Zifakwa kanjani izikulufu ze-pedicle?

Indlela yokubeka isikulufu se-Pedicle

1. Indawo yokungena: intamo, isifuba nokhalo kuhlukile;

2. Bamba i-engeli yendiza evundlile (TSA) kanye ne-engeli yendiza ye-sagittal (SSA) yokufaka isikulufu: I-engeli ye-TSA ingakalwa ngefilimu ye-CT. I-SSA inobudlelwano obuthile nesimo somzimba, futhi ingalawulwa nge-C-arm ngesikhathi sokuhlinzwa.

3. Ukujula: Ubude besikulufu bufinyelela ku-80% wobude be-axis ye-pedicle ukuze kutholwe amandla anele e-biomechanical, futhi kulula ukungena ethanjeni le-cortical futhi kulimaze imithambo yegazi uma umude kakhulu.

4. Ubude: kusukela endaweni yokufaka inaliti kuya ku-83% yobude obuphelele be-cortex yangaphambili yomzimba we-vertebral.

Umgogodla Womlomo wesibeletho

Indlela yokufaka isikulufu somlomo wesibeletho

Indlela yokufaka inaliti

Njengamanje, izindlela eziyinhloko zokufaka inaliti yilezi: Indlela ye-Abumi, indlela yokubeka uphawu lwe-anatomical landmark, indlela yokubeka isithombe esisetshenziswa ngekhompiyutha, njll.

indawo yokungena yomgogodla wesibeletho

• Ezimpambanweni ze-5mm ngaphansi komugqa ovundlile wonqenqema olungenhla lwe-lamina ye-axis ye-C2 kanye no-7mm ngaphandle komkhawulo ophakathi komsele womgogodla.

• C3-C6 Ukuphambana komugqa ophakathi nendawo ongaphezulu ongu-1/4 ovundlile kanye nomugqa wangaphandle omaphakathi ongu-1/4 oqondile ngemuva kwebhulokhi eseceleni.

• C7 Ukuphambana komugqa omaphakathi oqondile webhulokhi ehlangothini kanye nomugqa omaphakathi omaphakathi ongu-1/4 ovundlile ungaphezulu.

  
  

I-engeli yokugoqa i-vertebra yomlomo wesibeletho

• I-C2 ihlehla ngo-20-25° ihlehle ngo-10-15°

• I-C3-C6 incline 40-45 °, indiza evundlile ihambisana nama-endplates aphezulu naphansi

• I-C7 inclination 30-40 °, indiza evundlile ihambisana nama-endplates aphezulu naphansi

  
  

Isikulufu somgogodla wesibeletho

• I-C1～C5 idinga izikulufu ezinobubanzi obungu-3.5mm nokujula okungu-20mm

Uma ukuphakama kwe-arch engemuva ye-atlas kungaphansi kuka-4mm, kuguqulwa kube isikulufu se-lateral mass.

Uma ukuphakama noma ububanzi be-pedicle ye-axis bungaphansi kuka-5mm, kunconywa ukuthi ushintshele ku-lateral mass screw fixation.

Ukubekwa kwesikulufu sesisindo sohlangothi lwesibeletho

Indlela kaMagerl : Iphoyinti lokungena ngezikulufu litholakala ngo-1-2mm ngaphezu kwendawo emaphakathi yodonga olungemuva lwesisindo esingemuva; isiqondiso sokungena kwesikulufa singama-25-30 ° sithambekele ngaseceleni, futhi ikhanda litshekele ngo-30 ° (elihambisana nendawo engaphezulu ye-articular), futhi i-cortex ephikisanayo iyabhobozwa; ukujula kokulinganisa Ngemva kokujiya ngezikulufu zethambo lekhohlo elingu-3.5mm.

Indlela ye-Roy-Camille : indawo yokungena yesikulufa itholakala phakathi nendawo ngemuva kwesisindo esingemuva; isiqondiso sokungena ngesikulufu singu-10° ngokulandelanayo, i-cortex yangemuva eqondile iyabholwa, futhi i-contralateral cortex iyabhobozwa; ngemva komsindo, isikulufu sethambo lekhohlo engu-3.5mm siyafakwa.

Indlela ka-Anderson : Indawo yokungena ngesikulufu itholakala ngo-1mm phakathi nendawo yesisindo esingemuva, indawo yokungena ngesikulufu ingu-20° ngokulandelanayo, futhi ikhanda litshekisiwe ngo-20° ukuya ku-30° ukubhoboza imbobo, bese kubholwa i-cortex ephikisanayo.

Izwa isifinyezo

(1) Kufanele kuqashelwe ngokukhethekile ukuphepha kokufakelwa isikulufu. Udokotela ohlinzayo kufanele akhethe indlela efanele ngokusho kobuciko be-anatomy yomlomo wesibeletho kanye ne-pedicle screw technique.

