Ukubuyekezwa Kwekesi Lomtholampilo
Ukubuyekezwa okungahlonziwe kokulibaziseka kwenduku yomgogodla ukuthuthela emgodini we-thoracic, ngokunaka ukucabanga, izindlela zokuhluleka okungenzeka, ukuhlela ukubuyekezwa, ukulandelwa kanye nemingcele yalokho okungaphethwa ecaleni elilodwa elibikiwe.
Isaziso sokushicilelwa nokugunyazwa
Imvume ebhaliwe enolwazi yokushicilelwa kanye nemvume yokusebenzisa izithombe ezingakhonjwa itholiwe futhi igcinwa ngumshicileli. Izihlonzi eziqondile zesiguli, udokotela ohlinzayo kanye nesibhedlela zisusiwe kule nguqulo yewebhu.
Isifinyezo secala
Ngokwezinto ezisetshenziswayo zecala ezihlinzekiwe ukuze zibuyekezwe, umuntu omdala oneminyaka ephakathi onomlando oqhelile we-posterior thoracolumbar fusion waba nokungakhululeki kwesifuba se-pleuritic okuqhubekayo kanye ne-dyspnea yokuzikhandla. I-Radiography kanye ne-computed tomography kubikwa ukuthi ibonise ukufuduka kwe-cephalad yenduku yomgogodla we-longitudinal ngasemgodini we-thoracic kwesokunxele ngemva kokuxoshwa kusukela ku-posterior construct.
Ukuphathwa okubikiwe kuhilela ukususwa kwenduku ethuthiwe nokubuyekezwa kokulungisa okungemuva ngesikhathi esisodwa sokusebenza. Asikho isimangalo esijwayelekile mayelana nokuphakama kwedivayisi, ifomu lochungechunge, ukumiswa kwesixhumanisi esiphambanayo noma indlela yokuhlinzwa engenziwa kusukela kuleli cala kuphela.
Ukufuduka kwenduku yomgogodla kuyinto engavamile kodwa engase ibe yingozi yokubambezeleka kokusebenza komgogodla. Imibiko yamacala ashicilelwe ichaza ukuthuthela ku-canal yomgogodla, i-retroperitoneum, i-pelvis, i-mediastinum nezakhiwo ze-thoracic. Indlela kanye nokuphatha okufanele kuyehluka kakhulu phakathi kwezimo, yingakho ukuthwebula izithombe, isimo sokuhlanganisa, ikhwalithi yamathambo, isimo sokwakha kanye nokuba seduze kwezakhiwo ezibalulekile kufanele kuhlolwe ngazodwana.
Isisekelo sobufakazi nesimo sokuqinisekisa
Leli khasi lehlukanisa ukulandisa kwecala elinikeziwe kusukela ezincwadini zezokwelapha ezifinyeleleka ngokuzimela. Lowo mehluko ubalulekile: incazelo yecala ingabonisa inkinga yomtholampilo, kodwa ayikwazi ukusungula isigameko, ifakazele imbangela noma ibonise ukuthi idizayini yokufakelwa eyodwa ivimbela ukwehluleka kwesikhathi esizayo.
| Uhlobo lolwazi |
Umthombo osetshenziswe kuleli khasi |
Ukuqinisekiswa okudingekayo |
| Umlando wecala kanye nomugqa wesikhathi |
Izinto zekesi zinikezwe umshicileli |
Qinisekisa ngokumelene namarekhodi omtholampilo angakhonjiwe ngaphambi kokushicilelwa |
| Izithombe ze-Radiographic |
Izithombe ezimbili ezinikezwe isihloko sokuqala |
Qinisekisa imvume yesiguli, ubunikazi, ukungahlonzi kanye nemvume yokusebenzisa isithombe |
| Isizinda somtholampilo esijwayelekile |
Imibiko yamacala abuyekezwe ngontanga esohlwini olungezansi |
Abafundi kufanele babuyekeze izincwadi zokuqala kanye nemikhawulo yazo |
| Ulwazi lomkhiqizo |
Ulwazi lomkhiqizo we-XC Medico |
Qinisekisa ukucaciswa ngokumelene nokulebula kwamanje kanye nemibhalo yobuchwepheshe |
Isethulo secala elibikiwe
Idatha yecala elibikiwe Ukulandisa okuhlinzekiwe kuchaza owesilisa omdala osanda kweva eminyakeni engamashumi amahlanu enomlando wokulungiswa kokukhubazeka kwethoracolumbar kwangemuva kanye nokuhlanganisa kusuka ku-T11 kuya ku-L3 cishe eminyakeni eyi-15 ngaphambili. Izici ezifanelekile ezibikiwe zihlanganisa ukubhema, umfutho wegazi ophakeme olawulwayo kanye nokuncipha kwamathambo amaminerali.
