Zolakwa za odwala ochita opaleshoni komanso malo ndizovuta komanso zopewedwa. Malinga ndi Joint Commission on Accreditation of Healthcare Organisations, zolakwika zotere zitha kupangidwa mpaka 41% ya maopaleshoni a mafupa/ana. Kwa opaleshoni ya msana, kulakwitsa kwa malo opangira opaleshoni kumachitika pamene gawo la vertebral kapena lateralization siliri lolondola. Kuwonjezera pa kulephera kuthana ndi zizindikiro za wodwalayo ndi matenda, zolakwika zamagulu zingayambitse mavuto atsopano azachipatala monga kuthamanga kwa disc degeneration kapena kusakhazikika kwa msana m'magulu ena asymptomatic kapena abwinobwino.
Palinso nkhani zalamulo zomwe zimagwirizanitsidwa ndi zolakwika zamagulu pa opaleshoni ya msana, ndipo anthu, mabungwe a boma, zipatala, ndi mabungwe a opaleshoni alibe kulekerera zolakwa zoterezi. Maopaleshoni ambiri a msana, monga discectomy, fusion, laminectomy decompression, ndi kyphoplasty, amachitidwa pogwiritsa ntchito njira yapambuyo, ndipo malo oyenera ndi ofunika. Ngakhale teknoloji yamakono yojambula zithunzi, zolakwika zamagulu zikuchitikabe, ndi chiwerengero cha zochitika kuyambira 0.032% mpaka 15% zomwe zafotokozedwa m'mabuku. Palibe mfundo yoti ndi njira iti yomwe ili yolondola kwambiri.
Akatswiri ochokera ku dipatimenti ya Opaleshoni Yamafupa pa Mount Sinai School of Medicine, USA, adachita kafukufuku wofunsa mafunso pa intaneti omwe akuwonetsa kuti madokotala ambiri ochita opaleshoni ya msana amagwiritsa ntchito njira zochepa chabe, komanso kuti kumveketsa bwino zomwe zimayambitsa zolakwika kungakhale kothandiza kuchepetsa zolakwika zamagulu a opaleshoni, m'nkhani yomwe inafalitsidwa May 2014 mu Spine J. Phunziroli linachitidwa pogwiritsa ntchito mafunso otumizidwa ndi imelo. Kafukufukuyu adachitika pogwiritsa ntchito ulalo wotumizidwa ndi imelo ku mafunso omwe adatumizidwa kwa mamembala a North American Spine Society (kuphatikiza maopaleshoni a mafupa ndi ma neurosurgeon). Mafunsowo adatumizidwa kamodzi kokha, monga momwe bungwe la North American Spine Society linalimbikitsa. Madokotala onse a 2338 adalandira, 532 adatsegula ulalo, ndipo 173 (7.4% yankho la mayankho) adamaliza kufunsa. Makumi makumi asanu ndi awiri mphambu awiri mwa omaliza anali madokotala ochita opaleshoni ya mafupa, 28% anali ma neurosurgeon, ndipo 73% anali madokotala a msana pophunzitsidwa.
Mafunsowo anali ndi mafunso onse a 8 (mkuyu 1) okhudza njira zomwe zimagwiritsidwa ntchito kwambiri poyang'anira malo (zonse za anatomical ndi kumasulira kwazithunzi), zochitika za zolakwika zamagulu a opaleshoni, ndi mgwirizano pakati pa njira zowonongeka ndi zolakwika zamagulu. Mafunsowo sanayesedwe kapena kutsimikiziridwa. Mafunsowo amalola kusankha mayankho angapo.
Chithunzi 1 Mafunso asanu ndi atatu kuchokera mufunso. Zotsatirazi zinasonyeza kuti intraoperative fluoroscopy inali njira yomwe imagwiritsidwa ntchito kwambiri popanga opaleshoni ya posterior thoracic ndi lumbar spine (89% ndi 86%, motero), yotsatiridwa ndi radiographs (54% ndi 58%, motero). Madokotala 76 anasankha kugwiritsa ntchito njira zonse ziwiri kuti apezeke. Mitsempha ya spinous ndi pedicles yofananira inali zizindikiro za anatomic zomwe zimagwiritsidwa ntchito kwambiri pa opaleshoni ya thoracic ndi lumbar msana (67% ndi 59%), zotsatiridwa ndi njira za spinous (49% ndi 52%) (mkuyu 2). 68% ya madokotala adavomereza kuti adapanga zolakwika zamagulu m'machitidwe awo, ena mwa iwo adakonzedwa mwachisawawa (mkuyu 3).
Mkuyu 2 Njira zofananira ndi zofananirako zomwe zimagwiritsidwa ntchito.
Mkuyu. 3 Dokotala ndi intraoperative kukonza zolakwika gawo opaleshoni.
Pazolakwa za malo, 56% mwa madokotalawa adagwiritsa ntchito ma radiographs asanayambe opaleshoni ndipo 44% amagwiritsa ntchito intraoperative fluoroscopy. Zifukwa zodziwika bwino za zolakwika zoyikapo zisanachitike zinali kulephera kuwona malo odziwika (mwachitsanzo, msana wa sacral sunaphatikizidwe mu MRI), kusiyanasiyana kwa ma anatomical (lumbar displaced vertebrae kapena nthiti za 13-root), ndi kusamvetsetsana kwamagulu chifukwa cha thupi la wodwalayo. chikhalidwe (chiwonetsero cha X-ray chocheperako). Zomwe zimayambitsa zolakwika za intraoperative positioning zikuphatikizapo kusayankhulana kokwanira ndi fluoroscopist, kulephera kuyikanso pambuyo pa malo (kusuntha kwa singano pambuyo pa fluoroscopy), ndi malo olakwika owonetsera panthawi ya malo (lumbar 3/4 kuchokera ku nthiti pansi) (Chithunzi 4).
Mkuyu. 4 Zifukwa za preoperative ndi intraoperative kutanthauzira zolakwika.
Zotsatira zomwe zili pamwambazi zikuwonetsa kuti ngakhale pali njira zambiri zopangira malo, madokotala ambiri amagwiritsa ntchito ochepa chabe. Ngakhale zolakwika zamagulu opangira opaleshoni ndizosowa, ndiye kuti palibe. Palibe njira yokhazikika yochotsera zolakwika izi; komabe, kutenga nthawi yopangira malo ndi kuzindikira zomwe zimayambitsa zolakwika zoyika zingathandize kuchepetsa zochitika za opaleshoni ya opaleshoni mu msana wa thoracolumbar.
Nthawi yotumiza: Jul-24-2024
