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

I-Microscopic discectomy ngokusebenzisa iziteshi ezingavamisile kancane okwamanje iyindlela evame ukusetshenziswa kakhulu yokuhlinzwa yomgogodla yokwelashwa kwe-intervertebral disc herniation. I-MED minimally invasive lumbar discectomy iyindlela entsha yokuhlinzwa yomgogodla ehlasela kancane eyaqala ukwakhiwa nguFoley noSmith ngo-1997. I-MED minimally invasive lumbar discectomy idweba izinzuzo ze-posterior laminoplasty yendabuko kanye namasu e-endoscopic angena kancane kancane. Isungula indlela yokuhlinza ngokusebenzisa uchungechunge lweziteshi ezinwetshiwe futhi isebenzisa umzila osebenzayo we-1.6-1.8cm ukuqedela izinqubo ezifana ne-laminoplasty, ukukhishwa kwamalungu amancane, ukuchithwa kwe-nerve root canal, kanye nokukhishwa kwe-intervertebral disc okwakungenzeka kuphela ngokuhlinzwa okuvulekile. Uma kuqhathaniswa ne-discectomy ye-lumbar yendabuko, le nqubo isungula indlela yokuhlinzwa ngokusebenzisa uchungechunge lwama-catheter ahlanjululwe, ngaphandle kwesidingo se-dissection kanye ne-traction yemisipha ye-paraspinal, futhi iqeda yonke imisebenzi yokuhlinzwa ngaphakathi kwesiteshi sokusebenza esingu-1.6-1.8cm ububanzi. Ngakho-ke, inezinzuzo zokusikwa okuncane ngokuhlinzwa, ukulimala okuncane kwemisipha ye-paraspinal, ukopha okuncane, nokululama ngokushesha ngemva kokuhlinzwa. Ngenxa yesistimu yekhamera nevidiyo ethuthukisiwe, insimu yokubuka yokuhlinzwa ikhuliswa izikhathi ze-64, okuvumela ukuhlonza okunembe kakhudlwana nokuvikelwa kwe-dural sac, izimpande zezinzwa, kanye ne-vascular plexus ngaphakathi komgogodla womgogodla endaweni yokuhlinzwa ngesikhathi sokuhlinzwa; Ngesikhathi esifanayo, insimu yokuhlinzwa ecacile iqinisekisa ukuqedwa okunembile kwemisebenzi ehlukahlukene yokuhlinzwa, ukugwema ngokuphumelelayo ukushiyeka kwemikhakha yendabuko yokuhlinzwa yombono ojulile kanye nokulimala okuphawulekayo kwesakhiwo esihlangene samathambo ngemuva komgogodla. Ikhulisa ukulondolozwa kobuqotho besakhiwo se-posterior ligament composite yomgogodla, ngaleyo ndlela kunciphisa ngokuphumelelayo ukuvela kokunamathela kwesibazi se-postoperative kanye nokungazinzi kwe-lumbar.

Izinguquko ze-pathological endaweni ethile zinquma ukubekwa kwesiteshi somsebenzi. Ukuhlinzwa okuncane okungenabungozi kwe-lumbar decompression kunganikeza ukuwohloka okwanele emseleni ophakathi womgogodla, i-lateral recess, kanye nezifunda ze-intervertebral foramen. Ngaphezu kwalokho, izicubu ze-intervertebral disc ngaphandle kwe-intervertebral foramen nazo zingasuswa. Ngaphambi kokwenza i-decompression ezindaweni ezahlukene, kuyadingeka ukuhlela indlela yokuhlinzwa. Ukuze kuncishiswe izinzwa ze-extraforaminal, isiteshi esisebenzayo singafakwa kulwelwesi lwenqubo eguquguqukayo phakathi kwezinqubo eziguquguqukayo. Okokuqala, ulwelwesi lwenqubo evundlile luyanqunywa, futhi umsipha wenqubo eguquguqukayo uyasikwa uvuleke ukuze kuvezwe impande yawo yokuphuma ejulile yezinzwa. Uma impande ye-nerve yokuphuma inqunywa, izicubu ze-intervertebral disc eziphumayo zingatholakala engxenyeni ejulile yempande yezinzwa. Ucwaningo lwamuva luqhathanise i-discectomy engavamile kakhulu nokuhlinzwa okuvulekile kwendabuko, futhi imiphumela ibonisa ukuthi ukuhlinzwa okuncane kakhulu kunomonakalo omncane wezicubu, ukuphazamiseka okuncane kwezinzwa, ukulahlekelwa igazi elincane, izimpawu ezibuhlungu zangemva kokuhlinzwa, ukuhlala isikhashana esibhedlela, kanye nokululama ngokushesha nokubuyela emsebenzini. Ucwaningo olulawulwa ngokungahleliwe phakathi kwe-discectomy yendabuko evulekile ye-microsurgical kanye ne-microsurgical discectomy engenele kancane ngokusebenzisa isiteshi esingenele kancane kubonise ukuthi ukuhlinza ngesiteshi esincane kakhulu kuphephile futhi kusebenza kangcono.

