"Kada ku taba shakka cewa ƙaramin rukuni na masu tunani, ƴan ƙasa masu sadaukarwa na iya canza duniya.Hasali ma, ita kaɗai a wurin.”
Manufar Cureus ita ce ta canza tsarin wallafe-wallafen likita wanda ya daɗe, wanda ƙaddamar da bincike zai iya zama tsada, rikitarwa, da cin lokaci.
Neuroradiology, canja wurin vertebral, mahaifa vertebroplasty, posterolateral tsarin kula, lankwasa allura, tsoma baki neuroradiology, percutaneous vertebroplasty
Rubuta wannan labarin kamar haka: Swarnkar A, Zain S, Christie O, et al.(Mayu 29, 2022) Vertebroplasty don ɓarnawar cututtukan cututtuka na C2: wani yanayi na musamman na asibiti ta amfani da dabarar allura mai lanƙwasa.Magani 14(5): e25463.doi:10.7759/cureus.25463
Ƙarƙashin ƙaƙƙarfan ɓarna na ɓarna ya fito a matsayin madadin magani mai dacewa don karyewar kashin baya.Vertebroplasty yana da kyau a rubuce a cikin tsarin thoracic da lumbar na baya-bayan nan, amma ba a yi amfani da shi ba a cikin kashin mahaifa saboda yawancin mahimmancin jijiyoyi da jijiyoyi da ya kamata a kauce masa.Yin amfani da fasaha mai hankali da hoto yana da mahimmanci don sarrafa mahimman tsari da kuma rage haɗarin rikitarwa.A cikin hanyar da ta biyo baya, raunin ya kamata ya kasance a kan madaidaiciyar madaidaiciyar allura a gefe zuwa C2 vertebra.Wannan hanya na iya iyakance isassun jiyya na ƙarin raunukan da ke cikin tsaka-tsaki.Mun bayyana wani yanayi na musamman na asibiti na nasara kuma amintacciyar hanya ta baya don maganin ɓarna na C2 metastases ta amfani da allura mai lankwasa.
Vertebroplasty ya ƙunshi maye gurbin kayan ciki na jikin kashin baya don gyara karaya ko rashin daidaituwa na tsari.Ana amfani da siminti sau da yawa azaman kayan tattarawa, yana haifar da ƙara ƙarfin kashin baya, rage haɗarin rugujewa, da rage jin zafi, musamman a cikin marasa lafiya masu fama da osteoporosis ko raunin kashi [1].Percutaneous vertebroplasty (PVP) ana amfani dashi a matsayin haɗin kai ga analgesics da radiation far don kawar da ciwo a cikin marasa lafiya tare da kasusuwa na vertebral na biyu zuwa malignancy.Yawancin lokaci ana yin wannan hanya a cikin kashin thoracic da lumbar ta hanyar pedicle na baya ko na waje.Yawancin lokaci ba a yin PVP a cikin kashin baya na mahaifa saboda ƙananan ƙananan jijiyoyi da matsalolin fasaha da ke hade da kasancewar mahimman tsarin neurovascular a cikin kashin mahaifa irin su kashin baya, carotid arteries, jugular veins, da jijiyoyi na cranial.2].PVP, musamman a matakin C2, yana da ɗanɗano kaɗan ko ma da wuya saboda sarƙaƙƙiya na jiki da ƙwayar ƙwayar cuta a matakin C2.A cikin yanayin rashin kwanciyar hankali na osteolytic raunuka, ana iya yin vertebroplasty idan tsarin yana da wuyar gaske.A cikin raunukan PVP na jikin kashin baya na C2, ana yin amfani da allura madaidaiciya daga gaba, ta baya, fassarar, ko madaidaicin hanya (pharyngeal) don guje wa mahimman tsari [3].Yin amfani da allura madaidaiciya yana nuna cewa rauni dole ne ya bi wannan yanayin don isassun waraka.Launuka a waje da yanayin kai tsaye na iya haifar da iyakancewa, rashin isassun jiyya ko cikakken cirewa daga maganin da ya dace.An yi amfani da fasahar PVP mai lankwasa kwanan nan a cikin lumbar da kashin baya na thoracic tare da rahotanni na ƙara yawan maneuverability [4,5].Duk da haka, ba a ba da rahoton yin amfani da allura masu lanƙwasa a cikin kashin mahaifa ba.Mun bayyana wani lamari na asibiti na raunin ƙwayar cuta na C2 da ba kasafai ba na biyu zuwa ciwon daji na pancreatic metastatic wanda aka yi da shi tare da PVP na bayan mahaifa.
