He mea koʻikoʻi a hiki ke pale ʻia nā hewa o ka mea maʻi ʻoki kino a me ka wahi. Wahi a ke Komisina Hui no ka Hōʻoia ʻana o nā Hui Ola Kino, hiki ke hana ʻia kēlā mau hewa a hiki i ka 41% o nā ʻoki kino orthopedic/pediatric. No ke ʻoki kino iwi kuamoʻo, loaʻa kahi hewa o ka wahi ʻoki kino ke hewa kahi ʻāpana vertebral a i ʻole ka 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 segmental ke alakaʻi i nā pilikia olakino hou e like me ka wikiwiki o ka degeneration disc a i ʻole ka paʻa ʻole o ka iwi kuamoʻo i nā ʻāpana asymptomatic a i ʻole maʻamau.
Aia kekahi mau pilikia kānāwai e pili ana i nā hewa segmental i ke ʻoki ʻana o ka iwi kuamoʻo, a ʻo ka lehulehu, nā keʻena aupuni, nā haukapila, a me nā hui o nā kauka ʻokiʻoki ʻaʻohe o lākou hoʻomanawanui no ia mau hewa. Hana ʻia nā ʻoki ʻana o ka iwi kuamoʻo he nui, e like me ka discectomy, fusion, laminectomy decompression, a me kyphoplasty, me ka hoʻohana ʻana i kahi ala posterior, a he mea nui ke kūlana kūpono. ʻOiai ke ʻano o ka ʻenehana kiʻi o kēia manawa, ke kū mau nei nā hewa segmental, me nā helu hanana mai 0.032% a 15% i hōʻike ʻia ma ka palapala. ʻAʻohe hopena e pili ana i ke ʻano o ka localization i ʻoi aku ka pololei.
Ua hana nā kānaka ʻepekema mai ka ʻOihana ʻoki kino Orthopedic ma ke Kula Lapaʻau ʻo Mount Sinai, USA, i kahi noiʻi nīnau pūnaewele e hōʻike ana he hapa nui o nā kauka ʻoki iwi kuamoʻo e hoʻohana wale ana i kekahi mau ʻano o ka localization, a ʻo ka wehewehe ʻana i nā kumu maʻamau o ka hewa hiki ke lilo i mea kūpono i ka hōʻemi ʻana i nā hewa segmental ʻoki kino, ma kahi ʻatikala i paʻi ʻia ma Mei 2014 ma Spine J. Ua hana ʻia ke aʻo ʻana me ka hoʻohana ʻana i kahi nīnau i leka uila ʻia. Ua hana ʻia ke aʻo ʻana me ka hoʻohana ʻana i kahi loulou i leka uila ʻia i kahi nīnau i hoʻouna ʻia i nā lālā o ka North American Spine Society (me nā kauka ʻoki kino orthopedic a me nā neurosurgeons). Hoʻokahi wale nō ka hoʻouna ʻana i ka nīnau, e like me ka ʻōlelo a ka North American Spine Society. He 2338 mau kauka i loaʻa iā ia, 532 i wehe i ka loulou, a he 173 (7.4% pane pane) i hoʻopau i ka nīnau. He kanahikukumamālua pakeneka o ka poʻe i hoʻopau he mau kauka ʻoki kino orthopedic, 28% he mau neurosurgeons, a he 73% he mau kauka iwi kuamoʻo e aʻo ana.
ʻO ka nīnau nīnau he 8 mau nīnau (Kiʻi 1) e uhi ana i nā ʻano hana i hoʻohana pinepine ʻia no ka localization (nā hōʻailona anatomical a me ka localization kiʻi), ka nui o nā hewa segmental ʻoki kino, a me ka pilina ma waena o nā ʻano hana o ka localization a me nā hewa segmental. ʻAʻole i hoʻāʻo ʻia a hōʻoia ʻia paha ka nīnau nīnau. ʻAe ka nīnau nīnau i nā koho pane he nui.
Kiʻi 1 ʻEwalu mau nīnau mai ka nīnau nīnau. Ua hōʻike nā hopena ʻo ka fluoroscopy intraoperative ke ʻano hana i hoʻohana pinepine ʻia no ka localization no ke ʻoki hope o ka thoracic a me ka lumbar spine (89% a me 86%, kēlā me kēia), ukali ʻia e nā radiographs (54% a me 58%, kēlā me kēia). Ua koho nā kauka he 76 e hoʻohana i ka hui pū ʻana o nā ʻano hana ʻelua no ka localization. ʻO nā kaʻina hana spinous a me nā pedicles pili nā mea i hoʻohana pinepine ʻia no ke ʻoki ʻana o ka thoracic a me ka lumbar spine (67% a me 59%), ukali ʻia e nā kaʻina hana spinous (49% a me 52%) (Kiʻi 2). 68% o nā kauka i ʻae ua hana lākou i nā hewa localization segmental i kā lākou hana, a ua hoʻoponopono ʻia kekahi o ia mau mea i ka wā intraoperative (Kiʻi 3).
Kiʻi 2 Nā ʻano hana hoʻonohonoho kiʻi a me nā ʻano anatomical landmark i hoʻohana ʻia.
Kiʻi 3 Kauka a me ka hoʻoponopono ʻana i nā hewa ʻāpana ʻoki kino i loko o ke ʻoki kino.
No nā hewa localization, 56% o kēia mau kauka i hoʻohana i nā radiographs preoperative a 44% i hoʻohana i ka fluoroscopy intraoperative. ʻO nā kumu maʻamau no nā hewa hoʻonohonoho preoperative ʻo ia ka hiki ʻole ke ʻike i kahi kiko kuhikuhi i ʻike ʻia (e laʻa, ʻaʻole i hoʻokomo ʻia ka iwi kuamoʻo sacral i ka MRI), nā ʻano anatomical (lumbar displaced vertebrae a i ʻole 13-root ribs), a me nā ambiguities segmental ma muli o ke kūlana kino o ka mea maʻi (suboptimal X-ray display). ʻO nā kumu maʻamau o nā hewa hoʻonohonoho intraoperative e pili ana i ka launa pū ʻole me ka fluoroscopist, ka hiki ʻole o ka hoʻonohonoho hou ʻana ma hope o ke kau ʻana (neʻe ʻana o ka nila hoʻonohonoho ma hope o ka fluoroscopy), a me nā kiko kuhikuhi hewa i ka wā o ke kau ʻana (lumbar 3/4 mai nā iwi ʻaoʻao i lalo) (Kiʻi 4).
Kiʻi 4 Nā kumu no nā hewa localization preoperative a me intraoperative.
Hōʻike nā hopena i luna aʻe ʻoiai he nui nā ʻano hana o ka localization, hoʻohana ka hapa nui o nā kauka ʻokiʻoki i kekahi mau mea wale nō. ʻOiai he kakaikahi nā hewa segmental ʻokiʻoki, ʻo ka maikaʻi loa ʻaʻohe o lākou. ʻAʻohe ala maʻamau e hoʻopau ai i kēia mau hewa; akā naʻe, ʻo ka hoʻolilo ʻana i ka manawa e hana ai i ke kau ʻana a me ka ʻike ʻana i nā kumu maʻamau o nā hewa hoʻonoho hiki ke kōkua i ka hōʻemi ʻana i ka nui o nā hewa segmental ʻokiʻoki ma ka iwi kuamoʻo thoracolumbar.
Ka manawa hoʻouna: Iulai-24-2024
