Nhau - Vhura-DOOR Posterior Cervical Laminoplasty maitiro

KEYPOINT

1. Iyo unipolar electric knife inocheka fascia uye inobva yabvisa musuru pasi peperiosteum, teerera kuchengetedza articular synovial joint, panguva iyo ligament pamudzi we spinous process haifaniri kubviswa kuitira kuchengetedza kutendeseka kwekervical tension band;

2. Teerera to kuwedzera zvishoma nezvishoma kwekuvhurwa kwegonhi rose, maspatula maviri maduku anogona kushandiswa kuzarura chikamu chiduku cheimwe vertebral plate uye ipapo imwe, uye zvichingodaro kakawanda, uye zvishoma nezvishoma kuzarura kusvika kuhupamhi hwakakodzera (mugero wepelinha wakawedzerwa ne 4mm), iyo inogona kudzivisa kuputsika kwakakwana kwedivi rakaputika kusvika pamwero mukuru unogoneka;

3. Pakuvhurag musuwo unilaterally, kuruma kubva kune ligamentum flavum panzvimbo yekuvhura kunogona kutungamirira kubuda kweropa kubva pavenous plexus, panguva ino, usavhunduka, unogona kuisa bipolar electrocoagulation kumisa kubuda kweropa, kana gelatin sponges kumisa kubuda ropa.

OPEN-DOOR Posterior cervical spine surgery yakatanga kugadzirwa nenyanzvi dzechiJapan muma1970. Kunyange zvazvo yakagadziridzwa kakawanda, kuvhiyiwa kwekutanga kuchiri kunyanya kufanana, iyo inenge iri nyore uye yakafanana neyemashure maviri-gonhi rekushanda nemaitiro akafanana ekurapa, uye ndeimwe yemhando yekare yekervical spine kuvhiyiwa kwevanovhiya musana.

1.OPEN-DOOR Expansile Cervical Laminoplasty

Ichi chinyorwa chinobva kuDhipatimendi reNeurological Surgery paYunivhesiti yeMiami Hospital muMiami, Florida, uye maererano nesarudzo chaiyo yemaitiro, vakasarudza nzira yakazaruka yemukova kubva kuC3 kusvika kuC7 kune varwere vakawanda, pavanenge vachishandisa mbabvu dzeallograft dzakavhurika kune nzvimbo yakazaruka uye yakawedzerwa ne autologous implants, sezvinotsanangurwa pasi apa:

Murwere akaiswa panzvimbo yakagadzikana, musoro wakagadziriswa neMayfield head frame, tepi yakashandiswa kukwevera pasi bendekete remurwere uye kuigadzirisa pamubhedha wekushanda, 1% lidocaine uye epinephrine zvakashandiswa kupindira kwemukati uye ipapo ganda rakaputirwa pamwe chete nepakati kusvika kune fascia, uye misumbu yakabviswa kubva pasi periosurgical electro-facia. banga, uye kudzivirirwa kwe articular synovial joints yakabhadharwa, uye ligament ye sphenoidal root haifaniri kubviswa kuitira kuchengetedza kuvimbika kwebhendi rekunetsa re cervical vertebrae; kuratidzwa kwepamusoro uye kwepasi kwakaitwa. Nzvimbo dzepamusoro uye dzakadzika dzakatarisana dzakasvika kune chikamu chezasi cheC2 vertebral plate uye chikamu chepamusoro cheT1 vertebral plate, uye chetatu chezasi cheC2 vertebral plate uye chetatu chepamusoro cheT1 vertebral plate yakabviswa nekukuya, uye ipapo ligamentum flavum yakacheneswa ne 2-mm plate kuburitsa uye kusvuta chikamu chesimbi madura. simba rinoruma kugadzirira kuiswa kwebhonzo.

Zvadaro kuvhurwa kwegonhi reC3-C7 kwakaitwa, sezvakaratidzwa mumufananidzo uri pamusoro, kazhinji rutivi rwaiva nezviratidzo zvinorema rwakashandiswa serutivi rwekuvhura kwegonhi uye rutivi rwakareruka rwakashandiswa sehinge, gonhi rekuzarura kana nzvimbo yekutsvedza yakanga iri munzvimbo yekubatanidza kweplateti ye vertebral uye articular eminence, rutivi rwekuvhura kwemukova rwakanga rwakavhuvhuta kuburikidza nekortex kumativi ose uye pasi mukati memusoro we cortex uye musoro we cortex. yakashandiswa kuvhura gonhi.

