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Anterior cervical discectomy ine decompression uye implant fusion (ACDF) ndiyo imwe yeinonyanya kushandiswa nzira dzekuvhiya dzekurapa kwepinal cord-type uye nerve root-type cervical spondylosis, cervical spine trauma nezvimwe zvinonetsa, uye ine zvakanakira yekutanga kugadzikana, yakakwirira fusion rate, kusavapo kweyakajairwa kugadzirisa, kunze kweiyo conveve, etc. matambudziko akadai sekuoma kwekumedza, kupera kwezvikamu zvakatarisana, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, haematoma, utachiona, uye intervertebral implant subsidence etc. Chiitiko chese chemashure ekuvhiyiwa kwematambudziko anenge 8%.
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Mukupindura kumatambudziko ari pamusoro, nharaunda yevadzidzi inogara ichishanda pakuvandudza tekinoroji, mabhindauko epfungwa, uye prosthesis optimization. Iko-self-stabilising cervical spine fusion device (zero-trace), iyo inonyatsogadziriswa munzvimbo ye intervertebral uye inobudirira inoderedza dambudziko re postoperative dysphagia uye kuderera kwechikamu chepedyo, yakagamuchirwa zvikuru.
Matambudziko epashure ane chekuita neprostheses anokurukurwa pazasi --
1.Kukakavadzana pamusoro pekuti kana kuti kwete kuregedza yakakodzerwa vertebral joint
Mufananidzo 1 Schematic diagram yechimiro chekonotruncus, vertebral artery, uye musana uye nerve midzi.
a. Ukama pakati peiyo articular eminence ye concha uye vertebral artery.
b. Mubhuku racho, muganhu wepakati we articular eminence unobviswa, uye lateral edge inochengetedzwa zvakakodzera kuti irege kukuvadza kune vertebral artery.
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Fig. 2 Schematic diagram ye nerve root compression uye decompression nekuparadzira hyperplastic conical joints.
a. Kukura kwepfupa uye kupera kwepelinha yezvibatanidza zvekoni kunoderedza nzvimbo ye-cross-sectional ye intervertebral foramina, nokudaro kudzvinyirira midzi yetsinga.
b. Intervertebral fusion device / implant inogona kuzarura nzvimbo ye intervertebral kuti iwedzere nzvimbo ye intervertebral foramen uye inobata nerve root compression, uye panguva imwechete, kugadzirisa kugadzikana kwemusana.
Kudikanwa kwekuvhiyiwa kwe anterior cervical spine kubvisa hook vertebral joint yanga iri pfupa rekukakavara kubva pakatanga nzira.
Tsanangudzo yekutanga yeanterior cervical decompression uye implant fusion nekugadzirisa kwemukati yakapiwa naRobinson naSmith muna 1955 umo akatsanangura nzira yacho seasingadi kubviswa kwe leptokyphotic joint osteophyte. Cloward, mumwe muvambi weACDF, akasimbisa kuti kumanikidzwa kwese kunofanira kubviswa, uye kuti kubviswa kwakananga kwe hyperplastic leptokyphosis kwakakosha pakudzikisa, asi Robinson akapindura kuti leptokyphosis inogona kugadziriswa sekugadzikana kwemusana kwakasimbiswa uye sezvo maitiro asina kujairika emagetsi akanyangarika, uye kuti kusagadzikana uku kwaifungidzirwa kuti kwakabatana neptokyphosis.
Vanochengetedza vanopikisa kuti hook joint inobatsira 48% kusvika 60% yekugadzikana kwechikamu chimwe nechimwe uye inopa kugadzikana kukuru mumashure emusana wekervical spine, uye iyo yakajairwa cervical foraminotomy decompression decompresses posterior aspect of the hook joint and the anterior aspect of the neuraxial, most part of the neuraxiable, kusagadzikana pamwe nekutama kwenzvimbo yekusima kunoderedza kubudirira kweiyo fusion.