Ubuchwepheshe obusha be-intervertebral discoscopy (MED) obuthuthukiswe ngu-Foley no-Smith buyinhlanganisela ephelele yamasu amancane angenayo i-microsurgical kanye namasu e-endoscopic. Ukuhlinzwa kwe-MED kufana ne-discectomy evulekile encane futhi ingasetshenziselwa i-laminectomy, i-decompression, i-foraminotomy, nokuhlinzwa kwe-disc herniation. Ukusebenza kalula, izinkomba ezibanzi, nemisebenzi ehlukahlukene ye-MED yenza kube lula kodokotela abahlinzayo ukuthi bashintshe ukusuka ekuhlinzweni kwendabuko baye ekuhlinzeni i-endoscopic. Nakuba ukubonwa kwe-endoscopic akuhlinzeki nje kuphela insimu yokuhlinza ecacile futhi enwetshiwe, kodwa futhi kusiza futhi kuyasebenza, kunganikeza kuphela izithombe ze-2D futhi kuvame ukuvinjelwa ukuphuma kwegazi nokubonisa okungacacile, okungekuhle njenge-discectomy encane. Ukuthuthuka kwe-endoscopic imaging kanye nobuchwepheshe bokuhlanganiswa kwezithombe ze-endoscopic kungasiza ukuthuthukisa lolu daba.

Ukulawula ukopha kubaluleke kakhulu kunoma iyiphi indlela yokubuka ngeso lengqondo, njengoba ukopha kakhulu kwandisa ingozi yokudabuka kwesaka eliseduze kanye nokulimala kwezimpande zemizwa. Ukopha ngaphandle kokuqina noma eduze kwamalunga amancane kuphazamisa udokotela ohlinzayo ukuthi angakwazi ukuqhubeka nokusebenza, kodwa ezinye izindlela zendabuko ezifana ne-microscopic discectomy zingasetshenziswa (ijeli ye-fibrillar collagen, ijeli ye-thromboxane, isipontshi se-gelatin esimuncwayo nesiqeshana sikakotini esincane, njll.). I-Endius ikhiqize idivayisi encane ye-bipolar electrocoagulation (MDS) eneshevu enezendlalelo ezimbili, engasetshenziselwa ukwahlukanisa okubuthuntu, ukumunca igazi, kanye ne-electrocoagulation hemostasis. Ukwengeza, isistimu ye-endoscopic yomthombo wokukhanya okabili (i-infrared/ebonakalayo) iyamukelwa, eyengeza isiteshi se-infrared ohlelweni lwamanje lwe-laparoscopic. Lesi simiso singakwazi ukubona ukopha okuncane komthambo endaweni yokopha, sihlonze indawo ethile yokopha, sisize udokotela ohlinzayo ashise ngokushesha ukuze ayeke ukopha, futhi sinciphise imisebenzi ye-hemostasis ephindaphindiwe lapho iphuzu lokopha lingacacile.

