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I-Discectomy yangaphambili yomlomo wesibeletho ene-decompression and implant fusion (ACDF) ingenye yezindlela zokuhlinza ezivame ukusetshenziswa kakhulu zokwelapha uhlobo lwe-spinal cord kanye ne-nerve-type-spondylosis yomlomo wesibeletho, ukuhlukumezeka komgogodla wesibeletho kanye nezinye izinkinga, futhi kunezinzuzo zokuzinza kokuqala, izinga eliphezulu lokuhlanganisa, ukungabikho kokulungiswa okujwayelekile kwangaphandle, ukuguqulwa kwangaphandle, njll. izinkinga ezinjengobunzima bokugwinya, ukuwohloka kwezingxenye eziseduze, ukukhubazeka kwemizwa ye-laryngeal reentrant, ukuvuza kwe-cerebrospinal fluid, i-hematoma, ukutheleleka, kanye nokufakwa kwe-intervertebral implant subsidence njll. Isigameko esiphelele sezinkinga zangemva kokuhlinzwa cishe si-8%.
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Ukuphendula lezi zinkinga ezingenhla, umphakathi wezemfundo uhlala usebenza ekuthuthukisweni kobuchwepheshe, ukuthuthukiswa komqondo, kanye nokwenza kahle kokwenziwa. I-self-stabilizing cervical spine fusion device (zero-trace), ehlala ngokugcwele endaweni ye-intervertebral futhi inciphisa ngokuphumelelayo ingozi ye-postoperative dysphagia kanye nokuwohloka kwesigaba esiseduze, iye yamukelwa kabanzi.
Izinkinga zangemva kokuhlinzwa ezihambisana nama-prostheses kuxoxwa ngazo ngezansi——
I-1.Ingxabano mayelana nokuthi i-joint vertebral eboshwe noma cha
Umfanekiso we-1 Umdwebo we-Schematic wesakhiwo se-conotruncus, i-vertebral artery, nentambo yomgogodla kanye nezimpande zemizwa.
a. Ubudlelwano phakathi kwe-articular eminence ye-concha kanye ne-vertebral artery.
b. Encwadini, umkhawulo ophakathi we-articular eminence ususiwe, futhi umkhawulo we-lateral ugcinwa ngendlela efanele ukuze ugweme ukulimala komthambo we-vertebral.
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Umdwebo 2 Umdwebo we-Schematic wokucindezelwa kwezimpande zenzwa kanye nokuwohloka ngokusabalalisa amajoyinti ayi-hyperplastic conical.
a. Ukukhula kwamathambo kanye nokuwohloka komgogodla we-conical joints kunciphisa indawo ye-cross-sectional foramina ye-intervertebral, ngaleyo ndlela icindezela izimpande zezinzwa.
b. Idivayisi ye-intervertebral fusion / implant ingavula isikhala se-intervertebral ukuze kwandiswe indawo ye-intervertebral foramen futhi uxhumane nokucindezelwa kwezimpande ze-nerve, futhi ngesikhathi esifanayo, ukulungisa kabusha ukuzinza komgogodla.
Isidingo sokuhlinzwa komgogodla womlomo wesibeletho wangaphambili ukuze kukhishwe i-hook vertebral joint kuye kwaba ithambo lokungqubuzana kusukela ekuqaleni kwale nqubo.
Incazelo yokuqala ye-decompression yangaphambili yomlomo wesibeletho kanye nokuhlanganiswa kokufakelwa ngokulungiswa kwangaphakathi kwanikezwa nguRobinson noSmith ngo-1955 lapho echaza khona inqubo njengokungadingi ukususwa kwe-leptokyphotic joint osteophyte. UCloward, omunye umsunguli we-ACDF, ugcizelele ukuthi konke ukucindezela kufanele kususwe, nokuthi ukususwa okuqondile kwe-hyperplastic leptokyphosis kwakubalulekile ekunciphiseni, kuyilapho uRobinson ephendula ngokuthi i-leptokyphosis ingase iphinde ihlaziywe njengoba ukuqina komgogodla kwasungulwa futhi njengoba amandla angavamile omshini anyamalala, nokuthi lezi zingqinamba zazicatshangwa ukuthi zihlobene nokwakheka kwe-leptophosis.
I-preservationists iphikisana ngokuthi i-hook joint inikela nge-48% kuya ku-60% yokuzinza kwesigaba ngasinye futhi inikeza ukuzinza okukhulu kunawo wonke engxenyeni yangemuva yomgogodla womlomo wesibeletho, futhi lokho kukhishwa kwe-cervical foraminotomy decompression decompresses isici sangemuva se-hook joint kanye nesici sangaphambili se-neuraxial, ingxenye enkulu ye-neuraxial, i-joint, engakwazi ukususwa futhi ingakwazi ukususwa. ukungazinzi kanye nokugudluzwa kwesimo sokufakelwa kunciphisa impumelelo yokuhlanganisa.
