Amakuru - Gufungura-URUGERO Inyuma ya Cervical Laminoplasty inzira

INGINGO

1. Elec ya unipolaricyuma cya tric gikata fassiya hanyuma kigakuramo imitsi munsi ya periosteum, witondere kurinda ingingo ya synovial articular, hagati aho ligamente kumuzi wibikorwa bya spinous ntigomba kuvaho kugirango uburinganire bwumutwe winkondo y'umura;

2. Witondere to kwiyongera gahoro gahoro gufungura umuryango muri rusange, spatula ebyiri nto zirashobora gukoreshwa mugukingura agace gato k'isahani imwe ya vertebral hanyuma ikindi kindi, hanyuma nibindi byinshi, hanyuma ukingura buhoro buhoro kugeza mubugari bwiza (umuyoboro wumugongo wagutse na 4mm), ushobora kwirinda kuvunika burundu kuruhande rushyizweho kuburyo bushoboka bwose;

3. Iyo ufunguyeg umuryango utabogamye, kuruma flavum ya ligamentum ahantu hafunguye birashobora gutuma umuntu ava amaraso ava mumitsi, muriki gihe, ntugahagarike umutima, urashobora gukoresha bipolar electrocoagulation kugirango uhagarike kuva amaraso, cyangwa sponges ya gelatine kugirango uhagarike kuva amaraso.

GUKINGURA-URUGERO Kubaga umugongo w'inyuma y'umugongo byavumbuwe bwa mbere n'intiti z'Abayapani mu myaka ya za 70. Nubwo imaze kunonosorwa inshuro nyinshi, ibikorwa byibanze byo kubaga biracyari byinshi cyangwa bike, ibyo bikaba byoroshye kandi bisa nkibikorwa byinyuma byimiryango ibiri hamwe ningaruka zokuvura, kandi nikimwe mubikorwa byo kubaga umugongo byumugongo kubaga umugongo.

1.GUKINGURA-URUGERO Kwagura Laminoplasti Yinkondo y'umura

Iyi ngingo yavuye mu ishami ry’ubuvuzi bwa Neurologiya mu bitaro bya kaminuza ya Miami i Miami, muri Floride, kandi mu rwego rwo guhitamo uburyo bwihariye, bahisemo uburyo bwo gufungura imiryango kuva C3 kugeza kuri C7 ku barwayi benshi, mu gihe bakoresheje imbavu zose za allograft zakinguwe ku rugi rukinguye kandi zongerwamo insimburangingo, nk'uko byasobanuwe haruguru:

Umurwayi yashyizwe mu mwanya ukunze, umutwe washyizwe hamwe n'umutwe wa Mayfield, kaseti yakoreshejwe mu kumanura urutugu rw'umurwayi no kuwushyira ku buriri bwo kubaga, lidocaine na epinephrine 1% byakoreshejwe mu gucengera mu gace hanyuma uruhu rushyirwa ku murongo wo hagati kugira ngo rugere kuri fassiya, maze imitsi irashishwa kuva munsi ya periosteum hamwe no gukomeretsa kwa fassiya hamwe na feri ya fassiya. hitabiriwe, kandi ligamenti yumuzi wa sphenoidal ntigomba gusubirwamo kugirango hagumane ubusugire bwumutwe wa tension ya vertebrae yinkondo y'umura; hejuru no hepfo yerekanwe. Urwego rwo hejuru no hepfo rwagaragaye rwageze mu gice cyo hasi cy’isahani ya C2 n’igice cyo hejuru cy’isahani ya T1, naho igice cya gatatu cyo hasi cy’isahani ya vertebral hamwe na kimwe cya gatatu cyo hejuru cy’isahani ya vertebral yakuweho umwitozo wo gusya, hanyuma flavum ya ligamentum isukurwa ningingo ya mm 2 yo kuruma kugira ngo yerekane imbaraga zo kuruma kugira ngo yerekane imbaraga za dura. guterwa igufwa.

Ubukurikira hafunguwe umuryango C3-C7, nkuko bigaragara ku gishushanyo kiri hejuru, muri rusange uruhande rufite ibimenyetso biremereye rwakoreshejwe nk'uruhande rwo gukingura urugi kandi uruhande rworoheje rwakoreshwaga nka hinge, urugi rukingura cyangwa uruzitiro rwari mu masangano y'isahani ya vertebral kandi rugaragara cyane, uruhande rwo gufungura urugi rwaranyuze mu gice kimwe kandi uruzitiro rwumutwe rwakoreshwaga mu gice kimwe. gufungura.

