Maganin arthroscopic na rashin zaman lafiyar kafada na baya

Rashin kwanciyar hankali na baya baya yawanci ana haifar da rauni na baya ko kuma maimaituwar rauni mai rauni a lokacin motsa jiki ko wasu ayyukan, tare da adadin abubuwan da suka faru na shekara-shekara na 4.64 a cikin mutane 100000 a kowace shekara. An bayyana wasu fasahohin tiyata don maganin rashin lafiyar kafada na baya, ciki har da gyaran gyare-gyare mai laushi da budewa da arthroscopic kasusuwan kasusuwa. Koyaya, rikice-rikicen tiyata da aka ruwaito da ƙimar bita sun kai 14% da 67%, bi da bi. Musamman ma, daidaitaccen wuri na ƙasusuwan kasusuwa, daidaitawar dunƙulewa da kuma kula da raunuka masu haɗuwa ana ɗaukar ƙalubale. Don haka, ana buƙatar haɓaka dabarun tiyata.

Matakan aiki:

• An yi aikin a ƙarƙashin maganin sa barci na gabaɗaya tare da toshe yanki na sulcus intermuscular.

• Don tarin ƙwayar iliac, an yi amfani da maganin sa barci na gida ta hanyar subcutaneously da kuma na gaba.

• An sanya majiyyaci a cikin kujerar rairayin bakin teku tare da baya a kusurwar 45 ° don ba da damar cikakken hulɗa tare da iliac crest. Bayan an girbe dashen kashi, aikin ya ci gaba, kuma mai haƙuri yana zaune a kusurwar 70 °. An dakatar da majiyyacin ta daidaitaccen tsari na bakararre, kuma an karkatar da hannun mai aiki gaba 30 ° ta igiya mai nauyin kilogiram 2 zuwa 3.

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Arthroscopic haɗin gwiwa kimantawa

• Wannan hanya tana amfani da mashigai biyu ko uku. Ana iya amfani da ƙofar gaban farko (E) don cikakken binciken haɗin gwiwa.

  
  

• Za'a iya shigar da jeri kai tsaye cikin haɗin gwiwa ta hanyar tazarar rotator. A wasu lokuta, ba shi yiwuwa a gabatar da iyawar kai tsaye (watau tabo a kusa da tazarar rotator).

  
  

• Kuna iya ƙirƙirar ƙofar C ta gefe ko ƙofar D ta gaba, ta yadda za ku iya shiga sararin samaniya a ƙarƙashin kololuwar acromion, don ku iya lura da sararin tsokar rotator.

  
  

• An yi amfani da zubar mitar rediyo na arthroscopic don buɗe tazarar rotator.

  
  

• Ana sanya lever mai juyawa a cikin haɗin gwiwa ta hanyar shigarwar E don canza kewayo zuwa kallon ciki na haɗin gwiwa.

  
  

• Bayan cikakken kimantawa na haɗin gwiwa, raunin nama mai laushi da kuma haɗin gwiwa na glenoid da asarar kasusuwa na humeral (watau lebe na glenoid na baya, capsule na haɗin gwiwa, raunin glenoid gefe da baya na Hill Sachs) an kimanta su.

  
  

• Bayan cikakken kimantawa na arthroscopic na haɗin gwiwar glenohumeral da kuma tabbatar da alamun da suka dace, an samo kashi kashi.

  
  

Girbin dashen kashi da shiri

• An samo autograft na bicortical daga ipsilateral na baya na iliac crest don adana ƙwayar ciki na ƙashin ƙugu. Yi fatar jiki kamar 2cm a bayan kashin baya na gaba da 2cm a ƙasan ƙirjin tare da ƙashin ƙwarjin don guje wa samuwar tabo wanda ke rufe kullun kai tsaye.

  
  

• Bayan lura da kasusuwa na cortical α da β biyu daidaitattun Kirschner fil an saka su a cikin cortex na gefe ta cikin ramin, wanda a baya an sanye shi da dogayen coracoid screws guda biyu daga na'urar Arthroscopic Latarjet (Fig. 1).

