Ọgwụgwọ arthroscopic nke adịghị ike n'azụ ubu

Akwụsịghị ubu azụ na-emekarị site na nhụsianya dị n'azụ ma ọ bụ mmerụ ahụ na-emeghachi omume n'oge mmega ahụ ma ọ bụ ihe omume ndị ọzọ, yana ọnụ ọgụgụ 4.64 kwa afọ nke 100000 mmadụ kwa afọ. A kọwawo ọtụtụ usoro ịwa ahụ maka ọgwụgwọ nke adịghị ike n'azụ azụ, gụnyere nrụzi anụ ahụ dị nro na-emeghe na arthroscopic ọkpụkpụ ịwa ahụ. Agbanyeghị, nsogbu ịwa ahụ a kọrọ na ọnụego ngbanwe dị elu ruru 14% na 67%, n'otu n'otu. Karịsịa, a na-ewere ntinye ziri ezi nke ọkpụkpụ ọkpụkpụ, ntụgharị ihu na ọgwụgwọ nke ọnya concomitant dị ka ihe ịma aka. Ya mere, ọ dị mkpa ka emeziwanye usoro ịwa ahụ.

Usoro ọrụ:

• A na-arụ ọrụ ahụ n'okpuru mgbakasị izugbe jikọtara ya na ngọngọ mpaghara nke intermuscular sulcus.

• Maka nchịkọta nke crest iliac, a na-etinye ọgwụ anestetiiki mpaghara n'okpuru akpụkpọ ahụ na n'ime oge.

• A na-etinye onye ọrịa ahụ n'oche osimiri nke nwere azụ na 45 Celsius iji kwe ka kọntaktị zuru ezu na crest iliac. Mgbe emechara ọkpụkpụ ọkpụkpụ, ọrụ ahụ gara n'ihu, onye ọrịa ahụ nọ ọdụ n'akụkụ 70 Celsius. A kwụsịtụrụ onye ọrịa ahụ n'ụzọ na-adịghị mma, na ogwe aka na-arụ ọrụ na-ehulata n'ihu 30 Celsius site na eriri 2 ruo 3 n'arọ.

• 
  

Nyocha nkwonkwo arthroscopic

• Usoro a na-eji ọnụ ụzọ abụọ ma ọ bụ atọ. Enwere ike iji ọnụ ụzọ ihu nke mbụ (E) mee nchọpụta nkwonkwo nke ọma.

  
  

• Enwere ike iwebata ọkwa ozugbo n'ime nkwonkwo site na oge ntụgharị rotator. N'ọnọdụ ụfọdụ, ọ gaghị ekwe omume iwebata oke ahụ ozugbo (ya bụ, anụ ahụ dị n'akụkụ etiti rotator).

  
  

• Ị nwere ike ịmepụta ọnụ ụzọ C mpụta ma ọ bụ ọnụ ụzọ D n'ihu, ka ị nwee ike ịbanye na oghere n'okpuru ọnụ ọgụgụ acromion, ka i wee hụ oghere muscle rotator.

  
  

• A na-eji nkwụsị redio arthroscopic meghee etiti oge rotator.

  
  

• A na-edobe lever ngbanwe na nkwonkwo site na ntinye E iji gbanwee oke na nlele ime ime.

  
  

• Mgbe nyochachara nke ọma nke nkwonkwo ahụ, a na-enyocha ọnya anụ ahụ dị nro na ọnyá ndị metụtara nke glenoid na ọkpụkpụ humeral (ya bụ, egbugbere ọnụ glenoid azụ, nkwonkwo capsule, ọnyá glenoid n'akụkụ ọnya na reverse Hill Sachs lesion).

  
  

• Mgbe nyochachara arthroscopic nke ọma nke nkwonkwo glenohumeral na nkwenye nke ihe ngosi kwesịrị ekwesị, a na-enweta ọkpụkpụ ọkpụkpụ.

  
  

Owuwe ihe ubi na nkwadebe nke ọkpụkpụ ọkpụkpụ

• E nwetara autograft bicortical site na ipsilateral anterior iliac crest iji chekwaa cortex dị n'ime pelvis. Mee mbepụ akpụkpọ ahụ ihe dịka 2cm n'azụ azụ azụ azụ azụ nke elu elu yana 2cm n'okpuru crest n'akụkụ crest iliac iji zere ọdịdị ọnya na-ekpuchi crest ozugbo.

