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Disectomy-ka hore ee afka ilmo-galeenka oo leh isku-darka iyo isku-dhafka implant (ACDF) waa mid ka mid ah hababka qalliinka ee ugu badan ee loo isticmaalo daawaynta nooca laf-dhabarka iyo xidid-dareemaha nooca afka ilmo-galeenka, dhaawaca laf-dhabarka ilmo-galeenka iyo cilladaha kale, waxayna leedahay faa'iidooyinka xasilinta bilawga ah, heerka fiyuuska sare, dib u soo celinta dib-u-celinta caadiga ah, dib-u-soo-celinta dib-u-celinta caadiga ah. Dhibaatooyinka qalliinka ka dib sida liqitaanka oo ku adkaata, hoos u dhaca qaybaha ku xiga, curyaannimada neerfaha dib u soo noqda ee laryngeal, dareeraha dareeraha cerebrospinal, hematoma, caabuqa, iyo hoos u dhigista maqaar-galaha intervertebral iwm.
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Iyada oo laga jawaabayo dhibaatooyinka kor ku xusan, bulshada tacliintu waxay si joogto ah uga shaqeyneysaa hagaajinta farsamada, horumarka fikradaha, iyo hagaajinta sancada. Qalabka is-dejinta laf-dhabarka ilmo-galeenka (eber-trace), kaas oo si buuxda loogu habeeyey booska intervertebral wuxuuna si wax ku ool ah u yareeyaa khatarta dysphagia ka dib iyo hoos u dhaca qaybta ku xigta, ayaa si ballaaran loo aqbalay.
Dhibaatooyinka qalliinka ka dib ee la xidhiidha qalabka sanaaciga ah ayaa lagaga hadlay hoos --
1.Khilaaf ku saabsan in la saxo lafta laf dhabarta ee xidhan iyo in kale
Jaantuska 1 Jaantuska shaxanka ee qaab dhismeedka konotruncus, halbowlaha vertebral, iyo xudunta laf dhabarta iyo xididada dareemayaasha.
a. Xiriirka ka dhexeeya sumcadda articular ee concha iyo halbowlaha vertebral.
b. Buugga dhexdiisa, cidhifka dhexdhexaadka ah ee sumcadda articular waa la saarayaa, cidhifka dambena si habboon ayaa loo ilaaliyaa si looga fogaado dhaawaca xididdada vertebral.
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Jaantuska 2 Jaantuska shaxanka ee xididada xididada dareemayaasha iyo hoos u dhigista adoo fidaya kala-goysyada kooniska ee hyperplastic.
a. Koritaanka lafaha iyo laf-dhabarka laf-dhabarka ee kala-goysyada fiiqan waxay yareeyaan aagga is-goysyada ee foramina intervertebral, sidaas awgeedna xididdada dareemayaasha.
b. Qalabka fiyuuska intervertebral / implants wuxuu furi karaa booska intervertebral si uu u ballaariyo aagga faleebada intervertebral oo lala xiriiro xididada xididada xididada, isla mar ahaantaana, dib u habeynta xasiloonida lafdhabarta.
Baahida loo qabo qalliinka laf-dhabarka afka ilmo-galeenka ee hore si meesha looga saaro jilbaha vertebral-ka ayaa ahaa lafo muran tan iyo markii la bilaabay farsamada
Sharaxaadda koowaad ee depression-ka hore ee afka ilmo-galeenka iyo isku-dhafka maqaar-galaha oo leh hagaajin gudaha ah waxaa bixiyay Robinson iyo Smith 1955-kii kaas oo uu ku tilmaamay habka aan u baahnayn in laga saaro leptokyphotic wadajir ah osteophyte. Cloward, oo ah asaasaha ACDF, ayaa ku nuuxnuuxsaday in dhammaan cadaadiska la saaro, iyo in si toos ah looga saaro leptokyphosis hyperplastic ay lagama maarmaan u tahay depression, halka Robinson uu ka jawaabay in leptokyphosis-ka la soo celin karo maadaama xasilloonida laf dhabarta la aasaasay iyo sida xoogagga farsamada ee aan caadiga ahayn la waayay, iyo in xasillooni-darradan loo maleynayo inay la xiriiraan sameynta leptokyphosis.
Ilaaliyeyaasha ayaa ku doodaya in wadajirka jilbisku uu ka qaybqaato 48% ilaa 60% xasilloonida qayb kasta waxayna bixisaa xasilloonida ugu weyn ee dhinaca dambe ee laf-dhabarka ilmo-galeenka, iyo in decompression foraminotomy caadiga ah ee ilmagaleenka ilmo-galeenka ayaa hoos u dhigaya dhinaca dambe ee wadajirka jilbaha iyo dhinaca hore ee kanaalka neuraxial inta ugu badan ee laga saaro, iyo sidoo kale qayb ka mid ah kanaalka neerfaha. barokaca booska maqaar-galaha wuxuu yareeyaa guusha isku-dhafka.
