Izindaba - OPEN-DOOR Posterior Cervical Laminoplasty inqubo

I-KEYPOINT

1. I-elec ye-unipolarummese we-tric usika i-fascia bese uhlanza imisipha ngaphansi kwe-periosteum, unake ukuvikela i-articular synovial joint, okwamanje i-ligament ezimpandeni zenqubo ye-spinous akufanele isuswe ukuze kugcinwe ubuqotho bebhande lokucindezeleka komlomo wesibeletho;

2. Naka to ukwanda kancane kancane kokuvulwa komnyango wonke, ama-spatula amabili amancane angasetshenziswa ukuvula ingxenye encane yepuleti elilodwa le-vertebral bese kuba enye, njalonjalo ngokuphindaphindiwe, futhi kancane kancane uyivule ububanzi obufanele (umsele womgogodla ukhuliswe ngo-4mm), ongagwema ukuphuka okuphelele kohlangothi olufakwe kuze kufike ezingeni eliphezulu kakhulu;

3. Lapho ivulag umnyango unilaterally, ukuluma i-ligamentum flavum endaweni yokuvula kungase kuholele ekopheni kwe-venous plexus, ngalesi sikhathi, ungethuki, ungasebenzisa i-bipolar electrocoagulation ukuze umise ukopha, noma izipontshi ze-gelatin ukumisa ukopha.

OPEN-DOOR Ukuhlinzwa komgogodla wesibeletho kwaqala kwasungulwa osolwazi baseJapan ngeminyaka yawo-1970. Nakuba sekuthuthukisiwe izikhathi eziningi, ukuhlinzwa okuyisisekelo okuyisisekelo kusafana kakhulu noma okuncane, okuyinto elula kakhulu futhi efana nokusebenza kwe-posterior double door nomthelela ofanayo wokwelapha, futhi kungenye yezindlela zakudala zokuhlinzwa komgogodla womlomo wesibeletho kwabahlinzayo bomgogodla.

1.OPEN-DOOR Expansile Cervical Laminoplasty

Lesi sihloko sivela eMnyangweni Wokuhlinza Kwezinzwa eSibhedlela saseNyuvesi yaseMiami eMiami, eFlorida, futhi mayelana nokukhethwa okuqondile kwenqubo, bakhethe inqubo yokuvula umnyango ukusuka ku-C3 kuya ku-C7 ezigulini eziningi, kuyilapho besebenzisa izimbambo ze-allograft ezivulekele indawo evulekile futhi zengezwe ngokufakwa kwe-autologous, njengoba kuchazwe ngezansi:

Isiguli sasibekwe endaweni evamile, ikhanda laligxilwe ngohlaka lwekhanda likaMayfield, itheyipu yayisetshenziselwa ukudonsa phansi ihlombe lesiguli futhi ililungise embhedeni wokuhlinza, i-1% i-lidocaine ne-epinephrine yasetshenziselwa ukungena endaweni bese isikhumba sihlanjululwa emgqeni ophakathi ukuze sifinyelele i-fascia, futhi imisipha yahlukunyezwa ngaphansi kwe-periosurgical fascia-fascia. ummese, nokuvikelwa kwamalunga e-articular synovial kwanakwa, futhi umgudu wempande ye-sphenoidal akufanele ukhishwe ukuze kugcinwe ubuqotho bebhande lokucindezeleka le-vertebrae yomlomo wesibeletho; ukuchayeka okuphezulu nangaphansi kwenziwa. Ububanzi bokuchayeka obuphezulu naphansi bufinyelele engxenyeni engezansi ye-C2 vertebral plate kanye nengxenye engenhla ye-T1 vertebral plate, kanti ingxenye yesithathu ephansi ye-C2 vertebral plate kanye nengxenye yesithathu engaphezulu ye-T1 vertebral plate yasuswa nge-grinding drill, bese i-ligamentum flavum ihlanzwa ngepuleti le-2-mm, ipuleti le-2-mm liveze ipuleti le-spin kanye nengxenye ye-spin bitten. i-forceps elumayo ukulungiselela ukufakwa kwethambo.

Okulandelayo ukuvulwa komnyango we-C3-C7 kwenziwa, njengoba kuboniswe emfanekisweni ongenhla, ngokuvamile uhlangothi olunezimpawu ezinzima kakhulu lwalusetshenziswa njengohlangothi lokuvula umnyango futhi uhlangothi olulula lwalusetshenziswa njengehinge, indawo yokuvula umnyango noma indawo yokufaka i-slotting yayisendaweni yokuhlangana kwepuleti lomgogodla kanye nokugqama kwe-articular, uhlangothi lokuvula umnyango lwaluphansi ngokusebenzisa i-cortex ngokubili kanye nomhlabathi we-hingending onqenqemeni lwekhanda kanye nongqimba oluhlangene lwekhanda. yasetshenziswa ukuvula umnyango.