  
  

• Mgbe elele ọkpụkpụ cortical α na β abụọ yiri Kirschner atụnye n'ime mpụta cortex site na oghere, bụ nke a kwadebere na mbụ nwere ogologo coracoid skru abụọ site na Arthroscopic Latarjet ngwaọrụ (Fig 1).

  
  

• A na-atụgharị aka nke ntuziaka n'elu ka ọkpụkpụ ọkpụkpụ wee nwee ike jikọta ya na olu glenoid dị ala. Ntinye nke ntuziaka na-enye ohere nhọrọ nke elu elu dị ka akụkụ articular nke ọkpụkpụ ọkpụkpụ.

  
  

• Mgbe ahụ, kpalie oghere coracoid usoro mgbapu na Kirschner waya na gbapuo abụọ 2.9mm oghere na ọkpụkpụ ngọngọ. E wepụrụ ihe mkpọpu na ntụtụ Kirschner. Tupu ịtinye ihe nzacha okpu n'elu n'ime oghere a na-egwupụta ihe, kpatụ oghere ahụ na mgbata okpu n'elu.

  
  

• Ozugbo okpu dị n'elu dị, jiri mma swing ma ọ bụ ọkpụkpụ iji chekwaa cortex medial nke iliac crest na ihe ubi 2-cm × 1-cm × 1-cm grafts (Figures 2 and 3). Mgbe a na-egbute ihe nkedo ahụ, a na-ejikọta ngọngọ ọkpụkpụ na aka uwe usoro coracoid na ogologo abụọ nke oghere coracoid usoro kposara na-emepụta otu unit nke nwere ike ịmegharị ya na njedebe ikpeazụ (Fig 4).

  
  

• A na-emechi ọnya ahụ n'ọnya ahụ site na oyi akwa na tube drainage na eji ejiji. Mgbe ahụ gbanwee azụ nke tebụl ọrụ na akụkụ nke 70 Celsius.

Ọnụ ọgụgụ 1. A na-anakọta ọkpụkpụ ọkpụkpụ aka nri mgbe onye ọrịa nọ n'oche oche osimiri. A na-edobe agịga Kirschner abụọ na ngwaọrụ ntuziaka cannula abụọ, na aka nke cannula dị elu. (Ant, n'ihu; DCG, ntụzịaka mkpuchi okpukpu abụọ; Inf, obere akwụkwọ ozi, azụ; Sup, elu.)

Ọgụgụ 2. Mgbe onye ọrịa nọ n'oche oche nke osimiri, a na-ewere ọkpụkpụ ọkpụkpụ nke iliac ziri ezi. Wepu ihe a na-egwupụta ihe na waya Kirschner mgbe ị gbasasịrị n'elu ikpo okwu mpụta nke cortex iliac crest, wee tinye 2 'okpu'. (Ant, n'ihu; DCG, ntụzịaka mkpuchi okpukpu abụọ; Inf, ala; Post, azụ; Sup, elu; TH, okpu n'elu.)

Ọgụgụ 3. Mgbe onye ọrịa nọ n'oche oche nke osimiri, a na-ewere ọkpụkpụ ọkpụkpụ nke ọkpụkpụ aka nri. Ihe dị n'ime ime nke eriri afọ na-anọgide na-adịchaghị mma mgbe a na-egbute ya. (Ant, n'ihu; Inf, ala; IT, tebụl dị n'ime; Biputere, azụ; Sup, elu.)

Ọgụgụ 4. Kwadebe ọkpụkpụ ọkpụkpụ na tebụl n'akụkụ. Mgbe a na-egbute ihe nkedo ahụ, a na-ejikọta ọkpụkpụ ọkpụkpụ na cannula okpukpu abụọ site na iji ndị na-eme ihe abụọ. (Ant, n'ihu; DCG, ntụzịaka cannula abụọ; IBG, ntụgharị ọkpụkpụ iliac; Inf, ala; Post, n'azụ; Sup, elu.)

Akara azụ n'azụ yana ụzọ ịnweta ụzọ

• A na-ejikarị ọwa abụọ ruo atọ eme ihe. Ebumnuche bụ iji dozie ntinye azụ A na eriri njikọ glenohumeral dị ka o kwere mee. Ya mere, arthroscope na-achịkwa ya. Ya mere, a na-emekarị ya mgbe arụchara ọrụ ahụ site na ntinye ihu n'ihu.

