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Anterior cervical discectomy with decompression and implant fusion (ACDF) y’emu ku nkola z’okulongoosa ezisinga okukozesebwa mu kujjanjaba obulwadde bwa cervical spondylosis obw’ekika ky’omugongo n’ekika ky’ekikolo ky’obusimu, okulumwa omugongo gw’omumwa gwa nnabaana n’obuzibu obulala, era erina ebirungi eby’okutebenkera mu kusooka, omutindo gw’okuyungibwa ogw’amaanyi, okuzzaawo okuzimba okw’omu maaso okwa bulijjo, n’obutabaawo kwa bweru okunyweza, n’ebirala The ebizibu ebitera okubaawo oluvannyuma lw’okulongoosebwa ng’okukaluubirirwa okumira, okuvunda kw’ebitundu ebiriraanyewo, okusannyalala kw’obusimu obuddamu okuyingira mu nnyindo, okukulukuta kw’amazzi g’omu bwongo, okuzimba omusaayi, okukwatibwa yinfekisoni, n’okukka kw’ebintu ebiteekebwa mu mugongo n’ebirala Okutwalira awamu ebizibu ebiva mu kulongoosebwa biri nga 8%.
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Mu kwanukula ebizibu ebyo waggulu, abasomesa buli kiseera bakola ku nnongoosereza mu by’ekikugu, okumenyawo endowooza, n’okulongoosa enkola y’ekinnansi. Ekyuma ekigatta omugongo gw’omumwa gwa nnabaana ekyenyweza (zero-trace), ekiyingizibwa mu bujjuvu mu kifo ekiri wakati w’omugongo era nga kikendeeza bulungi ku bulabe bw’okulemererwa okulya oluvannyuma lw’okulongoosebwa n’okuvunda kw’ekitundu ekiriraanyewo, kikkirizibwa nnyo.
Ebizibu ebiva mu kulongoosebwa ebikwatagana n’ebitundu by’omubiri eby’omubiri byogerwako wansi ——
1.Okusika omuguwa ku ky’okusalako ekiwanga ky’omugongo ekiriko enkoba oba nedda
Ekifaananyi 1 Ekifaananyi ekiraga ensengekera y’ensengekera ya conotruncus, omusuwa gw’omugongo, n’emirandira gy’omugongo n’obusimu.
omu. Enkolagana wakati w’obugulumivu bw’ennyindo (articular eminence) obwa concha n’omusuwa gw’omugongo.
b. Mu kitabo, olukonko olw’omu makkati olw’ekitundu ekiyitibwa articular eminence luggyibwawo, era olukonko olw’ebbali lukuumibwa bulungi okwewala okwonooneka kw’omusuwa gw’omugongo.
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Ekifaananyi 2 Schematic diagram of nerve root compression and decompression nga tusaasaanya ennyondo za kkooni eziyitibwa hyperplastic conical joints.
omu. Okukula kw’amagumba n’okuvunda kw’omugongo mu binywa ebiringa kkooni bikendeeza ku kitundu ekisalasala ekya intervertebral foramina, bwe kityo ne kinyigiriza emirandira gy’obusimu.
b. Ekyuma/ekiteekebwa mu mugongo kisobola okuggulawo ekifo ekiri wakati w’omugongo okugaziya ekitundu ky’omugongo wakati n’okukwatagana n’okunyigirizibwa kw’emirandira gy’obusimu, ate mu kiseera kye kimu, okuddamu okukola obutebenkevu bw’omugongo.
