Kɛnɛyaso ka ko kɛlenw sɛgɛsɛgɛli : Ka kɔkolo fusion rod ka jiginni jugumanba ɲɛnabɔ senkɔni fɛ ka don barajuru kɔnɔ ni Zero-Tolerance Fixation ye

Dɔgɔtɔrɔso: Dɔgɔtɔrɔso Universitario San Ignacio, Bogotá, Kolonbi
Operelikɛla: Dɔgɔtɔrɔ Mateo Restrepo, Department of Complex Spine Reconstruction
Don: Ɔkutɔburukalo san 2025
Bana suguya: Catastrophique Hardware Migration / Revision Posterior Spinal Instrumentation
Kɔnɔnafiliba: Legary bere min jiginna kɔfɛ, o bɔli siɲɛ kelen ka bɔ ɲɛgɛnɛsira dankan na, o kɔfɛ, a bɛ kɛ ka a jɔcogo sabatili dafalen kɛ ni o ye XC Medico® Premium Sistɛmu poliyaksiyali. Opereli waati bɛɛ lajɛlen: miniti 155. Banabagatɔ min bɛ lajɛ lafiya la opereli kɔfɛ tile 2nan na.

Kow jiracogo

Banabagatɔw ka jamana hakɛ ni u ka kɛnɛyako tariku

• Banabagatɔ: Carlos Mendoza (a tɔgɔ ma fɔ)
• San: San 52. A si bɛ san 52 la
• Cɛya ni muso: Cɛ
• Sɛgɛsɛgɛli fɔlɔ : Funankɛninw ka barajurubana jugumanba
• Opereli tariku : Kɔkolo kɔfɛla tiɲɛni latilenni ni fusion spanning T11-L3 kɛra san 15 ka kɔn o ɲɛ ni legacy non-locking pedicle screw system ye.
• Opereli kɔfɛ kalan : Taamaʃyɛn tɛ a la ni a jɔcogo latilenni dafalen ye ani ka ɲɛnamaya kɛcogo bɛɛ lajɛlen don ɲɔgɔn na san tan ni kɔ kɔnɔ.
• Bana wɛrɛw : Tansiyɔn jiginni nɔgɔman (min bɛ kunbɛn), sigarɛtiminbaga min bɛ baara kɛ, kolotugudaw hakɛ min bɛ koloci daminɛ na (T-score -1.8).

Jalakili ni kɛnɛyaso waatibolodacogo jirali

Ɲininkali kunba : Disi dimi min tɛ kɛ dɔɔni dɔɔni, o bɛ daminɛ dɔɔni dɔɔni numanbolo fɛ, o bɛ bɔ ɲɛda la, o bɛ juguya ni fiɲɛ bilali juguman ye, o bɛ taa ni ninakilidegun nɔgɔman ye dɔgɔkun 3 kɔnɔ. Kɔdimi min bɛ kɛ yɔrɔ kelen na walima kɔdimi min bɛ kɛ duguma, o si ma fɔ.

Waati bolodacogo:

• Tile fɔlɔ (Don): Banabagatɔ min bɛ taa kɛnɛyaso la kɔrɔtɔko la, a sirannen don dusukun ni jolisiraw walima fogonfogonlabana jugumanba ɲɛ. Elektrokardiogramme ni cardiaque enzymes tun bɛ cogo la.
• Siga: Fɛnɲɛnɛma gɛlɛya min bɛ daminɛ kɔfɛ walima paravertebral mass.
• Ja tacogo fɔlɔ : STAT disi lajɛ ani o kɔfɛ barajuru CT scan min bɛ se ka ɲɛ kosɛbɛ, o yamaruyara lɛri 3 kɔnɔ.