Uma imiphumela yomtholampilo elinganayo ingafinyelelwa ngaphandle kokukhishwa kabusha kwe-hook vertebral joint, ukulondolozwa kwe-hook vertebral joint kungase kunikeze ngokuyisisekelo ukulungiselelwa okufanele kakhulu kwamazinga aphezulu e-fusion. Ukwengeza, ukulondolozwa kwe-hook vertebral joint kusiza ukunciphisa amathuba okuguqulwa kwe-vertebral postoperative, futhi kuye kwaphawulwa ukuthi lapho indawo ye-hook vertebral joint is resected by more than 38%, izinga le-interbody fusion subluxation lizokhula kakhulu.
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Ngokusho kwesikole somcabango we-resection, i-anatomically, udonga olungemuva lwe-leptospondylar luwudonga lwangaphambili lwe-nerve root canal, futhi izinsalela zamathambo ezivela ku-leptospondylar joint hyperplasia zingaholela ku-intervertebral foraminal stenosis.
Emisebenzini yamanje yomtholampilo, ukuchithwa kwe-decompression nge-excision ye-leptokyphosis kusakhuthazwa ezigulini ezinokucindezela okukhulu kwe-leptokyphotic joint hyperplasia, ukuze kukhululwe ukucindezelwa kwe-nerve noma i-vertebral artery ngokushesha ngangokunokwenzeka.
Sekukonke, ukungqubuzana bekulokhu kukhona, kodwa ukukhethwa kokulondoloza, ukulondoloza ingxenye, noma ukususa ngokuphelele i-spondylolisthesis ye-hook ngokusho kwesimo sesiguli kuye kwaba ukuvumelana emikhubeni ehlukahlukene yomtholampilo. Isu lokwelapha lomuntu ngamunye, nokho, libeka izidingo eziphezulu kusayizi we-prosthesis.
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Imikhondo evamile yokusika iqanda emakethe inqunyelwe isidingo sokugoqa izikulufu ezi-4 zokukhiya, futhi ububanzi bazo budinga ukuba ngu-17.5 mm, okuwusayizi omkhulu kwabanye abantu bezizwe, futhi ngokuvamile kudinga ukuvaleka okuyingxenye kwejoyinti ye-hook ukuze kufakwe i-fusion endaweni ye-intervertebral.
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I-SAGI 2-nail locking zero incision yehlisiwe yaba ngu-14.8 mm ububanzi, kucatshangelwa ubukhulu be-anatomical yabantu baseShayina, futhi inikeza opharetha ukwelashwa okuqondene nomuntu siqu kwejoyinti yehuku, okuvumela ukwelashwa kwejoyinti lehhuku ukuthi kukhethwe ngokuvumelana nesimo sangempela sesiguli, kuyilapho kuqinisekiswa ukuzinza kokuqala kanye nokuhlangana kwesikhathi eside.
I-postoperative epidural hematoma yomgogodla
I-Spinal epidural hematoma (SEH) iyinkimbinkimbi engavamile futhi engathi sína ngemva kwendlela yangaphambili yomlomo wesibeletho, enesigameko esingaba ngu-0.1% kuya ku-0.2%.SEH yenzeka ku-plexus ye-venous ecebile ye-epidural, okuzoholela ekulimaleni okunzima kokusebenza komgogodla uma ukwakheka kwe-hematoma kungelashwa ngesikhathi. Ukuhlinzwa okuphuthumayo ngemva kokuxilongwa kwe-SEH kungasiza ukubuyisela ukusebenza kwezinzwa.
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Uhlelo lwe-SEH lwangemva kokusebenza lwe-ACCF
I-spinal epidural haematomas ingenzeka ngemva kokubili kwe-ACDF kanye ne-ACCF, kanti i-ACCF inengozi enkulu ye-hemamatomas ngenxa yokulimala okukhulu kanye nezindawo zamathambo ezigelezayo; nokho, ivolumu iyonke yenqubo ye-ACDF inkulu, nenani eliphakeme lama-SEHs avelayo.
