enkola y’okuyingiza sikulaapu y’omumwa gwa nnabaana

Enkola y’okuyingiza empiso

Mu kiseera kino, enkola enkulu ez’okuyingiza empiso ze zino: Enkola ya Abumi, enkola y’okuteeka obubonero bw’omubiri (anatomical landmark positioning method), enkola y’okuteeka ebifaananyi mu kifo ky’ebifaananyi nga tuyambibwako kompyuta, n’ebirala.

ekifo ekiyingira mu mugongo gw’omumwa gwa nnabaana

• Ku nkulungo ya mm 5 wansi wa layini empanvu ey’empenda eya waggulu eya lamina y’ekisiki kya C2 ne mm 7 ebweru w’empenda ey’omu makkati ey’omukutu gw’omugongo.

• C3-C6 Entabaganya ya layini eya waggulu eya wakati 1/4 eyeesimbye ne layini ey’ebweru eya wakati 1/4 eyeesimbye emabega wa bulooka y’ebbali.

• C7 Entabaganya ya layini eya wakati eyeesimbye eya bulooka ey’ebbali ne layini eya waggulu eya wakati eya 1/4 empanvu eri waggulu.

  
  

Enkoona y’okusikula omugongo gw’omumwa gwa nnabaana

• C2 okuserengeta 20-25° okuserengeta 10-15°

• C3-C6 eserengeta 40-45°, ennyonyi empanvu ekwatagana n’enkomerero eza waggulu n’eza wansi

• C7 inclination 30-40°, ennyonyi empanvu ekwatagana n’enkomerero eza waggulu n’eza wansi

  
  

Sikulufu y’omugongo gw’omumwa gwa nnabaana

• C1～C5 yeetaaga sikulaapu ezirina obuwanvu bwa mm 3.5 ate obuziba bwa mm 20

Singa obugulumivu bw’ekisenge eky’emabega ekya atlas buba wansi wa mm 4, bukyusibwa ne bufuuka sikulaapu y’amasasi ag’ebbali.

Singa obugulumivu oba obugazi bwa pedicle y’ekisiki buba wansi wa mm 5, kirungi okukyusa okudda ku lateral mass screw fixation.

Okuteeka sikulaapu y’amasasi ag’ebbali mu nnabaana

Enkola ya Magerl : Ekifo ekiyingira mu sikulaapu kisangibwa mm 1-2 waggulu w’ensonga wakati w’ekisenge eky’emabega eky’ekizito eky’ebbali; obulagirizi bw’okuyingira kwa sikulaapu buserengese 25-30° mu mabbali, ate omutwe guserengese 30° (nga gukwatagana n’oludda lw’ennyindo olw’okungulu), era ekitundu ekiyitibwa contralateral cortex kisimibwa; okupima obuziba Oluvannyuma lw’okusikula mu sikulaapu z’amagumba g’omubiri aga mm 3.5.

Enkola ya Roy-Camille : ekifo ekiyingira mu sikulaapu kisangibwa wakati w’emabega w’ekizito eky’ebbali; obulagirizi bw’okuyingira kwa sikulaapu buli 10° mu bbali, ekitundu eky’emabega ekyesimbye kisimibwa, ate ekitundu eky’emabega ekisimiddwa; oluvannyuma lw’okuwulikika, sikulaapu ya mm 3.5 ey’amagumba g’omubiri (cortical bone screw) eyingizibwamu.

Enkola ya Anderson : Ekifo ekiyingira mu sikulaapu kisangibwa mm 1 munda mu makkati g’ekizito eky’ebbali, obulagirizi bw’okuyingira kwa sikulaapu buli 20° ku mabbali, ate omutwe guserengesebwa 20° okutuuka ku 30° okusima ekinnya, era ekitundu ekiyitibwa contralateral cortex kisimibwa.

Mu bufunze obumanyirivu

(1) Okufaayo okw’enjawulo kulina okussibwa ku bukuumi bw’okuteekebwamu sikulaapu. Omusawo alongoosa alina okulonda enkola entuufu okusinziira ku bukugu mu nkola ya cervical anatomy ne pedicle screw technique.

(2) Okunyweza sikulaapu y’amasasi ag’ebbali mu kitundu kya C3-C6 kwangu era kwa bukuumi okusinga okunyweza sikulaapu ya pedicle.

(3) Ekintu kino tekisobola kuyingira mu bbugwe ow’ebweru ow’ekikuta, bwe kitaba ekyo kijja kwonoona obusimu n’emisuwa ebiriraanyewo.

(4) Enkoona y’okuyingiza sikulaapu erina okwawukana n’enkoona y’ekisenge ky’omugongo.

(5) Okuyingira mu ggumba ly’omugongo mu maaso g’omubiri gw’omugongo kulina okwewalibwa.

