Kwiga Ikibazo cya Clinical: Gucunga Cephalad Ikomeye Yimuka Yuruti rwumugongo muri Thoracic Cavity Via Zero-Tolerance Fixation

Ibitaro: Ibitaro Universitario San Ignacio, Bogotá, Kolombiya
Kubaga: Dr. Mateo Restrepo, Ishami rishinzwe kongera kubaka uruti rwumugongo
Itariki: Ukwakira 2025
Urubanza Icyiciro: Catastrophique Hardware Migration / Revision Posterior Spinal Instrumentation
Ibyingenzi Ibyingenzi: Gukuramo umupaka wa XC ukomoka kumupaka wa XC. Sisitemu ya Polyaxial. Igihe cyose cyo gukora: iminota 155. Umurwayi yakanguriwe neza kumunsi wa 2 nyuma yibikorwa.

Ikiganiro

Imibare y'abarwayi n'amateka ya Clinical

• Murebwayire: Carlos Mendoza (utazwi)
• Imyaka: imyaka 52
• Uburinganire: Umugabo
• Isuzuma ryibanze: Umwangavu ukabije thoracolumbar scoliose
• Amateka yo kubaga: Gukosora ubumuga bwinyuma hamwe no guhuza T11-L3 byakozwe hashize imyaka 15 mbere yo gukoresha umurage udafunze pedicle screw.
• Amasomo ya nyuma yibikorwa: Asimptomatic hamwe no gukosora ibyuzuye no guhuza ubuzima bwuzuye mumyaka irenga icumi.
• Ingaruka: hypertension yoroheje (igenzurwa), itabi rikora, ubucucike bwamagufwa yerekana osteopenia kare (T-amanota -1.8).

Gutanga Ikirego hamwe nigihe cyamavuriro

Ikirego nyamukuru: Gutangira buhoro buhoro ububabare budasanzwe bwibumoso bwibumoso bwigituza bugaragara kuri scapula, bwiyongera kubwo guhumeka kwinshi, buherekejwe na dyspnea yoroheje mugihe cyibyumweru 3. Nta bubabare bw'umugongo bwaho cyangwa ibimenyetso byo mu mutwe byo hasi byigeze bigaragara.

Igihe:

• Umunsi wa 1 (Kwinjira): Umurwayi yashyikirijwe ishami ryihutirwa atinya indwara ikaze yumutima nimiyoboro cyangwa ibihaha. Electrocardiogram na enzymes yumutima byari bisanzwe.
• Gushidikanya: Gutinda-gutangira ibyuma bigoye cyangwa misa ya paravertebral.
• Kwerekana amashusho yibanze: STAT yigituza radiografi hamwe nibisubizo bihanitse bya thoracic CT scan byateganijwe mumasaha 3.

Kwerekana Ibishushanyo na Gahunda yo Kubaga

Ibisubizo bya Radiografiya & CT (Ishusho 1 & 2):

• Imiterere yubaka: Kunanirwa gukanika kumashanyarazi ibumoso bwa T11-L3 inkoni-screw. Ibumoso bwibumoso bushyizweho imigozi yari yasubiye inyuma rwose, bivamo gusenya kwuzuye.
• Guhindura ibyuma: Ibumoso bwa 5.5mm z'uburebure bwa stabilisation yari yarahagaritse rwose kuva kuri pedicle screw. Bitewe nimyaka myinshi yikurikiranya ryumugongo hamwe nizunguruka, inkoni idafite imipaka yimutse cyane (cephalad) na santimetero nyinshi.
• Ubwumvikane buke bwa Anatomical: Isonga ryo hejuru yinkoni yimutse yarenze indege ya paravertebral fascial, yambuka imipaka ya Costovertebral, hanyuma yinjira mu mwobo w’ibumoso wa thoracic, iruhukira hafi ya pleura ninzira nini ya thoracic.

Ikiganiro cyo kubaga: Icyemezo cyo kuvura

Kwihutirwa kwa Clinical: Kureka inkoni ya titanium idakumiriwe mumurima wa thoracic itera imbaraga biratera ubwoba bwihuse bwo gukomeretsa aortic, gutobora imitsi hagati, cyangwa pneumothorax mugihe ugenda utunguranye. Gukuramo byihutirwa kubaga no kubaka ibyasubiwemo byari itegeko.