Obwetaavu bw’okulongoosa omugongo gw’omumwa gwa nnabaana ogw’omu maaso okuggyawo ekiwanga ky’omugongo ekiyitibwa hook vertebral joint kibadde ggumba lya kuyomba okuva enkola eno lwe yatandikibwawo
Ennyonyola esooka ku kukendeeza ku kunyigirizibwa kw’omumwa gwa nnabaana ogw’omu maaso n’okuyungibwa kw’omumwa gwa nnabaana n’okunyweza munda yaweebwa Robinson ne Smith mu 1955 mwe yayogera ku nkola eno nga tekyetaagisa kuggyawo magumba ga leptokyphotic joint osteophyte. Cloward, omulala omutandisi wa ACDF, yakikkaatirizza nti okunyigirizibwa kwonna kulina okuggyibwawo, era nti okuggyawo obutereevu hyperplastic leptokyphosis kyali kyetaagisa nnyo mu decompression, ate Robinson n’addamu nti leptokyphosis esobola okuddamu okunyigibwa ng’obutebenkevu bw’omugongo buteereddwawo era ng’amaanyi ag’ebyuma agatali ga bulijjo gabula, era nti obutali butebenkevu buno bwalowoozebwa okuba nga bwekuusa ku kutondebwa kw’omugongo obulwadde bwa leptokyphosis.
Endowooza y’aba Reservist
Abakugu mu kukuuma bagamba nti ekiyungo ky’enkoba kikola ebitundu 48% ku 60% ku butebenkevu bwa buli kitundu era kiwa obutebenkevu obusinga mu kitundu eky’emabega eky’omugongo gw’omumwa gwa nnabaana, era nti standard cervical foraminotomy decompresses the posterior aspect of the hook joint and the anterior aspect of the neuraxial canal, so nga mu butuufu ekitundu ekisinga okunywevu eky’ekiwanga kye okuggyibwawo, n’obutabeera mu ntebenkevu nga bwe kiri okusengulwa ekifo ky’okuteekebwamu kikendeeza ku buwanguzi bw’okuyungibwa.
Singa ebiva mu bujjanjabi ebyenkanankana bisobola okutuukibwako awatali kusalako kiwanga ky’omugongo gwa hook, okukuuma ekiwanga ky’omugongo gwa hook mu ndowooza kuyinza okuwa embeera esinga okutuukirawo ku miwendo gy’okuyungibwa egy’oku ntikko. Okugatta ku ekyo, okukuuma ekiwanga ky’omugongo ekya hook kiyamba okukendeeza ku mikisa gy’okusumululwa kw’omugongo oluvannyuma lw’okulongoosebwa, era kizuuliddwa nti ekitundu ky’ekiwanga ky’omugongo ekya hook bwe kisalibwako ebitundu ebisukka mu 38%, omutindo gw’okuyungibwa kw’omugongo wakati w’omubiri gujja kweyongera nnyo.
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Endowooza y’aba excisionist
Okusinziira ku ssomero ly’endowooza y’okusalako, mu nkola y’omubiri, ekisenge eky’emabega eky’ekiwanga kya leptospondylar ye bbugwe ow’omu maaso ow’omukutu gw’emirandira gy’obusimu, era ebisigalira by’amagumba okuva mu kiwanga kya leptospondylar hyperplasia bisobola okuvaako okusannyalala kw’omugongo wakati w’omugongo.
Mu nkola y’obujjanjabi eriwo kati, okukendeeza ku kunyigirizibwa nga basalako obulwadde bwa leptokyphosis kukyawanirirwa mu balwadde abalina okunyigirizibwa okw’amaanyi okw’ekiwanga ekiyitibwa leptokyphotic joint hyperplasia, okusobola okumalawo okunyigirizibwa kw’obusimu oba omusuwa gw’omugongo amangu ddala nga bwe kisoboka.
Okutwaliza awamu, okusika omuguwa bulijjo kubaddewo, naye okulonda okukuuma, okukuuma ekitundu, oba okuggyawo ddala hook spondylolisthesis okusinziira ku mbeera y’omulwadde kifuuse okukkiriziganya mu nkola ez’enjawulo ez’obujjanjabi. Kyokka, enkola y’obujjanjabi ey’omuntu kinnoomu eteeka obwetaavu bungi ku bunene bw’ekiwanga.
