Ucwaningo Lwecala Lomtholampilo: Ukulawula Ukufuduka Kwe-Cephalad Okubi Kwe-Spinal Fusion Rod ku-Thoracic Cavity Nge-Zero-Tolerance Fixation

Isibhedlela: Isibhedlela Universitario San Ignacio, Bogotá, Colombia
Udokotela Ohlinzayo: UDkt. Mateo Restrepo, Umnyango Wokwakhiwa Kabusha Komgogodla
Usuku: Okthoba 2025
Isigaba Secala: I-Catastrophic Hardware Migration / Revision Posterior Spinal Instrumentation
Umphumela Obalulekile: Isiteji esisodwa esikhishwe umngcele ongemuva ophuma emngceleni ophelele we-plega ukuqiniswa kwesakhiwo kusetshenziswa i-XC Medico® Premium Polyaxial System. Isikhathi sokusebenza esiphelele: imizuzu eyi-155. Isiguli sihlanganiswe ngokuphepha ngosuku lwesi-2 lwangemva kokuhlinzwa.

Isethulo Secala

Izibalo Zesiguli kanye Nomlando Womtholampilo

• Isiguli: UCarlos Mendoza (ongaziwa)
• Ubudala: Iminyaka engama-52
• Ubulili: Owesilisa
• Ukuxilongwa okuyinhloko: I-thoracolumbar scoliosis yentsha enzima
• Umlando wokuhlinza: Ukulungiswa kokukhubazeka komgogodla wangemuva kanye nokuhlanganisa okuhlanganisa i-T11-L3 kwabulawa iminyaka engu-15 ngaphambi kokusebenzisa isistimu yesikulufu esingakhiyi ifa.
• Isifundo sangemva kokuhlinzwa: I-Asymptomatic enokulungiswa okugcwele kwesakhiwo kanye nokuhlanganiswa okuphelele kwendlela yokuphila iminyaka engaphezu kweshumi.
• I-Comorbidities: Umfutho wegazi ophansi (olawulwayo), obhemayo osebenzayo, ukuminyana kwamaminerali amathambo okubonisa i-osteopenia yokuqala (i-T-score -1.8).

Sethula Umugqa Wesikhathi Wezikhalazo kanye Nomtholampilo

Isikhalazo esiyinhloko: Ukuqala kancane kancane kwe-atypical, ubuhlungu besifuba esibukhali ohlangothini lwesobunxele obuphuma ku-scapula, bubhebhezelwa ukuphefumulelwa okujulile, okuhambisana ne-dyspnea encane yokuzikhandla esikhathini esingamaviki angu-3. Abukho ubuhlungu be-lumbar emuva bendawo noma ukulahlekelwa kwe-neurological ephansi kwabikwa.

Umugqa wesikhathi:

• Usuku 1 (Ukungena): Isiguli sethulwe emnyangweni wezimo eziphuthumayo sisaba isenzakalo esiyingozi senhliziyo noma sephaphu. I-Electrocardiogram kanye nama-enzyme enhliziyo ayejwayelekile.
• Ukusola: Inkinga ye-hardware eqala kamuva noma i-paravertebral mass.
• Ukubaluleka kokucabanga: i-STAT i-radiograph yesifuba kanye ne-thoracic CT scan enesinqumo esiphezulu eyalandela phakathi namahora angu-3.

Ukutholwa Kwezithombe NokuHlelwa Kokuhlinzwa

Okutholakele nge-Radiographic & CT (Izibalo 1 & 2):

• Isimo sokwakha: Qedela ukwehluleka kokusebenza esibonakalayo esingakwesokunxele se-T11-L3 rod-screw. Izikulufu zesethi eyisicaba yesokunxele zazihlehle ngokuphelele, okuholele ekuhlakazweni kokwakhiwa okuphelele.
• Ukudluliselwa kwezingxenyekazi zekhompuyutha: Induku yesokunxele engu-5.5mm yokuzinzisa ubude ikhishwe ngokuphelele kumasadlali wesikulufu se-pedicle. Iqhutshwa iminyaka yokuguquguquka okuqhubekayo komgogodla kanye nemijikelezo ejikelezayo, induku engavinjelwe yahamba phezulu (i-cephalad) ngamasentimitha amaningana.
• I-anatomical compromise: Ithiphu ephakeme yenduku efudukayo yephule izindiza ze-paravertebral fascial, yawela imingcele ye-costovertebral, futhi yangena ngokujulile emgodini we-thoracic wesobunxele, iphumula eduze kwe-pleura kanye namathrekhi amakhulu we-vascular thoracic.

