Nkhani - OPEN-DOOR Posterior Cervical Laminoplasty ndondomeko

MALANGIZO OTHANDIZA

1. Elec ya unipolartric mpeni amadula fascia ndiyeno peels minofu pansi periosteum, kulabadira kuteteza articular synovial olowa, panthawiyi ligament pa muzu wa ndondomeko spinous sayenera kuchotsedwa kuti kusunga umphumphu wa khomo lachiberekero mavuto gulu;

2. Samalani to Kuwonjezeka kwapang'onopang'ono kwa kutsegula kwa chitseko chonse, ma spatula awiri ang'onoang'ono angagwiritsidwe ntchito kutsegula gawo laling'ono la mbale imodzi ya vertebral ndiyeno ina, ndi zina zotero mobwerezabwereza, ndikutsegula pang'onopang'ono mpaka m'lifupi mwake ( ngalande ya msana imakulitsidwa ndi 4mm), yomwe ingapewe kusweka kwathunthu kwa mbali yotsekedwa mpaka momwe zingathere;

3. Pamene opening chitseko unilaterally, kuluma pa ligamentum flavum pamalo otsegulira kungayambitse magazi kuchokera ku venous plexus, panthawiyi, musachite mantha, mungagwiritse ntchito bipolar electrocoagulation kuti muyimitse magazi, kapena masiponji a gelatin kuti asiye magazi.

Opaleshoni ya OPEN-DOOR Posterior posterior khomo lachiberekero idapangidwa koyamba ndi akatswiri aku Japan m'ma 1970.Ngakhale kuti zakhala zikuyenda bwino nthawi zambiri, opaleshoni yoyambira opaleshoni imakhala yofanana, yomwe imakhala yabwino kwambiri komanso yofanana ndi opaleshoni yapakhomo yapakhomo yomwe ili ndi zotsatira zochiritsira zofanana, ndipo ndi imodzi mwa opaleshoni yapamwamba ya khomo lachiberekero. madokotala a msana.

1.OPEN-KHOMO Expansile Cervical Laminoplasty

Nkhaniyi ikuchokera ku Dipatimenti ya Opaleshoni ya Mitsempha ku chipatala cha University of Miami ku Miami, Florida, ndipo ponena za chisankho chenichenicho, adasankha njira yotsegula pakhomo kuchokera ku C3 kupita ku C7 kwa odwala ambiri, pamene akugwiritsa ntchito nthiti za allograft. lotseguka pamalo otseguka ndikuphatikizidwa ndi ma implants a autologous, monga tafotokozera pansipa:

Wodwalayo adayikidwa pamalo okhazikika, mutuwo unayikidwa ndi mutu wa Mayfield, tepiyo idagwiritsidwa ntchito kugwetsa phewa la wodwalayo ndikulikonza pa bedi la opaleshoni, 1% lidocaine ndi epinephrine amagwiritsidwa ntchito polowera m'deralo ndiyeno khungu. Anadulidwa pamzere wapakati kuti akafike ku fascia, ndipo minofu inachotsedwa pansi pa periosteum itatha kudulidwa kwa fascia ndi mpeni wa electrosurgical siteji imodzi, ndipo chitetezo cha articular synovial joints chinaperekedwa, ndipo ligament ya muzu wa sphenoidal sayenera kukhazikitsidwa kuti ukhalebe kukhulupirika kwa gulu lolimba la vertebrae ya khomo lachiberekero;mawonekedwe apamwamba ndi apansi anapangidwa.Mawonekedwe apamwamba ndi otsika adafika kumunsi kwa mbale ya C2 vertebral plate ndi kumtunda kwa T1 vertebral plate, ndipo gawo limodzi mwa magawo atatu a C2 vertebral plate ndi gawo lachitatu la T1 vertebral plate linachotsedwa ndi kubowola, ndiyeno ligamentum flavum inatsukidwa ndi 2-mm mbale kuluma forceps kuvumbulutsa dura mater, ndi mbali ya ndondomeko spinous analumidwa ndi forceps kuluma kukonzekera implantation wa fupa.

Kenako kutsegulira kwa chitseko cha C3-C7 kunachitika, monga momwe tawonetsera pa chithunzi pamwambapa, nthawi zambiri mbali yokhala ndi zizindikiro zolemera idagwiritsidwa ntchito ngati mbali yotsegulira khomo ndipo mbali yopepuka idagwiritsidwa ntchito ngati hinge, khomo lotsegula kapena malo olowera. Malo ophatikizika a mbale ya vertebral ndi articular eminence, khomo lotsegula la khomo linali pansi kudzera pa kotekisi ndipo mbali ya hinge inali pansi kupyola kotekisi mumsanjikiza umodzi, ndipo mutu wopera mutu unagwiritsidwa ntchito potsegula chitseko.