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Ebiwandiiko ebitera okusala zero ku katale bikoma olw’obwetaavu bw’okusikula mu sikulaapu 4 okusiba, era obugazi bwabyo bwetaaga okuba mm 17.5, nga kino sayizi nnene eri bannansi abamu, era emirundi mingi kyetaagisa okuzibikira ekitundu ky’ekiyungo ky’enkoba okusobola okuteekebwa mu kifo ekiri wakati w’omugongo.
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SAGI 2-nail locking zero incision ekendeezeddwa okutuuka ku mm 14.8 mu bugazi, nga etunuulidde ebipimo by’omubiri gw’abantu b’Abachina, era kiwa omukozi obujjanjabi obusingawo obw’obuntu mu kulongoosa ekinywa ky’enkoba, ekisobozesa obujjanjabi bw’ekiwanga ky’enkoba okulondebwa okusinziira ku mbeera y’omulwadde entuufu, ate nga kikakasa okutebenkera okusooka n’okuyungibwa okumala ebbanga eddene.
Obulwadde bw’omusaayi mu mugongo oluvannyuma lw’okulongoosebwa
Spinal epidural hematoma (SEH) kizibu ekitali kya bulijjo era eky’amaanyi oluvannyuma lw’okusemberera omumwa gwa nnabaana mu maaso, nga kibeerawo nga 0.1% ku 0.2%.SEH ebeerawo mu rich venous plexus of the epidural, ekijja okuvaako okukosa ennyo emirimu gy’omugongo singa okutondebwa kw’omusaayi tekujjanjabwa mu budde. Okulongoosa mu bwangu oluvannyuma lw’okuzuula obulwadde bwa SEH kuyinza okuyamba okuddamu okukola kw’obusimu.
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Oluvannyuma lw’okulongoosebwa SEH schematic ya ACCF
Okuvaamu omusaayi mu mugongo (spinal epidural haematomas) kisoboka oluvannyuma lwa ACDF ne ACCF byombi, nga ACCF erina obulabe obw’amaanyi obw’okuzimba omusaayi olw’okulumwa ennyo n’okukulukuta kw’amagumba okusinga; wabula, obuzito okutwalira awamu obw’enkola ya ACDF busingako, nga omuwendo gwa SEHs omunene gubeerawo.
Okuziyiza SEH oluvannyuma lw’okusemberera omumwa gwa nnabaana mu maaso kulina okugenda mu maaso mu kiseera kyonna eky’okulongoosebwa:
A. Okukeberebwa nga tebannalongoosebwa kulina okumalirizibwa, era n’okubuuza mu bujjuvu kulina okukolebwa oba waliwo endwadde zonna ez’okuzimba omusaayi, era oba waliwo ebyafaayo by’okunywa sigala n’okunywa omwenge okumala ebbanga eddene; bwe wabaawo abantu abamira eddagala eriweweeza ku kuzimba omusaayi, balina okulekera awo okulimira okumala wiiki emu nga tebannalongoosebwa;
B. Okuziyiza omusaayi mu bujjuvu mu kulongoosa, okuziyiza omusaayi okutali kujjuvu nga bakozesa ekiso ekikuba omusaayi kiyinza okuvaako okuvaamu omusaayi omupya, kirungi okukozesa ebipimo by’amasannyalaze ebiyitibwa bipolar electrocoagulation forceps; mu nkola y’okusalako omubiri gw’omugongo (vertebral body subtotal resection), olina okusiigibwako ‘bone wax’ okwewala omusaayi okukulukuta ennyo okuva ku magumba; okukozesa eddagala eriweweeza ku musaayi, gamba ng’okukuba asidi wa tranexamic, n’ebirala, okusobola okukendeeza ku kuvaamu omusaayi nga balongoosebwa; tekikwetaagisa kunoonya kusalako mu bujjuvu omusuwa ogw’emabega ogw’obuwanvu obw’ekitundu ekilongooseddwa, era okukuuma omusuwa omutono ogw’emabega ogw’obuwanvu ku njuyi zombi nakyo kisobola okutuuka ku kikolwa ky’okukendeeza ku kunyigirizibwa; okuteeka ekitundu ky’omubiri ekiyitibwa prosthesis kulina okuleka ekifo ekimala ku ludda olwa ddyo ne olwa kkono. Bw’oba oteeka ekiwanga, ekifo ekimala kisaana okulekebwa ku ludda olwa kkono ne ddyo omusaayi ogufuluma mu bitundu by’omubiri (epidural bleeding) gusobole okukulukuta okutuuka mu maaso g’omugongo ne gufulumizibwa nga guyita mu ttanka efulumya puleesa ya ‘negative pressure drainage tube’;
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C. Oluvannyuma lw’okulongoosebwa, weetegereze nnyo obubonero obukulu; okukuuma amazzi agakulukuta nga malungi; kozesa eddagala eriweweeza ku kuzimba omusaayi mu ngeri entuufu okwewala okuzimba omusaayi; okulondoola ennyo enkola y’obusimu; bwe wabaawo ekitali kya bulijjo, kikolere mu budde.
