Anterior screw fixation ea ts'ebetso ea odontoid e boloka mosebetsi oa ho potoloha ha C1-2 'me ho tlalehiloe libukeng hore ho na le tekanyo ea fusion ea 88% ho 100%.
Ka 2014, Markus R et al o ile a hatisa thuto ea mokhoa oa ho buoa oa anterior screw fixation bakeng sa fractures ea odontoid ho The Journal of Bone & Joint Surgery (Am).Sehlooho sena se hlalosa ka ho qaqileng lintlha tse ka sehloohong tsa mokhoa oa ho buoa, ho latela ts'ebetso ea morao-rao, lipontšo le litemoso ka mehato e tšeletseng.
Sengoloa se totobatsa hore ke mefuta ea mofuta oa II feela ea fractures e khonang ho tsamaisa screw fixation le hore ho khethoa sekoti se le seng sa screw screw.
Mohato oa 1: Boemo ba mokuli ka har'a opereishene
1. Li-radiographs tse nepahetseng tsa anteroposterior le lateral li tlameha ho nkoa bakeng sa boitsebiso ba opereishene.
2. Mokuli o lokela ho bolokoa a bulehile molomong nakong ea ho buuoa.
3. Ho robeha ho lokela ho tsosolosoa ka hohle kamoo ho ka khonehang pele ho qala ho buuoa.
4. Mokokotlo oa mokokotlo o lokela ho ba hyperextended ka hohle kamoo ho ka khonehang ho fumana ts'oaetso e nepahetseng ea motheo oa mokhoa oa odontoid.
5. Haeba hyperextension ea mokokotlo oa mokokotlo e ke ke ea khoneha - mohlala, ho fractures ea hyperextension le posterior displacement ea qetellong ea cephalad ea mokhoa oa odontoid - joale ho ka nahanoa ka ho fetolela hlooho ea mokuli ka tsela e fapaneng le ea kutu ea hae.
6. thibela hlooho ea mokuli hore e be boemong bo tsitsitseng kamoo ho ka khonehang.Bangoli ba sebelisa hlooho ea hlooho ea Mayfield (e bontšitsoeng ho Figure 1 le 2).
Mohato oa 2: Mokhoa oa ho buoa
Mokhoa o tloaelehileng oa ho buoa o sebelisoa ho pepesa lesela le ka pele la tracheal ntle le ho senya likarolo leha e le life tsa bohlokoa tsa anatomical.
Mohato oa 3: Sebaka sa ho kena ka Screw
Sebaka se nepahetseng sa ho kena se fumaneha moeling o ka pele o ka tlaase oa motheo oa 'mele oa vertebral oa C2.Ka hona, moeli o ka pele oa disc C2-C3 o tlameha ho pepesoa.(joalokaha ho bontšitsoe setšoantšong sa 3 le sa 4 ka tlase) Setšoantšo sa 3
Motsu o motšo ho Setšoantšo sa 4 o bontša hore mokokotlo oa C2 o ka pele o hlokomeloa ka hloko nakong ea ho bala pele ho ts'ebetso ea filimi ea axial CT 'me e tlameha ho sebelisoa e le letšoao la anatomical bakeng sa ho fumana ntlha ea ho kenngoa ha nale nakong ea ho buuoa.
2. Tiisa ntlha ea ho kena tlas'a maikutlo a anteroposterior le lateral fluoroscopic ea mokokotlo oa mokokotlo oa mokokotlo.3.
3. Tsamaisa nale pakeng tsa ntlha e ka pele e holimo ea C3 e ka holimo ea endplate le sebaka sa ho kena sa C2 ho fumana sebaka se nepahetseng sa ho kena.
Mohato oa 4: Ho beha Screw
1. Nale ea GROB ea bophara ba 1.8 mm e kenngoa pele e le tataiso, 'me nale e lebisitsoe hanyenyane ka mor'a ntlha ea notochord.Ka mor'a moo, ho kenngoa sekoti se sekoti sa 3.5 mm kapa 4 mm bophara.Nale e lokela ho lula e le cephalad e tsoetseng pele butle tlas'a tlhokomelo ea anteroposterior le lateral fluoroscopic.
2. Beha sekoti se sekoti ka tsela ea pini ea tataiso tlas'a tlhokomelo ea fluoroscopic 'me butle-butle u e hatele pele ho fihlela e kenella ho robeha.Sekoti se sekoti ha sea lokela ho kenella ka har'a cortex ea lehlakore la cephalad la notochord e le hore phini ea tataiso e se ke ea tsoa ka lesoba le sekoti.
