Iingxaki kunye nemingeni ejongene noqhaqho lwangaphambili lwe-spinal endoscopic

Ixesha le-endoscopy yotyando laqala ngasekupheleni kweminyaka yee-1970 ngokungeniswa kobuchwephesha be-endoscopy obuncediswa kumabonakude. Ngophuhliso olukhawulezayo lweendlela ezingephi ezifana ne-arthroscopy, i-laparoscopy, i-thoracoscopy, kunye ne-discoscopy, ngoku ithathe indawo yotyando oluvulekileyo lwemveli kunyango lotyando lwezifo ezininzi. Ngenxa yesakhiwo esikhethekileyo se-anatomical kunye neemfuno zotyando zomnqonqo, utyando lwangaphambili lwe-spinal invasive kancinane lujongene neengxaki ezininzi zeklinikhi, ubunzima obukhulu botyando, kunye neengozi eziphezulu zotyando kunye neengxaki, ezithintela kakhulu kwaye zithintele uphuhliso kunye nenkqubela phambili yotyando lwe-endoscopic lwangaphambili lomgogodla.

I-Endoscopic incedise utyando lokuthotywa kwe-endoscopic yangaphambili yomlomo wesibeleko. Iinzuzo zayo azikho nje ukuxhwaleka okuncinci kokuhlinzwa, kodwa kunye nokugcinwa kwediski ye-intervertebral yomlomo wesibeleko, ngaloo ndlela igcina umsebenzi wayo wemoto. Olu tyando lunempembelelo ebalulekileyo ekuphatheni iimpawu ze-unilateral radicular of the cervical spine, kodwa ingxaki ephambili yale ndlela kukulimala komthambo we-vertebral ngexesha lokunyangwa kwe-joint vertebral hook. U-Jho ukholelwa ukuba indawo yomlomo wesibeleko i-6-7 intervertebral space, i-lateral aspect of the joint vertebra joint, kunye ne-transverse process foramen yizona ndawo zixhaphake kakhulu ezinokubangela ukulimala komthambo we-vertebral. Umlomo wesibeleko 6-7 indawo ye-intervertebral ifumaneka phakathi kwenkqubo enqamlekileyo yomlomo wesibeleko 7 kunye nentamo ende yentamo. Ukuze ugweme ukulimala komthambo we-vertebral, u-Jho ucebisa ukusika intambo ende yentamo kwinqanaba lomlomo wesibeleko 6. Iqhekeza le-muscle liya kuhoxisa kwinkqubo eguquguqukayo yomlomo wesibeleko 7, ngaloo ndlela ibonise umthambo we-vertebral phantsi kwentamo ende; Ukuze ugweme ukulimala komthambo we-vertebral kwi-joint vertebra edibeneyo, i-drill yokugaya akufanele ingene kwi-transverse process hole. Uluhlu lwe-cortex yethambo lunokugcinwa ngexesha lokugaya kwi-joint vertebra edibeneyo, kwaye ke ithambo linokususwa nge-spatula. Emva kwe-discectomy yangaphambili kwizigulane ezineempawu zeengcambu ze-nerve unilateral, iimpawu zeengcambu ezichaseneyo zinokuthi zenzeke ngenxa yokungazinzi komlomo wesibeleko. Ukwenza nje i-nerve root decompression ayikwazi ukuphelisa ngokufanelekileyo iimpawu zentlungu yentamo kwezi zigulana. I-intervertebral fusion nayo iyimfuneko ukuze kugcinwe ukuzinza komlomo wesibeleko, kodwa i-fusion ye-endoscopic encinci kunye nokulungiswa komqolo wesibeleko wangaphambili ngumngeni ongasonjululwanga weklinikhi.

