Kɔnɔbara kɔkanna basigibaliya furakɛli ni joli-sira-funu ye

A ka ca a la, kɔfɛla basigibaliya bɛ sɔrɔ kɔfɛla jiginni juguman fɛ walima joginni segin-seginni fɛ min tɛ fɛn caman kɛ farikoloɲɛnajɛ walima baara wɛrɛw senfɛ, ni a sɔrɔli hakɛ ye san o san mɔgɔ 4,64 ye mɔgɔ 100000 o 100000 la san kɔnɔ. Opereli fɛɛrɛ caman ɲɛfɔra kɔfɛ kamankun basigibaliya furakɛli la, i n’a fɔ farikolo yɔrɔ nɔgɔlenw dilancogo ani kolo datugucogo da wulilen ni jolilabanaw opereli. Nka, opereli gɛlɛya minnu fɔra ani seginnkanni hakɛ minnu fɔra, olu tun bɛ se 14% ni 67% ma. Kɛrɛnkɛrɛnnenya la, kolotugudaw bilali tigitigi, kurukuruw ɲɛsincogo ani joginda minnu bɛ kɛ ɲɔgɔn fɛ, olu furakɛli bɛ jate gɛlɛya ye. O la, opereli fɛɛrɛw ka kan ka ɲɛ.

Baarakɛcogo minnu bɛ kɛ:

• Opereli kɛra anestezi caman fɛ min faralen don ɲɔgɔn kan ni regional block of intermuscular sulcus ye.

• Walasa ka kɔkiliw lajɛ, sigida la anesteziw tun bɛ kɛ fari jukɔrɔ ani ɲɛgɛnɛbara la.

• Banabagatɔ bilala kɔgɔjida sigilan kan, a kɔ bɛ kɛ 45° kɛrɛ ye walasa ka a to a ka se ka maga a ɲɛda la kosɛbɛ. Kolotuguda tigɛlen kɔfɛ, opereli bɛ senna, banabagatɔ sigilen tun bɛ 70 ° kɛrɛ fɛ. Banabagatɔ tun bɛ siri cogo la min tɛ se ka kɛ, ka opereli bolo kɔrɔta ka taa ɲɛfɛ 30° ka tɛmɛ kilo 2 fo kilo 3 sama juru fɛ.

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Joli jateminɛ ni joli-sira-funu ye

• O kɛcogo in bɛ Kɛ ni dondaw fla walima saba ye. Front (E) dondaw fɔlɔ bɛ se ka kɛ ka jɛ-ka-baara ɲinini kɛ ka ɲɛ.

  
  

• Ranges bɛ se ka don jogindaw kɔnɔ k’a ɲɛsin rotator intervals ma. Tuma dɔw la, a tɛ se ka kɛ ka skɔpi (skɔpi) don a kɔnɔ k’a ɲɛsin a ma (o kɔrɔ ye ko sɔgɔsɔgɔninjɛ bɛ rotateur interval lamini).

  
  

• Aw bɛ se ka C kɛrɛfɛyɔrɔ dɔ da walima ɲɛfɛla kɛrɛfɛ D dondaw, walasa aw ka se ka don yɔrɔ la min bɛ acromion peak jukɔrɔ, walasa aw ka se ka rotator muscle yɔrɔ kɔlɔsi.

  
  

• Arthroscopique radiofréquence ablation kɛra ka rotateur interval da wuli.

  
  

• Toggle lever bɛ bila joint kɔnɔ E dondaw fɛ walasa ka range wuli ka taa joint kɔnɔna lajɛ la.

  
  

• Joli jateminɛ bɛɛ kɔfɛ, farikolo yɔrɔ nɔgɔlenw joginda ni a ni ɲɔgɔn cɛ joginda minnu bɛ sɔrɔ glenoïde ni humeral kolo bɔli la (o kɔrɔ ye ko glenoïde kɔfɛ dawolo, kolotuguda kapisi, glenoïde marginal lesion ani reverse Hill Sachs joginda) jateminɛna.

  
  

• Glenohumeral joli jateminɛni kɔfɛ ni joli-sira-funu ye kosɛbɛ ani ka taamasiɲɛ bɛnnenw dafa, kolotugudaw sɔrɔla.

