Ọmụmụ ihe gbasara ụlọọgwụ: Ijikwa Mbugharị Cephalad siri ike nke Mkpanaka Ọkpụkpụ Ọkpụkpụ n'ime oghere Thoracic Site na ndozi enweghị ndidi.

Ụlọ ọgwụ: Ụlọ ọgwụ Universitario San Ignacio, Bogotá, Colombia
dọkịta na-awa ahụ: Dr. Mateo Restrepo, Department of Complex Spine Reconstruction
Date: October 2025
Case Category: Catastrophic Hardware Migration / Revision Posterior Spinal Instrumentation
Key results: Single-stage posterior extracting of a migrated legural rod, by the complete legural rod Sistemụ Polyaxial Medico® adịchaghị. Ngụkọta oge ọrụ: nkeji 155. A na-akpọkọta onye ọrịa n'enweghị nsogbu n'ime ụbọchị 2 gasịrị.

Ngosipụta ikpe

Ihe ndekọ ọnụ ọgụgụ ndị ọrịa na akụkọ nlekọta ahụike

• Onye ọrịa: Carlos Mendoza (anaghị akpọ aha)
• Afọ: 52 afọ
• okike: Nwoke
• Nchọpụta nke mbụ: scoliosis thoracolumbar na-eto eto siri ike
• Akụkọ gbasara ịwa ahụ: Ndozi nrụrụ azụ azụ na ngwakọta na-agbatị T11-L3 gburu afọ 15 tupu iji sistemu screw pedicle na-enweghị mkpọchi.
• Usoro ịwa ahụ mgbe emechara: Asymptomatic nwere mgbazi nhazi zuru oke yana ntinye ndụ zuru oke maka ihe karịrị afọ iri.
• Ihe mgbagwoju anya: ọbara mgbali elu dị nro (a na-achịkwa), onye na-ese anwụrụ ọkụ, ọkpụkpụ ịnweta ọkpụkpụ na-egosi mmalite osteopenia (T-score -1.8).

Na-egosi mkpesa na usoro iheomume nke ụlọ ọgwụ

Isi mkpesa: Mwepụta nke nta nke nta nke ụdị ihe mgbu obi dị n'akụkụ aka ekpe na-egbukepụ na scapula, na-esiwanye ike site na mkpali miri emi, na-esonyere dyspnea dị nro na-arụ ọrụ n'ime oge 3. Ọnweghị mgbu azụ lumbar mpaghara mpaghara ma ọ bụ ụkọ akwara ozi dị ala ka akọpụtara.

Usoro iheomume:

• Ụbọchị 1 (Nbanye): Onye ọrịa gosipụtara na ngalaba mberede na-atụ egwu nnukwu ọrịa obi ma ọ bụ ihe omume akpa ume. Electrocardiogram na enzymes obi bụ ihe nkịtị.
• Nrutuaka: Mgbagwoju anya ngwaike mmalite ma ọ bụ oke paravertebral.
• Ihe kacha mkpa onyonyo: redio obi STAT na nyocha thoracic CT dị elu na-esote nyere iwu n'ime awa 3.

Nchọpụta onyonyo na atụmatụ ịwa ahụ

Nchọpụta redio na CT (Foto 1 & 2):

• Nrụpụta ọnọdụ: Mmezu n'ibu ọdịda na ekpe T11-L3 mkpara-ịkpọsa interface. Ihe skru dị larịị nke akaekpe alaghachila azụ kpamkpam, butere mkpokọta mkpokọta.
• Ntugharị ngwaike: mkpanaka nkwụsi ike ogologo 5.5mm aka ekpe ewepụla kpamkpam na saddles screw pedicle. N'ịbụ ndị ọtụtụ afọ nke ngbanwe ọkpụkpụ azụ na-aga n'ihu na ntụgharị ntụgharị, mkpanaka ahụ na-enweghị mgbochi gara nke ọma (cephalad) site na ọtụtụ centimita.
• Nkwekọrịta anatomical: Ọnụ ọnụ elu nke mkpanaka akwagara mebiri ụgbọ elu paravertebral fascial, gafere ókèala costovertebral, wee banye n'ime oghere thoracic aka ekpe, na-ezu ike na nso nso pleura na nnukwu egwu thoracic vaskụla.

Mkparịta ụka ịwa ahụ: Mkpebi ọgwụgwọ

Ngwa ngwa ụlọ ọgwụ: Ịhapụ mkpanaka titanium na-enweghị mgbochi n'ime ogige thoracic dị ike na-ebute ihe egwu ozugbo nke laceration aortic, intercostal arịa perforation, ma ọ bụ erughị ala pneumothorax n'oge mmegharị mberede. Mwepụta ịwa ahụ ngwa ngwa na nrụgharị ya bụ iwu.

