“Tsis txhob ua xyem xyav tias ib pawg me me ntawm cov neeg xav txog, cov pej xeem mob siab rau tuaj yeem hloov pauv lub ntiaj teb.Qhov tseeb, nws tsuas yog ib qho nyob ntawd. "
Cureus 'lub hom phiaj yog los hloov tus qauv ntev ntawm kev tshaj tawm kho mob, uas qhov kev tshawb fawb xa tuaj yuav kim, nyuaj, thiab siv sijhawm.
Neuroradiology, hloov vertebral, ncauj tsev menyuam vertebroplasty, posterolateral mus kom ze, nkhaus koob, interventional neuroradiology, percutaneous vertebroplasty
Cite tsab xov xwm no li: Swarnkar A, Zain S, Christie O, thiab al.(Tsib Hlis 29, 2022) Vertebroplasty rau pathological C2 pob txha: ib qho kev kho mob tshwj xeeb uas siv cov txheej txheem nkhaus.Kho 14(5): e25463.doi: 10.7759/cureus.25463
Minimally invasive vertebroplasty tau tshwm sim los ua lwm txoj kev kho mob rau cov kab mob vertebral pob txha.Vertebroplasty yog cov ntaub ntawv zoo nyob rau hauv lub thoracic thiab lumbar posterolateral mus kom ze, tab sis tsis tshua muaj siv nyob rau hauv lub ncauj tsev menyuam qaum vim muaj ntau yam tseem ceeb neural thiab vascular lug uas yuav tsum tau zam.Kev siv cov txheej txheem ceev faj thiab kev ntsuas yog qhov tseem ceeb los tswj cov qauv tseem ceeb thiab txo qhov kev pheej hmoo ntawm cov teeb meem.Nyob rau hauv lub posterolateral mus kom ze, qhov txhab yuav tsum nyob rau ntawm ib tug ncaj koob trajectory lateral mus rau lub C2 vertebra.Txoj hauv kev no tuaj yeem txwv kev kho kom txaus ntawm cov kab mob hauv nruab nrab ntau dua.Peb piav qhia txog cov xwm txheej tshwj xeeb ntawm kev ua tiav thiab kev nyab xeeb posterolateral mus kom ze rau kev kho mob ntawm kev puas tsuaj medial C2 metastases siv rab koob nkhaus.
Vertebroplasty suav nrog kev hloov cov khoom siv sab hauv ntawm lub cev vertebral los kho cov pob txha tawg lossis cov qauv tsis ruaj khov.Cov cement feem ntau yog siv los ua cov khoom ntim, uas ua rau muaj zog ntawm cov vertebrae, txo kev pheej hmoo ntawm kev tawg, thiab txo qhov mob, tshwj xeeb tshaj yog rau cov neeg mob osteoporosis lossis osteolytic pob txha lesions [1].Percutaneous vertebroplasty (PVP) feem ntau yog siv los ua ib qho ntxiv rau kev kho mob analgesics thiab kev kho hluav taws xob los txo qhov mob hauv cov neeg mob uas muaj pob txha pob txha hauv nruab nrab mus rau malignancy.Cov txheej txheem no feem ntau yog ua nyob rau hauv lub thoracic thiab lumbar spine los ntawm posterolateral pedicle los yog extrapedicular mus kom ze.PVP feem ntau tsis ua nyob rau hauv lub ncauj tsev menyuam nqaj qaum vim qhov me me ntawm lub cev vertebral thiab cov teeb meem kev cuam tshuam nrog kev muaj cov txheej txheem tseem ceeb hauv cov hlab ntsha hauv lub ncauj tsev menyuam xws li tus txha caj qaum, cov hlab ntsha carotid, cov hlab ntsha jugular, thiab cov hlab ntsha cranial.2].PVP, tshwj xeeb tshaj yog nyob rau theem C2, kuj tsis tshua muaj los yog tsis tshua muaj vim yog qhov nyuaj ntawm anatomical thiab qog kev koom tes ntawm qib C2.Nyob rau hauv cov ntaub ntawv ntawm tsis ruaj tsis khov osteolytic lesions, vertebroplasty yuav ua tau yog hais tias tus txheej txheem yog heev nyuaj.Hauv PVP qhov txhab ntawm C2 vertebral lub cev, ib rab koob ncaj feem ntau yog siv los ntawm anterolateral, posterolateral, translational, lossis transoral (pharyngeal) mus kom ze kom tsis txhob muaj cov qauv tseem ceeb [3].Kev siv ib rab koob ncaj qhia tau hais tias qhov mob yuav tsum ua raws li txoj hauv kev no kom kho tau zoo.Cov kab mob sab nraud ntawm txoj kev ncaj qha tuaj yeem ua rau muaj kev txwv, kev kho tsis txaus lossis ua tiav tsis suav nrog kev kho kom tsim nyog.Cov txheej txheem nkhaus PVP tsis ntev los no tau siv nyob rau hauv lub lumbar thiab thoracic qaum nrog cov lus ceeb toom ntawm nce maneuverability [4,5].Txawm li cas los xij, kev siv cov koob nkhaus hauv lub ncauj tsev menyuam nqaj qaum tsis tau tshaj tawm.Peb piav qhia txog qhov xwm txheej ntawm qhov tsis tshua muaj C2 pathologic fracture theem nrab rau metastatic pancreatic cancer kho nrog posterior cervical PVP.