(6) Intraoperative fluoroscopy esobola okuzuula obulungi omubiri gw’omugongo n’ekifo ekiri wakati w’omugongo, n’okuteeka mu butuufu sikulaapu okuziyiza okusikula mu kifo ekiri wakati w’omugongo n’omukutu gw’omugongo.

Eky’omu kifuba

Ekifo we bayingira empiso:

1. Margel ne Roy Camille baatwala okutabaganya kwa layini empanvu ey’ensonga ey’omu makkati ey’enkola ey’okusalasala ne layini eyeesimbye ey’empenda ey’ebweru ey’enkola y’ennyindo ey’okungulu ng’ekifo eky’okuyingira.

2. Ebraheim yateesa nti wakati w’ekikuta kya T1-T2 kisangibwa mm 7-8 munda mu bbali w’ebweru w’enkola y’ennyindo ey’okungulu, ne mm 3-4 ku layini ey’omu makkati ey’enkola ey’okusala. ~8mm.

3. Kuba layini eyeesimbye mm 3 ebweru w’ensonga wakati w’ekiyungo ekya wansi, era okukuba layini eyeesimbye okuva ku kitundu eky’okungulu 1/3 eky’omusingi gw’enkola ey’okusala, era okutabaganya kwa layini zombi kwe kuyingira omusumaali.

4. Ku nkulungo ya layini ey’omu makkati ey’ekisiki ekiwanvu eky’enkola y’ennyindo eya wansi ne layini eyeesimbye ey’ensonga ey’omu makkati ey’ekikolo ky’enkola ey’okusalako, mm 1 wansi w’olunyiriri;

5. Mu mbeera enzibu, kya bulabe okuggya ekitundu ku lamina n’okussaamu sikulaapu za pedicle nga olaba butereevu.

Enkoona y’okuyingiza omugongo mu kifuba

Sagittal plane : Okukendeera mu kuserengeta kwa pedicle okuva ku T1 okutuuka ku T12. T1: 25° nga bwe kiri; T2: 20° nga bwe kiri; T3: 15° nga bwe kiri; T4-9: 10°, era nga bwe kiri; T10: 5°, era nga 5°; T11-12: 0°.

Sikulufu z’omugongo ogw’omu kifuba ogw’okungulu zirina okuba n’enkoona y’okuserengeta eya 10-20° n’ennyonyi ya sagittal, ate sikulaapu z’omugongo ogw’omu kifuba ogwa wakati n’ogwa wansi zirina okuba n’enkoona ey’okuserengeta eya 0-10° n’ennyonyi ya sagittal. Ebraheim yateesa nti T1 ne T2 pedicle screws zirina okuba 30-40° inclination ne sagittal plane, T3-T11 zirina okuba 20-25°, ate T12 zirina okuba 10°.

Ennyonyi empanvu : erina okuba nga ekwatagana n’enkomerero eza waggulu n’eza wansi.

Sikulufu y’okulonda omugongo gw’ekifuba

• T1～T5 yeetaaga obuwanvu bwa sikulaapu 3.5～4.0mm

• T6～T10 yeetaaga mm 4.0—5.0

• T11, T12 zeetaaga mm 5.5

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Ku bantu abakulu, obuwanvu bwa sikulaapu y’ekifuba (thoracic pedicle screw) buba wansi wa mm 5, era waliwo akabi k’okumenya sikulaapu. Mu mbeera nnyingi ez’omugongo ogw’omu makkati g’ekifuba, sikulaapu ezisukka mm 5 mu buwanvu teziyinza kuteekebwawo, ekiyinza okwanguyirwa okuvaako okukutuka kw’ekifuba.

Abamanyi abamu bakozesa enkola y’okuteekebwa mu bbali (lateral placement of the pedicle), ekigonjoola ekizibu kino obulungi ennyo. Nywa ku nsonga y’enkola ey’okusalako okuyingira mu ppini, era layini ey’omu makkati ey’enkola ey’okusalasala eba ya bbanga. Sooka okyuse ekituli ekitono, era obulagirizi bw’ekiwujjo busalagana n’olukonko olw’ebbali olw’ekiyungo kya facet eky’omugongo. Enkoona n’ennyonyi ya sagittal eri diguli 25-40, era diguli yeeyongera mpolampola okuva ku T12 okudda waggulu.

Sikulufu eyingiziddwa ejja kuyita mu nkola ya transverse, ekitundu ky’enkola ya costotransverse, ekiyungo kya costovertebral, ne bbugwe ow’ebbali ow’omubiri gw’omugongo. Okuva ekkubo ly’okuyingiza sikulaapu bwe liri ebweru w’ekiyungo kya facet, tekisoboka kuyingira mu mwala gw’omugongo, ogusinga okuba ogw’obukuumi. Okugatta ku ekyo, okweyongera kw’enkoona y’okuserengeta kifuula sikulaapu empanvu. , enzito, amaanyi g’okunyweza geeyongera, ebanga ly’enkoona y’okuteekebwamu linene, sikulaapu zisobola okuteekebwa mu layini, era okukuŋŋaanya kirungi nnyo.