Nyuma yo gusya unyuze muri cortex muburyo bubiri, uruhande rufunguye rwumuryango rugomba gusukurwa hamwe na ligamentum flavum hamwe nimbaraga zo kuruma zomuri vertebral kugeza igihe isakoshi ya dural ishobora kugaragara neza, hanyuma ugakoresha spatula ntoya kugirango ufungure "umuryango" kugeza kuri 8-16mm hanyuma ushyire mumwanya muto watewe kugirango isahani yorohewe kuri plaque imwe ikinguye kugeza kuri plaque ntoya ikinguye kuri enterineti. umubare mbere yo gufungura urundi, hanyuma usubiremo inzira, hanyuma ukingure urugi gahoro gahoro kugeza mubugari bwiza (umuyoboro waguka kuri 4mm), kandi murubu buryo, birashobora kwirindwa kugirango wirinde kuvunika kwuzuye kuruhande rwibice byinshi bishoboka.

Hagomba kubaho gato guhangayikishwa no kwikuramo ahantu hashyizwemo igufwa ryamagufa bidakenewe gukosorwa hanze, kandi abanditsi babonye ingorane nke cyane mumavuriro aho igufwa ryamagufa rigwa mumurongo wumugongo, hamwe no gushira kwanyuma kumagufa yakuwe mubikorwa bizunguruka kuruhande.

2.Fungura-URUGERO Cervical Expansile Laminoplasti

Iyi ngingo, yavuye mu ishami rya Neuroshirurgie mu kigo cy’ubuvuzi cya Keck cyo muri kaminuza y’Amajyepfo ya Kaliforuniya, ifite izina rimwe n’inyandiko zabanjirije iyi, hamwe n’imihindagurikire y’amagambo y’icyongereza, hamwe n’urwego rwo hejuru ruhoraho mu buryo bwayo na filozofiya y’imikorere, kandi rugaragaza uburinganire mu mahugurwa y’abaganga babaga muri Amerika.

Ibice byo kubaga byari hafi ya C3-7 kugirango byoroherezwe kwimura inyuma yumugongo; sphenoidal umuzi ligaments zabitswe kugirango byorohereze inkondo y'umura; imyitozo yo gusya umutwe yakoreshwaga kugirango ifungure umuryango kugirango hagabanuke kwangirika kwumugongo; n'amagufwa yashyizwe kuri C3, 5, na 7 kugirango ashyigikire umuryango.

Igishushanyo Icyitonderwa: A, Kumenyekanisha lamina kuva hepfo ya C2 kugeza hejuru ya T1. b, Gucukura ibice byuruhande hamwe na osteotomy yuzuye kuruhande rumwe na osteotomy igice kurundi ruhande. c, Uburebure bwa lamina kuva C3 kugeza C7 nkigice kimwe. d, Gushyira ahabigenewe amagufwa.

Igishushanyo Icyitonderwa: Kureba ibikorwa nyuma yo gucukura ibyobo mumashanyarazi ya C3, C5, na C7 (A) na nyuma yo gushyira imbavu ya allograft (B).

Nyamara, ibikoresho byayo byerekana amagufwa, usibye amagufwa ya allogeneque (Igicapo A), ni igufwa ryitwa vertebral autogenous amagufwa yakozwe na mesh acide polylactique, nkuko bigaragara hepfo (BC.), Ntibikunze kugaragara mubushinwa. Ukurikije ubugari bwugurura umuryango, ubugari bwiza bufatwa nka mm 10-15, butandukanye gato na mm 8-16 hejuru.

Mugihe ukora urugi rumwe rufungura isahani ya vertebral, kuruma flavum ya ligamentum ahafunguye umuryango bishobora kuvamo kuva amaraso, muriki gihe ntugahagarike umutima, urashobora gukoresha amashanyarazi ya bipolar kugirango uhagarike kuva amaraso cyangwa sponge ya gelatine kugirango uhagarike kuva amaraso.

3.Cervical Laminoplasty

Usibye gushyigikira igufwa ryugurura urugi, ubundi buryo bwo gutunganya urugi rwasobanuwe muriki kiganiro, nkuburyo bwa karuvati hamwe nuburyo bwo gutunganya microplates, ubu bwa nyuma bukaba bukoreshwa cyane mubikorwa byubuvuzi kandi butanga igisubizo gikwiye.