Nhau - Kuvhiyiwa kwePostterior Cervical Laminoplasty kwakavhurika

NZVIMBO YAKAKOSHA

1. Magetsi eUnipolarbanga reTrick rinocheka fascia robva rabvisa tsandanyama pasi peperiosteum, teererai kuchengetedza articular synovial joint, ukuwo ligament iri pamudzi we spinous process haifanirwe kubviswa kuitira kuchengetedza kuvimbika kwe cervical tension band;

2. TeereraiKana gonhi rikawedzera zvishoma nezvishoma, zvidimbu zviviri zvidiki zvinogona kushandiswa kuvhura chikamu chidiki cheplate imwe yemusana uye imwe yacho, zvichingodaro kakawanda, uye zvishoma nezvishoma kuivhura kusvika paupamhi hwakakodzera (mugero wemusana wakakura ne4mm), izvo zvinogona kudzivirira kutyoka kwedivi rakatsemuka kusvika pamwero wakanyanya;

3. Kana wavhuraKuruma gonhi rega rega, kuruma ligamentum flavum panzvimbo yakavhurika kunogona kukonzera kubuda ropa kubva mutsinga dzeropa, panguva ino, usavhunduke, unogona kushandisa bipolar electrocoagulation kumisa kubuda ropa, kana gelatin sponges kumisa kubuda ropa.

KUVHURWA KWEMUSUNGO WE ...

1. GOO RAKAVHURWA RINE EXPANSILE CRIVATION LAMINOPLAST

Nyaya iyi inobva kuDhipatimendi reNeurological Surgery paYunivhesiti yeMiami Hospital muMiami, Florida, uye maererano nesarudzo chaiyo yenzira yekuvhiya, vakasarudza nzira yekuvhiya yakavhurika kubva paC3 kusvika paC7 kune vazhinji vevarwere, uku vachiisa mbabvu dzeallograft dzakavhurika panzvimbo yakavhurika uye dzichiwedzerwa ne autologous implants, sezvakatsanangurwa pazasi:

Murwere akaiswa panzvimbo yakapfava, musoro wakasungirirwa neMayfield head frame, tepi yakashandiswa kudhonza pasi bendekete remurwere nekuriisa pamubhedha wekuvhiyiwa, 1% lidocaine ne epinephrine zvakashandiswa kupinda munzvimbo iyoyo uye ganda rakachekwa pakati kuti risvike pa fascia, uye tsandanyama dzakabviswa pasi pe periosteum mushure mekuchekwa kwe fascia nebanga remagetsi rimwe chete, uye kuchengetedzwa kwemajoini e synovial articular kwakanyatsotariswa, uye ligament yemudzi we sphenoidal haifanirwe kubviswa kuitira kuchengetedza kusimba kwebhandi rekumanikidzwa kwe cervical vertebrae; kuratidzwa kwepamusoro nepazasi kwakaitwa. Nzvimbo dzepamusoro nepazasi dzekuona mapfupa dzakasvika pachikamu chezasi cheplate yeC2 vertebral nechikamu chepamusoro cheplate yeT1 vertebral, uye chikamu chepazasi cheplate yeC2 vertebral nechikamu chepazasi cheplate yeT1 vertebral zvakabviswa ne grinding drill, uye ipapo ligamentum flavum yakacheneswa ne 2-mm plate bite forceps kuti dura mater ionekwe, uye chikamu che spinous process chakarumwa ne forceps bite kugadzirira kuiswa kwepfupa.

Tevere, kuvhurwa kwegonhi reC3-C7 kwakaitwa, sezvakaratidzwa pamufananidzo uri pamusoro, kazhinji divi rine zviratidzo zvakakura rakashandiswa sedivi rekuvhurwa kwegonhi uye divi rakareruka rakashandiswa sehinge, kuvhurwa kwegonhi kana nzvimbo yekupinza yaive munzvimbo inoungana vertebral plate uye articular eminence, divi rekuvhurwa kwegonhi rakakuyiwa nepakati pe cortex uye divi rehinge rakakuyiwa nepakati pe cortex nechikamu chimwe chete, uye musoro wekukuya wemusoro wemachisi wakashandiswa pakuvhurwa kwegonhi.

