Izindaba - Inqubo ye-Posterior Cervical Laminoplasty EVULEKILE

I-KEYPOINT

1. Ugesi we-unipolarUmmese oqinile usika i-fascia bese ukhipha imisipha ngaphansi kwe-periosteum, qaphela ukuvikela i-articular synovial joint, okwamanje i-ligament emsukeni wenqubo ye-spinous akufanele isuswe ukuze kugcinwe ubuqotho be-cervical tension band;

2. NakaUma umnyango wonke uvulwa kancane kancane, kungasetshenziswa ama-spatula amabili amancane ukuvula ingxenye encane yepuleti elilodwa lomgogodla bese kuba elinye, njalo njalo, bese ulivula kancane kancane libe ububanzi obufanele (umsele womgogodla ukhuliswa ngo-4mm), okungagwema ukuphuka ngokuphelele kohlangothi olunezikhala ngezinga eliphezulu ngangokunokwenzeka;

3. Uma uvulaUma umnyango ungena eceleni, ukuluma i-ligamentum flavum endaweni yokuvula kungaholela ekuphumeni kwegazi okuvela ku-venous plexus, ngalesi sikhathi, ungesabi, ungasebenzisa i-bipolar electrocoagulation ukuze umise ukuphuma kwegazi, noma iziponji ze-gelatin ukuze umise ukuphuma kwegazi.

OKUVULIWE Ukuhlinzwa komgogodla wesibeletho ngemuva kwasungulwa okokuqala yizazi zaseJapane ngawo-1970. Nakuba sekuthuthukiswe izikhathi eziningi, ukuhlinzwa okuyisisekelo kusafana kakhulu, okulula kakhulu futhi okufana nokuhlinzwa kweminyango emibili ngemuva okunomphumela ofanayo wokwelapha, futhi kungenye yokuhlinzwa komgogodla wesibeletho okuvamile kodokotela abahlinzayo bomgogodla.

1. I-Expansile Cervical Laminoplasty Evulekile Yomnyango

Lesi sihloko sivela eMnyangweni Wezokuhlinzwa Kwezinzwa e-University of Miami Hospital eMiami, eFlorida, futhi ngokwendlela ethile yokukhetha inqubo, bakhethe inqubo evulekile kusukela ku-C3 kuya ku-C7 yeziguli eziningi, ngenkathi befaka izimbambo ze-allograft eziphakanyiswe endaweni evulekile futhi zifakwe izimila ze-autologous, njengoba kuchaziwe ngezansi:

Isiguli sabekwa endaweni eqondile, ikhanda laqiniswa ngohlaka lwekhanda likaMayfield, itheyiphu yasetshenziselwa ukudonsa ihlombe lesiguli bese ilifaka embhedeni wokuhlinzwa, i-1% ye-lidocaine kanye ne-epinephrine kwasetshenziswa ekungeneni kwendawo bese isikhumba sanqunywa eceleni komugqa ophakathi ukuze sifinyelele i-fascia, futhi imisipha yahlutshulwa ngaphansi kwe-periosteum ngemva kokusikwa kwe-fascia ngommese wokuhlinzwa we-electro-stage eyodwa, futhi kwanakwa ukuvikelwa kwamalunga e-synovial articular, futhi i-ligament yempande ye-sphenoidal akufanele ikhishwe ukuze kugcinwe ubuqotho bebhande lokucindezeleka lamathambo omgogodla womlomo wesibeletho; ukuvezwa okuphezulu nokuphansi kwenziwa. Ububanzi bokuchayeka obuphezulu nobuphansi bufinyelela engxenyeni engezansi yepuleti le-C2 vertebral kanye nengxenye engenhla yepuleti le-T1 vertebral, kanti ingxenye yesithathu engezansi yepuleti le-C2 vertebral kanye nengxenye yesithathu engenhla yepuleti le-T1 vertebral kwasuswa nge-grinding drill, kwabe sekususwa i-ligamentum flavum nge-2-mm plate biting forceps ukuze kuvezwe i-dura mater, kanti ingxenye yenqubo ye-spinous yalunywa yi-biting forceps ukulungiselela ukufakwa kwethambo.

Okulandelayo kwenziwa ukuvulwa komnyango we-C3-C7, njengoba kuboniswe esithombeni esingenhla, ngokuvamile uhlangothi olunezimpawu ezisindayo lusetshenziswe njengohlangothi lokuvulwa komnyango kanti uhlangothi olukhanyayo lusetshenziswe njenge-hinge, ukuvulwa komnyango noma indawo yokubeka kwakusendaweni yokuhlangana kwepuleti lomgogodla kanye nokuvelela kwe-articular, uhlangothi lokuvulwa komnyango lwalugaywe nge-cortex ngamabili kanti uhlangothi lwe-hinge lwalugaywe nge-cortex ngeleveli eyodwa, kanti ikhanda lokugaya likamatshisi lasetshenziswa ekuvuleni komnyango.