Jaw sɔrɔli ani opereli bolodacogo

Radiographie & CT sɔrɔlenw (Ja 1 & 2):

• A jɔcogo : Masina dɛsɛ dafalen T11-L3 bere-kurun kinin fɛ. Nɛgɛbere fla set screws tun kɔsegira ka bɔ pewu, o kɛra sababu ye ka total construct disassembly.
• Hardware translocation: Nɛgɛbere 5,5mm janya sabatili bere tun bɔra pewu ka bɔ pedicle screw saddles la. K’a sababu kɛ san caman kɔkolo wulicogo ni a jiginni ye min bɛ to senna, bere min ma bali, o taara sanfɛ (cephalad) ni santimɛtɛrɛ damadɔ ye.
• Farikoloɲɛnajɛ bɛrɛbɛrɛ : Bere min bɛ taa yɔrɔ wɛrɛ la, o kun sanfɛla ye paravertebral fascial planes tiɲɛ, ka costovertebral dancɛw tigɛ, ka don ka don barajuru kiniyanfan fɛ ka taa a fɛ, ka lafiɲɛ teliya la ka surunya pleura ni joli siraba barajuru sirabaw la.

Opereli baro: Furakɛli latigɛ

Kɔrɔtɔko kɛnɛyaso la : Ni titaniyɔmu bere min ma bali, o tora barajuru fangama kɔnɔ, o bɛ kɛ sababu ye ka aorte laceration, intercostal vessel perforation, walima tension pneumothorax (banakisɛ tension) bila barajuru lamaga-lamagali senfɛ. Opereli teliya la bɔli ni construct revision tun ye wajibi ye.

Sugandili 1: Toracoscopie (VATS) bɔli min bɛ kɛ ni wideyow dɛmɛni ye, o dɔrɔn

Nafa minnu bɛ a la : Ni bere bɔra barajuru fɛɛrɛ fɛ, o bɛ kɔnɔnatumuw farati teliya la ɲɛnabɔ nka a bɛ banabagatɔ to barajuru jɔcogo basigilen tɛ min na, a karilen don. Ni kɔfɛla seginni ma kɛ, pedikili kuru tɔw tun bɛna degunba sɔrɔ, o bɛ na ni aseptiki lajɔli teliya ye, kɔdimi jugumanba, ani degun filanan ka taa ɲɛ.

Sugandili 2nan : Banakisɛ ni kɔnɔbara ni kɔfɛla da wulilen seginnkanni faralen ɲɔgɔn kan

Nafa minnu bɛ a la : Ni aw ye tigɛ fila danfaralenw kɛ (barakɔtɔmi ɲɛfɛla walasa ka bere sɔrɔ ani kɔfɛla da wulilen walasa ka kɔkolo sabati) tile caman kɔnɔ, o bɛ dɔ fara opereli waati bɛɛ kan ka se miniti 320+ ma. Nin fɛɛrɛ fila jɔcogo in bɛ joli bɔli, fogonfogon gɛlɛyaw, ani dɔgɔtɔrɔso dilan kuntaala caya kosɛbɛ fo ka se tile 6-8 ma a dɔgɔyalenba la.

Sugandili 3nan : Retrograde Retrograde Posterior Etape kelen + Fixation Cross-Link barikama (Sugandili) .

Fɛɛrɛbɔcogo : Ni kɔfɛla cɛmancɛ tigɛyɔrɔ kɔrɔ da wuli kokura, o tun bɛ sira di ka se ka don fɛnɲɛnamafagalan tɔ la. Operelikɛla tun bɛ baara kɛ ni foroko kɛrɛnkɛrɛnnenw ye minnu bɛ se ka fɛnw lasegin, ka tugu bere in sira kɔ ka taa kɔfɛ ka bɔ kɔfɛla la, k’a sɔgɔ ka bɔ barajuru la ni hakilisigi ye ni fluoroscopie bilasirali gɛlɛn ye. O kɛra sababu ye ka barajuru ɲɛfɛla sɛgɛsɛgɛli yɛrɛmahɔrɔnyalen bali.

Ni a bɔra a la, ciyɛn sigicogo min tɛ sabati, o bilala XC Medico® Premium Polyaxial Pedicle Screw System nɔ na . Walasa ka dɛsɛ fɔlɔ ju bɔ yen, o jɔli kura in ye fɛnɲɛnamafagalanw sigi sen kan minnu bɛ kɛ ni kɛrɛ jugu ye walasa ka jiriw jɛnsɛnni bali, ka fara ɲɔgɔn kan ni ɲɔgɔndan gɛlɛnw ye minnu bɛ se ka ladilan walasa ka kɛ karamɔgɔ naani ye min tɛ se ka lamaga.

