Iindaba - Inkqubo ye-Postterior Cervical Laminoplasty evuliweyo

INDAWO ENGUQALAYO

1. Umbane we-unipolarImela ye-tric inqumla i-fascia ize ikhuphe umsipha phantsi kwe-periosteum, nikela ingqalelo ekukhuseleni i-articular synovial joint, ngeli xesha i-ligament ekwiingcambu zenkqubo ye-spinous akufuneki isuswe ukuze kugcinwe ukuthembeka kwe-cervical tension band;

2. Nika ingqaleloo ukwanda kancinci kancinci kokuvulwa kocango lonke, iispatula ezimbini ezincinci zingasetyenziselwa ukuvula inxalenye encinci yepleyiti enye ye-vertebral uze emva koko enye, njalo njalo, kwaye uyivule kancinci kancinci ukuya kububanzi obufanelekileyo (umjelo womgogodla wandiswa nge-4mm), nto leyo enokuthintela ukwaphuka ngokupheleleyo kwecala elifakwe kwi-slots kangangoko kunokwenzeka;

3. Xa uvulaG ucango luhamba lodwa, ukuluma i-ligamentum flavum kwindawo evulekileyo kunokubangela ukopha kwi-venous plexus, ngeli xesha, ungoyiki, ungasebenzisa i-bipolar electrocoagulation ukunqanda ukopha, okanye i-gelatin sponges ukunqanda ukopha.

Utyando lomqolo wesibeleko olungasemva lwaqalwa ziingcali zaseJapan ngeminyaka yoo-1970. Nangona luye lwaphuculwa amaxesha amaninzi, utyando olusisiseko lusafana, olulula ngakumbi kwaye lufana notyando olungasemva oluneminyango emibini olunempembelelo efanayo yonyango, kwaye lolunye lotyando lomqolo wesibeleko oluqhelekileyo koogqirha botyando lomqolo.

1. I-Expansile Cervical Laminoplasty yomnyango ovulekileyo

Eli nqaku livela kwiSebe lezoNyango lweMithambo kwiYunivesithi yaseMiami eMiami, eFlorida, kwaye ngokwendlela ekhethekileyo yokukhetha inkqubo, bakhethe inkqubo evulekileyo ukusuka kwi-C3 ukuya kwi-C7 kwizigulane ezininzi, ngelixa befaka iimbambo ze-allograft ezixhonywe kwindawo evulekileyo kwaye zongezwa ngee-autologous implants, njengoko kuchaziwe ngezantsi:

Isigulana sabekwa kwindawo ethe nkqo, intloko yaqiniswa ngefreyimu yentloko kaMayfield, iteyiphu yasetyenziselwa ukutsala igxalaba lesigulana ize ilifake ebhedini yotyando, i-1% yelidocaine kunye ne-epinephrine zasetyenziswa ekungeneni kwangaphakathi kwaye emva koko ulusu lwanqunyulwa ecaleni komgca ophakathi ukuze lufikelele kwi-fascia, kwaye izihlunu zasuswa phantsi kwe-periosteum emva kokunqunyulwa kwe-fascia ngemela yokuhlinzwa yesigaba esinye, kwaye kwaqwalaselwa ukhuseleko lwamalungu e-synovial articular, kwaye i-ligament yengcambu ye-sphenoidal akufuneki isuswe ukuze kugcinwe ukuthembeka kwebhande loxinzelelo lwe-vertebrae yomlomo wesibeleko; ukuvezwa okuphezulu nokusezantsi kwenziwa. Uluhlu oluphezulu nolusezantsi lokuvezwa lufikelela kwinxalenye esezantsi yepleyiti ye-C2 vertebral kunye nenxalenye ephezulu yepleyiti ye-T1 vertebral, kwaye isithathu esisezantsi sepleyiti ye-C2 vertebral kunye nesithathu esingaphezulu sepleyiti ye-T1 vertebral zasuswa nge-grinding drill, kwaye emva koko i-ligamentum flavum yacocwa nge-2-mm plate biting forceps ukuze iveze i-dura mater, kwaye inxalenye yenkqubo ye-spinous yalunywa yi-biting forceps ukulungiselela ukufakwa kwethambo.

Emva koko kwenziwa ukuvulwa kocango lwe-C3-C7, njengoko kubonisiwe kumfanekiso ongentla, ngokubanzi icala elineempawu ezinzima lasetyenziswa njengecala lokuvulwa kocango kwaye icala elikhanyayo lasetyenziswa njengehinge, ukuvulwa kocango okanye indawo yokutsala kwakukwindawo yokudibana kwepleyiti yomqolo kunye nobukhulu be-articular, icala lokuvulwa kocango lagaywa nge-cortex kabini kwaye icala lehinge lagaywa nge-cortex kumgangatho omnye, kwaye intloko yokusila yentloko yomatshisi yasetyenziswa ekuvuleni kocango.

