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I-Neuroradiology, ukudluliselwa kwethambo lomqolo, i-vertebroplasty yomlomo wesibeleko, indlela yasemva, inaliti egobileyo, i-neuroradiology yokungenelela, i-vertebroplasty ye-percutaneous
Chaza eli nqaku njenge: Swarnkar A, Zain S, Christie O, et al.(ngoMeyi 29, 2022) I-Vertebroplasty ye-pathological C2 fractures: imeko ekhethekileyo yekliniki kusetyenziswa ubuchule benaliti egobileyo.Unyango 14(5): e25463.doi:10.7759/cureus.25463
I-vertebroplasty encinci ye-invasive iye yavela njengonyango olulolunye olusebenzayo lwe-pathological vertebral fractures.I-Vertebroplasty ibhalwe kakuhle kwindlela ye-thoracic kunye ne-lumbar posterolateral, kodwa ayifane isetyenziswe kumqolo wesibeleko ngenxa yezinto ezininzi ezibalulekileyo ze-neural kunye ne-vascular structures ekufuneka zigwenywe.Ukusetyenziswa kobuchule obunonopheleyo kunye nokucinga kubalulekile ekulawuleni izakhiwo ezibalulekileyo kunye nokunciphisa umngcipheko weengxaki.Kwindlela ye-posterolateral, i-lesion kufuneka ibekwe kwi-trajectory ye-trajectory ye-trajectory esecaleni kwi-vertebra ye-C2.Le ndlela inokunciphisa unyango olwaneleyo lwezilonda ezibekwe kwindawo ephakathi.Sichaza imeko yeklinikhi ekhethekileyo yendlela eyimpumelelo nekhuselekileyo ye-posterolateral yonyango lwe-C2 etshabalalisayo ye-metastases esebenzisa inaliti egobileyo.
I-Vertebroplasty ibandakanya ukutshintshwa kwezinto zangaphakathi ze-vertebral body ukulungisa iifractures okanye ukungazinzi kwesakhiwo.I-samente isoloko isetyenziswa njengento yokupakisha, okukhokelela ekunyukeni kwamandla e-vertebrae, ukunciphisa umngcipheko wokuwa, kunye nokunciphisa intlungu, ngakumbi kwizigulane ezine-osteoporosis okanye i-osteolytic bone lesions [1].I-Percutaneous vertebroplasty (PVP) isetyenziswa ngokuqhelekileyo njengento yokuncedisa i-analgesics kunye nonyango lwe-radiation ukukhulula intlungu kwizigulane ezine-vertebral fractures yesibini kwi-malignancy.Le nkqubo idla ngokuqhutyelwa kwi-thoracic kunye ne-lumbar spine ngokusebenzisa i-posterolateral pedicle okanye indlela ye-extrapedicular.I-PVP ngokuqhelekileyo ayikwenziwa kumqolo wesibeleko ngenxa yobukhulu obuncinci be-vertebral body kunye neengxaki zobuchwepheshe ezinxulumene nobukho bezakhiwo ezibalulekileyo ze-neurovascular kumqolo wesibeleko ezifana nentambo yomgogodla, i-carotid arteries, i-jugular veins, kunye ne-cranial nerves.2].I-PVP, ngokukodwa kwinqanaba le-C2, inqabile okanye inqabile ngenxa yobunzima be-anatomical kunye nokubandakanyeka kwe-tumor kwinqanaba le-C2.Kwimeko yezilonda ze-osteolytic ezingazinzanga, i-vertebroplasty inokwenziwa ukuba inkqubo ithathwa njengento enzima kakhulu.Kwizilonda ze-PVP zemizimba ye-vertebral ye-C2, inaliti echanekileyo idla ngokusetyenziswa kwi-anterolateral, posterolateral, translational, okanye transoral (pharyngeal) indlela yokuphepha izakhiwo ezibalulekileyo [3].Ukusetyenziswa kwenaliti ethe tye kubonisa ukuba isilonda kufuneka silandele le ndlela yokuphilisa ngokwaneleyo.Izilonda ezingaphandle kwendlela ethe ngqo zingabangela unyango olulinganiselwe, olungonelanga okanye ukukhutshwa ngokupheleleyo kunyango olufanelekileyo.I-PVP yenaliti egobileyo isetyenziswe kutshanje kwi-lumbar kunye ne-thoracic spine kunye neengxelo zokunyuka kwe-maneuverability [4,5].Nangona kunjalo, ukusetyenziswa kweenaliti ezigobileyo kumqolo wesibeleko akubikwanga.Sichaza imeko yeklinikhi ye-C2 enqabileyo ye-pathologic fracture yesibini ukuya kwi-metastatic pancreatic cancer ephathwa nge-PVP yomlomo wesibeleko yangasemva.
