Amaphutha esiguli sokuhlinzwa nawesayithi abucayi futhi ayavinjelwa. Ngokusho kweJoint Commission on Accreditation of Healthcare Organizations, amaphutha anjalo angenziwa kufika ku-41% wokuhlinzwa kwamathambo/kwezingane. Ngokuhlinzwa komgogodla, iphutha lesayithi lokuhlinzwa lenzeka lapho ingxenye ye-vertebral noma i-lateralization ingalungile. Ngaphandle kokwehluleka ukubhekana nezimpawu zesiguli kanye ne-pathology, amaphutha esigaba angaholela ezinkingeni ezintsha zezokwelapha ezifana nokusheshisa ukuwohloka kwe-disc noma ukungazinzi komgogodla kwezinye izingxenye ezingabonakali noma ezivamile.
Kukhona nezindaba ezingokomthetho ezihlobene namaphutha ezigaba ekuhlinzeni umgogodla, futhi umphakathi, izikhungo zikahulumeni, izibhedlela, nemiphakathi yodokotela abahlinzayo abawabekezeleli nhlobo amaphutha anjalo. Ukuhlinzwa okuningi komgogodla, okufana ne-discectomy, i-fusion, i-laminectomy decompression, ne-kyphoplasty, kwenziwa ngokusebenzisa indlela yangemuva, futhi ukubeka kahle kubalulekile. Naphezu kobuchwepheshe bamanje bokuthwebula izithombe, amaphutha esigaba asasenzeka, amazinga ezigameko asukela ku-0.032% kuya ku-15% abikwe ezincwadini. Asikho isiphetho sokuthi iyiphi indlela yokwenziwa kwasendaweni enembe kakhulu.
Izazi ezivela eMnyangweni Wokuhlinza Amathambo eMount Sinai School of Medicine, e-USA, zenze ucwaningo lwemibuzo ku-inthanethi oluphakamisa ukuthi iningi lodokotela abahlinza umgogodla basebenzisa izindlela ezimbalwa kuphela zokwenza indawo, nokuthi ukucaciswa kwezimbangela ezijwayelekile zamaphutha kungasebenza ukunciphisa amaphutha esigaba sokuhlinzwa, esihlokweni esanyatheliswa ngo-May 2014 ku-Spine J. Ucwaningo lwenziwe kusetshenziswa i-questionnaire ethunyelwe nge-imeyili. Ucwaningo lwenziwe kusetshenziswa isixhumanisi esithunyelwe nge-imeyili kuhlu lwemibuzo oluthunyelwe kumalungu e-North American Spine Society (okuhlanganisa odokotela abahlinza amathambo nama-neurosurgeon). Uhlu lwemibuzo luthunyelwe kanye kuphela, njengoba kunconywe yiNorth American Spine Society. Ingqikithi yodokotela be-2338 bayitholile, i-532 ivule isixhumanisi, futhi i-173 (isilinganiso sokuphendula esingu-7.4%) igcwalise uhlu lwemibuzo. Amaphesenti angamashumi ayisikhombisa nambili abaqedile ayengodokotela bamathambo, i-28% yayingama-neurosurgeon, kanti i-73% yayingodokotela bomgogodla ekuqeqesheni.
Uhlu lwemibuzo luqukethe isamba semibuzo engu-8 (Umdwebo 1) ehlanganisa izindlela ezivame ukusetshenziswa kakhulu zokwenza kwasendaweni (zombili izimpawu zendawo ze-anatomical nokwenza kwasendaweni kwesithombe), izehlakalo zamaphutha esigaba sokuhlinzwa, kanye nokuhlotshaniswa phakathi kwezindlela zokwenza kwasendaweni kanye namaphutha ezigaba. Uhlu lwemibuzo aluzange luhlolwe noma luqinisekiswe. Uhlu lwemibuzo luvumela ukukhetha kwezimpendulo eziningi.
Umfanekiso 1 Imibuzo eyisishiyagalombili evela kuhlu lwemibuzo. Imiphumela yabonisa ukuthi i-intraoperative fluoroscopy yayiyindlela evame ukusetshenziswa kakhulu yendawo yokuhlinzwa kwe-thoracic kanye ne-lumbar spine (89% kanye ne-86%, ngokulandelana), ilandelwa ama-radiographs (54% no-58%, ngokulandelana). Odokotela abangama-76 bakhethe ukusebenzisa inhlanganisela yazo zombili izindlela zokwenza okwasendaweni. Izinqubo ze-spinous kanye nama-pedicles ahambisanayo kwakuyizimpawu zomhlaba ezisetshenziswa kakhulu ze-anatomic zokuhlinzwa kwe-thoracic kanye ne-lumbar spine (67% kanye ne-59%), elandelwa izinqubo ze-spinous (49% ne-52%) (Fig. 2). I-68% yodokotela bavumile ukuthi benze amaphutha ezindawo zesigaba ekusebenzeni kwabo, okunye okulungisiwe ngokungahambisani (Fig. 3).
Umdwebo 2 Izindlela zokwenza indawo eyingqophamlando ye-anatomical ezisetshenzisiwe.
Umdwebo 3 Udokotela kanye nokulungiswa kwe-intraoperative yamaphutha engxenye yokuhlinzwa.
Ngamaphutha wendawo, i-56% yalaba dokotela basebenzisa i-radiographs yangaphambi kokuhlinzwa futhi i-44% isebenzisa i-intraoperative fluoroscopy. Izizathu ezijwayelekile zamaphutha okumisa ngaphambi kokuhlinzwa kwakuwukuhluleka ukubona ngeso lengqondo iphuzu elaziwayo lokubhekisela (isb., umgogodla we-sacral awuzange ufakwe ku-MRI), ukuhlukahluka kwe-anatomical (ama-vertebrae asusiwe e-lumbar noma izimbambo ze-13-root), kanye nokungaqondakali kwesigaba ngenxa yesimo somzimba wesiguli. isimo (isibonisi se-X-ray esingaphansi). Izimbangela ezivamile zamaphutha okubekwa kwe-intraoperative zihlanganisa ukuxhumana okunganele ne-fluoroscopist, ukwehluleka kokubeka kabusha ngemva kokubeka (ukunyakaza kokubeka inaliti ngemva kwe-fluoroscopy), kanye namaphuzu okubhekisela okungalungile ngesikhathi sokuma (i-lumbar 3/4 kusukela ezimbanjeni phansi) (Umfanekiso 4).
Fig. 4 Izizathu zamaphutha okwenziwa kwasendaweni ngaphambi kokuhlinzwa kanye ne-intraoperative.
Imiphumela engenhla ibonisa ukuthi nakuba ziningi izindlela zokwenza kwasendaweni, iningi lodokotela abahlinzayo lisebenzisa ezimbalwa zazo. Nakuba amaphutha esigaba sokuhlinzwa engavamile, empeleni awekho. Ayikho indlela evamile yokuqeda la maphutha; kodwa-ke, ukuthatha isikhathi sokwenza ukubeka nokukhomba izimbangela ezijwayelekile zokubeka amaphutha kungasiza ekunciphiseni ukwenzeka kwamaphutha esigaba sokuhlinzwa emgodleni we-thoracolumbar.
Isikhathi sokuthumela: Jul-24-2024
