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 kwekuvhura kwegonhi zvakazara, maviri madiki spatula anogona kushandiswa kuvhura chikamu chidiki cheimwe vertebral plate uye ipapo imwe, uye zvichingodaro kakawanda, uye zvishoma nezvishoma kuvhura iyo kuhupamhi hwakakodzera (the spinal canal inowedzerwa ne 4mm), iyo inogona kudzivirira kuputsika kwakazara kwedivi rakatsemurwa kusvika padanho rinogoneka;

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, izvo zviri nyore uye zvakafanana nemashure maviri-musuo oparesheni ane maitiro akafanana ekurapa, uye ndeimwe yemhando yekare yekuvhiya cervical spine. vanovhiya 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 kubva kuC3 kusvika kuC7 kune varwere vakawanda, vachishandisa mbabvu dzeallograft dzakasimudzwa. yakavhurika kune yakavhurika-gonhi saiti uye inowedzerwa ne autologous implants, sezvinotsanangurwa pazasi:

Murwere akaiswa panzvimbo yakatarisa, musoro wakagadziriswa neMayfield head frame, tepi yakashandiswa kukwevera pasi fudzi remurwere uye kuigadzirisa pamubhedha wekushanda, 1% lidocaine uye epinephrine zvakashandiswa kupindira kwemukati uye ipapo ganda. akaiswa padivi pepakati kusvika kune fascia, uye mhasuru dzakabviswa kubva pasi pe periosteum mushure mekucheka kwefascia nebanga rimwechete remagetsi emagetsi, uye kuchengetedzwa kwearticular synovial joints kwakabhadharwa, uye ligament ye sphenoidal root haifaniri kugadziriswa kuitira kuchengetedza kuvimbika kwebhendi rekumanikidza remutsipa wekervical vertebrae;kuratidzwa kwepamusoro uye kwepasi kwakaitwa.Nzvimbo dzepamusoro nepamusoro dzepamusoro dzakasvika kune chikamu chepasi cheC2 vertebral plate uye chikamu chepamusoro cheT1 vertebral plate, uye chikamu chetatu cheC2 vertebral plate uye chetatu chepamusoro cheT1 vertebral plate yakabviswa negrinding drill, uye ipapo ligamentum flavum yakacheneswa ne 2-mm ndiro inoruma forceps kuratidza dura mater, uye chikamu che spinous process yakarumwa neinoruma forceps kugadzirira kuisirwa kwebhonzo.

Tevere kuvhurwa kwegonhi reC3-C7 kwakaitwa, sezvakaratidzwa mumufananidzo uri pamusoro, kazhinji rutivi rwaiva nezviratidzo zvinorema rwakashandiswa serutivi rwokuzarura gonhi uye rutivi rwakareruka rwakashandiswa sehinge, gonhi rokuzarura kana kuti nzvimbo yokutsvedza yakanga iri mukati. nzvimbo yekubatanidza ye vertebral plate uye articular eminence, gonhi rekuvhurwa kwegonhi rakanga rakavhuvhuta kuburikidza necortex bilateral uye rutivi rwehinge rwakakuyiwa kuburikidza necortex muchikamu chimwe chete, uye musoro wemachisi wekukuya wakashandiswa pakuvhurwa kwegonhi.

Mushure mekugaya kuburikidza necortex bilaterally, rutivi rwakavhurika rwegonhi runoda kucheneswa ne ligamentum flavum ne vertebral plate inoruma forceps kusvikira dural sac ichionekwa zvakajeka, uye ipapo shandisa spatula diki kuvhura "gonhi" kusvika pa8-16mm uye woisa muchivharo chekuisa, uchiteerera kuwedzera zvishoma nezvishoma kwekukura kwese kwegonhi rakashama, uye maviri spatulas anogona kushandiswa kuvhura imwe vertebral plate kune imwe shoma isati yavhura imwe. , uye wozodzokorora nzira yacho, uye wozozarura musuo zvishoma nezvishoma kusvika kuhupamhi hwakakodzera (mugero unowedzera ne 4mm), uye nenzira iyi, inogona kudziviswa kudzivisa kuputsika kwakakwana padivi rezvivharo kusvika pamwero mukuru. zvinogoneka.

Panofanira kuva nekuvapo kuduku kwekumanikidzika kwekumanikidzika panzvimbo iyo pfupa repfupa rinoiswa pasina kudiwa kwekugadziriswa kwekunze, uye vanyori vakaona zvinetso zvishomanana mukiriniki apo pfupa remapfupa rinowira mumugero wepelinha, pamwe nekupedzisira kuiswa. yebhonzo yakabviswa kubva ku spinous process pa hinge side.

2.OPEN-DOOR Cervical Expansile Laminoplasty

Ichi chinyorwa, kubva kuDhipatimendi reNeurosurgery paKeck Medical Center yeYunivhesiti yeSouthern California, ine musoro wakafanana negwaro rakapfuura, neshanduko mukurongeka kwemazwi echiRungu, uye dhigirii yakakwirira yekusagadzikana munzira yayo uye. huzivi hwekushanda, uye inoratidza kufanana mukudzidziswa kwevanovhiya 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

Pamusoro pekutsigira bhonzo pakuvhurwa kwegonhi, dzimwe nzira dzekugadzirisa kuvhurwa kwegonhi dzinotsanangurwa muchinyorwa chino, senge nzira yekusunga-waya uye microplates kugadzirisa nzira, iyo yekupedzisira iyo parizvino inonyanya kushandiswa mukurapa kwekiriniki. uye inopa kugadzirisa kwakachengeteka.