  
  

• A na-etinye ọnụ ụzọ anterolateral E na oghere akwara rotator n'elu akwara biceps, nke nwere ike gosipụta nke ọma n'azụ akụkụ nke glenoid (Table 1).

  
  

• N'ọtụtụ ọnọdụ, ọ dịghị ọwa ọzọ achọrọ; Otú ọ dị, ọ bụrụ na ọ dị mkpa, enwere ike iji eriri azụ azụ B ọzọ site n'azụ cuff (dịka ọmụmaatụ, iji jikwaa prostheses na-arụkọ ọrụ ọnụ).

  
  

• Dị ka o kwesịrị, Ntinye A dị kpọmkwem na axis nke eriri nkwonkwo glenohumeral.

  
  

• Site n'ihu na azụ azụ nke ọnụ ụzọ E, tinye 2 agịga azụ azụ n'ebe dị anya nke 2.5 ruo 3 cm, ma tinye njikọ ahụ n'otu oge na elekere 7 na elekere 9 (ubu aka nri).

  
  

• Mee mbepụ akpụkpọ ahụ n'etiti agịga abụọ ma jiri ya dị ka ọnụ ụzọ azụ A (Foto 5A na B).

Onyonyo 5. (A) Onye ọrịa ahụ ga-akara akara ma kwadebe mbepụ akpụkpọ ahụ na 70 Celsius n'akuku ọdụ, ubu aka nri na nlele E. Iji nweta nhazi kacha mma n'etiti oghere azụ A na eriri njikọ glenohumeral, a na-etinye agịga azụ abụọ azụ azụ iji chọpụta ihe ịrịba ama nke mbepụ akpụkpọ ahụ.

(B) Ọhụụ arthroscopic, ubu aka nri, na eletrọnịkị portal ele onye ọrịa nwere agịga nọ n'ọnọdụ ọdụ 70 Celsius. (Ant, anterior; DCG, ntụzịaka cannula okpukpu abụọ; Gl, glenoid; Inf, usụhọde; Post, posterior; Pc, azụ capsule; Sn, agịga spinal; Sup, elu.)

Nkwadebe Glenoid

• A na-ebute ngwa ahụ site na ntinye azụ (A).

  
  

• Wepu labrum na capsule azụ site na 7 ruo 10 (ubu aka nri) na-eji VAPR na agụba (Fig. 6A na B, Video 1).

  
  

• Ghichaa olu glenoid dị n'azụ na arthroscopic burrs ruo mgbe ọkpụkpụ na-agba ọbara na-ekpughe ma kwadebere ụgbọelu ahụ (Fig 7). Ozugbo olu glenoid dị njikere, a na-agbasa oghere nke azụ A ka o kwe ka ụzọ nke akado na cannula coracoid okpukpu abụọ.

  
  

• Enwere ike iji akpụkpọ anụ ahụ gbasaa nkewa ahụ na cystotomy, ebe enwere ike iji trocar rectangular (subscapular) nwere ike iji mee ka akụkụ ahụ gbasaawanye (Fig 8).

Ọgụgụ 6. (AB) Nleba anya nke nkwadebe glenoid n'okpuru arthroscopy, onye ọrịa nọ ọdụ na 70 Celsius, ubu aka nri, nlele eletrọnịkị. N'oge nkwadebe nke glenoid, jiri VAPR na agụba wepụ egbugbere ọnụ glenoid na capsule azụ site na 7:00 ruo 10:00. (Ant, anterior; Gl, glenoid; Hh, isi humeral; Inf, usụhọde; PC, n'azụ capsule; Post, posterior; Sup, elu; V, VAPR.)

Ọgụgụ 7. Arthroscopic visualization nke glenoid nkwadebe: onye ọrịa nọdụ na n'akuku nke 70 Celsius, ubu aka nri, E-portal ele. Yiri olu glenoid azụ n'oge nkwadebe glenoid. (Ant, n'ihu; B, burr; Gl, glenoid; Inf, ala; Pgn, n'azụ glenoid olu; Post, n'azụ; Sup, elu.)

