Dyondzo ya Xiyimo xa Tliliniki: Ku Lawula ku rhurhela lokukulu ka Cephalad ka Spinal Fusion Rod eka The Thoracic Cavity hi ku tirhisa Zero-Tolerance Fixation

Xibedlhele: Xibedlhele Universitario San Ignacio, Bogotá, Colombia
Dokodela wa vuhandzuri: Dokodela Mateo Restrepo, Ndzawulo ya ku Akiwa Hi vuntshwa ka Nkolo lowu rharhanganeke
Siku: Khotavuxika 2025
Xiyenge xa Mhaka: Ku Rhurha ka Hardware ya Khombo / Ku Pfuxetiwa Switirhisiwa swa Nkolo wa le Ndzhaku
Mbuyelo wa nkoka: Ku humesiwa ka le ndzhaku ka xiteji xin’we ka nhonga ya legary leyi rhurheriweke ku suka eka ndzilakano wa pleural, ku landzeriwa hi ku tiyisisiwa loku heleleke ka xivumbeko hi ku tirhisa XC Medico® Sisiteme ya Xiyimo xa le Henhla ya Polyaxial. Nkarhi hinkwawo wa vuhandzuri: 155 wa timinete. Muvabyi u hlengeletiwile hi ku hlayiseka hi siku ra vumbirhi ra le ndzhaku ka vuhandzuri.

Nkomiso wa Mhaka

Nhlayo ya Vavabyi na Matimu ya Tliliniki

• Muvabyi: Carlos Mendoza (a nga tiviwi vito)
• Malembe: 52 wa malembe hi vukhale
• Rimbewu: Wa xinuna
• Ku kumiwa ko sungula: Vuvabyi byo tika bya thoracolumbar scoliosis bya vantshwa
• Matimu ya vuhandzuri: Ku lulamisiwa ka ku onhaka ka nkolo endzhaku na fusion spanning T11-L3 swi endliwile 15 wa malembe emahlweni hi ku tirhisa legacy non-locking pedicle screw system.
• Khoso ya le ndzhaku ka vuhandzuri: A yi na swikombiso na ku lulamisiwa loku heleleke ka xivumbeko na ku hlanganisiwa loku heleleke ka vutomi ku tlula khume ra malembe.
• Comorbidities: Nsusumeto wa le henhla wa ngati wo olova (lowu lawuriwaka), mubyari la gingiritekaka, bone mineral density leyi kombisaka osteopenia yosungula (T-score -1.8).

Ku nyikela Swivilelo na Nkarhi wa Tliliniki

Xivilelo lexikulu: Ku sungula hakatsongo-tsongo ka ku vava ka xifuva loku nga tolovelekangiki, loku tlhavaka ka tlhelo ra ximatsi loku hangalakaka ku ya eka scapula, loku nyanyisiweke hi ku huhuteriwa loku dzikeke, loku fambisanaka ni ku tsandzeka ku hefemula loku nga nyawuriki ka ku tikarhata eka nkarhi wa mavhiki ya 3. Ku hava ku vava ka le ndzhaku ka le ndzhaku ka ndhawu kumbe ku pfumaleka ka misiha ya le hansi loku vikiweke.

Nkarhi wa nkarhi:

• Siku ro sungula (Ku amukeriwa): Muvabyi u nyikeriwile eka ndzawulo ya xilamulela-mhangu hi ku chava xiendlakalo xa xihatla xa misiha ya mbilu kumbe ya mahahu. Electrocardiogram ni ti- enzyme ta mbilu a swi tolovelekile.
• Ku kanakana: Xiphiqo xa hardware lexi sungulaka endzhaku ka nkarhi kumbe paravertebral mass.
• Nchumu wa nkoka eka swifaniso: STAT radiograph ya xifuva na CT ya thoracic ya xiyimo xa le henhla leyi landzelaka leyi odaweke ku nga si hela tiawara ta 3.