Indoda eneminyaka engama-65 ubudala yaziswa esibhedlele ngentlungu entsha ebukhali egxalabeni lakhe lasekunene kunye nentamo eyaqhubeka kangangeentsuku ezili-10 ngaphandle kokukhululeka ngamayeza angaphaya kwekhawuntara.Ezi mpawu azinxulunyaniswa nakuphi na ukuba ndindisholo okanye ubuthathaka.Wayenembali ebalulekileyo yenqanaba le-IV lomhlaza we-metastatic elahlulwe kakubi, i-arterial hypertension kunye nokusela kakhulu utywala.Wagqiba imijikelezo ye-6 ye-FOLFIRINOX (i-leucovorin / leucovorin, i-fluorouracil, i-irinotecan hydrochloride kunye ne-oxaliplatin) kodwa yaqala i-regimen entsha ye-gemzar kunye ne-abraxane kwiiveki ezimbini ezidlulileyo ngenxa yokuqhubela phambili kwesifo.Ekuhlolweni komzimba, wayengenalo ububele kwi-palpation yomlomo wesibeleko, i-thoracic, okanye i-lumbar spine.Ukongezelela, kwakungekho kuphazamiseka kwengqondo kunye neemoto kwiindawo eziphezulu kunye nezisezantsi.I-reflexes yakhe yamazwe amabini yayiqhelekileyo.I-scan ye-computed tomography engaphandle kwesibhedlele (CT) yomqolo wesibeleko ibonise izilonda ze-osteolytic ezihambelana nesifo se-metastatic esibandakanya icala lasekunene lomzimba we-vertebral ye-C2, ubunzima be-C2 obufanelekileyo, iplate ye-vertebral esondeleyo, kunye necala elicinezelekileyo le-C2 .Ibhloko yendawo ye-articular ephezulu ngasekunene (umzobo 1).I-neurosurgeon idityaniswe, i-imaging magnetic resonance imaging (MRI) yomlomo wesibeleko, i-thoracic kunye ne-lumbar spine yenziwa, kuthathelwa ingqalelo izilonda ze-osteolytic ze-metastatic.Iziphumo ze-MRI zibonise i-T2 hyperintensity, i-T1 isointense izicubu ezithambileyo ezithatha indawo yecala lasekunene lomzimba we-vertebral ye-C2, kunye nokusabalalisa okulinganiselwe kunye nokuphuculwa kwe-post-contrast.Ufumene unyango lweradiation ngaphandle kokuphuculwa okubonakalayo kwiintlungu.Inkonzo ye-neurosurgical incoma ukuba ungenzi utyando olungxamisekileyo.Ngoko ke, i-radiology ye-interventional (IR) yayifuneka ukuba iqhubeke unyango ngenxa yeentlungu ezibuhlungu kunye nomngcipheko wokungazinzi kunye nokunyanzeliswa kwentambo yomgogodla.Emva kokuvavanya, kwagqitywa ukuba kwenziwe i-CT-guided percutaneous C2 spine plasty usebenzisa indlela ye-posterolateral.
Iphaneli A ibonisa izitenxo ezicacileyo kunye ne-cortical (iintolo) kwicala langaphambili langaphambili le-C2 yomzimba we-vertebral.Ukwandiswa kwe-asymmetric ye-atlantiaxial echanekileyo kunye ne-cortical irregularity kwi-C2 (utolo olutyebileyo, B).Oku, kunye nokucaca kobunzima kwicala lasekunene le-C2, kubonisa ukuphuka kwe-pathological fracture.