  
  

• Hannun jagorar yana karkata zuwa sama ta yadda za a iya daidaita kashin kashin da wuyan glenoid na baya. Matsayin jagorar yana ba da damar zaɓin ƙugiya na sama a matsayin gefen articular na toshe kashi.

  
  

• Sa'an nan, tura da rami coracoid aiwatar mataki rawar soja a kan Kirschner waya da kuma haƙa biyu 2.9mm ramukan a cikin toshe kashi. An cire guntun rawar soja da fil ɗin Kirschner. Kafin shigar da mai wankin hula na sama a cikin ramin rawar jiki, matsa ramin tare da fam ɗin hular saman.

  
  

• Da zarar hular saman ta kasance a wurin, yi amfani da abin zagi ko wuka na kasusuwa don adana tsaka-tsakin ɓawon burodi na iliac crest da girbi 2-cm × 1-cm × 1-cm grafts (Hoto na 2 da 3). Bayan an girbe kashin, an haɗa kasusuwan kasusuwa da hannun rigar tsarin coracoid kuma ana amfani da sukurori guda biyu masu tsayi mara ƙarfi don samar da naúrar da za a iya sarrafa ta zuwa matsayinta na ƙarshe (Fig. 4).

  
  

• An rufaffen raunin ƙwanƙolin ƙwanƙwasa Layer tare da bututun magudanar ruwa kuma an yi amfani da sutura. Sa'an nan daidaita baya na aiki tebur zuwa wani kwana na 70 °.

Hoto 1. An tattara kashi na ƙwanƙwasa na dama lokacin da mai haƙuri ya kasance a cikin kujerar kujera na bakin teku. An sanya alluran Kirschner guda biyu tare da na'urar jagorar cannula biyu, kuma hannun cannula yana sama. (Ant, gaba; DCG, jagorar casing biyu; Inf, ƙananan Post, baya; Sup, babba.)

Hoto 2. Lokacin da mai haƙuri ya kasance a cikin kujerar kujerar rairayin bakin teku, ana ɗaukar kashin kasusuwa na ƙwanƙwasa na dama. Cire rawar rawar soja da waya ta Kirschner bayan an haƙa dandali na gefe na ƙwanƙolin iliac, sannan a saka 2 'huluna' . (Ant, gaba; DCG, jagorar casing biyu; Inf, ƙananan; Post, baya; Sup, babba; TH, hular saman.)

Hoto 3. Lokacin da mai haƙuri ya kasance a cikin kujerar kujerar rairayin bakin teku, an dauki kashin kasusuwa na ƙwanƙwasa na dama. Wurin ciki na ƙwanƙwaran iliac ya kasance cikakke bayan an girbe girbi. (Ant, gaba; Inf, kasa; IT, tebur na ciki; Post, baya; Sup, saman.)

Hoto 4. Shirya tubalan kashi akan teburin gefe. Bayan da aka girbe girbi, an haɗa kasusuwan kasusuwa zuwa cannula biyu ta hanyar amfani da masu ɓoye cannula guda biyu. (Ant, gaba; DCG, jagorar cannula biyu; IBG, dashen kashi na iliac; Inf, ƙananan; Post, baya; Sup, babba.)

Alamomin titin baya da hanyoyin shiga

• Yawancin lokaci ana amfani da tashoshi biyu zuwa uku. Manufar ita ce daidaita mashigin A na baya tare da layin haɗin gwiwa na glenohumeral gwargwadon yiwuwa. Saboda haka, ana sarrafa shi ta hanyar arthroscope. Saboda haka, an fi yin shi ne bayan aikin daga mashigin gaba na gefe.

  
  

• Ƙofar gaba ta E an sanya shi a cikin sararin tsokar rotator sama da tsokar biceps, wanda zai iya nuna daidai ɓangaren gefen glenoid (Table 1).