Ib tug txiv neej muaj hnub nyoog 65 xyoo tau nthuav tawm mus rau tsev kho mob nrog qhov mob tshiab tshwm sim hauv nws lub xub pwg thiab caj dab uas nyob ntev li 10 hnub yam tsis tau txais kev pab nrog cov tshuaj hauv khw muag khoom.Cov tsos mob no tsis cuam tshuam nrog kev qaug zog lossis qaug zog.Nws muaj keeb kwm tseem ceeb ntawm metastatic tsis zoo sib txawv ntawm pancreatic cancer theem IV, arterial hypertension thiab cawv hnyav.Nws ua tiav 6 lub voj voog ntawm FOLFIRINOX (leucovorin / leucovorin, fluorouracil, irinotecan hydrochloride thiab oxaliplatin) tab sis tau pib ib txoj kev tshiab ntawm gemzar thiab abraxane ob lub lis piam dhau los vim muaj kab mob.Hauv kev kuaj lub cev, nws tsis muaj kev mob siab rau palpation ntawm lub ncauj tsev menyuam, thoracic, lossis lumbar qaum.Tsis tas li ntawd, tsis muaj qhov tsis hnov ​​​​tsw thiab lub cev muaj zog nyob rau sab sauv thiab sab qis.Nws ob tog reflexes yog ib txwm.Kev kuaj xyuas ntawm lub tsev kho mob tomography (CT) ntawm lub ncauj tsev menyuam nqaj qaum tau pom cov kab mob osteolytic zoo ib yam nrog cov kab mob metastatic cuam tshuam nrog sab xis ntawm C2 vertebral lub cev, txoj cai C2 loj, sab xis vertebral phaj, thiab sab xis ntawm C2. .Upper right articular nto thaiv (Fig. 1).Ib tug kws kho mob neurosurgeon tau sab laj, sib nqus resonance imaging (MRI) ntawm lub ncauj tsev menyuam, thoracic thiab lumbar qaum, noj mus rau hauv tus account metastatic osteolytic lesions.MRI kev tshawb pom pom T2 hyperintensity, T1 isointense mos cov ntaub so ntswg loj hloov sab xis ntawm C2 vertebral lub cev, nrog txwv tsis pub muaj kev sib txawv thiab kev txhim kho tom qab sib txawv.Nws tau txais kev kho hluav taws xob tsis muaj kev txhim kho hauv qhov mob.Cov kev pabcuam neurosurgical pom zoo kom tsis txhob ua kev phais xwm txheej ceev.Yog li, kev cuam tshuam hluav taws xob (IR) tau xav tau rau kev kho mob ntxiv vim qhov mob hnyav thiab muaj kev pheej hmoo ntawm kev tsis ruaj khov thiab ua tau rau tus txha caj qaum compression.Tom qab kev ntsuam xyuas, nws tau txiav txim siab los ua CT-guided percutaneous C2 spine plasty siv txoj hauv kev posterolateral.
Vaj Huam Sib Luag A qhia qhov txawv thiab cortical irregularities (xub xub) nyob rau sab xis anterior ntawm C2 vertebral lub cev.Asymmetric expansion ntawm txoj cai atlantoaxial sib koom thiab cortical irregularity ntawm C2 (thick xub, B).Qhov no, ua ke nrog lub pob tshab ntawm qhov loj ntawm sab xis ntawm C2, qhia txog kev puas tsuaj ntawm cov kab mob pathological.