Ingxoxo Yokuhlinza: Isinqumo Sokwelashwa

Ukuphuthuma komtholampilo: Ukushiya induku ye-titanium engavinjelwe ngaphakathi kwenkambu yethoracic eguquguqukayo kubangela usongo olusheshayo lwe-aorta laceration, i-intercostal vessel perforation, noma i-tension pneumothorax phakathi nokunyakaza okungazelelwe. Ukuhlinza okuphuthumayo nokubuyekezwa kokwakhiwa bekuyimpoqo.

Inketho 1: I-Minimalist Video-Assisted Thoracoscopic (VATS) Ukukhishwa Kuphela

Ukungalungi: Ukukhipha induku ngokusebenzisa indlela ye-thoracic kubhekana nengozi ye-visceral esheshayo kodwa kushiya isiguli ngesakhiwo se-thoracolumbar esingazinzile, esiphukile. Ngaphandle kokubuyekezwa kwangemuva, izikulufu ezisele ze-pedicle zingabhekana nokugxiliswa kwengcindezi enkulu, okuholela ekuxegisweni kwe-aseptic ngokushesha, ubuhlungu obukhulu beqolo, nokuqhubekela phambili kokukhubazeka.

Inketho yesi-2: Ukubuyekezwa Okuvuliwe Kwe-Thoraco-Abdominal kanye Ne-Postererior Open

Ukungalungi: Ukwenza ama-incision amabili ahlukene (i-thoracotomy yangaphambili yokubuyisela induku kanye nendlela evulekile yangemuva yokuqiniswa komgogodla) phakathi kwezinsuku eziningi kwandisa isikhathi sokusebenza esiphelele kumaminithi angu-320+. Lokhu kwakheka okumbaxambili kuphakamisa ngokumangazayo ukulahleka kwegazi, izinkinga zamaphaphu, nobude besikhathi sokulala esibhedlela ukuze bube buncane bezinsuku eziyi-6-8.

Inketho yesi-3: Ukubuyiswa kwe-Postererior Retrograde Retrograde + Ukuqiniswa Kwe-Cross-Link Fixation (Kukhethiwe)

Indlela yobuchwepheshe: Ukuvula kabusha i-posterior midline incision yangaphambilini kuvumele ukufinyelela okuqondile kumbhede wehadiwe osele. Esebenzisa ama-forcep akhethekile okubuyisela, udokotela ohlinzayo walandela ipheshana lenduku ngokuhlehlisa ukusuka ohlangothini olungemuva, elikhipha ngokucophelela emgodleni wethoracic ngaphansi kokuqondisa okuqinile kwe-fluoroscopic. Lokhu kwagwema i-thoracotomy yangaphambili ezimele.

Uma isikhishiwe, isistimu yefa engazinzile yathathelwa indawo I -XC Medico® Premium Polyaxial Pedicle Screw System . Ukuze kuqedwe umsuka wokwehluleka kwasekuqaleni, izikulufu ezintsha ezididiyelwe ezihlanganisiwe ze-engeli eyi-negative buttress ukuze kuvinjelwe ukusabalala kochungechunge, kuhlanganiswe nezixhumi eziqinile ezilungisekayo ezilungisekayo ukuze kwakhe uhlaka olunganyakazi lwe-quadrangular.

Ukukhethwa komkhiqizo: I-XC Medico's Premium Spinal Fixation System — ehlanganisa izikulufu ze-polyaxial pedicle ezinetorque ephezulu nezikulufi ezine-engeli eyi-negative kanye nezixhumanisi eziguquguqukayo eziqinile.