Swikumiwa swa Swifaniso na Vupulani bya Vuhandzuri

Swikumiwa swa Radiographic & CT (Swifaniso 1 & 2):

• Xiyimo xa ku aka: Ku tsandzeka loku heleleke ka michini eka xihlanganisi xa ximatsi xa T11-L3 rod-screw. Swikwirikiri swa left flat set a swi tlhelele endzhaku hi ku helela, leswi endleke leswaku ku hambanisiwa ka construct hi ku helela.
• Ku hundziseriwa ka hardware: Nsinya wa ximatsi wa 5.5mm longitudinal stabilization rod a wu hambanile hi ku helela eka ti pedicle screw saddles. Leswi a yi susumetiwa hi malembe ya ku olovisiwa ka nkolo loku yaka emahlweni ni ku rhendzeleka ka nkolo, nhonga leyi nga siveleriwangiki yi rhurhele ehenhla (cephalad) hi tisentimitara to hlayanyana.
• Ku pfumelelana ka anatomical: Nhloko ya le henhla ya nhonga leyi rhurheleke yi tshove ti paravertebral fascial planes, yi tsemakanya mindzilakano ya costovertebral, naswona yi nghena swinene eka left thoracic cavity, yi wisa ekusuhi hi xihatla na pleura na ti major vascular thoracic tracks.

Nkanelo wa Vuhandzuri: Xiboho xa Vutshunguri

Xihatla xa tliliniki: Ku siya nhonga ya titanium leyi nga siveleriwangiki endzeni ka nsimu ya xifuva leyi cinca-cincaka swi tisa nxungeto wa xihatla wa ku tshoveka ka aortic, ku pfuleka ka misiha ya intercostal, kumbe tension pneumothorax hi nkarhi wa ku famba-famba ka xitshuketa. Ku humesiwa ka vuhandzuri hi xihatla ni ku pfuxetiwa ka xivumbeko a swi boha.

Nhlawulo wo Sungula: Ku Humesiwa ka Thoracoscopic (VATS) leyi Pfunetiwaka hi Vhidiyo ya Minimalist Ntsena

Swiphiqo: Ku susa nhonga hi ku tirhisa ndlela ya thoracic swi lulamisa khombo ra xihatla ra visceral kambe swi siya muvabyi a ri na xivumbeko lexi nga tshamisekangiki, lexi tshovekeke xa thoracolumbar. Handle ka ku pfuxetiwa ka le ndzhaku, swikwirikiri swa pedicle leswi saleke a swi ta va na ku hlangana lokukulu ka ntshikilelo, leswi yisaka eka ku hatlisa ku ntshunxeka ka aseptic, ku vava lokukulu ka nkolo, na ku kula ka secondary deformity.

Nhlawulo wa 2: Ku Pfuxetiwa loku Hlanganisiweke ka Thoraco-Abdominal na Posterior Open

Swiphiqo: Ku endla swiphemu swimbirhi swo hambana (anterior thoracotomy for rod retrieval na posterior open approach for spine stabilization) eka masiku yotala swi engetela nkarhi hinkwawo wa vuhandzuri kuya eka 320+ wa timinete. Xivumbeko lexi xa maendlelo mambirhi xi tlakusa swinene ku lahlekeriwa hi ngati, swiphiqo swa mahahu, na nkarhi wa mubedo wa le xibedlhele ku ya eka 6-8 wa masiku ya le hansi.

Nhlawulo wa 3: Ku Vuyisa endzhaku ka Xiteji xin’we + Ku Tiyisisiwa ka Cross-Link (Ku Hlawuriwile) .

Endlelo ra xithekiniki: Ku pfula nakambe ku tsemiwa ka khale ka layini ya le xikarhi ka le ndzhaku swi pfumelele ku nghena hi ku kongoma eka mubedo wa hardware lowu saleke. Hi ku tirhisa ti forceps to hlawuleka to vuyisa, dokodela wa vuhandzuri u landzele xiphepherhele xa nhonga hi ku tlhelela endzhaku ku suka eka tlhelo ra le ndzhaku, a xi rhetela hi vukheta a huma eka xifuva ehansi ka nkongomiso lowu tiyeke wa fluoroscopic. Leswi swi papalate ku endliwa ka thoracotomy ya le mahlweni leyi tiyimeleke.

Loko se yi humesiwile, sisiteme ya ndzhaka leyi nga tshamisekangiki yi siviwe hi XC Medico® Premium Polyaxial Pedicle Screw System . Ku herisa xivangelo xa rimitsu xa ku tsandzeka ko sungula, xivumbeko lexintshwa xi hlanganisile swikwirikiri swa set ya buttress ya negative-angle ku sivela ku hangalaka ka thyaka, leswi hlanganisiweke na swihlanganisi swo tsemakanya leswi cinca-cincaka leswi tiyeke ku vumba furemu ya mune leyi nga rhurhekiki.

