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Indwara y'inkondo y'umura imbere hamwe na decompression hamwe na fusion fusion (ACDF) ni bumwe mu buryo bukoreshwa cyane mu kubaga uburyo bwo kuvura ubwoko bw'umugongo n'ubwoko bw'imitsi yo mu bwoko bwa cervical spondylose, ihahamuka ry'umugongo n'izindi mvururu, kandi bufite ibyiza byo gutuza kwa mbere, umuvuduko mwinshi, kugarura ibibazo bisanzwe, no gukosorwa kw'imbere, hamwe no kutabaho neza, kwangirika kw'ibice byegeranye, ubumuga bwa laryngeal reentrant nerval paralise, cerebrospinal fluid leakage, hematoma, infection, hamwe no kwandura intertertebral n'ibindi. Muri rusange abantu bafite ibibazo nyuma yo kubagwa ni 8%.
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Mu gusubiza ibibazo byavuzwe haruguru, umuryango w’amasomo uhora ukora ibijyanye no kunoza tekiniki, iterambere ryibitekerezo, hamwe no gukora prothèse. Igikoresho cyo kwikuramo inkondo y'umura cervical spine fusion (zeru-trace), cyuzuye neza mumwanya uhuriweho kandi kigabanya neza ibyago byo kurwara dysphagie nyuma yo kubagwa ndetse no kwangirika kwicyiciro, byemewe cyane.
Ingorane zimaze kuvurwa zijyanye na protezi zaganiriweho hepfo ——
1.Ikibazo cyo kumenya niba kutazongera guhuza urutirigongo
Igishushanyo 1 Igishushanyo mbonera cyimiterere ya conotruncus, imiyoboro y'amaraso, hamwe n'umugongo n'imizi y'imitsi.
a. Isano iri hagati ya articular eminence ya conha na vertebral arteri.
b. Mu gitabo, impande zo hagati ya eminence arctique zavanyweho, kandi impande zegeranye zabitswe neza kugirango birinde kwangirika kwimitsi.
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Igishushanyo cya 2 Igishushanyo mbonera cyerekana imitsi yo kwangirika no kwangirika mugukwirakwiza hyperplastic conical ingingo.
a. Gukura kw'amagufwa no kwangirika kw'umugongo kw'ingingo zifatika bigabanya agace kambukiranya igice cya foramina intervertebral, bityo bikagabanya imizi yumutima.
b. Igikoresho cya intervertebral fusion igikoresho / cyatewe gishobora gukingura umwanya uhuza intera kugirango wagure ubuso bwabakozi ba intervertebral hanyuma ugahuza imitsi yo mu mitsi, kandi mugihe kimwe, bigahindura ituze ryumugongo.
Gukenera kubagwa umugongo w'imbere kugira ngo ukureho urutirigongo rwa vertebral rwabaye igufwa ryamakimbirane kuva tekiniki yatangira.
Ibisobanuro bya mbere byerekeranye no gukuramo inkondo y'umura imbere hamwe no guhuza hamwe no gukosora imbere byatanzwe na Robinson na Smith mu 1955 aho yasobanuye ko inzira idasaba gukuraho osteophite ya leptokyphotic. Undi washinze ACDF, Cloward, yashimangiye ko kwikuramo byose bigomba kuvaho, kandi ko kuvanaho mu buryo butaziguye hyperptique leptokyphose ari ngombwa kugira ngo décompression, mu gihe Robinson yashubije ko leptokyphose ishobora gushyirwaho kubera ko umutekano w’umugongo washyizweho kandi ko imbaraga z’ubukanishi zidasanzwe zabuze, kandi ko izo mitekerereze zikekwa ko zifitanye isano n’ishyirwaho rya leptokyp.
Ibitekerezo bya Reserviste
Abashinzwe kubungabunga ibidukikije bavuga ko guhuza ifuni bigira 48% kugeza kuri 60% by’umutekano wa buri gice kandi bigatanga ihame rikomeye mu gice cy’inyuma cy’umugongo w’inkondo y'umura, kandi ko inkondo y'umura isanzwe ya foraminotomy decompression yangiza igice cy'inyuma cy'urugingo hamwe n'imbere y'imbere y'umuyoboro wa neuraxial, mu gihe igice kinini gihamye cy'urugingo rwavanyweho.