Ihitamo 1: Gukuramo Video ya Minimalist Ifashwa na Thoracoscopic (VATS) Gukuramo gusa

Ibibi: Gukuraho inkoni ukoresheje inzira ya thoracic ikemura akaga ako kanya ako kanya ariko igasiga umurwayi afite imiterere idahwitse, yamenetse ya thoracolumbar. Hatabayeho gusubiramo inyuma, imigozi isigaye ya pedicle ishobora guhura nibibazo byinshi, biganisha ku kwihuta kwa aseptic, kubabara umugongo bikabije, no gutera imbere kwa kabiri.

Ihitamo rya 2: Guhuza Thoraco-Inda na Posterior Gufungura Gusubiramo

Ibibi: Gukora ibice bibiri bitandukanye (thoracotomy yimbere yo kugarura inkoni hamwe nuburyo bwo gufungura inzira yo guhagarika umugongo) muminsi myinshi byongera igihe cyo gukora kugeza kuminota 320+. Ubu buryo bwuburyo bubiri buzamura cyane gutakaza amaraso, ingorane zimpyiko, hamwe nuburiri bwibitaro kugeza kumunsi 6-8 byibuze.

Ihitamo rya 3: Icyiciro kimwe Cyinyuma Yisubiramo Retrograde Kugarura + Byashimangiwe Kwambukiranya-Guhuza (Byatoranijwe)

Uburyo bwa tekiniki: Ongera ufungure ibice byinyuma byimbere byemerewe kugera kuburiri bwibikoresho bisigaye. Yifashishije imbaraga zihariye zo kugarura ibintu, umuganga abaga yakurikiranye agace k'inkoni asubira inyuma asubira inyuma, ayitandukanya yitonze ava mu mwobo wa thoracic ayobowe na fluoroscopique. Ibi birinze thoracotomy yigenga.

Bimaze gukurwa, sisitemu yumurage idahindagurika yasimbuwe na XC Medico® Premium Polyaxial Pedicle Screw Sisitemu . Kurandura intandaro yo kunanirwa kwambere, ibishya byubatswe bihujwe na negative-angle buttress yashyizeho imigozi kugirango wirinde urudodo ruvanze, ruhujwe nuburyo bukomeye bushobora guhinduka-guhuza ibice kugirango bitameze neza.

Guhitamo ibicuruzwa: Sisitemu ya XC Medico ya Premium Spinal Fixation Sisitemu - ikomatanya ibyuma birebire cyane bya polyaxial pedicle ya pedicle hamwe nu mfuruka itari nziza kandi igahuza imipaka.

Kwicwa kwa Surgical: Ibisobanuro birambuye

Umwanya no Kumurika

• Umwanya w'abarwayi: Umwanya ugaragara kumurongo usanzwe wa Relton-Hall, uhindura decompression yo munda kugirango ugabanye umuvuduko wamaraso.
• Kumenyekanisha: Inkovu yimbere yinyuma yimbere yaracukuwe. Gutandukanya Subperiosteal byakozwe neza kugirango berekane umurage pedicle umurage kuva T11 kugeza L3. Imikorere ikora yerekanwe muminota 25.

Kugarura ibyuma hamwe na Thoracic Clearance Icyiciro

• Ubushakashatsi: Ibumoso bwa pedicle screw tulips wasangaga ifunguye hamwe na shitingi zidahari rwose. Impera ya caudal yinkoni yimutse yamenyekanye isohoka gato ku buriri bwimitsi ya paravertebral hafi ya T11.
• Gukuramo: Mugukurikirana fluoroscopique ikurikiranye, imbaraga zihariye ziremereye zifatanije umurizo ugaragara winkoni. Ukoresheje tekinike igenzurwa, ihamye ya axial traction, inkoni yasubijwe inyuma inyuma yinzira yimuka.
• Kugenzura neza: Inkoni yakuweho neza nta guhura nimbogamizi. Igenzura ryihuse rya fluoroscopi hamwe no kwagura ibihaha ryemeje ko umupaka wishimye wagumye kuba mwiza nta pneumothorax ikaze. Icyiciro cyigihe: iminota 40.