Kubikwa ukuthi isiguli sibe nobuhlungu besifuba obubukhali ohlangothini lwesokunxele obubheke endaweni ye-scapular, bubhebhetheke kakhulu ngenxa yokuphefumulelwa okujulile, kanye ne-dyspnea encane yokuzikhandla emasontweni ambalwa. Akukho okusha kwe-neurological deficit entsha ebikiwe.
Umugqa wesikhathi womtholampilo obikiwe
| Isiteji |
Umcimbi obikiwe |
Ukuhambisana komtholampilo |
| Umlando oqhelile |
I-posterior thoracolumbar fusion kanye ne-instrumentation |
Isungula ukuxilonga okungaba khona okuhlobene nezingxenyekazi zekhompuyutha sekwephuzile |
| Isethulo |
Ukungakhululeki kwesifuba se-pleuritic kanye ne-dyspnea encane yokuzikhandla |
Izimpawu zenze ukuhlolwa kwezimbangela ze-cardiopulmonary kanye ne-hardware ehlobene |
| Isithombe sokuqala |
I-radiograph yesifuba ilandelwa yi-thoracic CT |
Kuchazwe indawo kanye ne-trajectory yezingxenyekazi zekhompuyutha ezithuthiwe |
| Ukungenelela |
Kubikwe ukubuyiswa kwangemuva nokwakhiwa kwesibuyekezo |
Ihloselwe ukususa ingxenye ethuthiwe futhi ibhekane nesakhiwo esisele |
| Landelela |
Ukubuyekezwa komtholampilo kanye ne-radiographic ezinyangeni ezintathu |
Umphumela wesikhashana kuphela; ayisunguli ukuqina kwesikhathi eside |
Ukutholwa kwesithombe
Kudingeka ukugunyazwa Izithombe ezingezansi zigcinwe kusukela ku-athikili enikeziwe ukuze ibuyekezwe ukuhlela. Kufanele zihlale zisesidlangalaleni kuphela uma umshicileli enemvume ebhaliwe kanye nemvume yokusebenzisa isithombe futhi eqinisekisile ukuthi ziyingxenye yecala elichaziwe.
![I-radiograph ebikiwe ebonisa ukufuduka kwe-cephalad yenduku yomgogodla ukuya emgodini wethoracic]()
Umfanekiso 1. Isithombe se-radiographic esihlinzekiwe sibikwe sibonisa ukugudluzwa kwe-cephalad yenduku yomgogodla we-longitudinal ngasensimini ye-thoracic. Umsuka wesithombe, imvume yesiguli kanye nemvume yokushicilelwa kufanele kuqinisekiswe ngaphambi kokusetshenziswa.
![Ukubukwa kwe-CT okubikiwe okusetshenziselwa ukuhlola isikhundla se-hardware yomgogodla efudukayo eduze nezakhiwo ze-thoracic]()
Umfanekiso 2. Ukubukwa kwe-CT enikeziwe kubikwe ukuze kubonise isikhundla se-hardware efudukayo ngokuhlobene nezakhiwo ze-thoracic. Amazwibela okugcina kufanele agunyazwe isazi se-radiologist esinikelayo noma ithimba lezokwelapha.