  
  

• A mafi yawan lokuta, ba a buƙatar ƙarin tashoshi; Duk da haka, idan ya cancanta, ana iya amfani da ƙarin mashigan B na baya ta hanyar daurin baya (misali, don sarrafa kayan aikin labial na haɗin gwiwa).

  
  

• Da kyau, Entrance A yana tsaye daidai akan layin haɗin gwiwa na glenohumeral.

  
  

• Ta hanyar hangen gaba da baya na ƙofar E, saka alluran kashin baya 2 baya a nesa na 2.5 zuwa 3 cm, kuma saka haɗin gwiwa a layi daya a karfe 7 da 9 na dare (kafadar dama).

  
  

• Yi yankan fata tsakanin allura 2 kuma amfani da ita azaman ƙofar A ta baya (Hoto 5A da B).

Hoto 5. (A) Mai haƙuri zai yi alama kuma ya shirya ƙaddamarwar fata a cikin 70 ° kusurwa zaune matsayi, kafada dama da kuma ƙofar E. Don cimma mafi kyawun daidaitawa tsakanin mashigin A na baya da layin haɗin gwiwa na glenohumeral, ana saka alluran kashin baya guda biyu a baya don tantance alamar ƙaddamarwar fata.

(B) hangen nesa na arthroscopic, kafadar dama, da ra'ayi na lantarki na majiyyaci tare da allura a cikin wurin zama na 70 °. (Ant, na baya; DCG, jagorar cannula biyu; Gl, glenoid; Inf, na baya; Post, na baya; Pc, capsule na baya; Sn, allura na kashin baya; Sup, babba.)

Glenoid shiri

• Ana gabatar da kayan aikin ta hanyar mashigan baya (A).

  
  

• Cire labrum da capsule na baya daga 7 zuwa 10 (kafadar dama) ta amfani da VAPR da reza (Fig. 6A da B, Bidiyo 1).

  
  

• Niƙa wuyan glenoid na baya tare da burrs na arthroscopic har sai an bayyana kashi na jini kuma an shirya jirgin (Fig. 7). Da zarar wuyan glenoid ya shirya, an faɗaɗa mashigin A na baya don ba da damar wucewa na dasa da cannula biyu na coracoid.

  
  

• Za a iya amfani da ƙwanƙwasa don faɗaɗa rabon tsoka da cystotomy, yayin da trocar rectangular m (tsarin subscapular) za a iya amfani da shi don ƙara fadada hanyar (Hoto 8).

Hoto 6. (AB) Ganin shirye-shiryen glenoid a ƙarƙashin arthroscopy, mai haƙuri yana zaune a kusurwar 70 °, kafada dama, kallon ƙofar lantarki. Yayin shirye-shiryen glenoid, yi amfani da VAPR da reza don cire leben glenoid da capsule na baya daga 7:00 zuwa 10:00. (Ant, gaba; Gl, glenoid; Hh, humeral head; Inf, na baya; PC, capsule na baya; Post, na baya; Sup, babba; V, VAPR.)

Hoto 7. Arthroscopic gani na shirye-shiryen glenoid: mai haƙuri ya zauna a kusurwar 70 °, kafada dama, E-portal view. Saka wuyan glenoid na baya yayin shirye-shiryen glenoid. (Ant, gaba; B, burr; Gl, glenoid; Inf, ƙananan; Pgn, wuyan glenoid na baya; Post, baya; Sup, babba.)

Hoto 8. Arthroscopic gani na shirye-shiryen glenoid: mai haƙuri ya zauna a kusurwar 70 °, kafada dama, E-portal view. Ƙara mashigin A na baya tare da maƙarƙashiya. (Ant, gaba; Bt: m trocar; Gl, glenoid; Inf, ƙananan; PC, capsule na baya; Post, na baya; Sup, babba.)

