Ubume bophuhliso lwetekhnoloji yotyando lomqolo oluncinci

Kumashumi eminyaka akutshanje, kunye nenkqubela phambili enkulu kwiingcamango zoqhaqho lomgogodla kunye nobuchwepheshe bezesayensi, ukuthandwa kotyando lomqolo oluncinci luye lwanda kakhulu. Ubuchwephesha bomnqonqo obuncinci benzelwe ukunciphisa umngcipheko weengxaki zotyando ngelixa zifumana iziphumo ezifanayo njengotyando oluvulekileyo lwemveli. Utyando lomgudu oluncinci lukhuthaza ukuphepha okanye ukunciphisa umonakalo wezicubu ezinxulumene nendlela yotyando kangangoko kunokwenzeka, ukugcina izakhiwo eziqhelekileyo ze-anatomical ngaphakathi kwendawo yotyando kangangoko kunokwenzeka, ngelixa uvumela ukubuyiswa ngokukhawuleza emva kokuhlinzwa kunye nomgangatho wobomi obungcono.

Ukuqala kwitekhnoloji ye-lumbar disc microresection, iindlela ezahlukeneyo zohlaziyo oluncinci ziyaqhubeka zivela kwaye ngokuthe ngcembe zithathe indawo yotyando oluvulekileyo. Ukuphuhliswa kwezixhobo ezincedisayo zotyando zanamhlanje ezifana ne-endoscopes, navigation kunye neerobhothi ziye zandisa ngakumbi ububanzi bezalathiso zotyando lomnqonqo oluncinci, okwenza ukuba lulungele izilonda ezininzi ezintsonkothileyo zomqolo. Ngokomzekelo, ukusebenzisa i-microscope okanye i-endoscope ayikwazi ukwenza kuphela imisebenzi ye-nerve decompression / fusion yesiqhelo ngokukhuselekileyo, kodwa inokuphucula kakhulu ukuba nokwenzeka kunye nokhuseleko lwemisebenzi enxulumene nezilonda ze-spinal metastatic, izifo eziyinkimbinkimbi zomgogodla, kunye nokulimala komgogodla.

01 Inkqubo yotyando

Ukuza kuthi ga ngoku, utyando lomnqonqo olungenelelayo oluncinci lubandakanya udibaniso lwangaphakathi lwelumbar interbody fusion (MIS-ALIF), invasive invasive posterior lumbar interbody fusion (MIS-PLIF)/minimently invasive transforaminal lumbar interbody fusion fusion (MIS-TLIF), oblique lateral lumbar interbody fusion (OLIF) kunye ne-lateral lateral lumbar interbody fusion (XLIF), kunye neteknoloji ye-endoscopic fusion eye yaphuhliswa ekuqaleni kwiminyaka yamuva. Kuyo yonke inkqubo yophuhliso lweendlela ezahlukeneyo zokunciphisa umqolo, yinkqubo yembali apho uphuhliso lwezesayensi luqhuba uphuhliso lweengqikelelo zotyando kunye nobuchwepheshe.

Ukusukela oko uMagerl eqala ingxelo yokubeka isikruru se-percutaneous pedicle ngo-1982, itekhnoloji yomqolo ehlaselayo encinci ingene ngokusemthethweni kwinqanaba lophuhliso. Kwi-2002, uFoley et al. i-MIS-TLIF ecetywayo kuqala. Kwangalo nyaka, Khoo et al. ingxelo ye-MISPLIF okokuqala ngqa isebenzisa umjelo osebenzayo ofanayo. Olu tyando lubini lwavula indlela yophuhliso lotyando lomnqonqo olungasemva. Nangona kunjalo, ukufikelela kwindawo yomgogodla ngokusebenzisa indlela yangasemva, akunakuphepheka ukukrazula izihlunu kunye nokususa inxalenye yesakhiwo sethambo, kwaye iqondo lokuvezwa kwebala lotyando liya kuchaphazela inani lokuphuma kwegazi, izinga lokusuleleka kunye nexesha lokubuyisela emva kokuhlinzwa. . I-ALIF ineenzuzo ezinokuthi zingangeni kwi-spinal canal, ukuphepha ukubunjwa kwe-epidural scar, ukugcina ngokupheleleyo isakhiwo se-musculo-osseous ye-posterior spine, kunye nokunciphisa umngcipheko wokulimala kwe-nerve.

