Ukufakwa kwesikulufo sangaphambili senqubo ye-odontoid kulondoloza umsebenzi wokujikeleza we-C1-2 futhi kuye kwabikwa ezincwadini ukuthi kunesilinganiso sokuhlanganiswa esingu-88% kuya ku-100%.
Ngo-2014, uMarkus R nabanye bashicilela isifundo mayelana nendlela yokuhlinzwa yokulungisa isikulufu sangaphambili sokuphuka kwama-odontoid ku-Journal of Bone & Joint Surgery (Am). Lesi sihloko sichaza ngokuningiliziwe amaphuzu ayinhloko enqubo yokuhlinzwa, ukulandelwa ngemva kokuhlinzwa, izinkomba kanye nezinyathelo zokuphepha ngezinyathelo eziyisithupha.
Lesi sihloko sigcizelela ukuthi ukuphuka kohlobo lwesibili kuphela okuvumelekile ukuqondisa ukulungiswa kwesikulufu sangaphambili nokuthi ukulungiswa kwesikulufu esisodwa esingenalutho kuyathandwa.
Isinyathelo 1: Ukubeka isiguli endaweni yaso ngesikhathi sokuhlinzwa
1. Kumelwe kuthathwe ama-radiograph angaphambili nangaseceleni ukuze kubhekwe kumqhubi.
2. Isiguli kumele sigcinwe sivulekile umlomo ngesikhathi sokuhlinzwa.
3. Ukuphuka kufanele kubekwe kabusha ngangokunokwenzeka ngaphambi kokuqala kokuhlinzwa.
4. Umgogodla womlomo wesibeletho kufanele unwetshwe kakhulu ngangokunokwenzeka ukuze uthole ukuchayeka okuhle kakhulu kwesisekelo senqubo ye-odontoid.
5. Uma i-hyperextension yomgogodla womlomo wesibeletho ingenakwenzeka – isib., ekuqhekekeni kwe-hyperextension kanye nokufuduka kwangemuva kwengxenye yokugcina ye-cephalad yenqubo ye-odontoid – khona-ke kungacatshangelwa ukuhumusha ikhanda lesiguli liye kolunye uhlangothi oluphambene nomzimba waso.
6. vimba ikhanda lesiguli endaweni eqinile ngangokunokwenzeka. Ababhali basebenzisa uhlaka lwekhanda lweMayfield (oluboniswe kuZithombe 1 no-2).
Isinyathelo 2: Indlela Yokuhlinzwa
Indlela ejwayelekile yokuhlinzwa isetshenziswa ukuze kuvezwe ungqimba lwangaphambili lwe-tracheal ngaphandle kokulimaza noma yiziphi izakhiwo ezibalulekile zomzimba.
Isinyathelo 3: Indawo yokungena ngesikulufo
Indawo efanele yokungena itholakala engxenyeni engezansi engaphambili yesisekelo somzimba we-C2 vertebral. Ngakho-ke, umkhawulo ongaphambili wediski ye-C2-C3 kumele uvezwe. (njengoba kuboniswe kuZithombe 3 no-4 ngezansi) Isithombe 3
Umcibisholo omnyama kuMfanekiso 4 ubonisa ukuthi umgogodla we-C2 wangaphambili ubhekwa ngokucophelela ngesikhathi sokufundwa kwefilimu ye-axial CT ngaphambi kokuhlinzwa futhi kumele usetshenziswe njengophawu lokwakheka komzimba ukuze kunqunywe indawo yokufaka inaliti ngesikhathi sokuhlinzwa.
2. Qinisekisa indawo yokungena ngaphansi kokubukwa kwe-anteroposterior kanye ne-lateral fluoroscopic yomgogodla wesibeletho. 3.
3. Slayida inaliti phakathi komphetho ongaphezulu ongaphambili we-endplate ephezulu ye-C3 kanye nendawo yokungena ye-C2 ukuze uthole indawo yokungena yesikulufu efanele.
Isinyathelo 4: Ukubeka isikulufu
1. Inaliti ye-GROB engu-1.8 mm ububanzi ifakwa kuqala njengesiqondiso, inenaliti iqondiswe kancane ngemuva kwesihloko se-notochord. Ngemva kwalokho, kufakwa isikulufu esingenalutho esingu-3.5 mm noma esingu-4 mm ububanzi. Inaliti kufanele ihlale iqondiswa kancane ngaphansi kokuqapha kwe-anteroposterior kanye ne-lateral fluoroscopic.
2. Beka i-drill engenalutho ohlangothini lwe-guide pin ngaphansi kokuqapha kwe-fluoroscopic bese uyiqhubekisela phambili kancane kancane ize ingene ekwaphukeni. I-drill engenalutho akufanele ingene engxenyeni ye-cortex yohlangothi lwe-cephalad lwe-notochord ukuze i-guide pin ingaphumi ne-drill engenalutho.