(2) Ukulungiswa kwesikulufu esikhulu se-lateral kusigaba se-C3-C6 kulula futhi kuphephile kunokulungisa isikulufu se-pedicle.

(3) Ithuluzi alikwazi ukungena odongeni lwangaphandle lwe-pedicle, ngaphandle kwalokho lizolimaza izinzwa eziseduze nemithambo yegazi.

(4) I-engeli yokufaka isikulufu kufanele ihluke nge-engeli ye-vertebral arch.

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

(6) I-fluoroscopy ye-intraoperative ingakwazi ukuthola ngokunembile umzimba we-vertebral kanye nesikhala se-intervertebral, futhi ifake ngokunembile izikulufu ukuvimbela ukugoqa endaweni ye-intervertebral kanye nomsele womgogodla.

I-Thoracic

Indawo yokungena yenaliti:

1. U-Margel no-Roy Camille bathathe ukuphambana komugqa ovundlile wephoyinti eliphakathi lenqubo eguquguqukayo kanye nomugqa oqondile wonqenqema lwangaphandle lwenqubo ye-articular ephakeme njengendawo yokungena.

2. U-Ebraheim uhlongoze ukuthi isikhungo se-pedicle ye-T1-T2 sitholakala ku-7-8 mm ngaphakathi konqenqema lwangaphandle lwenqubo ye-articular ephakeme, kanye no-3-4 mm emgqeni ophakathi wenqubo eguquguqukayo. ~8mm.

3. Dweba umugqa oqondile ongu-3 mm ngaphandle kwendawo emaphakathi yelunga eliphansi, bese udweba umugqa ovundlile ukusuka ku-1/3 engenhla yesisekelo senqubo ephambene, futhi ukuphambana kwemigqa emibili indawo yokungena yezipikili.

4. Ezimpambanweni zomugqa omaphakathi we-axis longitudinal yenqubo ye-articular engaphansi kanye nomugqa ovundlile wephoyinti eliphakathi lempande yenqubo eguquguqukayo, 1 mm ngaphansi kwe-facet;

5. Ezimweni eziyinkimbinkimbi, kuyisinqumo esiphephile ukususa ingxenye ye-lamina bese ufaka izikrini ze-pedicle ngaphansi kombono oqondile.

I-angle yokufaka umgogodla we-thoracic

Indiza ye-Sagittal : Ukuncipha kokuthambekela kwe-pedicle ukusuka ku-T1 kuye ku-T12. T1: 25°; T2: 20°; T3: 15°; I-T4-9: 10 °; T10: 5°; T11-12: 0°.

Izikulufu ze-pedicle ze-vertebrae ye-thoracic engenhla kufanele zibe ne-angle yokuthambekela engu-10-20 ° ngendiza ye-sagittal, futhi izikulufu ze-pedicle ze-vertebrae ye-thoracic ephakathi nendawo ephansi kufanele ibe ne-angle yokuthambekela engu-0-10 ° ngendiza ye-sagittal. U-Ebraheim uphakamise ukuthi izikulufu ze-T1 kanye ne-T2 kufanele zibe ngu-30-40° ngokuthambekela endizeni ye-sagittal, i-T3-T11 ibe ngu-20-25°, futhi i-T12 ibe ngu-10°.

Indiza evundlile : kufanele ihambisane nama-endplates aphezulu naphansi.

Isikulufu sokukhetha umgogodla we-thoracic

• I-T1～T5 idinga ububanzi besikulufa obungu-3.5 ~ 4.0mm

• I-T6～T10 idinga u-4.0—5.0mm

• I-T11, i-T12 idinga u-5.5mm

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Kubantu abadala, ububanzi besikulufu se-thoracic pedicle bungaphansi kuka-5mm, futhi kunengozi yokuphuka kwesikulufu. Ezimweni eziningi zomgogodla ophakathi kwe-thoracic, izikulufu ezinkulu kuno-5 mm ububanzi azikwazi ukubekwa, ezingase ziholele kalula ekuqhekekeni kwe-pedicle.

Ezinye izazi zisebenzisa ukubekwa kwe-lateral kwe-pedicle, okuxazulula le nkinga kahle kakhulu. Chofoza ithiphu lenqubo evundlile ukuze ufake iphinikhodi, futhi umugqa omaphakathi wenqubo evundlile uvundlile. Vula imbobo encane kuqala, futhi isiqondiso se-awl sinqamula umkhawulo ongemuva we-facet joint of the vertebra. I-engeli enendiza ye-sagittal ingama-degrees angu-25-40, futhi i-degree kancane kancane ikhula isuka ku-T12 kuya phezulu.