Kwi-1997, i-Mayer yabika indlela eguquguqukayo yecala kwi-ALIF, isebenzisa indlela ye-retroperitoneal / yangaphambili yepsoas kwinqanaba le-L2 / L3 / L4 / L5 kunye nendlela ye-intraperitoneal kwinqanaba le-L5 / S1. Ngo-2001, uPimenta waqala wachaza indlela yokudibanisa umgogodla ngokusebenzisa indawo esecaleni ye-retroperitoneal kunye nokwahlula i-psoas enkulu yezihlunu. Emva kwexesha lophuhliso, obu buchule bubizwa ngokuba yi-XLIF ngu-Ozgur et al. ngo 2006. Knight et al. okokuqala ingxelo ye-lateral lateral lumbar interbody fusion (DLIF) ngokusebenzisa indlela yepsoas efana ne-XLIF kwi-2009. Kwi-2012, uSilvestre et al. yashwankathela kwaye yaphucula itekhnoloji kaMayer kwaye wayibiza ngokuba yi-OLIF. Xa kuthelekiswa ne-XLIF kunye ne-DLIF, i-OLIF isebenzisa indawo ye-anatomical phambi kwe-psoas enkulu ye-muscle kwaye ayiphazamisi i-muscle kunye neentsholongwane ezingaphantsi kwayo. Akunakwenzeka kuphela ukuphepha ngokufanelekileyo umngcipheko womonakalo we-vascular obangelwa yi-ALIF, kodwa uphinde ugweme ukulimala okukhulu kwepsoas okubangelwa yi-XLIF / DLIF. Ukulimala kwe-Plexus, ukunciphisa iziganeko ze-postoperative hip flexion ubuthathaka kunye nokuphazamiseka kwethanga.

Kwelinye icala, ngokuphuculwa okuqhubekayo kwezixhobo zotyando kunye nokukhula kancinci kancinci kobuchwepheshe, imfuno yezigulane yotyando olungephi yonyukile. Kwi-1988, uKambin et al waqala wazama kwaye wazisa utyando lwe-endoscopic spine. Ukuza kuthi ga ngoku, eyona ndlela imele i-single-incision okanye i-double-incision endoscopic laminectomy ukunyanga i-lumbar spinal stenosis, i-lumbar disc herniation, njl. Ngaloo ndlela, i-endoscopic lumbar interbody fusion yavela. Ngokweempawu ze-endoscope, yahlulwe ibe yi-endoscope epheleleyo, i-microendoscope kunye ne-endoscope ephindwe kabini. Ngokusebenzisa indlela ye-transforaminal okanye indlela ye-interlaminar ye-spinal fusion. Ukuza kuthi ga ngoku, i-endoscopically assisted lateral lumbar interbody fusion (LLIF) okanye i-TLIF isetyenziswe ngokweklinikhi ukunyanga i-spondylolisthesis ewohlokayo kunye ne-lumbar spinal stenosis ehamba kunye nokungazinzi komgogodla okanye i-foraminal stenosis.

02 Izixhobo ezincedisayo zotyando

Ukongeza kuphuculo lweengqikelelo zotyando olungenelelayo olungephi kunye neendlela, ukusetyenziswa kwenani elikhulu lezixhobo ezincedisa utyando oluchanekileyo lukwaququzelela utyando olungephi. Kwintsimi yotyando lomqolo, isikhokelo somfanekiso wexesha langempela okanye iinkqubo zokuhamba zibonelela ngokhuseleko olukhulu kunye nokuchaneka kuneendlela eziqhelekileyo zezandla zasimahla. Imifanekiso ye-CT yomgangatho ophezulu wokuhamba nge-intraoperative inokubonelela ngembono ye-intuitive ye-three-dimensional intuitive field yotyando, ivumele ukulandelwa kwe-anatomical real-time-anatomical tracking ngexesha lotyando, kunye nokunciphisa umngcipheko wokuvezwa kwemitha yoogqirha kunye nezigulane ngaphezu kwe-90%.

Ngokwesiseko sokuhamba nge-intraoperative navigation, ukusetyenziswa kweenkqubo zerobhothi kwicandelo lotyando lomqolo kuye kwanda kwiminyaka yakutshanje. I-Pedicle screw ukulungiswa kwangaphakathi kusetyenziswa ummeli weenkqubo zerobhothi. Ngokudibanisa neenkqubo zokuhamba, iinkqubo zerobhothi zilindeleke ngokwethiyori ukuba zifezekise Ukulungisa i-pedicle screw yangaphakathi ngokuchanekileyo ngelixa unciphisa umonakalo wezicubu ezithambileyo. Nangona kungekho datha yeklinikhi eyoneleyo malunga nokusebenziseka kweenkqubo zerobhothi kutyando lomqolo, izifundo ezininzi zibonise ukuba ukuchaneka kokubekwa kwesikrufu se-pedicle ngeenkqubo zerobhothi kungaphezulu kunesikhokelo semanyuwali kunye ne-fluoroscopic. Enye yezona zinto zibalulekileyo zoqhaqho oluncediswa yirobhothi kukuba yoyisa ukudinwa kwengqondo nomzimba kogqirha wotyando ngexesha lotyando, ngaloo ndlela ibonelela ngotyando olungcono noluzinzileyo kunye neziphumo zeklinikhi.