Tus neeg mob tau muab tso rau hauv txoj cai pw tsaug zog thiab 2.5 mg ntawm Versed thiab 125 μg ntawm fentanyl tau muab faib ua koob tshuaj.Thaum pib, C2 vertebral lub cev tau muab tso rau thiab 50 ml ntawm qhov sib txawv ntawm cov hlab ntsha tau txhaj rau hauv thaj chaw sab xis ntawm cov hlab ntsha thiab npaj txoj kev nkag mus.Tom qab ntawd, ib rab koob 11-gauge qhia tau nce mus rau tom qab-qhov nruab nrab ntawm lub cev vertebral los ntawm txoj cai posterolateral mus kom ze (Fig. 2a).Ib tug nkhaus Stryker TroFlex® koob tau muab tso rau hauv (Fig. 3) thiab muab tso rau hauv qis nruab nrab ntawm C2 osteolytic lesion (Fig. 2b).Polymethyl methacrylate (PMMA) pob txha cement tau npaj raws li cov lus qhia txheem.Nyob rau theem no, nyob rau hauv kev tswj tsis tu ncua CT-fluoroscopic, cov pob txha cement tau txhaj los ntawm rab koob nkhaus (Fig. 2c).Thaum ua tiav qhov kev ua tiav ntawm qhov qis ntawm qhov txhab, cov koob tau muab tshem tawm ib nrab thiab tig mus rau qhov chaw sab sauv nruab nrab ntawm qhov txhab (Fig. 2d).Tsis muaj kev tiv thaiv rau rab koob repositioning vim qhov mob no yog qhov mob osteolytic hnyav.Txhaj ntxiv PMMA cement hla qhov txhab.Kev saib xyuas tau raug coj los ua kom tsis txhob muaj cov pob txha cement rau hauv tus txha caj qaum lossis cov ntaub so ntswg paravertebral.Tom qab ua tiav qhov txaus siab sau nrog cov cement, lub koob nkhaus raug tshem tawm.Postoperative imaging pom muaj kev vam meej PMMA pob txha cement vertebroplasty (Figures 2e, 2f).Postoperative neurological kuaj pom tsis muaj qhov tsis xws luag.Ob peb hnub tom qab, tus neeg mob tau tawm nrog lub ncauj tsev menyuam caj dab.Nws qhov mob, txawm tias tsis daws tau tag nrho, tau tswj tau zoo dua.Tus neeg mob tragically tuag ob peb lub hlis tom qab tso tawm hauv tsev kho mob vim muaj teeb meem ntawm kev mob qog noj ntshav pancreatic.
Computed tomography (CT) cov duab qhia txog cov ntsiab lus ntawm cov txheej txheem.A) Thaum pib, ib qho 11 gauge sab nraud cannula tau muab tso los ntawm txoj kev npaj txoj cai posterolateral mus kom ze.B) Muab ib rab koob nkhaus (ob xub xub) los ntawm lub cannula (ib xub xub) rau hauv qhov txhab.Lub taub ntawm rab koob yog muab tso rau hauv qab thiab ntau medially.C) Polymethyl methacrylate (PMMA) cement tau txhaj rau hauv qab ntawm qhov txhab.D) Lub koob khoov yog thim rov qab thiab rov muab tso rau hauv qhov nruab nrab sab nraud, thiab tom qab ntawd PMMA cement yog txhaj.E) thiab F) qhia txog kev faib tawm ntawm PMMA cement tom qab kho hauv coronal thiab sagittal dav hlau.
Vertebral metastases feem ntau pom nyob rau hauv lub mis, prostate, ntsws, thyroid, lub raum hlwb, zais zis, thiab melanoma, nrog ib tug qis dua ntawm cov pob txha metastases li ntawm 5 mus rau 20% nyob rau hauv pancreatic cancer [6,7].Kev koom tes ntawm ncauj tsev menyuam hauv pancreatic cancer yog qhov tsawg dua, tsuas yog plaub kis tau tshaj tawm hauv cov ntaub ntawv, tshwj xeeb tshaj yog cov cuam tshuam nrog C2 [8-11].Kev koom tes ntawm tus txha caj qaum tej zaum yuav yog asymptomatic, tab sis thaum ua ke nrog cov pob txha, nws tuaj yeem ua rau tsis muaj kev tswj xyuas qhov mob thiab tsis ruaj khov uas nyuaj rau kev tswj xyuas nrog kev tswj hwm thiab tuaj yeem ua rau tus neeg mob ua rau tus txha caj qaum compression.Yog li, vertebroplasty yog ib qho kev xaiv rau tus txha caj qaum stabilization thiab yog txuam nrog kev mob nyem nyob rau hauv ntau tshaj 80% ntawm cov neeg mob ua raws li cov txheej txheem no [12].
