V-mawonekedwe a Bichannel Endoscopy System (VBE)

Kuphatikizika kwa VBE-LIF (Transformminal VBE-LIF)

Kukonzekera koyambirira ndi kukonzekera: Musanayambe opaleshoni, tiyenera kufunsa mosamala mbiri yachipatala ya wodwalayo, kufufuza kwa thupi ndi kufufuza kothandizira kuti timveketse matenda a wodwalayo, ndikupatulapo zotsutsana zoyenera musanaganizire kuyenera kwa kusankha opaleshoni ya VBE. Musanachite opaleshoni, X-ray iyenera kuwerengedwa mosamala kuti ifufuze kusintha kwa vertebral, scoliosis, hyperplasia ya olowa, ndi kukhalapo kapena kusamuka kwa vertebrae ndi kuwonongeka kwa msana. Kutalika kwa danga la intervertebral, kukula ndi kutalika kwa intervertebral foramen, ndi ziwalo zing'onozing'ono za malo omwe ali ndi matenda a intervertebral ayenera kuwonedwa kudzera mu radiographs lateral, ndipo 3D morphology ya foramen ndi lumbar spine ikhoza kuwonedwa kupyolera mu kumangidwanso kwa 3D. a CT, ndi lumbar msana ayenera kusanthula mosamala ndi lumbar msana maginito resonance sagittal ndi transverse sikani, kuona kukhalapo kapena kusowa kwa mitsempha ya minyewa ya gawo opareshoni, ndi kumvetsa minyewa mizu yogwirizana. Timasanthula mosamala lumbar MRI sagittal ndi transverse scans kuti tiwone ngati mizu ya mitsempha mu gawo logwiritsiridwa ntchito ili ndi kusiyana kulikonse, kumvetsetsa njira ya mitsempha ya mitsempha, ndikukonzekera njira ya opaleshoni ndi njira zodzitetezera kuti tisawonongeke mitsempha. Malinga ndi njira yopangira opaleshoni, mtunda wa paracentesis ndi ngodya ya puncture imayesedwa pa filimu ya lumbar magnetic resonance. Nthawi zambiri, mtunda wa paracentesis wa lumbar VBE ndi 6 mpaka 9 cm, ndipo cephalad yochulukirapo, mtunda wa paracentesis umakhala wocheperako, ndipo ngodya yolanda nthawi zambiri imakhala 30 ° mpaka 45 °.

Kuyika kwa thupi ndi kuyika chizindikiro: wodwala amatenga malo opendekeka, mimba imayimitsidwa, ndipo zipatala zomwe zili ndi mikhalidwe zimatha kugwiritsa ntchito neurophysiological monitoring kuti iwonetse momwe thupi limakhalira pazikopa za pedicle ndi malo amtundu wapawiri-channel endoscopic incision ndi body surface locator. Nthawi zonse mankhwala ophera tizilombo toyambitsa matenda ndi kufalitsa thaulo, chifukwa endoscopy ya njira ziwiri imafunikira njira ziwiri zotsuka madzi, madzi otsuka ndi ochulukirapo, amayenera kukonzekera pafupifupi 3000 ml ya madzi otsuka, komanso nthawi yomweyo kutentha madzi otsuka, kupewa kuthamanga kwambiri. madzi okhudza kutentha kwa thupi la wodwalayo, kugwiritsa ntchito thumba lamadzi la arthroscopic kusonkhanitsa madzimadzi amthirira, malo a makina a C-arm X-ray ndi malo a zipangizo zojambula zomwe zinakonzedweratu, kuti athandize opaleshoni ndi fluoroscopy, pewani kusintha mobwerezabwereza kuchedwa nthawi ya opaleshoni.

Kuyika kwa zingwe zomangira zomangira za percutaneous pedicle: Nthawi zambiri, chingwe chowongolera kuti gawolo likhazikike ndi zomangira za percutaneous pedicle imayikidwa koyamba pansi pa fluoroscopy, koma imathanso kuchitidwa endoscopically.

Komabe, ndizothekanso kupanga endoscopic fusion yotsatiridwa ndi percutaneous pedicle screw guidewire implantation ndi fixation.

Kubowola kwa singano: Masingano apadera osawoneka bwino komanso osongoka amapezeka ngati gawo la chidacho ndipo amatha kusankhidwa malinga ndi zomwe dokotala wa opaleshoni amakonda. Njira yabwino kwambiri yopumira ili pamtunda wapamwamba wa thupi lotsika la vertebral, pafupi ndi malire a calcaneus pafupifupi 45 °. Kupatuka kwapamwamba ndi kotsatirako kumakonda kuvulaza muzu wotuluka, pamene kupatuka kwapakati kumakhala kovulaza thumba la dural ndi mizu yoyenda. Choncho, kukonzekera koyambirira kwa njira yopangira opaleshoni kuyenera kuchitidwa powerenga mosamala deta yojambula ndi

Dziwani njira yabwino kwambiri yoboola.

