Endoscopic discectomy binyuze mumwanya uhuza intera

Microscopique discectomy ikoresheje imiyoboro itera byibuze kuri ubu ni bwo buryo bukoreshwa cyane mu buryo bwo kubaga umugongo uburyo bwo kubaga umugongo bwo kuvura indwara ya herniation. MED minimally invasive lumbar discectomy nubuhanga bushya bwo kubaga umugongo bwo kubaga umugongo bwa mbere bwakozwe na Foley na Smith mu 1997. MED minimally invasive lumbar discectomy yifashisha ibyiza bya laminoplastique gakondo hamwe na tekinike ya endoskopi. Ishiraho uburyo bwo kubaga binyuze mu ruhererekane rw'imiyoboro yagutse kandi ikoresha umuyoboro wa diametre 1,6-1.8cm kugira ngo urangize inzira nka laminoplasti, uduce duto twa resection, imitsi yo mu mitsi ya decompression, hamwe na disikete ya disikete yari isanzwe bishoboka binyuze mu kubaga kumugaragaro. Ugereranije na disikuru ya gakondo, ubu buhanga bushyiraho uburyo bwo kubaga binyuze mu ruhererekane rwa cathete yagutse, bitabaye ngombwa ko habaho gutandukana no gukurura imitsi ya parasipine, kandi ikarangiza ibikorwa byose byo kubaga mu muyoboro wa diameter 1,6-1.8cm. Kubwibyo, ifite ibyiza byo kubagwa duto duto, gukomeretsa imitsi yoroheje ya parasipine, kuva amaraso make, no gukira vuba nyuma yo kubagwa. Bitewe na sisitemu ya kamera na videwo bigezweho, umurima wo kubaga wongerewe inshuro 64, bituma hashobora kumenyekana neza no kurinda isakoshi ya dural, imizi y’imitsi, hamwe n’imitsi y'amaraso iri mu muyoboro w’umugongo mu gice cyo kubaga mu gihe cyo kubagwa; Muri icyo gihe, umurima wo kubaga usobanutse neza urangiza neza ibikorwa bitandukanye byo kubaga, birinda neza ibitagenda neza byimirima gakondo yo kubaga ibyerekezo byimbitse kandi byangiza cyane imiterere yamagufwa yinyuma yumugongo. Iragabanya cyane kubungabunga ubusugire bwimiterere yinyuma yibice bigize uruti rwumugongo, bityo bikagabanya neza ibibaho nyuma yo kubagwa inkovu nyuma yo kubagwa no guhungabana.

Impinduka za pathologiya mukarere runaka zigena aho umuyoboro wakazi uhagaze. Kubaga byoroheje byibura kubaga birashobora gutanga decompression ihagije mumyanya yo hagati yumugongo, ikiruhuko cyuruhande, hamwe nuduce twa foramen. Mubyongeyeho, disiketi ya disiketi yinyuma hanze yimikorere ya intervertebral nayo irashobora gukurwaho. Mbere yo gukora decompression ahantu hatandukanye, birakenewe gutegura inzira yo kubaga. Kugirango decompression yimitsi idasanzwe, umuyoboro wakazi urashobora gushirwa kumurongo uhinduranya hagati yimikorere. Ubwa mbere, inzira ya transvers ya membrane iramenyekana, kandi inzira yo guhinduranya inzira yaciwe kugirango yerekane imizi yacyo yimbitse. Iyo imizi yo gusohoka imitsi imaze kugenwa, ingirabuzimafatizo ya disikuru isohoka irashobora kuboneka mugice cyimbitse cyumuzi. Ubushakashatsi buherutse kugereranya discectomie yibasiwe cyane no kubaga gakondo, kandi ibisubizo byerekana ko kubaga byibasiye byoroheje byangiza ingirangingo ntoya, kutagira imitsi mike, gutakaza amaraso make, ibimenyetso byububabare bworoheje nyuma yo kubagwa, kumara igihe gito mu bitaro, no gukira vuba no gusubira ku kazi. Ubushakashatsi bwagenzuwe hagati ya microsurgical discectomy gakondo ifunguye hamwe na microsurgical discectomie yibasiwe na minisiteri yibasiwe na minisiteri yibasiwe na minisiteri yerekanaga ko kubaga binyuze kumuyoboro muto byibasiye umutekano bifite umutekano kandi byiza.

Ubuhanga bushya bwa discoscopie intervertebral (MED) bwakozwe na Foley na Smith ni ihuriro ryiza rya tekinike ya microsurgical tekinike na tekinike ya endoskopi. Kubaga MED bisa no gufungura microscopique discectomy kandi birashobora gukoreshwa muri laminectomy, decompression, foraminotomy, no kubaga disiki ya herniation. Ubworoherane bwo gukora, ibimenyetso byinshi, hamwe nibikorwa bitandukanye bya MED byorohereza abaganga kuva mububiko gakondo bajya kubaga endoskopi. Nubwo iyerekwa rya endoskopique ridatanga gusa umurima wo kubaga usobanutse kandi wagutse gusa, ariko kandi ryoroshya kandi rifite akamaro, rirashobora gutanga amashusho 2D gusa kandi akenshi rikabuzwa no kuva amaraso no kwerekana bidasobanutse, ntabwo aribyiza nka microscopique discectomy. Iterambere rya endoskopi yerekana amashusho hamwe na tekinoroji ya endoskopi ya tekinoroji irashobora gufasha kunoza iki kibazo.