  
  

Kolow cili sumani ni a labɛnni

• Otograft bicortical sɔrɔla ka bɔ ipsilateral anterior iliac crest la walasa ka basi-bɔn kɔnɔna kolotuguda mara. Aw bɛ fari tigɛ kɛ santimɛtɛrɛ 2 ɲɔgɔn kɔ ɲɛfɛla sanfɛla kɔfɛ ani santimɛtɛrɛ 2 ɲɔgɔn kɔkolo jukɔrɔla kɔkolo la walasa ka aw tanga kurukuruw ma minnu bɛ kɔkolo datugu k’a ɲɛsin a ma.

  
  

• Kɔlɔsili kɔfɛ, kɔkolo kolo α ni β Kirschner pinɛ fila minnu bɛ taa ɲɔgɔn fɛ, olu donna kɛrɛfɛla la dingɛ fɛ, dingɛ min tun bɛ ni korakɔli kuru jan fila ye fɔlɔ ka bɔ Arthroscopic Latarjet minɛn na (Ja 1).

  
  

• Gafe in bolokɔni bɛ ɲɛsin sanfɛ walasa kolotuguda ka se ka bɛn farikolo yɔrɔ la ni kɔfɛla duguma glenoïde kɔ ye. Gafe in bilali bɛ sira Di sanfɛla kurulen sugandili ma i n’a fɔ kolo bloki bolokɔni fan.

  
  

• O kɔ, aw bɛ korakɔyi kɛcogo taamasiɲɛw sɔgɔli dingɛlen digi Kirschner ka nɛgɛ kan ka dingɛ fila sɔgɔ kolotuguda la min janya ye milimɛtɛrɛ 2,9 ye. Drill bit ni Kirschner pinɛ bɔra. Sani aw ka sanfɛla datugulan kolan don foroko dingɛ kɔnɔ, aw bɛ dingɛ gosi ni sanfɛla dawolo pɔnpe ye.

  
  

• Ni sanfɛla da bɛ a nɔ na, ​​aw bɛ sɔgɔsɔgɔninjɛ walima kolotuguda kɛ walasa ka kɔkolo cɛmancɛ kolotuguda mara ani ka santimɛtɛrɛ 2 × santimɛtɛrɛ 1 × santimɛtɛrɛ 1 jirisunw tigɛ (Jaa 2 ni 3). Kɔnɔbara tigɛlen kɔfɛ, kolotuguda bɛ siri korakɔyi kɛcogo bololanɛgɛ la ani korakɔyi kɛcogo bololanɛgɛ janyalen fila bɛ kɛ ka fɛn dɔ dilan min bɛ se ka kɛ ka se a jɔyɔrɔ laban ma (Ja 4).

  
  

• Joginda min bɛ sɔgɔsɔgɔninjɛ la, o datugulen don layini ni layini ni jibɔlan ye ani ka dressing kɛ. O kɔ, aw bɛ opereli tabali kɔfɛla ladilan ka kɛ 70 ° ye.

Jaa 1. Kɔnɔbara kininbolo kolo lajɛra ni banabagatɔ tun bɛ kɔgɔjida sigilan jɔyɔrɔ la. Kirschner pikirijikɛlan fila bɛ bila ɲɔgɔn fɛ ni kanɛli fila ɲɛminɛminɛn ye, ani kanɛli bolo bɛ sanfɛ. (Ant, ɲɛfɛ; DCG, guide double casing; Inf, duguma Post, kɔfɛ; Sup, sanfɛ.)

Jaa 2. Ni banabagatɔ bɛ kɔgɔjida sigilan jɔyɔrɔ la, a kininbolo kɔkolo kolotuguda bɛ ta. Aw bɛ drill bit ni Kirschner wire bɔ ka sɔrɔ ka ilic crest cortex kɛrɛfɛ plateforme sɔgɔ, o kɔ aw bɛ 'hats' 2 don a kɔnɔ. (Ant, ɲɛfɛ; DCG, guide double casing; Inf, duguma; Poste, kɔfɛ; Sup, sanfɛ; TH, sanfɛ fini.)