Matsayin graft da gyarawa

An shigar da dasa ta hanyar ƙofar baya tare da hannun yana fuskantar sama (Fig. 9) kuma an raba ta cikin tsoka da haɗin gwiwa har sai ya kasance kusa da wuyan glenoid na baya kuma ya zubar da fuskar bangon glenoid. Wannan mataki yana buƙatar mayar da hankali kan shirye-shiryen rarrabuwa, musamman buɗe lokacin farin ciki da ƙarfi na infraspinatus fascia da hana wucewar dasawa.

• Yana da mahimmanci a yi amfani da ɓangarorin ƙwanƙwasa don buɗe fascia da yawa. Idan ya cancanta, a cikin mataki na gaba na tiyata, idan zubar da ruwa yana da mahimmanci don kiyaye isasshen matsi a kafada, ana iya amfani da kayan aiki don rufe raunin tiyata (misali, shirye-shiryen raunuka).

  
  

• Coracoid cannula an sanya shi a layi daya zuwa saman articular don kada wayoyi na Kirschner na gaba da sukurori kada su shiga cikin haɗin gwiwa yayin sakawa.

  
  

• Biyu 1.5 mm tsawo Kirschner wayoyi aka saka ta cikin m coracoid tsari sukurori don gyara dasa a kan na baya glenoid wuyansa (Fig. 10).

  
  

• Shigar da waya ta Kirschner bai kamata ya wuce 40mm don kaucewa wucewa ta cikin wuyan glenoid na baya ba, wanda zai iya lalata tsarin tsarin neurovascular na gaba, ko da yake kawai wani ɓangare na tsoka na subscapularis yana wanzu tsakanin wuyansa da tsarin neurovascular don kare shi.

Hoto 9. Mai haƙuri ya shigar da dasa a cikin wurin zama na 70 °, kuma ya lura da kafadar dama da gefen baya. An shigar da dasa ta hanyar ƙofar baya tare da riƙon yana fuskantar sama. (Ant, gaba; DCG, jagorar casing biyu; Inf, ƙananan; Post, baya; Sup, babba.)

Hoto 10. Arthroscopic hangen nesa na dasa sakawa, haƙuri zaune a 70 ° kwana, dama kafada, E ƙofar view. Filayen Kirschner guda biyu da aka saka suna daidaita dasa a wuyan glenoid na baya. (Ant, gaba; Gl, glenoid; IBG, iliac graft kashi; Inf, ƙananan; Kw, waya Kirschner; Post, baya; Sup, babba.)

Tunda arthroscope na 30 ° ana kallon shi daga gaban jijiyar portal, a dabi'a yana ƙoƙarin karkatar da dasa zuwa kusurwa, yana mai da ƙasan farfajiyar fitacciyar maimakon madaidaiciya. Yana da mahimmanci a bincika ko har yanzu ƙwayar kashi na iya yiwuwa bayan sanyawa.

• Da zarar an juye dajin tare da gefen glenoid na baya, cire dogon coracoid dunƙule na farko kuma a yi rami mai faɗin glenoid mai faɗi 3-2mm akan wayar Kirschner.

  
  

• A cikin wannan mataki, yana da mahimmanci a ci gaba da kasancewa bayan aikin farko. Dole ne ma'aikatan taimako su kula da hannayensu biyu (Hoto 11).

  
  

• Dole ne a shirya don saka fil na Kirschner na uku a cikin ramin, saboda kullun Kirschner a matsayinsa na asali yawanci ana kama shi a cikin motar ba da gangan ba ta hanyar rawar soja.

  
  

• Dole ne a kula da kar a cire waya ta Kirschner lokacin da za a fitar da ɗigon rawar jiki ta hannun rigar coracoid. Sa'an nan, saka 4.5 mm partially threaded Latarjet dunƙule a cikin Kirschner waya (Fig. 12) sa'an nan gaba daya saka shi don hana dasawar daga motsi, sa'an nan kuma huda na sama dunƙule. Fi dacewa, da dunƙule tsawon kada ya wuce 32 zuwa 36 mm.

