Hoʻomaʻamaʻa ʻana o ka Phase III me ka ipu hoʻopiha iwi i hui pū ʻia me ka ʻenehana Pedicle Anchorage Technology Reversible Kummell's maʻi.

Hoʻopilikia koʻikoʻi ka maʻi o Kummell i ka maikaʻi o ke ola o ka poʻe ʻelemakule. I kēia manawa, ʻaʻole maopopo ka pathogenesis o kēia maʻi, a aia nā ʻōlelo like ʻole e wehewehe ana i kona kumu pathological, me ka necrosis iwi ischemic i loko o ke kino vertebral, ka hōʻailona vertebral fissure (IVC), ka hoʻokumu ʻana o nā pseudojoints intravertebral, ka haki ʻana o ka vertebral kahiko non union, a lohi ka hāʻule ʻana o ka vertebral ma hope o ka ʻeha. Hur et al. ua ʻike ʻia nā kiʻi X-ray o nā maʻi maʻi o Kummell i hōʻike i nā hōʻailona o ka sclerosis ma ka hope haʻihaʻi o ke kino vertebral. Ua hōʻike ʻia ʻo CT scan plain i nā hōʻailona o ka sclerosis i loko o ke kino vertebral, ʻoiai ʻo CT reconstruction i hōʻike maopopo i nā hōʻailona o IVC a me ka sclerosis ma ka hopena haʻihaʻi. Ua ʻike pū ʻia ka osteoporosis koʻikoʻi me ka degeneration disc intervertebral i loko o ke kino vertebral a puni ka hopena paʻakikī. ʻO ka "hōʻailona vacuum fissure", "hōʻailona wehe", a me ka "hōʻailona bilateral" i loko o ke kino vertebral he mea nui akā ʻaʻole kikoʻī kikoʻī. I kēia manawa, ua manaʻo ʻia ʻaʻole maikaʻi ka mālama ʻana i ka maʻi o Kumell, a hiki ke hoʻonui hou ʻia ka spinal kyphosis a i ʻole nā ​​hōʻailona spinal nerve i ka pae hope.

Ua loaʻa i ka PVP a me ka PKP nā hopena ʻoluʻolu i ka mālama ʻana i nā pae I a me II o Kummell. Me ka hoʻonui ʻia ʻana o nā maʻi ʻokiʻoki, ua ʻike ʻia ʻo ia hoʻi i nā maʻi maʻi ʻo Kummell stage III, ʻo ka leakage o ka iwi sima a me ka paheʻe ʻana o nā iwi sima ma hope he mau pilikia koʻikoʻi.

ʻO nā kumu o ka leakage sima iwi a me ka paheʻe i ka maʻi o Kummell e pili ana i nā kumu he nui, pili mua i ke ʻano pathological o ka hoʻokumu ʻana i nā haʻihaʻi vertebral. Hasegawa et al. ua ʻike ʻia ua hana ʻia ka ʻiʻo synovial a puni nā paia iwi o nā haʻihaʻi vertebral i ka wā o ka hoʻonui ʻana i ka vertebral. Ua manaʻoʻiʻo lākou aia ka nui o ka sima iwi i nā haʻihaʻi vertebral, he mea paʻakikī ke komo ʻana ma o ka ʻiʻo synovial i loko o nā trabeculae a puni, ke keʻakeʻa nei i ka hoʻokumu ʻia ʻana o kahi hale paʻa paʻa ma waena o ka sima iwi a me ka trabeculae vertebral, ʻaʻole hiki ke mālama i ke kūpaʻa. o ke kino vertebral. Ua alakaʻi kēia i ka leaka iwi iwi a me ka paheʻe ʻana o ka nui o nā iwi sima, e pili ana i ka hopena lapaʻau lōʻihi. I ka manawa like, pili pū ia i ke kaomi i loko o ke kino vertebral o ka maʻi Kummell a me nā mākau hana o ka mea hana. Hoʻi hou ka maʻi Kummell, a hoʻolōʻihi ʻia ke ala o ka maʻi. ʻO ka ʻiʻo fibrous ma ka ʻili o ka iwi paʻakikī i loko o ke kino vertebral e hoʻonui a hana i kahi capsule pani, i hoʻopiha ʻia me ka wai. E piʻi aʻe ke kaomi i loko o ke kino vertebral, a e kahe ka sima iwi ma ka vein vertebral. I ka wā o ka hoʻomaʻamaʻa lāʻau lapaʻau, ua ʻike nā kauka i ka wā e paʻa ai ka paia o ka lua, piʻi ka kūʻē ʻana i ka hoʻokuʻu ʻana i ka sima i loko o ka vertebra maʻi, e hoʻonui ai i ka hopena o ka leakage cement iwi. Hoppe et al. ʻike ʻia ʻo ka hoʻohana ʻana i nā ʻenehana hoʻoheheʻe wai ma mua o ka hoʻokomo ʻana i nā iwi sima i loko o nā maʻi ma lalo o ka anesthesia maʻamau e hiki ke hoʻemi i ke kaomi i loko o ke kino vertebral, a laila e hōʻemi ana i ka hiki ʻana o ka leaka ʻana o ka iwi ma ka vertebral vein a me ka leakage cortical defect type. ʻO ke kiʻekiʻe o ka hōʻeha ʻeha a me ka paʻa ʻana o ka spinal o nā maʻi postoperative e pili kokoke ana i ka nui o ka hoʻopiha ʻana i ka iwi. ʻO Kim et al. manaʻoʻiʻo ʻo ka hoʻomaha ʻana o ka ʻeha ma hope o ka vertebroplasty percutaneous i nā poʻe maʻi me ka maʻi ʻo Kummell e pili ana i ka lawa ʻole o ka paʻa ʻana o ka vertebral ma muli o ka lawa ʻole o ka iwi ciment injection.