Ku hlawuriwa ka swikumiwa: XC Medico’s Premium Spinal Fixation System — ku hlanganisa swikwirikiri swa polyaxial pedicle swa torque yale henhla na swikwirikiri swa negative-angle set na swihlanganisi swo tsemakanya leswi lulamisiwaka leswi tiyeke.

Ku Dlayiwa Hi Vuhandzuri: Vuxokoxoko bya Vuhandzuri

Ku Vekiwa ka Xiyimo na ku Paluxeka

• Ku vekiwa ka muvabyi: Ku yima hi ku olova eka furemu ya Relton-Hall leyi tolovelekeke, ku antswisa ku hunguta ntshikelelo wa khwiri ku hunguta ntshikelelo wa misiha.
• Ku paluxiwa: Xivati ​​xa le ndzhaku xa le xikarhi xa le ndzhaku xi tsemiwile. Subperiosteal dissection yi endliwile hi vukheta ku paluxa ti legacy pedicle screws kusuka eka T11 kuya eka L3. Ku paluxiwa ka nsimu ya vuhandzuri ku fikeleriwa hi timinete ta 25.

Xiyenge xa ​​ku Vuyisa Hardware na ku Pfuxetiwa ka Thoracic

• Ku lavisisa: Ti tulips ta left pedicle screw tikumeke ti pfulekile laha ti set screws tinga ri kona hiku hetiseka. Makumu ya caudal ya nhonga leyi rhurheleke ya tiveka ya huma nyana kusuka eka mubedo wa misiha ya paravertebral ekusuhi na T11.
• Ku humesiwa: Ehansi ka ku vekiwa tihlo loku yaka emahlweni ka lateral fluoroscopic, ti clamping forceps to hlawuleka leti tirhaka hi matimba ati khomanisiwile eka ncila lowu vonakaka wa nhonga. Hi ku tirhisa endlelo leri lawuriwaka, leri tiyeke ra axial traction, nhonga leyi yi kokeriwe endzhaku hi ndlela yo tlhelela endzhaku hi ku famba hi xiphepherhele xa yona xo rhurha.
• Clearance check: Nhonga yi humesiwile hiku olova handle ko hlangana na ku lwisana. Ku kamberiwa ka xihatla ka fluoroscopy na ku andzisiwa ka mahahu swi tiyisisile leswaku ndzilakano wa pleural wu tshamile wu nga onhakanga ku nga ri na acute pneumothorax. Nkarhi wa xiyenge: 40 wa timinete.

Ku Pfuxeta Ku Tiyisisiwa & Xiyenge xa ​​Nhlengeletano ya Fureme yo tiya

• Ku cincana ka swikwirikiri: Swikwirikiri swa ndzhaka leswi ntshunxekeke swi humesiwile. Ti pedicle tracts ti reamed no ndlandlamuxiwa leswaku tita amukela XC Medico® 6.0mm Premium Polyaxial Pedicle Screws, ku tiyisisa ku xava ka marhambu ya xiyimo xale henhla eka mibedo ya osteopenic.
• Ku pfala ka tinhonga: Tinhonga tintshwa ta 5.5mm letinga pre-contoured titanium alloy titshame. Xa nkoka swinene, swikwirikiri swa XC Medico swa reverse negative-angle set swi torqued kuya eka 8 Nm hiku tirhisa ti calibrated drivers. Thread profile yi koke marhangu ya tulip hiku gingiriteka endzeni, leswinga herisa khombo ra splay.
• Ku hlanganisiwa ka cross-link: Swihlanganisi swimbirhi swo tiya leswi lulamisiwaka swi vekiwile ku tsemakanya tinhonga ta ximatsi na ta xinene eka swiyimo swa T12 na L2. Leswi swi hundzule tinhonga timbirhi leti tiyimeleke ti va furemu yin’we, leyi tiyeke swinene ya xivumbeko, leswi endleke leswaku ku rhetela ka tinhonga to leha swi nga koteki hi tlhelo ra nyama. Nkarhi wa xiyenge: 70 wa timinete.

Ku Pfuxetiwa ko Hetelela na ku Pfala

Fluoroscopy yo hetelela ya biplanar yi tiyisisile vuenti bya screw lebyinene, ku vekiwa ka nhonga leyi ringanaka hi ku helela, na ku lulamisiwa nakambe ka anatomical. Ndzhawu leyi ayi cheletiwa kahle, ku vekiwile submuscular drain, naswona multi-layered fascial closure yihetisiwile. Nkarhi hinkwawo wa vuhandzuri: 155 wa timinete. Ku lahlekeriwa hi ngati loku ringanyetiweke: 210 mL. Mimpompelo ya ngati: Zero.

