Ibibazo nibibazo byugarije imbere yo kubaga umugongo endoskopi

Igihe cyo kubaga endoskopi yo kubaga cyatangiye mu mpera za za 70 hifashishijwe televiziyo ifasha ikoranabuhanga rya endoskopi. Hamwe niterambere ryihuse ryubuhanga bwibasirwa cyane nka arthroscopie, laparoscopi, thoracoscopy, na discoscopi, ubu byasimbuye kubaga gakondo kumugaragaro mubuvuzi bwindwara nyinshi. Bitewe nuburyo budasanzwe bwa anatomique hamwe nibisabwa byo kubaga umugongo, kubaga umugongo byoroheje byibasira umugongo uhura nibibazo byinshi byubuvuzi, ingorane zikomeye zo kubaga, hamwe ningaruka nyinshi zo kubaga hamwe ningorane, ibyo bikabuza cyane kandi bikabuza iterambere niterambere ryokubaga umugongo wa endoskopi.

Endoscopic yafashije kubaga imbere yinkondo y'umura ya foramen incision decompression kubaga byatangiye mu myaka ya za 90. Ibyiza byayo ntabwo ari ihahamuka rito ryo kubaga gusa, ahubwo ni no kubungabunga disiki yinkondo y'umura, bityo ikarinda imikorere yayo. Ubu kubaga bugira ingaruka zikomeye mu kuvura ibimenyetso by’uruhande rumwe rw'umugongo w'inkondo y'umura, ariko ingorane nyamukuru y'ubu buryo ni ugukomeretsa kw'imitsi y'urugingo mu gihe cyo kuvura ingingo zifatika. Jho yizera ko inkondo y'umura 6-7 ihuza imyanya ndangagitsina, impande zomugongo zifatanije na vertebra zifatanije, hamwe na transvers inzira yo guhinduranya ni ahantu hakunze gutera imvune yimitsi. Umwanya w'inkondo y'umura 6-7 uhuza umwanya uri hagati yuburyo bwo guhinduranya inkondo y'umura 7 n'imitsi miremire y'ijosi. Kugira ngo wirinde gukomeretsa kw'imitsi y'amaraso, Jho atanga igitekerezo cyo guca imitsi miremire yo mu ijosi kurwego rw'inkondo y'umura 6. Igice cy'imitsi kizasubira mu nzira yo guhinduranya inkondo y'umura 7, bityo bikagaragaza imiyoboro y'urugingo munsi y'imitsi miremire y'ijosi; Kugirango wirinde gukomeretsa kw'imitsi ya vertebral kuri vertebra ifatanye, imyitozo yo gusya ntigomba kwinjira mu mwobo. Igice cyamagufwa cortex irashobora kugumana mugihe cyo gusya hamwe na vertebra ifatanye, hanyuma igufwa rishobora gukurwaho na spatula. Nyuma yo gutandukana imbere kubarwayi bafite ibimenyetso byumuzi umwe umwe, ibimenyetso byumuzi bitandukanijwe bishobora kubaho kubera ihungabana ryinkondo y'umura. Gukora gusa imitsi ya decompression nervice ntishobora kugabanya neza ibimenyetso byububabare bwijosi muri aba barwayi. Guhuza intervertebral nabyo birakenewe kugirango ugumane inkondo y'umura, ariko guhuza endoskopique byibasiwe no gukosora uruti rw'umugongo w'imbere ni ikibazo kitavuwe.