Isikulufu esifakiwe sizodlula enqubweni eguquguqukayo, ingxenye yenqubo ye-costotransverse, ilunga le-costovertebral, kanye nodonga olungemuva lomzimba we-vertebral. Njengoba umzila wokufaka isikulufu utholakala ngaphandle kwe-facet joint, akunakwenzeka ukungena emseleni womgogodla, ophephile. Ngaphezu kwalokho, ukwanda kwe-engeli yokuthambekela kwenza isikulufu sibe side. , ukuqina, amandla okulungisa ayanda, ububanzi be-engeli yokufakelwa bukhulu, izikulufu zingatholakala emugqeni, futhi umhlangano ulula kakhulu.

I-Lumbar spine

I-Lumbar entry point

1. Indlela yokufaka inaliti esiqongweni se-herringbone ridge (iphoyinti lokuhlangana le-accessory process ridge ohlangothini lwe-posterolateral lwempande yenqubo ephakeme ye-articular kanye ne-isthmus ridge), ukuhluka kwalesi sikhundla kuncane (izinga lokuvela liyi-98%), futhi inqubo yokufinyelela ilunywa ngokumiswa.

2. Indlela yokuhlangana: ukuphambana komugqa omaphakathi we-eksisi eguquguqukayo yenqubo eguquguqukayo kanye ne-axis longitudinal ngaphandle kwe-facet joint, noma umphetho wangaphandle wenqubo ye-articular ephakeme,

3. Ezimweni eziyinkimbinkimbi, kuyisinqumo esiphephile ukususa ingxenye ye-lamina bese ufaka izikrini ze-pedicle ngaphansi kombono oqondile.

I-Lumbar screw angle

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

• I-angle yendiza evundlile : L1-4: ihambisana ne-endplate; I-L5: I-10 degrees yokuthambekela phansi (umzimba we-L5 we-vertebral emuva).

  
  

Isikulufu sokukhetha umgogodla we-Lumbar

• I-L1～L5 idinga ububanzi besikulufa obungu-6.5mm, isikulufu esingu-40-45mml

  
  

Izinyathelo Zokuhlinza

1. Ngaphambi kokuhlinzwa, kufanele kube nombono ocacile wangaphambili kanye nohlangothi lwe-lumbar spine. Ukubuka kwangaphambili kubonisa ukuma kwesikulufu endaweni evundlile, futhi ukubuka okuseceleni kungabonisa indawo yesikulufu endaweni eqondile.

2. Indawo yokungena kufanele ibe nenembile futhi ikhuliswe ngokufanelekile, futhi ithambo le-cortical endaweni yehange lingasuswa ngokuvuleka kwephiramidi engunxantathu noma i-rongeur.

3. Ngemva kokunquma isiqondiso esijwayelekile, sebenzisa amandla afanelekile ukuze uvule isifunda ngokucophelela. I-blunt-tip probe akufanele ihlangabezane nokuphikiswa okusobala ngesikhathi sokufakwa inaliti. Akufanele kube khona umuzwa 'wokwehluleka' noma ukumelana kungazelelwe. Lapho ukumelana kutholwa ku-5 ~ 15mm yokuqala, kufanele kube ngesikhathi. Lungisa indawo yokungena yenaliti kanye ne-engeli. Uma uhlangabezana nokuphikiswa okuqinile, kuyanconywa ukuthi uphume kuqala bese uphinde ukhethe indlela ozongena kuyo. Qinisekisa ukuthi ulandela isiqondiso se-pedicle. Ingaphakathi le-pedicle liyithambo elikhansela futhi ngaphandle ithambo le-cortical, elingaqondiswa ngokuzenzakalelayo, uma nje indawo yokungena inembile futhi ikhuliswe ngokufanele; Hamba ngo-10-15 ° emgqeni ophakathi, naka indiza ehambisana nomkhawulo ongaphezulu womzimba we-vertebral, futhi ubambe ukujula okungaba ngu-3cm. Ukuzizwa kubalulekile.

4. Kubaluleke kakhulu ukusebenzisa i-pedicle probe ukuze uhlolisise izindonga ezine, ikakhulukazi izindonga zangaphakathi, eziphansi nezingaphansi.

5. Lapho umehluko we-anatomical phakathi kwe-thoracic ephansi kanye ne-lumbar vertebrae ingacacile, luma inqubo yokufinyelela kanye nenqubo engezansi ye-articular, bese uluma kancane inqubo engenhla ye-articular, futhi ubheke ngqo odongeni lwangaphakathi lwe-pedicle kanye nokungena kwe-pedicle.

6. Kungcono ukuphuma ngaphandle kunangaphakathi, ukhuphuke ungehli; ukuzungezisa kuyinto esemqoka, futhi phambili kuyisengezo; ngenkathi uthuthuka futhi uphenya, yima lapho ubona kanzima, lungisa ngesikhathi, sebenzisa amandla omunwe kuphela, ungasonti ngamandla.

7. Ububanzi besikulufu akufanele budlule u-83% wobubanzi be-cortex yangaphandle ye-pedicle.

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