ʻO ka Bone Filling Container kahi ʻano mesh spherical i hana ʻia me nā mea hou. Ua ulana ʻia kēia ʻeke mesh me ka vertically a horizontally, a he maikaʻi ke kūpaʻa paʻa a me ka ductility. ʻO ke kumu hana o nā ʻeke mesh hoʻopiha iwi e hoʻemi nui i ka leaka ʻana o ka iwi ma o ka "wolf tooth effect" a me "onion effect". I ka wā o ke kaʻa ʻana, hoʻokomo ʻia ka ʻeke hoʻopiha hoʻopiha iwi iwi i waenakonu o ka māwae vertebral, a hoʻokuʻu ʻia ka iwi sima i loko. Hoʻopiha mālie ʻia ka ʻeke hoʻopiha piha ʻana o ka iwi, a ma ke kaomi ʻana i ka wai o ka ʻeke ʻeke sima iwi, hoʻokiʻekiʻe ʻia ke kino vertebral compressed e hoʻihoʻi i ke kiʻekiʻe o ke kino vertebral maʻi, a laila e hoʻihoʻi i ka biomechanics o ke kuamoʻo. Hoʻopili ʻia ka hapa nui o ka sima iwi i kahi ʻeke, e hōʻemi ana i ka leakage. Ke hele nei kekahi ʻāpana liʻiliʻi i loko o ke ʻano mesh a hoʻopaʻa ʻia me nā trabeculae iwi a puni, e hana ana i ka "hopena niho ʻīlio" e hoʻopaʻa a hoʻemi i ka paheʻe ʻana o nā puʻupuʻu sima iwi. Ke emi mālie nei ke kaomi o ka wai i loko o ka mesh mai ke kikowaena a hiki i ka ʻaoʻao, e hana ana i "ka hopena onion" e hōʻemi i ka hopena o ka leaka sima iwi. Xie Shengrong et al. Ua hōʻike ʻia ʻo ke kaʻina hana hou ʻana o ke kino vertebral no ka maʻi ʻo Kummell i loaʻa i ka 55.6% leakage iwi. Ua hōʻike ʻia ʻo Chen Shuwei he 35 mau mea maʻi me ka pae III reversible Kummell maʻi i mālama ʻia mai Ianuali 2018 a hiki i Dekemaba 2022, ua mālama ʻia lākou a pau me ka ʻeke ʻeke sima iwi i hui pū ʻia me ka ʻenehana heleuma pedicle. Ma waena o lākou, 6 mau hihia i loaʻa i ka leakage, me ka nui o ka leakage o 17.1% a me kahi emi nui.