Ọgụgụ 8. Arthroscopic visualization nke glenoid nkwadebe: onye ọrịa nọdụrụ n'akuku nke 70 Celsius, ubu aka nri, E-portal ele. Jiri trocar na-adịghị ahụ anya mee ka ụzọ mbata A dị n'azụ gbasaa. (Ant, n'ihu; Bt: trocar na-adịghị mma; Gl, glenoid; Inf, ala; PC, capsule azụ; Post, posterior; Sup, elu.)

Ndokwa graft na ndozi

A na-etinye ntinye aka site na ọnụ ụzọ azụ na aka na-eche ihu n'elu (Fig 9) wee kewaa site na akwara na nkwonkwo capsule ruo mgbe ọ dị nso n'olu nke glenoid dị n'azụ ma gbanye ya na elu articular nke glenoid. Nzọụkwụ a kwesịrị ilekwasị anya na nkwadebe nke nkewa, karịsịa imeghe infraspinatus fascia siri ike na nke siri ike ma gbochie nkwụsị nke aka.

• Ọ dị mkpa iji agụba agụba meghee fascia nke ukwuu. Ọ bụrụ na ọ dị mkpa, n'oge ikpeazụ nke ịwa ahụ, ọ bụrụ na mmiri na-agbapụta mmiri dị oke mkpa iji nọgide na-enwe nrụgide zuru oke n'ubu, a pụrụ iji ngwá ọrụ mechie ọnya ịwa ahụ (dịka ọmụmaatụ, ọnya ọnya).

  
  

• A na-etinye cannula coracoid n'akụkụ elu nke articular ka wires Kirschner na skru na-esote ghara ịbanye na nkwonkwo n'oge ntinye.

  
  

• Abụọ 1.5 mm ogologo Kirschner wires etinyere site na oghere coracoid usoro kposara iji dozie aka na azụ glenoid olu (Fig. 10).

  
  

• Ntinye nke waya Kirschner ekwesịghị ịfe 40mm iji zere ịgafe n'olu glenoid dị n'ihu, nke nwere ike imebi usoro neurovascular nke dị n'ihu, ọ bụ ezie na ọ bụ naanị akụkụ nke akwara subscapularis dị n'etiti olu na usoro neurovascular iji chebe ya.

Onyonyo 9. Onye ọrịa na-etinye aka na 70 Celsius nọ ọdụ, ma hụ ubu aka nri na akụkụ posterolateral. A na-etinye aka aka site na ọnụ ụzọ azụ na aka chere ihu n'elu. (Ant, n'ihu; DCG, ntụzịaka mkpuchi okpukpu abụọ; Inf, ala; Biputere, azụ; Sup, elu.)

Ọgụgụ 10. Arthroscopic visualization nke graft n'ọnọdu, ndidi nọ ọdụ na 70 Celsius n'akuku, nri ubu, E n'ọnụ ụzọ ele. Ntụtụ Kirschner abụọ etinyere na-eme ka akado kwụsie ike n'olu glenoid azụ. (Ant, n'ihu; Gl, glenoid; IBG, iliac ọkpụkpụ aka; Inf, ala; Kw, Kirschner waya; Post, n'azụ; Sup, elu.)

Ebe ọ bụ na a na-elele arthroscope 30 Celsius site n'ihu vein portal, ọ na-emekarị ka ọ na-atụgharị aka aka n'akụkụ, na-eme ka elu ala pụta ìhè kama ọ kwụ ọtọ. Ọ dị mkpa ịlele ma ọkpụkpụ ọkpụkpụ ka nwere ike ime mgbe etinyechara akado.

• Ozugbo a na-agbanye aka n'akụkụ akụkụ glenoid dị n'azụ, wepụ ihe nkedo coracoid ogologo nke mbụ wee gbanye oghere glenoid bicortical 3-2mm n'obosara na waya Kirschner.

  
  

• N'ime usoro a, ọ dị mkpa ịnọgide na-adị jụụ mgbe omume mbụ gasịrị. Ndị ọrụ inyeaka ga-eji aka abụọ na-edobe (Foto 11).

  
  

• Ọ ga-adị njikere itinye pin Kirschner nke atọ n'ime oghere ahụ, n'ihi na a na-ejidekarị pin Kirschner n'ọnọdụ mbụ ya n'ime moto ahụ n'amaghị ama site na ntanye egwu.