Khoso ya le ndzhaku ka vuhandzuri na Mimbuyelo

Endzhaku ka Vuhandzuri bya Xihatla (POD 0-1) .

Muvabyi u pfukile hi ku hatlisa ku lulamisiwa ka ku vava lokukulu ka xifuva (VAS yi hungutekile ku suka eka 8/10 pre-op ku ya eka 2/10 post-op). Mimpfumawulo ya ku hefemula leyi tolovelekeke yi tiyisisiwile hi matlhelo mambirhi, leswi nga sivela ku pneumothorax ya le ndzhaku. Ti radiographs ta post-op ti kombisile pristine hardware alignment. Hi madyambu ya POD 1, muvabyi a a tshame kahle etlhelo ka mubedo a ri ni vutshembeki lebyi heleleke bya misiha ya swirho swa le hansi.

Ku Hlela Ku Humesiwa (POD 2 — 48 Wa Tiawara) .

Eka tiawara ta 48 endzhaku ka vuhandzuri, submuscular drain yi susiwile (vuhumelerisi byintsongo). Muvabyi u fikelele swipimelo hinkwaswo swo huma exivandleni: ku famba-famba loku tiyimeleke hi ku famba loku tolovelekeke, ku dya kahle hi nomu, na ku vava loku lawuriwaka hi ku tirhisa switlhavi swa nomu. Ku humesiwa ka ha ri na nkarhi hi tiawara ta 48 swi hungute khombo ra mavabyi lama kumiweke exibedlhele na ku hunguta ndzhwalo wa mibedo ya nhlangano.

Ku Landzelerisa (6-Week & 3-Month) .

Eka mfungho wa tinhweti ta 3, Carlos a nga ri na switlhavi hi ku helela (VAS 0/10) naswona a a tlhelele eka mintirho yo olova ya xiphurofexinali. Ti radiographs ta serial ta xifuva na nkolo ti tiyisisile zero micro-motion eka mahlanganiselo ya screw-rod. Fureme ya XC Medico® leyi hlanganisiweke hi xihambano yi hlayise ku khoma ka xivumbeko loku hetisekeke, na swikombiso swosungula swa solid osseous fusion leswi tiyeke ku tsemakanya swiphemu swa thoracolumbar.

Nxopaxopo wa Ikhonomi: Rimba ra Mpfuxeto wa Xiyimo xin’we vs Ku Nghenelela loku Pfulekeke loku nga na Switeji Xiyenge

xa	​​Ntsengo Mpfuxeto wa Maendlelo yo Tala ya Xiteji (Ndzhaka)	Sisiteme ya Xiyimo xin’we xa XC Medico® (Xiviri).	Ku hambana ka
Swilo leswi nghenisiwaka hi vuhandzuri (Switirhisiwa swa Anterior/Thoracic) .	$9,800 (Swiporo swa thoracoscopic, swakudya swa nkarhinyana)	$0	-R1 000.00
Swilo leswi nghenisiwaka hi vuhandzuri (Posterior Spinal Frame) .	$8,400 (Standard parallel tinhonga & swikwirikiri)	$6,100 (Swikurufu swa XC Medico Premium & Swihlanganisi swo tsemakanya)	-R1 000
Nkarhi wo tirha (Ntsengo wa xitirhisiwa: $250/min)	$8,000 (320 wa timinete eka masiku yo hambana)	$3,875 (155 wa timinete ta ku vuyisa hi xiteji xin’we)	-R1 000.00
Dokodela wa Vuhandzuri, Mutivi wa Xifuva & Tihakelo ta Anesthesia	$8,500 (Tihakelo ta switeji swa swiyenge swo hambana) .	$4,800 (Ku dlayiwa ka le ndzhaku loku hlanganisiweke ka xiyenge xin’we)	-R1 000.00
Ku tshama exibedlhele eka ICU/Ward (Ntsengo wa mubedo: $450/siku)	$3,150 (7 wa masiku ya ku hola hi xiringaniso eka ku nghena loku pfulekeke ka thoracic)	$900 (ku tiyisisiwa ka masiku ya 2 ku humesiwa ka ha ri na nkarhi)	-R1 000.00
Ku teka swifaniso endzhaku ka vuhandzuri & Ku kamberiwa ka mahahu	R1 000	R1 000.00	-$225
NTSENGO HINKWAWO WO KONGOMA	$40,250	$17,860	-$22,390 (ku hungutiwa ka 55%)

