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I-discectomy yangaphambili yomlomo wesibeleko kunye ne-decompression kunye ne-implant fusion (ACDF) yenye yezona ndlela zixhaphakileyo zotyando zonyango lwe-spinal cord-type kunye ne-nerve-type ye-cervical spondylosis, i-trauma yomlomo wesibeleko kunye nezinye iziphazamiso, kwaye ineenzuzo zokuzinzisa kokuqala, izinga eliphezulu lokuxutywa, ukungabikho kokulungiswa okuqhelekileyo, ukuguqulwa kwangaphandle kunye ne-postoperative, njl njl. iingxaki ezinjengobunzima bokugwinya, ukuwohloka kwamacandelo akufutshane, ukukhubazeka kwe-laryngeal reentrant nerve, ukuvuza kwe-cerebrospinal fluid, i-hematoma, ukusuleleka, kunye ne-intervertebral implant subsidence njl njl.
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Ukuphendula kwezi ngxaki zingentla, uluntu lwezemfundo luhlala lusebenza ekuphuculeni ubugcisa, ukuphumelela kweengcamango, kunye nokuphucula i-prosthesis. Isixhobo sokuzinzisa somlomo wesibeleko somlomo wesibeleko (i-zero-trace), ehlaliswe ngokupheleleyo kwindawo ye-intervertebral kwaye inciphisa ngokufanelekileyo umngcipheko we-postoperative dysphagia kunye nokuncipha kwecandelo elisondeleyo, yamkelwe ngokubanzi.
Iingxaki zasemva kotyando ezinxulumene neprosthesis zixoxwa ngezantsi:—
I-1.Ingxabano malunga nokuba ungayicoca i-vertebral joint
Umzobo we-1 Umzobo weSchematic wesakhiwo se-conotruncus, i-vertebral artery, kunye nentambo yomgogodla kunye neengcambu ze-nerve.
a. Ubudlelwane phakathi kokuphakama kwe-articular ye-concha kunye ne-vertebral artery.
b. Kule ncwadi, umgca we-medial we-articular eminence ususiwe, kwaye umgca wecala ugcinwe ngokufanelekileyo ukuphepha umonakalo kwi-articular artery.
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Umzobo we-2 Umzobo we-Schematic of compression root compression kunye nokunciphisa ngokusabalalisa i-hyperplastic conical joints.
a. Ukukhula kwamathambo kunye nokuguqulwa komgogodla we-conical joints kunciphisa indawo ye-cross-sectional foramina ye-intervertebral, ngaloo ndlela icinezela iingcambu ze-nerve.
b. Isixhobo se-Intervertebral fusion / implanting sinokuvula indawo ye-intervertebral yokwandisa indawo ye-intervertebral foramen kwaye uqhagamshelane noxinzelelo lweengcambu ze-nerve, kwaye ngexesha elifanayo, ukulungiswa kozinzo lomqolo.
Imfuneko yotyando lwangaphambili lwe-cervical spine ukususa i-hook vertebral joint ibe lithambo lengxabano ukususela ekuqaleni kobuchule.
Inkcazo yokuqala ye-decompression yangaphambili yomlomo wesibeleko kunye nokufakelwa kwe-fusion kunye nokulungiswa kwangaphakathi kwanikezelwa nguRobinson noSmith kwi-1955 apho bachaza inkqubo njengento engayifuni ukususwa kwe-leptokyphotic joint osteophyte. UCloward, omnye umsunguli we-ACDF, wagxininisa ukuba konke ukunyanzeliswa kufuneka kususwe, kwaye ukususwa ngokuthe ngqo kwe-hyperplastic leptokyphosis kwakuyimfuneko ekunciphiseni, ngelixa uRobinson waphendula ukuba i-leptokyphosis inokuthi ihlaziywe njengoko ukuzinza komqolo kwakusekwe kwaye njengoko amandla angaqhelekanga omatshini anyamalala, kwaye ezi zinto zingenakulinganiswa zicatshangelwa ukuba zihlobene ne-leptophosis.
I-preservationists ixela ukuba i-hook joint igalelo kwi-48% ukuya kwi-60% yokuzinza kwecandelo ngalinye kwaye inika uzinzo olukhulu kwinkalo yangasemva yomqolo wesibeleko, kwaye i-standard ye-cervical foraminotomy decompression decompresses i-decompress ye-posterior ye-joint hook kunye ne-anterior aspect of the most of the joint, i-joint, i-joint, i-joint, i-joint, i-joint, i-joint, i-joint, i-joint, i-joint, ukungazinzi kunye nokufuduswa kwendawo yokufakelwa kunciphisa impumelelo yokudibanisa.
