Ukulungiswa kwe-screw yangaphambili yenkqubo ye-odontoid igcina umsebenzi ojikelezayo we-C1-2 kwaye kuye kwabikwa kwiincwadi ukuba zibe nesantya sokuxuba kwi-88% ukuya kwi-100%.
Ngo-2014, uMarkus R et al wapapasha i-tutorial kubuchule botyando bokulungiswa kwesikrufu sangaphambili sokwaphuka kwe-odontoid kwiJenali yethambo kunye noLwando oludibeneyo (Am).Eli nqaku lichaza ngokweenkcukacha iingongoma eziphambili zobuchule botyando, ukulandelwa kwasemva kokuhlinzwa, izibonakaliso kunye nezilumkiso kumanyathelo amathandathu.
Eli nqaku ligxininisa ukuba kuphela uhlobo lwe-II lwezahlulo oluvumelekileyo ukuba luqondise ukulungiswa kwe-screw yangaphambili kwaye ukulungiswa kwe-screw eyodwa kuyakhethwa.
Inyathelo 1: Ukubekwa kwesigulana kwi-intraoperative
1. Ii-radiographs ezifanelekileyo ze-anteroposterior kunye ne-lateral kufuneka zithathwe kwireferensi yomqhubi.
2. Isigulana kufuneka sigcinwe kwindawo evulekileyo yomlomo ngexesha lotyando.
3. Ukuqhekeka kufuneka kubekwe kwakhona kangangoko kunokwenzeka ngaphambi kokuqala kotyando.
4. Umgudu womlomo wesibeleko kufuneka ube yi-hyperextended kangangoko kunokwenzeka ukuze ufumane ukubonakaliswa okuphezulu kwesiseko senkqubo ye-odontoid.
5. Ukuba i-hyperextension yomgogodla womlomo wesibeleko ayinakwenzeka - umzekelo, kwi-hyperextension fractures kunye ne-posterior displacement ye-cephalad ekupheleni kwenkqubo ye-odontoid - ngoko kuqwalaselwe ukuguqulela intloko yesigulane kwicala elichaseneyo ngokubhekiselele kwi-trunk yakhe.
6. thintela intloko yesigulane kwindawo ezinzileyo kangangoko kunokwenzeka.Ababhali basebenzisa isakhelo sentloko kaMayfield (eboniswe kwiMifanekiso 1 kunye ne-2).
Inyathelo lesi-2: Indlela yotyando
Indlela yotyando eqhelekileyo isetyenziselwa ukuveza umaleko wetracheal wangaphambili ngaphandle kokonakalisa naziphi na izinto ezibalulekileyo ze-anatomical.
Inyathelo lesi-3: Indawo yokungena
Indawo efanelekileyo yokungena ifumaneka kumda wangaphambili ongaphantsi kwesiseko somzimba we-vertebral C2.Ngoko ke, umgca wangaphambili wediski ye-C2-C3 kufuneka ubonakaliswe.(njengoko kubonisiwe kwiMifanekiso 3 kunye ne-4 ngezantsi) Umfanekiso wesi-3
Utolo olumnyama kwi-Figure 4 lubonisa ukuba i-C2 yangaphambili yomqolo ijongwa ngokucophelela ngexesha lokufunda kwangaphambili kwefilimu ye-axial CT kwaye kufuneka isetyenziswe njengophawu lwe-anatomical ukumisela indawo yokufakwa kwenaliti ngexesha lotyando.
2. Qinisekisa indawo yokungena phantsi kweembono ze-anteroposterior kunye ne-lateral fluoroscopic yomqolo wesibeleko.3.
3. Slayida inaliti phakathi komphetho ongaphezulu we-C3 ephezulu kunye ne-C2 yokungena ukuze ufumane i-optimal screw entry point.
Inyathelo lesi-4: Ukubekwa kwescrews
1. Inaliti ye-GROB eyi-1.8 mm ububanzi ifakwe kuqala njengesikhokelo, kunye nenaliti ejoliswe kancinane emva kwencam yenotochord.Emva koko, kufakwe isikrufu esihollow esiyi-3.5 mm okanye 4 mm ububanzi.Inaliti kufuneka ihlale ihamba kancinci i-cephalad phantsi kohlolo lwe-anteroposterior kunye ne-lateral fluoroscopic.
2. Beka i-drill evulekileyo kwicala le-pin yesikhokelo phantsi kwe-fluoroscopic esweni kwaye ngokukhawuleza uyiqhubele phambili de ingene kwi-fracture.I-drill evulekileyo akufanele ingene kwi-cortex yecala le-cephalad ye-notochord ukwenzela ukuba i-pin yesikhokelo ingaphumi nge-drill engenanto.
