Nigute insinga za pedicle zinjizwa?

Uburyo bwa pedicle screw uburyo bwo gushyira

1. Ingingo yinjira: ijosi, igituza nu kibuno biratandukanye;

2. SSA ifitanye isano runaka numwanya wumubiri, kandi irashobora kugenzurwa na C-ukuboko mugihe cyo gukora.

3. Ubujyakuzimu: Uburebure bwa screw bugera kuri 80% yuburebure bwa pedicle axis kugirango ubone imbaraga zihagije za biomehanike, kandi biroroshye kwinjira mumagufwa ya cortical no kwangiza imiyoboro yamaraso niba ari ndende cyane.

4. Uburebure: kuva inshinge zinjizwamo kugeza kuri 83% yuburebure bwuzuye bwa cortex yimbere yumubiri wurugingo.

Uruti rw'umugongo

Cervical pedicle screw uburyo bwo kwinjiza

Uburyo bwo gushiramo inshinge

Kugeza ubu, uburyo bwingenzi bwo gushyiramo inshinge ni: Uburyo bwa Abumi, uburyo bwa anatomical markmark position position, uburyo bwa mudasobwa ifashwa na mudasobwa, nibindi.

inkondo y'umura yinjira

• Ku masangano ya 5mm munsi yumurongo utambitse wumurongo wo hejuru wa lamina ya C2 axis na 7mm hanze yuruhande rwagati rwumuyoboro wumugongo.

• C.

• C7 Ihuriro ryumurongo uhagaritse wumurongo wuruhande hamwe no hagati ya 1/4 umurongo utambitse uri hejuru.

  
  

Inkondo y'umura

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

• C3-C6 ihindagurika 40-45 °, indege itambitse irasa nu mpande zo hejuru no hepfo

• C7 impengamiro 30-40 °, indege itambitse irasa nu mpande zo hejuru no hepfo

  
  

Inkondo y'umura

• C1 ～ C5 bisaba imigozi ifite diameter ya 3.5mm n'uburebure bwa 20mm

Niba uburebure bwinyuma yinyuma ya atlas buri munsi ya 4mm, ihindurwa kumurongo rusange.

Niba uburebure cyangwa ubugari bwa pedicle ya axis iri munsi ya 5mm, birasabwa guhinduka kuruhande rwa misa ikosorwa.

Inkondo y'umura ikurikiranye

Uburyo bwa Magerl : Ahantu ho kwinjirira ni hagati ya 1-2mm hejuru yurukuta rwinyuma rwinyuma yinyuma; icyerekezo cyinjira cyerekezo ni 25-30 ° cyegeranye, kandi umutwe uhengamye 30 ° (ugereranije nubuso bwo hejuru), hanyuma cortex itandukanijwe; gupima ubujyakuzimu Nyuma yo gusunika muri 3.5mm cortical bone screw.

Uburyo bwa Roy-Camille : aho winjirira ya screw iri hagati yinyuma yinyuma yinyuma; icyerekezo cyinjira cyerekezo ni 10 ° kuruhande, vertical cortex cortex iracukurwa, na cortex itandukanijwe iracukurwa; nyuma yo kumvikana, 3.5mm ya cortical amagufwa ya screw.

Uburyo bwa Anderson : Ahantu ho kwinjirira ni 1mm imbere hagati ya misa yegeranye, icyerekezo cyinjira ni 20 ° kuruhande, kandi umutwe uhengamye 20 ° kugeza 30 ° kugirango ucukure umwobo, hanyuma cortex itandukanijwe iracukurwa.

Incamake y'uburambe

(1) Hagomba kwitabwaho cyane cyane umutekano watewe. Umuganga abaga agomba guhitamo uburyo bukwiranye nubuhanga bwa anatomiya yinkondo y'umura na tekinike ya pedicle screw.

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(3) Igikoresho ntigishobora kwinjira murukuta rwinyuma rwa pedicle, bitabaye ibyo byangiza imitsi yegeranye nimiyoboro yamaraso.

(4) Inguni yo kwinjiza screw igomba gutandukana nu mfuruka ya vertebral arch.

(5) Kwirinda kwinjira mu magufwa ya cortique imbere yumubiri wurugingo.

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Thoracic

Ingingo yo kwinjiramo inshinge:

1.

2. ~ 8mm.

3. Shushanya umurongo uhagaritse mm 3 hanze yikigero cyo hagati, hanyuma ushushanye umurongo utambitse uhereye hejuru ya 1/3 cyibanze cyibikorwa byo guhinduranya, kandi ihuriro ryimirongo yombi niho ryinjira mumisumari.

4. Ku masangano yo hagati yumurongo muremure wa axitudinal axis yuburyo butagaragara bwumurongo wumurongo utambitse hamwe numurongo utambitse wo hagati wumuzi wibikorwa byambukiranya, mm 1 munsi yumutwe;

5.Mu bihe bigoye, ni amahitamo meza yo gukuraho igice cya lamina hamwe nogushiraho imigozi ya pedicle munsi yicyerekezo.

Thoracic umugongo winjiza inguni

Indege ya Sagittal : Kugabanuka muri pedicle ihindagurika kuva T1 kugeza T12. T1: 25 °; T2: 20 °; T3: 15 °; T4-9: 10 °; T10: 5 °; T11-12: 0 °.

