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 kuthi elinye, njalonjalo ngokuphindaphindiwe, futhi kancane kancane livule ububanzi obufanele (i umsele womgogodla ukhuliswe ngo-4mm), ongagwema ukuphuka okuphelele kohlangothi olufakiwe kuze kube sezingeni eliphezulu;

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, okulula kakhulu futhi okufana nokusebenza kwe-posterior double door nomthelela ofanayo wokwelapha, futhi kungenye yokuhlinzwa okuvamile komgogodla wesibeletho odokotela abahlinza umgogodla.

1.OPEN-DOOR Expansile Cervical Laminoplasty

Lesi sihloko sivela eMnyangweni Wokuhlinzwa Kwezinzwa eSibhedlela saseNyuvesi yaseMiami eMiami, eFlorida, futhi ngokuya ngenqubo ethile yokukhetha, bakhethe inqubo yokuvula umnyango ukusuka ku-C3 kuya ku-C7 ezigulini eziningi, kuyilapho besebenzisa izimbambo ze-allograft ivuleleke endaweni enomnyango ovulekile futhi yengezwe ngokufakwa kwe-autologous, njengoba kuchazwe ngezansi:

Isiguli sibekwe endaweni ethambekele, ikhanda lalungiswa ne-Mayfield head frame, i-tape yasetshenziselwa ukudiliza ihlombe lesiguli futhi ilungiswe embhedeni wokuhlinza, i-1% i-lidocaine ne-epinephrine isetshenziselwa ukungena endaweni bese emva kwalokho isikhumba. yasikwa emgqeni ophakathi ukuze ifinyelele i-fascia, futhi imisipha yahluthulwa ngaphansi kwe-periosteum ngemva kokusikwa kwe-fascia ngommese wesiteji esisodwa we-electrosurgical, futhi ukuvikelwa kwamalunga e-articular synovial kwanakwa, kanye nomgudu womgogodla. impande ye-sphenoidal akufanele ikhishwe 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-drill drill, bese kuthi i-ligamentum flavum ihlanzwe nge-forceps yepuleti elingu-2-mm ukuze kuvezwe i-dura mater, futhi ingxenye yenqubo ye-spinous yalunywa yi-forceps elumayo ukuze kulungiselelwe 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 indawo okuhlangana kuyo ipuleti lomgogodla kanye nokugqama kwe-articular, uhlangothi lokuvula umnyango lwalugaywe nge-cortex ngokubili futhi uhlangothi lwehinji lwalugaywe nge-cortex ngongqimba olulodwa, futhi ikhanda likamentshisi eligayayo lasetshenziswa ekuvuleni komnyango.

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" kuya cishe ku-8-16mm bese ufaka ibhulokhi yokufakelwa, ukunaka ukwanda kancane kancane kosayizi jikelele womnyango ovulekile, futhi ama-spatula amabili amancane angasetshenziswa ukuvula ipuleti elilodwa lomgogodla ngenani elincane ngaphambi kokuvula elinye. , bese uphinda inqubo, bese uvula umnyango kancane kancane ububanzi obufanele (umsele unwebeka ngo-4mm), futhi ngale ndlela, ungagwenywa ukugwema ukuphuka okuphelele ohlangothini lwe-slots kuze kube sezingeni eliphezulu. kungenzeka.

Kufanele kube khona 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, ngokufakelwa kokugcina. kwethambo elikhishwe enqubweni ye-spinous ohlangothini lwe-hinge.

2.OPEN-DOOR Cervical Expansile Laminoplasty

Lesi sihloko, esivela eMnyangweni Wezokuhlinzwa Kwezinzwa e-Keck Medical Center yaseNyuvesi yaseSouthern California, sinesihloko esicishe sifane nesomqulu wangaphambili, ngoshintsho ekuhlelekeni kwamagama esiNgisi, kanye nezinga eliphezulu lokungaguquguquki endleleni yawo kanye nendlela yawo. ifilosofi yokusebenza, futhi ikhombisa 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 uvula umnyango owodwa wepuleti lomgogodla, ukuluma i-ligamentum flavum endaweni yokuvuleka komnyango kungase kubangele ukopha emthanjeni, ngalesi sikhathi ungesabi, ungasebenzisa i-bipolar electrocoagulation ukumisa ukopha noma isiponji se-gelatin. ukumisa ukopha.

3.I-Cervical Laminoplasty

Ngaphezu kokusekela ibhulokhi yethambo ekuvuleni komnyango, ezinye izindlela zokulungisa ukuvulwa komnyango zichazwe kulesi sihloko, njengendlela yokubopha i-tie-wire kanye nendlela yokulungisa ama-microplates, okwamanje asetshenziswa kakhulu emtholampilo. futhi inikeza ukulungiswa okuphephile.