I-discectomy ye-Endoscopic ngokusebenzisa indlela ye-intervertebral space

I-Microscopic discectomy ngokusebenzisa imijelo engaphantsi kwe-invasive okwangoku iyeyona ndlela isetyenziswa ngokuqhelekileyo i-spinal invasive yonyango yonyango lwe-intervertebral disc herniation. I-MED minimally invasive lumbar discectomy yindlela entsha yokuhlinzwa yomgogodla ehlanjululweyo yokuqala eyaphuhliswa nguFoley noSmith ngo-1997. Iseka indlela yokuhlinzwa ngokusebenzisa uchungechunge lwamashaneli ahlanjululweyo kwaye isebenzisa i-1.6-1.8cm ububanzi besiteshi sokusebenza ukugqiba iinkqubo ezifana ne-laminoplasty, i-joint resection encinci, i-nerve root canal decompression, kunye ne-intervertebral disc resection eyayinokwenzeka kuphela ngokuhlinzwa okuvulekileyo. Xa kuthelekiswa ne-discectomy yendabuko ye-lumbar, olu buchule luseka indlela yokuhlinzwa ngoluhlu lwee-catheters ezihlanjululweyo, ngaphandle kwesidingo sokuchithwa kunye nokunyanzeliswa kwemisipha ye-paraspinal, kwaye igqiba yonke imisebenzi yokuhlinzwa ngaphakathi kwe-channel ye-1.6-1.8cm ububanzi. Ke ngoko, ineengenelo zotyando oluncinci, ukwenzakala kancinci kwemisipha ye-paraspinal, ukopha kancinci, kunye nokuchacha ngokukhawuleza emva kotyando. Ngenxa yenkqubo yekhamera kunye nevidiyo ephezulu, intsimi yokujonga imboniselo yandiswa ngamaxesha e-64, ivumela ukuchongwa okuchanekileyo kunye nokukhuselwa kwe-sac dural, ingcambu ye-nerve, kunye ne-vascular plexus ngaphakathi komgudu womgogodla kwindawo yotyando ngexesha lotyando; Ngelo xesha, intsimi yotyando ecacileyo iqinisekisa ukugqitywa ngokuchanekileyo kwemisebenzi eyahlukeneyo yotyando, ukuphepha ngokufanelekileyo iintsilelo zemihlaba yokuhlinzwa yendabuko yombono onzulu kunye nomonakalo omkhulu kwisakhiwo esihlangeneyo samathambo emva komqolo. Ukwandisa ukugcinwa kwengqibelelo ye-posterior ligament composite structure yomqolo, ngaloo ndlela inciphisa ngokufanelekileyo ukwenzeka kwe-postoperative scar adhesion kunye nokungazinzi kwe-lumbar.

Utshintsho lwe-pathological kwindawo ethile lumisela ukubekwa komjelo womsebenzi. Utyando oluncinci lwe-lumbar decompression lunokubonelela ngoxinzelelo olwaneleyo kwi-canal central, i-lateral recess, kunye nemimandla ye-intervertebral foramen. Ukongezelela, i-disc intervertebral tissue ngaphandle kwe-intervertebral foramen nayo inokususwa. Ngaphambi kokwenza i-decompression kwiindawo ezahlukeneyo, kuyimfuneko ukucwangcisa indlela yokuhlinzwa. Ukunciphisa i-extraforaminal nerves, umjelo osebenzayo unokubekwa kwi-membrane yenkqubo enqamlekileyo phakathi kweenkqubo ezinqamlezayo. Okokuqala, inwebu yenkqubo enqamlezileyo iyamiselwa, kwaye i-ligament yenkqubo enqamlezileyo iyasikwa ivuleke ukuze iveze ingcambu yemithambo-luvo yokuphuma enzulu. Emva kokuba ingcambu ye-nerve ephumayo inqunywe, i-tissue ye-intervertebral disc ephumayo inokufumaneka kwindawo enzulu yengcambu ye-nerve. Uphando olutshanje luye lwathelekisa i-discectomy encinci kunye notyando oluvulekileyo lwendabuko, kwaye iziphumo zibonisa ukuba utyando oluncinci lunomonakalo omncinci wezicubu, ukuphazamiseka okuncinci kwe-nerve, ukulahleka kwegazi okuncinci, iimpawu zentlungu ephantsi emva kokuhlinzwa, ukuhlala esibhedlele okufutshane, kunye nokubuyisela ngokukhawuleza kunye nokubuyela emsebenzini. Uphononongo olulawulwa ngokungenamkhethe phakathi kwe-discectomy yemveli evulekileyo ye-microsurgical kunye ne-minimal invasive microsurgical discectomy ngokusebenzisa umjelo omncinci ongeyongozi ubonise ukuba utyando ngomzila omncinci ongeyena ukhuselekile kwaye usebenza ngakumbi.

