Gyaran sukurori na gaba don karyewar odontoid

Gyaran sukurori na gaba na tsarin odontoid yana kiyaye aikin juyawa na C1-2 kuma an ruwaito a cikin wallafe-wallafen cewa yana da ƙimar haɗuwa daga 88% zuwa 100%.

A shekarar 2014, Markus R da abokan aikinsa sun buga wani darasi kan dabarun tiyata na gyaran sukurori na gaba don karyewar odontoid a cikin Mujallar Kashi & Hadin Gwiwa (Am). Labarin ya bayyana dalla-dalla manyan abubuwan da suka shafi dabarar tiyata, bin diddigin bayan tiyata, alamu da matakan kariya a matakai shida.

Labarin ya jaddada cewa karyewar nau'in II ne kawai za a iya daidaita ta da sikirin gaba kai tsaye kuma an fi son a gyara sikirin guda ɗaya mai rami.

Mataki na 1: Matsayin majiyyaci a lokacin tiyata

1. Dole ne a ɗauki mafi kyawun hotunan rediyo na anteroposterior da na gefe don amfani da na'urar aunawa.

2. Dole ne a ajiye majiyyaci a wurin da yake buɗe baki yayin tiyata.

3. Ya kamata a sake daidaita karyewar gwargwadon iko kafin a fara tiyata.

4. Ya kamata a ƙara girman kashin baya na mahaifa gwargwadon iyawa don samun ingantaccen fallasa tushen tsarin odontoid.

5. Idan yawan tsawaita kashin mahaifa ba zai yiwu ba - misali, a cikin karaya mai yawa tare da canjin baya na ƙarshen cephalad na tsarin odontoid - to za a iya la'akari da fassara kan majiyyaci zuwa akasin alkibla dangane da gangar jikinsa.

6. a kwantar da kan majiyyaci a wuri mai kyau gwargwadon iko. Marubutan suna amfani da firam ɗin kan Mayfield (wanda aka nuna a Hotuna na 1 da 2).

Mataki na 2: Hanyar tiyata

Ana amfani da hanyar tiyata ta yau da kullun don fallasa layin trachea na gaba ba tare da lalata wani muhimmin tsarin jiki ba.

Mataki na 3: Maɓallin shiga

Mafi kyawun wurin shiga yana nan a gefen gaba na ƙasan tushen jikin ƙashin baya na C2. Saboda haka, dole ne a fallasa gefen gaba na faifan C2-C3. (kamar yadda aka nuna a Hoto na 3 da 4 a ƙasa) Hoto na 3

Kibiyar baƙi da ke cikin Hoto na 4 ta nuna cewa an lura da kashin bayan C2 na gaba a hankali yayin karatun fim ɗin CT na axial kafin tiyata kuma dole ne a yi amfani da shi azaman alamar jiki don tantance wurin da aka saka allura yayin tiyata.

2. Tabbatar da wurin shiga a ƙarƙashin kallon ƙashin bayan mahaifa ta hanyar amfani da hasken rana da kuma na gefe. 3.

3. Zana allurar tsakanin gefen gaba na saman farantin C3 da kuma wurin shiga C2 don nemo wurin shigar da sukurori mafi kyau.

Mataki na 4: Sanya sukurori

1. Da farko, ana saka allurar GROB mai diamita 1.8 mm a matsayin jagora, sannan a sanya allurar a ɗan gefen notochord ɗin. Daga nan, sai a saka sukurin rami mai diamita 3.5 mm ko 4 mm. Ya kamata a riƙa sanya allurar a hankali a ƙarƙashin sa ido a kan anteroposterior da kuma a gefe.

2. Sanya ramin ramin a gefen fil ɗin jagora a ƙarƙashin sa ido na fluoroscopic kuma a hankali a ci gaba da shi har sai ya ratsa karyewar. Bai kamata ramin ramin ya ratsa cortex na gefen cephalad na notochord don kada fil ɗin jagora ya fita tare da ramin ramin ba.

3. A auna tsawon sukurori mai rami da ake buƙata sannan a tabbatar da shi da ma'aunin CT kafin a yi tiyata don hana kurakurai. Lura cewa sukurori mai rami yana buƙatar shiga ƙashin cortical a ƙarshen aikin odontoid (don sauƙaƙe mataki na gaba na matse ƙarshen karyewa).

A mafi yawan shari'o'in marubutan, an yi amfani da sukurori guda ɗaya mai rami don gyarawa, kamar yadda aka nuna a Hoto na 5, wanda ke tsakiyar ƙasan tsarin odontoid yana fuskantar cephalad, tare da ƙarshen sukurori kawai yana ratsa ƙashin baya na cortical a ƙarshen tsarin odontoid. Me yasa ake ba da shawarar sukurori guda ɗaya? Marubutan sun kammala da cewa zai yi wuya a sami wurin shiga da ya dace a ƙasan tsarin odontoid idan aka sanya sukurori guda biyu daban-daban a nisan mm 5 daga tsakiyar layin C2.

Hoto na 5 ya nuna wani sukuri mai rami a tsakiya a gindin tsarin odontoid yana fuskantar cephalad, tare da ƙarshen sukurin kawai yana ratsa cortex na ƙashin a bayan ƙarshen tsarin odontoid.

Amma banda abin da ya shafi tsaro, shin sukurori biyu suna ƙara kwanciyar hankali bayan tiyata?

Wani bincike na biomechanical da aka buga a shekarar 2012 a cikin mujallar Clinical Orthopaedics and Related Research ta Gang Feng et al. na Royal College of Surgeons of the United Kingdom ya nuna cewa sukurori ɗaya da sukurori biyu suna samar da irin wannan matakin daidaito a cikin gyara karyewar odontoid. Saboda haka, sukurori ɗaya ya isa.

4. Idan aka tabbatar da matsayin karyewar da kuma fil ɗin jagora, sai a sanya sukurori masu ramuka da suka dace. Ya kamata a lura da matsayin sukurori da fil ɗin a ƙarƙashin fluoroscopy.

5. Ya kamata a yi taka-tsantsan don tabbatar da cewa na'urar sukurori ba ta shafi kyallen da ke kewaye ba yayin yin duk wani aikin da ke sama. 6. A daure sukurori don a matse su a wurin karyewar.

Mataki na 5: Rufe Rauni 

1. A wanke wurin tiyatar bayan an gama sanya sukurori.

2. Hawan jini sosai yana da matuƙar muhimmanci don rage matsalolin da suka biyo bayan tiyata kamar matsewar haematoma na trachea.

3. Dole ne a rufe tsokar latissimus dorsi ta hanyar da ta dace ko kuma kyawun tabon bayan tiyata zai lalace.

4. Ba lallai ba ne a rufe dukkan zurfin yadudduka.

5. Magudanar raunuka ba zaɓi ne da ake buƙata ba (masu rubutun galibi ba sa sanya magudanar ruwa bayan tiyata).

6. Ana ba da shawarar a yi amfani da dinki a cikin fata don rage tasirin da zai yi wa bayyanar majiyyaci.

Mataki na 6: Bibiya

1. Marasa lafiya ya kamata su ci gaba da sanya takalmin ɗaure wuya na tsawon makonni 6 bayan tiyata, sai dai idan kulawar jinya ta buƙaci hakan, kuma ya kamata a tantance su ta hanyar ɗaukar hoton bayan tiyata lokaci-lokaci.

2. Ya kamata a duba hotunan kashin baya na anteroposterior da na gefe na yau da kullun a makonni 2, 6, da 12 da kuma watanni 6 da 12 bayan tiyata. An yi gwajin CT a makonni 12 bayan tiyata.