Zifakwa njani izikrufu zepedicle?

Indlela yokubeka i-Pedicle screw

1. Indawo yokungena: intamo, isifuba kunye nesinqe zihluke;

2. Bamba i-angle ye-horizontal plane (TSA) kunye ne-sagittal plane angle (SSA) ye-screw entry: I-angle ye-TSA inokulinganiswa kwifilimu ye-CT. I-SSA inobudlelwane obuthile kunye nesikhundla somzimba, kwaye inokulawulwa nge-C-arm ngexesha lokusebenza.

3. Ubunzulu: Ubude be-screw bufikelela kwi-80% yobude be-pedicle axis ukufumana amandla aneleyo e-biomechanical, kwaye kulula ukungena kwithambo le-cortical kunye nokulimaza imithwalo yegazi ukuba ide kakhulu.

4. Ubude: ukusuka kwindawo yokufaka inaliti ukuya kwi-83% yobude obupheleleyo be-cortex yangaphambili ye-vertebral body.

Umqolo wesibeleko

Indlela yokufaka isikrufu somlomo wesibeleko

Indlela yokufaka inaliti

Okwangoku, iindlela eziphambili zokufakela inaliti zezi: Indlela ye-Abumi, indlela yokubeka uphawu lwe-anatomical landmark, indlela yokubeka umfanekiso woncedo lwekhompyutha, njl.

indawo yokungena yomqolo wesibeleko

• Kwi-intersection ye-5mm ngaphantsi komgca onqamlekileyo wecala eliphezulu le-lamina ye-axis ye-C2 kunye ne-7mm ngaphandle komda we-medial we-spinal canal.

• I-C3-C6 I-intersection yombindi ophezulu we-1/4 umgca othe tye kunye nombindi ongaphandle we-1/4 umgca othe nkqo ngasemva kwebhloko yecala.

• C7 Ukudibana komgca ophakathi othe nkqo webhloko esecaleni kunye nombindi ophezulu we-1/4 umgca othe tye ungentla.

  
  

I-angle ye-screwing angle yomlomo wesibeleko

• I-C2 iyancipha i-20-25 ° iyancipha i-10-15 °

• I-C3-C6 incline 40-45 °, indiza ethe tye ihambelana ne-endplates ephezulu kunye nesezantsi

• I-C7 inclination 30-40 °, indiza ethe tye ihambelana ne-endplates ephezulu nasezantsi.

  
  

Isikrufu somqolo wesibeleko

• I-C1～C5 ifuna izikrufu ezinobubanzi obuyi-3.5mm kunye nobunzulu obuyi-20mm

Ukuba ukuphakama kwe-arch yangasemva ye-atlas ingaphantsi kwe-4mm, iguqulwa ibe yi-screw lateral mass.

Ukuba ubude okanye ububanzi be-pedicle ye-axis bungaphantsi kwe-5mm, kuyacetyiswa ukuba utshintshe kwi-lateral mass screw fixation.

Ukubekwa kwesikrufu sobunzima bomqolo wesibeleko

Indlela kaMagerl : I-screw entry point ifumaneka kwi-1-2mm ngaphezu kwe-midpoint yodonga olungemva kobunzima becala; i-screw entry direction i-25-30 ° i-lateral inclined, kwaye intloko iyancipha i-30 ° (ihambelana nomgangatho ophezulu we-articular), kwaye i-cortex ye-contralateral iqhutywe; umlinganiselo wobunzulu Emva kokujija kwi-3.5mm yezikrufu zethambo lecortical.

Indlela ye-Roy-Camille : i-screw entry point ibekwe kumbindi womva we-lateral mass; i-screw entry direction yi-10 ° ecaleni, i-cortex engasemva ethe nkqo iye yagrunjwa, kwaye i-cortex ye-contralateral iye yagrunjwa; Emva kwesandi, isikrufu sethambo lecortical esiyi-3.5mm sijijwa ngaphakathi.