Pambuyo pogaya kupyola kotekisi, mbali yotseguka ya chitseko iyenera kutsukidwa ndi ligamentum flavum ndi vertebral plate kuluma forceps mpaka thumba lamkati liwoneke bwino, ndiyeno gwiritsani ntchito spatula kuti mutsegule "khomo" pafupifupi 8-16mm ndikuyika chipika choyikapo, kulabadira kuwonjezeka kwapang'onopang'ono kwa kukula konse kwa khomo lotseguka, ndipo ma spatula awiri ang'onoang'ono angagwiritsidwe ntchito kutsegula mbale imodzi ya vertebral pang'ono musanatsegule ina. , ndiyeno kubwereza ndondomekoyi, ndiyeno kutsegula chitseko pang'onopang'ono mpaka m'lifupi mwabwino (ngalandeyo imakula ndi 4mm), ndipo motere, zikhoza kupewedwa kuti mupewe kupasuka kwathunthu kumbali ya mipata mpaka kufika pamlingo waukulu. zotheka.

Payenera kukhala kukhalapo pang'ono kwa kupanikizika kwapang'onopang'ono pamalo omwe fupa la fupa limayikidwa popanda kufunikira kwa kukonzanso kwakunja, ndipo olemba awona zovuta zochepa kwambiri kuchipatala kumene fupa la fupa limagwera mumtsinje wa msana, ndikuyika komaliza. wa fupa kuchotsedwa njira spinous pa hinge mbali.

2.OPEN-KHOMO Pakhomo la Cervical Expansile Laminoplasty

Nkhaniyi, yochokera ku Dipatimenti ya Neurosurgery ku Keck Medical Center ya University of Southern California, ili ndi mutu wofanana ndi chikalata chapitachi, ndi kusintha kwa dongosolo la mawu a Chingerezi, ndi kusinthasintha kwakukulu mu njira yake ndi nzeru za opareshoni, ndikuwonetsa kufanana pakuphunzitsa maopaleshoni ku United States.

Magawo opangira opaleshoni anali pafupifupi C3-7 kuti athandize kusamuka kwapambuyo kwa msana;minyewa ya sphenoidal mizu idasungidwa kuti ithandizire kukhazikika kwa khomo lachiberekero;kubowola mutu wa machesi kunagwiritsidwa ntchito kutsegula chitseko kuti kuchepetsa kuwonongeka kwa msana;ndipo zitsulo za mafupa zinayikidwa pa C3, 5, ndi 7 kuti zithandizire kutsegula kwa chitseko.

Zindikirani pazithunzi: A, Kuwonekera kwa lamina kuchokera pansi pa C2 mpaka pamwamba pa T1.b, Kubowola kwa lateral poyambira ndi osteotomy wathunthu mbali imodzi ndi pang'ono osteotomy mbali ina.c, Kukwera kwa lamina kuchokera ku C3 kupita ku C7 ngati gawo limodzi.d, Kuyika kwa allograft fupa spacer.

Zindikirani: Kuwona kwapakatikati mutatha kubowola mabowo m'mizere yozungulira ya C3, C5, ndi C7 (A) komanso mutayika nthiti ya allograft (B).

Komabe, fupa lake kumezanitsa zakuthupi, kuwonjezera allogeneic fupa (mkuyu. A), ndi vertebral autogenous fupa kumezanitsa opangidwa ndi polylactic acid mauna, monga momwe m'munsimu (BC mkuyu.), Amene sali wamba ku China.Pankhani ya kukula kwa chitseko, m'lifupi mwake ndi 10-15 mm, yomwe ndi yosiyana kwambiri ndi 8-16 mm pamwamba.

Mukatsegula chitseko chimodzi cha mbale ya vertebral, kuluma kwa ligamentum flavum pamalo otsegula chitseko kungayambitse magazi kuchokera mumtsempha, panthawiyi musachite mantha, mungagwiritse ntchito bipolar electrocoagulation kuti muyimitse magazi kapena siponji ya gelatin. kuletsa kutuluka kwa magazi.

3.Cervical Laminoplasty

Kuwonjezera pa kuthandizira fupa la fupa pakhomo lotsegula, njira zina zokonzera kutsegula kwa chitseko zikufotokozedwa m'nkhaniyi, monga njira ya tayi-waya ndi microplates fixation njira, yotsirizirayi yomwe ikugwiritsidwa ntchito kwambiri pachipatala. ndipo imapereka kukhazikika kotetezeka.