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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 ndetse n'izindi ndwara, kandi bufite ibyiza byo gutuza kwa mbere, umuvuduko ukabije, kugarura ibibazo bisanzwe, no gukosorwa kw'imbere, hamwe no kutabaho neza, kwangirika kw'ibice byegeranye, ubumuga bwa laryngeal reentrant nervice 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 na prothèse optimiz. Igikoresho cyo kwikuramo ubwonko bwa cervical spine fusion (zeru-trace), cyuzuye neza mumwanya uhuriweho kandi kigabanya neza ibyago byo kurwara dysphagia nyuma yo kubagwa no kwangirika kwicyiciro, byemerwa 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. Muri iki gitabo, impande zo hagati ya arctular eminence zivanyweho, 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 gufungura umwanya wimbere kugirango wagure ubuso bwabakozi ba intervertebral hanyuma ugahuza imitsi yo mumitsi, kandi mugihe kimwe, bigahindura ituze ryumugongo.
Gukenera kubaga umugongo winkondo y'umura kugirango ukureho urutirigongo rwa vertebral rwabaye igufwa ryamakimbirane kuva tekiniki yatangira.
Ibisobanuro bya mbere byerekeranye no gukuramo inkondo y'umura imbere no guhuza hamwe no gukosora imbere byatanzwe na Robinson na Smith mu 1955 aho yasobanuye ko ubwo buryo budasaba gukuraho osteophyte ya leptokyphotic. Undi washinze ACDF, Cloward, yashimangiye ko kwikuramo byose bigomba kuvaho, kandi ko kuvanaho mu buryo butaziguye hyperplastique leptokyphose ari ngombwa kugira ngo décompression, mu gihe Robinson yashubije ko leptokyphose ishobora kongera gushyirwaho kubera ko hashyizweho ituze ry’umugongo 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 ingingo ifatika itanga 48% kugeza kuri 60% y’umutekano wa buri gice kandi ikanatanga ihame rikomeye mu gice cy’inyuma cy’umugongo w’inkondo y'umura, kandi ko inkondo y'umura isanzwe ya foraminotomy decompression yangiza igice cyinyuma cy’urugingo hamwe n’imbere y’imbere y’umuyoboro wa neuraxial, mu gihe mu byukuri igice gihamye cy’urugingo rwavanyweho.
Niba ibyavuye mu mavuriro bihwanye bishobora kugerwaho hatabayeho gukuraho ururondogoro rwa vertebral, kubungabunga ururondogoro rwururururururururururururururururururururururururururururururururururururururururururururirurururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururururumba Bunyarwanda Nurur. Byongeye kandi, kubungabunga ingingo zifatika zifasha kugabanya amahirwe yo kugabanuka kwa vertebral nyuma yo kubagwa, 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 wimyakura, kandi ibisigarira byamagufwa biva muri leptospondylar bihujwe na hyperplasia bishobora gutera intangangore hagati ya 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 gukuraho 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, bikaba binini cyane ku benegihugu bamwe na bamwe, kandi akenshi bisaba gufunga igice cyo gufatira hamwe kugira ngo hashyirwe hamwe mu mwanya uhuriweho.
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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 ingingo zifatika zifatiye ku miterere y’umurwayi, mu gihe zemeza ko zihagaze neza kandi zigahuza igihe kirekire.
Indwara ya spinal epidural hematoma
Indwara ya spinal epidural hematoma (SEH) ni ingorane zidasanzwe kandi zikomeye nyuma yuburyo bwimbere yinkondo y'umura, hamwe no kwandura hafi 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
Icyorezo cya epidural haematoma kirashoboka nyuma ya ACDF na ACCF, hamwe na ACCF ifite ibyago byinshi byo kurwara haematoma kubera ihahamuka ryinshi hamwe 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 inyuma yinyuma ya ligamenti yinyuma yicyiciro gikora, kandi kubika umubare muto winyuma ya longitudinal ligament kumpande zombi nabyo bishobora kugera ku ngaruka za decompression; 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 Imigozi ifunga ） nibisubizo byukuri bya orthopedic ibisubizo byateguwe neza na CZMEDITECH
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 ndetse n'izindi ndwara, kandi bufite ibyiza byo gutuza kwa mbere, umuvuduko ukabije, kugarura ibibazo bisanzwe, no gukosorwa kw'imbere, hamwe no kutabaho neza, kwangirika kw'ibice byegeranye, ubumuga bwa laryngeal reentrant nervice paralise, cerebrospinal fluid leakage, hematoma, infection, hamwe no kwandura intertertebral n'ibindi. Muri rusange abantu bafite ibibazo nyuma yo kubagwa ni 8%.