Ukubulawa Kokuhlinzwa: Imininingwane Yokusebenza

Ukuma kanye Nokuvezwa

• Ukuma kwesiguli: Indawo ethambekele kuhlaka olujwayelekile lwe-Relton-Hall, okuthuthukisa ukuwohloka kwesisu ukuze kuncishiswe ingcindezi ye-venous.
• Ukuchayeka: Isibazi somugqa ophakathi nendawo sangaphambilini sisusiwe. I-Subperiosteal dissection yenziwe ngokucophelela ukuze kudalulwe izikulufu ze-pedicle zefa ukusuka ku-T11 kuya ku-L3. Ukuchayeka kwenkundla yokusebenza kufinyelelwe emizuzwini engama-25.

Ukubuyiswa kwezingxenyekazi zekhompuyutha kanye nesigaba sokususa ithoracic

• Ukuhlola: I-tulips yesikulufu se-pedicle kwesokunxele itholwe ivuliwe izikulufo ezimisiwe zingekho ngokuphelele. Ukuphela kwe-caudal yenduku efudukayo kukhonjwe ukuthi iphume kancane embhedeni we-paravertebral muscle eduze ne-T11.
• Isizinda: Ngaphansi kokuqapha okuqhubekayo kwe-lateral fluoroscopic, ama-forceps akhethekile aqinile axhunywe emsileni obonakalayo wenduku. Kusetshenziswa indlela elawulwayo, eqinile ye-axial traction, induku yadonselwa emuva emuva eduze kwepheshana layo lokufuduka.
• Ukuhlolwa kokusula: Induku ikhishwe kahle ngaphandle kokubhekana nokumelana. Ukuhlolwa kwe-fluoroscopy nokunwetshwa kwamaphaphu ngokushesha kuqinisekisile ukuthi umngcele we-pleural uhlala uphelele ngaphandle kwe-pneumothorax ebukhali. Ubude besigaba: imizuzu engama-40.

Ukulungiswa Kokubuyekeza & Isigaba Somhlangano Wozimele Oqinile

• I-Screw exchange: Izikulufu zefa ezixegisiwe zikhishiwe. Amapheshana e-pedicle ahlelwa kabusha futhi akhuliswa ukuze amukele i-XC Medico® 6.0mm Premium Polyaxial Pedicle Screws, okuqinisekisa ukuthengwa kwamathambo okuphakeme emibhedeni ye-osteopenic.
• Ukukhiya induku: Izinti ezintsha ze-titanium ezikhonjiswe ngaphambili eziyi-5.5mm bezihlezi. Okubi kakhulu ukuthi izikulufu ze-XC Medico zokuhlehla ze-engeli eyi-negative zafakwa ku-8 Nm kusetshenziswa ama-calibrated drivers. Iphrofayili yentambo yadweba izindonga ze-tulip ngaphakathi, yaqeda ingozi ye-splay.
• Ukuhlanganiswa kwe-Cross-link: Izixhumi ezimbili eziqinile eziguquguqukayo eziguquguqukayo zafakwa ezindongeni zesokunxele nesokudla kumazinga we-T12 kanye ne-L2. Lokhu kuguqule izinti ezimbili ezizimele zaba uhlaka lwesakhiwo olulodwa, oluqine kakhulu, okwenza induku eyi-longitudinal ishelela ingenzeki ngokomzimba. Ubude besigaba: imizuzu engama-70.

Ukuncishiswa Kokugcina Nokuvalwa

I-biplanar fluoroscopy yokugcina iqinisekise ukujula okuhle kwesikulufu, ukubekwa kwenduku yokulinganisa okuphelele, kanye nokuhlelwa kabusha kwe-anatomical. Indawo yaniselwa kahle, kwafakwa umsele we-submuscular, futhi kwaqedwa ukuvalwa kwe-fascial enezingqimba eziningi. Isikhathi sokusebenza esiphelele: imizuzu eyi-155. Ukulahleka kwegazi okulinganiselwe: 210 mL. Ukumpontshelwa: Zero.

