Imbere yimbere ikosora inzira ya odontoid irinda imikorere yo kuzunguruka ya C1-2 kandi byavuzwe mubitabo ko ifite igipimo cya 88% kugeza 100%.
Mu mwaka wa 2014, Markus R n'abandi basohoye inyigisho ku buhanga bwo kubaga uburyo bwo gukosora ibice by'imbere byo kuvunika kwa odontoid mu kinyamakuru cya Bone & Joint Surgery (Am). Ingingo isobanura mu buryo burambuye ingingo z'ingenzi z'ubuhanga bwo kubaga, gukurikirana nyuma yo kubagwa, ibimenyetso no kwirinda mu ntambwe esheshatu.
Ingingo ishimangira ko kuvunika ubwoko bwa II byonyine ari byiza kwerekanwa neza imbere yimbere kandi ko guhitamo icyuma kimwe gusa.
Intambwe ya 1: Guhuza ibikorwa byumurwayi
1. Ibyiza bya anteroposterior hamwe na radiografi yinyuma bigomba gufatwa kugirango bikoreshwe.
2. Umurwayi agomba kubikwa mumunwa mugihe cyo kubagwa.
3. Ivunika rigomba guhindurwa uko bishoboka kose mbere yo gutangira kubagwa.
4. Umugongo winkondo y'umura ugomba kuba wongeyeho byinshi bishoboka kugirango ubone uburyo bwiza bwo kwerekana ishingiro rya odontoid.
5. Niba umuvuduko ukabije wumugongo winkondo y'umura udashoboka - urugero, mu kuvunika kwa hyperextension hamwe no kwimura inyuma ya cephalad iherezo rya gahunda ya odontoid - noneho hashobora kwitabwaho guhindura umutwe wumurwayi muburyo butandukanye ugereranije numutwe we.
6. Kwimura umutwe wumurwayi mumwanya uhamye bishoboka. Abanditsi bakoresha ikarita ya Mayfield (yerekanwe ku gishushanyo 1 na 2).
Intambwe ya 2: Uburyo bwo kubaga
Uburyo busanzwe bwo kubaga bukoreshwa mugushira ahabona tracheal yimbere itangiza ibyingenzi byingenzi.
Intambwe ya 3: Kuramo ingingo
Ahantu heza ho kwinjirira harimbere yimbere yimbere yimbere yumubiri wa C2 vertebral. Kubwibyo, impande yimbere ya C2-C3 igomba kugaragara. (nkuko bigaragara ku gishushanyo cya 3 n'icya 4 hepfo) Ishusho 3
Umwambi w'umukara ku gishushanyo cya 4 werekana ko umugongo w'imbere C2 wubahirizwa neza mugihe cyo gusoma mbere yo gutangira firime ya CT kandi igomba gukoreshwa nk'ikimenyetso kidasanzwe cyo kumenya aho winjiza inshinge mugihe cyo kubagwa.
2. Emeza aho winjirira munsi ya anteroposterior na fluoroscopic kuruhande rwumugongo winkondo y'umura. 3.
3. Shyira urushinge hagati yimbere yimbere yimbere ya C3 yo hejuru hejuru na C2 yinjira kugirango ubone aho winjirira neza.
Intambwe ya 4: Gushyira ahantu
1. Urushinge rwa mm 1,8 mm ya GROB yabanje kwinjizwa nkuyobora, hamwe nurushinge rwerekejwe inyuma gato yisonga rya notochord. Nyuma, hashyizwemo mm 3,5 cyangwa mm 4 z'umurambararo. Urushinge rugomba guhora rutezimbere cephalad gahoro gahoro munsi ya anteroposterior hamwe na fluoroscopique ikurikira.
2. Shira umwitozo wubusa mucyerekezo cya pin uyobora munsi ya fluoroscopique hanyuma ubiteze imbere buhoro buhoro kugeza byacitse. Imyitozo yubusa ntigomba kwinjira muri cortex yuruhande rwa cephalad kuruhande rwa notochord kugirango pin iyobora idasohoka hamwe na myitozo ya hollow.