Ka ʻike i ka hana ʻana o Bone Filling Container a me ka ʻenehana heleuma pedicle: (1) E nānā pono i nā kiʻi X-ray a me CT ma mua o ka hana ʻana e hoʻomaopopo i ka wahi o nā haʻihaʻi vertebral kūloko, ka nui a me ke kūlana o nā hemahema iwi, ka nui a me ka piha o ka pedicle kūkulu ʻia, a hoʻomohala i nā ala puncture pololei a me nā wahi heleuma no ka pedicle sima iwi. I ka manawa like, koho i ka nui kūpono o nā ʻeke mesh e pili ana i ka nui o nā haki; (2) I ka wā o ke kaʻa ʻana, pono e loaʻa ka fluoroscopy maʻemaʻe, e puncture pololei e like me ke ala o ka puncture preoperative, a pale i nā punctures pinepine, hana ʻana i nā ʻaoʻao wahaheʻe a i ʻole ke komo ʻana i ke kino vertebral e hana i ka iatrogenic leakage puncture. I ka manawa like, no nā poʻe maʻi ʻelemakule me ka osteoporosis, pono ka hana maʻalahi e pale aku i ke kuʻi ʻana i ka paia o ka cyst a me ka hōʻino ʻana i nā ʻāpana o loko a me nā kīʻaha koko; (3) Wehe i ka wai mai ka vertebral fissures, hoʻemi i ke kaomi i loko o ke kino vertebral, a hoʻemi i ka hopena o ka leakage sima iwi; (4) E ho'opa'a i ka manawa ho'okomo o ka iwi sima, i ka manawa ma'amau i ka "manawa huki", me ka ho'ohana 'ana i ke ko'oko'o pana'i, ho'oku'u mālie, a me ka nānā pono 'ana i ka piha 'ana o ka capsule a me ke kahe o ka iwi sima i loko o ke kino vertebral; (5) Hoʻokomo pinepine ʻia nā ʻeke hoʻopiha sima iwi ma nā kolamu mua a me waena o ka vertebrae i hōʻeha ʻia e hoʻomaʻamaʻa i ka hoʻihoʻi ʻana o ka morphology vertebral a me ka biomechanics, ʻoiai e hōʻemi ana i ka hopena o ka leaka sima iwi i loko o ke kahawai spinal. I ka manawa like, ʻo ka hapa nui o ka maʻi Kummell i hōʻeha ʻia i ka vertebrae i loaʻa nā kīnā iwi i pili i nā haʻihaʻi vertebral. ʻO ka hoʻopiha ʻana me ka ʻōpala o ka ʻūhā gelatin ma mua o ka hoʻokomo ʻana i nā iwi sima hiki ke hōʻemi i ka leaka ʻana o ka iwi; (6) Ma muli o ka hoʻoulu pinepine ʻana i ke koʻikoʻi kokoke i ka pedicle o ka vertebral arch, ua hoʻokumu ʻia kahi ʻāpana paʻakikī o ka iwi i ka wā o ka hoʻoponopono ʻana i ka iwi, a ʻoi aku ka paʻakikī o ka iwi kūloko, e maʻalahi ai ka hoʻohana ʻana i ka sima iwi no ka hoʻopaʻa ʻana i ka huelo. Ma kēia pūʻulu o nā hihia, ua hana ʻia ka paʻi pedicle bilateral a me ka heleuma huelo no ka hoʻopaʻa paʻa ʻana i ka nui o nā iwi sima. I ka manawa like, ua hana ʻia kēia hana i loko o kahi lima hana e pale ai i ka pilikia o ka leakage sima iwi kokoke i ka pedicle.

I ka hōʻuluʻulu ʻana, hiki i ka hui pū ʻana o Bone Filling Container a me ka ʻenehana heleuma pedicle ke hoʻihoʻi maikaʻi i ke kiʻekiʻe o ka vertebral, pale i ka hoʻoheheʻe ʻana o ka nui o nā iwi ciment i nā vertebral fissures, kūkulu hou i ka paʻa o nā biomechanics spinal, hoʻomaikaʻi maikaʻi i nā hōʻailona clinical, hoʻomaikaʻi i ka hana spinal, a hoʻonui i ka maikaʻi. o ke ola o ka poe elemakule i ka malama ana i ka ma'i kummell reversible stage III. Me ka hoʻolōʻihi ʻia o ke ola, pono e hahai ʻia nā hopena lōʻihi.

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http://www. lcwkzzz. com/CN/10.3969/j. issn. 10056483.2023.11.022

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