Indlela kaAnderson : I-screw entry point ibekwe kwi-1mm ngaphakathi kumbindi we-lateral mass, i-screw entry direction is 20 ° lateral, kwaye intloko ithotywe nge-20 ° ukuya kwi-30 ° ukubhobhoza umngxuma, kwaye i-cortex ye-contralateral iqhutywe.

Amava isishwankathelo

(1) Ingqwalasela ekhethekileyo kufuneka ihlawulwe kukhuseleko lwe-screw implantation. Ugqirha wotyando kufuneka akhethe indlela efanelekileyo ngokwendlela yobuchule be-anatomy yomlomo wesibeleko kunye ne-pedicle screw technique.

(2) I-lateral mass screw fixation kwi-C3-C6 segment ilula kwaye ikhuselekile kunokulungiswa kwe-screw ye-pedicle.

(3) Isixhobo asikwazi ukungena kwindonga yangaphandle ye-pedicle, ngaphandle koko iya kulimaza iimbilini ezikufutshane kunye nemithambo yegazi.

(4) I-angle yokufaka isikrufu kufuneka ihluke kunye ne-angle ye-vertebral arch.

(5) Ukungena kwethambo le-cortical phambi komzimba we-vertebral kufuneka kugwenywe.

(6) I-fluoroscopy ye-intraoperative inokubeka ngokuchanekileyo indawo ye-vertebral kunye ne-intervertebral space, kwaye ifake ngokuchanekileyo i-screws ukuthintela ukukrazula kwi-intervertebral space kunye ne-spinal canal.

I-Thoracic

Indawo yokungena inaliti:

1. UMargel noRoy Camille bathatha i-intersection ye-horizontal line ye-midpoint ye-transverse process kunye nomgca othe nkqo wecala elingaphandle lenkqubo ye-articular ephezulu njengendawo yokungena.

2. U-Ebraheim ucebise ukuba iziko le-pedicle ye-T1-T2 ifumaneka kwi-7-8 mm ngaphakathi komda wangaphandle wenkqubo ye-articular ephezulu, kunye ne-3-4 mm kumgca ophakathi wenkqubo enqamlezayo. ~8mm.

3. Dweba umgca othe nkqo kwi-3 mm ngaphandle kwe-midpoint ye-joint ephantsi, kwaye udwebe umgca othe tyaba ukusuka kwi-1/3 ephezulu yesiseko senkqubo enqamlezayo, kunye nokudityaniswa kwemigca emibini yindawo yokungena yesikhonkwane.

4. Kwi-intersection ye-midline ye-longitudinal axis yenkqubo ye-articular engaphantsi kunye nomgca othe tye we-midpoint yengcambu yenkqubo enqamlezayo, i-1 mm ngaphantsi kwe-facet;

5. Kwiimeko ezinzima, kukhetho olukhuselekileyo lokususa inxalenye ye-lamina kunye nokufakelwa kwe-pedicle screws phantsi kombono othe ngqo.

I-angle yokufaka i-thoracic spine

Indiza ye-Sagittal : Ukunciphisa ukuthambekela kwe-pedicle ukusuka kwi-T1 ukuya kwi-T12. T1: 25 °; T2: 20 °; T3: 15 °; T4-9: 10 °; T10: 5 °; T11-12: 0 °.

I-pedicle screws of the top thoracic vertebrae kufuneka ibe ne-angle inclination ye-10-20 ° kunye nendiza ye-sagittal, kunye ne-pedicle screws phakathi kunye nezantsi kwe-vertebrae ye-thoracic kufuneka ibe ne-angle inclination ye-0-10 ° kunye nendiza ye-sagittal. U-Ebraheim ucebise ukuba i-T1 kunye ne-T2 izikrufu ze-pedicle kufuneka zibe yi-30-40 ° ukuthambekela kunye nendiza ye-sagittal, i-T3-T11 kufuneka ibe ngu-20-25 °, kunye ne-T12 kufuneka ibe yi-10 °.

