Iindaba - OPEN-DOOR Posterior Cervical Laminoplasty inkqubo

INKONZO EYINGQONDO

1. I-elec ye-unipolari-tric knife inqumla i-fascia kwaye ikhupha i-muscle phantsi kwe-periosteum, ingqalelo ukukhusela i-articular synovial joint, okwangoku i-ligament kwingcambu yenkqubo ye-spinous akufanele isuswe ukuze kugcinwe ingqibelelo yebhendi yoxinzelelo lomlomo wesibeleko;

2. Nika ingqalelo to ukwanda ngokuthe ngcembe kokuvulwa kocango ngokubanzi, ii-spatula ezimbini ezincinci zingasetyenziselwa ukuvula inxalenye encinci yeplate ye-vertebral enye kwaye emva koko, kwaye ngokuphindaphindiweyo, kwaye ngokuthe ngcembe uyivule kububanzi obufanelekileyo (i-spinal canal yandiswa nge-4mm), enokuphepha ukuphuka okupheleleyo kwecala eliqingqiweyo ukuya kwinqanaba eliphezulu elinokwenzeka;

3. Xa ivulag umnyango unilaterally, ukuluma i-ligamentum flavum kwindawo yokuvula kunokukhokelela ekopheni kwi-venous plexus, ngeli xesha, ungothuki, unokusebenzisa i-bipolar electrocoagulation ukumisa ukopha, okanye iziponji zegelatin ukumisa ukopha.

OPEN-DOOR Utyando lwangasemva lomqolo wesibeleko lwaqalwa ngabaphengululi baseJapan ngeminyaka yoo-1970. Nangona kuye kwaphuculwa amaxesha amaninzi, utyando olusisiseko lusengaphezulu okanye lungaphantsi, olulunge ngakumbi kwaye lufana nomsebenzi wangasemva wambini-mnyango onempembelelo efanayo yonyango, kwaye yenye yotyando lwamandulo lomqolo wesibeleko kwiingcali zotyando.

1.OPEN-DOOR Expansile Cervical Laminoplasty

Eli nqaku livela kwiSebe le-Neurological Surgery kwiYunivesithi yaseMiami Hospital eMiami, eFlorida, kwaye ngokubhekiselele kukhetho oluthile lwenkqubo, bakhetha inkqubo yokuvula umnyango ukusuka kwi-C3 ukuya kwi-C7 kwizigulane ezininzi, ngelixa besebenzisa iimbambo ze-allograft ezivulwe zivuleleke kwindawo evulekileyo kwaye zongezwa kunye nokufakelwa kwe-autologous, njengoko kuchazwe ngezantsi:

Isigulana sibekwe kwindawo elungeleleneyo, intloko igxininiswe kunye nekhanda likaMayfield, i-tape yayisetyenziselwa ukukhupha igxalaba lesigulane kwaye uyilungise ebhedini yokusebenza, i-1% ye-lidocaine kunye ne-epinephrine yayisetyenziselwa ukungena kwendawo kwaye emva koko ulusu luxutywe kunye nomgca ophakathi ukufikelela kwi-fascia, kwaye izihlunu zahlanjululwa phantsi kwe-periosurgical fascia emva kwe-electrosteum. imela, kunye nokukhuselwa kwe-articular synovial joints kwanikelwa ingqalelo, kwaye i-ligament yengcambu ye-sphenoidal akufanele ikhutshwe ukuze kugcinwe ingqibelelo yebhanti yoxinzelelo lwe-vertebrae yomlomo wesibeleko; utyhileko oluphezulu nolusezantsi lwenziwe. Uluhlu oluphezulu kunye nolusezantsi lokubonakaliswa lufikelele kwindawo engezantsi ye-C2 ye-vertebral plate kunye nenxalenye ephezulu ye-T1 vertebral plate, kunye nesithathu esisezantsi se-C2 vertebral plate kunye nesithathu esiphezulu se-T1 ye-vertebral plate yasuswa nge-drill drill, emva koko i-ligamentum flavum yahlanjululwa yi-2-mm iplate yokubeka iplate ye-spin kunye ne-spin ye-biduraps. i-forceps elumayo ukulungiselela ukufakwa kwethambo.

Okulandelayo ukuvulwa kocango lwe-C3-C7 kwenziwa, njengoko kuboniswe kulo mfanekiso ungentla, ngokubanzi icala elineempawu ezinzima lisetyenziswe njengecala lokuvula umnyango kunye necala elikhanyayo lisetyenziswe njenge-hinge, ukuvulwa komnyango okanye indawo yokuqhawula yayikummandla we-junction yeplate ye-vertebral kunye nokuphakama kwe-articular, icala lokuvula umnyango laliphantsi kwi-cortex ngokuphindwe kabini kunye nomgca wecala le-hingending kunye nentloko ye-hingending. yayisetyenziselwa ukuvula umnyango.

