Izindaba - Inqubo Evulekile Yomlomo We-Doverical Lamical Lamitoplasty

I-keyyioner

1. I-Elec ye-Unipolar ElecI-Tric Knise isusa i-fascia bese ibheka umsipha ngaphansi kwe-periosteum, naka ukuvikela i-articular synovial ehlanganisiwe, ngaleso sikhathi i-ligament esempandeni yenqubo ye-spinous akufanele isuswe ukuze kugcinwe ubuqotho bebhendi yesibeletho;

2. Naka ukunaka to Ukwanda kancane kancane kokuvulwa komnyango kuphele konke, ama-spatulas amabili amancane angasetshenziswa ukuvula ingxenye encane yepuleti elilodwa le-vertebral bese elinye isikhathi, futhi likhuphule kancane, futhi likhuphuke kancane, elingakugwema ukuqhekeka okuphelele kohlangothi olubekiwe ngezinga elibunjiwe ngezinga elithile.

3. Lapho Openg umnyango ononiaterally, uluma i-ligavam ye-ligatum endaweni yokuvula kungaholela egcekeni kusuka ku-plexus ye-venous, ngalesi sikhathi, ungabi ukwethuka, ungafaka isicelo se-bipolar ukumisa ukopha, noma izipanji ze-gelatin ukumisa ukopha.

Ukuhlinzwa okuvulekile komnyango ovulekile umgogodla wesibeletho kwasungulwa kuqala izazi zaseJapan ngawo-1970. Yize ithuthukisiwe kaningi, ukuhlinzwa okuyisisekelo kusesekufana, okulula kakhulu, okufana kakhulu nokusebenza okungemuva komnyango ongemuva komphumela wezokwelapha ofanayo, futhi kungenye yemicibisholo ye-Classical Spine Spine yokwelashwa komgogodla.

1.Open-door Expansife Cervical Lamitopsty

Lo mbhalo uvela eMnyangweni Wezinzwa ze-Neurology esibhedlela sase-University of Miami eMiami, eFlorida, nangokukhethwa kwenqubo ethile evela ku-C3 kuye ku-C3 ku-C3 evulekele i-C3 ku-AUTOlolous, njengoba kuchazwe ngezansi: njengoba kuchazwe ngezansi:

Isiguli sabekwa endaweni ethambekele, ikhanda lalilungisiwe ngohlaka lwe-mayfield, i-tepi lalisetshenziselwa ukwehlisa ihlombe lesiguli futhi lisuswe embhedeni wendawo ukuze lifinyelele embhedeni wendawo, bese kubanjiswa izicubu ezivela ngaphansi kwe-fascia nge-fascia eyodwa ye-electrosurgical, futhi ukuvikelwa kwamalunga amalunga ayisihlobo e-articular kwabhekwa, futhi i-ligament yempande ye-sphonoidal akufanele iphinde yavuke ukuze kugcinwe ubuqotho bebhendi yengxabano ye-vertebrae yesibeletho; Kwenziwa ukuvezwa okuphezulu nangaphansi. Amabanga aphezulu aphezulu nangaphansi afinyelela engxenyeni engezansi yepuleti ye-C2 Vertebral kanye nengxenye engenhla yepuleti ye-T1 Vertebral, bese kuthi ingxenye engezansi yepuleti ye-T1 vertebral kanye nengxenye yesithathu ye-T1 vertebral ipuleti yokugaya i-forceps yokuluma ipuleti ukuze kudalulwe i-dura mater, kanye nengxenye ye Inqubo eSpinoud yalunywa yibutho elimazayo ukulungiselela ukufakwa kwethambo.

Ngokulandelayo kwenziwa ukuvulwa komnyango kwe-C3-C3, njengoba kukhonjisiwe kwisibalo esingenhla, ngokuvamile kusetshenziswe uhlangothi lwezimpawu ezisindayo kanye nohlangothi olukhanyayo lwalusetshenziswa nge-cortex, uhlangothi lwe-hinge lube semhlabathini nge-cortex engxenyeni eyodwa, kanye nomdlalo Ikhanda lokugaya ikhanda lalisetshenziselwa ukuvulwa komnyango.

