Ƙaddamarwa na baya na tsarin odontoid yana kiyaye aikin juyawa na C1-2 kuma an ruwaito a cikin wallafe-wallafen don samun nauyin haɗin kai na 88% zuwa 100%.
A cikin 2014, Markus R et al ya buga wani koyawa game da dabarun tiyata na gyaran gyare-gyare na baya don karyewar odontoid a cikin Journal of Bone & Joint Surgery (Am).Labarin ya bayyana dalla-dalla dalla-dalla mahimman abubuwan da ake amfani da su na fasahar tiyata, bin diddigin bayan aiki, alamu da kariya a cikin matakai shida.
Labarin ya jaddada cewa nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i)) don daidaitawa na gaba kuma an fi son gyaran dunƙule mara kyau guda ɗaya.
Mataki na 1: Matsayin majiyyaci cikin aiki
1. Dole ne a ɗauki mafi kyawun anteroposterior da faifan radiyo na gefe don bayanin mai aiki.
2. Dole ne a ajiye mai haƙuri a cikin buɗaɗɗen baki yayin tiyata.
3. Ya kamata a sake mayar da karaya kamar yadda zai yiwu kafin fara tiyata.
4. Ya kamata a kara girman kashin mahaifa kamar yadda zai yiwu don samun mafi kyawun bayyanar da tushe na tsarin odontoid.
5. Idan hyperextension na mahaifa kashin baya ba zai yiwu ba - misali, a hyperextension fractures tare da baya gudun hijira na cephalad karshen tsarin odontoid - sa'an nan za a iya ba da la'akari ga fassara kan mara lafiya a kishiyar shugabanci dangane da gangar jikin.
6. Sanya kan mara lafiya cikin kwanciyar hankali gwargwadon hali.Mawallafa suna amfani da firam ɗin kai na Mayfield (wanda aka nuna a Figures 1 da 2).
Mataki 2: Hanyar tiyata
Ana amfani da daidaitaccen tsarin fiɗa don fallasa murfin tracheal na baya ba tare da lalata kowane muhimmin tsarin jiki ba.
Mataki 3: Matsa wurin shigarwa
Mafi kyawun wurin shigarwa yana samuwa a gefen baya na baya na gindin jikin kashin baya na C2.Don haka, dole ne a fallasa gefen gaba na diski na C2-C3.(kamar yadda aka nuna a Figures 3 da 4 a kasa) Hoto na 3
Kibiya baƙar fata a cikin Hoto 4 yana nuna cewa an lura da kashin baya na C2 a hankali yayin karatun farko na fim ɗin axial CT kuma dole ne a yi amfani da shi azaman alamar anatomical don tantance ma'anar shigar allura yayin tiyata.
2. Tabbatar da ma'anar shigarwa a ƙarƙashin anteroposterior da ra'ayi na fluoroscopic na gefe na kashin mahaifa.3.
3. Zamar da allura a tsakanin babban gefen gaba na C3 babba na ƙarshen da kuma wurin shigarwar C2 don nemo madaidaicin wurin shigar dunƙule.
Mataki na 4: Sanya wuri
1. An fara saka allurar GROB mai diamita 1.8 mm a matsayin jagora, tare da allurar ta daidaita kadan a bayan tip na notochord.Bayan haka, an saka ƙugiya mai zurfi 3.5 mm ko 4 mm diamita.Ya kamata allura ta kasance a hankali ta ci gaba da haɓaka cephalad a ƙarƙashin kulawar anteroposterior da na gefe.
2. Sanya ramin rami a cikin jagorar fil ɗin jagora a ƙarƙashin sa ido na fluoroscopic kuma a hankali gaba da shi har sai ya shiga karaya.Ramin rami bai kamata ya shiga cikin bawo na gefen cephalad na notochord don kada fil ɗin jagora ya fita tare da ramin rami.
3. Auna tsawon madaidaicin dunƙule da ake buƙata kuma tabbatar da shi tare da ma'aunin CT da aka riga aka yi don hana kurakurai.Lura cewa dunƙule mai zurfi yana buƙatar shiga cikin kashin cortical a ƙarshen tsarin odontoid (don sauƙaƙe mataki na gaba na matsawar ƙarshen karaya).
A mafi yawan lokuta mawallafa, an yi amfani da dunƙule guda ɗaya don gyarawa, kamar yadda aka nuna a hoto na 5, wanda ke tsakiya a gindin tsarin odontoid yana fuskantar cephalad, tare da tip na dunƙule kawai ya shiga cikin kashin cortical na baya. tip na tsarin odontoid.Me yasa aka bada shawarar dunƙule guda ɗaya?Marubutan sun kammala cewa zai yi wuya a sami wurin shigar da ya dace a gindin tsarin odontoid idan za a sanya screws guda biyu 5 mm daga tsakiyar C2.
Hoto na 5 yana nuna madaidaicin dunƙule a tsakiya a gindin tsarin odontoid yana fuskantar cephalad, tare da titin dunƙule kawai yana shiga cikin bawo na kashi a bayan ƙarshen tsarin odontoid.
Amma ban da yanayin aminci, shin sukurori biyu suna ƙara kwanciyar hankali bayan aiki?
Wani binciken da aka buga a cikin 2012 a cikin mujallar Clinical Orthopedics da Bincike mai dangantaka ta Gang Feng et al.na Royal College of Surgeons na Burtaniya ya nuna cewa dunƙule ɗaya da screws guda biyu suna samar da daidaito iri ɗaya a cikin gyaran ɓangarorin odontoid.Saboda haka, dunƙule guda ɗaya ya wadatar.
4. Lokacin da aka tabbatar da matsayi na raguwa da fitilun jagora, an sanya ƙullun da aka dace.Ya kamata a lura da matsayi na sukurori da fil a ƙarƙashin fluoroscopy.
5. Ya kamata a kula don tabbatar da cewa na'urar zazzagewa ba ta haɗa da nama mai laushi da ke kewaye ba yayin yin kowane ɗayan ayyukan da ke sama.6. Ƙarfafa sukurori don amfani da matsa lamba zuwa wurin karaya.
Mataki na 5: Rufe Rauni
1. Shake wurin fiɗa bayan kammala sanya dunƙulewa.
2. Cikakken haemostasis yana da mahimmanci don rage rikice-rikicen bayan aiki kamar matsi na hematoma na trachea.
3. Dole ne a rufe tsokar latissimus dorsi na cervical a cikin daidaitaccen daidaituwa ko kuma za a lalata kayan ado na tabo bayan tiyata.
4. Cikakken rufewa na zurfin yadudduka ba lallai ba ne.
5. Magudanar rauni ba zaɓin da ake buƙata ba (marubuta yawanci ba sa sanya magudanar ruwa bayan aiki).
6. Ana ba da shawarar suturar intradermal don rage girman tasirin bayyanar mai haƙuri.
Mataki na 6: Bibiya
1. Marasa lafiya ya kamata su ci gaba da sa takalmin gyare-gyaren wuyansa na tsawon makonni 6 bayan tiyata, sai dai idan kulawar jinya ya buƙaci shi, kuma ya kamata a yi la'akari da shi tare da hoto na lokaci-lokaci.
2. Ya kamata a sake nazari na yau da kullum na anteroposterior da na gefe na kashin mahaifa a cikin 2, 6, da 12 makonni kuma a 6 da 12 watanni bayan tiyata.An yi gwajin CT a makonni 12 bayan tiyata.
Lokacin aikawa: Dec-07-2023