Fɛn dilannenw sugandili: XC Medico ka Premium Spinal Fixation System — min bɛ pedikilɛri poliaxiyali juruw fara ɲɔgɔn kan ni juruw ye minnu bɛ se ka kɛ ni angle jugu ye ani cross-links rigid adjustables.

Opereli kɛcogo: Opereli ɲɛfɔli

Yɔrɔ jɔcogo ani a jiracogo

• Banabagatɔ jɔyɔrɔ : A jɔcogo bɛ kɛ Relton-Hall karamɔgɔya la min bɛ kɛ ka kɛɲɛ ni sariya ye, o bɛ kɔnɔbara deguncogo ɲuman kɛ walasa ka joli siraw tansiyɔn dɔgɔya.
• Kɔnɔnafili : Kɔfɛla cɛmancɛ taamasiɲɛ kɔrɔlen tigɛra. Subperiosteal dissection kɛra ka ɲɛ walasa ka pedicle legacy screws bɔ kɛnɛ kan ka bɔ T11 la ka taa L3 la. Opereli foro kɔnɔna na, o bɛ sɔrɔ miniti 25 kɔnɔ.

Hardware Retrieval ani Thoracic Clearance Fase

• Sɛgɛsɛgɛli: Tulips (tulips) minnu bɛ kɛ ni pedicle (bololanɛgɛ) ye, olu dabɔlen don ni kuru sigilenw tɛ yen pewu. Bere min jiginna, o kɔfɛla laban dɔnna ka bɔ dɔɔni ka bɔ paravertebral muscle dilan na T11 kɛrɛfɛ.
• A bɔli : Kɛrɛfɛla fluoroscopie kɔlɔsili basigilen kɔnɔ, foroko kɛrɛnkɛrɛnnenw tun sirilen don bere kunkolo yelen na. Ni baara kɛra ni axial traction technique ye min bɛ kɔrɔsi, min bɛ sabati, bere in tun bɛ sama ka segin kɔfɛ a ka jiginni sira fɛ.
• Clearance check: Bere tun bɛ bɔ ka ɲɛ ka sɔrɔ a ma kunbɛn. Fluoroscopie teliya la ani fogonfogon bonya sɛgɛsɛgɛliw y’a jira ko fogonfogon dan bɛ to a cogo la ni sɔgɔsɔgɔninjɛ jugumanba tɛ a la. Fasa kuntaala: miniti 40.

Seginkanni Fixation & Rigid Frame Assemblage Fase

• Viru ɲɔgɔn falen-falen: Viru ciyɛn minnu lafiyalen don, olu bɔra. Pedikili siraw tigɛra ka u bonya walasa u ka se ka XC Medico® 6.0mm Premium Polyaxial Pedicle Screws sɔrɔ, o bɛ kolo sanni kɛcogo ɲuman sabati koloci dilanw na.
• Berew datugucogo: Titaniyɔmu sɔgɔlen bere kura minnu tun bɛ 5,5mm ka kɔn u ɲɛ, olu tun sigilen bɛ. Min nafa ka bon kosɛbɛ, o ye ko XC Medico ka reverse negative-angle set screws (reverse negative-angle set screws) kɛra torque (kurunba) ye fo ka se 8 Nm ma ni sofɛrɛw ye minnu kalifara. Filɛri profil ye tulip kogow sama ni timinandiya ye ka taa kɔnɔna na, ka farati bɔ u la.
• Cross-link integration : Cross-connecteur gɛlɛn fila minnu bɛ se ka ladilan, olu tun sigilen bɛ numanbolo ni numanbolo berew kan T12 ni L2 hakɛw la. O ye bere yɛrɛmahɔrɔnyalen fila caman tigɛli kɛ ka kɛ jɔli-yɔrɔ kelen ye, min ka gɛlɛn kosɛbɛ, o kɛra sababu ye ka bere janyalenw sɛgɛn farikolo ta fan fɛ. Fasa kuntaala: miniti 70.

Dɔgɔyali laban ani Dadon

Fluoroscopie biplanaire laban ye a jira ko kuru jugumanba ka ɲi, ka bere bilali simetriki dafalen na, ani ka farikolo labɛncogo kura. Ji tun bɛ o yɔrɔ la kosɛbɛ, farikolo jukɔrɔla jibɔyɔrɔ dɔ bilala, ka fasa datugucogo caman dafa. Opereli waati bɛɛ lajɛlen: miniti 155. Joli hakɛ jateminɛlen : mililitiri 210. Jolidoncogo: Zero.