Ngemuva kokugaya nge-cortex ehlanganayo, uhlangothi oluvulekile lomnyango ludinga ukuhlanzwa nge-ligavam ye-ligatum nge-vertebral Plate ForcePs kuze kube yilapho i-spatula ye-vertebral peple ivulekile, bese ifaka ukugcwala kancane kancane, futhi ama-spatulas amabili amancane angasetshenziswa Vula ipuleti elilodwa le-vertebral ngenani elincane ngaphambi kokuvula elinye, bese uphinda inqubo, bese uvula umnyango kancane kancane ku-4mm), futhi ngale ndlela, kungagwenywa ukugwema ukwaphuka okuphelele ohlangothini lwama-slots kuze kube sezingeni eliphelele.

Kufanele kube khona ubukhona obuncane bokucindezelwa okucindezelayo esizeni lapho i-bone block ibekwa ngaphandle kwesidingo sokulungiswa kwangaphandle, futhi ababhali babone kakhulu ubunzima emthonjeni lapho kuqubuka khona ithambo elisuswe kwinqubo ye-hinge.

I-2.open-door Cervical Expansile Laminoplasty

Lo mbhalo, ovela eMnyangweni weNeurosurgery eKeck Medical Center ye-University of Southern California, ucishe abe yisihloko esifanayo, futhi ushintsho ngokulandelana kokusebenza kwalo, futhi ukhombisa ukufana ekuqeqeshweni kodokotela abahlinzayo e-United States.

Izingxenye ezihlinzayo zazicishe zaba yi-C3-7 ukwenza lula ukuthunyelwa kwangemuva kwentambo yomgogodla; Ama-ligaments ezimpande ze-sphonoidal agcinwe ukwenza lula ukuqina kwesibeletho; Ikhanda lekhanda lokufanisa elidilikayo lalisetshenziselwa ukuvula umnyango ukuze linciphise ukulimala kwentambo yomgogodla; Futhi amabhulokhi amathambo abekwe ku-C3, 5, no-7 ukusekela ukuvulwa komnyango.

Umdwebo uqaphele: a, ukuvezwa kwe-lamina kusuka ezansi kwe-C2 kuya phezulu kwe-T1. b, ukumba komkhawulo we-lateral nge-osteotomy ephelele ohlangothini olulodwa kanye ne-osteotomy ethile ngakolunye uhlangothi. C, ukuphakama kwe-lamina kusuka ku-C3 kuye ku-C7 njengeyunithi elilodwa. d, ukubekwa kwe-allograft yamathambo amathambo.

Umdwebo uqaphele: Ukubuka okungabambisane ngemuva kokumba izimbobo ezihlangene ezithombeni zakamuva ze-C3, C5, ne-C7 (a) nangemva kokubekwa kwe-albacraft (b).

Kodwa-ke, impahla yayo yokuxhuma ithambo, ngaphezu kwethambo le-allogeneic (Fig. A), i-vertebral autogenous bone yokuhlanganiswa kwe-polylactic acid mesh, njengoba kukhonjisiwe ngezansi (BC Fig.), Okungajwayelekile eChina. Ngokwesilinganiso sobubanzi bokuvula umnyango, ububanzi obuhle bubhekwa njenge-10-15 mm, ehluke kancane kusuka ku-8-16 mm ngaphezulu.

Lapho wenza ukuvulwa komnyango okukodwa kwepuleti le-vertebral, kuluma i-ligavam ye-ligaveral endaweni yokuvulwa komnyango kungaholela ekuvulekeni komnyango kungahle kube nokuphambuka, ungafaka i-bipolar electronge ukuze umise ukopha noma i-gelatin sponge ukuze umise ukopha.

3.City Laminoplasty

Ngaphezu kokusekela i-bone block ekuvuleni komnyango, ezinye izindlela zokulungisa ukuvula umnyango zichazwe kule ndalo, njengendlela yokufaka uthayela kanye nendlela esetshenziswayo evame ukusetshenziswa kakhulu ekusebenzeni kwemitholampilo futhi ihlinzeka ngokulungiswa okuphephile.