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Anterior cervical discectomy with decompression and implant fusion (ACDF) ndi imodzi mwa njira zomwe zimagwiritsidwa ntchito popanga opaleshoni yamtundu wa msana ndi mitsempha yamtundu wa khomo lachiberekero spondylosis, kupwetekedwa kwa khomo lachiberekero ndi zovuta zina, ndipo ili ndi ubwino wa kukhazikika koyambirira, kuchuluka kwa kuphatikizika kwakukulu, kubwezeretsedwa kwachibadwa, kukonzanso kunja, ndi zina zotero. zovuta monga kuvutika kumeza, kuwonongeka kwa zigawo zoyandikana, kufooka kwa mitsempha ya laryngeal reentrant, cerebrospinal fluid, hematoma, matenda, ndi intervertebral implant subsidence etc. Chiwopsezo chonse cha zovuta za postoperative ndi pafupifupi 8%.
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Poyankha mavuto omwe ali pamwambawa, ophunzira akugwira ntchito mosalekeza kukonza luso, kupititsa patsogolo malingaliro, ndi kukhathamiritsa kwa prosthesis. Chipangizo chokhazikika cha chiberekero cha chiberekero (zero-trace), chomwe chimakhala chokwanira mu malo a intervertebral ndipo chimachepetsa bwino chiopsezo cha postoperative dysphagia ndi kuwonongeka kwa gawo loyandikana nalo, chavomerezedwa kwambiri.
Zovuta zapambuyo pa opaleshoni yokhudzana ndi ma prostheses zikufotokozedwa pansipa:
1.Kutsutsana kuti achotse kapena ayi kukonzanso mgwirizano wa msana
Chithunzi cha 1 Schematic graph of the conotruncus, vertebral artery, ndi msana ndi mitsempha ya mitsempha.
a. Kugwirizana pakati pa kukula kwa concha ndi vertebral artery.
b. M'bukuli, m'mphepete mwapakati pa articular eminence amachotsedwa, ndipo m'mphepete mwawo umasungidwa bwino kuti asawononge mitsempha ya vertebral.
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Mkuyu. 2 Schematic chithunzi cha minyewa psinjika muzu ndi decompression mwa kufalitsa hyperplastic conical mfundo.
a. Kukula kwa mafupa ndi kuwonongeka kwa msana kwa ma conical joints kumachepetsa gawo lapakati pa intervertebral foramina, motero kukakamiza mizu ya mitsempha.
b. Chipangizo cha intervertebral fusion / implant chikhoza kutsegula malo a intervertebral kuti akulitse dera la intervertebral foramen ndi kukhudzana ndi mitsempha ya mitsempha ya mitsempha, ndipo panthawi imodzimodziyo, kukonzanso kukhazikika kwa msana.
Kufunika kwa opaleshoni yam'mbuyo ya khomo lachiberekero kuti achotse mgwirizano wa mbedza wakhala fupa la mkangano kuyambira chiyambi cha njirayo.
Kufotokozera koyamba kwa khomo lachiberekero lachiberekero ndi kuphatikizika kwa implantation ndi kukhazikika kwamkati kunaperekedwa ndi Robinson ndi Smith mu 1955 momwe adafotokozera kuti njirayi sikufunika kuchotsedwa kwa leptokyphotic joint osteophyte. Cloward, woyambitsa wina wa ACDF, adatsindika kuti kuponderezedwa konse kuyenera kuchotsedwa, komanso kuti kuchotsa mwachindunji kwa hyperplastic leptokyphosis kunali kofunika kwambiri kuti awonongeke, pamene Robinson anayankha kuti leptokyphosis ikhoza kubwezeretsedwanso ngati kukhazikika kwa msana kunakhazikitsidwa ndipo pamene mphamvu zowonongeka zowonongeka zinatha, komanso kuti instabilities izi zinkaganiziridwa kuti ndizogwirizana ndi leptokyphosis.
Oteteza chitetezo amatsutsa kuti mgwirizano wa mbedza umathandizira 48% mpaka 60% ya kukhazikika kwa gawo lililonse ndipo umapereka kukhazikika kwakukulu kumbuyo kwa msana wa khomo lachiberekero, komanso kuti chiberekero cha chiberekero cha foraminotomy decompression chimasokoneza mbali yapambuyo ya mbedza ndi mbali yakunja ya gawo losasunthika, losasunthika komanso losasunthika. kusakhazikika komanso kusamuka kwa malo oyikapo kumachepetsa kupambana kwa kuphatikizika.