Wani dattijo mai shekaru 65 ya gabatar da shi ga asibiti tare da sabon ciwo mai tsanani a kafadarsa ta dama da wuyansa wanda ya ci gaba har tsawon kwanaki 10 ba tare da jin dadi ba tare da magunguna.Waɗannan alamun ba su da alaƙa da kowane rauni ko rauni.Yana da tarihin ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ciwon daji na pancreatic mataki IV, hauhawar jini da hauhawar jini.Ya kammala hawan 6 na FOLFIRINOX (leucovorin / leucovorin, fluorouracil, irinotecan hydrochloride da oxaliplatin) amma ya fara sabon tsarin gemzar da abraxane makonni biyu da suka wuce saboda ci gaba da cututtuka.A kan jarrabawar jiki, ba shi da tausayi ga palpation na mahaifa, thoracic, ko lumbar kashin baya.Bugu da ƙari, babu nakasasshen hankali da na motsa jiki a cikin babba da ƙananan ƙafafu.Hankalinsa na bangarorin biyu sun kasance al'ada.Wani binciken da aka ƙididdigewa daga asibiti (CT) na kashin baya na mahaifa ya nuna raunin osteolytic daidai da cututtukan metastatic wanda ya shafi gefen dama na jikin C2 vertebral, madaidaicin C2 taro, farantin dama na vertebral na dama, da kuma gefen C2 mai rauni. .Toshe saman saman hagu na dama (Fig. 1).Wani likitan neurosurgeon ya tuntubi, hoton maganadisu na maganadisu (MRI) na mahaifa, thoracic da lumbar kashin baya an yi, la'akari da raunin osteolytic metastatic.Abubuwan da aka gano na MRI sun nuna rashin ƙarfi na T2, T1 isointense mai laushi mai laushi wanda ya maye gurbin gefen dama na C2 vertebral jiki, tare da iyakacin rarrabawa da haɓakawa bayan-kwakwalwa.Ya karbi maganin radiation ba tare da wani ingantaccen ci gaba a cikin zafi ba.Sabis ɗin neurosurgical yana ba da shawarar rashin yin aikin tiyata na gaggawa.Sabili da haka, ana buƙatar radiyon shiga tsakani (IR) don ƙarin jiyya saboda ciwo mai tsanani da haɗarin rashin kwanciyar hankali da yiwuwar matsawa na kashin baya.Bayan kimantawa, an yanke shawarar yin CT-guided percutaneous C2 kashin baya plasty ta amfani da hanyar baya.
Panel A yana nuna bambanci da rashin daidaituwa (kibiyoyi) a gefen dama na gaban C2 jikin kashin baya.Fadada asymmetric na haɗin gwiwa na atlantoaxial dama da rashin daidaituwa na cortical a C2 (kibiya mai kauri, B).Wannan, tare da bayyana ma'anar taro a gefen dama na C2, yana nuna raguwar ƙwayar cuta.
An sanya mai haƙuri a gefen dama na kwance kuma an yi amfani da 2.5 MG na Versed da 125 μg na fentanyl a cikin nau'i-nau'i.Da farko, an saita jikin kashin baya na C2 kuma an yi allurar 50 ml na bambanci a cikin jijiya don gano madaidaicin jijiyar kashin baya da tsara yanayin shiga.Sa'an nan kuma, an ƙaddamar da allura mai gabatarwa na 11 zuwa sashin tsakiya na baya-tsakiyar jiki daga hanyar da ta dace (Fig. 2a).An saka allura mai lankwasa Stryker TroFlex® (Fig. 3) kuma an sanya shi a cikin ƙananan sashin tsakiya na C2 osteolytic raunuka (Fig. 2b).Polymethyl methacrylate (PMMA) ciminti kashi an shirya bisa ga daidaitattun umarnin.A wannan mataki, a ƙarƙashin kulawar CT-fluoroscopic tsaka-tsaki, an yi amfani da simintin kashi ta hanyar allura mai lankwasa (Fig. 2c).Da zarar an sami isasshen cike da ƙananan ƙwayar cuta, an cire allurar a wani ɓangare kuma an juya shi don samun dama ga matsayi na tsakiya (Fig. 2d).Babu juriya ga sake mayar da allura kamar yadda wannan rauni ya kasance mummunan rauni na osteolytic.Yi ƙarin siminti na PMMA akan raunin.An kula da shi don guje wa zubar da simintin kashi a cikin canal na kashin baya ko nama mai laushi na paravertebral.Bayan samun gamsuwa da ciminti, an cire allurar mai lanƙwasa.Hoto na baya-bayan nan ya nuna nasarar PMMA kashi simintin vertebroplasty (Figures 2e, 2f).Binciken jijiya bayan tiyata ya nuna babu lahani.Bayan 'yan kwanaki an sallami majiyyacin tare da abin wuya na mahaifa.Ciwon nasa, ko da yake ba a gama warware shi ba, an fi sarrafa shi.Majinyacin ya mutu cikin bala'i bayan 'yan watanni bayan an sallame shi daga asibiti saboda rikice-rikice na ciwon daji na pancreatic.
