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 a hankali na bude kofar gabaki daya, za a iya amfani da kananan spatula guda biyu wajen bude wani dan karamin kaso na farantin kashin baya sannan dayan, da sauransu, sannan a rika budewa a hankali zuwa fadin da ya dace (da Canal na kashin baya yana haɓaka da 4mm), wanda zai iya guje wa cikakkiyar karaya na gefen ramin zuwa iyakar iyakar da zai yiwu;

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.Kodayake an inganta shi sau da yawa, aikin tiyata na asali har yanzu yana da yawa ko žasa iri ɗaya, wanda ya fi dacewa kuma yana kama da aikin kofa biyu na baya tare da irin wannan sakamako na warkewa, kuma yana ɗaya daga cikin aikin tiyata na gargajiya na mahaifa. likitocin kashin baya.

1.BUDE-KOFA Expansile Cervical Laminoplasty

Wannan labarin ya fito ne daga Sashen Nazarin Neurological Surgery 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 haƙarƙari na allograft. bude zuwa shafin bude kofa kuma an kara masa shi tare da na'ura mai sarrafa kansa, kamar yadda aka bayyana a kasa:

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 fata. an ɗora shi tare da tsakiyar layi don isa ga fascia, kuma an cire tsokoki daga ƙarƙashin periosteum bayan ƙaddamar da fascia tare da wuka na electrosurgical mataki daya, kuma an kula da kariya ga haɗin gwiwar synovial na articular, da kuma ligament na ligament. Tushen sphenoidal bai kamata a sake sake shi ba don kiyaye amincin ƙungiyar tashin hankali na kashin mahaifa;na sama da na ƙasa an yi su.Matsakaicin filaye na sama da na ƙasa sun kai ƙananan ɓangaren farantin vertebral C2 da babban ɓangaren T1 vertebral farantin, kuma kashi na uku na C2 vertebral farantin da na sama na uku na T1 vertebral farantin an cire tare da rawar nika, sannan aka goge flavum na ligamentum ta wani farantin karfe 2-mm mai cizon karfi don fallasa dura mater, kuma wani bangare na tsarin kashin baya an cije shi ta hanyar cizo don shirya don dasa kashi.

Bayan haka an yi buɗe ƙofar C3-C7, kamar yadda aka nuna a cikin hoton da ke sama, gabaɗaya an yi amfani da gefen da ke da alamun bayyanar cututtuka kamar yadda gefen buɗe kofa kuma an yi amfani da gefen haske azaman hinge, buɗe kofa ko wurin slotting yana cikin. wurin mahaɗar farantin vertebral da fitattun articular, gefen buɗe ƙofar yana ƙasa ta cikin cortex bilaterally kuma gefen hinge yana ƙasa ta cikin cortex a cikin Layer guda ɗaya, an yi amfani da kan ashana kan niƙa don buɗe ƙofar.

Bayan an nika ta cikin bawo bilaterally, buɗe gefen ƙofar yana buƙatar tsaftacewa tare da ligamentum flavum tare da farantin vertebral mai cizon ƙarfi har sai an ga jakar dural a fili, sannan a yi amfani da ƙaramin spatula don buɗe "ƙofa" zuwa kusan 8-16mm kuma a saka a cikin shingen da aka dasa, kula da hankali ga karuwa a hankali na girman girman ƙofar budewa, kuma ana iya amfani da ƙananan spatulas guda biyu don buɗe farantin vertebral ɗaya na ɗan ƙaramin kaɗan kafin buɗe ɗayan. , sa'an nan kuma maimaita tsari, sa'an nan kuma bude kofa a hankali zuwa nisa mai kyau (canal yana faɗaɗa da 4mm), kuma ta wannan hanyar, ana iya kauce masa don kauce wa cikakken karaya a gefen ramummuka zuwa iyakar iyakar. mai yiwuwa.

Ya kamata a sami ɗan ƙaramin damuwa 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 shigarwa na ƙarshe. na kashi da aka cire daga tsarin spinous a gefen hinge.

2.BUDE-KOFAR Fadada Laminoplasty

Wannan labarin, daga Ma'aikatar Neurosurgery a Cibiyar Kiwon Lafiya ta Keck na Jami'ar Kudancin California, yana da kusan lakabi ɗaya da takardun da ya gabata, tare da canji a cikin tsari na kalmomin Ingilishi, da kuma babban mataki na daidaito a cikin hanyarsa kuma. falsafar aiki, da kuma nuna daidaito a cikin horar da likitocin fiɗa 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 vertebral, 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

Baya ga tallafawa toshewar kasusuwa a buɗe kofa, an bayyana wasu hanyoyin gyara buɗe ƙofar a cikin wannan labarin, kamar hanyar tie-wire da hanyar gyara microplates, wanda ƙarshensa a halin yanzu an fi amfani dashi a cikin aikin asibiti. kuma yana bada ingantaccen gyarawa.