Anterior screw fixation ye odontoid process inochengetedza basa rekutenderera kweC1-2 uye rakashumwa mumabhuku kuti rive ne fusion rate ye88% kusvika ku100%.
Muna 2014, Markus R et al akaburitsa chidzidzo chehunyanzvi hwekuvhiya kweanterior screw fixation yeodontoid fractures muThe Journal of Bone & Joint Surgery (Am).Nyaya yacho inotsanangura zvakadzama pfungwa huru dzemaitiro ekuvhiya, postoperative kutevera, zviratidzo uye zvidziviriro mumatanho matanhatu.
Chinyorwa chinosimbisa kuti mhando II chete mafractures anotenderwa kutungamira anterior screw fixation uye kuti imwechete hollow screw fixation inosarudzwa.
Danho 1: Intraoperative chinzvimbo chemurwere
1. Optimal anteroposterior uye lateral radiographs inofanira kutorwa kuti ionekwe nemushandi.
2. Murwere anofanira kuchengetwa ari pamuromo wakashama panguva yekuvhiyiwa.
3. Kuputsika kunofanira kuiswa zvakare zvakanyanya sezvinobvira kusati kwatanga kuvhiyiwa.
4. Chirwere chepervical spine chinofanira kunge chakawedzerwa zvakanyanya sezvinobvira kuti uwane kuratidzwa kwakakwana kwechigadziko chemaitiro odontoid.
5. Kana hyperextension ye cervical spine isingabviri - semuenzaniso, mu hyperextension fractures ne posterior displacement ye cephalad yekupedzisira yeodontoid process - ipapo kufunga kunogona kupiwa kushandura musoro wemurwere kune imwe nzira yakasiyana maererano ne trunk yake.
6. kusafambisa musoro wemurwere munzvimbo yakagadzikana sezvinobvira.Vanyori vanoshandisa Mayfield head frame (inoratidzwa muMifananidzo 1 uye 2).
Danho rechipiri: Kuvhiya nzira
Nzira yekuvhiya yakajairwa inoshandiswa kufumura anterior tracheal layer pasina kukuvadza chero yakakosha anatomical zvimiro.
Danho rechitatu: Screw yekupinda nzvimbo
Iyo yakakwana yekupinda nzvimbo inowanikwa kune anterior inferior margin yenheyo yeC2 vertebral body.Nokudaro, muganhu wepamberi weC2-C3 disc unofanira kubudiswa pachena.(sezvinoratidzwa muFigure 3 ne4 pazasi) Mufananidzo 3
Museve wakasviba muMufananidzo 4 unoratidza kuti anterior C2 musana inonyatsocherechedzwa panguva yekuverenga preoperative yeaxial CT firimu uye inofanira kushandiswa sechiratidzo cheanatomical chekutarisa pfungwa yekuiswa tsono panguva yekuvhiyiwa.
2. Simbisa pfungwa yekupinda pasi peanteroposterior uye lateral fluoroscopic maonero emutsipa wekervical.3.
3. Svetera tsono pakati peanterior yepamusoro pechete yeC3 yekumusoro endplate uye C2 yekupinda poindi kuti uwane optimal screw entry point.
Danho 4: Screw placement
1. A 1.8 mm dhayamita GROB tsono inotanga kuiswa segwara, netsono yakanangidzirwa zvishoma kuseri kwemuromo wenotochord.Zvadaro, 3.5 mm kana 4 mm dhayamita hollow screw inoiswa.Iyo tsono inofanira kugara ichikwira zvishoma nezvishoma cephalad pasi pe anteroposterior uye lateral fluoroscopic monitoring.
2. Isa chibooreso chegomba munzira yepini yekutungamira pasi pe fluoroscopic monitoring uye zvishoma nezvishoma uenderere mberi kusvika yapinda pakatyoka.Iyo hollow drill haifanirwe kupinda mukati me cortex ye cephalad side ye notochord kuitira kuti pini yekutungamira isabude neburi regoro.
3. Yera kureba kwegomba sikuruu inodiwa uye simbisa iyo ne preoperative CT kuyerwa kudzivirira kukanganisa.Ziva kuti hollow screw inoda kupinda mukati me cortical bone pamuromo weodontoid process (kugonesa nhanho inotevera yekuputsika kupera kwekumanikidza).
Muzvizhinji zvezviitiko zvevanyori, imwe hollow screw yakashandiswa kugadzirisa, sezvakaratidzwa muFigure 5, iyo iri pakati pepakati peiyo odontoid process yakatarisana necephalad, nemuromo wescrew uchingopinda mumashure ecortical bone pa. muromo weodontoid process.Sei screw imwe chete ichikurudzirwa?Vanyori vakagumisa kuti zvingava zvakaoma kuwana nzvimbo yakakodzera yekupinda pachigadziko chemaitiro odontoid kana maviri akaparadzana screws aifanira kuiswa 5 mm kubva pakati peC2.
Figure 5 inoratidza hollow screw iri nechepakati iri pazasi peodontoid process yakatarisana necephalad, nemuromo wescrew uchingopinda mucortex yebhonzo kuseri kwemuromo weodontoid process.
Asi kunze kwechinhu chekuchengetedza, ma screws maviri anowedzera postoperative kugadzikana?
Chidzidzo chebiomechanical chakabudiswa muna 2012 mumagazini Clinical Orthopedics uye Related Research naGang Feng et al.yeRoyal College of Surgeons yeUnited Kingdom yakaratidza kuti screw imwe uye screws mbiri zvinopa chiyero chakafanana chekudzikamisa mukugadzirisa kwe odontoid fractures.Naizvozvo, screw imwe chete yakakwana.
4. Kana nzvimbo yekuputsika uye mapini emutungamiri akasimbiswa, zvigadziko zvakakodzera zvakaiswa.Nzvimbo yezviputi nemapini inofanira kuonekwa pasi pe fluoroscopy.
5. Kuchengetedza kunofanira kutorwa kuti kuve nechokwadi chokuti screwing device haisanganisi zvinyoro zvakapoteredza kana ichiita chero ipi zvayo pamusoro apa.6. Simbisa ma screws kuti uise kumanikidza kune nzvimbo yekuputsika.
Danho 5: Kuvhara Maronda
1. Bvisa nzvimbo yekuvhiya mushure mekupedza kuisa screw.
2. Kunyatsobuda kwehemostasis kunokosha kuti kuderedze matambudziko epashure akadai sehematoma compression yetrachea.
3. Iyo incised cervical latissimus dorsi muscle inofanira kuvharwa mukurongeka kwakanyatsonaka kana kuti aesthetics yevanga mushure mekushanda ichakanganiswa.
4. Kuvhara zvakakwana kwezvikamu zvakadzika hazvidiwi.
5. Kuyerera kwemaronda hakusi kusarudzwa kunodiwa (vanyori kazhinji havaisi madhiraini epashure).
6. Intradermal sutures inokurudzirwa kuderedza kukanganisa pakuonekwa kwemurwere.
Danho rechitanhatu: Kutevera
1. Varwere vanofanira kuramba vachipfekedza mutsipa wakaoma kwemavhiki e6 mushure mekushanda, kunze kwekunge kutarisirwa kwekuyamwisa kuchida, uye kunofanira kuongororwa ne periodic postoperative imaging.
2. Standard anteroposterior uye lateral radiographs yekervical spine inofanira kuongororwa pa2, 6, uye mavhiki e12 uye pa6 uye 12 mwedzi mushure mekuvhiyiwa.A CT scan yakaitwa pamavhiki e12 mushure mekuvhiyiwa.
Nguva yekutumira: Zvita-07-2023