Opereli kɔfɛ kalan ni a kɔlɔlɔw

Opereli kɔfɛ teliya la (POD 0-1) .

Banabagatɔ kununna ni disidimi jugumanba bɔra a la joona (VAS dɔgɔyara ka bɔ 8/10 la sani opereli ka kɛ ka se 2/10 ma opereli kɔfɛ). Ninakili mankan nɔgɔmanw sɛgɛsɛgɛra fan fila fɛ, ka sɔgɔsɔgɔninjɛ laban bali. Opereli kɔfɛ arajografuw y’a jira ko fɛnɲɛnamafagalanw bɛ tali kɛ ɲɔgɔn na cogo jɛlen na. POD 1 wula fɛ, banabagatɔ tun sigilen bɛ dilan kɛrɛ fɛ ka ɲɛ ni a senw dugumayanfan hakiliɲagami dafalen ye.

Jibɔli bolodacogo (POD 2 — Lɛrɛ 48) .

Lɛrɛ 48 opereli kɔfɛ, farikolo jukɔrɔla jibɔyɔrɔ bɔra (bɔyɔrɔ fitinin). Banabagatɔ ye kɛnɛyaso bɔli sariyaw bɛɛ dafa: taama yɛrɛmahɔrɔnyalen ni taamacogo ɲuman ye, da kɔnɔ dunni ɲuman, ani dimi kunbɛnni dimimadafura da la. Ka bɔ kɛnɛyaso la joona sanga 48 kɔnɔ, o ye banakisɛw sɔrɔli farati dɔgɔya dɔgɔtɔrɔso la ani ka dɔ bɔ dɔgɔtɔrɔsow ka dilan doni na.

Kuntilenna (Dɔgɔkun 6 & Kalo 3)

Kalo 3 taamasiyɛn na, dimi tun tɛ Carlos la pewu (VAS 0/10) wa a tun seginna ka kɛ baarakɛlaw ka baara nɔgɔmanw ye. Disi ni kɔkolo lajɛ minnu kɛra ɲɔgɔn kɔ, olu y’a jira ko mikro-motion zero tɛ screw-rod ɲɔgɔndanw na. XC Medico® karamɔgɔya min sirilen don ɲɔgɔn na, o ye jɔcogo dafalen mara, ni kolotuguda jɛlen taamasiɲɛ fɔlɔw ye minnu bɛ sabati barajuru yɔrɔw bɛɛ la.

Sɔrɔko sɛgɛsɛgɛli : Seginkanni dakun kelen ni dakun dafalenw waleyali

musaka suguya	Sɛgɛsɛgɛli kɛcogo caman taabolo senfɛ (Ciya)	Dafara kelen XC Medico® Sistɛmu (Tiɲɛni)	Danfara
Opereli kɛcogo minnu bɛ don mɔgɔ la (Anterior/Thoracic tools) .	$9,800 (Toracoscopique ports, waati dɔɔnin dumunifɛnw)	$0 ye	-$9.800 ye
Opereli kɛcogo minnu bɛ don mɔgɔ la (Posterior Spinal Frame) .	$8,400 (Baraw ni vis parallèles standards)	$6,100 (XC Medico Premium Vis & Cross-links) Bamako, Mali.	-$2300 ye
Baarakɛwaati (Yɔrɔ musaka: $250/min)	$8000 (miniti 320 tile danfaralenw kɔnɔ)	$3,875 (miniti 155 sɔrɔli dakun kelen na)	-$4 125 ye
Operelikɛla, Barajuru kɛrɛnkɛrɛnnen & Anestezi sara	$8500 (Sɛbɛnni caman bɛ kɛ cogo min na) .	$4800 (Kɔfɛla fagali faralen ɲɔgɔn kan) .	-$3700 ye
Dɔgɔtɔrɔso ICU/Ward sigili (Dilan musaka: $450/tile)	$3150 (tile 7 kɛnɛyali cɛmancɛ la barajuru da wulilen dontaw la)	$900 (tile 2 bɔli joona tiɲɛni)	-$2250 ye
Opereli kɔfɛ ja lajɛ & Fogonfogon lajɛ	$2400 ye	$2 175 ye	-$225 ye
TOTAL DIRECT COST (KƆRƆBƆLI ƝƐNABƆLI).	$40 250 ye	$17 860 ye	-$22.390 (55% dɔgɔyara)