Mushure mekugaya kuburikidza necortex bilaterally, rutivi rwakavhurika rwegonhi rinoda kucheneswa ne ligamentum flavum ine vertebral plate inoruma forceps kusvikira dural sac ichinyatsoonekwa, uye zvino shandisa spatula diki kuvhura "gonhi" kusvika pa8-16mm uye kuisa muchivharo chekuisa, uchiteerera kune zvishoma nezvishoma kuwedzera kwekukura kwegonhi rinoshandiswa, uye zvishoma nezvishoma kuwedzera kwegonhi rinoshandiswa. vhura imwe vertebral plate kune shoma shoma usati wavhura imwe, uye wozodzokorora nzira yacho, uye wozovhura musuwo zvishoma nezvishoma kusvika kuhupamhi hwakakodzera (mugero unowedzera ne 4mm), uye nenzira iyi, inogona kudziviswa kudzivirira kuputsika kwakazara padivi peiyo slots kusvika pamwero mukuru unogoneka.

Panofanira kuva nekuvapo kuduku kwekumanikidzika kwekumanikidzika panzvimbo iyo pfupa rinoiswa pasina kudiwa kwekunze kwekugadzirisa, uye vanyori vakaona matambudziko mashomanana mukiriniki apo pfupa repfupa rinowira mumugero wepelinha, pamwe nekuiswa kwekupedzisira kwepfupa rinobviswa kubva kune spinous process padivi rehinge.

2.OPEN-DOOR Cervical Expansile Laminoplasty

Chinyorwa ichi, kubva kuDhipatimendi reNeurosurgery paKeck Medical Center yeYunivhesiti yeSouthern California, ine musoro wakada kufanana negwaro rakapfuura, neshanduko yehurongwa hwemashoko eChirungu, uye nehupamhi hwekusagadzikana munzira yayo uye huzivi hwekushanda, uye inoratidza kufanana mukudzidziswa kwevavhiyi muUnited States.

Zvikamu zvekuvhiya zvaive zvakangoita C3-7 chete kuti iite kuti posterior displacement yemuzongoza; sphenoidal root ligaments yakachengetedzwa kuti iite kuti cervical kugadzikana; mechi yekugaya chibooreso chakashandiswa kuvhura gonhi kuti kuderedze kukanganisa kumusana; uye mapfupa emapfupa akaiswa paC3, 5, uye 7 kutsigira kuvhurwa kwemukova.

Mufananidzo Cherechedza: A, Kuratidzwa kwelamina kubva pasi peC2 kusvika kumusoro kweT1. b, Kuboora lateral groove ine osteotomy yakakwana kune rimwe divi uye chikamu che osteotomy kune rimwe divi. c, Kukwidziridzwa kwelamina kubva kuC3 kusvika kuC7 sechinhu chimwe chete. d, Kuiswa kweallograft bone spacer.

Figure Note: Intraoperative maonero mushure mekuchera maburi mu lateral grooves yeC3, C5, uye C7 (A) uye mushure mekuiswa kweallograft rib spacer (B).

Zvisinei, pfupa rayo kubatanidza zvinhu, kuwedzera kune allogeneic bone (Fig. A), inonzi vertebral autogenous bone graft yakagadzirwa ne polylactic acid mesh, sezvinoratidzwa pasi apa (BC Fig.), Izvo zvisinganyanyi kuwanika muChina. Mukutaura kwehupamhi hwekuvhurwa kwegonhi, hupamhi hwakanaka hunoonekwa se 10-15 mm, iyo yakasiyana zvishoma kubva pa8-16 mm kumusoro.

Paunenge uchivhura gonhi rimwe chete re vertebral plate, kuruma kubva kune ligamentum flavum panzvimbo yekuvhurwa kwegonhi kunogona kukonzera kubuda ropa kubva mutsinga, panguva ino usavhunduka, unogona kuisa bipolar electrocoagulation kumisa kubuda ropa kana gelatin sponge kumisa kubuda ropa.

3.Cervical Laminoplasty

Mukuwedzera pakutsigira bhomba rebhonzo pamusuwo wekuvhura, dzimwe nzira dzekugadzirisa kuvhurwa kwegonhi dzinotsanangurwa munyaya ino, yakadai seye-tie-waya nzira uye microplates kugadzirisa nzira, iyo yekupedzisira iyo ikozvino inonyanya kushandiswa mumakiriniki maitiro uye inopa kugadzirisa kwakachengeteka.