Ngokusho kokuhumusha okunikeziwe, induku yayiyekile ukusuka ohlangothini lwesobunxele lwesakhiwo esingemuva futhi yathuthela phezulu. I-CT kubikwa ukuthi isetshenziselwa ukuhlola ubudlelwano phakathi kwe-hardware ne-pleura, amaphaphu kanye nezakhiwo ze-vascular eziseduze. Ubudlelwano obuqondile be-anatomic kufanele buchazwe kuphela udokotela oqeqeshiwe obuyekeze uchungechunge lwezithombe lwangempela.
Ukucatshangelwa kokuphatha
Izigameko ezishicilelwe zibonisa ukuthi ukuphatha kuncike kakhulu ezimweni ezithile. Izinto ezingase zibe nomthelela ekuhleleni zihlanganisa izimpawu, isimo se-fusion, ubufakazi bokutheleleka noma okungezona i-nonunion, ubuqotho be-hardware, ikhwalithi yamathambo, i-migration tract kanye nokuba seduze kwe-neural, i-vascular or visceral structures.
Izindlela ezingase zibe khona ezicatshangelwe endabeni enikeziwe
- Ukususwa okuhlosiwe kwengxenye ethuthiwe: kungase kubhekane nosongo olusheshayo lwehadiwe kodwa akuxazululi ngokuzenzekelayo ukungazinzi noma ukwehluleka kwenye indawo ekwakhiweni.
- Ukwelashwa okuhlanganisiwe kwangaphambili noma kwe-thoracic kanye ne-posterior: kungase kucatshangelwe lapho ukuboniswa okuqondile kwezakhiwo ze-thoracic kudingekile, kodwa izidingo zenqubo zincike kumuntu ngamunye nokuhlolwa kwe-multidisciplinary.
- Ukubuyiswa kwangemuva ngesibuyekezo sokwakha: kwakuyindlela ebikwe ngayo ecaleni elinikeziwe. Ukufaneleka kwayo akukwazi ukwenziwa okuvamile kwamanye amaphethini okufuduka.
Ukufuduka kwezinduku eduze komgodi wethoracic kungase kudale ingozi ekwakhiweni kwe-pleural, pulmonary noma i-vascular, kodwa umzila ophuthumayo kanye nokusebenza kufanele kunqunywe ochwepheshe bezokwelapha. Leli khasi aliyona inkomba yesu lokuhlinza.
Ukungenelela okubikiwe
Idatha yecala elibikiwe Ukulandisa okuhlinzekiwe kusho ukuthi indlela yangaphambilini yangaphambili yavulwa kabusha, izingxenyekazi zekhompuyutha ezisele zavezwa, futhi i-rod ehanjisiwe yahoxiswa eduze kwepheshana layo elikhona ngaphansi kokuqondisa kwesithombe. Ukwakhiwa kwasekuqaleni kwabe sekubuyekezwa kusetshenziswa izikulufu ze-pedicle ezingemuva, izinduku nezixhumi eziphambanayo.
Irekhodi elinikeziwe libika isikhathi sokusebenza esiyimizuzu eyi-155 kanye nokulahleka kwegazi okulinganiselwa ku-210 ml. Lezi zibalo kufanele zigcinwe kuphela uma ziqinisekiswa ngokumelene nerekhodi lomsebenzi elingahlonziwe. Bachaza le nqubo ebikiwe kuphela futhi akufanele bethulwe njengemiphumela elindelekile yamacala afanayo.
I-athikili yomthombo ibhekisele kusistimu yesikulufu se-polyaxial pedicle. Abafundi abafuna imininingwane yomkhiqizo ongewona owomtholampilo bangabuyekeza uhlelo lwe-screw pedicle screw . Ukucaciswa komkhiqizo kufanele kuqinisekiswe ngokumelene nemibhalo yezobuchwepheshe yamanje, futhi lesi sixhumanisi asiqinisekisi ukuthi umkhiqizo ubangele umphumela obikiwe.