Kugenzura amaraso ni ngombwa cyane cyane muburyo ubwo aribwo bwose bwo kubona amashusho, kuko kuva amaraso menshi byongera ibyago byo kurira igihe kirekire no gukomeretsa imizi. Amaraso ava hanze ya dura cyangwa hafi yingingo ntoya bibangamira kubaga kwa muganga kutabasha gukomeza gukora, ariko uburyo bumwe na bumwe bwa gakondo nka microscopique discectomy burashobora gukoreshwa (fibrillar collagen gel, gel tromboxane, gelatine sponge hamwe nuduce duto twa pamba, nibindi). Endius yakoze igikoresho gito cya bipolar electrocoagulation (MDS) gifite icyuma cyikubye kabiri, gishobora gukoreshwa muburyo butandukanye, kumena amaraso, hamwe na hemostasis ya electrocoagulation. Mubyongeyeho, sisitemu ebyiri yumucyo endoskopi sisitemu (infrared / igaragara) iremewe, ikongeramo umuyoboro wa infragre kuri sisitemu ya laparoskopi. Ubu buryo bushobora gutahura amaraso mato mato mu bidukikije biva kuva amaraso, kumenya aho amaraso aherereye, gufasha umuganga ubaga vuba gutwika kugira ngo ahagarike kuva amaraso, kandi bigabanye ibikorwa bya hemostasis inshuro nyinshi mugihe aho amaraso adasobanutse.

Kugeza ubu, endoskopi nyinshi zumugongo zivuga ko zifite ubunini bwa 20 x mugihe ukoresheje urumuri rwa xenon cyangwa halogen, kandi rushobora kugera kuri pigiseli 3 x 104. Ubuhanga bwa visualisation bwa vuba bushobora kugera kuri pigiseli 5 x 104 binyuze muri diameter ya 1.8mm ya fibre, ibyo bikaba bihagije kubagwa benshi. Kubaga umugongo endoskopique yo kubaga bizungukirwa na fibre ntoya, bitanga umwanya munini wo kubaga bitabangamiye ubwiza bwibishusho. Irindi terambere ni kumurika kabiri. MGB endoscopi ikoresha sisitemu ya telesikope yitwa Igicucu, ihuza amasoko abiri yigenga yo kumurika kuri endoskopi isanzwe ya 30 ° yo kubaga. Bitewe nimiterere ya Shadow, irashobora gutanga plastike nziza no gutandukanya, ishobora guhinduka mumashusho yibice bitatu, ikagera kumurongo muremure hamwe nuburyo bumwe bwo kubaga busobanutse. Ikindi cyateye imbere muri endoskopi yumugongo ni sisitemu yo kurwanya nebulisation, kuko re nebulisation nyuma yisuku yo hanze irashobora gutuma habaho guhagarika inshuro nyinshi kubaga. Kugumana icyerekezo gisobanutse ningirakamaro cyane mugushira mubikorwa umutekano wo kubaga umugongo byoroheje. Mu 1993, intiti zize kongeramo "sheath" (umuyoboro winyuma) kuri endoskopi gakondo, zishobora kweza no gukama lens optique igihe icyo aricyo cyose, kugirango lens ikomeze kuba isuku kandi ntigomba gukurwaho kenshi mumubiri wumurwayi. Wongeyeho defogger irashobora gukuraho umwotsi uterwa nicyuma kinini cyo kubaga amashanyarazi. Kubwamahirwe, sisitemu ntishobora gukumira atomisiyumu isanzwe iterwa nubusumbane buri hagati yubushyuhe bwa lens nubushuhe mukarere gakoreramo. Ibigo bimwe byagerageje kongeramo sensor hamwe ninsinga zirwanya ubushyuhe inyuma yinzira kugirango bikemure iki kibazo. Ukurikije ibisobanuro bihanitse byerekana amashusho (HDI) ya chip ya CCD, irashobora gutanga pigiseli miliyoni 2 mumurongo wa 1250 utambitse, bityo ukabona umurima wo kubaga usobanutse neza.

Iterambere rya tekinoroji ya mudasobwa hamwe n’ikoranabuhanga rya endoskopi ryashoboje kwiyubaka mu buryo butatu bwo kongera amashusho y’amashusho, bigahuzwa no guhuza amashusho mbere yo gutangira hamwe na scan ya intraoperative hanyuma bigashyirwa ku mashusho ya endoscopique. Ubuhanga nkubwo bwakoreshejwe mububiko bwa craniocerebral, bukomatanya kwiyubaka mbere yo gutangira amashusho hamwe na microscope yo kubaga. Ibi birashobora gufasha kubaga kwemeza imipaka yibibyimba no kubikuraho neza. Vuba aha, Mississauga (Kanada) yashyizeho urumogi rwa neuroendoscopique, rushobora gukoreshwa mu kureba aho endoskopi ihagaze hashingiwe ku makuru ya MRI na CT. Porogaramu idasanzwe itanga kurubuga rwa endoskopi amashusho hamwe nuburyo butatu bwerekana imyanya yibikoresho. Iyindi terambere ni ingofero yerekana ibirahuri, ihujwe na microscopes yo kubaga, ituma abaganga babaga bareba ibimenyetso byerekanwa byerekanwe hamwe nu gice cyo kubaga. Mu gihe cya vuba, iryo koranabuhanga rishobora no gukoreshwa mu kubaga uruti rw'umugongo endoskopi kugira ngo hishyurwe amakosa ya endoskopi y'imigongo ibiri. Iterambere ry'ejo hazaza mu buhanga bwo gufata amashusho rizaba ririmo no gukemura neza amashusho ya optique, kwibanda cyane nka microscopes yo kubaga, elastique nziza no gukora, ingaruka zikomeye zumuyoboro, hamwe no gukomeza kunoza amashusho ya 3D. Iterambere rirashobora gufata umugongo endoskopique kubaga murwego rushya.