Hotunan da aka ƙididdige su (CT) waɗanda ke nuna cikakkun bayanai na hanya.A) Da farko, an shigar da cannula na ma'auni na waje 11 daga tsarin da aka tsara na gaba.B) Saka allura mai lanƙwasa (kibiya biyu) ta cikin cannula (kibiya ɗaya) cikin rauni.Ana sanya titin allurar ƙasa da ƙari na tsakiya.C) Polymethyl methacrylate (PMMA) siminti an allura a cikin kasan rauni.D) Ana janye allurar da aka lanƙwasa kuma a sake sakawa a cikin mafi girman gefen tsakiya, sa'an nan kuma an yi allurar simintin PMMA.E) da F) suna nuna rarraba simintin PMMA bayan jiyya a cikin jiragen ruwa na coronal da sagittal.
An fi ganin metastases na vertebral a cikin nono, prostate, huhu, thyroid, ƙwayoyin koda, mafitsara, da melanoma, tare da ƙananan ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta daga 5 zuwa 20% a cikin ciwon daji na pancreatic [6,7].Shiga cikin mahaifa a cikin ciwon daji na pancreatic ya fi wuya, tare da lokuta hudu kawai aka ruwaito a cikin wallafe-wallafen, musamman waɗanda ke da alaƙa da C2 [8-11].Shigar da kashin baya na iya zama asymptomatic, amma idan aka hade tare da karaya, zai iya haifar da ciwo maras kyau da rashin kwanciyar hankali wanda ke da wuyar sarrafawa tare da matakan ra'ayin mazan jiya kuma yana iya haifar da mai haƙuri zuwa matsawa na kashin baya.Don haka, vertebroplasty wani zaɓi ne don daidaitawar kashin baya kuma yana da alaƙa da jin zafi a cikin fiye da 80% na marasa lafiya da ke fuskantar wannan hanya [12].
Kodayake ana iya yin nasarar aiwatar da hanyar a matakin C2, hadadden tsarin jikin mutum yana haifar da matsalolin fasaha kuma yana iya haifar da rikitarwa.Akwai tsarin neurovascular da yawa kusa da C2, kamar yadda yake gaba da pharynx da larynx, a gefe zuwa sararin carotid, na baya zuwa jijiyoyin vertebral da jijiya na mahaifa, da na baya ga jakar [13].A halin yanzu, ana amfani da hanyoyi guda huɗu a cikin PVP: anterolateral, posterolateral, transoral, and translational.Hanyar gabaɗaya yawanci ana yin ta ne a cikin matsayi na baya kuma yana buƙatar haɓakar kai don haɓaka mandible da sauƙaƙe damar C2.Sabili da haka, wannan fasaha bazai dace da marasa lafiya waɗanda ba za su iya kula da hawan hawan kai ba.Ana ratsa allurar ta cikin parapharyngeal, retropharyngeal da prevertebral sarari kuma tsarin bayan bayan jijiya na carotid artery ana sarrafa shi da hannu.Tare da wannan fasaha, lalacewar jijiyar vertebral, carotid artery, jugular vein, submandibular gland, oropharyngeal da IX, X da XI cranial jijiyoyi yana yiwuwa [13].Ciwon ƙwayar cuta na Cerebellar da C2 neuralgia na biyu zuwa zubar da siminti kuma ana ɗaukar rikitarwa [14].Hanya na baya baya buƙatar maganin sa barci na gaba ɗaya, ana iya amfani dashi a cikin marasa lafiya waɗanda ba za su iya haɓaka wuyansa ba, kuma yawanci ana yin su a cikin matsayi na baya.Ana wuce allura ta sararin bayan mahaifa a cikin gaba, cranial da na tsakiya, ƙoƙarin kada a taɓa jijiyar vertebral da farjinta.Don haka, matsalolin suna da alaƙa da lalacewa ga jijiyar vertebral da kashin baya [15].Samun shiga ta hanyar fasaha ba shi da rikitarwa kuma ya haɗa da shigar da allura zuwa bangon pharyngeal da sararin pharyngeal.Baya ga yuwuwar lalacewa ga jijiyoyi na kashin baya, wannan hanyar tana da alaƙa da haɗarin kamuwa da cuta da rikice-rikice irin su ƙurar pharyngeal da sankarau.Wannan hanyar kuma tana buƙatar maganin sa barci na gaba ɗaya da intubation [13,15].Tare da samun dama ta gefe, ana shigar da allurar cikin sararin da zai yiwu tsakanin sheaths na carotid artery da vertebral artery a gefe zuwa matakin C1-C3, yayin da hadarin lalacewa ga manyan jiragen ruwa ya fi girma [13].Matsala mai yuwuwa ta kowace hanya ita ce zubar da simintin kashi, wanda zai iya haifar da matsewar kashin baya ko tushen jijiya [16].