3. Gupima uburebure bwibisabwa bisabwa hanyuma ubigenzure ukoresheje ibipimo bya CT mbere yo gutangira kugirango wirinde amakosa. Menya ko umugozi wuzuye ugomba kwinjira mumagufwa ya cortical kumutwe wa odontoid (kugirango byorohereze intambwe ikurikira yo kuvunika kurangiza).
Mubyinshi mubibazo byabanditsi, umugozi umwe wubusa wakoreshejwe mugukosora, nkuko bigaragara ku gishushanyo cya 5, giherereye hagati mu nsi yimikorere ya odontoid ireba cephalad, hamwe nisonga rya screw ryinjira gusa mumagufwa yinyuma ya corticale kumutwe wa odontoid. Kuki hasabwa umugozi umwe? Abanditsi banzuye bavuga ko bigoye kubona aho byinjirira bikwiriye hashingiwe ku nzira ya odontoid niba hagomba gushyirwaho imiyoboro ibiri itandukanye kuva 5 mm uvuye hagati ya C2.
Igicapo 5 cerekana umugozi wimbere uri hagati yumushinga wa odontoid ureba cephalad, hamwe nisonga ryumugozi winjira gusa mumitsi yamagufwa inyuma yisonga rya odontoid.
Ariko usibye ibintu byumutekano, imigozi ibiri yongerera umutekano nyuma yibikorwa?
Ubushakashatsi bwibinyabuzima bwasohotse mu 2012 mu kinyamakuru Clinical Orthopedics n’ubushakashatsi bujyanye na Gang Feng n'abandi. ya Royal College of Surgeons yo mu Bwongereza yerekanye ko umugozi umwe n’imigozi ibiri bitanga urwego rumwe rwo gutuza mugukosora imvune za odontoid. Kubwibyo, umugozi umwe urahagije.
4. Iyo imyanya yamenetse hamwe nudupapuro tuyobora byemejwe, hashyizweho imigozi ikwiye. Umwanya wimigozi na pin bigomba kugaragara munsi ya fluoroscopi.
5.Hakagombye kwitonderwa kugirango igikoresho gisunika kitarimo imyenda yoroshye ikikije mugihe ukora kimwe mubikorwa byavuzwe haruguru. 6. Kenyera imigozi kugirango ushire igitutu kumwanya wavunitse.
Intambwe ya 5: Gufunga ibikomere
1. Fungura ahantu ho kubaga nyuma yo kurangiza gushyira screw.
2. Hemostasis nziza ni ngombwa kugirango igabanye ingorane nyuma yo kubagwa nka hematoma compression ya trachea.
3. Imitsi ya cervical latissimus dorsi imitsi igomba gufungwa neza neza cyangwa ubwiza bwinkovu nyuma yibikorwa bizahungabana.
4. Gufunga burundu ibice byimbitse ntabwo ari ngombwa.
5. Kuvoma ibikomere ntabwo ari amahitamo asabwa (abanditsi ntibashyira imiyoboro ya nyuma yibikorwa).
6. Imbere yimbere irasabwa kugabanya ingaruka kumiterere yumurwayi.
Intambwe ya 6: Gukurikirana
1. Abarwayi bagomba gukomeza kwambara ijosi rikomeye mu byumweru 6 nyuma yo kubagwa, keretse niba ubuforomo bubisabye, kandi bigomba gusuzumwa hamwe no gufata amashusho nyuma yibikorwa.
2. Amafoto asanzwe ya anteroposterior hamwe na radiyo yumugongo wigitereko cyumugongo bigomba gusubirwamo mubyumweru 2, 6, na 12 no kumezi 6 na 12 nyuma yo kubagwa. Isuzuma rya CT ryakozwe mu byumweru 12 nyuma yo kubagwa.
Igihe cyo kohereza: Ukuboza-07-2023
