Unyango lweSigaba sesi-III kunye neNgqomo yokuZalisa iBone eDityaniswe ne-Pedicle Anchorage Technology Reversible Kummell's disease

Isifo sikaKummell sichaphazela kakhulu umgangatho wobomi babantu abadala. Okwangoku, i-pathogenesis yesi sifo ayikacaci, kwaye kukho amagama ahlukeneyo achaza isiseko sayo se-pathological, kubandakanywa i-ischemic bone necrosis kwi-vertebral body, i-vertebral fissure sign (IVC), ukubunjwa kwe-intravertebral pseudojoints, i-vertebral fracture endala engekho umanyano, kunye ukulibaziseka ukuwa kwe-vertebral emva kokulimala. Hur et al. wafumanisa ukuba imifanekiso ye-X-ray yezigulane ze-Kummell's disease ibonise iimpawu ze-sclerosis ekupheleni kokuqhekeka kwe-vertebral body. I-CT plain scan ibonakalise iimpawu ze-sclerosis ngaphakathi komzimba we-vertebral, ngelixa ukwakhiwa kwakhona kwe-CT kubonisa ngokucacileyo iimpawu ze-IVC kunye ne-sclerosis ekupheleni kokuphuka. I-osteoporosis enzima kunye ne-intervertebral disc degeneration ehambelanayo nayo yabonwa kumzimba we-vertebral malunga nesiphelo esinzima. "Uphawu lwe-vacuum fissure", "isiganeko sokuvula", kunye "nesibonakaliso se-bilateral" ngaphakathi komzimba we-vertebral zibalulekile kodwa zingabonakali iimpawu zokucinga. Okwangoku, kukholelwa ukuba unyango olulondolozayo lwesifo sika-Kumell alusebenzi, kwaye kunokubakho i-kyphosis yomgogodla okanye iimpawu ze-nerve kwinqanaba elilandelayo.

I-PVP kunye ne-PKP ziye zafumana iziphumo ezanelisayo kunyango lwe-Kummell's disease stages I and II. Ngokunyuka kwamatyala otyando, kuye kwafunyaniswa ukuba ngakumbi kwi-Kummell's disease stage III izigulane, ukuvuza kwesamente yethambo kunye nokutyibilika kwe-samente yamathambo kamva kuseyingxaki enkulu.

Izizathu zokuvuza kwe-samente yamathambo kunye ne-slippage kwisifo sika-Kummell zihambelana nezinto ezininzi, okokuqala zihambelana nesakhiwo se-pathological of the formation of vertebral fractures. Hasegawa et al. yafumanisa ukuba izicubu ze-synovial zenziwe malunga neendonga zethambo ze-vertebral fractures ngexesha lotyando lwe-vertebral augmentation. Bakholelwa ukuba i-samente yethambo yayininzi kwi-vertebral fractures, okwenza kube nzima ukungena kwi-synovial tissue kwi-trabeculae ejikelezileyo, ukuthintela ukubunjwa kwesakhiwo sokudibanisa esizinzile phakathi kwesamente yamathambo kunye ne-vertebral trabeculae, engakwazi ukugcina ukuzinza. kumzimba we-vertebral. Oku kukhokelele ekuvuzeni kwesamente yethambo kunye nokutyibilika kwenqwaba yesamente, echaphazela umphumo wonyango wexesha elide. Ngexesha elifanayo, likwanxulumene noxinzelelo ngaphakathi kwe-vertebral body ye-Kummell isifo kunye nezakhono zokuhlinzwa zomqhubi. Isifo se-Kummell siphindaphinda ngokuphindaphindiweyo, kwaye ikhosi yesifo ithatha ixesha elide. Izicubu ze-fibrous ebusweni bethambo eliqinileyo kwi-vertebral body iya kukhula kwaye yenze i-capsule evaliweyo, ezaliswe ngamanzi. Uxinzelelo ngaphakathi komzimba we-vertebral luya kwanda, kwaye i-samente yethambo iya kuvuza kunye ne-vertebral vein. Ngethuba lokuziqhelanisa neklinikhi, oogqirha baye bafumanisa ukuba xa udonga lwe-cavity luqinile, ukuchasana nokutyhala i-samente kwi-vertebra egulayo kwanda, okwandisa umngcipheko wokuvuza kwe-samente yamathambo. Hoppe et al. wafumanisa ukuba ukusebenzisa iindlela zokunkcenkceshela ngaphambi kokujova i-samente yethambo kwizigulane phantsi kwe-anesthesia jikelele kunokunciphisa uxinzelelo ngaphakathi kwe-vertebral body, ngaloo ndlela kuncitshiswe amathuba okuvuza kwe-samente yethambo kunye ne-vertebral vein kunye ne-cortical defect type ukuvuza. Iqondo lokunciphisa intlungu kunye nokuzinza komgogodla wezigulane ze-postoperative zihambelana ngokusondeleyo kunye nomlinganiselo wokuzaliswa kwesamente yamathambo. UKim et al. bakholelwa ukuba intlungu ephantsi emva kwe-vertebroplasty ye-percutaneous kwizigulane ezine-Kummell's disease inxulumene nokungonelanga kozinzo lwe-vertebral ngenxa yokungonelanga kwenaliti yesamente yethambo.