Ikoranabuhanga rya kijyambere rya thoracoscopi ryatangiye mu ntangiriro ya za 90, kandi hamwe n’iterambere ryaryo, ryagiye rirangiza buhoro buhoro kuvura nka lobectomy, thymectomy, pericardial na pleural indwara. Kugeza ubu, tekinoroji ya thoracoscopique yakoreshejwe mu kuvura biopsy ya vertebral lesion biopsy, kuvoma ibibyimba no kuvura uruti rw'umugongo, disque intervertebral disc nucleus pulposectomy ya thoracic disc herniation, decompression imbere ndetse no gukosora imbere kuvunika kwa thoracic vertebral, ndetse no gukosora scoliose cyangwa kurekura. no gukosora ubumuga bwa kyphose. Imikorere n'umutekano byayo byamenyekanye cyane. Ariko, ugereranije no kubaga igituza gakondo, thoracoscopic byibura byibasiye umugongo wimbere wumugongo ntabwo ufite ikibazo kimwe gusa cyo guhura nibibazo byo kubaga, ariko kandi ifite igihe kinini cyo kubaga, ingorane zikomeye zo kubaga, hamwe ningaruka zo kubaga. Dickman n'abandi. yabazwe 15 ya thoracoscopique ku barwayi 14 barwaye disiki ya thoracic, bivamo indwara 3 za atelectasis, inshuro 2 zo mu bwoko bwa neuralgia intercostal, ikibazo 1 cyo kurekura imiyoboro isaba kuvanwaho, ikibazo 1 cya disiki zisigaye zisaba kubagwa kabiri, n’ikibazo 1 cyo kuva mu bwonko bwa cerebrospinal nibindi bibazo. McAfee n'abandi. yatangaje ko ikibazo cyo kuva amaraso gikora nyuma yo kubagwa thoracoscopic minimally invasive spinal inkingi yo kubaga ari 2%, indwara ya atelectasis ni 5%, indwara ya neuralgia intercostal ni 6%, kandi hari n'ingorane zikomeye nko gukomeretsa uruti rw'umugongo, chylothorax, imvune ya septal, nibindi bikomere byingingo. L ü Guohua n'abandi. yatangaje ko ingorane zo kubaga umugongo imbere ya thoracoscopic zirimo:; Bitewe no kuva amaraso aterwa no gukomeretsa kw'imitsi ya azygous, guhinduka kubagwa mu gatuza kugirango barekurwe ni 2,6%, ibikomere byo mu bihaha ni 5.2%, chylothorax ni 2,6%, atelectasis yaho ni 5.2%, pleurisie exudative ni 5.2%, igihe cyo gukuramo igituza> amasaha 36, ubwinshi bwamazi> 200ml ni 10.5%, urukuta rwigituza urufunguzo cyangwa ububabare ni 2,6%. Byerekanwe neza ko mugihe cyambere cyo kubaga thoracoscopic scoliose ifunguye, indwara ziterwa ni nyinshi kuruta kubaga gakondo. Hamwe no kwegeranya ubumenyi nuburambe mubikorwa, ibibazo byingutu bizagabanuka cyane. Watanabe n'abandi. yasesenguye abarwayi 52 barimo kubagwa umugongo wa thoracoscopic na laparoscopique, bafite ibibazo byinshi bya 42.3%. Umubare munini wibibazo nibibazo byo kubaga bidindiza iterambere rya thoracoscopic anterior thoracic kubaga. Kubera iyo mpamvu, intiti nyinshi zirasaba kandi zigakoresha thoracoscopique ifashwa no kubagwa mbere yo kubaga imbere ya thoracic, ibyo ntibituma gusa kubaga byoroshye, ariko kandi bigabanya igihe cyo kubaga.

Mu mpera za 1980, laparoskopi ya mbere ya cholecystectomy yakozwe na DuBois n'abandi. mubufaransa yazanye iterambere ryimpinduramatwara mubuhanga bwa laparoscopique. Kugeza ubu, kubaga umugongo wa laparoskopi ikoreshwa cyane cyane mu kuvanaho disiki yo hepfo yo mu nda no kubaga intanga (ALIF). Nubwo laparoscopique ALIF ishobora kugabanya neza kwangirika kwinyama, kubaga munda ALIF yo mu nda bisaba ko hashyirwaho pneumoperitoneum, ishobora gutera ingorane zo guhumeka no guhumeka ikirere mugihe cyo kubyimba no guhindura imyanya yinda mugihe cyo kubaga laparoskopi, bikaviramo umutwe muto n'ibirenge birebire. Byongeye kandi, ingorane ziterwa no kubaga imbere yimbere yo kubaga harimo hernia yo munda yo hanze, gukomeretsa ingingo zo munda, kwangirika kwamaraso manini, embolisme ya arterial na venine embolism, iatrogenic spinal nervice, gusohora retrograde, no guturika kw'ibikoresho. Ikibazo cyo gusohora retrograde nyuma yo kubagwa lumbar fusion kigenda gikurura abantu. Ibi biterwa no gukomeretsa imitsi ya nervice izenguruka inda yo hepfo iri imbere yumugongo wo hepfo mugihe cyo kubaga. Regan n'abandi. yatangaje ko indwara yo gusohora retrograde mu bantu 215 barwaye laparoskopi yo hepfo yo hagati ya BAK fusion yari 5.1%. Raporo yakozwe na FDA yo muri Amerika isuzuma ikoreshwa rya LT-CAGE mu guhuza laparoscopique interbody fusion, abagera ku 16.2% b’abarwayi babaga abagabo babaga bafite amasohoro ya retrograde, aho usanga umubare munini w’izo ngaruka ugereranije no kubaga gakondo. Newton n'abandi. bizere ko indwara ziterwa no kubaga umugongo wa thoracoscopique imbere y’umugongo isa n’ubwa gakondo yo kubaga mu gatuza, ariko umubare w’amazi nyuma yo kubagwa nyuma yo kubagwa kwa thoracoscopique uri hejuru cyane ugereranije no kubagwa mu gatuza. Bitewe ningorane zikomeye zo gukora hamwe ningaruka zo kubagwa laparoscopic lumbar interbody fusion kubagwa, hamwe n’ikibazo kinini cyo guhura n’ibibazo byo kubaga, laparoskopi yafashaga kubaga uduce duto duto two kubaga ntabwo ifite ihungabana rito gusa kandi byoroshye gukora, ariko kandi ifite igihe gito cyo gukora kandi ikibazo gito cyibibazo. Nicyerekezo cyiterambere ryigihe kizaza cyo kubaga byimbere byimbere.