Gusubiramo Gukosora & Rigid Frame Inteko Icyiciro

• Guhinduranya imigozi: Amashanyarazi yararekuwe yakuweho. Udupapuro twa pedicle twarahinduwe kandi turazamurwa kugira ngo twakire XC Medico® 6.0mm ya Premium Polyaxial Pedicle Screws, bituma igurwa ryamagufwa ryiza muburiri bwa osteopenic.
• Gufunga inkoni: 5.5mm nshya yabanje kubikwa titanium alloy inkoni. By'umwihariko, XC Medico ihinduranya ibice bitandukanya impande zose zashyizwe kuri 8 Nm ukoresheje abashoferi ba Calibrated. Umwirondoro wurudodo ushushanya cyane urukuta rwa tulip imbere, bikuraho ingaruka ziterwa.
• Kwishyira hamwe: Guhuza ibice bibiri bikomeye bishobora guhuzwa byashyizwe hejuru yibumoso n'iburyo kurwego rwa T12 na L2. Ibi byahinduye inkoni ebyiri zigenga muburyo bumwe, bukomeye cyane bwubatswe, bituma inkoni ndende itanyerera kumubiri bidashoboka. Icyiciro cyigihe: iminota 70.

Kugabanuka kwa nyuma no gufunga

Fiporoscopi ya nyuma ya biplanar yemeje ubujyakuzimu bwiza, gushyira inkoni yuzuye, hamwe na anatomical realignment. Ikibanza cyaravomerewe neza, hashyirwaho imiyoboro y'amazi, kandi gufunga ibyiciro byinshi byarangiye. Igihe cyose cyo gukora: iminota 155. Ikigereranyo cyo gutakaza amaraso: 210 mL. Amaraso: Zeru.

Amasomo ya nyuma yibikorwa nibisubizo

Nyuma yo gutangira (POD 0-1)

Umurwayi yakangutse ahita akemura ububabare bukabije bwo mu gatuza (VAS yagabanutse kuva 8/10 pre-op igera kuri 2/10 post-op). Amajwi asanzwe ahumeka yagenzuwe muburyo bubiri, byanze bikunze pneumothorax. Amafoto ya post-op yerekanaga ibyuma bya pristine bihuza. Ku mugoroba wa POD 1, umurwayi yari yicaye neza ku gitanda afite uburinganire bwuzuye bwo mu mutwe.

Guteganya gusohora (POD 2 - 48 Amasaha)

Ku masaha 48 post-op, imiyoboro ya subuscular yakuweho (ibisohoka bike). Umurwayi yujuje ibyangombwa byose bisohoka mu bigo: kwigenga byigenga hamwe no kugenda bisanzwe, gufata neza umunwa, hamwe nububabare bugenzurwa hakoreshejwe imiti yo mu kanwa. Gusohoka hakiri kare mu masaha 48 byagabanije ibyago byo kwandura ibitaro kandi bikagabanya imitwaro yo kuryama.

Gukurikirana (6-Icyumweru & 3-Ukwezi)

Ku mezi 3, Carlos nta bubabare yari afite (VAS 0/10) kandi yari yasubiye mu mirimo yoroheje. Igituza gikurikiranye hamwe na radiyo yumugongo byemeje zeru zeru zerekanwa kuri screw-inkoni. Ikadiri ihuza XC Medico® ikomeza gufata neza imiterere, hamwe nibimenyetso byambere byo guhuza osseous fusion ihuza ibice bya thoracolumbar.

Isesengura ryubukungu: Icyiciro kimwe cyo gusubiramo ibyiciro vs Icyiciro Gufungura Ibikorwa