Emva kokusila nge-cortex ngokuphindwe kabini, icala elivulekileyo lomnyango lifuna ukucocwa kunye ne-ligamentum flavum kunye ne-vertebral plate eluma i-forceps de i-dural sac ibonakale ngokucacileyo, kwaye usebenzise i-spatula encinci ukuvula "umnyango" malunga ne-8-16mm kwaye ubeke kwibhloko yokufakela, ubeke ingqalelo kuluhlu oluncinci olusetyenziswayo kunye nobukhulu obuncinci becala, kunye nobukhulu obuncinci obusetyenziswayo. vula ipleyiti enye ye-vertebral ngexabiso elincinci ngaphambi kokuvula enye, kwaye emva koko uphinda inkqubo, kwaye emva koko uvule umnyango ngokuthe ngcembe ukuya kububanzi obufanelekileyo (umsele unwebeka ngo-4mm), kwaye ngale ndlela, kunokuphetshwa ukuphepha ukuphuka okupheleleyo kwicala leendawo zokubeka ukuya kwinqanaba eliphezulu kunokwenzeka.

Kufuneka kubekho ubukho obuncinci bokuxinzezeleka koxinzelelo kwindawo apho i-bone block ibekwe khona ngaphandle kwesidingo sokulungiswa kwangaphandle, kwaye ababhali baye babona iingxaki ezimbalwa kakhulu kwiklinikhi apho i-bone block iwela kwi-spinal canal, kunye nokufakelwa kokugqibela kwethambo elisuswe kwinkqubo ye-spinous kwicala le-hinge.

2.OPEN-Umnyango weCervical Expansile Laminoplasty

Eli nqaku, elivela kwiSebe le-Neurosurgery kwiZiko lezoNyango le-Keck leYunivesithi yaseSouthern California, liphantse lifana nesihloko esifana nesoxwebhu lwangaphambili, kunye nokuguqulwa komyalelo wamagama esiNgesi, kunye neqondo eliphezulu lokuhambelana kwindlela yalo kunye nefilosofi yokusebenza, kwaye ibonisa ukufana ekuqeqesheni oogqirha botyando e-United States.

Amacandelo otyando ayephantse abe yi-C3-7 kuphela ukuququzelela ukufuduka ngasemva kwentambo yomgogodla; iingcambu ze-sphenoidal root ligaments zagcinwa ukwenzela ukuba kube lula ukuzinza komlomo wesibeleko; i-match head milling drill yayisetyenziselwa ukuvula umnyango ukunciphisa umonakalo kwintambo yomgogodla; kunye neebhloko zethambo zibekwe kwi-C3, i-5, kunye ne-7 ukuxhasa ukuvulwa komnyango.

Umzobo Qaphela: A, Ukubonakaliswa kwe-lamina ukusuka ezantsi kweC2 ukuya phezulu kwe-T1. b, Ukugrunjwa komjelo osecaleni kunye ne-osteotomy epheleleyo kwelinye icala kunye ne-osteotomy engaphelelanga kwelinye icala. c, Ukuphakama kwe-lamina ukusuka kwi-C3 ukuya kwi-C7 njengeyunithi enye. d, Ukubekwa kwe-allograft bone spacer.

Umzobo Qaphela: Umbono we-intraoperative emva kokubhoboza imingxuma kwiigrooves ezisecaleni ze-C3, i-C5, kunye ne-C7 (A) kwaye emva kokubekwa kwe-allograft rib spacer (B).

Nangona kunjalo, impahla yayo yokufakelwa kwethambo, ngaphezu kwethambo le-allogeneic (Umfanekiso A), i-vertebral autogenous bone graft eyenziwe nge-polylactic acid mesh, njengoko kuboniswe ngezantsi (i-BC Fig.), Engaqhelekanga e-China. Ngokumalunga nobubanzi bokuvula umnyango, ububanzi obufanelekileyo bubhekwa njenge-10-15 mm, ehluke kancinci kwi-8-16 mm ngaphezulu.

Xa uvula umnyango omnye weplate ye-vertebral, ukuluma i-ligamentum flavum kwindawo yokuvula umnyango kunokubangela ukopha kwi-vein, ngeli xesha ungoyiki, unokusebenzisa i-bipolar electrocoagulation ukumisa ukopha okanye isiponji se-gelatin ukumisa ukopha.

3.I-Cervical Laminoplasty

Ukongezelela ekuxhaseni ibhloko yethambo ekuvuleni komnyango, ezinye iindlela zokulungisa ukuvulwa komnyango zichazwe kweli nqaku, njengendlela yokubopha i-tie-wire kunye ne-microplates fixation method, leyo yokugqibela ngoku isetyenziswa ngokuqhelekileyo kwiikliniki kwaye inikezela ukulungiswa okukhuselekileyo.