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 buhoro buhoro kwugurura umuryango muri rusange, spatula ebyiri nto zirashobora gukoreshwa mugukingura agace gato k'isahani imwe ya vertebral hanyuma ikindi, hanyuma nibindi byinshi, hanyuma ukingura buhoro buhoro mubugari bwiza (the umuyoboro wumugongo wagutse na 4mm), ushobora kwirinda kuvunika kwuzuye kuruhande rwerekanwe 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 byatejwe imbere inshuro nyinshi, ibikorwa byibanze byo kubaga biracyari byinshi cyangwa bike, ibyo bikaba byoroshye kandi bisa nkibikorwa byinyuma byimiryango ibiri bifite ingaruka zokuvura, kandi nikimwe mubikorwa byo kubaga umugongo wa nyababyeyi 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 bijyanye n’uburyo bwihariye bwo guhitamo, bahisemo uburyo bwo gufungura imiryango kuva C3 kugeza C7 ku barwayi benshi, mu gihe bakoresha imbavu za allograft zashyizwe hejuru fungura urubuga rufunguye kandi rwuzuzwe hamwe na autologique, nkuko byasobanuwe hano hepfo:

Umurwayi yashyizwe ahantu hakunze kugaragara, 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 kwaho hanyuma uruhu yashizwe ku murongo wo hagati kugira ngo agere kuri fassiya, maze imitsi irakurwa munsi ya periosteum nyuma yo guterwa fassiya ikoresheje icyuma kimwe cya elegitoroniki yo kubaga, kandi hitabwa ku kurinda ingingo zifatika za synovial artique. umuzi wa sphenoidal ntugomba gusubirwamo kugirango ugumane ubunyangamugayo bwumubyimba wa vertebrae yinkondo y'umura;hejuru no hepfo yerekanwe.Urwego rwo hejuru no hepfo rugaragara rwageze ku gice cyo hasi cyisahani ya C2 nigice cyo hejuru cya plaque ya T1, naho igice cya gatatu cyo hepfo ya C2 vertebral na kimwe cya gatatu cyo hejuru cya plaque ya T1 yakuweho hamwe no gusya, hanyuma flavum ya ligamentum isukurwa ningufu za mm 2 zo kuruma kugirango zerekane mater mater, kandi igice cyinzira zizunguruka cyarumwe nimbaraga zo kuruma kugirango bitegure gutera igufwa.

Ubukurikira C3-C7 yo gufungura umuryango yarakozwe, nkuko bigaragara ku gishushanyo kiri hejuru, muri rusange uruhande rufite ibimenyetso biremereye rwakoreshejwe nkuruhande rwo gukingura urugi naho uruhande rworoheje rwakoreshwaga nka hinge, gufungura umuryango cyangwa urubuga rwarimo agace gahuza isahani ya vertebral na articular eminence, uruhande rwo gufungura urugi rwaranyuze muri cortex muburyo bubiri kandi uruhande rwa hinge rwaranyuze muri cortex murwego rumwe, kandi umutwe uhuza umutwe wasunikaga wakoreshejwe mugukingura urugi.

Nyuma yo gusya muri cortex muburyo bubiri, uruhande rwuguruye rwumuryango rugomba gusukurwa hamwe na flavum ya ligamentum hamwe na plaque yo kuruma ya vertebral kugeza igihe isakoshi ya dural ishobora kugaragara neza, hanyuma ugakoresha spatula ntoya kugirango ufungure "umuryango". kugeza kuri 8-16mm hanyuma ugashyira mumwanya watewe, witondera kwiyongera buhoro buhoro ubunini rusange bwumuryango ufunguye, kandi spatulas ebyiri nto zirashobora gukoreshwa mugukingura isahani imwe yintegamubiri kumafaranga make mbere yo gufungura indi , hanyuma ugasubiramo inzira, hanyuma ukingura urugi gahoro gahoro kugeza mubugari bwiza (umuyoboro waguka kuri 4mm), kandi murubu buryo, birashobora kwirindwa kugirango wirinde kuvunika kwuzuye kuruhande rwibibanza kurwego runini birashoboka.

Hagomba kubaho gato guhangayikishwa no kwikuramo ahantu hashyizwemo amagufwa adakeneye gukosorwa hanze, kandi abanditsi babonye ingorane nke cyane mumavuriro aho igufwa ryamagufa rigwa mumurongo wumugongo, hamwe no guterwa bwa nyuma. igufwa ryakuwe mubikorwa bizunguruka kuruhande rwa hinge.

2.Fungura-URUGERO Cervical Expansile Laminoplasti

Iyi ngingo, yo 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’ihinduka ry’imvugo y’icyongereza, hamwe n’urwego rwo hejuru ruhoraho mu buryo bwarwo kandi filozofiya y'ibikorwa, kandi ikagaragaza 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, Kugaragaza 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 urugi bishobora kuviramo kuva amaraso, muriki gihe ntugahagarike umutima, urashobora gukoresha amashanyarazi ya bipolar kugirango uhagarike kuva amaraso cyangwa sponge ya gelatine guhagarika amaraso.

3.Cervical Laminoplasty

Usibye gushyigikira igufwa ryamagufwa kumuryango, ubundi buryo bwo gutunganya urugi rwasobanuwe muriki kiganiro, nkuburyo bwa karuvati hamwe nuburyo bwo gutunganya microplates, ubu bukaba bukoreshwa cyane mubikorwa byubuvuzi. kandi itanga umutekano.