Itekhnoloji entsha ye-intervertebral discoscopy (MED) ephuhliswe nguFoley noSmith yindibaniselwano egqibeleleyo yobuchule obuncinci be-microsurgical kunye nobuchule be-endoscopic. Utyando lwe-MED lufana ne-discectomy evulekileyo ye-microscopic kwaye ingasetyenziselwa i-laminectomy, i-decompression, i-foraminotomy, kunye ne-disc herniation operation. Ukulula kokusebenza, izibonakaliso ezibanzi, kunye nemisebenzi eyahlukeneyo ye-MED yenza kube lula ukuba oogqirha botyando batshintshe ukusuka kuqhaqho lwendabuko ukuya kuqhaqho lwe-endoscopic. Nangona i-endoscopic visualization ayiboneleli kuphela indawo yokujonga ecacileyo kunye neyandisiweyo yotyando, kodwa iququzelela kwaye isebenze, inokubonelela kuphela ngemifanekiso ye-2D kwaye ivame ukuvinjelwa ngokuphuma kwegazi kunye nomboniso ongacacanga, ongekho kakuhle njenge-microscopic discectomy. Ukuqhubela phambili kwe-endoscopic imaging kunye ne-endoscopic image fusion yetekhnoloji inokunceda ukuphucula lo mba.

Ukulawula ukopha kubaluleke kakhulu kuyo nayiphi na indlela yokubona, njengoko ukopha kakhulu kwandisa umngcipheko wokukrazuka kwengxowankulu kunye nokwenzakala kweengcambu zemithambo-luvo. Ukopha ngaphandle kokuqina okanye ukujikeleza kwamalungu amancinci kuphazamisa ukungakwazi kogqirha wotyando ukuqhubeka nokusebenza, kodwa ezinye iindlela zendabuko ezifana ne-microscopic discectomy zingasetyenziswa (ijeli ye-fibrillar collagen, ijeli ye-thromboxane, isiponji se-gelatin esifunxayo kunye neqhekeza elincinci lomqhaphu, njl. U-Endius uvelise isixhobo esincinci se-bipolar electrocoagulation (MDS) esine-sheath ene-double-layer sheath, enokuthi isetyenziswe ukwahlula okucacileyo, ukufunxa igazi kunye ne-electrocoagulation hemostasis. Ukongezelela, inkqubo ye-endoscopic yomthombo wokukhanya ombini (i-infrared / ebonakalayo) iyamkelwa, eyongeza umzila we-infrared kwinkqubo yangoku ye-laparoscopic. Le nkqubo inokubona ukopha komthambo omncinci kwindawo yokopha, ukuchonga indawo ethile yokopha, incede ugqirha wotyando ukuba atshise ngokukhawuleza ukuba ayeke ukopha, kwaye anciphise imisebenzi ye-hemostasis ephindaphindiweyo xa indawo yokopha ingacacanga.