Izifundo Nemiphumela Yangemva Kokuhlinzwa

I-Immediate Postoperative (POD 0-1)

Isiguli sivuke ngokulungiswa okusheshayo kobuhlungu besifuba obubukhali (i-VAS yehla ukusuka ku-8/10 pre-op kuya ku-2/10 post-op). Imisindo yokuphefumula evamile yaqinisekiswa ngokubili, okukhipha i-pneumothorax sekwephuzile. Ama-radiographs we-post-op abonise ukuqondana kwezingxenyekazi zekhompuyutha ezihlanzekile. Kusihlwa kwe-POD 1, isiguli sasihlezi ngokunethezeka eceleni kombhede sinobuqotho obugcwele bezinzwa ezingaphansi.

Ukuhlelwa Kokukhipha (POD 2 — Amahora angu-48)

Emahoreni angu-48 ngemva kokuphuma, i-submuscular drain yakhishwa (ukukhishwa okuncane). Isiguli sahlangabezana nazo zonke izinqubo zokukhishwa kwesikhungo: i-ambulation yokuzimela ene-gait evamile, ukuthathwa komlomo okuhle kakhulu, nobuhlungu okulawulwayo ngama-analgesics omlomo. Ukukhishwa ngaphambi kwesikhathi emahoreni angama-48 kunciphisa ingcuphe yezifo ezitholwa esibhedlela futhi kwanciphisa umthwalo wemibhede yesikhungo.

Ukulandelela (Amaviki angu-6 nezinyanga ezingu-3)

Kumaki wezinyanga ezi-3, uCarlos wayengenabuhlungu ngokuphelele (VAS 0/10) futhi wayesebuyele emisebenzini elula yobungcweti. Isifuba se-serial kanye nama-radiographs omgogodla aqinisekise ukunyakaza okuncane okuyiziro kuma-screw-rod junctions. Uhlaka oluxhunywe ngokuphambano lwe-XC Medico® lugcine ukubamba kwesakhiwo okuphelele, nezimpawu zakuqala zokuhlangana kwe-osseous okuqinile okuhlanganisa kuwo wonke amasegimenti ethoracolumbar.

Ukuhlaziywa Komnotho: Uhlaka Olulodwa Lokubukeza Uhlaka oluqhathaniswa Nokungenelela Okuvuliwe Okuhleliwe

Kwezindleko Isigaba	Esimisiwe Sokubuyekezwa Kwezindlela Eziningi (Ifa)	Isigaba Esisodwa se-XC Medico® System (Okwangempela)	Umehluko
Izimila zokuhlinzwa (Amathuluzi angaphambili/ethoracic)	$9,800 (amachweba aseThoracoscopic, okuyisisekelo kwesikhashana)	$0	$9,800
Izimila zokuhlinzwa (Posterior Spinal Frame)	$8,400 (Izinduku ezihambisanayo ezijwayelekile nezikulufu)	$6,100 (Izikulufu ze-XC Medico Premium & Cross-link)	$2,300
Isikhathi sokusebenza (Izindleko zesikhungo: $250/min)	$8,000 (320 imizuzu phakathi nezinsuku ezihlukene)	$3,875 (imizuzu engu-155 ukubuyisa kwesiteji esisodwa)	$4,125
Izimali zikadokotela ohlinzayo, uchwepheshe weThoracic & Anesthesia	$8,500 (Izimali ezifakwe ezigabeni eziningi)	$4,800 (Ukubulawa kwangemuva kweseshini eyodwa)	$3,700
Isibhedlela ICU/Ukuhlala ewodini (Izindleko zombhede: $450/ngosuku)	$3,150 (izinsuku ezingu-7 zokutakula okumaphakathi kokufakiwe okuvuliwe kwe-thoracic)	$900 (izinsuku ezi-2 zokuqinisekisa ukukhishwa ngaphambi kwesikhathi)	$2,250
Ukuthwebula izithombe kwangemva kokuhlinzwa nokuhlolwa kwamaphaphu	$2,400	$2,175	$225
IZIMALI EZIYONKE EZINGQONDI	$40,250	$17,860	$22,390 (55% ukwehliswa)