Ka ɲɛsin sigida ka kɔkolo tiɲɛni ni a jɔli santiri ma min bɛ dɛsɛ gɛlɛnw ɲɛnabɔ, n’i ye XC Medico ka torque caman, angle negative locking systems ta, o bɛ institution ka bolomafara sɔrɔ min ye dɔrɔmɛ 22.390 USD ye ko kelen na , k’a sɔrɔ a bɛ baarakɛlaw ka jagokɛcogo ɲuman kɛ ani ka kɔrɔtɔko juru filananw dɔgɔya.

Technique Q&A ka ɲɛsin Complex Reconstruction Teams ma

J: Cogo jumɛn na buttress threads minnu bɛ kɛ ni angle négatif ye, olu bɛ set screw back-out bali ni i ye u suma ni standard flat threads ye?

A: Standard flat walima V-threads bɛ fanga radiyali kɛ kɛnɛma ka ɲɛsin kurukuru kunkolo (tulip) kɔnɔna kogow ma ni u sirilen don fo ka se girinya laban ma. Ni sɛgɛnba min bɛ kɛ ni masinw ye, o fanga radiyali bɛ kɛ sababu ye ka tulip kogow bonya dɔɔni walima 'splay.' Ni sɔgɔsɔgɔli kɛra, jiriw sirili bɛ jigin, o bɛ a to set screw ka kɔsegin ka bɔ. XC Medico ka nege-angle buttress thread bɛ jigin ni kɔnɔna jiginni jateminɛ jira. Ni girinya kɛra, jiri fanga bɛ tulip kogow sama tiɲɛ na ka taa kɔnɔna na, ka set screw datugu kosɛbɛ bere la ani ka splay-driven construct failure ban pewu.

J: Mun na cross-link system wajibiyalen don kɔfɛla latilenni janyalenw na walasa ka bere bali ka sɛgɛn?

A: Paralɛli berew yɛrɛmahɔrɔnyalenw bɛ u jigi da pedicle screw kelen-kelen bɛɛ ka sigida friction grip dɔrɔn de kan. Ni banabagatɔ kolo cogoya ye koloci ye, a kɔkolo jiginni segin-segin bɛ se ka kɛ sababu ye ka kurukuruw wuli ni mikroskɔpi ye, ka o sigida sɔgɔsɔgɔninjɛ minɛcogo tiɲɛ waati kɔnɔ. Ni i ye cross-connectors adjustables don ɲɔgɔn na, o bɛ numanbolo ni numanbolo berew bridge ka kɛ kɛsu naani gɛlɛn ye. O jὲɲɔgɔnya min bɛ Kɛ ni 'plan caman ye, o bɛ sɛgɛn degunw Lase fɛn dilannen bɛɛ ma, o bɛ kɛ sababu ye ka bere janya yɛrɛmahɔrɔnyalen sɛgɛn masinko siratigɛ la hali ni kuru kelen ɲɔgɔndan ye mikro-fretting sɛgɛn sɔrɔ.

Jagokɛlaw ka nafa jiracogo: Sigida tenderiw ka fanga bonya

• Jago siratigɛ la : Ka dɔgɔtɔrɔso sannijɛkuluw jira ni ɛntɛrinɛti fɛɛrɛ ye min bɛ seginnkanni farati dɔgɔya ani ka ko caman musaka bɛɛ lajɛlen dɔgɔya ni 55% ye, o bɛ jago nafa sigi senkan min tɛ se ka suma ni ɲɔgɔn ye tender lajɛw senfɛ.
• Dɔgɔtɔrɔso dannaya : Ka kɔkolo operelikɛlaw dɛmɛ ni TC4 Titanium fɛnɲɛnamafagalanw ye minnu sɛgɛsɛgɛlen don (ISO 13485) minnu bɛ ni sub-micron machining tolerances ye, o bɛ kɛ sababu ye ka dannaya kɛ ni torque locking ye, ka u tɔgɔ lakana sigida la ka bɔ jɔli dɛsɛw la minnu bɛ kɛ kɔfɛ.