Labari - BUDE-KOFA Tsarin Laminoplasty na baya na Cervical

MAGANAR

1. The unipolar elecwuka mai tric yana yanke fascia sannan kuma ya kwasfa tsoka a ƙarƙashin periosteum, kula da kare haɗin gwiwa na synovial na articular, a halin yanzu ba za a cire ligament a tushen tsarin spinous ba don kiyaye mutuncin ƙungiyar tashin hankali na mahaifa;

2. Kula da to da sannu-sannu na buɗe ƙofar gabaɗaya, ana iya amfani da ƙananan spatulas guda biyu don buɗe ƙaramin yanki na farantin kashin baya sannan ɗayan, da sauransu akai-akai, a hankali buɗe shi zuwa faɗin madaidaicin (canal na kashin baya yana haɓaka da 4mm), wanda zai iya guje wa fashe gaba ɗaya na gefen ramin zuwa iyakar iyakar;

3. Lokacin budewag kofa a gefe guda, cizon flavum na ligamentum a wurin budewa zai iya haifar da zubar jini daga venous plexus, a wannan lokacin, kada ku firgita, za ku iya shafa electrocoagulation na bipolar don dakatar da zubar jini, ko soso na gelatin don dakatar da zubar da jini.

BUDE-KOFA tiyatar kashin bayan mahaifa aka fara ƙirƙira ta masanan Japan a cikin 1970s. Ko da yake an inganta shi sau da yawa, aikin tiyata na asali har yanzu yana da yawa ko žasa, wanda ya fi dacewa kuma yana kama da aikin kofa biyu na baya tare da irin wannan sakamako na warkewa, kuma yana daya daga cikin aikin tiyata na mahaifa na mahaifa ga likitocin kashin baya.

1.BUDE-KOFA Expansile Cervical Laminoplasty

Wannan labarin ya fito ne daga Sashen Nazarin Jiki a Jami'ar Miami Hospital a Miami, Florida, kuma dangane da takamaiman zaɓi na hanya, sun zaɓi hanyar buɗe kofa daga C3 zuwa C7 ga yawancin marasa lafiya, yayin da ake amfani da haƙarƙarin allograft wanda aka buɗe zuwa wurin buɗe kofa kuma an ƙara shi tare da abubuwan da suka dace, kamar yadda aka bayyana a ƙasa:

An sanya majiyyaci a cikin matsayi mai sauƙi, an gyara kai tare da firam ɗin kai na Mayfield, an yi amfani da tef ɗin don cire kafadar mai haƙuri kuma a gyara shi a kan gadon aiki, 1% lidocaine da epinephrine an yi amfani da su don shiga cikin gida sannan kuma an ƙaddamar da fata tare da tsakiyar layi don isa ga fascia, kuma an cire tsokoki daga ƙarƙashin periosteum na fascia guda ɗaya, tare da kariya ta hanyar wutan lantarki. An ba da hankali ga haɗin gwiwar haɗin gwiwar articular synovial, kuma ba za a sake cire ligament na tushen sphenoidal ba don kiyaye mutuncin ƙungiyar tashin hankali na mahaifar mahaifa; na sama da na ƙasa an yi su. Na sama da ƙananan filaye sun isa ƙananan ɓangaren C2 farantin vertebral da na sama na T1 vertebral farantin, da ƙananan uku na C2 vertebral farantin da kuma na sama na uku na T1 vertebral farantin an cire tare da rawar nika, sa'an nan kuma ligamentum flavum da aka tsabtace sama da wani 2-mm farantin cizo da karfi da biting da mater biting da wani sashi. tilastawa don shirya don dasa kashi.

Bayan haka an yi buɗe ƙofar C3-C7, kamar yadda aka nuna a cikin hoton da ke sama, gabaɗaya gefen da ke da alamun bayyanar cututtuka an yi amfani da shi azaman gefen buɗe ƙofar kuma an yi amfani da gefen haske azaman hinge, buɗe kofa ko wurin slotting ya kasance a cikin junction yanki na farantin vertebral da mashahurin articular, gefen buɗe kofa yana ƙasa ta hanyar bawo bilaterally kuma an yi amfani da kai gefe ɗaya a cikin ƙasa don niƙa ta gefe ɗaya. bude kofa.