An lura cewa yin amfani da allura mai lankwasa a cikin wannan yanayin yana da wasu fa'idodi, gami da haɓaka damar samun damar gabaɗaya da sarrafa allura.Allurar da aka lanƙwasa tana ba da gudummawa ga: ikon zaɓin yin niyya ga sassa daban-daban na jikin kashin baya, ƙarin amintaccen shiga tsaka-tsakin tsaka-tsaki, rage lokacin aiki, rage yawan ruwan siminti, da rage lokacin fluoroscopy [4,5].Bisa ga nazarin mu na wallafe-wallafen, ba a ba da rahoton yin amfani da allura mai lankwasa a cikin kashin mahaifa ba, kuma a cikin lokuta da ke sama, an yi amfani da allura madaidaiciya don vertebroplasty na baya a matakin C2 [15,17-19].Idan aka yi la'akari da ƙayyadaddun tsarin jikin wuyan wuyansa, haɓakar haɓakar tsarin allura mai lanƙwasa na iya zama da fa'ida musamman.Kamar yadda aka nuna a cikin yanayinmu, an yi aikin a wuri mai dadi kuma mun canza matsayi na allura don cika sassa da dama na rauni.A cikin wani rahoto na kwanan nan, Shah et al.Allura mai lanƙwasa da aka bari bayan kyphoplasty na balloon hakika an fallasa, yana nuna yuwuwar rikitarwa na allurar mai lanƙwasa: siffar allurar na iya sauƙaƙe cire shi [20].
A cikin wannan mahallin, muna nuna nasarar nasarar maganin cututtukan cututtuka marasa ƙarfi na C2 vertebral jiki ta hanyar amfani da PVP na baya tare da allura mai lankwasa da CT fluoroscopy mai tsaka-tsaki, wanda ya haifar da tsangwama da kuma inganta yanayin jin zafi.Ƙwararren allura mai lankwasa yana da fa'ida: yana ba mu damar isa ga rauni daga hanya mafi aminci ta bayan fage kuma yana ba mu damar tura allurar zuwa duk abubuwan da ke cikin rauni kuma daidai kuma gaba ɗaya cika rauni tare da ciminti PMMA.Muna tsammanin wannan dabarar na iya iyakance amfani da maganin sa barci da ake buƙata don samun damar transoropharyngeal da kuma guje wa rikice-rikice na jijiyoyin jini da ke da alaƙa da hanyoyin gaba da gaba.
Abubuwan Dan Adam: Duk mahalarta wannan binciken sun ba da izini ko ba su ba da izini ba.Rikice-rikice na Sha'awa: Dangane da Form Bayyanar ICMJE Uniform, duk mawallafa suna bayyana abubuwan da ke gaba: Bayanan Biyan Kuɗi / Sabis: Duk marubutan sun bayyana cewa ba su sami tallafin kuɗi daga kowace ƙungiya don aikin da aka ƙaddamar ba.Dangantakar Kuɗi: Duk marubutan sun bayyana cewa ba su da alaƙar kuɗi a halin yanzu ko a cikin shekaru uku da suka gabata tare da kowace ƙungiyar da ke da sha'awar aikin da aka ƙaddamar.Sauran Dangantaka: Duk mawallafa sun bayyana cewa babu wasu alaƙa ko ayyukan da zasu iya shafar aikin da aka ƙaddamar.