Eka senthara ya ku vaviseka ka nkolo na ku pfuxetiwa ka nhlangano leyi lawulaka ku tsandzeka ka ndzhaka loku rharhanganeke, ku amukela tisisiteme to pfala ta torque ya le henhla, ya angle yo biha ya XC Medico swi humesa ku hlayisiwa ka nhlangano ka $22,390 USD hi mhaka loko ku ri karhi ku antswisiwa ku cinca ka ntirho na ku hunguta swikweleti swa xihatla swa vumbirhi.

Q&A ya Xithekiniki eka Swipano swo Aka Hi vuntshwa leswi rharhanganeke

Q: Xana ti thread ta negative-angle buttress ti sivela njhani set screw back-out loko ti pimanisiwa na ti standard flat threads?

A: Standard flat kumbe V-threads yi tirhisa matimba ya radial yale handle eka marhangu yale ndzeni ya nhloko ya screw (tulip) loko yi tiyisiwile kuya eka torque yohetelela. Ehansi ka ntshikelelo wa le henhla wa michini ya xirhendzevutani, matimba lawa ya radial ya endla leswaku marhangu ya tulip ya andlala nyana kutani 'splay.' Loko ku hangalaka ku humelela, ku hlanganisiwa ka thyaka ku hunguteka, leswi pfumelelaka xikurufu lexi vekiweke ku tlhelela endzhaku. XC Medico’s negative-angle buttress thread yi na geometry ya xirhendzevutani xa le hansi na le ndzeni. Loko ku tirhisiwa torque, matimba ya thread entiyisweni ya koka marhangu ya tulip kuya endzeni, ya khiya set screw swinene eka rod naswona ya herisa hiku hetiseka ku tsandzeka ka splay-driven construct.

Q: Ha yini sisiteme ya cross-link yi boha eka ku lulamisiwa ka le ndzhaku ka xiphemu xo leha ku sivela ku rhetela ka nhonga?

A: Ti parallel rods leti tiyimeleke ti titshege ntsena hi local friction grip ya ti pedicle screws ha yin’we yin’we. Loko muvabyi a ri na khwalithi ya marhambu ya osteopenic, ku rhendzeleka ka nsinya hi ku phindha-phindha ku nga endla leswaku tinhloko ta swikwirikiri swi cinca-cinca hi microscopic, leswi onhaka ku khoma koloko ka ku hlangana ka ndhawu hi ku famba ka nkarhi. Ku hlanganisa swihlanganisi swa xihambano leswi lulamisiwaka swi hlanganisa tinhonga ta ximatsi na ta xinene eka furemu ya bokisi ra mune leri tiyeke. Ku hlanganisiwa loku ka ti multi-planar ku hundzisela ntshikelelo wa shear eka xivumbeko hinkwaxo, leswi endlaka leswaku ku rhetela ka longitudinal rod leyi tiyimeleke hi ndlela ya michini swinga koteki hambi loko nhlangano wun’we wa screw wukuma micro-fretting wear.

Xiringanyeto xa Nkoka wa Vaxavisi: Ku Lawula Tiphotifoliyo ta Tithendara ta Ndhawu

• The Commercial Edge: Ku nyika swipano swa ku xava swibedlhele xitshunxo xa vunjhiniyara lexi hungutaka khombo ro pfuxeta na ku hunguta ntsengo hinkwawo wa tihakelo ta milandzu ya swiyenge swo hambana hi 55% swi simeka nkoka wa mabindzu lowu nga ringanisiwiki na nchumu hi nkarhi wa ku kamberiwa ka tithendara.
• Ku Titshemba ka Tliliniki: Ku nyika madokodela ya vuhandzuri bya nkolo hi hardware ya TC4 Titanium leyi tiyisisiweke (ISO 13485) leyi kombisaka ku tiyisela ka michini ya sub-micron swi tiyisisa ku tshembheka ka ku pfala ka torque ya le henhla, ku sirhelela ndhuma ya vona ya nhlangano eka ku tsandzeka ka ku aka ka xiteji xa le ndzhaku.