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Inshingano za Cureus nuguhindura uburyo bumaze igihe cyo gutangaza ubuvuzi, aho gutanga ubushakashatsi bishobora kuba bihenze, bigoye, kandi bitwara igihe.
Neuroradiology, kwimura vertebral, vertebroplasty cervical, inzira yinyuma, inshinge zigoramye, neuroradiology interventional interventional, vertebroplasty
Tanga iyi ngingo nka: Swarnkar A, Zain S, Christie O, n'abandi..Umuti 14 (5): e25463.doi: 10.7759 / gukiza.25463
Vertebroplasty yibasiwe byibuze byagaragaye nkuburyo bufatika bwo kuvura indwara ya vertebral.Vertebroplasty yanditse neza muburyo bwa thoracic na lumbar posterolateral, ariko ntibikunze gukoreshwa mugongo yinkondo y'umura kubera imiterere myinshi yingenzi yimitsi nimiyoboro y'amaraso igomba kwirindwa.Gukoresha tekinike yitonze no gufata amashusho nibyingenzi kugirango ukoreshe ibintu bikomeye kandi ugabanye ingaruka ziterwa nibibazo.Muburyo bwa posterolateral, igikomere kigomba kuba kiri munzira igororotse igororotse kuruhande rwa C2 vertebra.Ubu buryo bushobora kugabanya ubuvuzi buhagije bwo kuvura ibikomere byinshi.Turasobanura ikibazo cyihariye cyamavuriro yuburyo bwiza kandi bwizewe bwo kuvura imiti ya C2 yangiza ikoresheje urushinge rugoramye.
Vertebroplasty ikubiyemo gusimbuza ibikoresho byimbere byumubiri wurugingo kugirango bisane ibice cyangwa ihungabana ryimiterere.Isima ikunze gukoreshwa nk'ibikoresho byo gupakira, bigatuma imbaraga za vertebrae ziyongera, bikagabanya ibyago byo gusenyuka, ndetse no kugabanuka k'ububabare, cyane cyane ku barwayi barwaye osteoporose cyangwa amagufwa ya osteolitike [1].Vertebroplasty percutaneous (PVP) isanzwe ikoreshwa nkumugereka wo gusesengura no kuvura imirasire kugirango igabanye ububabare kubarwayi bafite imvune zurugingo rwa kabiri kugeza mbi.Ubu buryo busanzwe bukorwa mu ruti rw'umugongo rwa thoracic na lumbar unyuze kuri pedicle yinyuma cyangwa inzira zidasanzwe.Ubusanzwe PVP ntabwo ikorerwa mu ruti rw'umugongo bitewe n'ubunini buke bw'umubiri wa vertebral hamwe n'ibibazo bya tekiniki bifitanye isano no kuba hari imiterere ikomeye y'imitsi itwara imitsi mu ruti rw'umugongo nk'umugongo, urwungano ngogozi, imiyoboro y'amaraso, n'imitsi yo mu mutwe.2].PVP, cyane cyane kurwego rwa C2, ni gake cyane cyangwa ni gake cyane kubera anatomique igoye no kugira uruhare mubyimba kurwego rwa C2.Mugihe habaye ibikomere bya osteolytike idahindagurika, vertebroplasti irashobora gukorwa mugihe inzira ifatwa nkigikomeye.Muri PVP ibikomere byimibiri ya C2, urushinge rugororotse rusanzwe rukoreshwa muburyo butandukanye, inyuma, guhinduranya, cyangwa guhinduranya (pharyngeal) kugirango wirinde ibintu bikomeye [3].Gukoresha urushinge rugororotse byerekana ko igikomere kigomba gukurikira iyi nzira kugirango gikire bihagije.Ibibyimba hanze yinzira itaziguye birashobora kuvamo imiti mike, idahagije cyangwa kuvanwa burundu kubuvuzi bukwiye.Tekinike igoramye ya PVP tekinike iherutse gukoreshwa mu ruti rw'umugongo na thoracic hamwe na raporo zerekana ko abantu bagenda neza [4,5].Ariko, gukoresha inshinge zigoramye mu ruti rw'umugongo ntabwo byigeze bivugwa.Turasobanura ikibazo cyamavuriro ya C2 idasanzwe yamenetse ya kabiri ya kanseri yandura kanseri yanduye ivurwa na PVP yinyuma yinkondo y'umura.
