Akụkọ - OPEN-ỌDỤ N'azụ Cervical Laminoplasty Usoro

Isi okwu

1. The unipolar elecmma tric na-egbutu fascia wee kpochapụ ahụ ike n'okpuru periosteum, ṅaa ntị iji chebe nkwonkwo synovial articular, ka ọ dị ugbu a, a ghaghị iwepụ ligament na mgbọrọgwụ nke usoro spinous iji mee ka iguzosi ike n'ezi ihe nke eriri ụbụrụ cervical;

2. Lezienụ anya to mmụba nke nta nke nta nke oghere ọnụ ụzọ n'ozuzu ya, enwere ike iji obere spatulas abụọ mepee obere akụkụ nke otu efere vertebral na nke ọzọ, na ihe ndị ọzọ ugboro ugboro, ma jiri nwayọọ nwayọọ meghee ya na obosara dị mma (a na-eme ka ọkpụkpụ azụ na-abawanye site na 4mm), nke nwere ike izere mgbaji zuru ezu nke akụkụ slotted ruo n'ókè o kwere mee;

3. Mgbe emepereg ọnụ ụzọ n'otu n'otu, ịta ahụhụ ligamentum flavum na oghere oghere nwere ike iduga ọbara ọgbụgba site na venous plexus, n'oge a, atụla ụjọ, ị nwere ike itinye bipolar electrocoagulation iji kwụsị ọbara ọgbụgba, ma ọ bụ ogbo gelatin kwụsị ọbara ọgbụgba.

Ọkà mmụta Japan chepụtara nke mbụ ịwa ahụ spain cervical na 1970s. Ọ bụ ezie na a na-emeziwanye ya ọtụtụ ugboro, ọrụ ịwa ahụ bụ isi ka dị ma ọ bụ na-erughị otu, bụ nke dị mfe karị ma dị ka ọrụ nke ụzọ abụọ dị n'azụ nwere mmetụta ọgwụgwọ yiri ya, ọ bụkwa otu n'ime ịwa ahụ nke cervical kpochapụwo maka ndị dọkịta na-awa ọkpụkpụ azụ.

1.Oghere-ọnụ ụzọ Mgbasa Cervical Laminoplasty

Edemede a sitere na Ngalaba Ịwa Ahụhụ Neurological na Mahadum Miami Hospital na Miami, Florida, na n'ihe gbasara usoro nhọrọ a kapịrị ọnụ, ha họọrọ usoro oghere site na C3 ruo C7 maka ọtụtụ ndị ọrịa, ebe ha na-etinye ọgịrịga allograft meghere na saịtị oghere ma gbakwunye ya na ntinye nke autologous, dị ka akọwara n'okpuru:

A na-etinye onye ọrịa ahụ n'ọnọdụ dị mfe, a na-edozi isi ya na etiti Mayfield isi, a na-eji teepu ahụ kwatuo ubu onye ọrịa ma dozie ya n'elu akwa na-arụ ọrụ, 1% lidocaine na epinephrine na-eji ya mee ihe maka ntinye nke mpaghara wee tinye akpụkpọ ahụ n'etiti etiti ahụ iji ruo fascia, na mọzụlụ ahụ na-apụ n'okpuru periosteum nke fascia na-echebe ya na otu n'ime mma. nke nkwonkwo synovial articular na-elebara anya, na ligament nke mgbọrọgwụ sphenoidal ekwesịghị ime ka iguzosi ike n'ezi ihe nke eriri esemokwu nke cervical vertebrae; e mere ka mkpughe nke elu na nke ala. Oke mkpughe nke elu na nke dị ala rutere n'akụkụ ala nke C2 vertebral plate na akụkụ elu nke T1 vertebral efere, na nke atọ nke ala nke C2 vertebral efere na elu nke atọ nke T1 vertebral efere wepụrụ na-egweri egwu, na mgbe ahụ ligamentum flavum na-ekpocha ligamentum flavum site a 2-mm efere na-ata ihe ike na-agba agba na-eme ka a na-agbagharị agbagharị. ike iji kwado maka ịkụnye ọkpụkpụ.

Na-esote, a na-eme oghere ọnụ ụzọ C3-C7, dị ka e gosiri na foto dị n'elu, n'ozuzu akụkụ nke nwere mgbaàmà ndị dị arọ ka a na-eji ya dị ka oghere ọnụ ụzọ na akụkụ ọkụ ọkụ dị ka ihe mgbakwasị ụkwụ, oghere ọnụ ụzọ ma ọ bụ oghere oghere dị na mpaghara nkwụsị nke vertebral efere na articular eminence, ọnụ ụzọ oghere n'akụkụ bụ ala site na cortex bilaterally na isi n'akụkụ a na-egweri otu oyi akwa n'ihi na a na-eji isi ihe na-egweri n'ime ala. ọnụ ụzọ oghere.