Kana mhedzisiro yekiriniki yakaenzana inogona kuwanikwa pasina kudzokororwa kweiyo hook vertebral joint, kuchengetedzwa kwehoko ye vertebral joint kunogona kupa theoretically kurongeka kwakakodzera kwepamusoro fusion mazinga. Mukuwedzera, kuchengetedzwa kwehook vertebral joint kunobatsira kuderedza mikana ye postoperative vertebral subluxation, uye yakaonekwa kuti kana nzvimbo yehoko ye vertebral joint inogadziriswa neanopfuura 38%, chiyero che interbody fusion subluxation chichawedzera zvakanyanya.
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Zvinoenderana neresection school of thought, anatomically, posterior wall of the leptospondylar joint is the anterior wall of the nerve root canal, uye bony residu kubva kune leptospondylar joint hyperplasia inogona kutungamirira kune intervertebral foraminal stenosis.
Muchiito chekiriniki yemazuva ano, decompression nekubviswa kwe leptokyphosis ichiri kukurudzirwa kune varwere vane kudzvinyirira kwakanyanya kwe leptokyphotic joint hyperplasia, kuitira kusunungura kudzvinyirira kwetsinga kana vertebral artery nokukurumidza.
Pakazara, kukakavara kwakagara kuripo, asi kusarudzwa kwekuchengetedza, kuchengetedza zvishoma, kana kubvisa zvachose hook spondylolisthesis maererano nemamiriro emurwere yava kubvumirana mune zvakasiyana-siyana zvekliniki maitiro. Iyo yega yega nzira yekurapa, zvisinei, inoisa zvakanyanya kudiwa pahukuru hweiyo prosthesis.
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Izvo zvakajairika zero-cheki zvisaririra pamusika zvinoganhurirwa nekudikanwa kwekukochekera mune 4 screws yekukiya, uye hupamhi hwayo hunoda kuita 17.5 mm, inova saizi hombe kune dzimwe nyika, uye kazhinji inoda kuvharika kwechikamu chehoko yejoini yekumisikidza fusion munzvimbo yeintervertebral.
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Iyo SAGI 2-nail yekuvhara zero incision yakaderedzwa kusvika 14.8 mm muhupamhi, tichifunga nezve anatomical dimens yehuwandu hweChinese, uye inopa mutyairi kurapwa kwakasiyana-siyana kwemukati wejojo yehuku, zvichibvumira kurapwa kwejojo yehuku kusarudzwa zvichienderana nemamiriro chaiwo omurwere, uku achivimbisa kugadzikana kwekutanga uye kwenguva refu fusion.
Postoperative spinal epidural hematoma
Spinal epidural hematoma (SEH) idambudziko risingawanzoitiki uye rakakomba mushure mekufamba kwekervical anterior, nechiitiko che 0.1% kusvika 0.2%.SEH inoitika muhupfumi hwevenous plexus ye epidural, iyo inotungamirira kumusana wakaoma wepinal cord kukanganiswa kwekushanda kana kuumbwa kwehematoma kusina kurapwa nenguva. Kuvhiyiwa kwechimbichimbi mushure mekuongororwa kweSEH kunogona kubatsira kudzoreredza basa retsinga.
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Postoperative SEH schematic yeACCF
Spinal epidural haematomas inogoneka mushure mezvose ACDF neACCF, neACCF ine njodzi yakanyanya yehematomas nekuda kwekukuvadzwa kukuru uye kuwedzera kwemapfupa emapfupa; zvisinei, huwandu hwese hwemaitiro eACDF hwakakura, nehuwandu hwepamusoro hweSEHs huri kuitika.