Umusaza w'imyaka 65 yagejeje ku bitaro ububabare bushya butangira ububabare ku rutugu rw'iburyo no mu ijosi byakomeje kumara iminsi 10 nta gutabarwa n'imiti irenga imiti.Ibi bimenyetso ntabwo bifitanye isano no kunanirwa cyangwa intege nke.Yari afite amateka akomeye ya metastatike itandukanijwe nabi na kanseri ya pancreatic icyiciro cya IV, hypertension arterial hamwe nubusinzi bukabije.Yarangije inzinguzingo 6 za FOLFIRINOX (leucovorin / leucovorin, fluorouracil, hydrochloride ya irinotecan na oxaliplatine) ariko atangira gahunda nshya ya gemzar na abraxane mubyumweru bibiri bishize kubera iterambere ryindwara.Isuzuma ry'umubiri, ntabwo yari afite impuhwe zo guterwa umugongo w'inkondo y'umura, thoracic, cyangwa lumbar.Byongeye kandi, nta byerekeranye no kumva no gutwara moteri mu gice cyo hejuru no hepfo.Impinduka zombi zari zisanzwe.Isuzuma rya tomografiya yo hanze y’ibitaro (CT) ryerekana uruti rwumugongo rwerekanaga ibikomere bya osteolytique bihuye nindwara ya metastatike irimo uruhande rwiburyo rwumubiri wa C2, imbaga ya C2 iburyo, isahani yiburyo ya vertebral, hamwe nuruhande rwa C2 rwihebye. .Hejuru iburyo bwa arctular igaragara hejuru (Ishusho 1).Neurosurgueon yagishije inama, magnetic resonance imaging (MRI) yumugongo winkondo y'umura, thoracic na lumbar yakozwe, hitawe kubikomere bya osteolytike metastatike.Ubushakashatsi bwa MRI bwerekanye ko T2 hyperintensity, T1 isointense yoroheje yoroheje isimbuza uruhande rwiburyo rwumubiri wa C2, hamwe no gukwirakwizwa gukabije no kuzamura itandukaniro.Yakiriye imiti ivura imirasire nta terambere ryagaragaye afite mu bubabare.Serivise ya neurosurgie irasaba kutabagwa byihutirwa.Niyo mpamvu, radiologiya interventionaliste (IR) yasabwaga kugirango irusheho kuvurwa kubera ububabare bukabije hamwe n’ingaruka zo guhungabana no guhungabana kwumugongo.Nyuma yisuzuma, hafashwe umwanzuro wo gukora CT iyobowe na C2 iyobora C2 umugongo ukoresheje inzira yinyuma.
Ikibaho A cyerekana ibintu bidasanzwe kandi bya cortical (imyambi) kuruhande rwiburyo bwimbere bwumubiri wa C2.Kwiyongera kudasanzwe kwimyanya iburyo ya atlantoaxial hamwe na cortical idasanzwe kuri C2 (umwambi mwinshi, B).Ibi, hamwe nubucyo bwa misa kuruhande rwiburyo bwa C2, byerekana kuvunika indwara.
Umurwayi yashyizwe kuruhande rwiburyo aryamye kandi mg 2,5 za Versed na 125 μg za fentanyl zatanzwe mubice bigabanijwe.Ku ikubitiro, umubiri wa C2 urutirigongo washyizwe hamwe hanyuma miriyoni 50 zo gutandukanya imitsi zatewe inshinge zo mu muyoboro w’iburyo no gutegura inzira yo kugera.Hanyuma, urushinge rwa 11-rwerekana urushinge rwazamuwe rugana igice cyinyuma-hagati yumubiri wurugingo ruva muburyo bwiza (Ishusho 2a).Urushinge rugoramye rwa Stryker TroFlex® noneho rwinjijwemo (Ishusho 3) hanyuma rushyirwa mugice cyo hagati cyo hagati ya C2 osteolytic lesion (Ishusho 2b).Polymethyl methacrylate (PMMA) sima yamagufa yateguwe ukurikije amabwiriza asanzwe.Kuri iki cyiciro, mugihe kimwe na CT-fluoroscopique igenzurwa, sima yamagufa yatewe inshinge yagoramye (Ishusho 2c).Bimaze kugerwaho bihagije igice cyo hepfo yindwara, urushinge rwakuweho igice hanyuma ruzunguruka kugirango rugere kumwanya wo hagati wo hagati (Ishusho 2d).Nta kurwanya kurushinge rushyizweho kuko iki gisebe ni igikomere gikomeye cya osteolytike.Shyiramo sima yinyongera ya PMMA hejuru yindwara.Hafashwe ingamba zo kwirinda kumeneka kwa sima mu magufa cyangwa mu mitsi yoroshye ya paravertebral.Nyuma yo kugera ku kuzuza neza na sima, urushinge rugoramye rwakuweho.Kwerekana amashusho nyuma yubuvuzi bwerekanaga PMMA igufwa rya sima vertebroplasti (Ishusho 2e, 2f).Isuzuma rya neurologiya nyuma yo kubagwa ryagaragaje ko nta nenge.Nyuma y'iminsi mike, umurwayi yasohotse asohora inkondo y'umura.Ububabare bwe, nubwo butarakemuwe neza, bwagenzuwe neza.Umurwayi yapfuye mu buryo bubabaje nyuma y'amezi make asohotse mu bitaro kubera ibibazo bya kanseri yandura.