Jaa 3. Ni banabagatɔ bɛ kɔgɔjida sigilan jɔyɔrɔ la, a kininbolo kɔkolo kolotuguda bɛ ta. Kɔnɔbara basigilen kɔnɔna bɛ to a cogo la, jiribolo tigɛlen kɔfɛ. (Ant, ɲɛfɛ; Inf, duguma; IT, kɔnɔna tabali; Poste, kɔfɛ; Sup, sanfɛ.)

Jaa 4. Aw bɛ kolotugudaw labɛn kɛrɛfɛtabali kan. Kɔnɔbara tigɛlen kɔfɛ, kolotuguda sirilen don ni kansɛri fila ye ni kansɛri dabɔlan fila ye. (Ant, ɲɛfɛ; DCG, kanula fila ɲɛminɛni; IBG, kolo cili; Inf, duguma; Post, kɔfɛ; Sup, sanfɛ.)

Kɔfɛ sira taamasiyɛnw ani dondaw

• A ka c’a la, kan fila fo saba bɛ kɛ. O kun ye ka kɔfɛla A dondaw ni glenohumeral joli sira bɛn ɲɔgɔn ma ni a bɛ se ka kɛ. O la, a bɛ Kɔrɔsi ni joli-sira-funu ye. O la, a bɛ kɛ kosɛbɛ opereli kɔfɛ ka bɔ ɲɛfɛla kɛrɛfɛ dondaw la.

  
  

• A ɲɛfɛla dondaw E bɛ bila rotator muscle space la biceps muscle sanfɛ, o min bɛ se ka glenoïde da kɔfɛla yɔrɔ jira ka ɲɛ (Taabolo 1).

  
  

• A ka c’a la, kanw tɛ kɛ tuguni; Nka ni a mago bɛ a la, B dondaw wɛrɛ bɛ se ka kɛ kɔfɛla la ka tɛmɛ kɔfɛla bolokɔni fɛ (misali la, ka dawolo labɛncogo dafalenw ɲɛnabɔ).

  
  

• A ka fisa, Donda A bɛ sɔrɔ glenohumeral joint line (glenohumeral joint line) yɔrɔ la tigitigi.

  
  

• Aw bɛ dondaw E ɲɛfɛla ni kɔfɛla lajɛ fɛ, aw bɛ kɔkolo pikirijikɛlan 2 don kɔfɛ ka u janya santimɛtɛrɛ 2,5 fo santimɛtɛrɛ 3, ka joli don ɲɔgɔn na nɛgɛ kanɲɛ 7 ni waati 9 yɔrɔw la (kamankun kinin fɛ).

  
  

• Aw bɛ fari tigɛ pikirijikɛlan 2 ni ɲɔgɔn cɛ ka a kɛ kɔfɛ A dondaw ye (Ja 5A ni B).

Jaa 5. (A) Banabagatɔ ka kan ka fari tigɛcogo taamasiyɛn ani k’a labɛn sigiyɔrɔ la 70 ° kɛrɛ fɛ, a kininbolo kamankun ani E dondaw filɛli la. Walasa ka bɛnkan ɲuman sɔrɔ kɔfɛ A dondaw ni glenohumeral joint line cɛ, kɔkolo pikirijikɛlan fila bɛ don kɔfɛ walasa ka fari tigɛcogo taamasiɲɛ dɔn.

. (Ant, ɲɛfɛ; DCG, kanula fila ɲɛminɛni; Gl, glenoïde; Inf, duguma; Post, kɔfɛ; Pc, kɔfɛ kapisi; Sn, kɔkolo pikirijikɛlan; Sup, sanfɛ.)

Glenoid labɛnni

• Minɛn in bɛ don kɔfɛ (A) dondaw fɛ.

  
  

• Aw bɛ labrum ni kɔfɛla furakisɛ bɔ ka bɔ 7 la ka se 10 ma (kamankun kinin fɛ) ni VAPR ni razɔri ye (sɛbɛn ɲɛ 6A ni B, Wideyo 1).

  
  

• Aw bɛ kɔfɛ glenoïde kɔ mugumugu ni arthroscopic burrs ye fo joli bɔli ka bɔ kɛnɛ kan ani ka plan labɛn (sɛbɛn ɲɛ 7). Ni glenoïde kɔ labɛnna, kɔfɛ A dondaw bɛ bonya walasa ka a to graft ni double coracoid cannula ka tɛmɛ.