Ngemuva kokugaya nge-cortex ngokubili, uhlangothi oluvulekile lomnyango ludinga ukuhlanzwa nge-ligamentum flavum nge-vertebral plate eluma forceps kuze kube yilapho isikhwama se-dural sibonakala ngokucacile, bese usebenzisa i-spatula encane ukuze uvule "umnyango" cishe ku-8-16mm bese ufaka ibhulokhi yokufakelwa, ukunaka ukukhuphuka kancane kancane komnyango osetshenziswa kancane kancane kancane kancane kuvuleke kancane kancane kuvuleke kancane kancane komnyango. vula ipuleti elilodwa le-vertebral ngenani elincane ngaphambi kokuvula elinye, bese uphinda inqubo, bese uvula umnyango kancane kancane ububanzi obufanele (umsele unwebeka ngo-4mm), futhi ngale ndlela, kungagwenywa ukugwema ukuphuka okuphelele ohlangothini lwe-slots kuze kufike ezingeni eliphezulu kakhulu.

Kufanele kube khona ukutholakala okuncane kokucindezeleka okucindezelayo endaweni lapho i-bone block ibekwe khona ngaphandle kwesidingo sokulungiswa kwangaphandle, futhi abalobi baye babona izinkinga ezimbalwa kakhulu emtholampilo lapho i-bone block iwela emgodini womgogodla, ngokufakwa kokugcina kwethambo kukhishwe inqubo ye-spinous ohlangothini lwe-hinge.

2.OPEN-DOOR Cervical Expansile Laminoplasty

Lesi sihloko, esivela eMnyangweni Wezokuhlinzwa Kwezinzwa e-Keck Medical Center yase-University of Southern California, sinesihloko esicishe sifane nesomqulu wangaphambili, noshintsho ekuhlelekeni kwamagama esiNgisi, kanye nezinga eliphezulu lokungaguquguquki endleleni yawo nefilosofi yokusebenza, futhi sibonisa ukufana ekuqeqeshweni kodokotela abahlinzayo e-United States.

Izingxenye zokuhlinzwa zazicishe zibe yi-C3-7 kuphela ukuze kube lula ukufuduka kwangemuva komgogodla; izimpande ze-sphenoidal zagcinwa ukuze kube lula ukuzinza komlomo wesibeletho; i-match head milling drill yasetshenziswa ukuvula umnyango ukuze kuncishiswe ukulimala komgogodla; kanye namabhulokhi amathambo abekwe ku-C3, 5, no-7 ukusekela ukuvulwa komnyango.

Inothi Lomfanekiso: A, Ukuvezwa kwe-lamina kusukela phansi kwe-C2 ukuya phezulu kwe-T1. b, Ukubhobozwa kwe-lateral groove nge-osteotomy ephelele ngakolunye uhlangothi kanye ne-osteotomy ingxenye ngakolunye uhlangothi. c, Ukuphakama kwe-lamina kusuka ku-C3 kuya ku-C7 njengeyunithi eyodwa. d, Ukubekwa kwe-allograft bone spacer.

Inothi Lomfanekiso: Ukubuka kwangaphakathi kokuhlinzwa ngemva kokumba izimbobo emiseleni esemaceleni ye-C3, C5, ne-C7 (A) nangemuva kokubekwa kwe-allograft rib spacer (B).

Kodwa-ke, i-bone graft material yayo, ngaphezu kwethambo le-allogeneic (Fig. A), i-vertebral autogenous bone graft eyenziwe nge-polylactic acid mesh, njengoba kuboniswe ngezansi (i-BC Fig.), Engavamile kakhulu e-China. Ngokuphathelene nobubanzi bokuvulwa komnyango, ububanzi obufanele bubhekwa njengo-10-15 mm, obuhluke kancane ku-8-16 mm ngaphezulu.

Lapho wenza ukuvulwa komnyango owodwa we-vertebral plate, ukuluma i-ligamentum flavum endaweni yokuvula umnyango kungase kubangele ukopha emthanjeni, ngalesi sikhathi ungesabi, ungasebenzisa i-bipolar electrocoagulation ukumisa ukopha noma isiponji se-gelatin ukumisa ukopha.

3.I-Cervical Laminoplasty

Ngaphandle kokusekela ibhulokhi yamathambo ekuvuleni komnyango, ezinye izindlela zokulungisa ukuvulwa komnyango zichazwe kulesi sihloko, njengendlela yokubopha i-tie-wire kanye nendlela yokulungisa ama-microplates, okwamanje okuvame ukusetshenziswa kakhulu ekusebenzeni komtholampilo futhi inikeza ukulungiswa okuphephile.