Okwangoku, uninzi lwe-spinal endoscopes lubanga ukuba lunokukhulisa i-20 x xa usebenzisa i-xenon okanye imithombo yokukhanya ye-halogen, kwaye inokufikelela kwi-3 x 104 pixels. Ubuchule bokubonwa kwamva nje bunokufikelela kwiipikseli ezi-5 x 104 ngedayamitha yefayibha eyi-1.8mm, eyanele utyando oluninzi lwangoku. Utyando lwe-spinal endoscopic lwexesha elizayo luya kuzuza kwimicu emincinci, ukubonelela indawo yotyando ngakumbi ngaphandle kokuthomalalisa umgangatho womfanekiso. Enye inkqubela phambili kukukhanyisa kabini. I-endoscopy ye-MGB isebenzisa inkqubo yeteleskopu ebizwa ngokuba yiShadow, edibanisa imithombo yokukhanya emibini ezimeleyo kwi-endoscope yotyando esemgangathweni engama-30 °. Ngenxa yesakhiwo seShadow, inokubonelela ngeplastiki elungileyo kunye nokwahlukileyo, onokuthi utshintshwe ube yimifanekiso emithathu-ntathu, ukufezekisa isisombululo esiphezulu kunye nombono ofanayo ocacileyo wokuhlinzwa. Olunye uphuculo kwi-endoscopy yomgogodla yinkqubo yokuchasana ne-nebulization, njengoko i-nebulization emva kokucoca kwangaphandle inokukhokelela ekuphazamisekeni okuphindaphindiweyo kukuhlinzwa. Ukugcina umbono ocacileyo kubaluleke kakhulu ekuphunyezweni okukhuselekileyo kokuhlinzwa okuncinci komgogodla. Ngo-1993, abaphengululi bafunda ukongeza "i-sheath" eyongezelelweyo (ityhubhu yangaphandle) kwii-endoscopes zendabuko, ezinokucoca kwaye zomise i-lens optical nanini na, ukuze i-lens ihlale icocekile kwaye ayifuni ukuba isuswe ngokuphindaphindiweyo emzimbeni wesigulane. I-defogger eyongeziweyo inokususa umsi owenziwe ngeemela zombane ezisebenza ngokuphindaphindiweyo. Ngelishwa, inkqubo ayikwazi ukukhusela i-atomization yendalo ebangelwa ukungalingani phakathi kobushushu be-lens kunye nomswakama kwindawo yokusebenza. Ezinye iinkampani zizamile ukongeza izinzwa kunye neengcingo zokumelana nobushushu emva kwelensi ukusombulula le ngxaki. Ngokusekelwe kwi-high-definition imaging (HDI) umsebenzi we-CCD chip, inokubonelela nge-pixels yezigidi ezi-2 ngaphakathi komgca othe tyaba we-1250, ngaloo ndlela ifumana umbono ocacileyo wotyando.

Ukuqhubela phambili kobuchwephesha bekhompyuter kunye neteknoloji ye-endoscopic yenze ukuba kuphinde kwakhiwe imifanekiso enemigangatho emithathu-ntathu, edityaniswe ngokudibanisa imifanekiso yangaphambi kokusebenza kunye nezikena ze-intraoperative emva koko zincanyathiselwe kwimifanekiso ye-endoscopic ye-intraoperative. Ubuchule obufanayo busetyenzisiwe kutyando lwe-craniocerebral, oludibanisa ukwakhiwa kwakhona komfanekiso wangaphambi kotyando kunye nemifanekiso yotyando lwemicroscope yangaphakathi. Oku kunokuncedisa oogqirha botyando ekuqinisekiseni imida yamathumba kwaye bawasuse ngcono. Kungekudala, i-Mississauga (eCanada) ivelise isethi ye-neuroendoscopic cannula, engasetyenziselwa ukujonga indawo ye-endoscope esekelwe kwi-MRI kunye nedatha ye-CT. Isoftware ekhethekileyo ibonelela kwisiza semifanekiso ye-endoscopic kunye nokubekwa kweendawo ezintathu-ntathu kwizikhundla zesixhobo. Olunye uphuhliso ziiglasi zokubonisa isigcina-ntloko, eziqhagamshelwe kwimakroskopu yotyando, ezivumela oogqirha botyando ukuba bajonge imiqondiso esasazwayo kunye nendawo yokujonga indawo yotyando. Kwixesha elizayo elingekude, obu buchwephesha bunokusetyenziswa kwi-endoscopes yotyando lomqolo ukuhlawulela iintsilelo ze-endoscopes zomqolo ezimbini. Uphuculo lwexesha elizayo kwitekhnoloji yokucinga luya kubandakanya isisombululo esingcono somfanekiso, ugxininiso olungcono njengemakroskopu yotyando, ukuqina okungcono kunye nokusebenza, iziphumo ezinkulu zetshaneli ezisebenzayo, kunye nokuphuculwa okuqhubekayo kwemifanekiso ye-3D. Olu phuculo lungathatha utyando lwe-spinal endoscopic ukuya kubude obutsha.