I-Bone Filling Container sisakhiwo se-mesh esisangqa esenziwe ngezinto ezintsha. Le bhegi yemesh ilukwe ngokuthe nkqo nangokuthe tye, kwaye inokumelana nokucinezelwa okulungileyo kunye ne-ductility. Umgaqo osebenzayo wokuzalisa i-bone mesh bags ubukhulu becala unciphisa ukuvuza kwesamente yethambo ngokusebenzisa "impembelelo yezinyo lengcuka" kunye ne "onion effect". Ngethuba lotyando, isikhwama sokuzalisa i-samente yethambo sifakwe phakathi kwe-vertebral fissure, kwaye i-samente yethambo iqhutywe kuyo. Ingxowa yokuzalisa i-samente yethambo igcwalisa ngokuthe ngcembe, kwaye ngoxinzelelo lwe-fluid static ye-bone sement mesh bag, umzimba we-vertebral oxinyiweyo uyaphakanyiswa ukubuyisela ukuphakama komzimba we-vertebral ogulayo, ngaloo ndlela ubuyisela i-biomechanics yomqolo. Uninzi lwesamente yamathambo isongelwe kwingxowa, ukunciphisa ukuvuza. Inxalenye encinci idlula kwi-mesh structure kunye ne-interlocks kunye ne-trabeculae yamathambo ejikelezileyo, yenze "impembelelo yezinyo lengcuka" ezinzisayo kwaye inciphise ukutyibilika kwamathambo e-samente. Uxinzelelo lwe-fluid kwi-mesh luyancipha ngokuthe ngcembe ukusuka embindini ukuya kwi-periphery, lwenza "isiphumo se-anyanisi" esinciphisa umngcipheko wokuvuza kwesamente yethambo. Xie Shengrong et al. ingxelo yokuba utyando lokwakhiwa kwakhona komzimba we-vertebral kwisifo sikaKummell kubangele ukuvuza kwesamente yethambo isantya se-55.6%. I-Chen Shuwei iyonke izigulane ze-35 ezinesigaba se-III esibuyiselwayo se-Kummell isifo esiphathwe ukususela ngoJanuwari 2018 ukuya kuDisemba 2022 zabikwa, zonke zaye zaphathwa nge-bone sement mesh bag edibeneyo ne-pedicle anchoring technology. Phakathi kwabo, iimeko ezi-6 zifumene ukuvuza, kunye nezinga lokuvuza kwe-17.1% kunye nokuhla okukhulu.