Indiza ethe tyaba : kufuneka ihambelane ne-endplates ephezulu nasezantsi.

Isikrufu sokukhetha umqolo weThoracic

• I-T1～T5 idinga i-screw diameter 3.5 ~ 4.0mm

• T6～T10 idinga 4.0—5.0mm

• T11, T12 kufuneka 5.5mm

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Kubantu abadala, ububanzi be-screw ye-thoracic pedicle bungaphantsi kwe-5mm, kwaye kukho umngcipheko wokuphulwa kwe-screw. Kwiimeko ezininzi ze-middle-thoracic spine, izikhonkwane ezinkulu kune-5 mm ububanzi azikwazi ukubekwa, ezinokukhokelela ngokulula kwi-pedicle rupture.

Abanye abaphengululi basebenzisa i-lateral yokubekwa kwe-pedicle, eyisombulula le ngxaki kakuhle kakhulu. Cofa incam yenkqubo enqamlezileyo ukufaka iphini, kwaye umgca ophakathi wenkqubo enqamlezileyo uxwesileyo. Vula umngxuma omncinci kuqala, kwaye isalathiso se-awl sidibanisa nomda wecala le-facet joint of the vertebra. I-angle ene-sagittal plane yi-25-40 degrees, kwaye idigri inyuka ngokuthe ngcembe ukusuka kwi-T12 ukuya phezulu.

I-screw efakiweyo iya kudlula kwinkqubo enqamlezileyo, inxalenye yenkqubo ye-costotransverse, i-costovertebral joint, kunye nodonga olusecaleni lomzimba we-vertebral. Ekubeni indlela yokufaka i-screw ifumaneka ngaphandle kwe-facet joint, akunakwenzeka ukuba ungene kwi-spinal canal, ekhuselekileyo. Ukongeza, ukunyuka kwe-angle yokuthambekela kwenza i-screw ibe yinde. , ukuqina, amandla okulungisa ayanda, uluhlu lwe-angle yokufakelwa likhulu, izikrufu zinokufumaneka kumgca, kwaye indibano ifaneleka ngakumbi.

I-Lumbar spine

Indawo yokungena eLumbar

1. Indlela yokufaka inaliti kwi-apex ye-herringbone ridge (indawo yokuhlangana yenkqubo ye-accessory ridge kwicala le-posterolateral yengcambu yenkqubo ye-articular ephezulu kunye ne-isthmus ridge), ukuhluka kwesi sikhundla sincinci (izinga lokwenzeka yi-98%), kwaye inkqubo ye-accessory ilunywa ngokubeka.

2. Indlela ye-Intersection: i-intersection ye-midline ye-axis enqamlezayo yenkqubo enqamlezileyo kunye ne-longitudinal axis ngaphandle kwe-facet joint, okanye umda wangaphandle wenkqubo ye-articular ephezulu,

3. Kwiimeko ezinzima, kukhetho olukhuselekileyo lokususa inxalenye ye-lamina kunye nokufakelwa kwe-pedicle screws phantsi kombono othe ngqo.

I-angle ye-screw lumbar

• I-angle ye-Sagittal plane : I-L1-L3 ine-5-10 degrees of inversion, i-L4-L5 ine-10-15 degrees of inversion.

• I-angle ye-Horizontal yendiza : L1-4: ihambelana ne-endplate; I-L5: I-10 degrees of inclination downward (L5 umzimba we-vertebral ngasemva).

  
  

Isikrufu sokukhetha umqolo weLumbar

• I-L1～L5 idinga i-screw diameter 6.5mm, 40-45mml screw

  
  

Amanyathelo oNyango

1. Ngaphambi kokuhlinzwa, kufuneka kubekho imbonakalo ecacileyo yangaphambili kunye necala le-lumbar spine. Umbono wangaphambili ubonisa indawo ye-screw kwi-horizontal direction, kunye ne-lateral view ingabonisa indawo ye-screw kwindawo ethe nkqo.

