Ntinye skru dị n'ihu nke usoro odontoid na-echekwa ọrụ ntụgharị nke C1-2 ma akọpụtala n'akwụkwọ ndị a na-akọ na ọ nwere ọnụego njikọta nke 88% ruo 100%.
Na 2014, Markus R na ndị otu ya bipụtara nkuzi gbasara usoro ịwa ahụ nke nhazi skru anterior maka mgbawa odontoid na The Journal of Bone & Joint Surgery (Am). Isiokwu ahụ kọwara nke ọma isi ihe dị na usoro ịwa ahụ, nleba anya mgbe a wachara ahụ, ihe ngosi na ihe mgbochi n'ime usoro isii.
Isiokwu a na-emesi ike na ọ bụ naanị ụdị nke abụọ gbawara agbawa ka a ga-eji kpụọ skru n'ihu, nakwa na ọ ka mma itinye skru oghere n'otu ebe.
Nzọụkwụ nke 1: Ọnọdụ onye ọrịa n'oge ịwa ahụ
1. A ga-ewere rediograf kachasị mma maka ntụaka onye na-arụ ọrụ.
2. A ghaghị idobe onye ọrịa ahụ n'ọnụ mepere emepe mgbe a na-awa ahụ.
3. A ga-agbanwe ebe gbajiri agbaji ahụ ruo mgbe o kwere mee tupu a malite ịwa ahụ.
4. E kwesịrị ịgbatị ọkpụkpụ azụ nke dị n'ime olu ruo n'ókè o kwere mee iji nweta mkpughe kachasị mma nke ntọala nke usoro odontoid.
5. Ọ bụrụ na ọ gaghị ekwe omume ịgbatị ọkpụkpụ azụ nke isi - dịka ọmụmaatụ, na mgbawa hyperextension nke nwere mgbanwe azụ nke njedebe cephalad nke usoro odontoid - mgbe ahụ a ga-atụle ịtụgharị isi onye ọrịa n'akụkụ nke ọzọ ma e jiri ya tụnyere ogwe aka ya.
6. Mee ka isi onye ọrịa ghara ịgagharị n'ọnọdụ siri ike dịka o kwere mee. Ndị dere ya na-eji isi Mayfield (e gosiri na eserese 1 na 2).
Nzọụkwụ nke 2: Ụzọ ịwa ahụ
A na-eji usoro ịwa ahụ a na-ahụkarị ekpughere oyi akwa trachea dị n'ihu n'emebighị ihe owuwu dị mkpa nke anatomical.
Nzọụkwụ nke 3: Ebe ntinye skru
Ebe ntinye kacha mma dị n'akụkụ ala nke isi ahụ C2 vertebral. Ya mere, a ga-ekpughe akụkụ ihu nke diski C2-C3. (dịka egosiri na Foto 3 na 4 dị n'okpuru) Foto 3
Akụ ojii dị na Foto nke 4 na-egosi na a na-ahụ azụ C2 nke dị n'ihu nke ọma n'oge a na-agụ ihe nkiri CT nke axial tupu ịwa ahụ, a ga-ejikwa ya dị ka ihe nnọchianya anatomical maka ịchọpụta ebe a na-etinye agịga n'oge ịwa ahụ.
2. Kwenye ebe ị ga-abanye n'okpuru anya anteroposterior na lateral fluoroscopic nke ọkpụkpụ azụ cervical. 3.
3. Debe agịga ahụ n'etiti nsọtụ elu nke C3 n'elu na ebe ntinye C2 iji chọta ebe ntinye skru kacha mma.
Nzọụkwụ nke 4: Ntinye skru
1. A na-ebu ụzọ tinye agịga GROB nke dị sentimita 1.8 dịka nduzi, a na-etinye agịga ahụ ntakịrị n'azụ nsọtụ notochord ahụ. E mesịa, a na-etinye skru oghere nke dị sentimita 3.5 ma ọ bụ 4 mm. A ga-eji nwayọ nwayọ na-aga n'ihu agịga ahụ n'okpuru nlekota anteroposterior na lateral fluoroscopic.
2. Debe oghere ahụ n'akụkụ nke ntụtụ nduzi n'okpuru nlekota fluoroscopic ma jiri nwayọ gaa n'ihu ruo mgbe ọ banyere n'ime mgbawa ahụ. Oghere ahụ ekwesịghị ịbanye n'ime cortex nke akụkụ cephalad nke notochord ka ntụtụ nduzi ghara ịpụta na oghere ahụ.