Txawm hais tias tus txheej txheem tuaj yeem ua tiav ntawm qib C2, txoj kev kho lub cev ua rau muaj kev nyuaj siab thiab yuav ua rau muaj teeb meem.Muaj ntau cov kab mob neurovascular nyob ib sab ntawm C2, raws li nws yog anterior rau lub pharynx thiab larynx, lateral mus rau carotid qhov chaw, posterolateral mus rau lub vertebral hlab ntsha thiab lub ncauj tsev menyuam paj hlwb, thiab posterior mus rau lub hnab [13].Tam sim no, plaub txoj kev siv hauv PVP: anterolateral, posterolateral, transoral, thiab translational.Txoj kev anterolateral feem ntau yog ua nyob rau hauv txoj hauj lwm supine thiab yuav tsum tau hyperextension ntawm lub taub hau kom elevate lub mandible thiab pab C2 nkag.Yog li, cov txheej txheem no yuav tsis haum rau cov neeg mob uas tsis tuaj yeem tswj lub taub hau hyperextension.Cov koob tau dhau los ntawm qhov chaw parapharyngeal, retropharyngeal thiab prevertebral thiab cov qauv posterolateral ntawm carotid artery sheath yog ua tib zoo tswj manually.Nrog rau cov txheej txheem no, kev puas tsuaj rau cov hlab ntsha vertebral, carotid artery, jugular vein, submandibular gland, oropharyngeal thiab IX, X thiab XI cranial qab haus huv yog ua tau [13].Cerebellar infarction thiab C2 neuralgia theem nrab rau cov cement to kuj suav tias yog teeb meem [14].Txoj hauv kev posterolateral tsis tas yuav siv tshuaj loog, tuaj yeem siv rau hauv cov neeg mob uas tsis tuaj yeem ua rau lub caj dab hyperextend, thiab feem ntau yog ua nyob rau hauv txoj hauj lwm supine.Cov koob tau dhau los ntawm qhov chaw tom qab lub ncauj tsev menyuam hauv lub anterior, cranial thiab medial cov lus qhia, sim tsis txhob kov cov hlab ntsha vertebral thiab nws qhov chaw mos.Yog li, cov teeb meem cuam tshuam nrog kev puas tsuaj rau cov hlab ntsha vertebral thiab qaum qaum [15].Kev nkag mus rau Transoral yog technically tsawg nyuaj thiab koom nrog kev qhia ntawm ib rab koob rau hauv phab ntsa pharyngeal thiab qhov chaw pharyngeal.Ntxiv nrog rau kev puas tsuaj rau cov hlab ntsha vertebral, txoj kev no yog txuam nrog kev pheej hmoo siab ntawm kev kis kab mob thiab cov teeb meem xws li pharyngeal abscesses thiab meningitis.Txoj kev no kuj yuav tsum tau siv tshuaj loog thiab intubation [13,15].Nrog rau kev nkag mus rau sab nraud, rab koob tau muab tso rau hauv qhov chaw muaj peev xwm nruab nrab ntawm cov hlab ntsha ntawm cov hlab ntsha carotid thiab cov hlab ntsha vertebral mus rau theem ntawm C1-C3, thaum qhov kev pheej hmoo ntawm kev puas tsuaj rau cov hlab ntsha tseem ceeb yog siab dua [13].Ib qho teeb meem ntawm txhua txoj hauv kev yog qhov xau ntawm cov pob txha cement, uas tuaj yeem ua rau compression ntawm tus txha caj qaum lossis cov paj hlwb [16].