Itekhnoloji yanamhlanje ye-thoracoscopy yaqala ekuqaleni kweminyaka yee-1990, kwaye ngophuhliso lwayo oluqhubekayo, ngokuthe ngcembe luye lwagqiba unyango olufana ne-lobectomy, thymectomy, izifo ze-pericardial kunye ne-pleural. Okwangoku, iteknoloji ye-thoracoscopic isetyenziswe kunyango lwe-vertebral lesion biopsy, i-abscess drainage kunye ne-spinal lesion clearance, i-intervertebral disc nucleus pulposectomy ye-thoracic disc herniation, i-decompression yangaphambili kunye nokulungiswa kwangaphakathi kwe-thoracic vertebral fractures, kunye nokulungiswa kwe-scoliosis okanye ukukhulula. kunye nokulungiswa kwe-kyphosis deformities. Ukusebenza nokhuseleko kwayo kuye kwaqondwa ngokubanzi. Nangona kunjalo, xa kuthelekiswa notyando lwesifuba oluvulekileyo lwendabuko, utyando lwe-thoracoscopic oluncinci lwangaphambili lwe-spinal luneziganeko ezifanayo zeengxaki zotyando, kodwa lunexesha elide lotyando, ubunzima obukhulu botyando, kunye neengozi eziphezulu zotyando. UDickman et al. yenza utyando lwe-thoracoscopic ye-15 kwizigulane ze-14 ezine-thoracic disc herniation, okubangelwa iimeko ze-3 ze-atelectasis, iimeko ze-2 ze-intercostal neuralgia, i-1 case of screw loosening efuna ukususwa, i-1 case ye-disc intervertebral eseleyo efuna utyando lwesibini, kunye ne-1 imeko yokuvuza kwe-cerebrospinal fluid. kunye nezinye iingxaki. McAfee et al. ingxelo yokuba imeko yokopha okusebenzayo emva kotyando lwe-thoracoscopic oluncinci lwe-spinal invasive column yi-2%, izehlo ze-atelectasis yi-5%, izehlo ze-intercostal neuralgia yi-6%, kwaye kukho iingxaki ezinzulu ezifana nokulimala kwe-spinal cord nerve, i-chylothorax; ukwenzakala kwemisipha ye-septal, kunye nolunye ukwenzakala kwamalungu. L ü Guohua et al. ingxelo yokuba iingxaki ze-thoracoscopic utyando lwangaphambili lomgogodla ziquka:; Ngenxa yokopha okubangelwa yingozi ye-azygous vein, ukuguqulwa ukuvula utyando lwesifuba ukuze kukhululwe yi-2.6%, ukulimala kwemiphunga yi-5.2%, i-chylothorax yi-2.6%, i-atelectasis yendawo yi-5.2%, i-pleurisy exudative yi-5.2%, ixesha lokuphuma kwesifuba> iiyure ezingama-36, umthamo we-drainage>200ml yi-10.5%, udonga lwesifuba i-keyhole i-numbness okanye intlungu yi-2.6%. Kucaciswe ngokucacileyo ukuba kwinqanaba lokuqala lotyando oluvulekileyo lwe-thoracoscopic scoliosis, iziganeko zeengxaki ziphezulu kunotyando lwendabuko. Ngokuqokelelwa kobuchule kunye namava ekusebenzeni, iziganeko zeengxaki ziya kuncitshiswa kakhulu. Watanabe et al. uhlalutye izigulane ze-52 ezithatha utyando lwe-thoracoscopic kunye ne-laparoscopic yomgogodla, kunye neziganeko eziphezulu zeengxaki ze-42.3%. Iziganeko eziphezulu zeengxaki kunye neengozi zotyando zithintela ukuphuhliswa kotyando lwe-thoracoscopic lwangaphambili lwe-thoracic. Ngenxa yesi sizathu, abaphengululi abaninzi bancoma kwaye bamkele i-thoracoscopic incedise utyando oluncinci lwe-thoracic lwangaphambili, olungagcini nje ukwenza utyando lube lula, kodwa lunciphisa kakhulu ixesha lotyando.