Okwesikhungo sokuhlukumezeka komgogodla kanye nesikhungo sokwakha kabusha esilawula ukwehluleka kwefa okuyinkimbinkimbi, ukwamukela itorque ephezulu ye-XC Medico, amasistimu wokukhiya ama-engeli angemuhle kuletha ukonga kwesikhungo okungu- $22,390 USD esimweni ngasinye kuyilapho kuthuthukiswa inzuzo yokusebenza kanye nokunciphisa izikweletu zesibili eziphuthumayo.

I-Q&A Yezobuchwepheshe Yamaqembu Okwakha Kabusha Ayinkimbinkimbi

Q: Ingabe imicu ye-engeli ephikisayo ye-buttress ivimbela kanjani i-set screw back-out uma iqhathaniswa nemicu eyisicaba evamile?

IMP: Isicaba esijwayelekile noma imicu engu-V isebenzisa amandla eradial angaphandle ngokumelene nezindonga zangaphakathi zekhanda lesikulufa (i-tulip) lapho liqiniswa ku-torque yokugcina. Ngaphansi kwengcindezi ephezulu yomjikelezo, lamandla eradial abangela ukuthi izindonga ze-tulip zikhule kancane noma 'splay.' Uma i-splay seyenzekile, intambo engenelanayo iyehla, okuvumela isikulufu esisethiwe ukuthi sihlehle. Intambo yesinqe esinegethivu ye-XC Medico ifaka ijometri eyehlelayo eya phansi nangaphakathi. Lapho i-torque isetshenziswa, amandla entambo empeleni adonsela izindonga ze-tulip ngaphakathi, akhiye isikulufu esisethiwe ngokuqinile ngokumelene nenduku futhi aqede ngokuphelele ukwehluleka kokwakha okuqhutshwa yi-splay.

Q: Kungani isistimu ye-cross-link iphoqelekile ekulungiseni okungemuva kwengxenye ende ukuze kuvinjelwe ukushelela kwenduku?

A: Ama-parallel rods azimele ancike kuphela ekubambeni kwasendaweni kwezikulufu ezingazodwana ze-pedicle. Uma isiguli sinekhwalithi yamathambo e-osteopenic, ukujikeleza kwe-trunk okuphindaphindayo kungabangela ukuguqulwa okubonakalayo kwamakhanda ayisikulufu, okokwehlisa ukungqubuzana kwendawo ngokuhamba kwesikhathi. Ukuhlanganisa izixhumi eziyisiphambano ezilungisekayo kuhlanganisa izinti zesokunxele nesokudla zibe uzimele webhokisi elingunxantathu oqinile. Lokhu kuxhumana okunezinhlelo eziningi kudlulisa izingcindezi ze-shear kuwo wonke amabhilidi, okwenza induku ezimele ye-longitudinal isheleleke ingenzeki ngomshini ngisho noma i-screw junction eyodwa ihlangabezana nokuguga kwe-micro-fretting.

Isiphakamiso senani loMsabalalisi: Ukulawula Imigodlagodla Yendawo Yethenda

• Umkhawulo Wezentengiselwano: Ukwethula amathimba okuthengwa kwempahla ezibhedlela ngesixazululo sobunjiniyela esinciphisa ubungozi bokubukeza futhi sehlise inani lezindleko zamacala amaningi okuqondiswa kwezigwegwe ngo-55% kuveza inani lezentengiselwano elingenakuqhathaniswa phakathi nokubuyekezwa kwamathenda.
• Ukuzethemba Komtholampilo: Ukunikeza odokotela abahlinza umgogodla abanezitifiketi (ISO 13485) TC4 Titanium hardware efaka ukubekezelelana komshini we-sub-micron kuqinisekisa ukwethembeka kokukhiya kwetorque ephezulu, kuvikela isithunzi sabo sesikhungo ekuhlulekeni kokwakhiwa kwesiteji sekwephuzile.