Haddii natiijooyin caafimaad oo u dhigma la heli karo iyada oo aan la kala saarin jilbaha vertebral-ka, ilaalinta wadajirka vertebral-ka ee jilbaha ayaa fikrad ahaan bixin kara goobta ugu habboon ee heerarka fiyuuska sare. Intaa waxaa dheer, ilaalinta isku-dhafka vertebral-ka ee jilbaha waxay gacan ka geysaneysaa yareynta fursadaha subluxation vertebral postoperative, waxaana la xusay in marka aagga jilbaha vertebral ee jilbaha la gooyo in ka badan 38%, heerka subluxation fusion interbody ayaa si weyn u kordhin doona.
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Sida laga soo xigtay iskoolka fekerka, anatomically, gidaarka dambe ee leptospondylar-ka laftiisa waa darbiga hore ee kanaalka xididka dareemayaasha, iyo haraaga lafaha ee ka soo baxa leptospondylar hyperplasia ee wadajirka ah waxay u horseedi kartaa stenosis intervertebral foraminal.
Dhaqanka caafimaad ee hadda jira, depression by goynta leptokyphosis ayaa weli u ololeeya bukaanada qaba cadaadis daran ee hyperplasia wadajirka leptokyphotic, si ay u nafiso cadaadinta dareemayaasha ama xididdada vertebral sida ugu dhakhsaha badan.
Guud ahaan, khilaafku had iyo jeer wuu jiray, laakiin doorashada ilaalinta, qayb ahaan ilaalinta, ama gebi ahaanba ka saarida spondylolisthesis jillaab leh sida waafaqsan xaaladda bukaanku waxay noqotay mid la isku raacsan yahay ee dhaqamada kala duwan ee kiliinikada. Istaraatiijiyadda daawaynta ee gaarka ah, si kastaba ha ahaatee, waxay dhigaysaa baahiyo badan xajmiga sanaaciga.
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Raadka eber-goynta caadiga ah ee suuqa ayaa xaddidan baahida loo qabo in lagu xidho 4 boolal oo lagu xidho, ballacooduna wuxuu u baahan yahay inuu ahaado 17.5 mm, taas oo ah cabbir weyn oo loogu talagalay muwaadiniinta qaar, oo inta badan waxay u baahan tahay qayb ka mid ah xannibaadda isku-dhafka jilbaha si loogu dhejiyo fiyuuska ee booska intervertebral.
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Jeexitaanka eber ee SAGI 2-cidida qufulka ayaa hoos loo dhigay ilaa 14.8 mm oo ballac ah, iyadoo la tixgelinayo cabbirrada anatomical ee dadweynaha Shiinaha, waxayna siisaa hawlwadeenka daawayn gaar ah oo gudaha ah oo ka mid ah wadajirka jillaabyada, taas oo u oggolaanaysa daaweynta wadajirka jillaabka in lagu doorto iyadoo loo eegayo xaaladda dhabta ah ee bukaanka, iyadoo la hubinayo xasilloonida bilowga ah iyo isku-dhafka muddada-dheer.
Qalliinka ka dib hematoma laf-dhabarka epidural'ka
Hematoma laf-dhabarka ee hematoma (SEH) waa xaalad naadir ah oo halis ah ka dib habka afka ilmagaleenka hore, oo leh dhacdo ku saabsan 0.1% ilaa 0.2%.SEH waxay ku dhacdaa xuubka xididdada hodanka ah ee epidural'ka, taas oo u horseedi doonta cillad shaqo oo daran oo laf dhabarta ah haddii qaabka hematoma aan la daaweynin waqtigeeda. Qalliinka degdegga ah ka dib ogaanshaha SEH wuxuu caawin karaa dib u soo kabashada shaqada neerfaha.
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Qorshaha SEH ee qalliinka kadib ee ACCF
Hematomas laf dhabarta laf dhabarta ayaa suurtogal ah ka dib ACDF iyo ACCF labadaba, iyadoo ACCF ay leedahay halis sare oo baabasi ah sababtoo ah dhaawac weyn iyo dusha sare ee lafaha oo soo baxaya; si kastaba ha ahaatee, mugga guud ee nidaamka ACDF ayaa ka weyn, iyadoo tiro badan oo SEHs ah ay dhacayaan.
