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 ngokupheleleyo, iispatula ezimbini ezincinci zingasetyenziselwa ukuvula inxalenye encinci yeplate ye-vertebral enye kwaye enye, njalo njalo ngokuphindaphindiweyo, kwaye ngokuthe ngcembe uyivule kububanzi obufanelekileyo ( i-spinal canal yandiswa nge-4mm), enokuthi igweme ukuphuka okupheleleyo kwecala elifakwe kwinqanaba eliphezulu;

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 nocango lwangasemva oluphindwe kabini olunempembelelo efanayo yonyango, kwaye yenye yotyando lwamandulo lomqolo wesibeleko. oogqirha bomqolo.

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. ivuleleke kwisiza esinomnyango ovulekileyo kwaye incediswe ngofakelo lwe-autologous, njengoko kuchaziwe ngezantsi:

Isigulana sibekwe kwindawo echanekileyo, intloko igxininiswe kunye nekhanda likaMayfield, i-tape yayisetyenziselwa ukudiliza ihlombe lesigulane kwaye uyilungise ebhedini yokusebenza, i-1% i-lidocaine kunye ne-epinephrine yayisetyenziselwa ukungena kwendawo kwaye emva koko ulusu. yasikwa ecaleni komgca ophakathi ukufikelela kwi-fascia, kwaye izihlunu zahluthwa phantsi kwe-periosteum emva kokusikwa kwe-fascia ngemela enye yenqanaba le-electrosurgical, kunye nokukhuselwa kwe-articular synovial joints kwanikwa ingqalelo, kunye ne-ligament of the ingcambu ye-sphenoidal akufanele ihlaziywe ukuze igcine ingqibelelo yebhanti yoxinzelelo lwe-vertebrae yomlomo wesibeleko;utyhileko oluphezulu nolusezantsi lwenziwe.Uluhlu oluphezulu kunye nolusezantsi lokuvezwa lufikelele kwindawo ephantsi ye-C2 ye-vertebral plate kunye nenxalenye ephezulu ye-T1 vertebral plate, kunye nesithathu esisezantsi se-C2 ye-vertebral plate kunye nesithathu esiphezulu se-T1 ye-vertebral plate isuswe nge-drill drill, kwaye ke i-ligamentum flavum yacocwa nge-2-mm ipleyiti yokuluma forceps ukubonisa i-dura mater, kwaye inxalenye yenkqubo ye-spinous yalunywa yi-forceps elumayo ukulungiselela ukufakwa kwethambo.

Okulandelayo ukuvulwa kocango lwe-C3-C7 lwenziwa, njengoko kubonisiwe kulo mfanekiso ungasentla, ngokubanzi icala elineempawu ezinzima lisetyenziswe njengecala lokuvula umnyango kunye necala elilula lisetyenziswe njengehinge, ukuvulwa kocango okanye indawo yokubeka yayingaphakathi. ummandla wokudityaniswa kwepleyiti yomqolo kunye nokuphakama kwe-articular, icala lokuvula ucango laliphantsi ngecortex ngokuphindwe kabini kwaye icala lehenjisi laligutywe ngecortex kumaleko omnye, kwaye intloko yematshisi yokusila yasetyenziswa ekuvuleni kocango.

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" ukuya malunga ne-8-16mm kwaye ubeke kwibhloko yokufakelwa, ukunikela ingqalelo ekunyuseni ngokuthe ngcembe ubungakanani ngokubanzi bomnyango ovulekileyo, kunye ne-spatulas ezimbini ezincinci zingasetyenziselwa ukuvula ipleyiti enye ye-vertebral ngemali encinci 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 bexinzelelo loxinzelelo kwindawo apho ibhloko yethambo ibekwe khona ngaphandle kwesidingo sokulungiswa kwangaphandle, kwaye ababhali baye babona iingxaki ezimbalwa kakhulu kwikliniki apho ibhloko yethambo iwela kumgudu womgogodla, kunye nokufakelwa kokugqibela. yethambo ekhutshwe kwinkqubo ye-spinous kwicala lehinge.

2.OPEN-Umnyango weCervical Expansile Laminoplasty

Eli nqaku, elivela kwiSebe le-Neurosurgery kwi-Keck Medical Centre yeYunivesithi yaseSouthern California, liphantse lifana nesihloko esifana nesoxwebhu lwangaphambili, kunye nokuguqulwa komyalelo wamagama esiNgesi, kunye neqondo eliphezulu lokuhambelana kwindlela yalo kunye neyokuqala. ifilosofi yokusebenza, kwaye ibonisa ukufana kuqeqesho loogqirha botyando eUnited 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. ukunqanda ukopha.

3.I-Cervical Laminoplasty

Ukongezelela ekuxhaseni ibhloko yethambo ekuvuleni umnyango, ezinye iindlela zokulungisa ukuvulwa komnyango zichazwe kweli nqaku, njengendlela yokubopha intambo kunye ne-microplates fixation method, leyo yokugqibela ngoku isetyenziswa ngokuqhelekileyo kwiikliniki. kwaye ibonelela ngokulungiswa okukhuselekileyo.