3. Tụọ ogologo nke skru oghere achọrọ ma jiri nha CT tupu ịwa ahụ chọpụta ya iji gbochie mmejọ. Mara na skru oghere ahụ kwesịrị ịbanye n'ọkpụkpụ cortical n'ọnụ usoro odontoid (iji mee ka usoro ọzọ nke mgbakasị njedebe mgbawa dị mfe).
N'ọtụtụ ọnọdụ nke ndị edemede ahụ, e jiri otu skru oghere mee ihe maka idozi ya, dịka egosiri na Foto nke 5, nke dị n'etiti etiti na ntọala usoro odontoid na-eche ihu cephalad, ebe isi skru ahụ na-abanye n'ọkpụkpụ azụ nke cortical n'ọnụ usoro odontoid. Gịnị mere e ji atụ aro otu skru? Ndị dere akwụkwọ ahụ kwubiri na ọ ga-esiri ike ịchọta ebe ntinye kwesịrị ekwesị na ntọala usoro odontoid ma ọ bụrụ na a ga-etinye skru abụọ dị iche iche na 5 mm site na etiti ahịrị nke C2.
Foto nke ise na-egosi skru oghere dị n'etiti etiti nke usoro odontoid na-eche ihu na cephalad, ebe isi skru ahụ na-abanye n'ime cortex nke ọkpụkpụ ahụ kpọmkwem n'azụ isi usoro odontoid.
Ma e wezụga ihe nchekwa ahụ, skru abụọ ọ na-eme ka iguzosi ike mgbe a wachara ahụ dịkwuo mma?
Nnyocha biomechanical nke e bipụtara n'afọ 2012 n'akwụkwọ akụkọ Clinical Orthopaedics and Related Research nke Gang Feng et al. nke Royal College of Surgeons of the United Kingdom dere gosiri na otu skru na skru abụọ na-enye otu ọkwa nke nkwụsi ike na idozi ọkpụkpụ odontoid. Ya mere, otu skru zuru ezu.
4. Mgbe a kwadoro ọnọdụ nke mgbawa ahụ na ntụtụ nduzi ahụ, a na-etinye skru oghere kwesịrị ekwesị. A ga-ahụ ọnọdụ nke skru na ntụtụ ahụ site na iji fluoroscopy.
5. A ga-akpachara anya hụ na ngwaọrụ ịkpụcha ihe anaghị agụnye anụ ahụ dị nro gbara ya gburugburu mgbe ọ na-arụ ọrụ ọ bụla dị n'elu. 6. Mee ka skru ndị ahụ sie ike iji tinye nrụgide n'ebe gbawara agbawa ahụ.
Nzọụkwụ nke 5: Mmechi Ọnya
1. Sachaa ebe a na-awa ahụ mgbe ị rụchara nhazi skru.
2. Ọ dị mkpa ka e jiri ọbara gbazee nke ọma iji belata nsogbu ndị dị ka mkpakọ nke trachea mgbe a wachara ahụ.
3. A ga-emechi akwara latissimus dorsi nke e bepụrụ abepụ n'usoro ziri ezi ma ọ bụghị ya, ọ ga-emebi ọdịdị nke ọnya ahụ mgbe a wachara ya ahụ.
4. Ọ dịghị mkpa imechi oyi akwa miri emi kpamkpam.
5. Ọ bụghị ihe dị mkpa ka a na-eme ka ọ gbapụ ọnya (ndị edemede anaghị etinyekarị ọwara mmiri mgbe a wachara ahụ).
6. A na-atụ aro ka e jiri ihe e ji emechi akpụkpọ ahụ mee ihe iji belata mmetụta ọ na-enwe n'ọdịdị onye ọrịa.
Nzọụkwụ nke 6: Nlekota anya
1. Ndị ọrịa kwesịrị ịnọgide na-eyi ihe nkwado olu siri ike ruo izu isii mgbe a wachara ha ahụ, ọ gwụla ma nlekọta nọọsụ chọrọ ya, a kwesịkwara inyocha ya site na iji onyonyo mgbe a wachara ha ahụ.
2. A ga-enyocha rediograf nke ọkpụkpụ azụ anteroposterior na lateral nke nkịtị n'izu 2, 6, na 12 na n'ime ọnwa 6 na 12 mgbe a wachara ya ahụ. E mere nyocha CT n'izu 12 mgbe a wachara ya ahụ.
Oge ozi: Disemba-07-2023
