Ndozi ihe nkedo ihu nke usoro odontoid na-echekwa ọrụ ntụgharị nke C1-2 ma kọwapụta ya na akwụkwọ akụkọ ka ọ nwee ọnụ ọgụgụ njikọ nke 88% ruo 100%.
N'afọ 2014, Markus R et al bipụtara nkuzi na usoro ịwa ahụ nke nhazi ihu ihu maka ọkpụkpụ odontoid na Journal of Bone & Joint Surgery (Am).Isiokwu na-akọwa n'ụzọ zuru ezu isi ihe nke usoro ịwa ahụ, postoperative nsochi, egosi na akpachara anya na isii nzọụkwụ.
Edemede a na-emesi ike na ọ bụ naanị ụdị mgbaji II nwere ike ime ka ọ bụrụ ihe ndozi ihu ihu yana ndozi otu oghere oghere ka a na-ahọrọ.
Kwụpụ 1: Ndokwa n'ọnọdụ intraoperative nke onye ọrịa
1. A ga-ewere redio dị n'akụkụ anteroposterior na mpụta maka nrụtụ aka onye ọrụ.
2. A ga-edobe onye ọrịa ahụ na oghere ọnụ n'oge ịwa ahụ.
3. Ekwesịrị ịmegharị mgbaji ahụ dịka o kwere mee tupu ịmalite ịwa ahụ.
4. A ghaghị ịgbatị ọkpụkpụ cervical dị ka o kwere mee iji nweta ihe ngosi kachasị mma nke isi nke usoro odontoid.
5. Ọ bụrụ na hyperextension nke spine cervical agaghị ekwe omume - dịka ọmụmaatụ, n'ọkpụkpụ hyperextension na nkwụsị azụ nke njedebe cephalad nke usoro odontoid - mgbe ahụ enwere ike ịtụle ịtụgharị isi onye ọrịa n'akụkụ nke ọzọ n'akụkụ akụkụ ya.
6. mee ka isi onye ọrịa ghara imegharị ya n'ọnọdụ kwụsiri ike dịka o kwere mee.Ndị ode akwụkwọ na-eji etiti isi Mayfield (gosiri na foto 1 na 2).
Nzọụkwụ 2: Ụzọ ịwa ahụ
A na-eji usoro ịwa ahụ ọkọlọtọ kpughee oyi akwa tracheal nke dị n'ihu na-emebighị ihe ọ bụla dị mkpa na-arụ ọrụ ahụ.
Kwụpụ 3: Tinye ebe ntinye
Ebe ntinye kacha mma dị n'akụkụ azụ azụ nke isi nke C2 vertebral ahụ.Ya mere, a ghaghị ikpughe ihu ihu nke diski C2-C3.(dị ka e gosiri na foto 3 na 4 n'okpuru) foto 3
Akụ ojii dị na eserese 4 na-egosi na a na-ahụ nke ọma na azụ azụ C2 dị n'ihu n'oge a na-agụ ihe nkiri axial CT na a ga-eji ya mee ihe dị ka akara ngosi anatomical maka ikpebi ebe ntinye agịga n'oge ịwa ahụ.
2. Kwado ebe ntinye n'okpuru anteroposterior na akuku fluoroscopic echiche nke spine cervical.3.
3. Gbanye agịga n'etiti ihu elu dị elu nke elu C3 na ebe ntinye C2 iji chọta ebe ntinye ihe nkedo kacha mma.
Nzọụkwụ 4: Kpọọ ebe
1. A na-ebu ụzọ tinye agịga GROB dayameta 1.8 mm dị ka ntuziaka, na agịga ahụ na-adabere ntakịrị n'azụ n'ọnụ nke notochord.Mgbe nke ahụ gasịrị, a na-etinye ihe nkedo oghere 3.5 mm ma ọ bụ 4 mm dayameta.Agịga ahụ kwesịrị ịdị nwayọọ nwayọọ na-aga n'ihu cephalad n'okpuru nlele anteroposterior na mpụta fluoroscopic.
2. Debe oghere oghere na ntụziaka nke pin ndu n'okpuru nlekota fluoroscopic ma jiri nwayọọ nwayọọ na-aga n'ihu ruo mgbe ọ na-abanye n'ime ọkpụkpụ.Oghere oghere ekwesịghị ịbanye n'ime cortex nke akụkụ cephalad nke notochord ka ntụtụ nduzi wee ghara ịpụ na oghere oghere.
