Ukulungiswa kwesikulufu se-Anterior kwenqubo ye-Odontoid kugcina umsebenzi wokushintshana we-C1-2 futhi kubikwe ezincwadini ukuthi zibe nezinga lama-88% kuya ku-100%.
Ngo-2014, uMarkus r et al washicilela isifundo sendlela yokuhlinzwa ye-anterior screw fidentation yama-odontoid fractures kumagazini weBone & Joint Working (AM). I-athikili ichaza ngokuningiliziwe amaphuzu aphambili wendlela yokuhlinzwa, ukulandela okusebenzayo, izinkomba kanye nokuphepha ngezinyathelo eziyisithupha.
Isihloko sigcizelela ukuthi uhlobo lwe-II kuphela ama-fractures alungile ukuqondisa ukulungiswa kwesikulufa se-anterior sokulula nokuthi kukhethwa i-alow aze isikulufa sokulungiswa.
Isinyathelo 1: Ukubekwa kwezangameleli kwesiguli
1. I-radiographs elungele i-anteroposteror ne-lateral kumele ithathwe ireferensi yomsebenzisi.
2. Isiguli kufanele sigcinwe endaweni evulekile ngesikhathi sokuhlinzwa.
I-3. Ukuqhekeka kufanele kubuyiselwe ngangokunokwenzeka ngaphambi kokuqala kokuhlinzwa.
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6 Ababhali basebenzisa i-Mayfield Head Frame (ekhonjiswe kwizibalo 1 no-2).
Isinyathelo 2: indlela yokuhlinza
Indlela ejwayelekile yokuhlinza isetshenziselwa ukudalula ungqimba we-anterior tracheal ngaphandle kokulimaza noma yiziphi izakhiwo ezibalulekile ze-anatomical.
Isinyathelo 3: Iphuzu Lokungena
Iphoyinti lokungena elifanele litholakala emgodini ongaphansi wangemuva wesisekelo somzimba we-vertebral. Ngakho-ke, umphetho wangaphandle we-C2-C3 disc kumele uvezwe. (Njengoba kukhonjisiwe kwizibalo 3 no-4 ngezansi) Umdwebo 3
Umcibisholo omnyama kuMdwebo 4 ukhombisa ukuthi umgogodla we-Anterior C2 ubonwa ngokucophelela ngesikhathi sokufunda kwe-axial CT film futhi kufanele asetshenziswe njengendawo yokuthola indawo yokuthola iphoyinti lokufakwa ngesikhathi sokuhlinzwa.
2. Qinisekisa iphuzu lokungena ngaphansi kokubukwa kwe-anteroposteror kanye nokubukwa kwe-fluoroscopic komgogodla wesibeletho. 3.
3. Shelelela inaliti phakathi komphetho ophakeme wangaphandle we-C3 Phezulu ExpperPlate kanye ne-C2 Entry Point ukuthola indawo efanelekile yokungena kwesikulufa.
Isinyathelo 4: Ukubekwa kwesikulufa
1. Inaliti engu-1.8 mm i-Grob i-Grob ifakwe okokuqala njengesiqondisi, nenaliti ekhishwe kancane ngemuva kwesihloko se-notochord. Kamuva, kufakwe isikulufa esingenalutho esingu-3.5 mm noma 4 mm. Inaliti kufanele ihlale ithuthuke kancane kancane uCephalad ngaphansi kokuqapha kwe-anteroposteror kanye ne-wateral fluoroscopic.
2. Beka umshayeli ongenalutho ohlangothini lwe-PIN Guide PIN ngaphansi kokuqapha i-fluorooscopic futhi uyithuthukise kancane kancane kuze kube yilapho ingena ekuqhekekeni. I-hollowr drill akufanele ingene kwi-cortex yohlangothi lwe-cephalad lwe-notochord ukuze i-PIM ye-PURD ingaphumi nge-hollow drill.
3. Kala ubude besikhethi esidingekayo esidingekayo bese usiqinisekisa ngesilinganiso se-CT preperative ukuvikela amaphutha. Qaphela ukuthi isikulufa esingenalutho sidinga ukungena ethanjeni le-cortical lapho kunesici senqubo ye-odontoid (ukwenza lula igxathu elilandelayo le-Fracture End Compression).
Kwabaningi amacala ababhali, kusetshenziselwe isikuluze esisodwa esingenalutho sokulungiswa, njengoba kukhonjisiwe kuMdwebo 5, okutholakala enkabeni yenqubo ye-Odontoid ebheke e-Cortical Preterical, i-Tip yesikhafu ingena nje i-Porterior Bone esemuva kwenqubo ye-odontoid. Kungani isikulufa esisodwa sinconyiwe? Abalobi baphetha ngokuthi kuzoba nzima ukuthola iphuzu lokungena elifanelekile endaweni yenqubo ye-odontoid uma kufakwe izikulufo ezimbili ezihlukile kusuka ku-midline of C2.
Umdwebo 5 ukhombisa isikulufa esingenalutho esisezingeni eliphakathi kwenqubo ye-odontoid ebheke eCephalad, ngesici sesigaxa nje ukungena kwi-cortex yenqubo ye-odontoid.
Kepha ngaphandle kwesici sokuphepha, yenza izikulufo ezimbili zikhulisa ukuzinza kwe-postoperative?
Ucwaningo lwe-biomechanical olushicilelwe ngonyaka ka-2012 ku-Journal Clinical Orthopedics kanye nocwaningo oluhlobene neGang Fung et al. IRoyal College of Surgeon of United Kingdom yabonisa ukuthi isikulufa esisodwa nezikulufo ezimbili zinikeza izinga elifanayo lokuzinza ngokulungiswa kwama-odontoid fractures. Ngakho-ke, isikulufo esisodwa sanele.
4. Lapho isikhundla sokuphuka kanye nezikhonkwane zemihlahlandlela ziqinisekiswa, kufakwa izikulufa ezifanele eziyize. Isikhundla sezikulufa nezikhonkwane kufanele zibhekwe ngaphansi kwe-fluoroscopy.
I-5 6. Qinisa izikulufo ukufaka ingcindezi yesikhala sokuphuka.
Isinyathelo 5: Ukuvalwa Kwendwangu
1. Flush indawo yokuhlinzwa ngemuva kokuqeda ukubekwa kwesikulufa.
2. I-haemostasis ephelele ibalulekile ukuze unciphise izinkinga zokubambisana njenge-hematoma ukucindezelwa kwe-trachea.
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4. Ukuvalwa okuphelele kwezendlalelo ezijulile akudingekile.
I-5. Ukudonsa amanxeba akuyona inketho edingekayo (ababhali ngokuvamile abafaki imisele yokuphambanisa).
I-6. Kunconywe ama-stutermalralmalmalmalmalmate ukunciphisa umthelela ekubukekeni kwesiguli.
Isinyathelo 6: Landela
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2. I-radine evamile ye-anteroporeser kanye nomgogodla wesibeletho kufanele ibukezwe kumaviki ama-2, 6, namaviki ayi-12 futhi ezinyangeni ezi-6 nezingu-12 ngemuva kokuhlinzwa. I-CT SCAN yenziwa emavikini ayi-12 ngemuva kokuhlinzwa.
Isikhathi sePosi: Dec-07-2023
