Kết quả ban đầu phẫu thuật bệnh lý đĩa đệm cột sống cổ lối trước sử dụng miếng ghép tự khóa

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Tác giả: Đình Hùng Kiều, Trung Kiên Trần

Ngôn ngữ: Vie

Ký hiệu phân loại: 617 Miscellaneous branches of medicine Surgery

Thông tin xuất bản: Tạp chí Nghiên cứu Y học, 2020

Mô tả vật lý: 232-241

Bộ sưu tập: Metadata

ID: 415977

Thêm vào giỏ Liên kết toàn văn

Phẫu thuật lấy đĩa đệm cổ lối trước hàn xương liên thân đốt (ACDF) được chỉ định rộng rãi trong các bệnh lý thoái hóa hoặc thoát vị cột sống cổ đa tầng. Trước đây, phẫu thuật viên sử dụng nẹp cổ trước để đảm bảo độ vững và tránh tình trạng lún miếng ghép đĩa đệm. Tuy nhiên nẹp cổ trước cũng đem lại nhiều biến chứng, như tổn thương phần mềm quanh thực quản gây phù nề, khó nuốt, đặc biệt nghiêm trọng trong phẫu thuật đa tầng đĩa đệm. Miếng ghép đĩa đệm tự khóa ra đời, đảm bảo tỷ lệ liền xương tối đa, hạn chế biến chứng khó nuốt và rút ngắn thời gian phẫu thuật. Cuối năm 2019, hệ thống này đã được FDA chấp nhận trong các phẫu thuật cột sống cổ đa tầng. Tại khoa ngoại A, Bệnh viện Đại học Y Hà Nội đã tiến hành ứng dụng và thu được những kết quả bước đầu thuận lợi. Bước đầu nghiên cứu tiến cứu trên 10 bệnh nhân có thoái hóa và thoát vị đĩa đệm cột sống cổ. Đã có 21 miếng ghép được sử dụng. Các bệnhnhân được đánh giá triệu chứng lâm sàng trước và sau mổ theo protocol, theo thang điểm đau VAS (Visual Analogue Scale), thang điểm chức năng cột sống cổ NDI (Neck Disability Index) và đánh giá mức độ khó nuốt sau mổ. Bệnh nhân được chụp xquang đánh giá trước và sau mổ về các chỉ số góc cột sống cổ, thời gian, lượng máu mất cũng như các biến chứng. Kết quả cho thấy các bệnh nhân đều có tiến triển tốt về triệu chứng đau kiểu rễ và đau cột sống cổ, chỉ số chức năng cột sống cổ cải thiện tốt. X-quang sau mổ không ghi nhận có bất thường, ghi nhận có sự cải thiện về độ ưỡn cột sống cổ. Thời gian phẫu thuật ngắn hơn và lượng máu mất ít hơn. Không ghi nhận trường hợp nào có biểu hiện khó nuốt và các biến chứng nói chung. Phẫu thuật cột sống cổ lối trước sử dụng miếng ghép tự khóa cho hiệu quả lâm sàng tốt, mức độ chỉnh trục cột sống tốt, rút ngắn thời gian phẫu thuật và hiện tại không ghi nhận biến chứng sau mổ kể cả nuốt nghẹn. , Tóm tắt tiếng anh, Anterior cervical discectomy and fusion (ACDF) is widely indicated for degenerative or multilevel cervical disc herniation. In the past, anterior plates were used to maintain stability and avoid subsidence. However, they also come with complications, such as soft tissue damaged causing esophagus edema, dysphagia, especially in multi-level surgery. The interlock disc graft was invented to ensure maximum fusion rate, less complications, dysphagia and save surgery time. By the end of 2019, this system was approved by the FDA in multi-level cervical surgery. At Department A, Hanoi Medical University Hospital, we have applied and obtained favorable initial results. This is a preliminary prospective study of 10 patients with degenerative and cervical disc herniation. 21 interlocks have been used. Patients were evaluated for clinical symptoms pre-and post operation according to protocol, VAS (Visual Analogue Scale) scale for pain, NDI (Neck Disability Index) and scale for dysphagia. Pre-and postoperative X-ray assessment of sagittal cervical angle, surgery time, blood loss as well as complications were also assessed. All patients had good improvement of nerve root compression and cervical pain, improved NDI and improved lordosis. X-ray post-operation did not notice any abnormality. Surgery time and blood loss are minimized. There was no dysphagia or general complications. ACDF using interlock came with good results, maintain cervical lordosis, save surgery time, blood loss and currently does not record any postoperative complications including dysphagia.

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