Nws tau raug sau tseg tias kev siv rab koob nkhaus hauv qhov xwm txheej no muaj qee qhov zoo, suav nrog kev nkag mus tau yooj yim thiab rab koob maneuverability.Lub koob nkhaus txhawb nqa rau: lub peev xwm xaiv lub hom phiaj sib txawv ntawm lub cev vertebral, txhim khu kev qha midline nkag mus, txo cov sijhawm ua haujlwm, txo cov cement to, thiab txo lub sijhawm fluoroscopy [4,5].Raws li peb qhov kev tshuaj xyuas ntawm cov ntaub ntawv, kev siv cov koob nkhaus ntawm lub ncauj tsev menyuam nqaj qaum tsis tau tshaj tawm, thiab nyob rau hauv cov ntaub ntawv saum toj no, cov koob ncaj tau siv rau posterolateral vertebroplasty ntawm qib C2 [15,17-19].Muab qhov nyuaj ntawm lub cev ntawm lub caj dab hauv cheeb tsam, qhov nce maneuverability ntawm txoj kev nkhaus koob yuav tau txais txiaj ntsig tshwj xeeb.Raws li pom nyob rau hauv peb cov ntaub ntawv, lub lag luam tau ua nyob rau hauv ib tug xis lateral txoj hauj lwm thiab peb hloov txoj hauj lwm ntawm lub koob mus rau sau ob peb qhov chaw ntawm qhov txhab.Hauv tsab ntawv ceeb toom tsis ntev los no, Shah et al.Lub koob nkhaus sab laug tom qab lub zais pa kyphoplasty tau tshwm sim tiag tiag, qhia txog qhov muaj feem cuam tshuam ntawm rab koob nkhaus: cov duab ntawm rab koob tuaj yeem pab txhawb kev tshem tawm [20].
Hauv cov ntsiab lus no, peb qhia txog kev kho mob zoo ntawm cov kab mob tsis ruaj khov ntawm C2 vertebral lub cev siv posterolateral PVP nrog ib rab koob nkhaus thiab sib quas ntus CT fluoroscopy, ua rau pob txha ruaj khov thiab txhim kho qhov mob.Cov txheej txheem nkhaus koob yog qhov zoo dua: nws tso cai rau peb kom ncav cuag qhov mob los ntawm kev nyab xeeb dua tom qab txoj hauv kev thiab tso cai rau peb hloov lub koob mus rau txhua yam ntawm qhov txhab thiab txaus thiab ntau dua ua tiav qhov mob nrog PMMA cement.Peb cia siab tias cov txheej txheem no yuav txwv tsis pub siv cov tshuaj loog uas xav tau rau kev nkag mus rau transoropharyngeal thiab zam cov teeb meem neurovascular cuam tshuam nrog rau sab hauv thiab sab nraud.
Tib neeg Cov Ntsiab Lus: Txhua tus neeg koom hauv txoj kev tshawb fawb no tau muab lossis tsis pom zoo.Kev tsis sib haum xeeb ntawm kev txaus siab: Raws li ICMJE Uniform Disclosure Form, txhua tus kws sau ntawv tshaj tawm cov lus hauv qab no: Cov ntaub ntawv them nqi / Kev Pabcuam: Txhua tus kws sau ntawv tshaj tawm tias lawv tsis tau txais kev txhawb nqa nyiaj txiag los ntawm ib lub koom haum rau kev xa ua haujlwm.Kev Sib Raug Zoo Nyiaj Txiag: Txhua tus kws sau ntawv tshaj tawm tias lawv tsis tam sim no lossis hauv peb lub xyoos dhau los muaj kev sib raug zoo nyiaj txiag nrog rau ib lub koom haum uas yuav nyiam ua haujlwm.Lwm Cov Kev Sib Raug Zoo: Txhua tus kws sau ntawv tshaj tawm tias tsis muaj lwm yam kev sib raug zoo lossis kev ua ub no uas yuav cuam tshuam rau cov haujlwm xa mus.
Swarnkar A, Zane S, Christie O, et al.(Tsib Hlis 29, 2022) Vertebroplasty rau pathological C2 pob txha: ib qho kev kho mob tshwj xeeb uas siv cov txheej txheem nkhaus.Kho 14(5): e25463.doi: 10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Qhov no yog ib tsab xov xwm qhib tau muab faib raws li cov ntsiab lus ntawm Creative Commons Attribution License CC-BY 4.0.Unlimited siv, faib, thiab luam tawm nyob rau hauv ib qho nruab nrab yog tso cai, yog tus thawj sau thiab qhov chaw yog credit.