Isigulane sibekwe kwicala lasekunene lokulala kunye ne-2.5 mg ye-Versed kunye ne-125 μg ye-fentanyl ilawulwa ngamaxabiso ahlukeneyo.Ekuqaleni, umzimba we-vertebral we-C2 wawubekwe kwaye i-50 ml ye-intravenous intravenous injected to localize the right vertebral artery and plan the access trajectory.Emva koko, i-11-gauge introducer inaliti yaqhubela phambili kwi-posterior-medial part of the vertebral body from the right posterolateral approach (Umfanekiso 2a).Inaliti ye-Stryker TroFlex® egobileyo yafakwa emva koko (umzobo 3) kwaye ibekwe kwindawo esezantsi ye-C2 lesion osteolytic (Fig. 2b).I-Polymethyl methacrylate (PMMA) i-samente yethambo yalungiswa ngokwemiyalelo eqhelekileyo.Ngeli nqanaba, phantsi kolawulo lwe-CT-fluoroscopic olungenasiphelo, i-samente yethambo yafakwa ngenaliti egobileyo (Umfanekiso 2c).Emva kokuba ukuzaliswa okwaneleyo kwenxalenye engezantsi yesilonda kuphunyeziwe, inaliti yahoxiswa ngokuyinxenye kwaye yajikeleza ukufikelela kwindawo ephezulu ye-lesion ephakathi (Umfanekiso 2d).Akukho ukuchasana nokubekwa ngokutsha kwenaliti njengoko esi silonda sisilonda esibi se-osteolytic.Faka isamente eyongezelelweyo ye-PMMA phezu kwesilonda.Ukunyamekela kwathathwa ukuphepha ukuvuza kwesamente yamathambo kwi-canal yomgogodla okanye izicubu ezithambileyo ze-paravertebral.Emva kokufezekisa ukuzaliswa okwanelisayo ngesamente, inaliti egobileyo yasuswa.I-postoperative imaging ibonise impumelelo ye-PMMA yethambo le-cement vertebroplasty (Amanani 2e, 2f).Uvavanyo lwemithambo-luvo lwasemva kotyando alubonisanga ziphene.Kwiintsuku ezimbalwa kamva isigulane sakhutshwa ngekhola yomlomo wesibeleko.Intlungu yakhe, nangona ingaconjululwanga ngokupheleleyo, yalawuleka ngakumbi.Isigulana sasweleka kabuhlungu kwiinyanga ezimbalwa emva kokukhutshwa esibhedlele ngenxa yeengxaki zomhlaza wepancreatic.
Imifanekiso ye-Computed tomography (CT) ebonisa iinkcukacha zenkqubo.A) Ekuqaleni, i-cannula ye-11 yegeyiji yangaphandle yafakwa ukusuka kwindlela echanekileyo ecwangcisiweyo ye-posterolateral.B) Ukufakwa kwenaliti egobileyo (utolo oluphindwe kabini) kwi-cannula (utolo olunye) kwi-lesion.Incam yenaliti ibekwe ngaphantsi nangaphezulu phakathi.C) I-Polymethyl methacrylate (PMMA) isamente yafakwa ngaphantsi kwesilonda.D) Inaliti egobileyo ihlehlisiwe kwaye iphinde ifakwe kwicala eliphezulu le-medial, kwaye emva koko i-samente ye-PMMA ifakwe.E) kunye noF) babonisa ukuhanjiswa kwesamente ye-PMMA emva kokunyangwa kwiindiza ze-coronal kunye ne-sagittal.
I-Metastases ye-Vertebral ibonakala ngokuqhelekileyo kwisifuba, i-prostate, imiphunga, i-thyroid, iiseli zezintso, i-bladder, kunye ne-melanoma, kunye nesiganeko esisezantsi se-skeletal metastases ukusuka kwi-5 ukuya kwi-20% kwi-cancer ye-pancreatic [6,7].Ukubandakanyeka komlomo wesibeleko kumhlaza we-pancreatic kunqabile, kunye neemeko ezine kuphela ezichazwe kwiincwadi, ngakumbi ezo zihambelana neC2 [8-11].Ukubandakanyeka komgogodla kunokuthi kungabonakali, kodwa xa kudibaniswa nokuphuka, kunokukhokelela kwiintlungu ezingalawulekiyo kunye nokungazinzi okunzima ukulawula ngamanyathelo olondolozo kwaye kunokukhokelela isigulane kwintambo yomgogodla.Ngaloo ndlela, i-vertebroplasty iyindlela yokukhetha ukuzinza komgogodla kwaye ihambelana nokunciphisa intlungu ngaphezu kwe-80% yezigulane ezenza le nkqubo [12].
