Thuto ea Tleliniki: Ho Laola Severe Cephalad Migration ea Spinal Fusion Rod ho ea Thoracic Cavity Via Zero-Tolerance Fixation

Sepetlele: Sepetlele Universitario San Ignacio, Bogotá, Colombia
Ngaka e buoang: Dr. Mateo Restrepo, Lefapha la Tsoelo-pele ea Mokokotlo
Letsatsi: Mphalane 2025
Category: Catastrophic Hardware Migration / Revision Posterior Spinal Instrumentation
Sephetho Se Bohloko: Mohato o le mong o lateloa ho tloha moeling oa mothati o le mong ho tloha moeling o phetheselang. matlafatso ea meralo e sebelisang XC Medico® Premium Polyaxial System. Kakaretso ea nako ea ts'ebetso: 155 metsotso. Mokuli o phuthetsoe ka mokhoa o sireletsehileng ka letsatsi la 2 la postoperative.

Tlhahiso ea Nyeoe

Palo ea batho ba mokuli le nalane ea bongaka

• Mokuli: Carlos Mendoza (ea sa tsejoeng)
• Lilemo: lilemo tse 52
• Bong: Monna
• Tlhahlobo ea mantlha: Thoracolumbar scoliosis e matla ea bacha
• Histori ea Opereishene: Ho lokisoa ha mokokotlo oa mokokotlo oa mokokotlo le fusion ea T11-L3 e ileng ea bolaoa lilemo tse 15 pele ho sebelisoa tsamaiso ea screw ea pedicle e sa notlellang.
• Koetliso ea Postoperative: Asymptomatic e nang le tokiso e felletseng ea sebopeho le ho kopanya bophelo bo felletseng ka nako e fetang lilemo tse leshome.
• Likokoana-hloko: Khatello ea mali e bonolo (e laoloang), motho ea tsubang ea tsubang, ho teteka ha masapo a masapo a bontšang hore osteopenia ea pele (T-score -1.8).

Ho Hlahisa Nako ea Litletlebo le Bongaka

Tletlebo e ka sehloohong: Butle-butle ho qala ha bohloko ba sefuba bo sa tloaelehang, bo bohale bo ka lehlakoreng le letšehali bo phallang ho scapula, bo mpefalitsoeng ke pululelo e tebileng, e tsamaeang le dyspnea e fokolang ea boikitlaetso ka nako ea libeke tsa 3. Ha ho na bohloko ba mokokotlo oa mokokotlo oa lumbar kapa bofokoli ba methapo ea methapo e tlaase e tlalehiloeng.

Lenane la nako:

• Letsatsi la 1 (Kamohelo): Mokuli o hlahisoa lefapheng la tšohanyetso a tšaba ketsahalo e mpe ea pelo kapa ea matšoafo. Electrocardiogram le li-enzyme tsa pelo li ne li tloaelehile.
• Pelaelo: Bothata ba hardware ea morao-rao kapa boima ba paravertebral.
• Ntho ea bohlokoa ka ho fetisisa ea ho nahana: STAT sefuba radiograph le thoracic CT scan ea morao-rao e laetsoeng ka hare ho lihora tse 3.

Liphuputso tsa ho Imaging le Moralo oa ho Buoa

Liphuputso tsa Radiographic & CT (Litšoantšo 1 & 2):

• Boemo ba ho aha: Ho hloleha ho felletseng ha mochini ka letsohong le letšehali la T11-L3 rod-screw interface. Likurufu tsa sete e ka ho le letšehali li ne li theohile ka ho feletseng, e leng se ileng sa baka ho qhaqhoa ho feletseng.
• Ho fetisoa ha Hardware: Thupa e ka ho le letšehali ea 5.5mm longitudinal stabilization e ne e khaohile ka ho feletseng ho tloha ho li-saddles tsa pedicle screw. E khannoa ke lilemo tse sa khaotseng tsa mokokotlo oa mokokotlo le lipotoloho tse potolohang, molamu o sa tsitsang o ile oa falla ka holimo (cephalad) ka lisenthimithara tse 'maloa.
• Tlhaloso ea Anatomical: Ntlheng e phahameng ea molamu o fallang e ile ea tlōla lifofane tsa paravertebral fascial, ea tšela meeli ea costovertebral, 'me ea kenella ka hare ho sefuba se letšehali sa sefuba, se phomotse haufi le pleura le litsela tse kholo tsa vascular thoracic.

Puisano ea Karo: Qeto ea Kalafo

Ho potlaka ha meriana: Ho siea molamu oa titanium o sa tsitsang ka har'a sebaka se matla sa sefuba ho baka tšoso e potlakileng ea ho phatloha ha aortic, ho phunyeha ha sekepe sa intercostal, kapa pneumothorax ea tsitsipano nakong ea ho sisinyeha ka tšohanyetso. Ho etsoa opereishene e potlakileng le ho nchafatsoa ha kaho e ne e le tlamo.