Nhọrọ 1: Obere vidiyo-enyere Thoracoscopic (VATS) mmịpụta naanị

Ihe ọghọm: Iwepụ mkpanaka ahụ site na usoro thoracic na-eleba anya na ihe ize ndụ visceral ozugbo ma na-ahapụ onye ọrịa ahụ na-akwụghị ụgwọ, gbajiri thoracolumbar arụ ọrụ. Na-enweghị ngbanwe nke azụ, skru pedicle fọdụrụ ga-enweta oke nrụgide nrụgide, na-eduga n'ịtọhapụ aseptic ngwa ngwa, mgbu azụ dị ukwuu, na nrụrụ nke abụọ.

Nhọrọ 2: Ejikọtara Thoraco-Abdominal na Ndozi emepe emepe

Ọdịmma: Ime nbibi abụọ dị iche iche (n'ihu thoracotomy maka mweghachi mkpanaka na ụzọ mepere emepe nke azụ maka nkwụsi ike ọkpụkpụ azụ) n'ime ọtụtụ ụbọchị na-abawanye ngụkọta oge ọrụ na nkeji 320+. Ihe owuwu ụzọ abụọ a na-ebuli n'ụzọ dị egwu mfu ọbara, nsogbu akpa ume, na oge akwa ụlọ ọgwụ ruo ụbọchị 6-8 kacha nta.

Nhọrọ 3: Mweghachiteghachi otu ọkwa dị n'azụ + Ndozi Cross-Link (Ahọpụtara)

Usoro nka na ụzụ: Imepegharị mbepụ etiti azụ azụ na-enye ohere ịbanye ozugbo banye akwa ngwaike fọdụrụnụ. N'iji ike iweghachite ọkachamara pụrụ iche, dọkịta na-awa ahụ gbasoro traktị nke mkpanaka ahụ nke ọma site n'akụkụ azụ, jiri nlezianya wepụ ya na oghere thoracic n'okpuru nduzi fluoroscopic siri ike. Nke a na-ezere thoracotomy anterior nọọrọ onwe ya.

Ozugbo ewepụtara ya, ejiri XC Medico® Premium Polyaxial Pedicle Screw Sistemu dochie usoro ihe nketa na-adịghị akwụsi ike . Iji kpochapụ isi ihe kpatara ọdịda mbụ ahụ, ihe nrụpụta ọhụrụ agbakwunyere n'akụkụ buttress na-adịghị mma na-etinye skru iji gbochie eriri eri, jikọtara ya na njikọ njikọ obe na-agbanwe agbanwe na-eme ka ọkpụkpụ anọ na-enweghị ike ibugharị.

Nhọrọ ngwaahịa: Sistemụ ndozi Spinal nke XC Medico - ijikọ skru polyaxial pedicle dị elu yana skru na-adịghị mma na njikọ njikọ ga-agbanwe agbanwe.

Mmegbu ịwa ahụ: nkọwa ọrụ

Ndokwa na ngosi

• Ndokwa ndị ọrịa: Ọnọdụ dị mfe na etiti Relton-Hall ọkọlọtọ, na-ebuli mgbaka afọ iji belata nrụgide venous.
• Ngosipụta: E wepụrụ ọnya etiti azụ azụ. Ejiri nlezianya mee nkesa subperiosteal iji kpughee skru pedicle nke nketa sitere na T11 ruo L3. Emere mkpughe nke ubi na-arụ ọrụ n'ime nkeji iri abụọ na ise.

Mweghachi ngwaike na Usoro mkpochapụ Thoracic

• Nchọgharị: Ahụrụ tulip pedicle skru nke aka ekpe ka o meghere ya na skru setịpụrụ adịghị kpamkpam. Achọpụtara njedebe caudal nke mkpanaka akwaga na-apụta ntakịrị site na akwa akwara paravertebral dị nso T11.
• Mwepụta: N'okpuru nlekota fluoroscopic mpụta na-aga n'ihu, a na-etinye ike na-amachi ọrụ dị arọ pụrụ iche na ọdụ a na-ahụ anya nke mkpanaka. N'iji usoro traction axial a na-achịkwa, nke na-adịgide adịgide, mkpanaka ahụ dọghachiri azụ azụ n'akụkụ traktị mbugharị ya.
• Nlele nlegharị anya: Ewepụtara mkpanaka ahụ nke ọma n'enwetaghị nguzogide. Ngwa ngwa fluoroscopy na nyocha mgbasawanye akpa ume gosipụtara na oke akụkụ nke pleural ka dịgidere na-enweghị nnukwu pneumothorax. Ogologo oge: 40 nkeji.

