Ngā Pūrongo - Te Tukanga Laminoplasty o te Poutū-te-Kāwai Tuwhera

PŪTAKI MATUA

1. Te hiko kotahi-polarKa tapahia te fascia mā te maripi tric, kātahi ka tihorea te uaua i raro i te periosteum, kia tupato ki te tiaki i te hononga synovial articular, i te wā tonu, kaua e tangohia te ligament i te pūtake o te spinous process kia mau tonu ai te hononga o te whitiki kume o te kaki.

2. Kia aro kio te whakanui haere i te whakatuwheratanga o te tatau katoa, ka taea te whakamahi i ngā spatula iti e rua hei whakatuwhera i tētahi wāhanga iti o tētahi pereti tuaiwi, kātahi ko tētahi atu, me te pera tonu, me te whakatuwhera haere mārire ki te whānui tika (ka whakanuia te awa tuaiwi mā te 4mm), ka taea ai te karo i te whati katoa o te taha kōhao ki te taumata teitei rawa atu;

3. Ina whakatuwheratiaKi te ngau te tatau i tetahi taha, mā te ngau i te ligamentum flavum i te wāhi tuwhera ka puta te toto mai i te plexus uaua, i tēnei wā, kaua e mataku, ka taea e koe te whakamahi i te electrocoagulation bipolar hei whakamutu i te toto, i ngā hautai gelatin rānei hei whakamutu i te toto.

KŪAHA TUWHERA I hangaia tuatahitia te pokanga tuaiwi o muri o te kaki e ngā tohunga Hapanihi i ngā tau 1970. Ahakoa kua maha ngā whakapainga kua oti, he rite tonu te pokanga taketake, he ngāwari ake, he rite tonu ki te pokanga tatau-rua o muri me te pānga rongoā rite tonu, ā, ko tētahi o ngā pokanga tuaiwi tawhito mō ngā taote tuaiwi.

1. Whakatō Laminoplasty o te Cervical Wāhanga Tuwhera

Nō te Tari Pokanga Niho i te Hōhipera o te Whare Wānanga o Miami i Miami, Florida tēnei tuhinga, ā, mō te kōwhiringa tikanga motuhake, i whiriwhiria e rātou he tikanga tatau tuwhera mai i te C3 ki te C7 mō te nuinga o ngā tūroro, me te whakamahi i ngā rara allograft e tūwhera ana ki te wāhi tatau tuwhera, ā, e tāpirihia ana ki ngā whakaurunga autologous, e ai ki te whakaahuatanga i raro nei:

I whakatakotoria te tūroro ki te tūnga takoto, i whakapūmauhia te māhunga ki te anga māhunga o Mayfield, i whakamahia te rīpene hei kukume i te pakihiwi o te tūroro ki raro, hei whakapūmau ki te moenga pokanga, i whakamahia te 1% lidocaine me te epinephrine mō te urunga ā-rohe, kātahi ka tapahia te kiri i te rārangi waenga kia tae atu ki te fascia, ā, ka tihorea ngā uaua i raro i te periosteum i muri i te tapahi i te fascia ki te maripi pokanga hiko kotahi-wāhanga, ā, i arohia te tiakitanga o ngā hononga synovial hononga, ā, kaua te hononga o te pūtake sphenoidal e tapahia kia mau tonu ai te hononga o te taura o te tuaiwi kaki; i whakaaturia ngā taha o runga me raro. I tae ngā awhe whakaaturanga o runga me raro ki te wāhanga o raro o te pereti tuaiwi C2 me te wāhanga o runga o te pereti tuaiwi T1, ā, i tangohia te tuatoru o raro o te pereti tuaiwi C2 me te tuatoru o runga o te pereti tuaiwi T1 ki te wiri huri, kātahi ka horoia te ligamentum flavum mā te whakamahi i te kuku ngau pereti 2-mm hei whakaatu i te dura mater, ā, i ngaua tetahi wāhanga o te tukanga tuaiwi ki te kuku ngau hei whakarite mō te whakaurunga o te wheua.

I muri mai ka mahia te whakatuwheratanga o te tatau C3-C7, e ai ki te pikitia i runga ake nei, i te nuinga o te wā ko te taha he nui ake ngā tohu i whakamahia hei taha whakatuwheratanga o te tatau, ā, ko te taha māmā i whakamahia hei hononga, ko te whakatuwheratanga o te tatau, te wāhi mokowā rānei i te wāhi hononga o te pereti tuaiwi me te hononga hononga, i hurihia te taha whakatuwheratanga o te tatau mā roto i te cortex i ngā taha e rua, ā, i hurihia te taha hononga mā roto i te cortex i roto i te paparanga kotahi, ā, i whakamahia he upoko huri pane mati mō te whakatuwheratanga o te tatau.