Kwinkqubo yotyando lomqolo oluncinci, kubalulekile ukukhetha izikhombisi ezifanelekileyo kunye nokuqinisekisa ukwaneliseka kwesigulane ngeziphumo zonyango. Ukudityaniswa kobukrelekrele bokwenziwa (AI) kunye nokufunda komatshini kuya kunceda oogqirha botyando baphucule ukucwangciswa kwangaphambili, izicwangciso zokwenziwa kotyando kunye nokwandisa ukhetho lwesigulane ukuze kuqinisekiswe iziphumo eziphuculweyo zasemva kokuhlinzwa kunye nokwaneliseka kwesigulane.

03 Ukujonga

Nangona iteknoloji ye-spinal invasive encinci yenze inkqubela phambili kwaye okwangoku iyona ngcamango eyamkelekileyo kakhulu kwi-kliniki yokusebenza kweklinikhi, kufuneka siphinde siqaphele imida yotyando oluncinci. Ukuphuhliswa kobuchwephesha obuncinci bunciphise kakhulu ukuvezwa kwezakhiwo ze-anatomical zasekhaya ngexesha lotyando. Kwangaxeshanye, ibeke iimfuno eziphezulu kwizakhono zogqirha wotyando kunye nokuqonda izakhiwo ze-anatomical. Utyando oluninzi lomqolo, olunjengotyando lokulungiswa komqolo ngenxa yokukhubazeka okukhulu, sele kunzima kakhulu ukwenza naphantsi kweemeko eziphezulu zokuvezwa. Ukubonakaliswa ngokupheleleyo kwendawo yokuhlinzwa kunceda izixhobo zokusebenza kunye nokusebenza kwe-intraoperative, kunye nokuvezwa ngokupheleleyo kwe-nerve kunye nezakhiwo ze-vascular nako kunzima. Unokunciphisa ngempumelelo umngcipheko weengxaki. Ekugqibeleni, injongo ephambili yotyando lomqolo kukuqinisekisa ukuba inkqubo yenziwa ngokukhuselekileyo.

Isishwankathelo, utyando olungephi luye lwaba yinto engenakuphepheka ekuphuhliseni iikhonsepthi zotyando lomqolo kwihlabathi liphela. Injongo ephambili yokuhlinzwa okuncinci komgogodla kukunciphisa umonakalo wezicubu ezithambileyo ezinxulumene nendlela kunye nokugcina isakhiwo esiqhelekileyo se-anatomical, ukukhawuleza inkqubo yokubuyisela emva kokuhlinzwa kunye nokuphucula umgangatho wobomi ngaphandle kokuchaphazela umphumo wotyando. Kwiminyaka embalwa edlulileyo, ukuqhubela phambili okukhulu kwiingcamango zotyando kunye nobuchwepheshe bezesayensi kwenze ukuba utyando lomqolo oluncinci luqhubele phambili. Iindlela ezahlukeneyo zotyando zivumela oogqirha ukuba benze i-360 ° i-decompression invasive encinci kunye ne-fusion ejikeleze umqolo; itekhnoloji ye-endoscopic yandisa kakhulu intsimi ye-anatomical ye-intraoperative; Ukuhamba kunye neenkqubo zerobhothi zenza i-pedicle screw fixation yangaphakathi ibe lula ngakumbi.

Nangona kunjalo, utyando olungenelelayo oluncinci luzisa nemingeni emitsha:
1. Okokuqala, utyando oluncinci oluncinci lunciphisa kakhulu uluhlu lwe-exposure, olunokwenza kube nzima kakhulu ukujongana neengxaki ze-intraoperative, kwaye kunokufuna ukuguqulwa ekuvuleni utyando.
2. Okwesibini, ithembele kakhulu kwizixhobo ezincedisayo ezibiza kakhulu kwaye ine-curve yokufunda, nto leyo eyandisa ubunzima bokupasa kwayo ekliniki.

Sijonge phambili ekuboneleleni izigulana ngeendlela ezingcono nezingcono ezingeyongozi ngokuqhubekayo kwiikhonsepthi zotyando kunye nophuhliso oluqhubekayo lwesayensi kunye nobuchwepheshe kwixesha elizayo.