Nangona inkqubo inokwenziwa ngempumelelo kwinqanaba le-C2, i-anatomy eyinkimbinkimbi idala ubunzima bezobugcisa kwaye inokukhokelela kwiingxaki.Kukho izakhiwo ezininzi ze-neurovascular ezikufutshane ne-C2, njengoko ingaphambili kwi-pharynx kunye ne-larynx, i-lateral kwisithuba se-carotid, i-posterolateral kwi-vertebral artery kunye ne-nerve yomlomo wesibeleko, kunye ne-posterior kwi-sac [13].Okwangoku, iindlela ezine zisetyenziswa kwi-PVP: i-anterolateral, i-posterolateral, i-transoral, kunye nokuguqulela.Indlela ye-anterolateral idla ngokuqhutyelwa kwindawo ephezulu kwaye idinga i-hyperextension yentloko ukuphakamisa i-mandible kwaye iququzelele ukufikelela kwe-C2.Ngoko ke, obu buchule bungenakufaneleka kwizigulane ezingakwazi ukugcina i-hyperextension yentloko.Inaliti idlula kwi-parapharyngeal, i-retropharyngeal kunye ne-prevertebral structure kunye nesakhiwo se-posterolateral ye-carotid artery sheath iphathwa ngokucophelela ngesandla.Ngobu buchule, umonakalo kwi-vertebral artery, i-carotid artery, i-jugular vein, i-submandibular gland, i-oropharyngeal kunye ne-IX, i-X kunye ne-XI ye-cranial nerves inokwenzeka [13].I-Cerebellar infarction kunye ne-C2 neuralgia yesibini ukuvuza kwe-samente nayo ithathwa njengeengxaki [14].Indlela ye-posterolateral ayifuni i-anesthesia jikelele, ingasetyenziselwa izigulane ezingenakukwazi ukugqithisa intamo, kwaye ngokuqhelekileyo iqhutywe kwisigxina esiphezulu.Inaliti idluliswa kwindawo yangasemva yomlomo wesibeleko kwindlela yangaphambili, ye-cranial kunye ne-medial, uzama ukungayichukumisi i-vertebral artery kunye ne-vagina yayo.Ngaloo ndlela, iingxaki zidibene nomonakalo kwi-artebral artery kunye nentambo yomgogodla [15].Ukufikelela kwi-Transoral ngokobuchwepheshe kunzima kakhulu kwaye kubandakanya ukungeniswa kwenaliti kudonga lwe-pharyngeal kunye ne-pharyngeal space.Ukongeza kumonakalo onokwenzeka kwi-artebral arteries, le ndlela ihambelana nomngcipheko ophezulu wokusuleleka kunye neengxaki ezifana ne-abscesses pharyngeal kunye ne-meningitis.Le ndlela ifuna kwakhona i-anesthesia jikelele kunye ne-intubation [13,15].Ngokufikelela kwinqanaba, inaliti ifakwe kwindawo enokubakho phakathi kweeshethi ze-carotid artery kunye ne-vertebral artery lateral ukuya kwinqanaba le-C1-C3, ngelixa umngcipheko wokulimala kwiinqanawa eziphambili ziphezulu [13].Ingxaki enokubakho kuyo nayiphi na indlela kukuvuza kwesamente yethambo, enokubangela ukunyanzeliswa kwentambo yomgogodla okanye iingcambu ze-nerve [16].
Kuye kwaphawulwa ukuba ukusetyenziswa kwenaliti egobileyo kule meko kuneenzuzo ezithile, kubandakanywa nokunyuka kokuguquguquka kokufikelela jikelele kunye nokuhamba kweenaliti.Inaliti egobileyo inegalelo: ukukwazi ukukhetha ngokukhethiweyo kwiindawo ezahlukeneyo ze-vertebral body, ukungena okuthenjelwa ngakumbi kwe-midline, ukunciphisa ixesha lenkqubo, ukunciphisa izinga lokuvuza kwe-samente, kunye nokunciphisa ixesha le-fluoroscopy [4,5].Ngokusekelwe kuphononongo lwethu loncwadi, ukusetyenziswa kweenaliti ezigobileyo kumqolo wesibeleko akuzange kuchazwe, kwaye kwiimeko ezingentla, iinaliti ezithe tye zazisetyenziselwa i-posterolateral vertebroplasty kwinqanaba le-C2 [15,17-19].Ukunikezelwa kwe-anatomy eyinkimbinkimbi yommandla wentamo, ukunyuka kwe-maneuverability yendlela yenaliti egobileyo kunokuba luncedo kakhulu.Njengoko kubonisiwe kwimeko yethu, utyando lwenziwa kwindawo ekhululekileyo esecaleni kwaye satshintsha indawo yenaliti ukuze sizalise iindawo ezininzi zesilonda.Kwingxelo yetyala lamva nje, u-Shah et al.Inaliti egobileyo eshiywe emva kwebhaluni kyphoplasty yavezwa ngokwenene, iphakamisa ingxaki enokubakho yenaliti egobileyo: ukumila kwenaliti kunokwenza kube lula ukususwa kwayo [20].