Nubwo iterambere ryibinyabuzima rishobora kongera imbaraga zo guhuza, haracyariho ibitagenda neza, nko kugenda gake hamwe no kongera imihangayiko mubice byegeranye. Kubera izo mpamvu, gusimbuza disikuru ya intervertebral niyiterambere rishimishije cyane. Nubwo gukora disiki yubukorikori ihwanye rwose nibiranga ibintu bitandukanye biranga disiki isanzwe iragoye cyane, ni ingirakamaro rwose kumubiri wumuntu. Irashobora kugabanya inkomoko yubwandu, kugabanya ihungabana ryatewe na disiketi igabanya ubukana bwa disiketi, kugarura ihungabana risanzwe, no kugarura imiterere yumugongo. Mubyigisho, gusimbuza disiki yububiko birashobora gusimbuza kubaga fusion, bigatanga physiologique yumugongo no gutinda kwangirika kwibice byegeranye. Gusimbuza disiki ya mbere ya lumbar yakozwe mu 1996, yasimbuye ububabare bwa disiki. Kugeza ubu, hari ubwoko butandukanye bwa disiki yubukorikori irahari. Ibikoresho byayo birimo ibyuma cyangwa ibyuma byoroshye. Vuba aha, hariho disiki yubukorikori igizwe nububiko bwimbere bwa polyethylene hamwe ninyuma ya peptide, hanyuma igashyirwaho plasma. Ariko, igipimo cyo gutsinda cyo guhuza nticyemejwe neza. Mubyongeyeho, ubuvanganzo bwerekana ko gutoranya imanza, imiterere, ingano, n'umwanya wa disiki ya arttertebral ari ingirakamaro kugirango bivure neza. Raporo zabanje zibanze cyane cyane kubagwa imbere yo gusimbuza disikuru hagati, kandi tekinoroji ya endoskopique irashobora no gukoreshwa mugusimbuza disiki ya laparoskopi. Prodisc iherutse guteza imbere igisekuru cya kabiri cya prothèse ya intervertebral, ishobora kwihanganira imipaka yose yimitsi uretse kugenda. Ni ntoya mubunini kuruta disiki zisanzwe, ariko irashobora kwinjizwa binyuze muri laparoskopi yimbere cyangwa uduce duto binyuze muburyo bwa retroperitoneal.

Hamwe niterambere ryiterambere rya tekinoroji ya kijyambere yo kubaga umugongo no gukoresha biomateriali nibikoresho bishya mubikorwa byubuvuzi, kubaga umugongo byinshi kandi byinshi birasimburwa no kubaga inyuma. Kubaga umugongo byingenzi byakoreshwaga bisaba inzira yinyuma ninyuma birangira buhoro buhoro kubagwa icyiciro kimwe. Bitewe nuburyo bugoye bwa anatomique, ihahamuka rikomeye ryo kubaga, hamwe n’ikibazo kinini cyo kubaga uburyo bwo kubaga imbere y’umugongo, hamwe n’imbogamizi zidasanzwe zo kubaga hamwe n’ingaruka ziterwa no kubaga umugongo wa endoskopi, mu myaka yashize, kubaga umugongo wa endoskopi. buhoro buhoro byasimbuwe nimbaraga zoroheje zitera imbere cyangwa kuruhande imbere, inyuma, hamwe no kubaga umugongo kubaga umugongo bifashwa na endoskopi. Mu bihe biri imbere, kubaga umugongo w'imbere munsi ya laparoskopi bizakoreshwa cyane mu kubaga imbere hamwe n'inyuma yo kubaga umugongo bifashwa na laparoscopi. Ibi ntibikoresha gusa ibimenyetso byibasiye uburyo bwo kubaga endoskopique yo kubaga, ariko kandi birinda n'ingaruka zo kubagwa mu nda bigoye, igihe kinini cyo kubagwa, ndetse no guhura n’ibibazo byinshi. Hamwe nogutezimbere no gukwirakwiza ikoranabuhanga rya laparoskopi yuburyo butatu, hashyizweho ibyumba bikoreramo byubwenge kandi bivangavanze, hazabaho iterambere ryinshi mubuhanga bwo kubaga umugongo byibasiye cyane.