Ukulungiswa kwesikulufu sangaphambili senqubo ye-odontoid kugcina umsebenzi wokujikeleza we-C1-2 futhi kubikwe ezincwadini ukuthi kube nesilinganiso sokuhlanganisa esingu-88% kuya ku-100%.
Ngo-2014, u-Markus R et al washicilela okokufundisa ngendlela yokuhlinza yokulungisa isikulufu sangaphambili sokuphuka kwe-odontoid ku-Journal of Bone & Joint Surgery (Am).Lesi sihloko sichaza ngokuningiliziwe amaphuzu ayinhloko wenqubo yokuhlinzwa, ukulandelwa kwe-postoperative, izinkomba kanye nezindlela zokuphepha ezinyathelweni eziyisithupha.
I-athikili igcizelela ukuthi uhlobo lwe-II kuphela ukuphuka okuvumelekile ukuze kuqondiswe ukulungiswa kwesikulufu sangaphambili nokuthi ukulungiswa kwesikulufu esisodwa esingenalutho kuyakhethwa.
Isinyathelo 1: Ukuma kwesiguli ngaphakathi kokuhlinzwa
1. Ama-radiographs alungile we-anteroposterior kanye ne-lateral kufanele athathwe ukuze kusetshenziswe ireferensi yomsebenzisi.
2. Isiguli kufanele sigcinwe sivuleke umlomo ngesikhathi sokuhlinzwa.
3. Ukuphuka kufanele kubekwe kabusha ngangokunokwenzeka ngaphambi kokuqala kokuhlinzwa.
4. Umgogodla womlomo wesibeletho kufanele u-hyperextended ngangokunokwenzeka ukuze uthole ukuvezwa okuphelele kwesisekelo senqubo ye-odontoid.
5. Uma i-hyperextension yomgogodla womlomo wesibeletho ingenakwenzeka - isibonelo, ekuqhekekeni kwe-hyperextension nge-posterior displacement yokuphela kwe-cephalad yenqubo ye-odontoid - khona-ke ukucatshangelwa kungase kunikezwe ukuhumusha ikhanda lesiguli ngokuphambene nesiqu sakhe.
6. vimbela ikhanda lesiguli endaweni ezinzile ngangokunokwenzeka.Ababhali basebenzisa ifreyimu yekhanda likaMayfield (eliboniswe kuMfanekiso 1 no-2).
Isinyathelo sesi-2: Indlela yokuhlinzwa
Indlela yokuhlinzwa evamile isetshenziselwa ukuveza ungqimba lwangaphambili lwe-tracheal ngaphandle kokulimaza noma yiziphi izakhiwo ezibalulekile ze-anatomical.
Isinyathelo sesi-3: Indawo yokufaka isikulufu
Iphuzu lokungena elilungile litholakala emaphethelweni angaphambili angaphansi kwesisekelo somzimba we-vertebral C2.Ngakho-ke, unqenqema lwangaphambili lwediski ye-C2-C3 kufanele luvezwe.(njengoba kukhonjisiwe kuMfanekiso 3 no-4 ngezansi) Umfanekiso 3
Umcibisholo omnyama ku-Figure 4 ubonisa ukuthi umgogodla we-C2 wangaphambili ubhekwa ngokucophelela ngesikhathi sokufunda kwangaphambili kwefilimu ye-axial CT futhi kufanele isetshenziswe njengophawu lwendawo ye-anatomical ekunqumeni iphuzu lokufakwa kwenaliti ngesikhathi sokuhlinzwa.
2. Qinisekisa iphuzu lokungena ngaphansi kokubukwa kwe-anteroposterior kanye ne-lateral fluoroscopic yomgogodla womlomo wesibeletho.3.
3. Shelelezisa inaliti phakathi konqenqema lwangaphambili lwangaphezulu lwe-endplate engenhla ye-C3 kanye nendawo yokungena ye-C2 ukuze uthole indawo ekahle yokungena ngesikulufu.
Isinyathelo sesi-4: Ukubekwa kwesikulufu
1. Inalithi ye-GROB engu-1.8 mm ifakwa okokuqala njengegayidi, inaliti iqonde kancane ngemuva kwechopho le-notochord.Kamuva, kufakwa isikulufu esingenalutho esingu-3.5 mm noma esingu-4 mm ububanzi.Inaliti kufanele ihlale ithuthuke kancane i-cephalad ngaphansi kokuqapha kwe-anteroposterior kanye ne-lateral fluoroscopic.