Ukuba iziphumo ezilinganayo zeklinikhi zinokufezekiswa ngaphandle kokutshatyalaliswa kwe-hook vertebral joint, ukugcinwa kwe-hook ye-vertebral joint inokubonelela ngeyona ndlela ifanelekileyo yokumisela amazinga aphezulu okudibanisa. Ukongezelela, ukugcinwa kwe-hook ye-vertebral joint kunceda ekunciphiseni amathuba okuba i-postoperative vertebral subluxation, kwaye kuye kwaphawulwa ukuba xa indawo ye-hook ye-vertebral joint ihlaziywa ngaphezu kwe-38%, izinga le-interbody fusion subluxation liya kwanda kakhulu.
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Ngokutsho kwesikolo se-resection of thought, i-anatomically, udonga lwangasemva lwe-leptospondylar joint ludonga lwangaphambili lwe-nerve root canal, kunye ne-bony residu evela kwi-leptospondylar joint hyperplasia ingakhokelela kwi-intervertebral foraminal stenosis.
Kwinkqubo yangoku yeklinikhi, ukunyanzeliswa ngokuchithwa kwe-leptokyphosis kusakhuthazwa kwizigulane ezinoxinzelelo olunzima lwe-leptokyphotic joint hyperplasia, ukwenzela ukukhulula ukunyanzeliswa kwe-nerve okanye i-vertebral artery ngokukhawuleza.
Ngokubanzi, ingxabano ibisoloko ikhona, kodwa ukhetho lokulondoloza, ukugcinwa kwenxalenye, okanye ukususa ngokupheleleyo i-spondylolisthesis ye-hook ngokwemeko yesigulane ibe yimvumelwano kwiinkqubo ezahlukeneyo zeklinikhi. Isicwangciso sonyango lomntu ngamnye, nangona kunjalo, sibeka iimfuno eziphezulu kubukhulu beprosthesis.
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Iimpawu eziqhelekileyo ze-zero-cut traces kwi-marketment zilinganiselwe ngesidingo sokukrazula kwi-screws ezi-4 zokutshixa, kwaye ububanzi bazo kufuneka bube yi-17.5 mm, ubukhulu becala kubantu abathile bezizwe, kwaye kaninzi kufuna ukuvalelwa kwenxalenye ye-hook joint for fusion implantation kwisithuba se-intervertebral.
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I-SAGI ye-2-nail yokutshixa i-zero incision iye yancitshiswa ukuya kwi-14.8 mm ububanzi, ithathela ingqalelo imilinganiselo ye-anatomical yabantu baseTshayina, kwaye inika umqhubi ngonyango lobuqu lwe-intraoperative ye-joint hook, evumela ukuba unyango lwe-hook joint likhethwe ngokuhambelana nemeko yokwenyani yesigulane, ngelixa liqinisekisa ukuzinza kokuqala kunye nokudibanisa kwexesha elide.
I-postoperative spinal epidural hematoma
I-spinal epidural hematoma (SEH) yingxaki enqabileyo kunye neyona nto inzima emva kwendlela yangaphambili yomlomo wesibeleko, kunye nesiganeko malunga ne-0.1% ukuya kwi-0.2%. Utyando olungxamisekileyo emva kokuxilongwa kwe-SEH lunokunceda ukubuyiswa komsebenzi we-neurological.
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Isicwangciso se-SEH sasemva kokusebenza kwe-ACCF
I-spinal epidural haematomas inokwenzeka emva kwe-ACDF kunye ne-ACCF, kwaye i-ACCF inomngcipheko ophezulu we-haematomas ngenxa yokwenzakala okukhulu kunye nomphezulu ongaphezulu wamathambo; nangona kunjalo, umthamo opheleleyo wenkqubo ye-ACDF mkhulu, kunye nenani eliphezulu le-SEHs eyenzekayo.