Amashusho yabazwe ya tomografiya (CT) yerekana ibisobanuro birambuye.A) Mu ikubitiro, urumogi 11 rwo hanze rwinjijwe muburyo buteganijwe neza.B) Kwinjiza urushinge rugoramye (imyambi ibiri) unyuze muri cannula (umwambi umwe) muri lesion.Isonga y'urushinge ishyirwa hepfo kandi murwego rwo hagati.C) Isima ya polymethyl methacrylate (PMMA) yatewe mu nsi y’igisebe.D) Urushinge rwunamye rusubira inyuma hanyuma rwongera kwinjizwa muruhande rwo hejuru rwagati, hanyuma hashyirwaho sima ya PMMA.E) na F) berekana ikwirakwizwa rya sima ya PMMA nyuma yo kuvurwa mu ndege ya coronale na sagittal.
Metastase ya vertebral ikunze kugaragara cyane mu ibere, prostate, ibihaha, tiroyide, selile zimpyiko, uruhago, na melanoma, aho usanga umubare muto w’imitsi ya skeletale uri hagati ya 5 na 20% muri kanseri yandura [6,7].Uruhare rw'inkondo y'umura muri kanseri yandura ni gake cyane, aho abantu bane bonyine bavugwa mu bitabo, cyane cyane abajyanye na C2 [8-11].Uruhare rwumugongo rushobora kuba rudasanzwe, ariko iyo ruhujwe no kuvunika, birashobora gutera ububabare butagenzuwe hamwe n’umutekano muke bigoye kugenzura hakoreshejwe ingamba zo kubungabunga ibidukikije kandi bishobora guteganya umurwayi kwikuramo umugongo.Niyo mpamvu, vertebroplasty ari uburyo bwo guhagarika urutirigongo kandi bifitanye isano no kugabanya ububabare ku barwayi barenga 80% bari muri ubu buryo [12].
Nubwo inzira ishobora gukorwa neza kurwego rwa C2, anatomiya igoye itera ingorane tekinike kandi irashobora gukurura ingorane.Hariho imyubakire myinshi ya neurovasculaire yegeranye na C2, kuko iri imbere yimitsi na larynx, kuruhande rwumwanya wa karotide, kuruhande rwimitsi iva mu mitsi no mumitsi yinkondo y'umura, hamwe ninyuma yumufuka [13].Kugeza ubu, uburyo bune bukoreshwa muri PVP: impande zombi, zinyuranye, izenguruka, hamwe nubusobanuro.Uburyo bwa anterolateral busanzwe bukorwa mumwanya wa supine kandi bisaba hyperextension yumutwe kugirango uzamure byemewe kandi byorohereze C2 kwinjira.Kubwibyo, ubu buhanga ntibushobora kuba bubereye abarwayi badashobora gukomeza hyperextension yo mumutwe.Urushinge rwanyuze mumwanya wa parapharyngeal, retropharyngeal na prevertebral kandi imiterere yinyuma yimitsi ya karoti ikoreshwa neza nintoki.Hamwe nubu buhanga, kwangirika kwimitsi yumugongo, imiyoboro ya karoti, imitsi ya jugular, gland submandibular gland, oropharyngeal na IX, X na XI imitsi yimitsi irashoboka [13].Indwara ya Cerebellar na C2 neuralgia ya kabiri kugeza sima yamenetse nabyo bifatwa nkibibazo [14].Uburyo bwa posterolateral ntabwo busaba anesthesia rusange, burashobora gukoreshwa mubarwayi badashobora kwongera ijosi, kandi mubisanzwe bikorerwa mumwanya mwiza.Urushinge rwanyuze mumyanya yinyuma yinyuma yinyuma