Niba ibyavuye mu mavuriro bishobora kugerwaho hatabayeho gukuraho ururondogoro rwa vertebral, kubungabunga ururondogoro rwurururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururumburumbumba Bunyuma, Burambi: Byongeye kandi, kubungabunga ururondogoro rwa hook bifasha kugabanya amahirwe yo kugabanuka kwa vertebral nyuma yuburwayi, kandi byagaragaye ko mugihe agace k’urugingo rw’urugingo rwimuwe hejuru ya 38%, umuvuduko wo guhuza abantu uziyongera cyane.
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Dukurikije ishuri ryibitekerezo bya resection, anatomatique, urukuta rwinyuma rwurugingo rwa leptospondylar ni urukuta rwimbere rwumuyoboro wumuzi wa nervice, kandi ibisigarira byamagufwa biva muri leptospondylar bihujwe na hyperplasia bishobora gutera intangangore ya foraminal stenosis.
Mubikorwa byubuvuzi byubu, decompression ikoresheje leptokyphose iracyashyigikirwa kubarwayi bafite kwikanyiza gukabije kwa leptokyphotic hyperplasia, kugirango bagabanye kwikuramo imitsi cyangwa imitsi ya vertebral vuba bishoboka.
Muri rusange, impaka zabayeho kuva kera, ariko guhitamo kubungabunga, kubungabunga igice, cyangwa kuvanaho burundu icyuma cyitwa spondylolisthesis ukurikije uko umurwayi ameze byabaye ubwumvikane mubikorwa bitandukanye byubuvuzi. Ingamba zo kuvura kugiti cye, ariko, zisaba cyane ubunini bwa prothèse.
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Ibimenyetso bisanzwe byaciwe ku isoko bigarukira ku gukenera gucomeka mu miyoboro 4 yo gufunga, kandi ubugari bwabyo bugomba kuba mm 17.5, bukaba ari bunini bunini ku benegihugu bamwe na bamwe, kandi akenshi bisaba gufunga igice cyo gufatira hamwe kugira ngo hashyirwe hamwe mu mwanya w’imbere.
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SAGI 2-imisumari ifunga zeru yagabanutse kugera kuri mm 14.8 z'ubugari, hitawe ku bipimo bya anatomique by’abaturage b’Ubushinwa, kandi biha uyikoresha uburyo bwihariye bwo kuvura indwara zifatanije n’ururobo, bituma hashobora kuvurwa imiti y’ururondogoro hakurikijwe uko umurwayi ameze, mu gihe hakomeza kubaho ituze no guhuza igihe kirekire.
Indwara ya spinal epidural hematoma
Epidural epidural hematoma (SEH) ni ingorane zidasanzwe kandi zikomeye nyuma yuburyo bwa nyababyeyi bwimbere, aho usanga abantu bagera kuri 0.1% kugeza 0.2% .SEH iboneka mumitsi ikungahaye yimitsi y'icyorezo cya epidural, ibyo bikaba byaviramo ubumuga bukomeye bwumugongo niba imiterere ya hematoma itavuwe mugihe gikwiye. Kubaga byihutirwa nyuma yo gusuzuma SEH birashobora gufasha kugarura imikorere yimitsi.
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Nyuma yo gutangira SEH igishushanyo cya ACCF
Indwara ya spinal epidural haematoma irashoboka nyuma ya ACDF na ACCF, hamwe na ACCF ifite ibyago byinshi byo kurwara haematoma kubera ihahamuka ryinshi no hejuru yamagufwa; icyakora, ingano rusange yuburyo bwa ACDF ni nini, hamwe numubare munini wa SEHs.