Mgbe ị na-egweri site na cortex bilaterally, a ga-ehichapụ akụkụ nke oghere ọnụ ụzọ ya na flavum ligamentum na efere vertebral na-ata ahụhụ ruo mgbe a ga-ahụ nke ọma nke sac dural, wee jiri obere spatula mee ka "ọnụ ụzọ" gaa ihe dị ka 8-16mm ma tinye n'ime ihe mgbochi, na-aṅa ntị na ọnụ ọgụgụ nke nta nke nta nke nta nke nta nke nta nke nta na-emeghe ọnụ ụzọ abụọ na spalas na-emeghe ọnụ ụzọ. otu efere vertebral maka obere ego tupu imeghe nke ọzọ, wee megharịa usoro ahụ, wee meghee ọnụ ụzọ nke nta nke nta ka ọ bụrụ obosara dị mma (ọwa mmiri na-amụba site na 4mm), na n'ụzọ dị otú a, a pụrụ izere ya iji zere mgbaji zuru ezu n'akụkụ nke oghere ndị ahụ ruo n'ókè kachasị ike.

Ekwesịrị inwe ntakịrị ọnụnọ nke nrụgide nrụgide na saịtị ebe a na-etinye ngọngọ ọkpụkpụ na-enweghị mkpa maka nhazi nke mpụga, na ndị na-ede akwụkwọ ahụwo nsogbu ole na ole na ụlọ ọgwụ ebe ọkpụkpụ ọkpụkpụ na-adaba n'ime ọkpụkpụ azụ, na ntinye ikpeazụ nke ọkpụkpụ na-ewepụ ya na usoro spinous n'akụkụ nkuchi.

2.Oghere-ọnụ ụzọ Cervical Expansile Laminoplasty

Isiokwu a, site na Department of Neurosurgery na Keck Medical Center nke University of Southern California, nwere fọrọ nke nta ka otu aha dị ka akwụkwọ gara aga, na mgbanwe na usoro nke English okwu, na a elu ogo nke anọgidesi na ya usoro na nkà ihe ọmụma nke ọrụ, na-egosipụta uniformity na ọzụzụ nke dọkịta na-awa na United States.

Akụkụ ịwa ahụ fọrọ nke nta ka ọ bụrụ naanị C3-7 iji mee ka mgbapụ azụ azụ nke ọkpụkpụ azụ; sphenoidal mgbọrọgwụ akwara na-echekwara iji kwado nkwụsi ike nke cervical; a na-eji igwe igwe ihe eji eme ihe iji meghee ụzọ iji belata mmebi nke ọkpụkpụ azụ azụ; na ọkpụkpụ ọkpụkpụ na-etinye na C3, 5, na 7 iji kwado oghere ọnụ ụzọ.

Ihe atụ: A, Ngosipụta nke lamina site na ala C2 ruo n'elu T1. b, Igwu osteotomy zuru oke n'akụkụ akụkụ ya na akụkụ osteotomy dị n'akụkụ nke ọzọ. c, Elu nke lamina site na C3 ruo C7 dị ka otu unit. d, Ntinye nke oghere oghere ọkpụkpụ allograft.

Ihe onyonyo onyonyo: Nleba anya intraoperative mgbe ị gbasasịrị oghere n'akụkụ mpụta nke C3, C5, na C7 (A) na mgbe etinyechara oghere oghere allograft (B).

Otú ọ dị, ihe ọkpụkpụ ọkpụkpụ ya, na mgbakwunye na ọkpụkpụ allogeneic (Fig. A), bụ ọkpụkpụ vertebral autogenous ọkpụkpụ nke ejiri polylactic acid mesh, dị ka e gosiri n'okpuru (BC Fig.), Nke na-adịkarịghị na China. N'ihe gbasara obosara nke oghere ọnụ ụzọ, a na-ewere obosara dị mma dị ka 10-15 mm, nke dịtụ iche na 8-16 mm n'elu.

Mgbe ị na-eme otu ụzọ oghere nke efere vertebral, ịta ahụhụ ligamentum flavum na saịtị nke oghere ọnụ ụzọ nwere ike ịkpata ọbara ọgbụgba site na vein, n'oge a, atụla ụjọ, ị nwere ike itinye bipolar electrocoagulation iji kwụsị ọbara ọgbụgba ma ọ bụ ogbo gelatin iji kwụsị ọbara ọgbụgba.

3.Cervical Laminoplasty

Na mgbakwunye na ịkwado ọkpụkpụ ọkpụkpụ na oghere ọnụ ụzọ, a na-akọwa ụzọ ndị ọzọ na-edozi oghere ọnụ ụzọ n'isiokwu a, dị ka usoro tie-wire na usoro nhazi microplates, nke ikpeazụ a na-ejikarị eme ihe ugbu a na omume ụlọ ọgwụ ma na-enye nchebe dị nchebe.