Murwere wekuvhiya uye zvikanganiso zvesaiti zvakakomba uye zvinodzivirirwa. Zvinoenderana neJoint Commission on Accreditation of Healthcare Organisations, zvikanganiso zvakadaro zvinogona kuitwa kusvika ku41% yekuvhiya kwemapfupa/vana. Kuvhiyiwa kwemusana, kukanganisa kwenzvimbo yekuvhiya kunoitika kana vertebral segment kana lateralization isiriyo. Mukuwedzera pakukundikana kugadzirisa zviratidzo zvemurwere uye chirwere, zvikanganiso zvezvikamu zvinogona kutungamirira kumatambudziko matsva ezvehutano akadai sekukurumidza kuderera kwe disc kana kusagadzikana kwepelinha mune zvimwe zvikamu zvisinganzwisisike kana zvakajairika.
Kune zvakare nyaya dzemutemo dzakabatanidzwa nezvikanganiso zvechikamu mukuvhiya musana, uye veruzhinji, masangano ehurumende, zvipatara, uye nzanga dzevanovhiya vane zero kushivirira kwezvikanganiso zvakadaro. Kuvhiyiwa kwepelinha kwakawanda, kwakadai se discectomy, fusion, laminectomy decompression, uye kyphoplasty, inoitwa uchishandisa nzira yemashure, uye kuisa kwakakodzera kunokosha. Pasinei nekombiyuta yezvino yekufungidzira, zvikanganiso zvezvikamu zvichiri kuitika, nehuwandu hwezviitiko kubva ku0.032% kusvika ku15% zvakataurwa mumabhuku. Iko hakuna mhedziso yekuti ndeipi nzira yenzvimbo yakanyanya kunaka.
Nyanzvi kubva kuDhipatimendi reOrthopedic Surgery paGomo reSinai Chikoro cheMishonga, USA, yakaita tsvakurudzo yepaIndaneti ichiratidza kuti vazhinji vevavhiyi vemusana vanoshandisa nzira shomanana dzekugara, uye kuti kujekeswa kwezvikonzero zvinowanzokonzera kukanganisa kunogona kubudirira mukuderedza zvikanganiso zvekuvhiya, mune imwe nyaya yakabudiswa May 2014 mu Spine J. Chidzidzo ichi chakaitwa pachishandiswa email link kumibvunzo yakatumirwa kunhengo dzeNorth American Spine Society (kusanganisira vanachiremba vemapfupa uye neurosurgeons). Gwaro remibvunzo rakatumirwa kamwe chete, sekukurudzirwa neNorth American Spine Society. Zvose zvevanachiremba ve2338 vakazvigamuchira, 532 yakazarura chinongedzo, uye 173 (7.4% mhinduro yehuwandu) yakazadza mubvunzo. Makumi manomwe nemaviri muzana yevakapedzisa vaive vanachiremba vemapfupa, 28% vaive neurosurgeon, uye 73% vaive vanachiremba vemuzongoza mukudzidziswa.
Bvunzurudzo yacho yaive nemibvunzo yese ye8 (Fig. 1) inovhara nzira dzinonyanya kushandiswa dzenzvimbo (zvose anatomical landmarks uye imaging localization), chiitiko chekuvhiya zvikanganiso zvechikamu, uye kushamwaridzana pakati pemitoo yenzvimbo uye segmental kukanganisa. Gwaro remibvunzo harina kuedzwa kana kusimbiswa. Bhuku remibvunzo rinobvumira sarudzo dzakawanda dzemhinduro.
Mufananidzo 1 Mibvunzo misere kubva mugwaro remibvunzo. Zvigumisiro zvakaratidza kuti intraoperative fluoroscopy ndiyo nzira inowanzoshandiswa yekugara kwemashure echipfuva uye lumbar spine kuvhiyiwa (89% uye 86%, maererano), inoteverwa neradiographs (54% uye 58%, maererano). 76 vanachiremba vakasarudza kushandisa musanganiswa wenzira mbiri dzekugara. Iyo spinous maitiro uye inowirirana pedicles ndiyo yainyanya kushandiswa anatomic landmarks ye thoracic uye lumbar spine kuvhiyiwa (67% uye 59%), inoteverwa ne spinous process (49% uye 52%) (Fig. 2). 68% yevanachiremba vakabvuma kuti vakanga vaita segmental localization zvikanganiso mukuita kwavo, mamwe acho akagadziriswa intraoperatively (Fig. 3).
Fig. 2 Kufananidzira uye anatomical landmark localization nzira dzakashandiswa.
Fig. 3 Chiremba uye intraoperative kururamisa kwekuvhiya chikamu zvikanganiso.
Pakukanganisa kwenzvimbo, 56% yevanachiremba ava vakashandisa preoperative radiographs uye 44% vakashandisa intraoperative fluoroscopy. Zvikonzero zvinowanzoitika zvekukanganisa kwekuisa nzvimbo yepamberi kwaive kutadza kuona nzvimbo inozivikanwa yekutarisisa (semuenzaniso, sacral spine haina kuverengerwa muMRI), anatomical variations (lumbar displaced vertebrae kana 13-root ribs), uye segmental ambiguities nekuda kwemamiriro emuviri wemurwere (suboptimal X-ray kuratidza). Zvikonzero zvinowanzoitika zvekukanganisa kwekumisikidza kwemukati zvinosanganisira kutadza kutaurirana nefluoroscopist, kutadza kwekugadzirisa mushure mekuisa (kufamba kwetsono yekumisikidza mushure me fluoroscopy), uye zvisizvo zvibodzwa zvinonongedza panguva yekumisikidza (lumbar 3/4 kubva mbabvu zvichidzika) (Mufananidzo 4).
Fig. 4 Zvikonzero zve preoperative uye intraoperative localization kukanganisa.
Migumisiro iri pamusoro inoratidza kuti kunyange zvazvo kune nzira dzakawanda dzekugara, vazhinji vevavhiyi vanoshandisa vashoma vavo chete. Kunyangwe zvikanganiso zvekuvhiya segmental zvisingawanzo, zvine musoro hazvipo. Hapana nzira yakajairika yekubvisa zvikanganiso izvi; zvisinei, kutora nguva yekuita nzvimbo uye kuziva zvikonzero zvinowanzokonzera kukanganisa kwekugadzirisa zvinogona kubatsira kuderedza kuitika kwekuvhiya kwezvikamu zvezvikanganiso mu thoracolumbar spine.
Nguva yekutumira: Jul-24-2024
