Mā te whakapiri i te tīwiri o mua o te tukanga odontoid ka tiakina te mahi hurihuri o C1-2, ā, kua pūrongohia i roto i ngā tuhinga he tere hanumi o te 88% ki te 100%.
I te tau 2014, i whakaputa a Markus R me ētahi atu i tētahi akoranga mō te tikanga pokanga o te whakapiri tīwiri o mua mō ngā whati odontoid i roto i te The Journal of Bone & Joint Surgery (Am). E whakaahua ana te tuhinga i ngā kaupapa matua o te tikanga pokanga, te aroturukitanga i muri i te pokanga, ngā tohu me ngā mahi ārai i roto i ngā taahiraa e ono.
E whakanui ana te tuhinga ko ngā whati momo II anake ka taea te whakapiri tika ki te tīwiri o mua, ā, he pai ake te whakapiri i te tīwiri tuwhera kotahi.
Hipanga 1: Te tūnga o te tūroro i te wā o te pokanga
1. Me tango ngā whakaahua X-ray tino pai o te taha mua me te taha o te puku hei tirotiro mā te kaiwhakahaere.
2. Me noho te tūroro ki te tūnga tuwhera-waha i te wā e pokangahia ana.
3. Me nekehia te tūranga o te whati i te mea ka taea i mua i te tīmatanga o te pokanga.
4. Me tino totoro te tuaiwi o te kaki kia taea ai te kitea pai o te turanga o te tukanga odontoid.
5. Mena kāore e taea te toronga nui o te tuaiwi kaki – hei tauira, i roto i ngā whati toronga nui me te nekehanga o muri o te pito upoko o te tukanga odontoid – ka whakaarohia pea te whakawhiti i te upoko o te tūroro ki te taha ke e pā ana ki tōna tinana.
6. whakaūngia te upoko o te tūroro ki te tūranga pumau rawa atu. Ka whakamahia e ngā kaituhi te anga upoko o Mayfield (e whakaaturia ana i ngā Pikitia 1 me te 2).
Hipanga 2: Huarahi pokanga
Ka whakamahia he tikanga pokanga paerewa hei whakaatu i te paparanga trachea o mua, me te kore e kino ngā hanganga tinana nui.
Hipanga 3: Pūwāhi whakauru tīwiri
Ko te wāhi whakauru pai rawa atu kei te taha o mua o raro o te turanga o te tinana tuaiwi C2. Nō reira, me whakaatu te taha o mua o te kōpae C2-C3. (e whakaatuhia ana i ngā Pikitia 3 me te 4 i raro nei) Pikitia 3
E whakaatu ana te pere mangu i te Pikitia 4 ka tirohia marietia te tuaiwi C2 o mua i te wā e pānuihia ana te kiriata CT axial i mua i te pokanga, ā, me whakamahi hei tohu ā-tinana hei whakatau i te pūwāhi e werohia ai te ngira i te wā e pokanga ana.
2. Whakaūtia te pūwāhi whakaurunga i raro i ngā tirohanga fluoroscopic anteroposterior me lateral o te tuaiwi kaki. 3.
3. Pania te ngira ki waenganui i te taha whakarunga o mua o te pereti pito o runga C3 me te pūwāhi urunga C2 kia kitea ai te pūwāhi urunga tīwiri tino pai.
Hipanga 4: Te whakanoho i te tīwiri
1. Ka whakaurua tuatahitia he ngira GROB he 1.8 mm te whānui hei aratohu, me te anga o te ngira ki muri i te pito o te notochord. Muri iho, ka whakaurua he tīwiri tuwhera he 3.5 mm, he 4 mm rānei te whānui. Me neke mārire tonu te ngira ki te upoko i raro i te aroturukitanga o mua me te taha o te fluoroscopic.
2. Whakatakotoria te wiri poka ki te ahunga o te pine ārahi i raro i te aroturukitanga o te hihi-ataata, ā, āta nekehia kia uru ki te whati. Kaua te wiri poka e uru ki te kiri o te taha upoko o te notochord kia kore ai te pine ārahi e puta me te wiri poka.