3. Tulee ogologo nke skru oghere achọrọ wee nyochaa ya na nha CT tupu arụ ọrụ iji gbochie mmejọ.Rịba ama na mkpọsa oghere kwesịrị ịbanye n'ọkpụkpụ cortical n'ọnụ ọnụ nke usoro odontoid (iji kwado nzọụkwụ ọzọ nke mgbaji njedebe njedebe).
N'ọtụtụ n'ime ndị na-ede akwụkwọ, a na-eji otu ihe nkedo oghere mee ihe maka nhazi, dị ka egosiri na Figure 5, nke dị na etiti nke usoro odontoid na-eche ihu cephalad, na ọnụ ọnụ nke ịghasa na-abanye n'ọkpụkpụ azụ cortical. n'ọnụ nke usoro odontoid.Kedu ihe kpatara akwadoro otu skru?Ndị na-ede akwụkwọ kwubiri na ọ ga-esi ike ịchọta ebe ntinye kwesịrị ekwesị na ntọala nke usoro odontoid ma ọ bụrụ na a ga-etinye skru abụọ dị iche iche 5 mm site na etiti C2.
Ọgụgụ 5 na-egosi screw oghere nke dị na ntọala nke usoro odontoid chere ihu cephalad, na ọnụ ọnụ nke ịghasa na-abanye n'ime cortex nke ọkpụkpụ dị n'azụ n'ọnụ nke usoro odontoid.
Mana ewezuga ihe nchekwa, skru abụọ ọ na-abawanye nkwụsi ike mgbe arụchara ọrụ ahụ?
Ọmụmụ ihe ọmụmụ biomechanical e bipụtara na 2012 na akwụkwọ akụkọ Clinical Orthopedics na Nnyocha metụtara Gang Feng et al.nke Royal College of Surgeons nke United Kingdom gosiri na otu screw na skru abụọ na-enye otu ọkwa nke nkwụsi ike na nhazi nke ọkpụkpụ odontoid.Ya mere, otu ịghasa zuru ezu.
4. Mgbe a kwadoro ọnọdụ nke mgbawa na ntụnye nduzi, a na-etinye skru oghere kwesịrị ekwesị.Ekwesịrị ịhụ ọnọdụ nke kposara na ntụtụ n'okpuru fluoroscopy.
5. Ekwesịrị ịkpachara anya iji hụ na ngwaọrụ screwing anaghị emetụta anụ ahụ dị nro gbara ya gburugburu mgbe ị na-arụ ọrụ ọ bụla dị n'elu.6. Mechie ihe nkedo iji tinye nrụgide na oghere mgbaji.
Nzọụkwụ 5: Mmechi ọnya
1. Ghichaa mpaghara ịwa ahụ mgbe ịmechara ntinye ihe nkedo.
2. Hemostasis zuru oke dị mkpa iji belata nsogbu mgbe ịwachara ahụ dịka mkpakọ hematoma nke trachea.
3. A ghaghị imechi ahụ ike nke cervical latissimus dorsi cervical n'ụzọ ziri ezi ma ọ bụ na a ga-emebi ihe ịchọ mma nke ọnya ahụ mgbe ọ gasịrị.
4. Mmechi zuru oke nke akwa akwa adịghị mkpa.
5. Ọnwụ ọnya abụghị nhọrọ achọrọ (ndị na-ede akwụkwọ anaghị etinyekarị drains postoperative).
6. A na-atụ aro sutures intradermal iji belata mmetụta na ọdịdị onye ọrịa.
Nzọụkwụ 6: Soro
1. Ndị ọrịa kwesịrị ịga n'ihu na-eyi ihe nkwado olu siri ike maka izu 6 mgbe a rụchara ọrụ ahụ, ọ gwụla ma nlekọta nọọsụ chọrọ ya, a ga-enyocha ya site na onyonyo mgbe ọ gachara.
2. Standard anteroposterior na mpụta redio nke spine cervical kwesịrị nyochaa na 2, 6, na 12 izu na na 6 na 12 ọnwa mgbe ịwachara ahụ.Emere nyocha CT na izu iri na abụọ mgbe a wachara ya ahụ.
Oge nzipu: Dec-07-2023