Ngati zotsatira zachipatala zofanana zingapezeke popanda kuchotsedwa kwa cholumikizira cha vertebral cholumikizira, kusungidwa kwa mbewa ya vertebral joint kungapereke malo oyenera kwambiri kuti azitha kuphatikizika kwambiri. Kuonjezera apo, kusungidwa kwa mbedza yamtundu wa vertebral kumathandiza kuchepetsa mwayi wa postoperative vertebral subluxation, ndipo zadziwika kuti pamene malo a mbedza ya vertebral joint amachotsedwa ndi oposa 38%, mlingo wa interbody fusion subluxation udzawonjezeka kwambiri.
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Malingana ndi sukulu ya resection of thought, anatomically, khoma lakumbuyo la leptospondylar joint ndi khoma lakumbuyo la mitsempha ya mitsempha, ndipo zotsalira za bony kuchokera ku leptospondylar joint hyperplasia zingayambitse intervertebral foraminal stenosis.
M'machitidwe amakono azachipatala, decompression ndi excision ya leptokyphosis imalimbikitsidwabe kwa odwala omwe ali ndi vuto lalikulu la leptokyphotic joint hyperplasia, kuti athetse kupsinjika kwa mitsempha kapena mitsempha ya msana mwamsanga.
Ponseponse, mikangano idakhalapo nthawi zonse, koma kusankha kosunga, kusungitsa pang'ono, kapena kuchotsa kwathunthu mbedza ya spondylolisthesis malinga ndi momwe wodwalayo alili kwakhala kuvomerezana muzochita zosiyanasiyana zamankhwala. Njira yothandizira payekhapayekha, komabe, imayika zofunikira kwambiri pakukula kwa prosthesis.
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Zomwe zimachitika pamsika zimakhala zochepa chifukwa chosowa zomangira 4 zotsekera, ndipo m'lifupi mwake kuyenera kukhala 17.5 mm, kukula kwakukulu kwa anthu amitundu ina, ndipo nthawi zambiri kumafuna kutsekeka pang'ono kwa mbedza kuti mulowetsedwe mu intervertebral space.
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The SAGI 2-misomali locking zero incision yachepetsedwa kufika 14.8 mm m'lifupi, poganizira kukula kwa anatomical a anthu aku China, ndipo imapatsa wogwiritsa ntchito chithandizo chapadera cha mbedza, kulola kuti chithandizo cha mbedza chisankhidwe molingana ndi momwe wodwalayo alili, ndikuwonetsetsa kukhazikika koyambirira komanso kusakanikirana kwanthawi yayitali.
Postoperative spinal epidural hematoma
Spinal epidural hematoma (SEH) ndizovuta kwambiri komanso zovuta kwambiri pambuyo pa njira yapakhomo ya khomo lachiberekero, ndi zochitika za pafupifupi 0.1% mpaka 0.2%.SEH imapezeka mu venous plexus ya epidural, yomwe idzatsogolera kuwonongeka kwakukulu kwa msana ngati mapangidwe a hematoma sakuchitidwa panthawi yake. Opaleshoni yadzidzidzi pambuyo pozindikira SEH ikhoza kuthandizira kubwezeretsa ntchito ya mitsempha.
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Pambuyo pa opaleshoni SEH schematic ya ACCF
Msana wa epidural haematomas ndi wotheka pambuyo pa ACDF ndi ACCF, ndi ACCF yokhala ndi chiopsezo chachikulu cha hematomas chifukwa cha kuvulala kwakukulu ndi kuphulika kwa mafupa; komabe, kuchuluka kwa njira ya ACDF ndi yayikulu, ndipo kuchuluka kwa SEH kumachitika.