Ndozigharị & Usoro Mgbakọ Frame siri ike

• Mkpọsa mgbanwe: E weputara skru ihe nketa atọpụrụ. E degharịrị traktị pedicle ahụ wee bulie elu iji nabata XC Medico® 6.0mm Premium Polyaxial Pedicle Screws, na-eme ka ịzụrụ ọkpụkpụ dị elu n'àkwà osteopenic.
• Mkpọchi mkpara: New 5.5mm tupu contoured titanium alloy mkpanaka nọ ọdụ. N'ụzọ dị oke mkpa, skru setịpụ akụkụ adịghị mma nke XC Medico ka a tụgharịrị na 8 Nm site na iji ndị ọkwọ ụgbọ ala nwere akara. Profaịlụ eri ahụ dọtara mgbidi tulip nke ọma n'ime, na-ewepụ ihe egwu splay.
• Njikọ njikọ cross-njikọ: A na-agbanye njikọ njikọ abụọ siri ike na-agbanwe agbanwe n'ofe aka ekpe na aka nri na ọkwa T12 na L2. Nke a gbanwere mkpara abụọ nọọrọ onwe ha ka ọ bụrụ otu ebe arụrụ arụ siri ike nke ukwuu, na-eme ka mkpanaka ogologo na-amịgharị n'anụ ahụ agaghị ekwe omume. Ogologo oge: 70 nkeji.

Mbelata ikpeazụ na mmechi

Fluoroscopy biplanar ikpeazụ kwadoro omimi nke skru dị mma, ntinye mkpanaka symmetrical zuru oke, na nhazigharị anatomical. A na-agbaba ebe ahụ mmiri nke ọma, a na-etinye mmiri mmiri dị n'okpuru muscular, ma mechie mmechi nke ọtụtụ okpukpu. Ngụkọta oge ọrụ: nkeji 155. Atụmatụ ọnwụ ọbara: 210 ml. Mịnye: efu.

Agụmakwụkwọ na nsonazụ ịwachara ahụ

Ịwa ahụ ozugbo (POD 0-1)

Onye ọrịa tetara na mkpebi ozugbo nke mgbu obi dị nkọ (VAS belatara site na 8/10 pre-op ruo 2/10 post-op). A na-enyocha ụda iku ume n'ụzọ abụọ, na-ewepụ pneumothorax n'oge. Radiograph post-op gosipụtara nhazi ngwaike pristine. Ka ọ na-erule mgbede nke POD 1, onye ọrịa ahụ nọ ọdụ nke ọma n'akụkụ ihe ndina nwere nguzosi ike n'akụkụ akwara dị ala.

Atụmatụ mkpofu (POD 2 - awa 48)

N'ime awa 48 gachara, ewepụrụ drain submuscular (mmepụta ntakịrị). Onye ọrịa ahụ zutere njirisi mwepụ ụlọ ọrụ niile: ambulation nke onwe ya na ije ije nkịtị, oke ọnụ ọnụ, yana mgbu na-achịkwa site na analgesics ọnụ. Mwepụ mbụ n'ime awa 48 belatara ihe ize ndụ nke ọrịa butere ụlọ ọgwụ yana ibelata ibu ihe ndina ụlọ ọrụ.

Nsoso (izu 6 na ọnwa 3)

Na akara ọnwa 3, Carlos enweghị ihe mgbu kpamkpam (VAS 0/10) wee laghachi na ọrụ ọkachamara. Serial chest and spinal radiographs akwadoro obere mmegharị ahụ efu na njikọ mkpọda. Okpokoro XC Medico® nwere njikọ obe jigidere njide nhazi zuru oke, yana akara mmalite nke ngwakọta osseous siri ike na-agbakọta n'ofe akụkụ thoracolumbar.