2. Indawo yokungena kufuneka ichaneke kwaye ikhuliswe ngokufanelekileyo, kwaye ithambo le-cortical kwindawo ye-anchor inokususwa ngokuvulwa kwephiramidi ye-triangular okanye i-rongeur.

3. Emva kokumisela ulwalathiso oluqhelekileyo, sebenzisa amandla afanelekileyo ukuvula isiphaluka ngokucophelela. I-blunt-tip probe akufanele ihlangabezane nokuchasana okucacileyo ngexesha lokufakwa kwenaliti. Akufuneki kubekho 'ukusilela' okanye ukuxhathisa ngequbuliso. Xa ukuchasana kudibene ne-5 ~ 15mm yokuqala, kufuneka kube ngexesha elifanelekileyo. Lungisa indawo yokungena yenaliti kunye ne-angle. Ukuba ufumana ukuchasana okunamandla, kuyacetyiswa ukuba uphume kuqala kwaye ukhethe kwakhona indlela yokungena. Qinisekisa ukuba ulandele ulwalathiso lwe-pedicle. Ngaphakathi kwe-pedicle ithambo elikhansela kwaye ngaphandle ithambo le-cortical, elinokuthi likhokelwa ngokuzenzekelayo, ngaphandle kokuba indawo yokungena ichanekile kwaye yandiswe ngokufanelekileyo; Nciphisa i-10-15 ° ukuya kumgca ophakathi, qaphela indiza ehambelana nomda ophezulu we-vertebral body, kwaye ubambe ubunzulu malunga ne-3cm. Ukuziva kubalulekile.

4. Kubaluleke kakhulu ukusebenzisa i-pedicle probe ukukhangela iindonga ezine, ngakumbi iindonga zangaphakathi, eziphantsi kunye nezantsi.

5. Xa ulwahlulo lwe-anatomical phakathi kwe-thoracic ephantsi kunye ne-lumbar vertebrae engacacanga, luma i-accessory process kunye nenkqubo ye-articular ephantsi, kwaye emva koko ulume kancinci kwinkqubo ye-articular ephezulu, kwaye ujonge ngqo kudonga lwangaphakathi lwe-pedicle kunye nokungena kwe-pedicle.

6 Kulungile ukuphuma phandle kunangaphakathi, ukunyuka ungehli; ukujikeleza yeyona nto iphambili, kwaye phambili isongezelelo; ngelixa uhambela phambili kwaye uhlola, yima xa ubona nzima, hlengahlengisa ngexesha, sebenzisa amandla omnwe kuphela, musa ukujija ngamandla.

7. Ububanzi be-screw akufanele budlule i-83% yobubanzi be-cortex yangaphandle ye-pedicle.

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

Kuba I-CZMEDITECH , sinomgca wemveliso ogqityiweyo kakhulu wokufakelwa kotyando lwamathambo kunye nezixhobo ezihambelanayo, iimveliso ezibandakanya ukufakelwa komqolo, iinzipho ze-intramedullary, ipleyiti yokwenzakala, ipleyiti yokutshixa, i-cranial-maxillofacial, iprosthesis, izixhobo zamandla, izilungisi zangaphandle, arthroscopy, ukhathalelo lwezilwanyana kunye neeseti zezixhobo ezixhasayo.

Ukongeza, sizibophelele ekuqhubekeni siphuhlisa iimveliso ezintsha kunye nokwandisa imigca yemveliso, ukuze sihlangabezane neemfuno zotyando zoogqirha abaninzi kunye nezigulana, kwaye senze inkampani yethu ikhuphisane ngakumbi kulo lonke ilizwe lehlabathi lokufakelwa kwamathambo kunye nezixhobo.

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