Byiciro Icyiciro	Icyiciro Cyiciro Cyinshi Cyisubiramo (Umurage)	Icyiciro kimwe XC Medico® Sisitemu (Ifatika)	Itandukaniro
Gutera kubaga (Ibikoresho by'imbere / Thoracic)	$ 9.800 (Ibyambu bya Thoracoscopic, ibyingenzi by'agateganyo)	$ 0	- $ 9.800
Gutera kubaga (Ikibaho cyinyuma)	$ 8.400 (Ibisanzwe bigereranya inkoni & screw)	$ 6.100 (XC Medico Premium Screws & Cross-link)	- $ 2,300
Igihe cyo gukora (Igiciro cyoroshye: $ 250 / min)	$ 8,000 (iminota 320 muminsi itandukanye)	$ 3.875 (iminota 155 yo kugarura icyiciro kimwe)	- $ 4.125
Kubaga, Thoracic Inzobere & Amafaranga ya Anesthesia	$ 8.500 (Amafaranga menshi yatanzwe)	$ 4.800 (Isomo rimwe rihuza ibyakozwe inyuma)	- $ 3.700
Ibitaro ICU / Ward guma guma (Igiciro cyo kuryama: $ 450 / kumunsi)	$ 3,150 (iminsi 7 yo kugereranya gukira kwa thoracic ifunguye)	$ 900 (Iminsi 2 yo gusohora hakiri kare)	- $ 2,250
Amashusho ya nyuma yibikorwa & Kugenzura ibihaha	$ 2,400	$ 2,175	- $ 225
UMUBARE W'UBUYOBOZI	$ 40.250	$ 17.860	- $ 22.390 (kugabanya 55%)

Ku ihahamuka ry’umugongo n’ikigo cyiyubaka gikemura ibibazo byananiranye mu murage, gukoresha uburyo bwo gufunga XC Medico nini cyane, uburyo bwo gufunga impande zombi zitanga amafaranga yo kuzigama amadolari 22.390 USD kuri buri rubanza mu gihe hagamijwe kugurisha ibicuruzwa no kugabanya inshingano z’ubutabazi bwihutirwa.

Tekiniki Ikibazo na tekiniki yamakipe yo kwiyubaka

Ikibazo: Nigute utudodo twiza-twibanze twirinda gushiraho imigozi inyuma ugereranije nuudodo dusanzwe?

Igisubizo: Igorofa isanzwe cyangwa V-insinga ikoresha imbaraga za radiyo yinyuma kurukuta rwimbere rwumutwe wa tulip (tulip) iyo uhambiriye kumurongo wanyuma. Mugihe cyumuvuduko ukabije wubukanishi, izo mbaraga za radiyo zitera urukuta rwa tulip kwaguka gato cyangwa 'splay. ' Iyo splay imaze kubaho, urudodo rufatanya ruragabanuka, bituma umugozi washyizweho usubira inyuma. XC Medico itemewe-inguni ya buttress iranga epfo na ruguru geometrie. Iyo torque ikoreshejwe, imbaraga zurudodo zikurura urukuta rwa tulip imbere, gufunga umugozi washyizweho cyane kurinkoni no gukuraho burundu kunanirwa kwubaka.

Ikibazo: Ni ukubera iki sisitemu ihuza imiyoboro iteganijwe mugukosora ibice birebire byo gukosora kugirango wirinde kunyerera?

Igisubizo: Inkoni yigenga ibangikanye gusa yishingikiriza kumurongo wo guteranya ibice bya pedicle. Niba umurwayi afite amagufwa ya osteopenic, guhinduranya inshuro nyinshi bishobora gutera microscopique guhinduranya imitwe ya screw, bigatesha agaciro ubwo bushyamirane bwaho bufata igihe. Kwinjizamo guhuza kwambukiranya guhuza ibiraro ibumoso n iburyo muburyo bukomeye bune buringaniye. Ihuriro ryinshi-ryimura ihererekanyabubasha ryimyubakire yubaka, bigatuma inkoni yigenga ndende itambuka kuburyo budashoboka nubwo ihuriro rimwe ryahuye na micro-fretting.

Abagabuzi Agaciro Icyifuzo: Kuganza Amasoko yaho

• Impande zubucuruzi: Kugaragaza amatsinda agura amasoko yibitaro hamwe nigisubizo cyubwubatsi kigabanya ibyago byo gusubiramo kandi bikagabanya amafaranga yakoreshejwe mu manza nyinshi kuri 55% byerekana agaciro k’ubucuruzi ntagereranywa mugihe cyo gusuzuma amasoko.
• Icyizere cya Clinical: Guha abaganga babaga umugongo ibyemezo byemewe (ISO 13485) TC4 Titanium ibyuma byerekana kwihanganira imashini ya micronike itanga uburyo bwo gufunga umuriro mwinshi, bikarinda izina ryinzego zabo kunanirwa kubaka.