Kahortagga SEH ka dib habka afka ilmagaleenka hore waa inuu sii socdaa inta lagu jiro xilliga qalliinka:
A. Waa in la dhammeeyaa baaritaanka qalliinka ka hor, waana in la sameeyaa baaritaan faahfaahsan oo ku saabsan haddii ay jiraan cudurro xinjirowga ah, iyo haddii ay jiraan taariikh sigaar cabbid iyo khamri cabid ah; haddii ay jiraan dad qaata dawooyinka xinjirowga lidka ku ah, waa inay joojiyaan qaadashada hal toddobaad ka hor qaliinka;
B. Dhiig-baxa xididdada dhiigga oo buuxa, dhiig-baxa dhiig-baxa aan dhamaystirnayn ee mindida korantada waxay keeni kartaa dhiig-bax cusub, waxaa lagu talinayaa in la isticmaalo xoogga laba-cirifoodka ee korantada; Inta lagu jiro habka dib-u-soo-celinta jirka ee vertebral, dhuka lafaha waa in la mariyaa si looga fogaado dhiig-bax badan oo ka yimaada dusha lafta; isticmaalka dawooyinka dhiig-baxa, sida cirbadeynta tranexamic acid, iwm, si loo yareeyo dhiig-baxa gudaha; Muhiim ma aha in la raadiyo dib-u-soo-celinta dhamaystiran ee lafdhabarta dhererka dambe ee qaybta la shaqeeyo, iyo ilaalinta qadar yar oo ka mid ah xuubka dhererka dambe ee labada dhinac ayaa sidoo kale gaari kara saameynta depression; meelaynta sanaaci waa in ay ka tagtaa meel ku filan dhinacyada midig iyo bidix. Marka la saarayo sanaaci, meel ku filan waa in looga tagaa dhinaca bidix iyo midig si dhiigbaxa epidural'ku u qulqulo dhinaca hore ee laf dhabarta oo laga sii daayo tuubada dheecaanka cadaadiska xun;
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C. Qalitaanka ka dib, si dhow u fiirso calaamadaha muhiimka ah; ka ilaali qulqulka qulqulka; u isticmaal dawooyinka xinjirowga lidka ku ah si macquul ah si looga fogaado xinjirowga dhiigga; si dhow ula soco shaqada habdhiska dareenka; Haddii ay jiraan wax aan caadi ahayn, wax ka qabso waqtiga.
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Loogu talagalay in lagu daboolo cabbirrada anatomical ee qaranka
1. Waxay bixisaa xal caafimaad oo shakhsi ahaaneed oo loogu talagalay maaraynta wadajirka vertebral ee xiran.
2. Yaree fursadda hoos u dhaca jirka vertebral
3. Yaree halista hematoma laf dhabarta
Naqshadaynta xagasha isbedbeddelaysa ee qalliinka fudud
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Xirmooyinka leh xagal lulid halbowleed oo ah -1.5°11.5° iyo xagal lulid cephalad ah 36°44° si ay u fududaato meelaynta ciddiyaha gudaha
Uma baahnid in meel kale oo dheeri ah lagu dhejiyo galinta furaha, meesha ugu yar ee la jeexay ayaa laga soo yareeyay 2.5cm ilaa 2.0cm.
La qabsan kara fikradda hawlgalka endoscopic laf-dhabarta, garashada Endo-ACDF.
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ku saabsan CZMEDITECH
Qafiska ilmo-galeenka (2 ama 4 Boolal quful ) waa xal lafaha saxda ah oo si taxadar leh u soo saaray CZMEDITECH oo udub dhexaad u ah kala-baxa discectomy-ka hore ee ilmo-galeenka iyo isku-dhafka maqaar-galaha oo ay dhaqaajiso aragti caalami ah, oo u heellan bixinta xalal daaweyn oo hufan, ku habboon oo kharash-ool ah oo loogu talagalay bukaannada qaba jabka adag ee adduunka oo dhan.
Disectomy-ka hore ee afka ilmo-galeenka oo leh isku-darka iyo isku-dhafka implant (ACDF) waa mid ka mid ah hababka qalliinka ee ugu badan ee loo isticmaalo daawaynta nooca laf-dhabarka iyo xidid-dareemaha nooca afka ilmo-galeenka, dhaawaca laf-dhabarka ilmo-galeenka iyo cilladaha kale, waxayna leedahay faa'iidooyinka xasilinta bilawga ah, heerka fiyuuska sare, dib u soo celinta dib-u-celinta caadiga ah, dib-u-soo-celinta dib-u-celinta caadiga ah. Dhibaatooyinka qalliinka ka dib sida liqitaanka oo ku adkaata, hoos u dhaca qaybaha ku xiga, curyaannimada neerfaha dib u soo noqda ee laryngeal, dareeraha dareeraha cerebrospinal, hematoma, caabuqa, iyo hoos u dhigista maqaar-galaha intervertebral iwm.
