Endoscopic discectomy los ntawm qhov chaw intervertebral mus kom ze

Microscopic discectomy los ntawm minimally invasive raws yog tam sim no feem ntau siv minimally invasive spinal phais txheej txheem rau kev kho mob ntawm intervertebral disc herniation. MED minimally invasive lumbar discectomy yog ib qho kev phais mob me me tshiab uas tsim los ntawm Foley thiab Smith hauv xyoo 1997. MED minimally invasive lumbar discectomy draws on the advantages of traditional posterior laminoplasty and endoscopic minimally invasive techniques. Nws tsim txoj kev phais mob los ntawm ntau txoj hauv kev dilated thiab siv 1.6-1.8cm txoj kab uas hla ua haujlwm kom tiav cov txheej txheem xws li laminoplasty, me me resection, hlab ntsha hauv paus kwj dej decompression, thiab intervertebral disc resection uas yav tas los tsuas yog ua tau los ntawm kev phais qhib. Piv nrog rau cov tsoos lumbar discectomy, cov txheej txheem no tsim ib txoj kev phais los ntawm ib tug series ntawm dilated catheters, tsis tas yuav tsum tau rau dissection thiab traction ntawm paraspinal cov leeg, thiab ua tiav tag nrho cov kev phais nyob rau hauv ib tug 1.6-1.8cm txoj kab uas hla ua hauj lwm channel. Yog li ntawd, nws muaj qhov zoo ntawm kev phais me me, me me paraspinal leeg raug mob, los ntshav tsawg, thiab rov qab ua haujlwm sai. Vim lub koob yees duab thiab yees duab siab heev, qhov kev phais ntawm qhov kev pom tau nthuav dav los ntawm 64 lub sij hawm, tso cai rau kev txheeb xyuas qhov tseeb thiab kev tiv thaiv ntawm dural sac, paj paj hauv paus, thiab vascular plexus nyob rau hauv tus txha caj qaum hauv thaj chaw phais thaum lub sij hawm phais; Nyob rau tib lub sijhawm, qhov chaw phais kom meej meej ua kom tiav qhov tseeb ntawm ntau yam kev phais, kom tsis txhob muaj qhov tsis zoo ntawm cov kev phais ib txwm muaj ntawm qhov pom kev sib sib zog nqus thiab kev puas tsuaj loj rau cov pob txha pob txha hauv qab ntawm tus txha nraub qaum. Nws maximizes lub preservation ntawm lub posterior ligament composite qauv ntawm tus txha nraub qaum, yog li zoo txo ​​qhov tshwm sim ntawm postoperative caws pliav adhesion thiab lumbar instability.

Cov kev hloov pauv pathological hauv ib cheeb tsam tshwj xeeb txiav txim siab qhov chaw ua haujlwm channel. Kev phais mob lumbar decompression tsawg kawg nkaus tuaj yeem ua rau muaj kev puas tsuaj txaus rau hauv nruab nrab tus txha caj qaum, sab nraub qaum, thiab thaj chaw intervertebral foramen. Tsis tas li ntawd, cov ntaub so ntswg intervertebral sab nraum lub intervertebral foramen tuaj yeem raug tshem tawm. Ua ntej ua decompression ntawm ntau qhov chaw, nws yog ib qho tsim nyog los npaj txoj kev phais. Rau decompression ntawm cov hlab ntsha extraforaminal, cov channel ua haujlwm tuaj yeem muab tso rau ntawm cov txheej txheem transverse membrane ntawm cov txheej txheem transverse. Ua ntej, cov txheej txheem transverse membrane yog txiav txim siab, thiab cov txheej txheem transverse ligament raug txiav qhib kom nthuav tawm nws qhov tob tawm ntawm cov paj hlwb. Thaum qhov tawm ntawm cov hlab ntsha hauv paus tau txiav txim siab, cov ntaub so ntswg intervertebral tuaj yeem pom nyob rau hauv qhov tob ntawm cov paj hlwb. Cov kev tshawb fawb tsis ntev los no tau muab piv rau qhov kev txiav txim siab me me nrog kev phais qhib, thiab cov txiaj ntsig tau pom tias qhov kev phais mob me me muaj cov ntaub so ntswg puas tsawg, kev cuam tshuam ntawm cov hlab ntsha tsawg, cov ntshav tsawg tsawg, cov tsos mob mob me me, nyob hauv tsev kho mob luv luv, thiab rov qab mus ua haujlwm sai. Ib txoj kev tshawb nrhiav kev tswj hwm ntawm ib txwm qhib microsurgical discectomy thiab minimally invasive microsurgical discectomy los ntawm cov channel minimally invasive pom tias kev phais los ntawm cov channel minimally invasive muaj kev nyab xeeb thiab zoo dua.

