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Ntchito ya Cureus ndikusintha chitsanzo chomwe chakhalapo nthawi yayitali cha kusindikiza kwachipatala, momwe kuperekera kafukufuku kungakhale kodula, kovuta, komanso nthawi yambiri.
Neuroradiology, vertebral transfer, cervical vertebroplasty, posterolateral njira, singano yopindika, interventional neuroradiology, percutaneous vertebroplasty
Tchulani nkhaniyi monga: Swarnkar A, Zain S, Christie O, et al.(Meyi 29, 2022) Vertebroplasty ya ma pathological C2 fractures: vuto lapadera lachipatala pogwiritsa ntchito njira yokhotakhota ya singano.Kuchiza 14(5): e25463.doi:10.7759/cureus.25463
Ma vertebroplasty ocheperako pang'ono atuluka ngati njira ina yothandizira ma pathological vertebral fractures.Vertebroplasty imalembedwa bwino mu njira ya thoracic ndi lumbar posterolateral, koma sagwiritsidwa ntchito kawirikawiri msana wa khomo lachiberekero chifukwa cha zofunikira zambiri za neural ndi mitsempha zomwe ziyenera kupeŵedwa.Kugwiritsira ntchito njira mosamala ndi kujambula n'kofunikira kuti pakhale zovuta zowonongeka komanso kuchepetsa chiopsezo cha zovuta.Mu njira ya posterolateral, chotupacho chiyenera kukhala pa singano yowongoka yopita ku C2 vertebra.Njirayi ikhoza kuchepetsa chithandizo chokwanira cha zotupa zomwe zili pakati.Timalongosola zachipatala chapadera cha njira yopambana komanso yotetezeka ya posterolateral pochiza ma metastases owononga apakati a C2 pogwiritsa ntchito singano yopindika.
Vertebroplasty imaphatikizapo kusintha zinthu zamkati za thupi la vertebral kukonza zosweka kapena kusakhazikika kwapangidwe.Simenti nthawi zambiri imagwiritsidwa ntchito ngati zolembera, zomwe zimapangitsa kuti vertebrae ikhale yolimba, kuchepetsa chiopsezo cha kugwa, ndi kuchepa kwa ululu, makamaka kwa odwala osteoporosis kapena osteolytic bone zilonda [1].Percutaneous vertebroplasty (PVP) imagwiritsidwa ntchito ngati chothandizira ku analgesics ndi ma radiation therapy kuti athetse ululu kwa odwala omwe ali ndi vertebral fractures yachiwiri mpaka kuwonongeka.Njirayi nthawi zambiri imachitidwa mu thoracic ndi lumbar msana kudzera mu posterolateral pedicle kapena extrapedicular approach.PVP nthawi zambiri sichimachitidwa mumsana wa khomo lachiberekero chifukwa cha kuchepa kwa thupi la vertebral ndi zovuta zamakono zomwe zimagwirizanitsidwa ndi kukhalapo kwa ziwalo zofunika kwambiri za ubongo mu msana wa khomo lachiberekero monga msana, mitsempha ya carotid, mitsempha ya jugular, ndi mitsempha ya cranial.2].PVP, makamaka pamlingo wa C2, imakhala yosowa kwambiri kapena yosowa chifukwa cha zovuta za anatomical ndi chotupa pamlingo wa C2.Pankhani ya zilonda zosakhazikika za osteolytic, vertebroplasty ikhoza kuchitidwa ngati ndondomekoyi ikuwoneka yovuta kwambiri.Mu zilonda za PVP za C2 matupi a vertebral, singano yowongoka nthawi zambiri imagwiritsidwa ntchito kuchokera ku anterolateral, posterolateral, translational, kapena transoral (pharyngeal) njira yopewera zovuta [3].Kugwiritsiridwa ntchito kwa singano yowongoka kumasonyeza kuti chotupacho chiyenera kutsatira njira iyi kuti chichiritse mokwanira.Kutupa kunja kwa njira yolunjika kungapangitse chithandizo chochepa, chosakwanira kapena kuchotsedwa kwathunthu ku chithandizo choyenera.Njira yokhotakhota ya singano ya PVP yakhala ikugwiritsidwa ntchito posachedwapa mu msana wa lumbar ndi thoracic ndi malipoti owonjezereka oyendetsa [4,5].Komabe, kugwiritsa ntchito singano zokhotakhota mumsana wa khomo lachiberekero sikunanenedwe.Timalongosola zachipatala cha C2 pathologic fracture yachiwiri ya khansa ya metastatic pancreatic yomwe imachitidwa ndi PVP yapakhomo lachiberekero.