Bayan nika ta cikin bawo bilaterally, bude gefen kofa yana buƙatar tsaftacewa tare da ligamentum flavum tare da farantin vertebral farantin cizon karfi har sai da dural jakar za a iya gani a fili, sa'an nan kuma amfani da karamin spatula zuwa pry bude "kofa" zuwa game da 8-16mm da kuma saka a cikin implant block, da kula da hankali ga girman bude kofa biyu a hankali bude kofa zuwa gaba ɗaya girman spatula. farantin vertebral guda ɗaya don ɗan ƙaramin adadin kafin buɗe ɗayan, sannan sake maimaita tsari, sannan buɗe kofa a hankali zuwa faɗin manufa (canal yana faɗaɗa da 4mm), kuma ta wannan hanyar, ana iya kauce masa don guje wa cikakken karaya a gefen ramummuka zuwa iyakar iyaka.

Ya kamata a sami ɗan ƙaranci na matsa lamba a wurin da aka sanya toshe kashi ba tare da buƙatar gyarawa na waje ba, kuma marubutan sun ga ƙananan matsaloli a cikin asibitin inda kasusuwan kasusuwa ya fada cikin canal na kashin baya, tare da ƙaddamar da kashi na ƙarshe da aka cire daga tsarin spinous a gefen hinge.

2.BUDE-KOFAR Fadada Laminoplasty

Wannan labarin, daga Ma'aikatar Neurosurgery a Keck Medical Center na Jami'ar Kudancin California, yana da kusan lakabi iri ɗaya da takardun da ya gabata, tare da canji a cikin tsari na kalmomin Ingilishi, da kuma matsayi mai girma a cikin hanyarsa da falsafar aiki, kuma yana nuna daidaituwa a cikin horar da likitocin likitoci a Amurka.

Sassan tiyata sun kasance kusan kawai C3-7 don sauƙaƙe ƙaura na baya na kashin baya; sphenoidal tushen ligaments an kiyaye su don sauƙaƙe kwanciyar hankali na mahaifa; an yi amfani da rawar motsa jiki don buɗe kofa don rage lalacewar kashin baya; kuma an sanya tubalan kashi a C3, 5, da 7 don tallafawa buɗe ƙofar.

Hoto bayanin kula: A, Bayyanar lamina daga ƙasan C2 zuwa saman T1. b, Zazzage tsagi na gefe tare da cikakken osteotomy a gefe ɗaya da wani ɓangaren osteotomy a wancan gefe. c, Girman lamina daga C3 zuwa C7 a matsayin guda ɗaya. d, Sanya na'urar sarari na kashi.

Hoto bayanin kula: Duban ciki bayan hako ramuka a cikin ramuka na gefe na C3, C5, da C7 (A) da kuma bayan sanya wani allograft rib spacer (B).

Duk da haka, kayan daskararren kashin sa, ban da allogeneic kashi (Fig. A), shi ne kashin kashin baya na autogenous wanda aka yi da polylactic acid raga, kamar yadda aka nuna a kasa (BC Fig.), wanda ba shi da yawa a kasar Sin. Dangane da nisa na bude kofa, ana la'akari da nisa mafi kyau a matsayin 10-15 mm, wanda ya bambanta da 8-16 mm a sama.

Lokacin buɗe kofa guda ɗaya na farantin kashin baya, cizon flavum na ligamentum a wurin buɗe kofa na iya haifar da zubar jini daga jijiya, a wannan lokacin kada ku firgita, zaku iya amfani da electrocoagulation na bipolar don dakatar da zubar jini ko soso gelatin don dakatar da zubar jini.

3.Cervical Laminoplasty

Bugu da ƙari, goyon bayan toshe kashi a ƙofar ƙofar, an kwatanta wasu hanyoyin da za a gyara bude kofa a cikin wannan labarin, kamar hanyar tie-wire da kuma hanyar gyaran microplates, wanda a halin yanzu an fi amfani da shi a cikin aikin asibiti kuma yana samar da ingantaccen gyarawa.