Endoscopic discectomy ta hanyar intervertebral sararin samaniya

Microscopic discectomy ta hanyar ƙananan tashoshi masu ɓarna a halin yanzu shine mafi yawan amfani da dabarar tiyata na kashin baya kaɗan don maganin herniation intervertebral. MED minimally invasive lumbar discectomy shine sabuwar dabarar tiyata ta kashin baya da Foley da Smith suka fara haɓaka a cikin 1997. Yana kafa tsarin aikin tiyata ta hanyar jerin tashoshi masu tasowa kuma yana amfani da tashar tashar aiki na diamita na 1.6-1.8cm don kammala matakai irin su laminoplasty, ƙananan haɗin gwiwa na haɗin gwiwa, jijiyar tushen tushen jijiya, da ƙwayar cuta ta intervertebral wanda a baya kawai zai yiwu ta hanyar bude tiyata. Idan aka kwatanta da discectomy na al'ada na al'ada, wannan fasaha ta kafa tsarin tiyata ta hanyar jerin nau'in catheters mai zurfi, ba tare da buƙatar rarrabawa da ƙwanƙwasa tsokoki na paraspinal ba, kuma ya kammala duk aikin tiyata a cikin tashar aiki na 1.6-1.8cm diamita. Sabili da haka, yana da fa'idodi na ƙananan ɓangarorin tiyata, rauni mai rauni na tsoka mai rauni, ƙarancin zubar jini, da saurin dawowa bayan tiyata. Saboda ci gaba da kyamarar kyamara da tsarin bidiyo, filin kallon tiyata yana karuwa da sau 64, yana ba da damar ƙarin ganewar ganewa da kariya daga jakar dural, tushen jijiya, da plexus na jijiyoyin jini a cikin canal na kashin baya a cikin yanki na tiyata a lokacin tiyata; A lokaci guda kuma, filin aikin tiyata mai haske yana tabbatar da cikakkiyar kammala aikin tiyata daban-daban, yadda ya kamata ya guje wa gazawar filayen tiyata na gargajiya na zurfin hangen nesa da kuma mummunar lalacewar tsarin haɗin gwiwa na kashin baya. Yana ƙara yawan kiyaye amincin tsarin haɗin gwiwar haɗin gwiwa na baya na kashin baya, ta yadda ya kamata ya rage abin da ya faru na mannewar tabo bayan tiyata da rashin zaman lafiya na lumbar.

Canje-canje na pathological a cikin wani yanki na musamman yana ƙayyade sanya tashar tashar aiki. Minista mara hankali mai lalata jaruntaka na lalata tiyata na iya samar da isasshen lalata a tsakiyar canal canal, lokacin hutu, da kuma yankuna na Foramen. Bugu da ƙari, ana iya cire nama na diski na intervertebral a waje da kumfa na intervertebral. Kafin yin lalata a wurare daban-daban, ya zama dole don tsara hanyar tiyata. Don ƙaddamar da jijiyoyi na extraforaminal, tashar aiki za a iya sanya shi a kan membrane na tsari mai tsaka-tsaki tsakanin hanyoyin da ke jujjuyawa. Da fari dai, an ƙaddara membrane na tsari mai jujjuyawar, kuma an yanke ligament ɗin mai jujjuyawa don fallasa tushen jijiya mai zurfi. Da zarar an ƙayyade tushen jijiya na fita, za a iya samun nama mai tasowa na intervertebral a cikin zurfin ɓangaren jijiya. Binciken na baya-bayan nan ya kwatanta ƙananan ƙwayar cuta tare da tiyata na gargajiya na gargajiya, kuma sakamakon ya nuna cewa aikin tiyata mafi ƙanƙanci yana da ƙananan lalacewar nama, ƙananan tsoma baki, ƙananan asarar jini, ƙananan bayyanar cututtuka na ciwo bayan tiyata, ɗan gajeren asibiti, da sauri dawo da dawowa aiki. Wani binciken da bazuwar da aka yi tsakanin al'ada na budewa na microsurgical discectomy da ƙananan ƙwayar cuta ta microsurgical discectomy ta hanyar daɗaɗɗen ƙwayar cuta ya nuna cewa tiyata ta hanyar tashoshi kadan ya fi aminci kuma mafi tasiri.

Sabuwar fasaha ta intervertebral discoscopy (MED) wanda Foley da Smith suka kirkira shine cikakkiyar haɗuwa da ƙananan fasaha na ƙananan ƙwayoyin cuta da fasaha na endoscopic. Yin tiyata na MED yana kama da buɗewa na microscopic discectomy kuma ana iya amfani dashi don laminectomy, decompression, foraminotomy, da tiyata na diski. Sauƙaƙan aiki, alamomi masu faɗi, da ayyuka daban-daban na MED suna sauƙaƙa wa likitocin tiyata don canzawa daga aikin tiyata na gargajiya zuwa aikin tiyata na endoscopic. Kodayake hangen nesa na endoscopic ba wai kawai yana samar da fili da faɗaɗa filin duban tiyata ba, amma kuma yana sauƙaƙe kuma yana da tasiri, yana iya samar da hotuna na 2D kawai kuma sau da yawa yana toshe shi ta hanyar zubar da jini da bayyanar da ba a sani ba, wanda ba shi da kyau kamar microscopic discectomy. Ci gaban hoton endoscopic da fasahar haɗin hoto na endoscopic na iya taimakawa inganta wannan batu.

