Labarai - Aikin Laminoplasty na Ƙofa a Buɗaɗɗen Ƙofa

MAI MUHIMMANCI

1. Elektiron mai lamba ɗayaWuka mai kauri yana yanke fascia sannan ya bare tsokar da ke ƙarƙashin periosteum, a kula da kare haɗin gwiwar synovial na articular, yayin da bai kamata a cire jijiyar da ke tushen tsarin spinous ba domin kiyaye daidaiton madaurin tashin hankali na mahaifa;

2. Kula da to Ƙara buɗe ƙofar a hankali a hankali, ana iya amfani da ƙananan spatula guda biyu don buɗe ƙaramin ɓangare na farantin ƙwaya ɗaya sannan ɗayan, da sauransu akai-akai, sannan a buɗe shi a hankali zuwa faɗin da ya dace (magudanar kashin baya ta faɗaɗa da 4mm), wanda zai iya guje wa karyewar gefen da aka raba har zuwa iyakar da zai yiwu;

3. Lokacin buɗewaG ƙofar gaba ɗaya, cizon ligamentum flavum a wurin buɗewa na iya haifar da zubar jini daga venous plexus, a wannan lokacin, kada ku firgita, za ku iya amfani da bipolar electrocoagulation don dakatar da zubar jini, ko gelatin sponges don dakatar da zubar jini.

BUƊE ƘOFAR ƊAYA Masanan ƙasar Japan ne suka fara ƙirƙiro tiyatar bayan ƙashin ƙugu a shekarun 1970. Duk da cewa an inganta ta sau da yawa, aikin tiyata na asali har yanzu yana da sauƙi, wanda ya fi dacewa kuma yayi kama da aikin ƙofa biyu na bayan baya tare da irin wannan tasirin magani, kuma yana ɗaya daga cikin tiyatar bayan ƙashin ƙugu ta gargajiya ga likitocin tiyatar baya.

1. ƘOFAR BUƊEWA Mai Faɗaɗawa a Mahaifa

Wannan labarin ya fito ne daga Sashen Tiyatar Jijiyoyi a Asibitin Jami'ar Miami da ke Miami, Florida, kuma dangane da takamaiman zaɓin hanyar, sun zaɓi hanyar buɗe ƙofa daga C3 zuwa C7 ga yawancin marasa lafiya, yayin da suke shafa haƙarƙarin allograft da aka buɗe a wurin buɗe ƙofa kuma an ƙara musu da dashen autologous, kamar yadda aka bayyana a ƙasa:

An sanya majiyyacin a wuri mai lanƙwasa, an gyara kan da firam ɗin kan Mayfield, an yi amfani da tef ɗin don jawo kafadar majiyyacin a gyara shi a kan gadon tiyata, an yi amfani da lidocaine da epinephrine 1% don shiga cikin gida sannan aka yanke fatar a tsakiyar layin don isa ga fascia, sannan aka cire tsokoki daga ƙarƙashin periosteum bayan an yanke fascia da wuka mai aiki da lantarki, kuma an kula da kare haɗin gwiwar synovial na articular, kuma bai kamata a cire haɗin tushen sphenoidal ba don kiyaye amincin madaurin tashin hankali na ƙashin baya na mahaifa; an yi fallasa sama da ƙasa. Manyan layukan fallasa na sama da na ƙasa sun kai ƙasan farantin vertebral na C2 da kuma saman farantin vertebral na T1, sannan aka cire ƙasan kashi ɗaya na farantin vertebral na C2 da kuma saman kashi ɗaya na farantin vertebral na T1 da wani niƙa, sannan aka tsaftace flavum ɗin ligamentum da wani ƙarfe mai girman 2-mm don fallasa mater ɗin dura, kuma wani ɓangare na tsarin spinous an ciji shi da wani ƙarfe mai cizo don shirya dasa ƙashi.

Bayan haka, an yi buɗe ƙofar C3-C7, kamar yadda aka nuna a hoton da ke sama, gabaɗaya an yi amfani da gefen da ke da alamun da suka fi nauyi a matsayin ɓangaren buɗe ƙofar kuma an yi amfani da gefen mai sauƙi a matsayin hinges, wurin buɗe ƙofar ko wurin slotting yana cikin yankin haɗin farantin vertebral da articular eminence, an niƙa gefen buɗe ƙofar ta cikin cortex a ɓangarorin biyu kuma an niƙa gefen hinges ta cikin cortex a cikin layi ɗaya, kuma an yi amfani da kan niƙa kai a daidaita don buɗe ƙofar.