Mnyamata wina wazaka 65 adapezeka kuchipatala ndi ululu watsopano paphewa lake lakumanja ndi khosi lomwe linapitirira kwa masiku a 10 popanda mpumulo ndi mankhwala osagwiritsidwa ntchito.Zizindikirozi sizimayendera limodzi ndi dzanzi kapena kufooka kulikonse.Anali ndi mbiri yodziwika bwino ya khansa ya kapamba ya metastatic siteji IV, matenda oopsa komanso uchidakwa kwambiri.Anamaliza maulendo a 6 a FOLFIRINOX (leucovorin / leucovorin, fluorouracil, irinotecan hydrochloride ndi oxaliplatin) koma adayambitsa ndondomeko yatsopano ya gemzar ndi abraxane masabata awiri apitawo chifukwa cha matenda.Pakupimidwa thupi, iye analibe chifundo pa palpation wa khomo lachiberekero, thoracic, kapena lumbar msana.Kuonjezera apo, panalibe kusokonezeka kwamaganizo ndi magalimoto kumtunda ndi m'munsi.Maonekedwe ake apawiri anali abwinobwino.Kujambula kwa kunja kwa chipatala computed tomography (CT) ya msana wa khomo lachiberekero kunasonyeza zilonda za osteolytic zogwirizana ndi matenda a metastatic omwe amakhudza mbali yamanja ya C2 vertebral body, C2 mass yolondola, pafupi ndi vertebral plate, ndi mbali yovutika maganizo ya C2. .Chapamwamba kumanja articular pamwamba chipika (mkuyu. 1).Dokotala wochita opaleshoni adafunsidwa, kujambula kwa magnetic resonance (MRI) kwa khomo lachiberekero, thoracic ndi lumbar msana kunachitika, poganizira zotupa za metastatic osteolytic.Zotsatira za MRI zimasonyeza T2 hyperintensity, T1 isointense minofu yofewa m'malo mwa mbali yamanja ya C2 vertebral body, ndi kufalikira kochepa komanso kupititsa patsogolo kusiyana.Analandira chithandizo cha radiation popanda kusintha kulikonse kwa ululu.Achipatala amalimbikitsa kuti musachite opaleshoni yadzidzidzi.Choncho, interventional radiology (IR) inkafunika chithandizo chowonjezereka chifukwa cha ululu wopweteka kwambiri komanso chiopsezo cha kusakhazikika komanso zotheka kuponderezedwa kwa msana.Pambuyo pakuwunika, adaganiza zopanga CT-guided percutaneous C2 spine plasty pogwiritsa ntchito njira ya posterolateral.
Gulu A likuwonetsa zolakwika zosiyana ndi za cortical (mivi) kumbali yakumanja ya thupi la vertebral C2.Kukula kwapang'onopang'ono kwa mgwirizano wa atlantoaxial wolondola ndi kusakhazikika kwa kortical pa C2 (muvi wandiweyani, B).Izi, limodzi ndi kuwonekera kwa misa kumanja kwa C2, zikuwonetsa kupasuka kwa pathological.