yimbere, imbere, hagati, igerageza kudakora kumitsi yumugongo nigituba.Rero, ingorane zifitanye isano no kwangirika kwimitsi yumugongo nu mugongo [15].Kwinjira byinzibacyuho ntabwo bigoye cyane kandi bikubiyemo kwinjiza urushinge murukuta rwa pharyngeal na space pharyngeal.Usibye kwangirika kwimitsi yumugongo, ubu buryo bufitanye isano n’ibyago byinshi byo kwandura hamwe n’ingaruka nka ibibyimba byo mu mitsi na meningite.Ubu buryo busaba kandi anesthesia muri rusange hamwe na intubation [13,15].Hamwe no kugera kuruhande, urushinge rwinjizwa mumwanya ushobora kuba uri hagati yimyenda yimitsi ya karotide na vertebral artera kuruhande kugeza kurwego rwa C1-C3, mugihe ibyago byo kwangirika kumitsi nyamukuru ari byinshi [13].Ingorabahizi zishoboka muburyo ubwo aribwo bwose ni ukumeneka kwa sima ya sima, ishobora gutera kwikuramo umugongo cyangwa imizi yumutima [16].
Byagaragaye ko gukoresha urushinge rugoramye muri ibi bihe bifite inyungu zimwe, zirimo kongera uburyo bworoshye bwo guhinduka no kuyobora inshinge.Urushinge rugoramye rugira uruhare mu: ubushobozi bwo guhitamo guhitamo ibice bitandukanye byumubiri wurugingo, kwizerwa hagati yumurongo wo hagati, kugabanya igihe cyateganijwe, kugabanya umuvuduko wa sima, no kugabanya igihe cya fluoroscopi [4,5].Dushingiye ku isubiramo ry’ubuvanganzo, ntabwo byavuzwe ko hakoreshwa inshinge zigoramye mu ruti rw'umugongo, kandi mu bihe byavuzwe haruguru, inshinge zigororotse zakoreshwaga kuri vertebroplastique nyuma y’urwego rwa C2 [15,17-19].Urebye anatomiya igoye yakarere ka ijosi, kwiyongera kwimikorere yuburyo bwinshinge zigoramye birashobora kuba ingirakamaro cyane.Nkuko bigaragara muritwe, igikorwa cyakozwe muburyo bwiza bwuruhande kandi twahinduye umwanya wurushinge kugirango twuzuze ibice byinshi byindwara.Muri raporo y'imanza iherutse, Shah n'abandi.Urushinge rugoramye rusigaye nyuma ya ballon kyphoplasty rwerekanwe rwose, byerekana ko hashobora kubaho ingorane zurushinge rugoramye: imiterere y'urushinge irashobora koroshya kuyikuraho [20].
Ni muri urwo rwego, turerekana uburyo bwiza bwo kuvura imvune zidahungabana z’umubiri wa C2 zikoresha urutirigongo dukoresheje PVP ya posterolateral PVP hamwe nurushinge rugoramye hamwe na fluoroscopi ya CT rimwe na rimwe, bikaviramo guhagarara neza no kunoza ububabare.Tekinike igoramye ya tekinike ni akarusho: iradufasha kugera ku gisebe duhereye ku buryo butekanye kandi ikadufasha kwerekeza urushinge ku mpande zose z’igisebe kandi bihagije kandi byuzuye kuzuza igikomere na sima ya PMMA.Turateganya ko ubu buhanga bushobora kugabanya ikoreshwa rya anesteziya ikenewe kugirango umuntu yinjire muri transoropharyngeal kandi akirinda ingorane zifata imitsi zifitanye isano nuburyo bwimbere.
