Kugadzika kwe screw ye odontoid process pamberi pemusoro kunochengetedza basa rekutenderera kweC1-2 uye zvakataurwa mumabhuku kuti ine fusion rate ye88% kusvika 100%.
Muna 2014, Markus R nevamwe vake vakaburitsa chidzidzo pamusoro penzira yekuvhiya yekugadzirisa screw yekuvhiya yeanterior screw yekutyoka kwe ondoid muThe Journal of Bone & Joint Surgery (Am). Chinyorwa ichi chinotsanangura zvakadzama pfungwa huru dzenzira yekuvhiya, kutevera mushure mekuvhiyiwa, zviratidzo uye matanho ekudzivirira mumatanho matanhatu.
Nyaya yacho inosimbisa kuti kupwanyika kwerudzi rwechipiri chete ndiko kunogona kutungamira kugadzirisa sikuruu yepamberi uye kuti kugadzirisa sikuruu imwe chete isina chinhu ndiyo inosarudzwa.
Danho 1: Kuisa murwere panzvimbo yake panguva yekuvhiyiwa
1. MaX-ray akakodzera e anteroposterior ne lateral anofanira kutorwa kuti aonekwe nemushandi.
2. Murwere anofanira kugara akashama muromo panguva yekuvhiyiwa.
3. Kutsemuka kunofanira kugadziriswa zvakanyanya sezvinobvira usati watanga kuvhiyiwa.
4. Muzongoza wemuromo wechibereko unofanira kutambanudza zvakanyanya sezvinobvira kuti pave nekuonekwa kwakakodzera kwechikamu chemuzongoza wemuromo.
5. Kana mutsipa wemutsipa wepamuromo usingakwanise kutambanudza zvakanyanya – semuenzaniso, kana mutsipa wepamuromo wakatsemuka nekusuduruka kwemashure kwechikamu chechipfuva chemusana wemusana wemusana – ipapo zvingafungwa nezvekushandura musoro wemurwere nenzira yakasiyana nedumbu rake.
6. Dzima musoro wemurwere panzvimbo yakagadzikana sezvinobvira. Vanyori vanoshandisa furemu yemusoro yeMayfield (inoratidzwa muMifananidzo 1 ne2).
Danho rechipiri: Nzira yekuvhiya
Nzira yekuvhiya yakajairika inoshandiswa kuburitsa pachena chikamu chepamberi chetracheal pasina kukuvadza chero chimiro chakakosha chemuviri.
Danho rechitatu: Nzvimbo yekupinda nescrew
Nzvimbo yakakodzera yekupinda iri pamucheto wepasi pemuviri weC2 vertebral. Nokudaro, mupendero wepamberi wediski yeC2-C3 unofanira kuratidzwa. (sezvinoratidzwa muMifananidzo 3 ne4 pazasi) Mufananidzo 3
Museve mutema uri paMufananidzo 4 unoratidza kuti musana weC2 wekumberi unocherechedzwa nokungwarira panguva yekuverenga firimu reCT re axial usati wavhiyiwa uye unofanirwa kushandiswa sechiratidzo chemuviri chekuona nzvimbo yekuisa tsono panguva yekuvhiyiwa.
2. Simbisa nzvimbo yekupinda pasi pekutarisa kwemusana wemuromo wechibereko uchishandisa anteroposterior uye lateral fluoroscopic. 3.
3. Isa tsono pakati pemucheto wepamusoro weC3 upper endplate nenzvimbo yekupinda yeC2 kuti uwane nzvimbo yakakodzera yekupinda nesikuruu.
Danho rechina: Kuisa sikuruu
1. Tsono yeGROB ine dhayamita ye1.8 mm inotanga yaiswa senzira yekutungamira, tsono yakatarisa zvishoma kumashure kwemucheto wenotochord. Zvadaro, sikuruu ine hollow ye3.5 mm kana 4 mm dhayamita inoiswa. Tsono inofanira kugara ichifambiswa zvishoma nezvishoma pasi pe anteroposterior uye lateral fluoroscopic monitoring.
2. Isa chibooreso chegomba riri pasi pechinongedzo che fluoroscopic wochifambisa zvishoma nezvishoma kusvika chapinda pakatyoka. Chibooreso chegomba harifaniri kupinda mukati me cortex ye cephalad side ye notochord kuitira kuti chibooreso chegomba chisabude ne chibooreso chegomba riri pasi.