3. Inehia te roa o te tīwiri tuwhera e hiahiatia ana, ā, manatokohia mā te inenga CT i mua i te pokanga hei ārai i ngā hapa. Kia mahara me uru te tīwiri tuwhera ki roto i te wheua cortical i te pito o te tukanga odontoid (hei whakahaere i te taahiraa e whai ake nei o te pēhitanga o te pito whati).
I te nuinga o ngā wā a ngā kaituhi, i whakamahia he tīwiri kotahi te pūrua hei whakapiri, e whakaaturia ana i te Pikitia 5, kei waenganui i te pūtake o te tukanga odontoid e anga ana ki te upoko, me te pito o te tīwiri e uru noa ana ki te wheua cortical o muri i te pito o te tukanga odontoid. He aha i tūtohutia ai he tīwiri kotahi? I whakatau ngā kaituhi he uaua ki te kimi i tētahi wāhi whakauru e tika ana ki te pūtake o te tukanga odontoid mēnā ka whakanohoia ngā tīwiri e rua motuhake kia 5 mm mai i te rārangi waenganui o C2.
E whakaatu ana te Pikitia 5 i tētahi tīwiri tuwhera kei waenganui i te pūtake o te tukanga odontoid e anga ana ki te upoko, me te pito o te tīwiri e ngoto noa ana ki te cortex o te wheua i muri tata i te pito o te tukanga odontoid.
Engari i tua atu i te āhuatanga haumaru, ka whakapiki ake rānei ngā tīwiri e rua i te pumau o muri i te pokanga?
I roto i tētahi rangahau koiora-mechanical i whakaputaina i te tau 2012 i roto i te puka Clinical Orthopedics and Related Research nā Gang Feng et al. o te Royal College of Surgeons o te United Kingdom, i whakaatuhia e te kotahi tīwiri me ngā tīwiri e rua te taumata ōrite o te pumau o ngā whati odontoid. Nō reira, he rawaka te kotahi tīwiri.
4. Ina whakaūtia te tūranga o te whati me ngā pine ārahi, ka whakatakotoria ngā tīwiri tuwhera e tika ana. Me tirotiro te tūranga o ngā tīwiri me ngā pine i raro i te fluoroscopy.
5. Me tūpato kia kore ai e pāngia ngā kiko ngohengohe e karapoti ana e te taputapu whakawiri ina mahia ana tetahi o ngā mahi o runga ake nei. 6. Whakakīia ngā tīwiri kia pēhia ai te wāhi pakaru.
Hipanga 5: Te Katinga o te Whara
1. Horoia te wāhi pokanga i muri i te whakatakotoranga o te tīwiri.
2. He mea nui te whakahaere i te toto kia pai ai te rere o te toto hei whakaiti i ngā raruraru i muri i te pokanga pērā i te pēhanga o te toto ki te trachea.
3. Me tino tika te tūnga o te uaua latissimus dorsi o te kaki kua tapahia, ki te kore ka whakararuraruhia te ataahua o te koha i muri i te pokanga.
4. Kāore e hiahiatia te katinga katoa o ngā paparanga hōhonu.
5. Kāore e hiahiatia te tango wai i te patunga (kāore ngā kaituhi e whakatakoto i ngā waikeri i muri i te pokanga).
6. E taunakihia ana kia tuituia ngā tuitui kiri kia iti ai te pānga ki te āhua o te tūroro.
Hipanga 6: Whai muri
1. Me mau tonu ngā tūroro i te whitiki kaki mārō mō ngā wiki e 6 i muri i te pokanga, ki te kore e hiahiatia e te atawhai nēhi, ā, me arotakehia mā te whakaahua whakaahua i ia wā i muri i te pokanga.
2. Me arotake ngā whakaahua X-ray paerewa o te tuaiwi kaki me te tuara o te kaki i ngā wiki 2, 6, me te 12, me ngā marama 6 me te 12 i muri i te pokanga. I mahia he matawai CT i ngā wiki 12 i muri i te pokanga.
Wā tuku: Hakihea-07-2023
