He koʻikoʻi a hiki ke pale ʻia nā hewa o ka maʻi ʻokiʻoki a me ka pūnaewele. Wahi a ka Joint Commission on Accreditation of Healthcare Organizations, hiki ke hana ʻia kēlā mau hewa a hiki i ka 41% o nā orthopedic/pediatric surgeries. No ka ʻoki ʻana i ka iwi kuamoʻo, loaʻa ka hewa o ka pae ʻoki i ka wā i hewa ʻole ka ʻāpana vertebral a i ʻole lateralization. Ma waho aʻe o ka hiki ʻole ke hoʻoponopono i nā hōʻailona a me ka pathology o ka mea maʻi, hiki i nā hewa ʻāpana ke alakaʻi i nā pilikia olakino hou e like me ka wikiwiki o ka disc degeneration a i ʻole ka spinal instability i nā ʻāpana asymptomatic a maʻamau.
Aia kekahi mau hihia pili i ke kānāwai e pili ana i nā hapa hapa o ka ʻoki kuamoʻo, a ʻo ka lehulehu, nā keʻena aupuni, nā halemai, a me nā hui o nā kauka lapaʻau ʻaʻole i ʻae ʻia no ia mau hewa. Hoʻohana ʻia ka nui o nā ʻoki spinal, e like me discectomy, fusion, laminectomy decompression, a me kyphoplasty, me ka hoʻohana ʻana i ke ala hope, a he mea nui ke kūlana kūpono. ʻOiai ʻo ka ʻenehana kiʻi kiʻi i kēia manawa, e kū mau ana nā hapa hapa, me ka nui o nā hanana mai ka 0.032% a i ka 15% i hōʻike ʻia ma ka palapala. ʻAʻohe hopena e pili ana i ke ʻano o ka localization i pololei loa.
Ua alakaʻi nā kānaka ʻepekema mai ke Keʻena ʻo Orthopedic Surgery ma Mount Sinai School of Medicine, USA, i kahi noiʻi nīnau nīnau ma ka pūnaewele e hōʻike ana i ka hoʻohana ʻana o ka hapa nui o nā kauka spine i kekahi mau ʻano o ka localization, a ʻo ka hoʻomaʻamaʻa ʻana i nā kumu maʻamau o ka hewa e hiki ke kūpono i e hōʻemi ana i nā hewa ʻāpana o ke kaʻina hana, ma kahi ʻatikala i paʻi ʻia ma Mei 2014 ma Spine J. Ua mālama ʻia ke aʻo ʻana me ka nīnau nīnau leka uila. Ua hana ʻia ke aʻo ʻana me ka hoʻohana ʻana i kahi loulou i leka uila i kahi nīnau nīnau i hoʻouna ʻia i nā lālā o ka North American Spine Society (me nā kauka orthopedic a me nā neurosurgeons). Hoʻokahi wale nō hoʻouna ʻia ka nīnau nīnau, e like me ka ʻōlelo a ka North American Spine Society. He 2338 mau kauka i loaʻa, 532 i wehe i ka loulou, a 173 (7.4% pane pane) i hoʻopau i ka nīnau nīnau. He kanahikukūmālua pākēneka o ka poʻe hoʻopau he mau kauka lapaʻau orthopedic, 28% he neurosurgeons, a he 73% he mau kauka spine i ke aʻo ʻana.
ʻO ka nīnau nīnau he 8 mau nīnau (Fig. 1) e uhi ana i nā ʻano hana maʻamau o ka localization (nā ʻāina anatomical a me ka localization imaging), ka hopena o nā hewa o ke kaʻina hana, a me ka hui ʻana ma waena o nā ʻano o ka localization a me nā hewa segmental. ʻAʻole i hoʻāʻo a hōʻoia ʻia ka nīnau nīnau. Hāʻawi ka nīnau nīnau i nā koho pane he nui.
Kiʻi 1 ʻEwalu nīnau mai ka nīnau nīnau. Ua hōʻike nā hualoaʻa i ka intraoperative fluoroscopy ka mea maʻamau i hoʻohana ʻia no ka localization no ka ʻoki hope ʻana o ka ʻāʻī a me ka lumbar spine (89% a me 86%, kēlā me kēia), a ukali ʻia e nā radiographs (54% a me 58%, kēlā me kēia). Ua koho nā kauka 76 e hoʻohana i kahi hui o nā ala ʻelua no ka localization. ʻO nā kaʻina spinous a me nā pedicles e pili ana i nā hiʻohiʻona anatomic maʻamau i hoʻohana ʻia no ka ʻoki ʻana i ka thoracic a me ka lumbar spine (67% a me 59%), a ukali ʻia e nā kaʻina spinous (49% a me 52%) (Fig. 2). Uaʻaeʻo 68% o nā kauka ua hana lākou i nā hewa localization segmental i kā lākou hana, a ua hoʻoponoponoʻia kekahi o ia mau mea i loko o ka hana (Fig. 3).
Fig. 2 Hoʻohana ʻia nā ʻano hana hoʻokalakupua kiʻi a me ka ʻāina anatomical.
Fig. 3 Kauka a me ka hoʻoponopono intraoperative o nā hewa ʻāpana o ka ʻoki.
No nā hewa kūloko, 56% o kēia mau kauka i hoʻohana i nā radiograph preoperative a me 44% i hoʻohana i ka fluoroscopy intraoperative. ʻO nā kumu maʻamau o ka hoʻonohonoho mua ʻana o ka hoʻonohonoho ʻana, ʻaʻole i ʻike ʻia kahi wahi kuhikuhi i ʻike ʻia (e laʻa, ʻaʻole i hoʻokomo ʻia ka spine sacral i loko o ka MRI), nā ʻano ʻano anatomical (lumbar displaced vertebrae a i ʻole 13-root ribs), a me nā ʻāpana ambiguities ma muli o ke kino o ka mea maʻi. kūlana (hōʻike X-ray suboptimal). ʻO nā kumu maʻamau o nā hewa hoʻonohonoho intraoperative, ʻo ia ke kamaʻilio kūpono ʻole me ka fluoroscopist, ka hiki ʻole ke hoʻonohonoho hou ʻana ma hope o ka hoʻonohonoho ʻana (ka neʻe ʻana o ka nila hoʻonohonoho ma hope o ka fluoroscopy), a me nā helu kuhi hewa i ka wā e hoʻonoho ai (lumbar 3/4 mai nā iwi ʻaoʻao i lalo) (Figure 4).
Fig. 4 Nā kumu no ka hana mua a me ka intraoperative localization hewa.
Hōʻike nā hopena i luna ʻoiai he nui nā ʻano o ka localization, ʻo ka hapa nui o nā kauka lapaʻau e hoʻohana wale i kekahi o lākou. ʻOiai he kakaikahi ka hapa o ke kaʻina hana, ʻoi aku ka maikaʻi ʻaʻole lākou. ʻAʻohe ala maʻamau e hoʻopau i kēia mau hewa; akā naʻe, ʻo ka lawe ʻana i ka manawa e hana ai i ka hoʻonohonoho ʻana a me ka ʻike ʻana i nā kumu maʻamau o ka hoʻonohonoho ʻana e hiki ke kōkua i ka hōʻemi ʻana i ka nui o nā hewa o ke kaʻina hana i loko o ka spine thoracolumbar.
Ka manawa hoʻouna: Iulai-24-2024