Wodwalayo anayikidwa kumbali yakumanja yogona ndipo 2.5 mg ya Versed ndi 125 μg ya fentanyl inaperekedwa mumagulu ogawanika.Poyambirira, thupi la C2 vertebral lidayikidwa ndipo 50 ml ya kusiyana kwa mtsempha inayikidwa kuti iwonetsetse mtsempha wamtundu woyenera ndikukonzekera njira yolowera.Kenaka, singano ya 11-gauge introducer inapita patsogolo ku gawo lapakati-pakatikati la thupi la vertebral kuchokera ku njira yoyenera ya posterolateral (Mkuyu 2a).A Stryker TroFlex® singano yokhotakhota idayikidwa (mkuyu 3) ndikuyika m'munsi mwapakati pa C2 osteolytic lesion (Mkuyu 2b).Simenti ya mafupa ya polymethyl methacrylate (PMMA) inakonzedwa motsatira malangizo anthawi zonse.Panthawi imeneyi, pansi pa nthawi CT-fluoroscopic ulamuliro, fupa simenti anali jekeseni kudzera singano yokhotakhota (mkuyu. 2c).Pamene kudzazidwa kokwanira kwa gawo lapansi la zilonda kunapindula, singanoyo inachotsedwa pang'onopang'ono ndikuzungulira kuti ipeze malo apamwamba apakati (mkuyu 2d).Palibe kukana kuyikanso singano chifukwa chotupa ichi ndi chotupa chachikulu cha osteolytic.Ikani simenti yowonjezera ya PMMA pamwamba pa chotupacho.Chisamaliro chinatengedwa kuti zisatayike kutayikira kwa simenti ya fupa mu ngalande ya msana kapena minofu yofewa ya paravertebral.Pambuyo pokwaniritsa kudzaza kokwanira ndi simenti, singano yokhotakhota idachotsedwa.Kujambula kwa postoperative kunawonetsa bwino PMMA bone simenti vertebroplasty (Zithunzi 2e, 2f).Kuwunika kwa minyewa pambuyo pa opaleshoni kunawonetsa kuti palibe cholakwika chilichonse.Patapita masiku angapo wodwalayo anatulutsidwa ndi kolala ya khomo lachiberekero.Ululu wake, ngakhale kuti sunatheretu kotheratu, unalamuliridwa bwino.Wodwalayo adamwalira momvetsa chisoni miyezi ingapo atatuluka m'chipatala chifukwa cha zovuta za khansa ya kapamba.
Zithunzi za computed tomography (CT) zosonyeza tsatanetsatane wa ndondomekoyi.A) Poyambirira, cannula yakunja ya 11 inayikidwa kuchokera ku njira yoyenera ya posterolateral.B) Kulowetsa singano yopindika (muvi wawiri) kudzera pa cannula (muvi umodzi) mu chotupa.Nsonga ya singano imayikidwa pansi komanso pakati.C) Simenti ya polymethyl methacrylate (PMMA) idabayidwa pansi pa chotupacho.D) Singano yopindika imabwezeretsedwa ndikulowetsedwanso kumbali yapakati, ndiyeno simenti ya PMMA imayikidwa.E) ndi F) amasonyeza kugawidwa kwa simenti ya PMMA pambuyo pa chithandizo mu ndege za coronal ndi sagittal.
Metastases yam'mimba imapezeka kwambiri m'mawere, prostate, mapapo, chithokomiro, maselo a impso, chikhodzodzo, ndi melanoma, ndi kuchepa kwa chigoba cha metastases kuyambira 5 mpaka 20% mu khansa ya pancreatic [6,7].Kukhudzidwa kwa khomo lachiberekero mu khansa ya pancreatic ndikosowa kwambiri, ndi milandu inayi yokha yomwe inalembedwa m'mabuku, makamaka omwe amagwirizanitsidwa ndi C2 [8-11].Kuphatikizidwa kwa msana kungakhale kopanda zizindikiro, koma kuphatikizika ndi fractures, kungayambitse kupweteka kosalamulirika ndi kusakhazikika komwe kumakhala kovuta kulamulira ndi njira zodzitetezera ndipo kungapangitse wodwalayo kupsinjika kwa msana.Choncho, vertebroplasty ndi njira yothetsera kukhazikika kwa msana ndipo imagwirizanitsidwa ndi kupweteka kwa odwala oposa 80% omwe akuchitidwa njirayi [12].