Ibintu byabantu: Abitabiriye ubu bushakashatsi batanze cyangwa ntibatanze uburenganzira.Amakimbirane y'inyungu: Dukurikije ifishi yo kumenyekanisha ICMJE Uniform, abanditsi bose batangaza ibi bikurikira: Amakuru yo Kwishura / Serivisi: Abanditsi bose batangaza ko batabonye inkunga y'amafaranga n'umuryango uwo ariwo wose ku mirimo yatanzwe.Isano ry’imari: Abanditsi bose batangaza ko badafite muri iki gihe cyangwa mu myaka itatu ishize bafitanye umubano w’amafaranga n’umuryango uwo ariwo wose ushobora gushishikarira umurimo watanzwe.Ubundi busabane: Abanditsi bose batangaza ko ntayindi mibanire cyangwa ibikorwa bishobora kugira ingaruka kumurimo watanzwe.
Swarnkar A, Zane S, Christie O, n'abandi..Umuti 14 (5): e25463.doi: 10.7759 / gukiza.25463
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Ikibaho A cyerekana ibintu bidasanzwe kandi bya cortical (imyambi) kuruhande rwiburyo bwimbere bwumubiri wa C2.Kwiyongera kudasanzwe kwimyanya iburyo ya atlantoaxial hamwe na cortical idasanzwe kuri C2 (umwambi mwinshi, B).Ibi, hamwe nubucyo bwa misa kuruhande rwiburyo bwa C2, byerekana kuvunika indwara.
Amashusho yabazwe ya tomografiya (CT) yerekana ibisobanuro birambuye.A) Mu ikubitiro, urumogi 11 rwo hanze rwinjijwe muburyo buteganijwe neza.B) Kwinjiza urushinge rugoramye (imyambi ibiri) unyuze muri cannula (umwambi umwe) muri lesion.Isonga y'urushinge ishyirwa hepfo kandi murwego rwo hagati.C) Isima ya polymethyl methacrylate (PMMA) yatewe mu nsi y’igisebe.D) Urushinge rwunamye rusubira inyuma hanyuma rwongera kwinjizwa muruhande rwo hejuru rwagati, hanyuma hashyirwaho sima ya PMMA.E) na F) berekana ikwirakwizwa rya sima ya PMMA nyuma yo kuvurwa mu ndege ya coronale na sagittal.
Impuguke Yimpinduka Quotient ™ (SIQ ™) ninzira yacu idasanzwe nyuma yo gutangaza urungano rwo gusuzuma isuzuma.Shakisha byinshi hano.
Ihuza rizakujyana kurubuga rwagatatu rudafitanye isano na Cureus, Inc. Nyamuneka menya ko Cureus idashinzwe kubintu byose cyangwa ibikorwa bikubiye mubufatanye cyangwa kurubuga rwishamikiyeho.
Impuguke Yimpinduka Quotient ™ (SIQ ™) ninzira yacu idasanzwe nyuma yo gutangaza urungano rwo gusuzuma isuzuma.SIQ ™ isuzuma akamaro nubwiza bwingingo ukoresheje ubwenge rusange bwumuryango wose wa Cureus.Abakoresha bose biyandikishije barashishikarizwa gutanga umusanzu kuri SIQ ™ yingingo zose zasohotse.(Abanditsi ntibashobora kugereranya ingingo zabo.)
Ibipimo bihanitse bigomba kubikwa kubikorwa bishya rwose mubikorwa byabo.Agaciro ako ari ko kose kari hejuru ya 5 kagomba kurebwa hejuru yikigereranyo.Mugihe abakoresha biyandikishije bose ba Cureus bashobora kugereranya ingingo yatangajwe, ibitekerezo byinzobere mu ngingo bifite uburemere burenze ibitekerezo by’abatari inzobere.SIQ ™ yingingo izagaragara kuruhande rwingingo imaze guhabwa inshuro ebyiri, kandi izongera kubarwa hamwe n amanota yinyongera.
Impuguke Yimpinduka Quotient ™ (SIQ ™) ninzira yacu idasanzwe nyuma yo gutangaza urungano rwo gusuzuma isuzuma.SIQ ™ isuzuma akamaro nubwiza bwingingo ukoresheje ubwenge rusange bwumuryango wose wa Cureus.Abakoresha bose biyandikishije barashishikarizwa gutanga umusanzu kuri SIQ ™ yingingo zose zasohotse.(Abanditsi ntibashobora kugereranya ingingo zabo.)
Nyamuneka menya ko kubikora wemeye kongerwaho kurutonde rwa imeri ya imeri ya buri kwezi.