Bayan an niƙa ta cikin cortex ɗin a ɓangarorin biyu, ana buƙatar a tsaftace ɓangaren buɗewar ƙofar da flavum na ligamentum tare da wani ƙarfe mai cizon farantin vertebral har sai an ga jakar dural a sarari, sannan a yi amfani da ƙaramin spatula don buɗe "ƙofar" zuwa kusan 8-16mm sannan a saka a cikin toshewar dasawa, tare da mai da hankali kan ƙaruwar girman ƙofar da aka buɗe a hankali, kuma ana iya amfani da ƙananan spatula guda biyu don buɗe farantin vertebral ɗaya akan ƙaramin adadin kafin buɗe ɗayan, sannan a maimaita aikin, sannan a buɗe ƙofar a hankali zuwa faɗin da ya dace (magudanar tana faɗaɗa da 4mm), kuma ta wannan hanyar, ana iya guje mata don guje wa karyewar gaba ɗaya a gefen ramukan har zuwa iyakar da za ta yiwu.

Ya kamata a sami ɗan ƙaramin matsin lamba a wurin da aka sanya toshewar ƙashi ba tare da buƙatar gyarawa ta waje ba, kuma marubutan sun ga ƙarancin matsaloli a asibitin inda toshewar ƙashi ke faɗawa cikin magudanar kashin baya, tare da cire dashen ƙashin na ƙarshe daga tsarin juyawa a gefen hinges.

2. ƘOFAR BUƊEWA TA HANYAR KARƘAWAR ƘURJI

Wannan labarin, daga Sashen Kula da Jijiyoyin Jijiyoyi a Cibiyar Kiwon Lafiya ta Keck ta Jami'ar Kudancin California, yana da kusan taken da ya yi daidai da takardar da ta gabata, tare da canjin tsarin kalmomin Ingilishi, da kuma babban matakin daidaito a cikin hanyarsa da falsafar aiki, kuma yana nuna daidaito a cikin horar da likitocin tiyata a Amurka.

Sassan tiyata kusan C3-7 ne kawai aka yi su don sauƙaƙe matsar da kashin baya; an kiyaye jijiyoyin tushen sphenoidal don sauƙaƙe kwanciyar hankali na mahaifa; an yi amfani da injin niƙa kan ashana don buɗe ƙofar don rage lalacewar kashin baya; kuma an sanya tubalan ƙashi a C3, 5, da 7 don tallafawa buɗe ƙofar.

Bayanin Hoto: A, Bayyanar lamina daga ƙasan C2 zuwa saman T1. b, Haƙa ramin gefe tare da cikakken osteotomy a gefe ɗaya da kuma wani ɓangare na osteotomy a ɗayan gefen. c, Tsawaita lamina daga C3 zuwa C7 a matsayin raka'a ɗaya. d, Sanya na'urar raba ƙashi ta allograft.

Bayanin Hoto: Duban da aka yi a lokacin tiyata bayan an haƙa ramuka a cikin ramukan gefe na C3, C5, da C7 (A) da kuma bayan an sanya wani allograft haƙarƙari (B).

Duk da haka, kayan dashen ƙashi, ban da ƙashin allogeneic (Hoto na A), wani dashen ƙashi ne na vertebral autogenous da aka yi da ragar polylactic acid, kamar yadda aka nuna a ƙasa (Hoto na BC), wanda ba a saba gani ba a China. Dangane da faɗin buɗe ƙofa, ana ɗaukar faɗin da ya dace shine 10-15 mm, wanda ya ɗan bambanta da 8-16 mm da ke sama.

Lokacin da ake buɗe ƙofa ɗaya ta farantin ƙashin baya, cizon flavum na ligamentum a wurin buɗe ƙofa na iya haifar da zubar jini daga jijiyar, a wannan lokacin kada ku firgita, za ku iya amfani da electrocoagulation na bipolar don dakatar da zubar jini ko soso na gelatin don dakatar da zubar jini.

3. Laminoplasty na Mahaifa

Baya ga tallafawa toshewar ƙashi a buɗewar ƙofa, an bayyana wasu hanyoyin gyara buɗewar ƙofa a cikin wannan labarin, kamar hanyar ɗaure waya da hanyar gyara microplates, wanda na ƙarshen a halin yanzu ana amfani da shi sosai a aikin asibiti kuma yana ba da ingantaccen gyara.