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Ekoleddwa okutuukana n’ebipimo by’omubiri gw’eggwanga
1. Ewa eky’okugonjoola eky’obujjanjabi ekikukwatako ku nzirukanya y’ekiwanga ky’omugongo ekiriko enkoba.
2. Okukendeeza ku mikisa gy’omubiri gw’omugongo okukka
3. Okukendeeza ku bulabe bw’obulwadde bwa spinal epidural hematoma
Dizayini ya sikulaapu ey’enkoona ekyukakyuka okusobola okwanguyirwa okukola
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Sikulufu ezirina enkoona ya coronal swing angle ya -1.5°11.5° ne cephalad swing angle ya 36°44° okusobola okwanguyirwa okuteeka emisumaali mu kulongoosa
Tekyetaagisa kutereka kifo kya njawulo okuyingiza sikulaapu, okusala okutono kukendeezebwa okuva ku sentimita 2.5 okutuuka ku sentimita nga 2.0.
Okusinga okutuukagana n’endowooza y’okulongoosa omugongo endoscopic, okutegeera Endo-ACDF.
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Ebikwata ku CZMEDITECH
Cervical Peek Cage(2 oba 4 Locking Screws) bye bikozesebwa mu kujjanjaba amagumba ebituufu ebikoleddwa n’obwegendereza CZMEDITECH yeesigamye ku anterior cervical discectomy decompression and implant fusion era nga evugirwa okwolesebwa kw’ensi yonna, nga yeewaddeyo okuwa obujjanjabi obujjuvu obulungi, obwangu era obutasaasaanya ssente nnyingi eri abalwadde abalina okumenya okuzibu okwetoloola ensi yonna.
Anterior cervical discectomy with decompression and implant fusion (ACDF) y’emu ku nkola z’okulongoosa ezisinga okukozesebwa mu kujjanjaba obulwadde bwa cervical spondylosis obw’ekika ky’omugongo n’ekika ky’ekikolo ky’obusimu, okulumwa omugongo gw’omumwa gwa nnabaana n’obuzibu obulala, era erina ebirungi eby’okutebenkera mu kusooka, omutindo gw’okuyungibwa ogw’amaanyi, okuzzaawo okuzimba okw’omu maaso okwa bulijjo, n’obutabaawo kwa bweru okunyweza, n’ebirala The ebizibu ebitera okubaawo oluvannyuma lw’okulongoosebwa ng’okukaluubirirwa okumira, okuvunda kw’ebitundu ebiriraanyewo, okusannyalala kw’obusimu obuddamu okuyingira mu nnyindo, okukulukuta kw’amazzi g’omu bwongo, okuzimba omusaayi, okukwatibwa yinfekisoni, n’okukka kw’ebintu ebiteekebwa mu mugongo n’ebirala Okutwalira awamu ebizibu ebiva mu kulongoosebwa biri nga 8%.