Khetho ea 1: Ho Nkoa ha Thoracoscopic (VATS) ea Minimalist Video-Assisted

Mefokolo: Ho tlosa molamu ka mokhoa oa sefuba ho sebetsana le kotsi e potlakileng ea visceral empa ho siea mokuli ka mohaho o sa tsitsang, o robehileng oa thoracolumbar. Ntle le ntlafatso ea morao-rao, li-screw tse setseng tsa pedicle li ne li tla ba le khatello e matla ea khatello ea maikutlo, e leng se lebisang ho potlakisang ho lokoloha ha aseptic, bohloko bo boholo ba morao, le tsoelo-pele ea ho holofala ha bobeli.

Khetho ea 2: Tlhahlobo e Kopantsoeng ea Thoraco-Abdominal le Posterior Open

Mefokolo: Ho etsa likarolo tse peli tse arohaneng (thoracotomy e ka pele bakeng sa ho khutlisa molamu le mokhoa o bulehileng oa morao bakeng sa botsitso ba mokokotlo) ho pholletsa le matsatsi a mangata ho eketsa nako eohle ea ts'ebetso ho metsotso ea 320 +. Mohaho ona oa mekhoa e 'meli o phahamisa tahlehelo ea mali, mathata a matšoafo, le nako ea ho robala sepetlele ho fihlela bonyane matsatsi a 6-8.

Khetho ea 3: Phatlalatso ea Mohato o le Mong oa Ka morao-rao ea morao + e Matlafalitsoeng ea ho Lokisoa ha Lihokelo tsa Sefapano (E khethiloe)

Mokhoa oa botekgeniki: Ho bula hape mothapo o fetileng o ka morao oa midline o lumelletse ho fihlella ka kotloloho betheng e setseng ea hardware. E sebelisa li-forceps tse khethehileng tsa ho khutlisa, ngaka e buoang e ile ea latela pampitšana ea molamu ka morao ho tloha ka morao ho tloha ka morao, ka hloko e e ntša ka ntle ho sefuba sa sefuba tlas'a tataiso e tiileng ea fluoroscopic. Sena se ile sa qoba thoracotomy e ikemetseng e ka pele.

Hang ha e ntšitsoe, tsamaiso e sa tsitsang ea lefa e ile ea nkeloa sebaka ke XC Medico® Premium Polyaxial Pedicle Screw System . Ho felisa sesosa sa ho hloleha ha pele, li-screws tse ncha tse kopantsoeng tsa negative-angle buttress seta ho thibela khoele e hohlaneng, e kopantsoeng le likhokahano tse thata tse feto-fetohang ho etsa foreimi e sa sisinyeheng ea quadrangular.

Khetho ea sehlahisoa: XC Medico's Premium Spinal Fixation System — e kopanyang likurufu tsa polyaxial pedicle tse nang le torque e phahameng ka li-screw tse nang le li-angle tse tlase le likhokahano tse thata tse feto-fetohang.

Ho Buoa: Lintlha tsa Ts'ebetso

Boemo le Ponahatso

• Maemo a mokuli: Maemo a ka tlase ho foreimi e tloaelehileng ea Relton-Hall, e ntlafatsang ho senyeha ha mpa ho fokotsa khatello ea venous.
• Ho pepeseha: Lebali le ka morao la mola o bohareng le ntšitsoe. Subperiosteal dissection e ile ea etsoa ka hloko ho pepesa li-screw tsa lefa ho tloha T11 ho ea L3. Ponahalo ea tšebetso ea tšebetso e fihletsoe ka metsotso e 25.

Ho Khutlisa Hardware le Phase ea ho Hlakola Thoracic

• Tlhahlobo: Li-tulips tsa 'pedicle screw' tse ka letsohong le letšehali li fumanoe li butsoe ka li-screw tsa sete li le sieo ho hang. Qetello ea caudal ea molamu o fallang e ile ea khetholloa e hlahella hanyenyane ho tloha betheng ea mesifa ea paravertebral haufi le T11.
• Ho ntšoa: Tlas'a leihlo le tsoelang pele la lateral fluoroscopic, li-clamping forceps tse khethehileng tse boima li ne li khomaretsoe mohatleng o bonahalang oa molamu. Ho sebelisoa mokhoa o laoloang, o tsitsitseng oa axial traction, molamu o ile oa huloa morao ka morao tseleng ea eona ea ho falla.
• Tlhokomelo ea ho hlakola: Molamu o ile oa ntšoa hantle ntle le ho hanyetsoa. Liteko tsa hang-hang tsa fluoroscopy le katoloso ea matšoafo li netefalitse hore moeli oa pleural o ntse o le teng ntle le pneumothorax e matla. Nako ea nako: metsotso e 40.