2. Beka i-drill engenalutho ngasendleleni yephinikhodi ngaphansi kokuqapha kwe-fluoroscopic futhi uyithuthuke kancane kancane ize ingene ekuqhekekeni.I-drill engenalutho akufanele ingene ku-cortex yohlangothi lwe-cephalad lwe-notochord ukuze iphinikhodi ingaphumi nge-drill engenalutho.
3. Linganisa ubude besikulufu esingenalutho esidingekayo bese usiqinisekisa ngesilinganiso se-CT sangaphambi kokusebenza ukuze uvimbele amaphutha.Qaphela ukuthi isikulufu esingenalutho sidinga ukungena ethanjeni lekholamu ekugcineni kwenqubo ye-odontoid (ukwenza kube lula isinyathelo esilandelayo sokucindezelwa kokuphela kokuphuka).
Ezimweni eziningi zababhali, kusetshenziswe isikulufu esisodwa esingenalutho ukuze kulungiswe, njengoba kukhonjisiwe kuMfanekiso 5, obekwe phakathi nendawo phansi kwenqubo ye-odontoid ebheke ku-cephalad, ichopho lesikulufu lingena nje ethanjeni lekhohlo elingemuva. ithiphu yenqubo ye-odontoid.Kungani kunconywa isikulufa esisodwa?Ababhali baphethe ngokuthi kungaba nzima ukuthola indawo efanelekile yokungena esisekelweni senqubo ye-odontoid uma izikulufi ezimbili ezihlukene zizobekwa ngo-5 mm ukusuka emgqeni ophakathi we-C2.
Umfanekiso wesi-5 ubonisa isikulufu esingenalutho esiphakathi nendawo phansi kwenqubo ye-odontoid ebheke ku-cephalad, isihloko sesikulufu singena nje ku-cortex yethambo ngemva nje kwesihloko senqubo ye-odontoid.
Kodwa ngaphandle kwesici sokuphepha, ingabe izikulufi ezimbili zandisa ukuzinza kwangemva kokuhlinzwa?
Ucwaningo lwe-biomechanical olwanyatheliswa ngo-2012 kumagazini we-Clinical Orthopedics kanye Nocwaningo Oluhlobene lukaGang Feng et al.yeRoyal College of Surgeons yase-United Kingdom yabonisa ukuthi isikulufu esisodwa nezikulufu ezimbili zinikeza izinga elifanayo lokuzinza ekulungiseni ukuphuka kwe-odontoid.Ngakho-ke, isikulufa esisodwa sanele.
4. Lapho isikhundla sokuphuka kanye nezikhonkwane zomhlahlandlela kuqinisekiswa, izikulufa ezingenalutho ezifanele zibekwe.Ukuma kwezikulufu nezikhonkwane kufanele kubhekwe ngaphansi kwe-fluoroscopy.
5. Kufanele kuqikelelwe ukuthi isikulufa asibandakanyi izicubu ezithambile ezizungezile lapho kwenziwa noma yimiphi imisebenzi engenhla.6. Qinisa izikulufo ukuze ufake ingcindezi endaweni yokuphuka.
Isinyathelo sesi-5: Ukuvalwa Kwenxeba
1. Hlanza indawo yokuhlinza ngemva kokuqeda ukubeka isikulufu.
2. I-haemostasis ephelele ibalulekile ukuze kuncishiswe izinkinga zangemva kokuhlinzwa njengokucindezelwa kwe-hematoma kuqhoqhoqho.
3. Umsipha womlomo wesibeletho we-latissimus dorsi osikiwe kufanele uvalwe ngokuqondanisa okunembile noma ubuhle besibazi sangemva kokuhlinzwa kuzophazamiseka.
4. Ukuvalwa okuphelele kwezingqimba ezijulile akudingekile.
5. Ukugeleza kwamanxeba akuyona inketho edingekayo (ababhali ngokuvamile abawabeki ama-drain postoperative).
6. I-Intradermal sutures inconywa ukunciphisa umthelela ekubukeni kwesiguli.
Isinyathelo sesi-6: Ukulandelela
1. Iziguli kufanele ziqhubeke nokugqoka i-brace yentamo eqinile amasonto angu-6 ngemva kokuhlinzwa, ngaphandle uma ukunakekelwa kwabahlengikazi kudinga lokho, futhi kufanele kuhlolwe nge-imaging yezikhathi ezithile ngemva kokuhlinzwa.
2. I-radiographs ejwayelekile ye-anteroposterior kanye ne-lateral yomgogodla womlomo wesibeletho kufanele ibuyekezwe kumaviki angu-2, 6, kanye ne-12 kanye nezinyanga ezingu-6 kanye ne-12 ngemva kokuhlinzwa.I-CT scan yenziwa emavikini angu-12 ngemva kokuhlinzwa.
Isikhathi sokuthumela: Dec-07-2023