3. Kala ubude besikulufu esingenalutho esidingekayo bese usiqinisekisa ngesilinganiso se-CT sangaphambi kokuhlinzwa ukuze uvimbele amaphutha. Qaphela ukuthi isikulufu esingenalutho sidinga ukungena ethanjeni le-cortical esiqongweni senqubo ye-odontoid (ukuze kube lula isinyathelo esilandelayo sokucindezelwa kokuphela kokuqhekeka).
Ezimweni eziningi zababhali, kwasetshenziswa isikulufu esisodwa esingenalutho ukuze kufakwe, njengoba kuboniswe kuMfanekiso 5, esitholakala phakathi nendawo phansi kwenqubo ye-odontoid ebheke i-cephalad, kanti isihloko sesikulufu singena nje ethanjeni le-cortical elingemuva ekugcineni kwenqubo ye-odontoid. Kungani kunconywa isikulufu esisodwa? Ababhali baphetha ngokuthi kungaba nzima ukuthola indawo yokungena efanele phansi kwenqubo ye-odontoid uma izikulufu ezimbili ezihlukene zingabekwa ku-5 mm ukusuka phakathi kwe-C2.
Isithombe 5 sibonisa isikulufu esingenalutho esitholakala phakathi nendawo esisekelweni senqubo ye-odontoid sibheke i-cephalad, kanti isihloko sesikulufu singena nje ku-cortex yethambo ngemuva nje kwesihloko senqubo ye-odontoid.
Kodwa ngaphandle kwesici sokuphepha, ingabe izikulufo ezimbili zandisa ukuzinza ngemva kokuhlinzwa?
Ucwaningo lwe-biomechanical olwanyatheliswa ngo-2012 kumagazini i-Clinical Orthopaedics and Related Research nguGang Feng et al. weRoyal College of Surgeons of the United Kingdom lubonise ukuthi isikulufu esisodwa nezikulufu ezimbili zinikeza izinga elifanayo lokuzinza ekuqiniseni ukuqhekeka kwama-odontoid. Ngakho-ke, isikulufu esisodwa sanele.
4. Uma indawo yokuqhekeka kanye nezikhonkwane zokuqondisa ziqinisekisiwe, kufakwa izikulufo ezifanele ezingenalutho. Indawo yezikulufo kanye nezikhonkwane kufanele ibhekwe ngaphansi kwe-fluoroscopy.
5. Kufanele kuqashelwe ukuqinisekisa ukuthi idivayisi yokugoqa ayibandakanyi izicubu ezithambile ezizungezile lapho kwenziwa noma yimiphi imisebenzi engenhla. 6. Qinisa izikulufo ukuze ufake ingcindezi endaweni yokuqhekeka.
Isinyathelo 5: Ukuvalwa Kwenxeba
1. Hlanza indawo yokuhlinzwa ngemva kokuqeda ukubeka isikulufu.
2. Ukususwa kwegazi ngokuphelele kubalulekile ukunciphisa izinkinga zangemva kokuhlinzwa njengokucindezelwa kwe-hematoma kwe-trachea.
3. Umsipha we-cervical latissimus dorsi oqoshiwe kumele uvalwe ngendlela eqondile noma ubuhle besibazi sangemva kokuhlinzwa buzophazamiseka.
4. Ukuvalwa okuphelele kwezingqimba ezijulile akudingekile.
5. Ukukhipha amanzi emanxebeni akuyona inketho edingekayo (ababhali ngokuvamile abafaki amapayipi okukhipha amanzi ngemva kokuhlinzwa).
6. Kunconywa ukuthi kufakwe izithungo zangaphakathi kwesikhumba ukuze kuncishiswe umthelela ekubukekeni kwesiguli.
Isinyathelo 6: Ukulandelela
1. Iziguli kufanele ziqhubeke nokugqoka i-brace eqinile entanyeni amasonto ayisithupha ngemva kokuhlinzwa, ngaphandle kokuthi ukunakekelwa kwabahlengikazi kudinga lokho, futhi kufanele zihlolwe ngezithombe zangemuva kokuhlinzwa njalo.
2. Ama-radiograph ajwayelekile e-anteroposterior kanye ne-lateral yomgogodla wesibeletho kufanele abuyekezwe emavikini angu-2, 6, kanye ne-12 kanye nasezinyangeni ezingu-6 kanye ne-12 ngemva kokuhlinzwa. I-CT scan yenziwe emavikini angu-12 ngemva kokuhlinzwa.
Isikhathi sokuthunyelwe: Disemba-07-2023