  
  

• Sɛgɛsɛgɛli bɛ se ka kɛ ka farikolo tilacogo ni sistotomi bonya, ka sɔrɔ trocar rectangulaire blunt (subscapular passage) bɛ se ka kɛ ka tɛmɛsira bonya ka taa a fɛ (Jaa 8).

Jaa 6. (AB) Glenoïde labɛnni yecogo yeli arthroscopy kɔnɔ, banabagatɔ sigilen bɛ 70 ° kɛrɛ fɛ, a kininbolo kamankun, ɛntɛrinɛti dondaw filɛli. Glenoïde labɛnni waati, aw bɛ VAPR ni razɔri kɛ ka glenoïde dawolo ni kɔfɛla furakisɛ bɔ ka bɔ 7:00 na ka se 10:00 ma. (Ant, ɲɛfɛ; Gl, glenoïde; Hh, humeral kunkolo; Inf, duguma; Pc, kɔfɛ kapisi; Post, kɔfɛ; Sup, sanfɛ; V, VAPR.)

Jaa 7. Glenoïde labɛnni yecogo ni joli-sira-funu ye : banabagatɔ sigilen tun bɛ 70 ° kɛrɛ fɛ, a kininbolo kamankun, E-portal view. Glenoïde kɔkanna kɔ doncogo glenoïde labɛnni waati. (Ant, ɲɛfɛ; B, burr; Gl, glenoïde; Inf, duguma; Pgn, kɔfɛ glenoïde kɔ; Poste, kɔfɛ; Sup, sanfɛ.)

Jaa 8. Glenoïde labɛnni ni joli-sira-funu yecogo ye : banabagatɔ sigilen tun bɛ 70 ° kɛrɛ fɛ, a kininbolo kamankun, E-portal view. Aw bɛ kɔfɛ A dondaw bonya ni trocar blunt ye. (Ant, ɲɛfɛ; Bt: trocar blunt; Gl, glenoïde; Inf, duguma; Pc, kɔfɛ kapisi; Post, kɔfɛ; Sup, sanfɛ.)

Graft sigili ani a sirili

Aw bɛ jiribolo don kɔfɛla da fɛ ni a bolokɔni ɲɛsinnen bɛ san fɛ (ja 9) ka tila ka tɛmɛ farikolo ni kolotuguda furakisɛ fɛ fo a ka surun kɔfɛ ɲɛgɛnɛsira kɔ la ani ka a kɛ ni ɲɛgɛnɛsira bolokɔni ɲɛda ye. Nin sen in ka kan ka sinsin farali labɛnni kan, kɛrɛnkɛrɛnnenya la ka infraspinatus fascia belebeleba ni barikama da ani ka jiribolo tɛmɛni bali.

• A nafa ka bon ka baara kɛ ni sɔgɔsɔgɔninjɛ ye walasa ka fasa da wuli kosɛbɛ. Ni a mago bɛ a la, opereli kɔfɛ, ni ko jibɔyɔrɔ nafa ka bon kojugu walasa ka degun bɛrɛ to kamankun na, minɛnw bɛ se ka kɛ ka opereli joginda yɔrɔ dɔ datugu (misali la, joginda sirilanw).

  
  

• Korakɔyi kanɛli bɛ bila ka kɛɲɛ ni joli-sira-funu-yɔrɔ ye walasa Kirschner ka nɛgɛw ni juruw minnu bɛ tugu o kɔ, olu kana don joli la a dontuma na.

  
  

• Kirschner nɛgɛ fila minnu janya ye milimɛtɛrɛ 1,5 ye, olu donna korakɔyi kɛcogo juruw fɛ minnu kɔnɔna bɛ dingɛ kɔnɔ walasa ka jirisunba in siri kɔfɛ glenoid kɔ la (Ja 10).

  
  

• Kirschner ka nɛgɛ donni man kan ka tɛmɛ milimɛtɛrɛ 40 kan walasa a kana tɛmɛ ɲɛgɛnɛsira ɲɛfɛla kɔ fɛ, o bɛ se ka ɲɛda ɲɛfɛla farikolojidɛsɛ tiɲɛ, hali ni subscapularis farikolo yɔrɔ dɔ dɔrɔn de bɛ kɔ ni senfagabana sigicogo cɛ walasa k’a lakana.