3. Yera kureba kwe screw ine hollow inodiwa woiongorora uchishandisa CT measurement usati wavhiyiwa kudzivirira zvikanganiso. Cherechedza kuti screw ine hollow inofanira kupinda mu cortical bone pamucheto we odontoid process (kuti iite kuti danho rinotevera rekudzvanywa kwe breakage end compression rive nyore).
Muzviitiko zvakawanda zvevanyori, sikuruu imwe chete isina chinhu yakashandiswa pakugadzirisa, sezvakaratidzwa muMufananidzo 5, iyo iri pakati pepasi penzira ye odontoid yakatarisana ne cephalad, muromo we sikuruu uchingopinda mubhonzo re posterior cortical pamucheto wenzira ye odontoid. Sei sikuruu imwe chete ichikurudzirwa? Vanyori vakagumisa kuti zvaizova zvakaoma kuwana nzvimbo yakakodzera yekupinda pasi penzira ye odontoid kana sikuruu mbiri dzakasiyana dzikaiswa 5 mm kubva pakati peC2.
Mufananidzo 5 unoratidza sikuruu ine hollow iri pakati pechikamu che "odontoid process" chakatarisana ne "cephalad", muromo wesikuruu uchingopinda mu "cortex" yebhonzo seri kwemucheto we "odontoid process".
Asi kunze kwekuchengetedza, screw mbiri dzinowedzera kugadzikana mushure mekuvhiyiwa here?
Chidzidzo chebiomechanical chakaburitswa muna 2012 mujenari reClinical Orthopaedics and Related Research rakanyorwa naGang Feng nevamwe veRoyal College of Surgeons of the United Kingdom chakaratidza kuti sikuruu imwe chete nesikuruu mbiri zvinopa mwero wakafanana wekugadzikana pakugadzika kwemapfupa asina kupatsanuka. Saka, sikuruu imwe chete yakakwana.
4. Kana nzvimbo yekutyoka uye mapini ekutungamira zvasimbiswa, masikuruu akakodzera ane mhango anoiswa. Nzvimbo yemasikuruu nemapini inofanira kucherechedzwa pasi pe fluoroscopy.
5. Chenjererai kuti muchina wekukurunga usasanganise matishu akapfava akakomberedza pakuita chero mabasa ari pamusoro apa. 6. Simbisai masikuru kuti muise kumanikidzwa panzvimbo yakatyoka.
Danho rechishanu: Kuvhara Ronda
1. Sukurudza nzvimbo yekuvhiyiwa mushure mekupedza kuisa sikuruu.
2. Kubvisa ropa zvakanyanya kwakakosha kuderedza matambudziko mushure mekuvhiyiwa akadai sekumanikidzwa kwetrachea nehematoma.
3. Tsandanyama yemutsipa wechibereko yakachekwa inofanira kuvharwa zvakanaka kana kuti runako rwevanga repashure pekuvhiyiwa ruchakanganiswa.
4. Kuvhara zvizere zvidimbu zvakadzika hazvidiwi.
5. Kubvisa maronda kubva muronda hakusi sarudzo inodiwa (vanyori havawanzoisa madhireni mushure mekuvhiyiwa).
6. Kusukwa kweganda mukati meganda kunokurudzirwa kuderedza kukanganisa chitarisiko chemurwere.
Danho 6: Kutevera
1. Varwere vanofanira kuramba vakapfeka simbi yakasimba yemutsipa kwemavhiki matanhatu mushure mekuvhiyiwa, kunze kwekunge zvichidikanwa nekutarisira vakwegura, uye vanofanira kuongororwa nemifananidzo yenguva nenguva mushure mekuvhiyiwa.
2. Kuongororwa kwe radiographs dzemusana wemuromo wechibereko (anteroposterior) nedzemusana (lateral radiographs) dzinofanira kuongororwa pamavhiki maviri, matanhatu, negumi nemaviri (2), uye pamwedzi mitanhatu negumi nemaviri (6) mushure mekuvhiyiwa. Kuongororwa kweCT kwakaitwa pamavhiki gumi nemaviri mushure mekuvhiyiwa.
Nguva yekutumira: Zvita-07-2023