Okwamanje, ama-endoscope amaningi omgogodla athi anokukhulisa okungu-20 x uma usebenzisa imithombo yokukhanya ye-xenon noma i-halogen, futhi angafinyelela kumaphikseli angu-3 x 104. Izindlela zakamuva zokubuka zingafinyelela amaphikseli angu-5 x 104 ngobubanzi befayibha elingu-1.8mm, elanele ukuhlinzwa okuningi kwamanje. Ukuhlinzwa kwe-endoscopic yomgogodla kwesikhathi esizayo kuzozuza emicu emincane, kunikeze isikhala esiningi sokuhlinza ngaphandle kokuyekethisa ikhwalithi yesithombe. Enye intuthuko ukukhanya okukabili. I-MGB endoscopy isebenzisa isistimu yesibonakude ebizwa ngokuthi i-Shadow, ehlanganisa imithombo yokukhanya emibili ezimele ku-endoscope yokuhlinzwa engu-30 ° evamile. Ngenxa yesakhiwo se-Shadow, inganikeza i-plasticity enhle kanye nokuphambene, okungaguqulwa kube izithombe ezintathu-dimensional, ukufeza ukulungiswa okuphezulu kanye nenkundla yokubuka ecacile yokuhlinzwa. Okunye ukuthuthukiswa kwe-endoscopy yomgogodla uhlelo lwe-anti nebulization, njengoba ukuvuselelwa kabusha ngemva kokuhlanza kwangaphandle kungaholela ekuphazamisekeni okuphindaphindiwe ekuhlinzeni. Ukugcina umbono ocacile kubaluleke kakhulu ekusetshenzisweni okuphephile kokuhlinzwa komgogodla okuncane kakhulu. Ngo-1993, izazi zafunda ukwengeza "umgodla" owengeziwe (ithubhu langaphandle) kuma-endoscopes wendabuko, angahlanza futhi omise i-lens optical nganoma yisiphi isikhathi, ukuze i-lens ihlale ihlanzekile futhi ayidingi ukususwa ngokuphindaphindiwe emzimbeni wesiguli. I-defogger eyengeziwe ingasusa intuthu ekhiqizwe imimese kagesi yokuhlinza enemvamisa ephezulu. Ngeshwa, uhlelo alukwazi ukuvimbela i-athomu yemvelo ebangelwa ukungalingani phakathi kwezinga lokushisa le-lens kanye nomswakama endaweni yokusebenza. Ezinye izinkampani zizamile ukungeza izinzwa nezintambo zokumelana nokushisa ngemuva kwelensi ukuze kuxazululwe le nkinga. Ngokusekelwe kumsebenzi we-high-definition imaging (HDI) we-CCD chip, inganikeza amaphikseli ayizigidi ezingu-2 ngaphakathi komugqa ovundlile we-1250, ngaleyo ndlela ithole insimu yokubuka ecacile yokuhlinzwa.

Ukuthuthuka kobuchwepheshe bekhompiyutha kanye nobuchwepheshe be-endoscopic kwenze ukuthi kwakhiwe kabusha izinhlangothi ezintathu zezithombe ezibonakalayo, ezihlanganiswa ngokuhlanganisa izithombe zangaphambi kokuhlinzwa nezikena zangaphakathi kokuhlinzwa bese zinamathiselwa ezithombeni ze-intraoperative endoscopic. Kusetshenziswe amasu afanayo ekuhlinzeni i-craniocerebral, okuhlanganisa ukwakhiwa kabusha kwesithombe sangaphambi kokuhlinzwa nemifanekiso ye-microscope yokuhlinzwa yokuhlinzwa. Lokhu kungasiza odokotela abahlinzayo ekuqinisekiseni imingcele yamathumba futhi bawasuse kangcono. Muva nje, iMississauga (Canada) ithuthukise isethi ye-neuroendoscopic cannula, engasetshenziswa ukubuka indawo ye-endoscope ngokusekelwe kudatha ye-MRI ne-CT. Isofthiwe ekhethekile ihlinzeka ngezithombe ze-endoscopic esizeni kanye nokuma kwezindawo zensimbi enezinhlangothi ezintathu. Enye intuthuko izingilazi zokubonisa umakalabha, ezixhunywe kumabonakhulu okuhlinzwa, okuvumela odokotela abahlinzayo ukuthi babheke amasignali adluliswayo kanye nendawo yokubuka yokuhlinzwa. Esikhathini esizayo esiseduze, lobu buchwepheshe bungasetshenziswa futhi kuma-endoscopes okuhlinzwa komgogodla ukuze kunxeshezelwe ukushiyeka kwama-endoscopes omgogodla we-two-dimensional. Intuthuko yesikhathi esizayo kubuchwepheshe bezithombe izophinde ihlanganise ukucaca okungcono kwesithombe, ukugxila kangcono njengezibonakhulu zokuhlinzwa, ukunwebeka okungcono nokusebenza kahle, imiphumela emikhulu yokusebenza kwesiteshi, nokuthuthukiswa okuqhubekayo kwezithombe ze-3D. Lokhu kuthuthukiswa kungathatha ukuhlinzwa kwe-endoscopic yomgogodla kuya ekuphakameni okusha.