Kukhazikitsa njira yogwirira ntchito: Malo a singano akafika pokhutiritsa, chubu chofananira cha dilatation chimagwiritsidwa ntchito kukulitsa pang'onopang'ono. Mukamaliza kukulitsa, njira yogwirira ntchito yokhala ndi pachimake choyikidwa imayikidwa pamodzi ndi singano yoboola kuti ifike pamalo okhutiritsa. Macheka ozungulira ozungulira amadulidwa mu articular synovial joint kuchokera mkati mwa njirayo molunjika kapena fluoroscopy. Macheka ozungulira akafika pamalo otetezeka kwambiri, fupa la fupa limachotsedwa ndikusungidwa kuti fupa ligwirizane.

Chithandizo cha intervertebral space: Pambuyo pa fupa la fupa kuchotsedwa ndi macheka ozungulira ndi mfuti, malo a intervertebral amatha kufika mwachindunji, nucleus pulposus imachotsedwa ndi nucleus pulposus forceps, intervertebral space spreader imafalikira pang'onopang'ono, ndi intervertebral. space reamer ndi spatula amagwiritsidwa ntchito kuthana ndi ma endplates mpaka atatuluka magazi komanso otetezedwa bwino. Mapangidwe amakono a chida cha VEB microscopic ndi chozama-chochepa, ndi kulowa mozama mu intervertebral space osapitirira 40 mm, zomwe zimatsimikizira kuti mitsempha ya magazi ndi ziwalo zapambuyo pa thupi la vertebral sizivulala.

Kuphatikizika kwa mafupa a mafupa: Pambuyo pa malo a intervertebral atachiritsidwa bwino, fupa la fupa la fupa limalowetsedwa mu intervertebral space kuti mafupa agwirizane. Kuphatikizika kwa mafupa a intervertebral kumafunika kuwonetsetsa kuti kuchuluka kwa fupa kumezanitsidwa ndikokwanira, ndipo nthawi zambiri, fupa lopangidwa ndi autogenous la articular eminence lilibe kuchuluka kwa fupa lofunika kuti liphatikizidwe, choncho m'pofunika kuyika mafupa okwanira a allogeneic kapena opangira ngati m'malo mwa zinthu, kapena kugwiritsa ntchito zinthu zomwe zimalimbikitsa mapangidwe a mafupa, monga BMPs, pofuna kuonetsetsa kuti fupa lolumikizidwa limatha kuphatikizika.

Kuyika kwa chipangizo chophatikizira: Pambuyo pa kulumikiza mafupa, chipangizo chophatikizira chimayikidwa. Ndi mwayi wapawiri wa VBE, njira yonse yophatikizira yophatikizika imatha kuchitidwa moyang'aniridwa ndi endoscopic. Zida zophatikizira zomwe zikugwiritsidwa ntchito pano zimapezeka mumitundu yokhazikika komanso yolimba. Zida zophatikizira braced ndizosavuta kuziyika m'makona chifukwa chakuchepa kwake ndipo zimatha kumangirizidwa chida chophatikiziracho chitayikidwa m'malo mwake.

Ipsilateral ndi contralateral decompression: Nthawi zambiri amalangizidwa kuti decompression ichitike pambuyo poti fusion implantation ikamalizidwa, zomwe zitha kuchitidwa mwachindunji ndi zida zophatikizika zanjira ziwiri popanda kulowetsa trocar yogwira ntchito panjira ziwiri. Ngati malo owonera sali omveka bwino chifukwa cha magazi, etc., intervertebral foramen wamba akhoza m'malo kuchita decompression ndi disc kuchotsa; ngati padakali herniated kapena stenotic disc kumbali ya contralateral, ochiritsira intervertebral foramen angagwiritsidwe ntchito kumbali ya contralateral kuti awonongeke, kuchotsedwa kwa nucleus pulposus, ndi kuchotsedwa kwa nucleus pulposus. Nucleus pulposus ikhoza kuchotsedwa kumbali ya contralateral ngati pali disc herniation kapena stenosis, ndipo mbali zonse ziwiri zimatha kuyendetsedwa ndi ogwira ntchito awiri panthawi imodzi, zomwe sizikuwonjezera nthawi ya opaleshoni.

Percutaneous screw fixation: Pambuyo pomaliza kuphatikizika ndi decompression, percutaneous pedicle screw fixation imachitidwa. Pambuyo pa fluoroscopy ndi kutsimikizira, zomangira za percutaneous zimakongoletsedwa motsatira kalozera woyikidwa ndipo chobowolacho chimatsekedwa.