Swarnkar A, Zane S, Christie O, et al.(Mayu 29, 2022) Vertebroplasty don ɓarnawar cututtukan cututtuka na C2: wani yanayi na musamman na asibiti ta amfani da dabarar allura mai lanƙwasa.Magani 14(5): e25463.doi:10.7759/cureus.25463
© Haƙƙin mallaka 2022 Svarnkar et al.Wannan labarin buɗe ido ne wanda aka rarraba ƙarƙashin sharuɗɗan lasisin Haɗin Haɗin Halittun Halittu CC-BY 4.0.An ba da izinin amfani mara iyaka, rarrabawa, da haɓakawa a kowace matsakaici, in dai an ƙididdige ainihin marubucin da tushen.
Wannan labarin buɗaɗɗen shiga ne wanda aka rarraba ƙarƙashin Lasisin Haɗin Haɗin Halittun Halittu, wanda ke ba da izinin amfani mara iyaka, rarrabawa, da haɓakawa a kowace matsakaici, in dai an ƙididdige marubucin da tushen.
Panel A yana nuna bambanci da rashin daidaituwa (kibiyoyi) a gefen dama na gaban C2 jikin kashin baya.Fadada asymmetric na haɗin gwiwa na atlantoaxial dama da rashin daidaituwa na cortical a C2 (kibiya mai kauri, B).Wannan, tare da bayyana ma'anar taro a gefen dama na C2, yana nuna raguwar ƙwayar cuta.
Hotunan da aka ƙididdige su (CT) waɗanda ke nuna cikakkun bayanai na hanya.A) Da farko, an shigar da cannula na ma'auni na waje 11 daga tsarin da aka tsara na gaba.B) Saka allura mai lanƙwasa (kibiya biyu) ta cikin cannula (kibiya ɗaya) cikin rauni.Ana sanya titin allurar ƙasa da ƙari na tsakiya.C) Polymethyl methacrylate (PMMA) siminti an allura a cikin kasan rauni.D) Ana janye allurar da aka lanƙwasa kuma a sake sakawa a cikin mafi girman gefen tsakiya, sa'an nan kuma an yi allurar simintin PMMA.E) da F) suna nuna rarraba simintin PMMA bayan jiyya a cikin jiragen ruwa na coronal da sagittal.
Quotient Impact Quotient ™ (SIQ™) shine na musamman namu na musamman na bitar bitar takwarorinmu.Nemo ƙarin anan.
Wannan hanyar haɗin za ta kai ku zuwa gidan yanar gizo na ɓangare na uku wanda ba shi da alaƙa da Cureus, Inc. Lura cewa Cureus ba shi da alhakin duk wani abun ciki ko ayyukan da ke ƙunshe akan abokan hulɗarmu ko rukunin yanar gizo masu alaƙa.
Quotient Impact Quotient ™ (SIQ™) shine na musamman namu na musamman na bitar bitar takwarorinmu.SIQ™ yana kimanta mahimmanci da ingancin labarai ta amfani da hikimar gamayya na dukkan al'ummar Cureus.Ana ƙarfafa duk masu amfani da rajista don ba da gudummawa ga SIQ™ na kowane labarin da aka buga.(Marubuta ba za su iya tantance labaran nasu ba.)
Ya kamata a keɓance manyan ƙididdiga don ingantaccen aiki na gaske a fannonin su.Duk wani ƙima sama da 5 yakamata a yi la'akari da shi sama da matsakaici.Duk da yake duk masu amfani da Cureus masu rijista na iya ƙididdige kowane labarin da aka buga, ra'ayoyin ƙwararrun batutuwa suna ɗaukar nauyi fiye da ra'ayoyin waɗanda ba ƙwararru ba.SIQ™ na labarin zai bayyana kusa da labarin bayan an ƙididdige shi sau biyu, kuma za a sake ƙididdige shi tare da kowane ƙarin maki.
Quotient Impact Quotient ™ (SIQ™) shine na musamman namu na musamman na bitar bitar takwarorinmu.SIQ™ yana kimanta mahimmanci da ingancin labarai ta amfani da hikimar gamayya na dukkan al'ummar Cureus.Ana ƙarfafa duk masu amfani da rajista don ba da gudummawa ga SIQ™ na kowane labarin da aka buga.(Marubuta ba za su iya tantance labaran nasu ba.)
Da fatan za a lura cewa ta yin haka kun yarda a ƙara zuwa jerin wasiƙar imel ɗin mu na wata-wata.