Revision Fixation & Rigid Frame Assembly Phase

• Screw exchange: Ho ile ha ntšoa li-screws tsa lefa tse lokolotsoeng. Lipampitšana tsa pedicle li ile tsa tsosolosoa 'me tsa phahamisoa ho amohela XC Medico® 6.0mm Premium Polyaxial Pedicle Screws, ho netefatsa theko e phahameng ea masapo libetheng tsa osteopenic.
• Ho notlela ka lere: Lithupa tse ncha tsa 5.5mm tse entsoeng ka pele tsa titanium li ne li lutse. Habohlokoa, li-screw tsa XC Medico tsa reverse negative-angle set li ile tsa phahamisoa ho 8 Nm ho sebelisoa li-driver tse lekantsoeng. Boemo ba khoele bo ne bo hulela marako a tulip kahare, a felisa kotsi ea splay.
• Khokahano ea li-cross-link: Lihokelo tse peli tse thata tse feto-fetohang li ne li kentsoe ka mose ho melamu ea leqele le le letona maemong a T12 le L2. Sena se ile sa fetola melamu e 'meli e ikemetseng hore e be foreimi e le 'ngoe, e thata haholo, e leng ho etsang hore lere la longitudinal le thellehe ho se khonehe. Nako ea nako: 70 metsotso.

Phokotso ea ho Qetela le Ho Koalloa

Biplanar fluoroscopy ea ho qetela e netefalitse botebo bo loketseng ba screw, ho beoa ha molamu o lekanang hantle, le ho feto-fetoha ha sebōpeho. Sebaka seo se ile sa nosetsoa ka ho feletseng, ho kenngoa mokelikeli oa submuscular, 'me ho koaloa ha sefahleho sa mefuta e mengata ho ile ha phethoa. Kakaretso ea nako ea ts'ebetso: 155 metsotso. Khakanyo ea tahlehelo ea mali: 210 ml. Litšelo: Zero.

Thupelo le Liphello tsa Postoperative

Hang-hang ka mor'a Opereishene (POD 0-1)

Mokuli o ile a tsoha ka qeto e potlakileng ea bohloko bo bohloko ba sefuba (VAS e fokotsehile ho tloha 8/10 pele ho 2/10 ka mor'a op). Melumo e tloaelehileng ea phefumoloho e ile ea netefatsoa ka mahlakore ka bobeli, e tlosa pneumothorax ea morao. Li-radiograph tsa post-op li bonts'itse ho lokisoa ha hardware ea pristine. Mantsiboeeng a POD 1, mokuli o ne a lutse a phutholohile pela bethe a e-na le boko bo felletseng ba methapo ea kutlo.

Moralo oa Phallo (POD 2 — 48 Hours)

Ka mor'a lihora tse 48 ka mor'a ts'ebetso, mokelikeli oa submuscular o ile oa tlosoa (sephetho se fokolang). Mokuli o ile a kopana le mekhoa eohle ea ts'ebetso ea setsi: ho ikemela ka boithaopo ka mokhoa o tloaelehileng oa ho tsamaea, ho noa molomo o monate, le bohloko bo laoloang ka li-analgesics tsa molomo. Ho tsoa sepetlele kapele ka lihora tse 48 ho ile ha fokotsa kotsi ea mafu a bakiloeng ke lipetlele le ho fokotsa libethe tsa setsi.

Tsoelo-pele (Libeke tse 6 le Likhoeli tse 3)

Ka letšoao la likhoeli tsa 3, Carlos o ne a se na bohloko ka ho feletseng (VAS 0/10) 'me o ne a khutletse mesebetsing e bobebe ea setsebi. Sefuba sa serial le li-radiograph tsa mokokotlo li netefalitse 'zero micro-motion' liphapanong tsa screw-rod. Sebopeho sa XC Medico® se kopantsoeng ka sefapano se ile sa boloka sebopeho se phethahetseng, se nang le matšoao a pele a fusion e tiileng ea osseous e kopanyang likarolo tsa thoracolumbar.