Ngakhale njirayo imatha kuchitidwa bwino pamlingo wa C2, mawonekedwe ovuta a anatomy amabweretsa zovuta zaukadaulo ndipo zingayambitse zovuta.Pali mitundu yambiri ya mitsempha yomwe ili pafupi ndi C2, monga momwe zimakhalira kutsogolo kwa pharynx ndi larynx, lateral kwa carotid space, posterolateral kwa vertebral artery ndi khomo lachiberekero, ndi kumbuyo kwa thumba [13].Pakalipano, njira zinayi zimagwiritsidwa ntchito mu PVP: anterolateral, posterolateral, transoral, and translational.Njira ya anterolateral nthawi zambiri imachitidwa pamtunda ndipo imafuna hyperextension ya mutu kukweza mandible ndikuthandizira C2 kupeza.Choncho, njirayi singakhale yoyenera kwa odwala omwe sangathe kusunga mutu wa hyperextension.Singano imadutsa m'malo a parapharyngeal, retropharyngeal ndi prevertebral ndipo mawonekedwe a posterolateral a mtsempha wa carotid amayendetsedwa mosamala pamanja.Ndi njirayi, kuwonongeka kwa mitsempha ya vertebral, carotid artery, jugular vein, submandibular gland, oropharyngeal ndi IX, X ndi XI mitsempha ya cranial ndizotheka [13].Cerebellar infarction ndi C2 neuralgia yachiwiri mpaka kutayikira kwa simenti amaonedwanso kuti ndizovuta [14].Njira ya posterolateral siimafuna anesthesia wamba, ingagwiritsidwe ntchito kwa odwala omwe sangathe kupititsa patsogolo khosi, ndipo nthawi zambiri amachitidwa pamtunda.Singano imadutsa kumtunda wa khomo lachiberekero kumalo akunja, cranial ndi medial, kuyesera kuti asakhudze mitsempha ya vertebral ndi nyini yake.Choncho, zovuta zimagwirizanitsidwa ndi kuwonongeka kwa mitsempha ya msana ndi msana [15].Kufikira ku Transoral ndikosavuta mwaukadaulo ndipo kumaphatikizapo kulowetsa singano pakhoma la pharyngeal ndi pharyngeal space.Kuphatikiza pa kuwonongeka kwa mitsempha ya vertebral, njirayi imagwirizanitsidwa ndi chiopsezo chachikulu cha matenda ndi zovuta monga pharyngeal abscesses ndi meningitis.Njirayi imafunanso anesthesia wamba ndi intubation [13,15].Pokhala ndi mwayi wopita patsogolo, singano imalowetsedwa mu malo omwe angakhalepo pakati pa mitsempha ya mitsempha ya carotid ndi vertebral artery lateral mpaka mlingo wa C1-C3, pamene chiopsezo cha kuwonongeka kwa ziwiya zazikulu ndipamwamba [13].Vuto lomwe lingakhalepo panjira iliyonse ndi kutayikira kwa simenti ya mafupa, komwe kungayambitse kupsinjika kwa msana kapena mizu ya mitsempha [16].
Zadziwika kuti kugwiritsa ntchito singano yokhotakhota panthawiyi kuli ndi ubwino wina, kuphatikizapo kuwonjezereka kwa kusinthasintha komanso kusinthasintha kwa singano.Singano yokhotakhota imathandizira ku: kutha kulunjika mbali zosiyanasiyana za thupi la vertebral, kulowa kwapakati pakatikati, kuchepetsa nthawi ya ndondomeko, kuchepetsa kuchepa kwa simenti, ndi kuchepetsa nthawi ya fluoroscopy [4,5].Kutengera kuwunika kwathu kwa mabukuwa, kugwiritsa ntchito singano zokhotakhota mumsana wa khomo lachiberekero sikunanenedwe, ndipo pamilandu yomwe ili pamwambapa, singano zowongoka zidagwiritsidwa ntchito popanga vertebroplasty pamlingo wa C2 [15,17-19].Chifukwa cha zovuta za chigawo cha khosi, kuwonjezereka kwa njira ya singano yokhotakhota kungakhale kopindulitsa kwambiri.Monga momwe tawonetsera m'nkhani yathu, opaleshoniyi inkachitidwa momasuka ndipo tinasintha malo a singano kuti tidzaze mbali zingapo za zilondazo.Mu lipoti laposachedwa, Shah et al.Singano yopindika yomwe idasiyidwa pambuyo pa baluni kyphoplasty idawululidwa, kuwonetsa zovuta zomwe zingachitike pa singano yopindika: mawonekedwe a singano angathandize kuti achotsedwe [20].