I muri i te huri i te kiriuhi e rua, me horoi te taha tuwhera o te tatau ki te ligamentum flavum me te whakamahi i te kuku ngau pereti tuaiwi kia kitea mārama ai te putea dural, kātahi ka whakamahia he spatula iti hei whakatuwhera i te "tatau" ki te 8-16mm pea ka whakauru i te poraka whakauru, me te aro ki te piki haere o te rahi katoa o te tatau tuwhera, ā, ka taea te whakamahi i ngā spatula iti e rua hei whakatuwhera i tetahi pereti tuaiwi mō te iti i mua i te whakatuwheratanga o tetahi atu, kātahi ka mahi anō i te tukanga, kātahi ka whakatuwhera haere i te tatau ki te whānui tika (ka whānui te awaawa mā te 4mm), ā, mā tēnei, ka taea te karo i te whati katoa i te taha o ngā mokowā ki te taumata teitei rawa atu.

Me iti noa te ahotea pēhanga i te wāhi i whakatakotoria ai te poraka wheua, me te kore e hiahiatia he whakapiringa ki waho, ā, he iti noa ngā raruraru kua kitea e ngā kaituhi i roto i te whare hauora i te wā e taka ai te poraka wheua ki roto i te awa tuaiwi, me te tango i te whakaurunga whakamutunga o te wheua mai i te tukanga tuaiwi ki te taha o te hononga.

2. Te Whakamahinga Laminoplasty Whanui o te Kūaha Tuwhera

Nō te Tari Pokanga Niho o te Pokapū Hauora o Keck o te Whare Wānanga o Southern California tēnei tuhinga, ā, tata rite tonu te taitara ki te tuhinga o mua, engari kua rerekē te raupapa o ngā kupu Pākehā, ā, he tino ōrite te tikanga me te rapunga whakaaro mō te mahi, ā, e whakaata ana i te ōritetanga o te whakangungu o ngā taote pokanga i te Hononga o Amerika.

Ko ngā wāhanga pokanga he C3-7 anake hei whakahaere i te nekehanga o muri o te taurakira; i tiakina ngā hononga pakiaka sphenoidal hei whakahaere i te pumau o te kaki; i whakamahia he wiri mira pane mati hei whakatuwhera i te tatau hei whakaiti i te kino ki te taurakira; ā, i whakanohoia ngā poraka wheua ki C3, 5, me te 7 hei tautoko i te whakatuwheratanga o te tatau.

Tuhipoka Pikitia: A, Te whakaaturanga o te lamina mai i raro o C2 ki te tihi o T1. b, Te keri i te awaawa taha me te osteotomy katoa i tetahi taha me te osteotomy wāhanga i tetahi taha. c, Te whakanui ake i te lamina mai i C3 ki C7 hei wae kotahi. d, Te whakatakotoranga o te mokowā wheua allograft.

Tuhipoka Pikitia: Tirohanga i mua i te pokanga i muri i te keri i ngā kōhao i ngā awaawa taha o C3, C5, me C7 (A) me muri i te whakatakotoranga o te mokowā rara allograft (B).

Heoi, ko tana rauemi honohono wheua, hei tāpiri atu ki te wheua allogeneic (Pikitia A), he honohono wheua autogenous vertebral i hangaia ki te mata waikawa polylactic, e whakaaturia ana i raro nei (Pikitia BC), he iti ake te kitea i Haina. Mō te whānui o te whakatuwheratanga o te tatau, ko te whānui pai rawa atu ko te 10-15 mm, he rerekē paku tēnei i te 8-16 mm i runga ake nei.

I te wā e whakatuwhera ana i te pereti tuaiwi kotahi, mā te ngau i te ligamentum flavum i te wāhi e whakatuwhera ana te tatau ka puta he toto mai i te uaua, kaua e mataku i tēnei wā, ka taea e koe te whakamahi i te electrocoagulation bipolar hei whakamutu i te toto, i te hautai gelatin rānei hei whakamutu i te toto.

3. Te Whakatō Laminoplasty o te Uha

Haunga te tautoko i te poraka wheua i te whakatuwheratanga o te tatau, kei roto i tēnei tuhinga ētahi atu tikanga hei whakatika i te whakatuwheratanga o te tatau, pērā i te tikanga here-waea me te tikanga whakatika pereti iti, ko tēnei e whakamahia whānuitia ana i roto i te mahi haumanu, ā, e whakarato ana i te whakatikanga haumaru.