Tlhahlobo ea Moruo: Mehato e le 'Ngoe ea Phetoho ea Mehato Khahlanong le Mehato e Bulehileng ea Litšenyehelo

Sehlopha sa	Phapang ea Mekhoa e Meholo ea Mehato (Lefa)	Single-Stage XC Medico® System (ea Sebele)	Phapang.
Li-implants tsa ho buoa (Lisebelisoa tsa pele / tsa Thoracic)	$9,800 (likou tsa thoracoscopic, lijo tsa nakoana)	$0	$9,800
Lisebelisoa tsa ho buoa (Posterior Spinal Frame)	$8,400 (Lithupa le likurufu tse tloaelehileng)	$6,100 (XC Medico Premium Screw & Cross-links)	$2,300
Nako ea ho sebetsa (Litšenyehelo tsa setsi: $250/min)	$8,000 (metsotso e 320 ka matsatsi a fapaneng)	$3,875 (ho khutlisa metsotso e 155 ka mohato o le mong)	$4,125
Ngaka e buoang, Setsebi sa Thoracic & Litefiso tsa Anesthesia	$8,500 (litefiso tsa mekhahlelo e mengata)	$4,800 (polao e le 'ngoe e kopantsoeng ka morao)	$3,700
Bolulo ba sepetlele ICU/Ward (Litšenyehelo tsa ho robala: $450 ka letsatsi)	$3,150 (karolelano ea matsatsi a 7 ea ho hlaphoheloa bakeng sa ho kenngoa ha thoracic)	$900 (matsatsi a 2 netefatso ea ho lokolloa ha pele)	$2,250
Lits'oants'o tsa Postoperative & Litlhahlobo tsa Pulmonary	$2,400	$2,175	$225
PELETE TLHOKOMELO	$40,250	$17,860	$22,390 (phokotso ea 55%)

Bakeng sa setsi sa ts'oaetso ea lesapo la mokokotlo le setsi sa kaho se laolang mefokolo e rarahaneng ea lefa, ho amohela litsamaiso tse notlelang tse phahameng tsa XC Medico ho fana ka poloko ea setheo ea $22,390 USD ka nyeoe ha e ntse e ntlafatsa phallo ea ts'ebetso le ho fokotsa mekoloto ea bobeli ea tšohanyetso.

Lipotso le Likarabo tsa Tekheniki bakeng sa Lihlopha tsa Kaho-bocha tse Felletseng

P: Ke joang likhoele tsa 'negative-angle buttress' li thibelang 'set screw back-out' ha li bapisoa le likhoele tse tloaelehileng tse bataletseng?

A: Likhoele tse tloaelehileng tse bataletseng kapa V li sebelisa matla a kantle a radial khahlano le mabota a ka hare a 'tulip' ha a tiisitsoe torque ea ho qetela. Tlas'a khatello e phahameng ea cyclic mechanical, matla ana a radial a etsa hore mabota a tulip a hole hanyenyane kapa 'splay.' Hang ha splay e etsahala, khoele e lohellanang ea theoha, e lumellang sekoti sa setoutu ho khutlela morao. XC Medico's negative-angle buttress khoele e na le jiometry e eang tlase le e ka hare ea moepa. Ha torque e sebelisoa, matla a khoele a hula marako a tulip ka hare, a notlella sekoti ka thata khahlanong le molamu le ho felisa ka ho feletseng ho hlōleha ha mohaho o entsoeng ka splay.

P: Ke hobane'ng ha tsamaiso ea li-cross-link e tlameha ho lokisoa ka morao ho karolo e telele ho thibela ho thella ha molamu?

K: Lithupa tse bapileng tse ikemetseng li its'etleha feela holim'a likhohlano tsa lehae tsa likurufu tsa pedicle ka bomong. Haeba mokuli a e-na le boleng ba masapo a osteopenic, ho potoloha ha kutu e ipheta-phetang ho ka etsa hore lihlooho tsa screw li fetolehe, ho theola khohlano ea sebaka seo ha nako e ntse e ea. Ho kopanya li-cross-connectors tse feto-fetohang ho kopanya lithupa tse ka ho le letšehali le tse ka ho le letona hore e be foreimi e thata ea lebokose la quadrangular. Khokahano ena e nang le lipolanete tse ngata e fetisa likhatello tsa ho kuta mohahong oohle, e leng se etsang hore molamu o ikemetseng oa longitudinal o thellehe ka mokhoa o sa khoneheng le haeba 'screw junction' e le 'ngoe e apareloa ke micro-fretting.

Tlhahiso ea Boleng ba Morekisi: Ho laola Liphothefolio tsa Tente ea Lehae

• The Commercial Edge: Ho hlahisa lihlopha tsa thepa ea sepetlele ka tharollo ea boenjiniere e fokotsang kotsi ea ntlafatso le ho theola kakaretso ea litšenyehelo tsa linyeoe tse fapaneng ka 55% ho theha boleng bo ke keng ba lekanngoa ba khoebo nakong ea litlhahlobo tse bonolo.
• Boitšepo ba Kliniki: Ho fana ka lingaka tsa mokokotlo tse nang le setifikeiti (ISO 13485) TC4 Titanium hardware e nang le mamello ea machining ea sub-micron e netefatsa ts'epo ea ho notlela torque e phahameng, e sireletsang botumo ba bona ba setsi ho tsoa mefokolong ea morao-rao ea kaho.