Cov neeg mob phais thiab qhov chaw ua yuam kev yog qhov hnyav thiab tiv thaiv tau. Raws li Lub Koom Haum Koom Tes ntawm Kev lees paub ntawm Cov Koom Haum Saib Xyuas Kev Noj Qab Haus Huv, cov kev ua yuam kev no tuaj yeem ua tau txog li 41% ntawm kev phais mob orthopedic/pediatric. Rau kev phais tus txha caj qaum, qhov chaw phais qhov yuam kev tshwm sim thaum lub vertebral ntu lossis lateralization tsis raug. Ntxiv nrog rau qhov tsis ua raws li tus neeg mob cov tsos mob thiab pathology, segmental yuam kev tuaj yeem ua rau muaj teeb meem kev kho mob tshiab xws li kev ua kom nrawm ntawm disc degeneration lossis txha caj qaum instability nyob rau hauv lwm yam asymptomatic lossis ib ntus.
Kuj tseem muaj teeb meem kev cai lij choj cuam tshuam nrog segmental yuam kev hauv kev phais txha caj qaum, thiab cov pej xeem, tsoom fwv cov koom haum, tsev kho mob, thiab cov koom haum ntawm cov kws phais neeg tsis muaj kev zam rau qhov tsis raug. Ntau qhov kev phais mob txha caj qaum, xws li discectomy, fusion, laminectomy decompression, thiab kyphoplasty, yog ua los ntawm kev siv txoj hauv kev tom qab, thiab qhov chaw zoo yog qhov tseem ceeb. Txawm hais tias tam sim no imaging thev naus laus zis, segmental yuam kev tseem tshwm sim, nrog cov xwm txheej ntawm 0.032% mus rau 15% qhia hauv cov ntaub ntawv. Tsis muaj kev txiav txim siab seb txoj kev twg hauv zos yog qhov tseeb tshaj plaws.
Cov kws tshawb fawb los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Orthopedic ntawm Mount Sinai Tsev Kawm Ntawv Tshuaj, Tebchaws Asmeskas, tau ua cov lus nug hauv online qhia tias feem coob ntawm cov kws phais neeg txha caj qaum tsuas yog siv ob peb txoj hauv kev hauv zos xwb, thiab qhov kev qhia meej ntawm qhov kev ua yuam kev ib txwm muaj peev xwm ua tau zoo hauv kev txo cov kev phais segmental yuam kev, hauv ib tsab xov xwm luam tawm hauv Spine 20 J. Txoj kev tshawb no tau ua los ntawm kev xa email mus rau ib daim ntawv nug xa mus rau cov tswv cuab ntawm North American Spine Society (xws li kws phais orthopedic thiab neurosurgeons). Daim ntawv nug tsuas yog xa ib zaug xwb, raws li kev pom zoo los ntawm North American Spine Society. Tag nrho ntawm 2338 tus kws kho mob tau txais nws, 532 qhib qhov txuas, thiab 173 (7.4% tus nqi teb) ua tiav daim ntawv nug. Xya caum-ob feem pua ntawm cov neeg ua tiav yog cov kws phais mob orthopedic, 28% yog cov kws kho mob hlwb, thiab 73% yog cov kws kho mob txha caj qaum hauv kev cob qhia.
Cov lus nug muaj tag nrho ntawm 8 cov lus nug (Daim duab 1) uas suav nrog cov kev siv feem ntau ntawm kev ua haujlwm hauv cheeb tsam (ob qho tib si anatomical landmarks thiab imaging localization), qhov tshwm sim ntawm kev phais segmental yuam kev, thiab kev koom tes ntawm txoj kev hauv zos thiab segmental yuam kev. Daim ntawv nug tsis tau sim los yog ua pov thawj. Daim ntawv nug tso cai rau ntau cov lus teb xaiv.
Daim duab 1 Yim lo lus nug los ntawm daim ntawv nug. Cov txiaj ntsig tau pom tias kev siv tshuaj fluoroscopy feem ntau yog siv txoj hauv kev hauv cheeb tsam rau kev phais mob tom qab thoracic thiab lumbar qaum (89% thiab 86%, feem), ua raws li cov duab hluav taws xob (54% thiab 58%, feem). 76 tus kws kho mob tau xaiv los siv ob qho kev sib xyaw ua ke rau hauv zos. Cov txheej txheem spinous thiab sib thooj pedicles yog cov feem ntau siv anatomic landmarks rau thoracic thiab lumbar spine (67% thiab 59%), ua raws li cov txheej txheem spinous (49% thiab 52%) (Fig. 2). 68% ntawm cov kws kho mob tau lees paub tias lawv tau ua segmental localization yuam kev hauv lawv qhov kev coj ua, qee qhov raug kho tsis raug (daim duab 3).
Fig. 2 Kev kos duab thiab anatomical landmark localization txoj kev siv.
Fig. 3 Tus kws kho mob thiab kho qhov kev phais ntawm qhov kev phais.
Rau qhov ua yuam kev hauv cheeb tsam, 56% ntawm cov kws kho mob no siv cov xov tooj cua ua ntej thiab 44% siv cov tshuaj fluoroscopy intraoperative. Cov laj thawj ib txwm ua rau kev ua haujlwm tsis raug ua ntej yog qhov tsis pom qhov kev paub txog qhov taw qhia (xws li, sacral spine tsis suav nrog hauv MRI), anatomical variations (lumbar displaced vertebrae or 13-root ribs), thiab segmental ambiguities vim tus neeg mob lub cev mob (suboptimal X-ray zaub). Feem ntau ua rau muaj qhov tsis zoo ntawm qhov chaw ua haujlwm muaj xws li kev sib txuas lus tsis txaus nrog fluoroscopist, tsis ua haujlwm ntawm kev rov ua haujlwm tom qab muab tso rau (txav ntawm lub koob tso npe tom qab fluoroscopy), thiab cov ntsiab lus tsis raug thaum muab tso rau (lumbar 3/4 los ntawm tav tav) (Daim duab 4).
Fig. 4 Yog vim li cas rau preoperative thiab intraoperative localization yuam kev.
Cov txiaj ntsig saum toj no qhia tau hais tias txawm hais tias muaj ntau txoj hauv kev hauv zos, feem coob ntawm cov kws phais neeg siv tsuas yog qee qhov ntawm lawv. Txawm hais tias kev phais segmental yuam kev tsis tshua muaj, qhov tseeb lawv tsis tuaj. Tsis muaj txoj hauv kev los tshem tawm cov yuam kev no; Txawm li cas los xij, siv sij hawm los ua qhov chaw thiab txheeb xyuas qhov ua rau ib txwm ua rau qhov yuam kev tuaj yeem pab txo qis qhov tshwm sim ntawm kev phais segmental yuam kev hauv tus txha caj qaum thoracolumbar.
Post lub sij hawm: Lub Xya hli ntuj-24-2024
