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 (nke ahụ A na-eme ka ọkpụkpụ azụ na-amụba site na 4mm), nke nwere ike izere mgbaji zuru oke nke akụkụ oghere ruo n'ókè kachasị ike;

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 ọ na-emeziwanye ọtụtụ ugboro, isi ịwa ahụ ọrụ ka ọzọ ma ọ bụ na-erughị otu, nke bụ dịtụ mfe na yiri nke azụ abụọ-ụzọ ọrụ na yiri ọgwụgwọ mmetụta, na ọ bụ otu n'ime kpochapụwo cervical spain ịwa ahụ 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 mmeghe site na C3 ruo C7 maka ọtụtụ ndị ọrịa, ebe ha na-etinye ihe mgbanaka allograft. meghee 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 isi Mayfield, a na-eji teepu ahụ kwatuo ubu onye ọrịa ma dozie ya n'àkwà na-arụ ọrụ, 1% lidocaine na epinephrine na-eji maka ntinye mpaghara na mgbe ahụ akpụkpọ ahụ. a na-etinye ya n'etiti etiti etiti iji ruo fascia, a na-ewepụkwa uru ahụ n'okpuru periosteum mgbe a na-eji mma electrosurgical nke otu-ogbo nke fascia, na nchebe nke nkwonkwo synovial articular na-elebara anya, na njikọ nke ligament. E kwesịghị ịkpụgharị mgbọrọgwụ sphenoidal iji mee ka iguzosi ike n'ezi ihe nke eriri esemokwu nke vertebrae cervical;e mere ka mkpughe nke elu na nke ala.Oghere mkpughe nke elu na nke dị ala rutere n'akụkụ ala nke C2 vertebral plate na akụkụ elu nke T1 vertebral plate, na nke atọ nke C2 vertebral efere na elu nke atọ nke T1 vertebral efere wepụrụ na-egweri egwu egwu, na mgbe ahụ, a na-ehichapụ flavum ligamentum site na mpempe akwụkwọ 2-mm na-ata ahụhụ iji kpughee dura mater, na akụkụ nke usoro spinous ka a na-ata ahụhụ site na ntanye iji kwadebe 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 dị arọ ka a na-eji ọnụ ụzọ emeghe ọnụ ụzọ na akụkụ ọkụ ọkụ dị ka mgbanaka, oghere ọnụ ụzọ ma ọ bụ oghere oghere dị na ya. ebe nkwụsị nke vertebral efere na articular eminence, ọnụ ụzọ oghere n'akụkụ bụ ala site na cortex bilaterally na hinge akụkụ bụ ala site na cortex na otu oyi akwa, na a egwuregwu isi-egweri isi na-eji maka oghere ọnụ ụzọ.

Mgbe ị na-egweri site na cortex bilaterally, akụkụ oghere nke ọnụ ụzọ ahụ kwesịrị ka a kpochaa ya na ligamentum flavum nke nwere efere vertebral na-ata ume ruo mgbe a ga-ahụ nke ọma nke ọma, wee jiri obere spatula mee ka "ọnụ ụzọ" pụta. ruo ihe dịka 8-16mm ma tinye ya na ngọngọ ntinye, na-aṅa ntị na mmụba nke nta nke nta nke ọnụ ụzọ ghe oghe, na obere spatulas abụọ nwere ike imeghe 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-agbasawanye site na 4mm), na n'ụzọ dị otú a, enwere ike izere ya iji zere mgbaji zuru ezu n'akụkụ oghere ndị ahụ ruo n'ókè kachasị. kwere omume.

Ekwesịrị inwe ntakịrị ọnụnọ nke nrụgide nrụgide na saịtị ebe a na-etinye ọkpụkpụ 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 azụ, na ntinye ikpeazụ. nke ọkpụkpụ wepụrụ site na usoro spinous na akụkụ hinge.

2.Oghere-ọnụ ụzọ Cervical Expansile Laminoplasty

Edemede a, sitere na Ngalaba Neurosurgery na Keck Medical Center nke Mahadum Southern California, nwere ihe fọrọ nke nta ka ọ bụrụ otu aha ahụ dị ka akwụkwọ gara aga, na-agbanwe n'usoro nke okwu Bekee, yana nnukwu nkwụsi ike na usoro ya na nkà ihe ọmụma nke ọrụ, ma na-egosipụta ịdị n'otu na ọzụzụ nke ndị 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 mkpọ igwe ihe egwuregwu meghee ụzọ iji belata mmebi n'ọkpụkpụ 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 oghere ọnụ ụzọ 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 gelatin sponge. 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 microplates fixation method, nke ikpeazụ a na-ejikarị eme ihe ugbu a na ụlọ ọgwụ. ma na-enye ndozi echekwara.