Amakuru - Uburyo bwo gupima inyuma y'inkondo y'umura bufunguye

INGENZI

1. Amashanyarazi ya Unipolaricyuma gikata fascia hanyuma kigakura imitsi munsi ya periosteum, witondere kurinda urugingo rwa synovial rw'ingingo, hagati aho umutsi uri ku mizi y'imikorere y'insinga ntugomba gukurwaho kugira ngo ukomeze ubusugire bw'umugozi wo mu mura;

2. Witondereo kwiyongera buhoro buhoro k'urugi rwose, uduce duto tubiri dushobora gukoreshwa mu gufungura igice gito cy'umugongo umwe hanyuma ukongeraho ikindi, bityo kenshi, hanyuma ukongera ukagifungura buhoro buhoro kugeza ku bugari bukwiye (umuyoboro w'umugongo waguweho 4mm), ibyo bikaba byakwirinda kuvunika burundu k'uruhande rwashyizwemo ku rugero rushoboka;

3. Iyo ufunguyeg urugi uruhande rumwe, kuruma ligamentum flavum aho ufunguye bishobora gutuma uva amaraso mu mitsi, muri iki gihe, ntugatinye, ushobora gukoresha electrocoagulation ya bipolar kugira ngo uhagarike kuva amaraso, cyangwa sponges za gelatin kugira ngo uhagarike kuva amaraso.

KUBAGA UMUGOZI W'INYUBAKO Gufungura uruti rw'umugongo rw'inkondo y'umura byavumbuwe bwa mbere n'abahanga b'Abayapani mu myaka ya 1970. Nubwo byavuguruwe kenshi, kubaga by'ibanze biracyari bimwe, byoroshye cyane kandi bisa n'uko kubaga inzugi ebyiri inyuma bifite ingaruka nk'izo kuvura, kandi ni kimwe mu kubaga uruti rw'umugongo rusanzwe ku baganga babaga uruti rw'umura.

1. IFUNGIWE RY'UMUGOZI WA INTERI Y'INKOKO IFUNGUYE URUGI RW'IBYIBUHO RY'UMUGOZI

Iyi nkuru yavuye mu Ishami ry’Ubuvuzi bw’Imitsi mu Bitaro bya Kaminuza ya Miami i Miami, muri Florida, kandi ku bijyanye n’uburyo bwihariye bwo kuvura, bahisemo uburyo bwo kuvura kuva kuri C3 kugeza kuri C7 ku barwayi benshi, mu gihe bashyiraga imbavu za allograft zifunguye ku muryango ufunguye kandi zongeweho implants za autologous, nk’uko bivugwa hano hepfo:

Umurwayi yashyizwe mu mwanya we, umutwe we ushyirwaho umutwe wa Mayfield, kaseti yakoreshejwe mu gukuraho urutugu rw'umurwayi no kuwushyira ku buriri bwo kubaga, 1% ya lidocaine na epinephrine byakoreshejwe mu kwinjira mu gace k'umubiri hanyuma uruhu rucibwa hagati kugira ngo rugere ku gice cy'umubiri, maze imitsi ikurwa munsi ya periosteum nyuma yo gukata igice cy'umubiri hakoreshejwe icyuma cyo kubaga cy'urwego rumwe, kandi hakwitabwaho uburyo bwo kurinda ingingo za synovial, kandi umutsi w'umuzi wa sphenoidal ntugomba gukurwaho kugira ngo hakomeze kuba imiterere y'umugozi w'umugongo w'inkondo y'umura; hejuru no hepfo hakozwe uburyo bwo kugaragara. Ingano yo hejuru n'iyo hasi yageraga ku gice cyo hasi cy'uruti rw'umugongo rwa C2 n'igice cyo hejuru cy'uruti rw'umugongo rwa T1, hanyuma igice cya gatatu cyo hasi cy'uruti rw'umugongo rwa C2 n'igice cyo hejuru cy'uruti rw'umugongo rwa T1 bikurwaho hakoreshejwe icyuma gisya, hanyuma ligamentum flavum isukurwa n'icyuma gitera ibyuma cya mm 2 kugira ngo hagaragare uduce dura mater, hanyuma igice cy'inzira y'imitsi cyarumwe n'icyuma gitera ibyuma kugira ngo bitegure gutera igufwa.

Hakurikiyeho gufungura umuryango wa C3-C7, nk'uko bigaragara ku ishusho iri hejuru, muri rusange uruhande rufite ibimenyetso bikomeye rwakoreshejwe nk'uruhande rwo gufungura umuryango naho uruhande rworoshye rukoreshwa nk'aho uhambiriye, aho urugi rwinjirira cyangwa aho rufungira hari mu gace gahurira uruziga rw'umugongo n'ubuhanga bw'ingingo, uruhande rwo gufungura umuryango rwakozwe mu gice cy'umutima n'igice cy'umubiri, uruhande rwo gufungura umuryango rwakozwe mu gice cy'umutima n'igice cy'umubiri rukozwe mu gice cy'umubiri mu buryo bubiri, naho uruhande rwo gufungura umuryango rwakozwe mu gice cy'umubiri rukozwe mu gice cy'umubiri mu buryo bumwe, kandi umutwe w'igitambaro wakoreshejwe mu gufungura umuryango.