Jaa 9. Banabagatɔ ye jiribolo don a sigicogo la 70 °, ka a kininbolo kamankun ni a kɔfɛla kɔlɔsi. O jirisunba in tun bɛ don kɔfɛda fɛ ni a bololanɛgɛ ɲɛsinnen bɛ sanfɛ. (Ant, ɲɛfɛ; DCG, guide double casing; Inf, duguma; Poste, kɔfɛ; Sup, sanfɛ.)

Jaa 10. Arthroscopique visualisation de la positionnement de graft, banabagatɔ sigilen bɛ 70 ° kɛrɛ la, a kininbolo kamankun, E dondaw filɛli. Kirschner pinɛ fila donna a kɔnɔ, olu bɛ jiribolo sabati glenoïde kɔfɛla kɔ la. (Ant, ɲɛfɛ; Gl, glenoïde; IBG, kolo sɔgɔlen; Inf, duguma; Kw, Kirschner ka nɛgɛ; Poste, kɔfɛ; Sup, sanfɛ.)

Ikomi 30 ° joli-sira-funu bɛ lajɛ ka bɔ da la joli-sira-funu ɲɛfɛ, a dacogo la, a bɛ teli ka jiribolo kɔrɔta ka kɛ kɛrɛ ye, o bɛ a to duguma yɔrɔ bɛ ye sanni ka kɛ tilennen ye. A nafa ka bon ka a lajɛ ni koloci bɛ se ka kɛ hali bi kolotuguda bilali kɔfɛ.

• Ni jiribolo in kɛra ni kɔfɛ glenoïde da la, aw bɛ korakoid kuru jan fɔlɔ bɔ ka glenoïde bicortical tunnel dɔ sɔgɔ Kirschner ka nɛgɛ kan min bonya ye milimɛtɛrɛ 3-2 ye.

  
  

• Nin sen in na, a nafa ka bon ka to yɔrɔ kelen na degeliw fɔlɔ kɔfɛ. Dɛmɛbagaw ka kan ka ladonni kɛ ni u bolo fila ye (Jaa 11).

  
  

• A ka kan ka labɛn ka Kirschner pinɛ sabanan don dingɛ kɔnɔ, bawo Kirschner pinɛ min bɛ a jɔyɔrɔ fɔlɔ la, a ka c’a la, o bɛ minɛ motɛri kɔnɔ a yɛrɛ sago la ni drill bit ye.

  
  

• Aw ka kan ka aw janto aw kana Kirschner ka nɛgɛ bɔ ni aw bɛ drill bit sama ka bɔ coracoïde bolokɔni fɛ. O kɔ, aw bɛ Latarjet kurukuru min janya ye milimɛtɛrɛ 4,5 ye, a yɔrɔ dɔ bɛ a la, aw bɛ o don Kirschner nɛgɛ la (ja 12) ka a don a bɛɛ la walasa ka jiribolo bali ka wuli, o kɔ aw bɛ sanfɛla kurukuruni sɔgɔ. A ka fisa, kuru janya man kan ka tɛmɛ milimɛtɛrɛ 32 fo milimɛtɛrɛ 36 kan.

  
  

• Ni a janya ka ca ni milimɛtɛrɛ 40 ye, o ka kan ka sɛgɛsɛgɛ kosɛbɛ, barisa o bɛ se ka kɛ sababu ye ka jiribolo in kɛrɛ janya ni a bɛ tali kɛ glenoid (glenoïde) yɔrɔ la, o bɛ se ka kɛ sababu ye ka jiribolo wuli. Nin waati in na, jiribolo jɔcogo hakɛ bɛ se ka latilen hali bi ni glenoid (glenoïde) jiginni ye duguma kuru lamini na.

  
  

• Kuru fɔlɔ (jugu) donlen kɔfɛ, Kirschner pini fɔlɔ bɛ se ka bɔ. Aw bɛ kuru filanan don o cogo kelen na.