Cov thev naus laus zis tshiab ntawm intervertebral discoscopy (MED) tsim los ntawm Foley thiab Smith yog kev sib xyaw ua ke zoo tshaj plaws ntawm cov txheej txheem microsurgical minimally invasive thiab endoscopic cov tswv yim. MED phais zoo ib yam li qhib microscopic discectomy thiab tuaj yeem siv rau laminectomy, decompression, foraminotomy, thiab disc herniation phais. Qhov yooj yim ntawm kev ua haujlwm, kev qhia dav dav, thiab ntau yam kev ua haujlwm ntawm MED ua rau nws yooj yim dua rau cov kws phais mob hloov pauv ntawm kev phais ib txwm mus rau kev phais endoscopic. Txawm hais tias endoscopic pom tsis tau tsuas yog muab qhov pom tseeb thiab nthuav dav ntawm kev pom, tab sis kuj pab txhawb thiab ua tau zoo, nws tsuas tuaj yeem muab cov duab 2D thiab feem ntau cuam tshuam los ntawm cov ntshav thiab cov zaub tsis meej, uas tsis zoo li microscopic discectomy. Kev nce qib ntawm endoscopic imaging thiab endoscopic duab fusion tshuab tuaj yeem pab txhim kho qhov teeb meem no.

Kev tswj los ntshav yog qhov tseem ceeb tshwj xeeb rau txhua qhov kev pom kev pom, vim tias ntshav ntau dhau ua rau muaj kev pheej hmoo ntawm dural sac tear thiab paj hlwb raug mob. Cov ntshav tawm sab nraud ntawm lub dura lossis ib ncig ntawm cov pob qij txha me cuam tshuam nrog tus kws phais tsis muaj peev xwm ua haujlwm ntxiv, tab sis qee qhov kev siv ib txwm siv xws li microscopic discectomy (fibrillar collagen gel, thromboxane gel, absorbable gelatin sponge thiab cov paj rwb me me, thiab lwm yam). Endius tau tsim cov cuab yeej me me bipolar electrocoagulation (MDS) nrog ob txheej txheej txheej, uas tuaj yeem siv rau kev sib cais, nqus ntshav, thiab electrocoagulation hemostasis. Tsis tas li ntawd, ob lub teeb ci qhov chaw endoscopic (infrared / pom) tau txais, uas ntxiv ib qho infrared channel rau laparoscopic system tam sim no. Cov txheej txheem no tuaj yeem kuaj pom cov hlab ntsha me me hauv ib puag ncig ntawm kev los ntshav, txheeb xyuas qhov chaw tshwj xeeb ntawm cov ntshav, pab tus kws phais mob sai sai kom tsis txhob los ntshav, thiab txo qis kev ua haujlwm hemostasis rov qab thaum lub ntsiab lus los ntshav tsis meej.