Ngasekupheleni kwee-1980, i-cholecystectomy yokuqala ye-laparoscopic eyenziwa nguDuBois et al. eFransi kwazisa uphuhliso lwenguqu kubuchwephesha be-laparoscopic. Okwangoku, utyando lwangaphambili lwe-laparoscopic lwangaphambili lusetyenziselwa ukususwa kweediski ze-lumbar intervertebral kunye nokuhlinzwa kwe-intervertebral fusion (ALIF). Nangona i-ALIF ye-laparoscopic inokunciphisa ngokufanelekileyo umonakalo wezicubu, utyando lwe-ALIF lwesisu lufuna ukusekwa kwe-pneumoperitoneum, enokubangela ubunzima ekuphuhliseni umoya kunye ne-air embolism xa i-inflating kunye nokulungelelanisa indawo yesisu ngexesha lotyando lwe-laparoscopic, okubangelwa intloko ephantsi kunye neenyawo eziphezulu. Ukongeza, iingxaki zotyando lwe-anterior lumbar interbody fusion ziquka i-hernia yesisu yangaphandle, ukwenzakala kwelungu lesisu, umonakalo kwimithambo yegazi emikhulu, i-arterial and venous embolism, i-iatrogenic spinal nerve injury, i-retrograde ejaculation, kunye nokugqabhuka kwesixhobo. Umba we-retrograde ejaculation emva kotyando lwe-lumbar fusion uyanda ukutsala umdla wabantu. Oku kungenxa yokwenzakala kwi-nerve plexus ebangela ukuba isisu esisezantsi sibekwe phambi kwe-lumbar spine esezantsi ngexesha lokusebenza. URegan et al. ingxelo yokuba iziganeko ze-retrograde ejaculation kwiimeko ze-215 ze-laparoscopic ephantsi kwe-lumbar interbody BAK fusion yayingu-5.1%. Ngokwengxelo ye-US FDA evavanya ukusetyenziswa kwe-LT-CAGE kwi-laparoscopic interbody fusion, ukuya kuthi ga kwi-16.2% yezigulane zotyando zamadoda zifumana i-retrograde ejaculation, kunye nesiganeko esiphezulu kakhulu sezi ngxaki xa kuthelekiswa notyando oluvulekileyo lwendabuko. Newton et al. bakholelwa ukuba iziganeko zeengxaki kwi-thoracoscopic utyando lwangaphambili lomgogodla lufana nelo lotyando lwendabuko oluvulekileyo lwesifuba, kodwa umthamo wokukhupha amanzi emva kokuhlinzwa kwe-thoracoscopic uphezulu kakhulu kunotyando lwesifuba esivulekileyo. Ngenxa yobunzima obuphezulu bokusebenza kunye nomngcipheko wotyando lwe-laparoscopic lumbar interbody fusion, kunye neziganeko eziphezulu zeengxaki zotyando, i-laparoscopic incedise utyando oluncinci lwendlela yangaphambili yotyando alunayo nje i-trauma encinci kwaye kulula ukuyisebenzisa, kodwa inexesha elifutshane lokusebenza kwaye iziganeko eziphantsi zeengxaki. Yisalathiso sophuhliso lwexesha elizayo lotyando lwe-lumbar oluncinci lwangaphambili.