  
  

• Ni aw ye kuru 2 don a kɔnɔ ani ka Kirschner ka nɛgɛ bɔ, aw bɛ sonda kɛ Donda A la walasa ka jiribolo laban jɔyɔrɔ lajɛ (Jaa 13). Fɛnɲɛnɛma yɔrɔ minnu bɛ bɔ kɛnɛ kan, olu bɛɛ ka kan ka tigɛ ni jirisunw ye, ani farikolo yɔrɔ nɔgɔlenw dilancogo si man kan ka kɛ walasa ka kolotugudaw gɛlɛya.

Jaa 11. A jirisunba in bilala yɔrɔ la ka a jɔ. Banabagatɔ sigilen tun bɛ 70 ° kɛrɛ fɛ k’a kininbolo kamankun lajɛ ka bɔ san fɛ. Implant drilling waati ni a kɔfɛ, aw bɛ guider to a jɔlen na ni aw bolo fila ye walasa K layini kana tunɛri lajɔ. (Ant, ɲɛfɛ; DCG, kanula fila ɲɛminɛcogo; Kw, Kirschner ka nɛgɛ; Poste, kɔfɛ; Sup, sanfɛ.)

Jaa 12. Arthroscopique visualisation de la graft fixation, banabagatɔ sigilen bɛ 70 ° angle la, a kininbolo kamankun, a doncogo ɛntɛrinɛti kan. Latarjet kuru min bɛ duguma ni 4,5mm ye, n’a yɔrɔ dɔ ye jiri ye, o bɛ fɔlɔ ka sɔrɔ Kirschner pinɛ sanfɛ. (Ant, ɲɛfɛ; Gl, glenoïde; IBG, kolo sɔgɔlen; Inf, duguma; S, vis; Poste, kɔfɛ; Sup, sanfɛ.)

Jaa 13. Arthroscopie visualisation de la positionnement de graft, banabagatɔ sigilen bɛ 70 ° kɛrɛ la, a kininbolo kamankun, E dondaw filɛli. Ni aw ye kuru fila don a kɔnɔ ani ka Kirschner ka nɛgɛ bɔ, aw bɛ a jiginni laban yɔrɔ lajɛ. Nin koloci suguya in bɛ se ka degun ka ɲɛ, wa a jɔyɔrɔ tɛ kuncɛbaya la. (Ant, ɲɛfɛla; Gl, glenoïde; Hh, humeral kunkolo; IBG, kɔkolo kolo sɔgɔlen; Inf, duguma; Post, kɔfɛ; Sup, sanfɛ.)

Opereli kɔfɛ, kamankun sirilen don ni 20° abduction angle ye ani ka neutre rotation kɛ dɔgɔkun 6 kɔnɔ:

• O dugujɛ opereli kɔfɛ, aw bɛ senkɔniw, kɔkiliw ani bolokɔniw lamagacogo farikoloɲɛnajɛ daminɛ min tɛ kɛ. Aw ka kan ka aw yɛrɛ tanga a birili ni dimi ma.

  
  

• Dɔgɔkun 3 la, aw bɛ lamaga-lamagali kɛcogo ɲumanw daminɛ.

  
  

• Ni jiribolo sabatili dafalen don ni fotow tali ye dɔgɔkun 6 opereli kɔfɛ, farikoloɲɛnajɛ gɛlɛn bɛ se ka daminɛ.

  
  

• Farikoloɲɛnajɛla minnu b’a fɛ ka kɛnɛya joona, u ka kan ka tomografi kɛ ɔridinatɛri fɛ kalo 3 opereli kɔfɛ walasa ka jiribolo doncogo jateminɛ.

  
  

Cogo min na i bɛ se ka kolotugudaw ni kolotugudaw sancogo?

Kosɔn CZMEDITECH , an bɛ ni fɛn dilannenw ye minnu dafalen don kosɛbɛ kolotugudaw opereli fɛnw na ani minɛn minnu bɛ bɛn o ma, furaw sen bɛ o la kɔkolo doncogo, wulu minnu bɛ kɛ ɲɛgɛnɛsira kɔnɔ, trauma plate, da tuguli plati, kunkolo-kɔnɔ-kɔnɔ-kɔnɔ, prothèse (banakisɛfagalan) min bɛ kɛ, kuran baarakɛminɛnw, kɛnɛma fiɲɛbɔlanw, joli-sira-funu (arthroscopie)., baganmara ladonni n’u dɛmɛnanw sigicogo.

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