3. Linganisa ubude be-screw efunekayo kwaye uqinisekise ngomlinganiselo wangaphambili we-CT ukuthintela iimpazamo.Qaphela ukuba i-screw egobileyo kufuneka ingene kwithambo le-cortical kwincam yenkqubo ye-odontoid (ukuququzelela inyathelo elilandelayo lokunyanzeliswa kokuphela kwe-fracture).
Kuninzi lwamatyala ababhali, isikrufu somgongxo esinye sisetyenziselwe ukulungiswa, njengoko kubonisiwe kuMfanekiso 5, obekwe embindini wesiseko senkqubo ye-odontoid ejongene ne-cephalad, kunye nencam yesikrufu esingena nje kwithambo lekhohlo yangasemva. incam yenkqubo ye-odontoid.Kutheni kucetyiswa isikrufu esinye?Ababhali baphetha ukuba kuya kuba nzima ukufumana indawo efanelekileyo yokungena kwisiseko senkqubo ye-odontoid ukuba izikrini ezimbini ezihlukeneyo ziza kufakwa kwi-5 mm ukusuka kumgca ophakathi weC2.
Umzobo wesi-5 ubonisa isikrufu esinomgongxo esisembindini kwisiseko senkqubo ye-odontoid ejongene ne-cephalad, kunye nencam yesikrufu singena nje kwi-cortex yethambo emva kwencam yenkqubo ye-odontoid.
Kodwa ngaphandle kwento yokhuseleko, ngaba izikrufu ezimbini zonyusa uzinzo emva kokusebenza?
Uphononongo lwe-biomechanical olupapashwe kwi-2012 kwiphephancwadi i-Clinical Orthopedics kunye noPhando oluNxulumeneyo nguGang Feng et al.yeKholeji yaseRoyal of Surgeons yaseUnited Kingdom yabonisa ukuba isikrufu esinye kunye nezikrufu ezimbini zibonelela ngenqanaba elifanayo lokuzinzisa ekulungiseni ukuphuka kwe-odontoid.Ngoko ke, isikrufu esinye sanele.
4. Xa indawo yokuphuka kunye nezikhonkwane zesikhokelo ziqinisekisiwe, i-screws efanelekileyo egobileyo ifakwe.Isikhundla se-screws kunye nezikhonkwane kufuneka zigcinwe phantsi kwe-fluoroscopy.
5. Ukunyamekela kufuneka kuthathwe ukuqinisekisa ukuba ifowuni ye-screwing ayibandakanyi izicubu ezithambileyo ezijikelezayo xa zenza nayiphi na imisebenzi engentla.6. Qinisa izikrufu ukufaka uxinzelelo kwindawo yokuphuka.
Inyathelo 5: Ukuvalwa Kwenxeba
1. Gubha indawo yotyando emva kokugqiba ukubeka isikrufu.
2. I-haemostasis ecacileyo ibalulekile ekunciphiseni iingxaki emva kokuhlinzwa ezifana nokunyanzeliswa kwe-hematoma yoqhoqhoqho.
3. Isihlunu somlomo wesibeleko se-latissimus dorsi kufuneka sivalwe ngolungelelwaniso oluchanekileyo okanye i-aesthetics yesilonda se-postoperative iya kuphazamiseka.
4. Ukuvalwa ngokupheleleyo kweengqimba ezinzulu akuyimfuneko.
5. Ukukhutshwa kwamanxeba akuyiyo inketho efunekayo (ababhali ngokuqhelekileyo abayifaki i-postoperative drains).
6. I-Intradermal sutures inconywa ukunciphisa impembelelo kwimbonakalo yesigulane.
Inyathelo lesi-6: Ukulandelela
1. Izigulane kufuneka ziqhubeke zinxibe intamo eqinile kwiiveki ze-6 emva kokusebenza, ngaphandle kokuba ukunakekelwa kobuhlengikazi kufuna oko, kwaye kufuneka kuhlolwe nge-imaging postoperative.
2. I-radiographs esemgangathweni ye-anteroposterior kunye ne-lateral yomqolo wesibeleko kufuneka ihlaziywe kwi-2, i-6, kunye ne-12 iiveki kunye ne-6 kunye neenyanga ze-12 emva kokuhlinzwa.I-CT scan yenziwa kwiiveki ze-12 emva kokuhlinzwa.
Ixesha lokuposa: Dec-07-2023