Nangona inkqubela phambili kwibhayoloji inokuphucula ukusebenza kodibaniso, kusekho iziphene ezithile, ezinje ngokushukuma okulinganiselweyo kunye noxinzelelo olwandisiweyo kumacandelo akufutshane. Ngenxa yezi zizathu, i-intervertebral disc replacement yangoku yinkqubela phambili ekhuthazayo. Nangona ukuyila iidiski ze-intervertebral ezenziweyo ezilingana ngokupheleleyo neempawu ezahlukeneyo ze-intervertebral discs zendalo kunzima kakhulu, ngokwenene kunenzuzo kumzimba womntu. Inokunciphisa umthombo wokusuleleka, ukunciphisa ukungazinzi okubangelwa yi-disc intervertebral discs, ukubuyisela ukwabelana ngoxinzelelo lwendalo, kunye nokubuyisela iimpawu zokunyakaza komgogodla. Kwithiyori, ukutshintshwa kwediski eyenziweyo kunokutshintsha indawo yotyando lwe-fusion, ukubonelela ngentshukumo ye-physiological yomqolo kunye nokulibazisa ukuwohloka kwamacandelo akufutshane. I-lumbar disc replacement yokuqala yenziwa kwi-1996, eyathatha indawo ye-disc herniation ebuhlungu. Okwangoku, kukho iintlobo ezahlukeneyo zeediski ze-intervertebral ezenziweyo ezikhoyo. Izinto zayo ziquka isinyithi okanye i-elastic fibers. Kutshanje, kukho i-disc intervertebral eyenziweyo kunye ne-polyethylene yangaphakathi kunye ne-peptides yangaphandle, ethi ifakwe kwi-plasma. Nangona kunjalo, izinga lempumelelo yokudibanisa alikaqinisekiswa ngokupheleleyo. Ukongeza, uncwadi lubonisa ukuba ukhetho lwamatyala, imilo, ubungakanani, kunye nesikhundla sediski ye-intervertebral eyenziweyo ibalulekile ekusebenzeni konyango. Iingxelo zangaphambili zigxininise kakhulu kuqhaqho oluvulekileyo lwangaphambili lwe-intervertebral disc replacement, kunye neendlela zangoku ze-endoscopic nazo zingasetyenziselwa ukutshintshwa kwediski ye-laparoscopic yokufakelwa. I-Prodisc isandul 'ukuphuhlisa isizukulwana sesibini se-intervertebral disc prostheses, enokumelana nayo yonke imida ye-lumbar motion ngaphandle kwe-axial motion. Zincinci ngobukhulu kuneediski ze-intervertebral eziqhelekileyo, kodwa zinokufakwa nge-laparoscopy yangaphambili okanye i-incision encinci ngokusebenzisa indlela ye-retroperitoneal.

Ngenkqubela phambili eqhubekayo yeteknoloji yotyando lwangoku kunye nokusetyenziswa kwezinto ezintsha ze-biomaterials kunye nezixhobo ekusebenzeni kweklinikhi, utyando lwangaphambili lwangaphambili luthatyathelwa indawo lutyando lwangasemva. Olona tyando luphambili lomqolo obelukade lufuna iindlela zangaphambili nezingasemva luqukunjelwa ngokuthe ngcembe lutyando lwangasemva olukwinqanaba elinye. Ngenxa yesakhiwo esintsonkothileyo se-anatomical, umonzakalo omkhulu wotyando, kunye neziganeko eziphezulu zeengxaki zotyando kwindlela yangaphambili yomqolo, kunye nemida yotyando ekhoyo kunye nemingcipheko ehambelana notyando lomqolo lwangaphambili lwe-endoscopic, kwiminyaka yakutshanje, utyando lwangaphambili lwe-endoscopic. yatshintshwa kancinci kancinci ngaphambili okanye ngasemva, utyando lomnqonqo olungasemva kunye nolwemva oluncediswa yi-endoscopy. Kwixesha elizayo, utyando lwangaphambili lomqolo phantsi kwe-laparoscopy luya kusetyenziswa ngokuqhelekileyo utyando oludibeneyo lwangaphambili kunye nolwemva oluncediswa yi-laparoscopy. Oku akupheleli nje ekunyuseni umgangatho weempawu zendlela yotyando lwe-endoscopic, kodwa ikwathintela imiqobo yotyando oluntsonkothileyo lwesisu, ixesha elide lotyando, kunye neziganeko eziphezulu zeengxaki. Ngophuhliso kunye nedijithali yeteknoloji ye-laparoscopic ye-laparoscopy, ukusekwa kwamagumbi okusebenza ahlakaniphile kunye ne-hybridi, kuya kubakho uphuhliso olukhulu kwi-teknoloji yotyando lomgogodla oluncinci kwixesha elizayo.