3. Lekanya bolelele ba sekoti se hlokehang 'me u se netefatse ka tekanyo ea CT pele ho ts'ebetso ho thibela liphoso.Hlokomela hore sekoti se sekoti se hloka ho kenella lesapo la cortical ntlheng ea ts'ebetso ea odontoid (ho tsamaisa mohato o latelang oa khatello ea pheletso ea fracture).
Maemong a mangata a bangoli, ho ile ha sebelisoa screw e le 'ngoe bakeng sa ho lokisa, joalo ka ha ho bonts'itsoe ho Setšoantšo sa 5, se bohareng ba mokhoa oa odontoid o shebaneng le cephalad, 'me ntlha ea screw e phunyeletsa lesapo le ka morao la cortical. ntlha ya mokgoa wa odontoid.Ke hobane'ng ha sekoti se le seng se khothalletsoa?Bangoli ba ile ba etsa qeto ea hore ho tla ba thata ho fumana sebaka se loketseng sa ho kena botlaaseng ba ts'ebetso ea odontoid haeba li-screws tse peli tse arohaneng li ne li tla behoa 5 mm ho tloha bohareng ba C2.
Setšoantšo sa 5 se bontša sekoti se sekoti se bohareng ba botlaaseng ba mokhoa oa odontoid se shebaneng le cephalad, 'me ntlha ea screw e phunyeletsa feela cortex ea lesapo ka mor'a ntlha ea ts'ebetso ea odontoid.
Empa ntle le ntlha ea polokeho, na li-screw tse peli li eketsa botsitso ba postoperative?
Boithuto ba biomechanical bo phatlalalitsoeng ka 2012 koranteng ea Clinical Orthopedics le Lipatlisiso tse Amanang ka Gang Feng et al.ea Royal College of Surgeons of the United Kingdom e bontšitse hore sekurufu se le seng le likurufu tse peli li fana ka boemo bo tšoanang ba ho tsitsisa ha ho lokisoa ha fractures ea odontoid.Ka hona, sekoti se le seng se lekane.
4. Ha boemo ba ho robeha le lithapo tsa tataiso li tiisitsoe, li-screws tse loketseng tse sekoti li behoa.Boemo ba li-screws le lithapo bo lokela ho bonoa tlas'a fluoroscopy.
5. Tlhokomelo e lokela ho nkoa ho etsa bonnete ba hore sesebelisoa sa screwing ha se akarelletse lisele tse bonolo tse potolohileng ha li etsa leha e le efe ea ts'ebetso e ka holimo.6. Tiisa li-screws ho kenya khatello sebakeng sa fracture.
Mohato oa 5: Ho Koala Maqeba
1. Hlakola sebaka sa ho buoa ka mor'a ho qeta ho beha screw.
2. Haemostasis e feletseng ke ea bohlokoa ho fokotsa mathata a postoperative a kang khatello ea hematoma ea trachea.
3. Mosifa oa cervical latissimus dorsi o kentsoeng o tlameha ho koaloa ka mokhoa o nepahetseng kapa botle bo botle ba leqeba la postoperative le tla senyeha.
4. Ho koaloa ka ho feletseng ha lihlopha tse tebileng ha ho hlokahale.
5. Metsi a maqeba ha se khetho e hlokahalang (bangoli hangata ha ba behe li-drain tsa postoperative).
6. Li-intradermal sutures li khothalletsoa ho fokotsa tšusumetso ponahalong ea mokuli.
Mohato oa 6: Tsoela pele
1. Bakuli ba lokela ho tsoela pele ho roala molala o thata bakeng sa libeke tsa 6 ka mor'a ho buuoa, ntle le haeba tlhokomelo ea booki e e hloka, 'me e lokela ho hlahlojoa ka litšoantšo tsa nakoana tsa postoperative.
2. Li-radiographs tse tloaelehileng tsa anteroposterior le lateral tsa mokokotlo oa mokokotlo li lokela ho hlahlojoa ho 2, 6, le libeke tsa 12 le 6 le likhoeli tsa 12 ka mor'a ho buuoa.CT scan e ile ea etsoa libeke tse 12 ka mor'a ho buuoa.
Nako ea poso: Dec-07-2023