Amava ekusebenzeni kwe-Bone Filling Container kunye ne-pedicle anchoring technology: (1) Hlaziya ngokucophelela i-X-ray kunye nemifanekiso ye-CT ngaphambi kokuhlinzwa ukuze uqonde indawo ye-vertebral fractures yangaphakathi, ubukhulu kunye nesikhundla sokukhubazeka kwamathambo, ubungakanani kunye nokuphelela kwe-pedicle. isakhiwo, kunye nokuphuhlisa iindlela zokubhoboza ezichanekileyo kunye neendawo zokubambelela kwi-bone sement pedicle. Ngexesha elifanayo, khetha ubungakanani obufanelekileyo beengxowa ze-mesh ngokusekelwe kubukhulu beefractures; (2) Ngexesha lotyando, kuyimfuneko ukuba ube ne-fluoroscopy ecacileyo, ukuhlatywa ngokuchanekileyo ngokwendlela yokugqobhoza kwangaphambili, kwaye ugweme ukubetha ngokuphindaphindiweyo, ukwenza iipaseji zobuxoki okanye ukungena kumzimba we-vertebral ukwenza i-iatrogenic leakage puncture. Kwangaxeshanye, kwizigulana ezisele zikhulile ezineosteoporosis, utyando kufuneka lube thambileyo ukuze kuthintelwe ukugqobhoza udonga lwecyst nokonakalisa amalungu angaphakathi kunye nemithambo yegazi; (3) Khipha umbane kwi-vertebral fissures, ukunciphisa uxinzelelo ngaphakathi kwe-vertebral body, kunye nokunciphisa umngcipheko wokuvuza kwesamente yamathambo; (4) Bamba ixesha le-injection ye-samente yamathambo, ngokuqhelekileyo ngexesha "lomzobo", usebenzisa intonga ejikelezayo ejikelezayo, iqhube ngokukhawuleza, kwaye ibeke iliso ngokusondeleyo ukuzaliswa kwe-capsule kunye nokuhamba kwe-samente yethambo ngaphakathi komzimba we-vertebral; (5) Iingxowa zokuzalisa i-samente yamathambo ngokuqhelekileyo zifakwe kwiikholomu zangaphambili kunye neziphakathi ze-vertebrae ezilimeleyo ukwenzela ukuba kube lula ukubuyiswa kwe-vertebral morphology kunye ne-biomechanics, ngelixa ukunciphisa umngcipheko wokuvuza kwe-samente yamathambo kwi-canal yomgogodla. Kwangaxeshanye, uninzi lwesifo se-Kummell i-vertebrae eyonzakeleyo ineziphene zamathambo ezidityaniswe ne-vertebral fractures. Ukuzalisa i-gelatin i-sponge debris ngaphambi kokutofa i-samente yethambo kunokunciphisa ukuvuza kwe-samente yethambo; (6) Ngenxa yokuvuselela uxinzelelo oluphindaphindiweyo kufuphi ne-pedicle ye-vertebral arch, indawo yokuqina kwethambo yenziwa ngexesha lokulungiswa kwamathambo, kwaye ithambo lendawo linzima, okwenza kube lula ukuba i-samente yethambo isetyenziswe ukulungiswa komsila. Kweli qela lamatyala, i-pedicle puncture ye-bilateral pedicle kunye ne-anchoring ye-tailing yenziwa ukubonelela ukulungiswa okukhuselekileyo kobunzima besamente yamathambo. Ngelo xesha, lo msebenzi wenziwa kwi-sleeve yokusebenza ukuze ugweme umngcipheko wokuvuza kwesamente yethambo kufuphi ne-pedicle.

Isishwankathelo, ukudibanisa i-Bone Filling Container kunye ne-pedicle anchoring iteknoloji inokubuyisela ngokufanelekileyo ukuphakama kwe-vertebral, ukuthintela ukutyibilika kwamathambo e-samente kwi-vertebral fissures, ukuvuselela ukuzinza kwe-spinal biomechanics, ukunciphisa ngokufanelekileyo iimpawu zeklinikhi, ukuphucula umsebenzi womgogodla, kunye nokuphucula umgangatho. bobomi babantu abadala kunyango lwesigaba esiguqukayo se-III Kummell isifo. Ngokwandiswa kobomi, iziphumo zexesha elide zisafuna ukulandelwa.

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http://www. lcwkzz. com/CN/10.3969/j. issn. 10056483.2023.11.022

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