  
  

• Duk wani tsayin da ya fi 40 mm yana buƙatar bincike mai zurfi, saboda wannan yana iya kasancewa saboda kusurwar kusurwar daɗaɗɗen dangantaka da glenoid surface, wanda zai iya haifar da raguwa. A wannan mataki, ana iya gyara matakin ɗorawa ta hanyar juya glenoid a kusa da ƙananan dunƙule.

  
  

• Bayan shigar da dunƙule na farko (ƙananan), za'a iya cire fil ɗin Kirschner na farko. Saka dunƙule na biyu a cikin hanya guda.

  
  

• Bayan shigar da screws 2 da cire wayar Kirschner, yi amfani da bincike a Entrance A don duba matsayi na ƙarshe (Hoto 13). Ya kamata a gyara duk wani ɓangaren da ke fitowa daga cikin datti da bursu, kuma kada a yi gyaran nama mai laushi don hana taurin haɗin gwiwa.

Hoto 11. An saita dasa kuma an gyara shi. Mai haƙuri ya zauna a kusurwar 70 ° tare da kafadarsa ta dama daga sama. Lokacin da kuma bayan hakowa, kiyaye jagorar har yanzu da hannaye biyu don hana layin K sassauta rami. (Ant, gaba; DCG, jagorar cannula biyu; Kw, waya Kirschner; Post, baya; Sup, babba.)

Hoto 12. Arthroscopic hangen nesa na gyaran gyare-gyare, mai haƙuri yana zaune a kusurwar 70 °, kafada dama, kallon ƙofar lantarki. Ƙarƙashin 4.5mm wani ɓangaren zaren Latarjet mai zaren Latarjet yana farawa a sama da fil ɗin Kirschner. (Ant, gaba; Gl, glenoid; IBG, iliac graft; Inf, ƙananan; S, dunƙule; Post, baya; Sup, babba.)

Hoto 13. Arthroscopic hangen nesa na dasa matsayi, haƙuri zaune a 70 ° kwana, dama kafada, E ƙofar view. Bayan shigar da sukurori biyu da cire wayar Kirschner, duba wurin dasawa na ƙarshe. Irin wannan nau'i na kashin kashi yana da kyau matsawa kuma ba shi da matsayi mai girman kai. (Ant, gaba; Gl, glenoid; Hh, humeral kai; IBG, iliac kasusuwa; Inf, ƙananan; Post, na baya; Sup, babba.)

Bayan tiyata, an gyara kafada tare da kusurwar sata 20 ° da juyawa tsaka tsaki na makonni 6:

• Kashegari bayan aikin, fara kafada mai wucewa, gwiwar hannu da kewayon motsa jiki na hannu. Ya kamata a kauce wa pronation da motsi masu raɗaɗi.

  
  

• A makonni 3, fara aikin motsa jiki na motsa jiki.

  
  

• Bayan an tabbatar da kwanciyar hankali ta hanyar ɗaukar hotuna makonni 6 bayan aikin, ana iya fara motsa jiki mai tsanani.

  
  

• Ga 'yan wasan da ke neman murmurewa da sauri, ya kamata a yi tambarin kwamfuta na kwamfuta watanni 3 bayan tiyata don tantance haɗin kai.

  
  

Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?

Domin CZMEDITECH , muna da cikakken samfurin layi na kayan aikin tiyata na orthopedic da kayan aiki masu dacewa, samfurori ciki har da kashin baya implants, intramedullary kusoshi, farantin rauni, farantin kulle, cranial-maxillofacial, prosthesis, kayan aikin wuta, masu gyara waje, arthroscopy, kula da dabbobi da saitin kayan aikinsu.

Bugu da kari, mun himmatu wajen ci gaba da bunkasa sabbin kayayyaki da fadada layin samfur, ta yadda za a iya biyan bukatun tiyata na karin likitoci da marasa lafiya, da kuma sa kamfaninmu ya kara yin gasa a cikin dukkan masana'antar sarrafa kasusuwa ta duniya da masana'antar kayan aiki.

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