Nyocha Akụ na ụba: Nhazi Ndozigharị otu-Stage vs nke akwadoro mmeghe meghere

ọnụ ahịa	akwadoro ọtụtụ ụzọ ntụgharị (ihe nketa)	Otu-Stage XC Medico® Sistemu (N'ezie)	dị iche.
Ihe ntinye ịwa ahụ (ngwaọrụ ihu/ọkpụkpụ)	$9,800 (ọdụ ụgbọ mmiri thoracoscopic, ihe ndị na-adịru nwa oge)	$0	- $9,800
Ihe etinyere n'ịwa ahụ (Ọkpụkpụ azụ azụ)	$8,400 (Ụra ndị yiri ya na skru)	$6,100 (XC Medico Premium screws & Cross-links)	- $2,300
Oge ọrụ (ọnụahịa akụrụngwa: $250/min)	$8,000 (nkeji 320 gafee ụbọchị dị iche iche)	$3,875 (155 nkeji eweghachite otu nkeji)	- $4,125
Dọkịta na-awa ahụ, Ọkachamara Thoracic & Ụgwọ Anesthesia	$8,500 (ụgwọ akwadoro ọtụtụ ọzụzụ)	$4,800 (Mmebi n'azụ jikọtara otu nnọkọ)	- $3,700
Ụlọ ọgwụ ICU/Ọdụdọ (ọnụahịa akwa: $450 kwa ụbọchị)	$3,150 (nkezi mgbake ụbọchị 7 maka ndenye oghere thoracic)	$900 (ụbọchị 2 n'oge mbido mwepụta)	- $2,250
Onyonyo mgbe arụchara ọrụ gasịrị & nlele akpa ume	$2,400	$2,175	- $225
Mkpokọta ọnụ ozugbo	$40,250	$17,860	- $22,390 (mbelata 55%)

Maka ụlọ ọrụ ọgbaghara azụ azụ na ebe mwugharị ụlọ na-ejikwa ọdịda ihe nketa gbagwojuru anya, ịnakwere sistemu mgbachi dị elu nke XC Medico na-eme ka ụlọ ọrụ chekwaa $22,390 USD kwa ikpe ka na-ebuli ntụgharị ọrụ yana belata ụgwọ mberede nke abụọ.

Ajụjụ & A nka nka maka ndị otu mwugharị mgbagwoju anya

Ajụjụ: Kedu ka eri buttress na-adịghị mma si egbochi ịghasa azụ azụ ma e jiri ya tụnyere eriri larịị ọkọlọtọ?

A: Ọkọlọtọ larịị ma ọ bụ V-threads na-egosipụta ike dị n'èzí megide mgbidi dị n'ime nke isi ịghasa (tulip) mgbe a na-agbatị ya na torque ikpeazụ. N'okpuru nrụgide usoro cyclic dị elu, ike radial a na-eme ka mgbidi tulip gbasaa ntakịrị ma ọ bụ 'splay.' Ozugbo splay pụtara, eriri na-ejikọta ya na-adaba, na-ekwe ka ihe nkedo ahụ daa azụ. Eriri buttress na-adịghị mma nke XC Medico na-egosipụta geometry mgbada ala na ime. Mgbe a na-etinye torque, eriri eri na-adọba mgbidi tulip n'ime, na-ekpochi ihe nkedo ahụ nke ọma na mkpanaka ahụ ma na-ewepụ mmebi iwu nke na-akpata splay kpamkpam.

Ajụjụ: Gịnị kpatara usoro njikọ njikọ ga-adị mkpa na ngbanwe dị ogologo n'azụ iji gbochie mkpanaka?

A: Mkpara myirịta ndị kwụụrụ onwe ha na-adabere naanị na njigide esemokwu mpaghara nke skru pedicle n'otu n'otu. Ọ bụrụ na onye ọrịa nwere ogo ọkpụkpụ osteopenic, ntụgharị ogwe osisi ugboro ugboro nwere ike ime ka ọ gbanwee isi ihe nkedo ahụ, na-eweda esemokwu mpaghara na-ejide ka oge na-aga. Ijikọ njikọ njikọ obe na-agbanwe agbanwe na-ejikọta mkpanaka aka ekpe na aka nri n'ime igbe igbe anọ siri ike. Njikọ ọtụtụ atụmatụ a na-enyefe nrụgide shiee n'ofe ihe niile a na-arụ, na-eme ka mkpanaka ogologo ogologo na-amị amị na-agaghị ekwe omume ọbụlagodi ma ọ bụrụ na otu screw junction na-enweta obere ihe na-akpata iwe.

Ntụnye uru nke onye nkesa: Pọtụfoliyo obi ụtọ na-achị mpaghara

• The Commercial Edge: Igosi ndị otu nzụta ụlọ ọgwụ nwere usoro injinia nke na-ebelata ihe egwu nlegharị anya wee wedata mkpokọta ụgwọ ikpe ọtụtụ ọzụzụ site na 55% na-ewepụta uru azụmaahịa na-enweghị atụ n'oge nyocha dị nro.
• Ntụkwasị obi nke ụlọ ọgwụ: Inye ndị dọkịta na-awa spine nwere asambodo (ISO 13485) ngwaike TC4 Titanium nke na-egosipụta nnabata nnabata nke sub-micron na-eme ka ntụkwasị obi kpochie elu dị elu, na-echebe aha ụlọ ọrụ ha site na ọdịda ọdịda nke ikpeazụ.