Uthintelo lwe-SEH emva kwendlela yangaphambili yomlomo wesibeleko kufuneka iqhubeke kulo lonke ixesha lokusebenza:
A. Uvavanyo lwangaphambi kotyando kufuneka lugqitywe, kwaye kufuneka kwenziwe imibuzo eneenkcukacha malunga nokuba kukho naziphi na izifo zokuxinana, nokuba kukho imbali yokutshaya nokusela utywala ixesha elide; ukuba kukho abantu abasebenzisa iziyobisi ze-anticoagulant, kufuneka bayeke ukuzisebenzisa iveki enye phambi kotyando;
B. I-haemostasis ye-intraoperative, i-haemostasis engaphelelanga ngemela ye-electrocoagulation inokukhokelela ekopheni okutsha, kuyacetyiswa ukuba kusetyenziswe i-bipolar electrocoagulation forceps; kwinkqubo ye-vertebral body subtotal resection, i-wax yamathambo kufuneka isetyenziswe ukuphepha ukukhupha igazi elininzi ukusuka kwithambo; ukusetyenziswa kweziyobisi haemostatic, ezifana naliti tranexamic acid, njalo njalo, ukuze kuncitshiswe ukopha intraoperative; akuyimfuneko ukufuna ukutshatyalaliswa okupheleleyo kwe-posterior longitudinal ligament yecandelo elisebenzayo, kunye nokugcinwa kwenani elincinci le-posterior longitudinal ligament kumacala amabini kunokufezekisa umphumo wokunciphisa; ukubekwa kweprosthesis kufuneka kushiye indawo eyaneleyo kwicala lasekunene nasekhohlo. Xa ubeka i-prosthesis, indawo eyaneleyo kufuneka ishiywe kwicala lasekhohlo nasekunene ukwenzela ukuba ukuphuma kwegazi kwe-epidural kuhambe ukuya phambi kwe-vertebrae kwaye kukhutshwe kwi-tube yokukhupha uxinzelelo olubi;
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C. Emva kotyando, qwalasela iimpawu ezibalulekileyo; gcina amanzi agudileyo; sebenzisa iziyobisi ze-anticoagulant ngokufanelekileyo ukuphepha i-thrombosis; esweni ngokusondeleyo umsebenzi we-nervous system; ukuba kukho nakuphi na ukungaqhelekanga, jongana nako kwangethuba.
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Yenzelwe ukuhlangabezana nemilinganiselo ye-anatomical yesizwe
1. Ibonelela ngesisombululo seklinikhi yomntu ngamnye kulawulo lwe-vertebral joint.
2. Ukunciphisa ithuba lokunciphisa umzimba we-vertebral
3. Ukunciphisa umngcipheko we-spinal epidural hematoma
Uyilo oluguquguqukayo lwe-engile screw ukuze usebenze lula
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Izikrweqe ezineengile yokujingi yecoronal engu -1.5°11.5° kunye ne-cephalad swing angle engama-36°44° ukulungiselela ukubekwa lula kwezikhonkwane kwi-intraoperative.
Akukho sidingo sokugcina indawo eyongezelelweyo yokufaka isikrufu, ubuncinci bokusika buncitshisiwe ukusuka kwi-2.5cm ukuya malunga ne-2.0cm.
Ukulungelelaniswa ngakumbi kwingcamango yokusebenza kwe-spinal endoscopic, ukuqonda i-Endo-ACDF.
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Malunga ne-CZMEDITECH
ICervical Peek Cage (2 okanye 4 Locking Screw) zizisombululo ezichanekileyo ze-orthopedic eziphuhliswe ngononophelo ngu I-CZMEDITECH igxile kwi-discectomy ye-discectomy yangaphambili kunye nokuxutywa kwe-implant kwaye iqhutywe ngumbono wehlabathi jikelele, uzinikele ekunikezeni izisombululo zonyango ezisebenzayo, ezifanelekileyo kunye neendleko ezipheleleyo kwizigulane ezineefracture ezinzima emhlabeni jikelele.
I-discectomy yangaphambili yomlomo wesibeleko kunye ne-decompression kunye ne-implant fusion (ACDF) yenye yezona ndlela zixhaphakileyo zotyando zonyango lwe-spinal cord-type kunye ne-nerve-type ye-cervical spondylosis, i-trauma yomlomo wesibeleko kunye nezinye iziphazamiso, kwaye ineenzuzo zokuzinzisa kokuqala, izinga eliphezulu lokuxutywa, ukungabikho kokulungiswa okuqhelekileyo, ukuguqulwa kwangaphandle kunye ne-postoperative, njl njl. iingxaki ezinjengobunzima bokugwinya, ukuwohloka kwamacandelo akufutshane, ukukhubazeka kwe-laryngeal reentrant nerve, ukuvuza kwe-cerebrospinal fluid, i-hematoma, ukusuleleka, kunye ne-intervertebral implant subsidence njl njl.