Ngemva kokugaya i-cortex ngezindlela ezimbili, uhlangothi oluvulekile lomnyango ludinga ukuhlanzwa nge-ligamentum flavum nge-vertebral plate biting forceps kuze kube yilapho i-dural sac ibonakala kahle, bese usebenzisa i-spatula encane ukuvula "umnyango" ube cishe ngu-8-16mm bese ufaka i-implant block, unake ukwanda kancane kancane kosayizi womnyango ovulekile, futhi ama-spatula amabili amancane angasetshenziswa ukuvula i-vertebral plate eyodwa ngenani elincane ngaphambi kokuvula elinye, bese uphinda inqubo, bese uvula umnyango kancane kancane ube ububanzi obufanele (umsele uyanda ngo-4mm), futhi ngale ndlela, kungagwenywa ukugwema ukuphuka okuphelele ohlangothini lwezikhala ngezinga eliphezulu ngangokunokwenzeka.

Kufanele kube khona ukucindezeleka okuncane endaweni lapho kubekwa khona i-bone block ngaphandle kwesidingo sokulungiswa kwangaphandle, futhi ababhali babone izinkinga ezimbalwa kakhulu emtholampilo lapho i-bone block iwela khona emgudwini womgogodla, lapho ukufakwa kokugcina kwethambo kususwa enkambisweni ye-spinous ohlangothini lwe-hinge.

2. I-Laminoplasty Evulekile Yesibeletho Ebanzi Yesibeletho

Lesi sihloko, esivela kuMnyango Wezokuhlinzwa Kwezinzwa eKeck Medical Center yaseNyuvesi yaseNingizimu California, sicishe sifane nesihloko sangaphambilini, ngokushintsha kokulandelana kwamagama esiNgisi, kanye nezinga eliphakeme lokuvumelana endleleni yaso kanye nefilosofi yokusebenza, futhi sibonisa ukufana ekuqeqeshweni kodokotela abahlinzayo e-United States.

Izingxenye zokuhlinzwa cishe zaziyi-C3-7 kuphela ukuze kube lula ukuhambisa umgogodla ngemuva; izimpande ze-sphenoidal zagcinwa ukuze kube lula ukuzinza komlomo wesibeletho; kwasetshenziswa i-drill yokugaya ikhanda likamatshisi ukuvula umnyango ukuze kuncishiswe umonakalo emgogodleni; futhi amabhlogo ethambo abekwa ku-C3, 5, kanye no-7 ukuze kusekelwe ukuvulwa komnyango.

Isibalo Qaphela: A, Ukuvezwa kwe-lamina kusukela phansi kwe-C2 kuya phezulu kwe-T1. b, Ukubhoboza umsele ohlangothini olune-osteotomy ephelele ohlangothini olulodwa kanye ne-osteotomy engaphelele kolunye uhlangothi. c, Ukuphakama kwe-lamina kusuka ku-C3 kuya ku-C7 njengeyunithi eyodwa. d, Ukubekwa kwe-allograft bone spacer.

Inothi Lomfanekiso: Umbono wokuhlinzwa ngemva kokubhoboza imigodi emifuleni eseceleni ye-C3, C5, kanye ne-C7 (A) kanye nokubekwa kwesikhala se-allograft rib (B).

Kodwa-ke, izinto zayo zokufakelwa kwamathambo, ngaphezu kwethambo le-allogeneic (Umfanekiso A), iyi-vertebral autogenous bone graft eyenziwe nge-polylactic acid mesh, njengoba kuboniswe ngezansi (Umfanekiso we-BC), okuyinto engavamile eShayina. Ngokuphathelene nobubanzi bokuvulwa komnyango, ububanzi obufanele bubhekwa njengo-10-15 mm, okuhlukile kancane kuno-8-16 mm ngaphezulu.

Uma wenza ukuvula umnyango owodwa we-vertebral plate, ukuluma i-ligamentum flavum endaweni yokuvula komnyango kungabangela ukuphuma kwegazi emthanjeni, ngalesi sikhathi ungesabi, ungasebenzisa i-bipolar electrocoagulation ukuze umise ukuphuma kwegazi noma i-gelatin sponge ukuze umise ukuphuma kwegazi.

3. I-Laminoplasty yomlomo wesibeletho

Ngaphezu kokusekela i-bone block ekuvulekeni komnyango, ezinye izindlela zokulungisa ukuvulwa komnyango zichazwe kulesi sihloko, njengendlela yokubopha ucingo kanye nendlela yokulungisa ama-microplates, okuyindlela yokugcina esetshenziswa kakhulu emtholampilo futhi enikeza ukuqina okuphephile.