Ukuvimbela i-SEH ngemuva kwendlela yomlomo wesibeletho yangaphambili kufanele kuqhubeke phakathi nesikhathi sokuhlinzwa:
A. Ukuhlolwa kwangaphambi kokuhlinzwa kufanele kuqedwe, futhi kwenziwe imibuzo eningiliziwe mayelana nokuthi zikhona yini izifo zokuqunjelwa, nokuthi ingabe ukhona yini umlando wokubhema nokuphuza utshwala isikhathi eside; uma kunabantu abasebenzisa ama-anticoagulant, kufanele bayeke ukuwaphuza isonto elilodwa ngaphambi kokuhlinzwa;
B. I-haemostasis ye-intraoperative, i-haemostasis engaphelele ngommese we-electrocoagulation ingase iholele ekopheni okusha, kunconywa ukusebenzisa i-bipolar electrocoagulation forceps; enkambweni ye-vertebral body subtotal resection, i-wax yamathambo kufanele isetshenziswe ukuze kugwenywe ukuphuma kwegazi eliningi kusuka ebusweni bethambo; ukusetshenziswa kwezidakamizwa ze-haemostatic, njengomjovo we-tranexamic acid, njll., ukuze kwehliswe ukopha ngokusebenza; akudingekile ukufuna ukukhishwa okuphelele kwe-posterior longitudinal ligament yesigaba esiqhutshwayo, futhi ukugcinwa kwenani elincane le-posterior longitudinal ligament ezinhlangothini ezimbili kungabuye kufinyelele umphumela wokunciphisa; ukubekwa kwe-prosthesis kufanele kushiye isikhala esanele ngakwesokudla nakwesobunxele. Uma ubeka i-prosthesis, isikhala esanele kufanele sishiywe ngakwesobunxele nangakwesokudla ukuze ukuphuma kwegazi kwe-epidural kugeleze phambi kwe-vertebrae futhi kukhishwe nge-tube yokukhipha ingcindezi embi;
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C. Ngemva kokuhlinzwa, bhekisisa izimpawu ezibalulekile; gcina i-drainage ibushelelezi; sebenzisa izidakamizwa ze-anticoagulant ngokunengqondo ukuze ugweme i-thrombosis; ukuqapha ngokucophelela umsebenzi wesimiso sezinzwa; uma kukhona okungajwayelekile, kulungise kusenesikhathi.
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Idizayinelwe ukuhlangabezana nobukhulu be-anatomical bukazwelonke
1. Ihlinzeka ngesixazululo somtholampilo somuntu siqu sokuphathwa kwejoyinti le-vertebral ehlanganisiwe.
2. Yehlisa ithuba lokuncipha komzimba we-vertebral
3. Yehlisa ingozi ye-spidural hematoma yomgogodla
Idizayini yesikulufu se-engeli eguquguqukayo ukuze isebenze kalula
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Izikulufu ezine-engeli ye-coronal swing engu- -1.5°11.5° kanye ne-cephalad swing angle engu-36°44° ukuze kube lula ukubeka izinzipho ngaphakathi kokusebenza
Asikho isidingo sokugodla isikhala esengeziwe sokufaka isikulufu, ukusika okuncane kuyancishiswa ukusuka ku-2.5cm kuye ku-2.0cm.
Ukuvumelana nezimo ngokwengeziwe kumqondo wokusebenza komgogodla we-endoscopic, eqaphela i-Endo-ACDF.
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Mayelana ne-CZMEDITECH
I-Cervical Peek Cage (2 noma 4 Locking Screw) ziyizixazululo ezinembayo ze-orthopedic ezithuthukiswe ngokucophelela I-CZMEDITECH igxile ekucindezelweni kwe-discectomy yomlomo wesibeletho yangaphambili kanye nokuhlanganiswa kokufakelwa futhi kuqhutshwa umbono womhlaba wonke, ozinikele ekuhlinzekeni izixazululo zokwelapha eziphumelelayo, ezilula futhi ezingabizi kakhulu zeziguli ezinezinkinga eziyinkimbinkimbi emhlabeni jikelele.
I-Discectomy yangaphambili yomlomo wesibeletho ene-decompression and implant fusion (ACDF) ingenye yezindlela zokuhlinza ezivame ukusetshenziswa kakhulu zokwelapha uhlobo lwe-spinal cord kanye ne-nerve-type-spondylosis yomlomo wesibeletho, ukuhlukumezeka komgogodla wesibeletho kanye nezinye izinkinga, futhi kunezinzuzo zokuzinza kokuqala, izinga eliphezulu lokuhlanganisa, ukungabikho kokulungiswa okujwayelekile kwangaphandle, ukuguqulwa kwangaphandle, njll. izinkinga ezinjengobunzima bokugwinya, ukuwohloka kwezingxenye eziseduze, ukukhubazeka kwemizwa ye-laryngeal reentrant, ukuvuza kwe-cerebrospinal fluid, i-hematoma, ukutheleleka, kanye nokufakwa kwe-intervertebral implant subsidence njll. Isigameko esiphelele sezinkinga zangemva kokuhlinzwa cishe si-8%.