Omugongo gw’omugongo

Ekifo ekiyingira mu lumbar

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3. Mu mbeera enzibu, kya bulabe okuggya ekitundu ku lamina n’okussaamu sikulaapu za pedicle nga olaba butereevu.

Enkoona ya sikulaapu y’omugongo

• Sagittal plane angle : L1-L3 zirina diguli 5-10 ez’okukyusakyusa, L4-L5 zirina diguli 10-15 ez’okukyusakyusa.

• Enkoona y’ennyonyi eyesimbye : L1-4: ekwatagana n’ekipande ky’enkomerero; L5: Diguli 10 ez’okuserengeta wansi (L5 omubiri gw’omugongo nga gudda emabega).

  
  

Sikulufu y’okulonda omugongo gw’omugongo

• L1～L5 beetaaga sikulaapu diameter 6.5mm, 40-45mml sikulaapu

  
  

Okwegendereza mu kulongoosa

1. Nga tonnalongoosebwa, wateekwa okubaawo okulaba obulungi omugongo gw’omugongo mu maaso n’ebbali. Okulaba okw’omu maaso kulaga ekifo kya sikulaapu mu kkubo ery’okwesimbye, ate okutunula okw’ebbali kuyinza okulaga ekifo kya sikulaapu mu kifo ekyesimbye.

2. Ekifo ekiyingira kirina okuba nga kituufu era nga kigaziyiziddwa mu ngeri esaanidde, era eggumba ly’omubiri (cortical bone) ku kifo we lisimba ennanga liyinza okuggyibwawo nga liggulwawo kwa piramidi ey’enjuyi essatu oba rongeur.

3. Oluvannyuma lw’okuzuula obulagirizi obw’awamu, kozesa empalirizo esaanira okuggulawo ekiyungo n’obwegendereza. Ekikebera eky’ensonga ezitali nnungi tekirina kusanga kuziyiza kweyoleka mu kiseera ky’okuyingiza empiso. Tewalina kubaawo kuwulira kwa 'kulemererwa' oba okuziyiza okw'amangu. Obuziyiza bwe busangibwa mu mm 5 ~ 15 ezisooka, bulina okuba mu budde. Teekateeka ekifo empiso w’eyingira n’enkoona. Bw’osanga okuziyiza okw’amaanyi, kirungi okusooka okufuluma n’oddamu okulonda obulagirizi bw’ogenda okuyingira. Kakasa nti ogoberera obulagirizi bwa pedicle. Munda mu pedicle ggumba lya cancellous ate ebweru ggumba lya cortical bone, eriyinza okulung’amibwa mu ngeri ey’otoma, kasita ekifo we bayingira kiba kituufu era nga kigaziyiziddwa bulungi; Serengeta 10-15° ku layini eya wakati, weetegereze ennyonyi ekwatagana n’empenda eya waggulu ey’omubiri gw’omugongo, era kwata obuziba bwa sentimita nga 3. Owulira kikulu.

4. Kikulu nnyo okukozesa pedicle probe okunoonyereza ku bisenge ebina naddala eby’omunda, ebya wansi n’ebya wansi.

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6. Kirungi okufuluma ebweru okusinga munda, okulinnya so si kukka; okukyusakyusa kye kintu ekikulu, ate mu maaso kye kigatta; nga bw’ogenda mu maaso n’okunoonyereza, yimirira ng’olaba nnyo, tereeza mu budde, kozesa amaanyi g’engalo zokka, tokyusakyusa n’amaanyi.

7. Dyaamu ya sikulaapu tesaana kusukka bitundu 83% ku dayamita y’ekitundu eky’ebweru eky’ekikuta.

Engeri y'okugulamu ebyuma ebiteekebwa mu magumba n'ebikozesebwa mu kulongoosa amagumba?

A CZMEDITECH , tulina product line enzijuvu ennyo ey'okulongoosa amagumba implants n'ebikozesebwa ebikwatagana, ebintu omuli okuteekebwamu omugongo, emisumaali egy’omu lubuto (intramedullary nails)., essuuka y’okulumwa, ebbakuli y’okusiba, cranial-maxillofacial mu maaso, okuzimba omubiri (prosthesis)., ebikozesebwa eby’amasannyalaze, ebinyweza eby’ebweru, okukebera ebinywa, okulabirira ebisolo n’ebikozesebwa byabwe ebibiwagira.

Okugatta ku ekyo, twewaddeyo okugenda mu maaso n’okukola ebintu ebipya n’okugaziya layini z’ebintu, tusobole okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde bangi, era n’okufuula kkampuni yaffe okuvuganya ennyo mu mulimu gwonna ogw’ensi yonna ogw’okussaamu amagumba n’ebikozesebwa.

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