Kubikwe inkambo yangemva kokuhlinzwa kanye nokulandelela
Indaba exoxwayo yecala elinikeziwe ibika ukuthuthuka kobuhlungu besifuba ngemva kwenqubo, ilondolozwe ukusebenza kwezinzwa eziphansi komkhawulo kanye nokuhlanganisa phakathi nenkathi yokuqala yangemva kokuhlinzwa. Iphinde ibike ukugcinwa kokuqondanisa kwesakhiwo kanye nokuthuthukiswa kwezimpawu ekubuyekezweni kwezinyanga ezintathu.
Lokhu ukubonwa kwesikhathi esifushane, okuhambisana necala elithile. Imisho efana nokuthi 'zero micro-motion,' 'i-perfect structural hold' noma 'ukwehluleka kuqedwe' isuswe ngamabomu ngoba ukuthwebula okujwayelekile kokulandelela akukwazi ukusekela lezo ziphetho eziphelele.
Izindlela ezingenzeka zokufuduka kwenduku yomgogodla
Isizathu esiqondile kuleli cala elinikeziwe asikaziwa ngokuzimela. Imibiko eshicilelwe ixoxa ngabaningi abangaba negalelo, okuhlanganisa ukunqanyulwa kwenduku noma i-set-screw, ukuphuka kwengxenye, i-pseudarthrosis, ukuqiniswa okunganele, ukungalingani kokwakha, ukulayisha okuphindaphindiwe, ukuncishiswa kwekhwalithi yamathambo kanye nokwehluleka ukuhlanganisa.
Isibonelo, amacala ashicilelwe achaza ukufuduka kwenduku endaweni ye-thoracic subarachnoid, i-retroperitoneum, i-pelvis kanye nezakhiwo zamaphaphu. Le mibiko ihlale iveza ukufuduka okude njengokungavamile futhi igcizelela ukuthwebula izithombe kanye nokulandelela isikhathi eside kunokuba inikeze indlela eyodwa yendawo yonke.
Ungasho imbangela eyodwa
Ukuma kwe-set-screw kukodwa akufakazeli ukuthi kungani ukwakhiwa kwehlulekile. Isimo se-Fusion, ubuqotho bengxenye, indlela yokuhlinzwa kanye nezici zesiguli nazo zidinga ukubuyekezwa.
Gwema izimangalo zedizayini eziphelele
Ijiyomethri yochungechunge nezixhumi eziphambanayo zingaba nomthelela kumakhenika wokwakha, kodwa icala elilodwa alikwazi ukufakazela ukuthi isici siqeda ukuxega noma ukufuduka.
Sebenzisa ukugada kwesikhathi eside
Okunye ukufuduka okushicilelwe kwenzeka eminyakeni emva kwenqubo yenkomba, ukusekela ukunakekelwa okuqhubekayo ebuhlungu obusha, izimpawu ze-neurological noma izikhalazo ezingachazwanga ze-cardiopulmonary.
Fanisa ukuphathwa ku-anatomy
Indawo yezingxenyekazi zekhompuyutha ezithuthiwe ngokuhlobene ne-neural, vascular and visceral structures ingashintsha ngokubonakalayo ukuhlela kokusebenza.
Imikhawulo yalokhu kubuyekezwa kwecala
- Amarekhodi omthombo wecala elithile awanikeziwe noma acwaningwe ngokuzimela kulokhu kubuyekezwa kwe-SEO.
- Imvume ebhaliwe, ubunikazi besithombe kanye nokugunyazwa kwesikhungo kufanele kuqinisekiswe ngaphambi kokushicilelwa.
- Leli icala elilodwa elibikiwe ngaphandle kweqembu lokulawula.
- Ukulandelela kukhawulelwe esikhathini esibikwe endabeni enikeziwe.
- Icala alikwazi ukusungula isigameko, imbangela, ukuphakama kwedivayisi noma ukuvimbela ukwehluleka kwesikhathi eside.
- Ukubandakanyeka komkhiqizo kanye nemininingwane kufanele kuqinisekiswe ngokumelene namarekhodi alandelekayo kanye nemibhalo yezobuchwepheshe yamanje.