Kulo mxholo, sibonisa unyango oluyimpumelelo lwe-pathological fractures ye-C2 yomzimba we-vertebral usebenzisa i-PVP ye-posterolateral enenaliti egobileyo kunye ne-CT fluoroscopy ephazamisayo, ekhokelela ekuzinzeni kwe-fracture kunye nokuphucula ulawulo lweentlungu.Ubuchwephesha benaliti egobileyo buyinzuzo: ivumela ukuba sifikelele kwi-lesion ukusuka kwindlela ekhuselekileyo ye-posterolateral kwaye isivumela ukuba siqondise inaliti kuzo zonke iinkalo ze-lesion kwaye ngokufanelekileyo kwaye ngokuzeleyo sizalise isilonda nge-samente ye-PMMA.Silindele ukuba obu buchule bunokunciphisa ukusetyenziswa kwe-anesthesia efunekayo ukufikelela kwi-transoropharyngeal kwaye igweme iingxaki ze-neurovascular ezinxulumene neendlela zangaphambili kunye necala.
Izifundo zoluntu: Bonke abathathi-nxaxheba kolu phononongo banike okanye abazange bavume.Ukungqubuzana koMdla: Ngokuhambelana neFom ye-ICMJE yokuDala i-Uniform, bonke ababhali bavakalisa oku kulandelayo: Intlawulo / iNgcaciso yeNkonzo: Bonke ababhali bavakalisa ukuba abazange bafumane inkxaso yezemali kuyo nayiphi na inhlangano yomsebenzi ongenisiweyo.Ubudlelwane bezeMali: Bonke ababhali bavakalisa ukuba okwangoku okanye kwiminyaka emithathu edlulileyo banobudlelwane bezemali kunye nawo nawuphi na umbutho onokuba nomdla kumsebenzi ongenisiweyo.Olunye uBudlelwane: Bonke ababhali bavakalisa ukuba akukho budlelwane obunye okanye imisebenzi enokuchaphazela umsebenzi ongenisiweyo.
Swarnkar A, Zane S, Christie O, et al.(ngoMeyi 29, 2022) I-Vertebroplasty ye-pathological C2 fractures: imeko ekhethekileyo yekliniki kusetyenziswa ubuchule benaliti egobileyo.Unyango 14(5): e25463.doi:10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Eli linqaku elivulekileyo lokufikelela lisasazwe phantsi kwemigaqo ye-Creative Commons Attribution License CC-BY 4.0.Ukusetyenziswa okungenamkhawulo, ukuhanjiswa, kunye nokuveliswa kwakhona kuyo nayiphi na indlela kuvunyelwe, ngaphandle kokuba umbhali wokuqala kunye nomthombo banikwe ikhredithi.
Eli linqaku elivulekileyo lokufikelela lisasazwe phantsi kweLayisensi ye-Creative Commons Attribution, evumela ukusetyenziswa okungathintelwanga, ukuhanjiswa, kunye nokuveliswa kwakhona kuyo nayiphi na indlela, ngaphandle kokuba umbhali kunye nomthombo banikwe ikhredithi.
Iphaneli A ibonisa izitenxo ezicacileyo kunye ne-cortical (iintolo) kwicala langaphambili langaphambili le-C2 yomzimba we-vertebral.Ukwandiswa kwe-asymmetric ye-atlantiaxial echanekileyo kunye ne-cortical irregularity kwi-C2 (utolo olutyebileyo, B).Oku, kunye nokucaca kobunzima kwicala lasekunene le-C2, kubonisa ukuphuka kwe-pathological fracture.
Imifanekiso ye-Computed tomography (CT) ebonisa iinkcukacha zenkqubo.A) Ekuqaleni, i-cannula ye-11 yegeyiji yangaphandle yafakwa ukusuka kwindlela echanekileyo ecwangcisiweyo ye-posterolateral.B) Ukufakwa kwenaliti egobileyo (utolo oluphindwe kabini) kwi-cannula (utolo olunye) kwi-lesion.Incam yenaliti ibekwe ngaphantsi nangaphezulu phakathi.C) I-Polymethyl methacrylate (PMMA) isamente yafakwa ngaphantsi kwesilonda.D) Inaliti egobileyo ihlehlisiwe kwaye iphinde ifakwe kwicala eliphezulu le-medial, kwaye emva koko i-samente ye-PMMA ifakwe.E) kunye noF) babonisa ukuhanjiswa kwesamente ye-PMMA emva kokunyangwa kwiindiza ze-coronal kunye ne-sagittal.
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