Kwirinda SEH nyuma yuburyo bwimbere yinkondo y'umura bigomba gukomeza mugihe cya perioperative:
A. Ikizamini kibanziriza gutangira kigomba kurangira, hagomba gukorwa iperereza rirambuye niba hari indwara ziterwa na coagulation, kandi niba hari amateka yo kunywa itabi igihe kirekire no kunywa inzoga; niba hari abantu bafata imiti igabanya ubukana, bagomba guhagarika kuyifata icyumweru kimwe mbere yo kubagwa;
B. Haemostasis yuzuye idasanzwe, haemostasis ituzuye ukoresheje icyuma cya electrocoagulation ishobora gutera amaraso mashya, birasabwa gukoresha ingufu za bipolar electrocoagulation; mugikorwa cyumubiri wa vertebral subtotal resection, hagomba gukoreshwa ibishashara byamagufwa kugirango wirinde kumena amaraso menshi hejuru yamagufwa; gukoresha imiti ya haemostatike, nka inshinge ya tranexamic, nibindi, kugirango bigabanye kuva amaraso; ntabwo ari ngombwa gushakisha byimazeyo burundu ligamenti ya longitudinal ligament igice cyakorewe, kandi kubungabunga agace gato k'inyuma ndende ndende ku mpande zombi nabyo bishobora kugera ku ngaruka zo gutesha umutwe; gushyira prothèse bigomba gusiga umwanya uhagije iburyo n'ibumoso. Iyo ushyize prothèse, umwanya uhagije ugomba gusigara kuruhande rwibumoso n iburyo kugirango amaraso ava epidural ashobore gutembera imbere yintegamubiri hanyuma asohore binyuze mumiyoboro mibi itwara amazi;
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C. Nyuma yo kubaga, witegereze neza ibimenyetso byingenzi; komeza amazi meza; koresha imiti igabanya ubukana kugirango wirinde trombose; gukurikiranira hafi imikorere ya sisitemu y'imitsi; niba hari ibintu bidasanzwe, bikemure mugihe.
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Yashizweho kugirango ihuze ibipimo byigihugu
1. Itanga igisubizo cyihariye cyamavuriro yo gucunga urutirigongo rwafashwe.
2. Kugabanya amahirwe yo kugabanuka kwumubiri
3. Kugabanya ibyago byo kurwara umugongo epidural hematoma
Impinduka zinguni zingirakamaro kubikorwa byoroshye
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Imiyoboro ifite inguni ya coronale ya -1.5 ° 11.5 ° na cephalad inguni ya 36 ° 44 ° kugirango byoroherezwe gushyira imisumari imbere.
Ntibikenewe kubika umwanya winyongera kugirango winjizemo screw, incike ntarengwa yagabanutse kuva kuri 2.5cm kugeza kuri 2.0cm.
Birenzeho guhuza nigitekerezo cyimikorere ya spinal endoscopic, kumenya Endo-ACDF.
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Ibyerekeye CZMEDITECH
Cervical Peek Cage （2 cyangwa 4 Gufunga imigozi） nibisubizo byuzuye orthopedic ibisubizo byateguwe neza na CZMEDITECH yibanze kumyanya ndangagitsina ya cervical discectomy decompression hamwe no guhuza fusion kandi itwarwa nicyerekezo cyisi yose, igamije gutanga ibisubizo byuzuye, byoroshye kandi bihendutse kubisubizo byuzuye kubarwayi bafite imvune zikomeye kwisi.
Indwara y'inkondo y'umura imbere hamwe na decompression hamwe na fusion fusion (ACDF) ni bumwe mu buryo bukoreshwa cyane mu kubaga uburyo bwo kuvura ubwoko bw'umugongo n'ubwoko bw'imitsi yo mu bwoko bwa cervical spondylose, ihahamuka ry'umugongo n'izindi mvururu, kandi bufite ibyiza byo gutuza kwa mbere, umuvuduko mwinshi, kugarura ibibazo bisanzwe, no gukosorwa kw'imbere, hamwe no kutabaho neza, kwangirika kw'ibice byegeranye, ubumuga bwa laryngeal reentrant nerval paralise, cerebrospinal fluid leakage, hematoma, infection, hamwe no kwandura intertertebral n'ibindi. Muri rusange abantu bafite ibibazo nyuma yo kubagwa ni 8%.