Kupewa kwa SEH pambuyo pa njira yolowera pachibelekero kuyenera kupitilira nthawi yonseyi:
A. Kuyezetsa magazi asanayambe kuchitidwa opaleshoni kuyenera kumalizidwa, ndipo kufunsa mwatsatanetsatane kuyenera kupangidwa ngati pali matenda a coagulation, komanso ngati pali mbiri ya kusuta fodya ndi kumwa mowa kwa nthawi yaitali; ngati pali anthu omwe amamwa mankhwala oletsa magazi kuundana, ayenera kusiya kumwa kwa sabata imodzi isanayambe opaleshoni;
B. Mokwanira intraoperative haemostasis, wosakwanira haemostasis ndi electrocoagulation mpeni kungachititse kuti magazi atsopano, tikulimbikitsidwa kugwiritsa ntchito bipolar electrocoagulation forceps; mu ndondomeko ya vertebral thupi subtotal resection, phula fupa ayenera kugwiritsidwa ntchito kupewa magazi kwambiri seepage kuchokera fupa pamwamba; kugwiritsa ntchito mankhwala a haemostatic, monga jekeseni wa tranexamic acid, ndi zina zotero, pofuna kuchepetsa kutuluka kwa magazi mkati mwa opaleshoni; sikoyenera kufunafuna kukonzanso kwathunthu kwa gawo la posterior longitudinal ligament la gawo loyendetsedwa, komanso kusungidwa kwa kachigawo kakang'ono kamene kamakhala kumbuyo kwa mbali ziwirizi kungathenso kukwaniritsa zotsatira za decompression; kuyika kwa prosthesis kuyenera kusiya malo okwanira kumanja ndi kumanzere. Poika prosthesis, malo okwanira ayenera kutsalira kumanzere ndi kumanja kotero kuti magazi a epidural amatha kuyenda kutsogolo kwa vertebrae ndikutulutsidwa kudzera mu chubu chosokoneza madzi;
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C. Opaleshoni ikatha, yang'anani mosamala zizindikiro; kusunga ngalande yosalala; gwiritsani ntchito anticoagulant kuti mupewe thrombosis; kuwunika mosamala ntchito ya dongosolo lamanjenje; ngati pali vuto lililonse, thetsani nthawi yake.
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Zapangidwa kuti zigwirizane ndi miyeso ya anatomical ya dziko
1. Amapereka yankho lachipatala laumwini la kasamalidwe ka fupa la msana.
2. Kuchepetsa mwayi wa vertebral body subsidence
3. Kuchepetsa chiopsezo cha msana epidural hematoma
Mapangidwe a screw screw kuti agwire ntchito mosavuta
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Zomangira zokhala ndi ngodya yozungulira ya coronal ya -1.5°11.5° ndi cephalad swing angle ya 36°44° kuti akhazikike mosavuta msomali mkati mwa opaleshoni
Palibe chifukwa chosungira malo owonjezera kuti mulowetse wononga, kudula kochepa kumachepetsedwa kuchoka pa 2.5cm kufika pa 2.0cm.
Zowonjezereka ku lingaliro la opaleshoni ya msana endoscopic, kuzindikira Endo-ACDF.
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Za CZMEDITECH
Cervical Peek Cage (2 kapena 4 Zomangira zokhoma ) ndi njira zolondola za mafupa opangidwa mosamala ndi CZMEDITECH yokhazikika pa khomo lachiberekero discectomy decompression ndi implant fusion ndi kuyendetsedwa ndi masomphenya a dziko lonse, odzipereka kuti apereke njira zothandizira, zosavuta komanso zotsika mtengo zothandizira odwala omwe ali ndi zothyoka zovuta padziko lonse lapansi.
Anterior cervical discectomy with decompression and implant fusion (ACDF) ndi imodzi mwa njira zomwe zimagwiritsidwa ntchito popanga opaleshoni yamtundu wa msana ndi mitsempha yamtundu wa khomo lachiberekero spondylosis, kupwetekedwa kwa khomo lachiberekero ndi zovuta zina, ndipo ili ndi ubwino wa kukhazikika koyambirira, kuchuluka kwa kuphatikizika kwakukulu, kubwezeretsedwa kwachibadwa, kukonzanso kunja, ndi zina zotero. zovuta monga kuvutika kumeza, kuwonongeka kwa zigawo zoyandikana, kufooka kwa mitsempha ya laryngeal reentrant, cerebrospinal fluid, hematoma, matenda, ndi intervertebral implant subsidence etc. Chiwopsezo chonse cha zovuta za postoperative ndi pafupifupi 8%.