Kudzivirirwa kweSEH mushure meanterior cervical approach inofanira kuenderera mberi munguva yose yeperioperative:
A. Kuongorora kusati kwaitwa kunofanira kupedzwa, uye kubvunzurudzwa kwakadzama kunofanira kuitwa pamusoro pokuti kune hosha dzipi nedzipi dzecoagulation, uye kana pane nhoroondo yokusvuta kwenguva refu nokunwa doro; kana pane vanhu vanotora anticoagulant zvinodhaka, vanofanira kurega kuatora kwevhiki imwe vasati vavhiyiwa;
B. Yakakwana intraoperative haemostasis, incomplete haemostasis ne electrocoagulation banga inogona kutungamirira pakubuda ropa kutsva, zvinokurudzirwa kushandisa bipolar electrocoagulation forceps; mukuita kwe vertebral body subtotal resection, pfupa wax inofanira kushandiswa kuti isapinda ropa rakawandisa kubva pamapfupa; kushandiswa kwemishonga yehemostatic, yakadai setranexamic acid jekiseni, nezvimwewo, kuitira kuderedza kubuda kweropa; hazvidikanwi kutsvaga kugadziriswa kwakakwana kwemashure ekureba kwenguva refu kwechikamu chinoshandiswa, uye kuchengetedzwa kwechikamu chiduku chemashure ekureba pamativi maviri anogonawo kubudirira mugumisiro wekuderera; kuiswa kweprosthesis kunofanira kusiya nzvimbo yakakwana kurudyi uye kuruboshwe kumativi. Pakuisa prosthesis, nzvimbo yakakwana inofanira kusara kuruboshwe uye kumativi ekurudyi kuitira kuti kubuda ropa kwepidural kunogona kuyerera kumberi kwe vertebrae uye kubudiswa kuburikidza neakaipa pressure drainage tube;
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C. Mushure mekuvhiyiwa, nyatsocherechedza zviratidzo zvinokosha; chengetedza mvura yakachena; shandisa anticoagulant zvinodhaka zvine musoro kuti udzivise thrombosis; kunyatsocherechedza basa renheyo system; kana pane abnormality, gadzirisai nenguva.
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Yakagadzirirwa kusangana nenyika anatomical dimensions
1. Inopa munhu wega kiriniki mhinduro yehutungamiri hwehook vertebral joint.
2. Deredza mukana we vertebral body subsidence
3. Deredza njodzi yepidural hematoma yemusana
Variable angle screw dhizaini kuitira nyore kushanda
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Zvikurukuru zvine coronal swing angle ye -1.5°11.5° uye cephalad swing angle ye36°44° kuitira kugadzika zvipikiri zviri nyore.
Hapana chikonzero chekuchengeta imwe nzvimbo yekuisa screw, iyo shoma incision inoderedzwa kubva pa2.5cm kusvika pa2.0cm.
Kunyanya kuchinjika kune pfungwa yespinal endoscopic operation, kuona Endo-ACDF.
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Nezve CZMEDITECH
Cervical Peek Cage (2 kana 4 Masiruu ekukiya ） idzo dzakanyatsogadziriswa dzemapfupa dzakanyatsogadzirwa ne CZMEDITECH yakanangana neanterior cervical discectomy decompression uye implant fusion uye inofambiswa nechiratidzo chepasi rose, yakatsaurirwa kupa zvinobudirira, zviri nyore uye zvisingadhuri zvinogadziriswa zvekurapa zvinogadziriswa kune varwere vane matambudziko akaomarara pasi rese.
Anterior cervical discectomy ine decompression uye implant fusion (ACDF) ndiyo imwe yeinonyanya kushandiswa nzira dzekuvhiya dzekurapa kwepinal cord-type uye nerve root-type cervical spondylosis, cervical spine trauma nezvimwe zvinonetsa, uye ine zvakanakira yekutanga kugadzikana, yakakwirira fusion rate, kusavapo kweyakajairwa kugadzirisa, kunze kweiyo conveve, etc. matambudziko akadai sekuoma kwekumedza, kupera kwezvikamu zvakatarisana, laryngeal reentrant nerve paralysis, cerebrospinal fluid leakage, haematoma, utachiona, uye intervertebral implant subsidence etc. Chiitiko chese chemashure ekuvhiyiwa kwematambudziko anenge 8%.