Sarrafa zub da jini yana da mahimmanci musamman ga kowace dabarar gani, saboda yawan zubar jini yana ƙara haɗarin yaga jakar kwata-kwata da raunin jijiya. Zubar da jini a waje da dura ko kusa da ƙananan gidajen abinci yana tsoma baki tare da gazawar likitan tiyata don ci gaba da aiki, amma ana iya amfani da wasu hanyoyin gargajiya kamar microscopic discectomy (gel collagen fibrillar, gel thromboxane, soso gelatin mai ɗaukar ruwa da ƙaramin auduga, da sauransu). Endius ya ƙirƙira ƙaramin na'urar lantarki ta bipolar (MDS) tare da kumfa mai nau'i biyu, wanda za'a iya shafa shi don rarrabuwar kai, tsotsar jini, da hemostasis electrocoagulation. Bugu da ƙari, an karɓi tsarin endoscopic tushen haske mai dual (infrared / bayyane), wanda ke ƙara tashar infrared zuwa tsarin laparoscopic na yanzu. Wannan tsarin zai iya gano ƙananan jini na jijiya a cikin mahallin jini, gano takamaiman wurin da zubar da jini, taimaka wa likitan fiɗa da sauri ya ƙone don dakatar da zubar jini, da kuma rage yawan aikin hemostasis lokacin da ba a san inda jinin ba.

A halin yanzu, yawancin endoscopes na kashin baya suna da'awar suna da haɓakar 20 x lokacin amfani da xenon ko tushen hasken halogen, kuma suna iya kaiwa 3 x 104 pixels. Dabarun gani na baya-bayan nan na iya cimma pixels 5 x 104 ta hanyar diamita na fiber 1.8mm, wanda ya isa ga yawancin aikin tiyata na yanzu. Yin tiyatar endoscopic na kashin baya na gaba zai amfana daga ƙananan zaruruwa, yana samar da ƙarin sararin aikin tiyata ba tare da lalata ingancin hoto ba. Wani ci gaba shine hasken dual. MGB endoscopy yana amfani da tsarin na'urar hangen nesa da ake kira Shadow, wanda ke haɗa hanyoyin samar da haske masu zaman kansu zuwa madaidaicin endoscope na 30 °. Saboda tsarin Shadow, yana iya samar da kyakkyawan filastik da bambanci, wanda za'a iya canza shi zuwa hotuna masu girma uku, samun babban ƙuduri da kuma cikakkiyar filin kallon tiyata. Wani cigaba a cikin endoscopy na kashin baya shine tsarin anti nebulization, kamar yadda sake nebulization bayan tsaftacewa na waje zai iya haifar da maimaitawa a cikin tiyata. Tsayar da hangen nesa yana da mahimmanci musamman don amintaccen aiwatar da aikin tiyatar kashin baya kaɗan. A shekara ta 1993, masana sun yi nazari kan ƙara wani ƙarin "kube" (bututun waje) zuwa na'urorin zamani na gargajiya, wanda zai iya tsaftacewa da bushewar ruwan tabarau a kowane lokaci, ta yadda ruwan tabarau ya kasance mai tsabta kuma baya buƙatar cirewa akai-akai daga jikin majiyyaci. Ƙarar da aka ƙara za ta iya cire hayakin da wuƙaƙen lantarki masu yawa ke haifarwa. Abin takaici, tsarin ba zai iya hana atomization na halitta wanda ya haifar da rashin daidaituwa tsakanin zafin ruwan tabarau da zafi a cikin wurin aiki. Wasu kamfanoni sun yi ƙoƙarin ƙara na'urori masu auna firikwensin da wayoyi masu juriya a bayan ruwan tabarau don magance wannan matsalar. Dangane da aikin babban ma'anar hoto (HDI) na guntu CCD, zai iya samar da pixels miliyan 2 a cikin layin kwance 1250, don haka samun filin duban fiɗa.

Ci gaban fasahar kwamfuta da fasahar endoscopic ya ba da damar sake gina hotuna masu kama da fuska uku, waɗanda aka haɗa su ta hanyar haɗa hotuna da aka riga aka yi tare da sikanin ciki sannan kuma a haɗe zuwa hotunan endoscopic na ciki. An yi amfani da irin waɗannan fasahohin a aikin tiyata na craniocerebral, wanda ya haɗu da sake gina hoton da aka rigaya ya yi tare da hotunan microscope na ciki. Wannan zai iya taimaka wa likitocin tiyata don tabbatar da iyakokin ciwace-ciwacen daji da kuma cire su da kyau. Kwanan nan, Mississauga (Kanada) ya haɓaka saitin cannula na neuroendoscopic, wanda za'a iya amfani dashi don lura da matsayi na endoscope dangane da bayanan MRI da CT. Software na musamman yana ba da hotuna na endoscopic na kan yanar gizo da kuma matsayi mai girma uku na matsayi na kayan aiki. Wani ci gaba shine gilashin nunin kwalkwali, waɗanda ke da alaƙa da na'urorin aikin tiyata, baiwa likitocin tiyata damar lura da siginonin nunin da aka watsa da filin duban tiyata. Nan gaba kadan, wannan fasaha kuma za a iya amfani da ita a cikin endoscopes tiyata na kashin baya don rama kurakuran na'urorin endoscopes masu girma biyu. Haɓakawa a nan gaba a fasahar hoto kuma za ta haɗa da mafi kyawun ƙudurin hoton gani, mafi kyawun mayar da hankali kamar na'urorin tiyata, mafi kyawun ƙarfi da aiki, mafi girman tasirin tashar aiki, da ci gaba da haɓaka hotunan 3D. Waɗannan haɓakawa na iya ɗaukar tiyatar endoscopic na kashin baya zuwa sabon tsayi.