Qhov no yog ib tsab xov xwm qhib nkag tau muab faib raws li Creative Commons Attribution License, uas tso cai txwv tsis pub siv, kev faib tawm, thiab luam tawm hauv ib qho nruab nrab, muab tus sau thiab cov peev txheej tau txais txiaj ntsig.
Vaj Huam Sib Luag A qhia qhov txawv thiab cortical irregularities (xub xub) nyob rau sab xis anterior ntawm C2 vertebral lub cev.Asymmetric expansion ntawm txoj cai atlantoaxial sib koom thiab cortical irregularity ntawm C2 (thick xub, B).Qhov no, ua ke nrog lub pob tshab ntawm qhov loj ntawm sab xis ntawm C2, qhia txog kev puas tsuaj ntawm cov kab mob pathological.
Computed tomography (CT) cov duab qhia txog cov ntsiab lus ntawm cov txheej txheem.A) Thaum pib, ib qho 11 gauge sab nraud cannula tau muab tso los ntawm txoj kev npaj txoj cai posterolateral mus kom ze.B) Muab ib rab koob nkhaus (ob xub xub) los ntawm lub cannula (ib xub xub) rau hauv qhov txhab.Lub taub ntawm rab koob yog muab tso rau hauv qab thiab ntau medially.C) Polymethyl methacrylate (PMMA) cement tau txhaj rau hauv qab ntawm qhov txhab.D) Lub koob khoov yog thim rov qab thiab rov muab tso rau hauv qhov nruab nrab sab nraud, thiab tom qab ntawd PMMA cement yog txhaj.E) thiab F) qhia txog kev faib tawm ntawm PMMA cement tom qab kho hauv coronal thiab sagittal dav hlau.
Scholarly Impact Quotient ™ (SIQ™) yog peb qhov tshwj xeeb tom qab tshaj tawm cov txheej txheem kev tshuaj xyuas cov neeg sib tw.Xav paub ntau ntxiv ntawm no.
Qhov txuas no yuav coj koj mus rau lub vev xaib thib peb uas tsis koom nrog Cureus, Inc. Thov nco ntsoov tias Cureus tsis muaj lub luag haujlwm rau cov ntsiab lus lossis cov haujlwm uas muaj nyob hauv peb tus khub lossis cov chaw koom nrog.
Scholarly Impact Quotient ™ (SIQ™) yog peb qhov tshwj xeeb tom qab tshaj tawm cov txheej txheem kev tshuaj xyuas cov neeg sib tw.SIQ ™ ntsuas qhov tseem ceeb thiab zoo ntawm cov khoom siv kev txawj ntse ntawm tag nrho cov zej zog Cureus.Txhua tus neeg siv sau npe raug txhawb kom pab txhawb rau SIQ ™ ntawm ib tsab xov xwm luam tawm.(Cov kws sau ntawv tsis tuaj yeem ntsuas lawv tus kheej cov ntawv.)
Kev ntsuas siab yuav tsum tau tshwj tseg rau kev ua haujlwm tshiab hauv lawv cov haujlwm.Txhua tus nqi siab dua 5 yuav tsum suav tias yog siab tshaj qhov nruab nrab.Thaum txhua tus neeg siv sau npe ntawm Cureus tuaj yeem ntsuas cov ntawv tshaj tawm, cov kev xav ntawm cov kws tshaj lij muaj qhov hnyav ntau dua li cov kev xav ntawm cov tsis yog kws tshaj lij.SIQ ™ ntawm ib tsab xov xwm yuav tshwm sim tom ntej ntawm tsab xov xwm tom qab nws tau ntsuas ob zaug, thiab yuav suav nrog txhua qhov qhab nia ntxiv.
Scholarly Impact Quotient ™ (SIQ™) yog peb qhov tshwj xeeb tom qab tshaj tawm cov txheej txheem kev tshuaj xyuas cov neeg sib tw.SIQ ™ ntsuas qhov tseem ceeb thiab zoo ntawm cov khoom siv kev txawj ntse ntawm tag nrho cov zej zog Cureus.Txhua tus neeg siv sau npe raug txhawb kom pab txhawb rau SIQ ™ ntawm ib tsab xov xwm luam tawm.(Cov kws sau ntawv tsis tuaj yeem ntsuas lawv tus kheej cov ntawv.)
Thov nco ntsoov tias los ntawm kev ua li ntawd koj pom zoo kom muab ntxiv rau hauv peb cov ntawv xov xwm txhua hli email.