Imigozi ya pedicle ya vertebrae yo hejuru ya thoracic igomba kuba ifite impagarike ya 10-20 ° hamwe nindege ya sagittal, naho imigozi ya pedicle ya vertebrae yo hagati na hepfo ya thoracic igomba kuba ifite inguni ya 0-10 ° hamwe nindege ya sagittal. Ebraheim yasabye ko imiyoboro ya T1 na T2 igomba kuba 30-40 ° ihindagurika hamwe nindege ya sagittal, T3-T11 igomba kuba 20-25 °, naho T12 igomba kuba 10 °.

Indege itambitse : igomba kuba ibangikanye na epfo na ruguru.

Thoracic umugongo wo guhitamo umugozi

• T1 ～ T5 ikeneye diameter ya screw 3.5 ～ 4.0mm

• T6 ～ T10 ikeneye 4.0-5.0mm

• T11, T12 ikeneye 5.5mm

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Ku bantu bakuru, diameter ya thoracic pedicle screw iri munsi ya 5mm, kandi harikibazo cyo kumeneka. Mubihe byinshi byumugongo wo hagati wa thoracic, imigozi irenze mm 5 ya diametre ntishobora gushyirwaho, ibyo bikaba byoroshye gutuma pedicle iturika.

Intiti zimwe zikoresha kuruhande rwa pedicle, zikemura iki kibazo neza. Kanda isonga ryibikorwa byo guhinduranya kugirango winjire muri pin, kandi hagati yumurongo uhinduranya ni horizontal. Banza uhindure umwobo muto, hanyuma icyerekezo cya awl gihura nuruhande rwuruhande rwuruhande rwurugingo rwa vertebra. Inguni hamwe nindege ya sagittal ni dogere 25-40, kandi impamyabumenyi igenda yiyongera kuva T12 hejuru.

Imashini yashizwemo izanyura muburyo bwo guhinduranya, igice cyibikorwa bya Costotransverse, ingingo ya costovertebral, hamwe nurukuta rwuruhande rwumubiri wurugingo. Kubera ko inzira yo kwinjiza screw iherereye hanze yumutwe, ntibishoboka kwinjira mumuyoboro wumugongo, ufite umutekano. Mubyongeyeho, kwiyongera kwinguni ihindagurika bituma screw iba ndende. , umubyimba, imbaraga zo gukosora zongerewe, ingero zinguni zingana ni nini, imigozi irashobora kuba kumurongo, kandi inteko iroroshye.

Uruti rw'umugongo

Ingingo yo kwinjira

1.

2.

3. Mubihe bigoye, ni amahitamo meza yo gukuraho igice cya lamina hamwe nogushyiramo pedicle screw munsi yicyerekezo kiboneye.

Inguni ya Lumbar

• Inguni y'indege ya Sagittal : L1-L3 ifite dogere 5-10 zo guhinduka, L4-L5 ifite dogere 10-15 zo guhinduka.

• Inguni y'indege itambitse : L1-4: ibangikanye n'iherezo; L5: dogere 10 zo kumanuka (L5 vertebral umubiri inyuma).

  
  

Umugozi wo guhitamo umugongo

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

  
  

Uburyo bwo kubaga

1. Mbere yo kubagwa, hagomba kubaho kureba neza imbere no kuruhande rwumugongo. Imbere yimbere irerekana umwanya wa screw mu cyerekezo gitambitse, kandi kuruhande rushobora kwerekana umwanya wa screw mumwanya uhagaze.

2. Ingingo yinjira igomba kuba yuzuye kandi yagutse neza, kandi igufwa rya cortical kumaguru ya ankeri irashobora gukurwaho no gufungura piramide ya mpandeshatu cyangwa rongeur.

3. Nyuma yo kumenya icyerekezo rusange, koresha imbaraga zikwiye kugirango ufungure uruziga witonze. Iperereza ryibanze ntirishobora guhura nikibazo mugihe cyo gushiramo inshinge. Ntabwo hagomba kubaho kumva 'gutsindwa ' cyangwa kurwanywa gitunguranye. Iyo kurwanya bihuye na 5 ~ 15mm yambere, bigomba kuba mugihe. Hindura urushinge rwinjira nu mfuruka. Niba uhuye nikibazo gikomeye, birasabwa gusohoka mbere hanyuma ukongera guhitamo icyerekezo cyo kwinjira. Witondere gukurikiza icyerekezo cya pedicle. Imbere muri pedicle ni igufwa risesuye kandi hanze ni igufwa rya cortical, rishobora guhita riyoborwa, mugihe aho ryinjirira ari ryuzuye kandi ryagutse neza; Shyira 10-15 ° kumurongo wo hagati, witondere indege ibangikanye nuruhande rwo hejuru rwumubiri wurugingo, hanyuma ufate ubujyakuzimu bwa 3cm. Kumva ari ngombwa.

4.Ni ngombwa cyane gukoresha pedicle probe kugirango ugenzure inkuta enye, cyane cyane imbere, imbere no hepfo.

5. Iyo itandukaniro rya anatomique riri hagati ya thoracic yo hepfo na lumbar vertebrae ridasobanutse, kuruma inzira yububiko hamwe nuburyo bwo hepfo, hanyuma ukaruma igice igice cyo hejuru, hanyuma ukareba neza kurukuta rwimbere rwa pedicle no kwinjira kwa pedicle.

6. Nibyiza gusohoka hanze kuruta imbere, kuzamuka ntumanuke; kuzunguruka nicyo kintu cyingenzi, kandi imbere ninyongera; mugihe utera imbere no kugerageza, hagarara mugihe ubonye bikomeye, uhindure mugihe, koresha gusa urutoki, ntugoreke ku gahato.

7. Diameter ya screw ntigomba kurenga 83% ya diameter ya cortex yo hanze ya pedicle.

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