Tam sim no, feem ntau tus txha caj qaum endoscopes thov kom muaj qhov loj ntawm 20 x thaum siv xenon lossis halogen lub teeb ci, thiab tuaj yeem ncav cuag 3 x 104 pixels. Cov tswv yim pom pom tsis ntev los no tuaj yeem ua tiav 5 x 104 pixels los ntawm 1.8mm fiber ntau txoj kab uas hla, uas yog txaus rau feem ntau cov kev phais tam sim no. Yav tom ntej spinal endoscopic phais yuav tau txais txiaj ntsig los ntawm cov fibers me, muab qhov chaw phais ntau dua yam tsis muaj kev cuam tshuam cov duab zoo. Lwm qhov kev nce qib yog dual illumination. MGB endoscopy siv lub telescope system hu ua Shadow, uas integrates ob lub teeb pom kev ywj pheej mus rau tus qauv 30 ° phais endoscope. Vim yog tus qauv ntawm Duab Ntxoo, nws tuaj yeem muab cov yas zoo thiab qhov sib txawv, uas tuaj yeem hloov mus rau hauv peb-dimensional dluab, ua tiav cov kev daws teeb meem siab thiab tsis pom kev pom kev pom. Lwm qhov kev txhim kho ntawm tus txha caj qaum endoscopy yog cov tshuaj tiv thaiv nebulization, vim tias rov ua dua tom qab ntxuav sab nraud tuaj yeem ua rau muaj kev cuam tshuam ntau dua hauv kev phais. Kev tuav lub zeem muag pom tseeb yog qhov tseem ceeb tshwj xeeb rau kev nyab xeeb ntawm kev phais mob me me. Hauv xyoo 1993, cov kws tshawb fawb tau kawm ntxiv qhov ntxiv "shuaj" (lub raj sab nrauv) rau cov tshuaj endoscopes, uas tuaj yeem ntxuav thiab ziab lub qhov muag qhov muag txhua lub sijhawm, kom lub lens tseem huv si thiab tsis tas yuav rov qab tshem tawm ntawm tus neeg mob lub cev. Qhov ntxiv defogger tuaj yeem tshem tawm cov pa luam yeeb uas tsim los ntawm cov riam phais hluav taws xob ntau zaus. Hmoov tsis zoo, lub kaw lus tsis tuaj yeem tiv thaiv lub ntuj atomization tshwm sim los ntawm qhov tsis sib xws ntawm qhov ntsuas kub ntawm lub lens thiab cov av noo hauv thaj chaw ua haujlwm. Qee lub tuam txhab tau sim ntxiv cov sensors thiab thermal resistance wires tom qab lub lens los daws qhov teeb meem no. Raws li kev ntsuas siab (HDI) kev ua haujlwm ntawm CCD nti, nws tuaj yeem muab 2 lab pixels nyob rau hauv 1250 kab kab rov tav, yog li tau txais kev pom kev phais kom pom tseeb.

Kev nce qib ntawm kev siv tshuab computer thiab thev naus laus zis endoscopic tau ua rau peb-dimensional reconstruction ntawm virtual dluab, uas yog synthesized los ntawm combining preoperative dluab nrog intraoperative scans thiab ces txuas mus rau intraoperative endoscopic dluab. Cov tswv yim zoo sib xws tau siv hauv kev phais craniocerebral, uas muab cov duab ua ntej rov tsim dua tshiab nrog cov duab phais kev phais mob. Qhov no tuaj yeem pab cov kws phais mob kom paub meej txog thaj tsam ntawm cov qog thiab tshem tawm lawv zoo dua. Tsis ntev los no, Mississauga (Canada) tau tsim cov txheej txheem neuroendoscopic cannula, uas tuaj yeem siv los saib xyuas txoj haujlwm ntawm qhov endoscope raws li MRI thiab CT cov ntaub ntawv. Cov software tshwj xeeb muab cov duab endoscopic nyob rau ntawm qhov chaw thiab peb-dimensional positioning ntawm cov cuab yeej cuab tam. Lwm txoj kev loj hlob yog kaus mom hlau tsom iav, uas txuas nrog kev phais microscopes, tso cai rau cov kws phais neeg saib xyuas cov teeb liab kis tau tus mob thiab kev phais kev pom. Nyob rau yav tom ntej, cov thev naus laus zis no tseem tuaj yeem siv rau hauv kev phais txha caj qaum endoscopes los them nyiaj rau qhov tsis txaus ntawm ob sab ntawm tus txha caj qaum endoscopes. Kev txhim kho yav tom ntej hauv kev yees duab thev naus laus zis tseem yuav suav nrog cov duab kho qhov muag zoo dua qub, tsom mus zoo dua li kev phais lub tshuab tsom, zoo dua elasticity thiab ua haujlwm tau zoo, ua haujlwm zoo dua, thiab kev txhim kho txuas ntxiv ntawm 3D duab. Cov kev txhim kho no tuaj yeem ua rau kev phais mob caj dab endoscopic mus rau qhov siab tshiab.