Mushure mekupwanya cortex nepakati pemaviri, divi rakavhurika remusuwo rinofanira kucheneswa ne ligamentum flavum ne vertebral plate biting forceps kusvika dural sac yave kunyatsoonekwa, uye wobva washandisa spatula diki kuvhura "musuwo" kusvika pa 8-16mm woisa mu implant block, uchinyatsoteerera kuwedzera zvishoma nezvishoma kwehukuru hwese hwemusuwo wakavhurika, uye spatula mbiri diki dzinogona kushandiswa kuvhura vertebral plate imwe kwenguva diki usati wavhura imwe, wobva wadzokorora maitiro acho, wozovhura door zvishoma nezvishoma kusvika paupamhi hwakakodzera (canal inowedzera ne 4mm), uye nenzira iyi, inogona kudzivirirwa kudzivirira kuputsika kwakazara padivi pemigero kusvika pamwero wakanyanya.

Panofanira kuva nekumanikidzwa kudiki panzvimbo inoiswa bhonzo pasina chikonzero chekuiswa kwekunze, uye vanyori vakaona matambudziko mashoma mukiriniki apo bhonzo rinowira mumuzongoza, nekuiswa kwekupedzisira kwebhonzo kubva mukuita kwespinous parutivi rwehinge.

2. Laminoplasty yeCervical Expansile Laminoplasty yakavhurika

Chinyorwa chino, chakabva kuDhipatimendi reNeurosurgery paKeck Medical Center yeYunivhesiti yeSouthern California, chine musoro wakafanana negwaro rapfuura, nekuchinja kwekurongeka kwemashoko eChirungu, uye mwero wepamusoro wekuenderana kwemaitiro ayo nepfungwa dzekushanda, uye chinoratidza kufanana mukudzidziswa kwevanachiremba vekuvhiya muUnited States.

Zvikamu zvekuvhiyiwa zvaive zveC3-7 chete kuti zvibatsire kusuduruka kwemusana kumashure; mitsipa yemidzi yesphenoidal yakachengetedzwa kuti muromo wechibereko ugare zvakanaka; chibooreso chekugaya chemusoro wemachisi chakashandiswa kuvhura musuwo kuti musana usakuvare; uye mapfupa akaiswa paC3, 5, ne7 kuti atsigire kuvhurwa kwemusuwo.

Mufananidzo Cherechedza: A, Kuonekwa kwelamina kubva pasi peC2 kusvika pamusoro peT1. b, Kuboorwa kwe lateral groove ne osteotomy yakakwana kune rumwe rutivi uye osteotomy yechikamu kune rumwe rutivi. c, Kukwidziridzwa kwelamina kubva paC3 kusvika paC7 seyuniti imwe chete. d, Kuiswa kwe allograft bone spacer.

Mufananidzo Cherechedza: Kuonekwa panguva yekuvhiyiwa mushure mekuboora maburi mumigero yeC3, C5, neC7 (A) uye mushure mekuiswa kwechikamu cheallograft rib spacer (B).

Zvisinei, zvinhu zvayo zvekubatanidza mapfupa, pamusoro pemapfupa eallogeneic (Mufananidzo A), ipfundo remapfupa re vertebral autogenous rakagadzirwa ne polylactic acid mesh, sezvakaratidzwa pazasi (Mufananidzo weBC), iro risingawanzoitiki muChina. Panyaya yehupamhi hwegonhi, hupamhi hwakakodzera hunoonekwa se10-15 mm, hwakasiyana zvishoma ne8-16 mm pamusoro.

Paunenge uchivhura gonhi rimwe chete re vertebral plate, kuruma ligamentum flavum panzvimbo yekuvhura gonhi kunogona kukonzera kubuda ropa kubva mutsinga, panguva ino usavhunduke, unogona kushandisa bipolar electrocoagulation kumisa kubuda ropa kana gelatin sponge kumisa kubuda ropa.

3. Kuvhiyiwa kweLaminoplasty yemumuromo wechibereko

Pamusoro pekutsigira bhonzo repamusuwo, dzimwe nzira dzekugadzirisa musuwo dzakatsanangurwa munyaya ino, dzakadai senzira yekubatanidza waya uye nzira yekubatanidza ma microplates, iyo yekupedzisira iri kushandiswa zvakanyanya mukurapa uye inopa kugadzika kwakachengeteka.