M'nkhaniyi, tikuwonetsa chithandizo chopambana cha fractures yosakhazikika ya C2 vertebral body pogwiritsa ntchito posterolateral PVP yokhala ndi singano yokhotakhota ndi intermittent CT fluoroscopy, zomwe zimapangitsa kuti fracture ikhale yokhazikika komanso kuwongolera bwino kwa ululu.Njira ya singano yokhotakhota ndi yopindulitsa: imatithandiza kuti tifike pachilondacho kuchokera ku njira yotetezeka ya posterolateral ndipo imatilola kuti tilowetsenso singano ku mbali zonse za zilondazo ndikudzaza mokwanira ndi kudzaza chilondacho ndi simenti ya PMMA.Tikuyembekeza kuti njirayi ingachepetse kugwiritsa ntchito opaleshoni yofunikira kuti munthu athe kupeza transoropharyngeal ndikupewa zovuta za mitsempha zomwe zimagwirizanitsidwa ndi njira zam'mbuyo ndi zam'mbali.
Nkhani Za Anthu: Onse omwe adachita nawo kafukufukuyu adapereka kapena sanapereke chilolezo.Kutsutsana kwa Chidwi: Mogwirizana ndi Fomu Yodziwitsa Zofanana za ICMJE, olemba onse amalengeza zotsatirazi: Malipiro / Utumiki Wautumiki: Olemba onse amalengeza kuti sanalandire thandizo la ndalama kuchokera ku bungwe lililonse pa ntchito yoperekedwa.Ubale Wazachuma: Olemba onse amalengeza kuti pakali pano kapena m'zaka zitatu zapitazi alibe maubwenzi azachuma ndi bungwe lililonse lomwe lingakhale ndi chidwi ndi ntchito yomwe yatumizidwa.Maubale Ena: Olemba onse amalengeza kuti palibe maubale kapena zochitika zina zomwe zingakhudze ntchito yotumizidwa.
Swarnkar A, Zane S, Christie O, et al.(Meyi 29, 2022) Vertebroplasty ya ma pathological C2 fractures: vuto lapadera lachipatala pogwiritsa ntchito njira yokhotakhota ya singano.Kuchiza 14(5): e25463.doi:10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Iyi ndi nkhani yotseguka yopezeka yoperekedwa motsatira malamulo a Creative Commons Attribution License CC-BY 4.0.Kugwiritsa ntchito mopanda malire, kugawa, ndi kutulutsanso m'njira iliyonse ndikololedwa, malinga ngati wolemba ndi gwero loyambirira atchulidwa.
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Gulu A likuwonetsa zolakwika zosiyana ndi za cortical (mivi) kumbali yakumanja ya thupi la vertebral C2.Kukula kwapang'onopang'ono kwa mgwirizano wa atlantoaxial wolondola ndi kusakhazikika kwa kortical pa C2 (muvi wandiweyani, B).Izi, limodzi ndi kuwonekera kwa misa kumanja kwa C2, zikuwonetsa kupasuka kwa pathological.
Zithunzi za computed tomography (CT) zosonyeza tsatanetsatane wa ndondomekoyi.A) Poyambirira, cannula yakunja ya 11 inayikidwa kuchokera ku njira yoyenera ya posterolateral.B) Kulowetsa singano yopindika (muvi wawiri) kudzera pa cannula (muvi umodzi) mu chotupa.Nsonga ya singano imayikidwa pansi komanso pakati.C) Simenti ya polymethyl methacrylate (PMMA) idabayidwa pansi pa chotupacho.D) Singano yopindika imabwezeretsedwa ndikulowetsedwanso kumbali yapakati, ndiyeno simenti ya PMMA imayikidwa.E) ndi F) amasonyeza kugawidwa kwa simenti ya PMMA pambuyo pa chithandizo mu ndege za coronal ndi sagittal.
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