Nyuma yo gusya mu gice cy’imbere cy’umuryango, uruhande rw’umuryango rufunguye rugomba gusukurwa n’umusemburo w’uruti rw’umugongo ukoresheje forceps zo kuruma kugeza aho agasaho k’imbere gashobora kugaragara neza, hanyuma ugakoresha agasaho gato kugira ngo ukingure "urugi" kugeza kuri mm 8-16 hanyuma ushyiremo agasanduku k’imashini, witaye ku kwiyongera buhoro buhoro kw’ingano rusange y’urugi rufunguye, maze udusako tubiri duto dushobora gukoreshwa mu gufungura isahani imwe y’umugongo ku rugero ruto mbere yo gufungura urundi, hanyuma ugasubiramo inzira, hanyuma ukingura urugi buhoro buhoro kugeza ku bugari bukwiye (umuyoboro waguka ho mm 4), kandi muri ubu buryo, bishobora kwirindwa kugira ngo hirindwe kuvunika burundu ku ruhande rw’aho icyuho kigera ku rugero rushoboka.

Ahantu hagomba kubaho ikibazo cyo gukandagira aho igufwa rishyirwa hatabayeho gufatirwa inyuma, kandi abanditsi babonye ingorane nke cyane mu ivuriro aho igufwa rigwa mu muyoboro w'umugongo, aho igufwa rishyirwa mu gice cy'umugongo ku ruhande rw'inyuma.

2. Laminoplasty yo mu bwoko bwa "cervical expansile laminoplasty" ifunguye ku muryango

Iyi nkuru, yavuye mu Ishami ry’Ubuvuzi bw’Imitsi muri Keck Medical Center muri Kaminuza ya Southern California, ifite umutwe umwe n’uwabanje, hamwe n’impinduka mu buryo amagambo y’Icyongereza akurikirana, hamwe n’uburyo bwo kuyikoresha n’imikorere yayo, kandi igaragaza uburyo abaganga b’inzobere mu kubaga bahuzwa n’imitsi muri Leta Zunze Ubumwe za Amerika.

Ibice byo kubaga byari hafi ya C3-7 kugira ngo byorohereze kwimuka kw'umugongo inyuma; imitsi y'umuzi wa sphenoidal yarabikwaga kugira ngo yorohereze umura; hakoreshejwe imashini isya umutwe w'igikoni kugira ngo ikingure umuryango kugira ngo ugabanye kwangirika k'umugongo; kandi hashyizweho uduce tw'amagufwa kuri C3, 5, na 7 kugira ngo bishyigikire urugi.

Icyitonderwa: A, Kugaragara kw'agace k'umugongo kuva hasi kuri C2 kugera hejuru ya T1. b, Gucukura umuyoboro wo ku ruhande hamwe no gucukura osteotomy yuzuye ku ruhande rumwe n'agace k'umugongo ku rundi ruhande. c, Kuzamura agace k'umugongo kuva kuri C3 kugeza kuri C7 nk'igice kimwe. d, Gushyiramo agace k'igufwa ka allograft.

Icyitonderwa: Ishusho yo mu gihe cyo kubaga nyuma yo gucukura imyobo mu miyoboro ya C3, C5, na C7 (A) no nyuma yo gushyiramo agace k'uruti rw'umurambararo (B).

Ariko, ibikoresho byayo byo gushyira amagufwa, uretse igufwa rya allogeneic (Ishusho A), ni igufwa rya autogenous ry’umugongo rikozwe muri polylactic acid mesh, nk'uko bigaragara hano hasi (Ishusho ya BC), ritakunze kugaragara cyane mu Bushinwa. Ku bijyanye n'ubugari bw'urugi, ubugari bwiza bufatwa nka mm 10-15, butandukanye gato na mm 8-16 hejuru.

Mu gihe ufungura urugi rumwe rw'icyuma gifunga urugi, gukurura ligamentum flavum aho urugi rufunguye bishobora gutuma uva amaraso mu mitsi, muri iki gihe ntugatinye, ushobora gukoresha electrocoagulation ya bipolar kugira ngo uhagarike kuva amaraso cyangwa gelatin sponge kugira ngo uhagarike kuva amaraso.

3. Laminoplasty yo mu mura

Uretse gushyigikira igufwa ry’urugi, hari ubundi buryo bwo gufunga urugi buvugwa muri iyi nkuru, nk'uburyo bwo gufata umugozi n'uburyo bwo gufata imigozi mito, ubu buryo bwa nyuma bukoreshwa cyane mu buvuzi kandi butanga uburyo bwo gufunga neza.