- Asikho isiphetho esisebenza ngempumelelo ngenxa yokuthi imodeli yezindleko yasekuqaleni ibingahambisani futhi ingatholakali ngaphandle.
Amaphuzu okufunda abalulekile
- Ukufuduka kwenduku yomgogodla okukude kuyivelakancane kodwa kungase kuhlanganise neural, vascular, pleural or visceral structures.
- Isifuba esisha, isisu, i-pelvic noma izimpawu zemizwa esigulini esinezinsimbi zomgogodla ezikude zingathethelela ukuhlolwa kwenkinga ye-hardware ebambezelekile.
- I-Radiography ne-CT ingasiza ukuchaza indawo yehadiwe futhi isekele ukuhlela kwemikhakha eminingi.
- Abaphathi kufanele bacabangele kokubili ingxenye efudukayo kanye nesimo sesakhiwo esisele.
- Umphumela owodwa omuhle awukhombisi ukuthi isici somkhiqizo sivimbela ukwehluleka kokwakha kwesikhathi esizayo.
Imibuzo ejwayelekile ukubuzwa
Ingabe induku yomgogodla ingahamba iminyaka ngemva kokuhlinzwa kwe-fusion?
Idokhumenti yemibiko yamacala ashicilelwe ilibazisekile ukufuduka kwenduku eminyakeni embalwa ngemva kokwenziwa komgogodla. Kuthathwa njengokungajwayelekile, futhi indlela yokusebenza iyahluka phakathi kwamacala.
Yiziphi izimpawu ezingase zihlotshaniswe ne-hardware yomgogodla efudukayo?
Izimpawu zincike endaweni yokufuduka futhi zingabandakanya ubuhlungu bendawo, ukuguqulwa kwezinzwa, izimpawu zokuphefumula noma izimpawu ezibangelwa ukucasuka kwezakhiwo eziseduze. Izimpawu ezifanayo zinezinye izimbangela eziningi futhi zidinga ukuhlolwa komtholampilo.
Ingabe i-cross-link ivimbela ukufuduka kwenduku yomgogodla?
Izixhumanisi eziphambanayo zingashintsha izimishini zokwakha nokuzinza kokujikeleza ekucushweni okukhethiwe, kodwa ngeke kushiwo ukuthi ziqeda ubungozi bokufuduka. Ukusetshenziswa kwabo kunqunywa udokotela ohlinzayo okwelapha kanye nezidingo zokwakha.
Ingabe leli cala lifakazela ukuthi uhlelo olulodwa lwesikulufu se-pedicle luphephe kakhudlwana?
Cha. Icala elilodwa alikwazi ukusungula ukuphepha okuqhathaniswayo noma ukusebenza kahle. Lezo ziphetho zidinga ubufakazi obufanele bemishini, bokulawula kanye nobomtholampilo.
Hlola okwengeziwe izifundo zemitholampilo ezivela ku-XC Medico. Icala ngalinye kufanele lihunyushwe ngaphakathi kobufakazi obushiwo, isimo sokugunyazwa kanye nemikhawulo.
Cela imibhalo yomkhiqizo wobuchwepheshe
Ngemibuzo yabasabalalisi noma yobungcweti, cela ukucaciswa kwamanje, ukulebula kanye nemibhalo yezobuchwepheshe yesistimu yomgogodla efanele. Ulwazi lomkhiqizo aluthathi indawo yokwahlulela komtholampilo noma ukubuyekezwa kokulawula okuqondene nemakethe.
Xhumana ne-XC Medico
Isaziso sokusetshenziswa kochwepheshe: Lokhu kubuyekezwa kwecala okokufundisa nolwazi lwebhizinisi ukuya kwebhizinisi. Akusona iseluleko sezokwelapha, izincomo zokuhlinzwa noma ubufakazi bokuthi noma iyiphi idivayisi ethile izovimbela ukufuduka kwehadiwe. Izinqumo zokwelashwa kufanele zenziwe odokotela abaqeqeshiwe besebenzisa ulwazi oluqondene nesiguli kanye nokulebula okusebenzayo komkhiqizo.