Emva kokugawula i-cortex ngokwahlukeneyo, icala elivulekileyo lomnyango kufuneka licocwe nge-ligamentum flavum nge-vertebral plate biting forceps de i-dural sac ibonakale ngokucacileyo, uze usebenzise i-spatula encinci ukuvula "umnyango" ukuya kuthi ga kwi-8-16mm uze ufake i-implant block, unike ingqalelo ekunyukeni kancinci kobukhulu bomnyango ovulekileyo, kwaye ii-spatula ezimbini ezincinci zingasetyenziselwa ukuvula ipleyiti enye ye-vertebral kancinci ngaphambi kokuvula enye, uze uphinde le nkqubo, uze uvule ucango kancinci kancinci ukuya kububanzi obufanelekileyo (umjelo uyanda nge-4mm), kwaye ngale ndlela, unokuthintelwa ukuthintela ukwaphuka okupheleleyo kwicala leendawo ezivulekileyo kangangoko kunokwenzeka.

Kufuneka kubekho uxinzelelo oluncinci kwindawo apho ibhloko yamathambo ibekwe khona ngaphandle kwesidingo sokulungiswa kwangaphandle, kwaye ababhali babone iingxaki ezimbalwa kakhulu kwikliniki apho ibhloko yamathambo iwela kumjelo womgogodla, apho ukufakwa kokugqibela kwethambo kususwa kwinkqubo ye-spinous kwicala le-hinge.

2. I-Laminoplasty yoMcango oVulekileyo weSibeleko

Eli nqaku, elivela kwiSebe leNeurosurgery kwiKeck Medical Center kwiYunivesithi yaseMzantsi California, linesihloko esifana kakhulu neso sangaphambili, kunye notshintsho kwindlela amagama esiNgesi alandelelana ngayo, kunye nomgangatho ophezulu wokungaguquguquki kwindlela yawo kunye nefilosofi yokusebenza, kwaye libonisa ukufana koqeqesho loogqirha abatyandayo eMelika.

Amacandelo otyando ayephantse abe yi-C3-7 kuphela ukuze kube lula ukuhambisa umqolo emva; iingcambu ze-sphenoidal ligaments zagcinwa ukuze kube lula ukuzinza komlomo wesibeleko; kwasetyenziswa i-drill yokusila intloko yomatshisi ukuvula ucango ukunciphisa umonakalo kumqolo; kwaye iibhloko zamathambo zabekwa kwi-C3, 5, kunye ne-7 ukuxhasa ukuvulwa kocango.

Inqaku loMfanekiso: A, Ukuvezwa kwe-lamina ukusuka ezantsi kwe-C2 ukuya phezulu kwe-T1. b, Ukubhoboza umngxuma osecaleni nge-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.

Inqaku loMfanekiso: Umbono wotyando emva kokubhoboza imingxuma kwimiqolo esecaleni ye-C3, C5, kunye ne-C7 (A) nasemva kokubekwa kwe-allograft rib spacer (B).

Nangona kunjalo, izinto zayo zokufakelwa kwamathambo, ukongeza kwithambo le-allogeneic (Umzobo A), yi-vertebral autogenous bone graft eyenziwe nge-polylactic acid mesh, njengoko kubonisiwe ngezantsi (Umzobo we-BC), engaxhaphakanga kangako eTshayina. Ngokuphathelele ububanzi bomnyango, ububanzi obufanelekileyo buthathwa njenge-10-15 mm, obahluke kancinci kobo buyi-8-16 mm ngasentla.

Xa uvula ucango olunye kwipleyiti yomqolo, ukuluma i-ligamentum flavum kwindawo yokuvula ucango kunokubangela ukopha emthanjeni, ngeli xesha ungoyiki, ungasebenzisa i-bipolar electrocoagulation ukunqanda ukopha okanye i-gelatin sponge ukunqanda ukopha.

3. I-Laminoplasty yoMbeleko

Ukongeza ekuxhaseni ibhloko yamathambo ekuvulekeni komnyango, ezinye iindlela zokulungisa ukuvulwa komnyango zichazwe kweli nqaku, njengendlela yokubopha ucingo kunye nendlela yokulungisa ii-microplates, eyona yokugqibela isetyenziswa kakhulu kwizonyango kwaye inika ukuqina okukhuselekileyo.