  
  

• A ghaghị ịkpachara anya ka ị ghara iwepụ waya Kirschner mgbe ị na-ewepụ ihe ọkpụkpụ ahụ site na uwe aka coracoid. Mgbe ahụ, fanye eriri Latarjet 4.5 mm nke akụkụ akụkụ ya n'ime waya Kirschner (Fig 12) ma tinye ya nke ọma ka ọ ghara imegharị ihe ahụ, wee gbanye nkedo elu. Dị mma, ogologo ịghasa ekwesịghị gafere 32 ruo 36 mm.

  
  

• Ogologo ọ bụla karịrị 40 mm chọrọ nyocha nke ọma, n'ihi na nke a nwere ike ịbụ n'ihi nrịgo dị elu nke ntinye aka n'akụkụ elu glenoid, nke nwere ike iduga nkwụsịtụ aka. N'oge a, a ka nwere ike imezi ọkwa nke ntinye aka site n'ịtụgharị glenoid gburugburu ihe nkedo ala.

  
  

• Mgbe ịtinye ihe nkedo mbụ (nke dị ala), enwere ike wepụ ihe mbụ Kirschner pin. Tinye ihe nkedo nke abụọ n'otu ụzọ ahụ.

  
  

• Mgbe ịtinye skru 2 wee wepụ waya Kirschner, jiri nyocha dị na ntinye A iji lelee ọnọdụ ntinye aka ikpeazụ (Nyocha 13). Ekwesịrị iji burrs dozie akụkụ ọ bụla na-apụtapụta ìhè, ọ dịghịkwa arụzi anụ ahụ dị nro ka a ga-emerịrị iji gbochie nkwonkwo nkwonkwo.

Ọgụgụ 11. A na-etinye aka na-edozi ma dozie ya. Onye ọrịa ahụ nọ ọdụ n'akụkụ 70 Celsius na ubu aka nri ya na-ele ya anya n'elu. N'oge na mgbe a na-egwupụta ihe ọkụkụ, mee ka onye nduzi ahụ jiri aka abụọ mee ka ahịrị K ghara ịtọpụ ọwara ahụ. (Ant, n'ihu; DCG, ntụzịaka cannula abụọ; Kw, waya Kirschner; Post, n'azụ; Sup, elu.)

Ọgụgụ 12. Arthroscopic visualization nke aka aka fixation, ndidi nọ ọdụ na 70 Celsius n'akuku, nri ubu, eletrọnịkị nbata ele. Ihe mkpuchi Latarjet nke 4.5mm nke nwere akụkụ akụkụ dị na mbụ dị n'elu ntụtụ Kirschner. (Ant, n'ihu; Gl, glenoid; IBG, iliac ọkpụkpụ aka; Inf, ala; S, ịghasa; Post, n'azụ; Sup, elu.)

Ọgụgụ 13. Arthroscopic visualization nke graft n'ọnọdu, ndidi nọ ọdụ na 70 Celsius n'akuku, nri ubu, E n'ọnụ ụzọ ele. Mgbe ịtinye skru abụọ wee wepụ waya Kirschner, lelee ọnọdụ ntụgharị ikpeazụ. Ụdị ọkpụkpụ ọkpụkpụ a nwere ezigbo mkpakọ na enweghị ọnọdụ mpako. (Ant, anterior; Gl, glenoid; Hh, isi humeral; IBG, iliac ọkpụkpụ aka; Inf, ala; Post, posterior; Sup, elu.)

Mgbe a wachara ya ahụ, a na-edozi ubu ya na akụkụ 20 Celsius na ntụgharị na-anọpụ iche maka izu 6:

• N'echi ya ka ịwachara ahụ ahụ, bido ubu na-agafe agafe, ikiaka na mgbatị aka. Ekwesịrị ịzere pronation na mmegharị ahụ na-egbu mgbu.

  
  

• N'ime izu atọ, malite mmegharị mmegharị ahụ nke na-arụsi ọrụ ike.

  
  

• Mgbe nkwụsi ike nke aka aka kwadoro site na ịse foto 6 izu mgbe ọrụ ahụ gasịrị, enwere ike ịmalite mmega ahụ kpụ ọkụ n'ọnụ.

  
  

• Maka ndị na-eme egwuregwu na-achọ mgbake ngwa ngwa, a ga-eme ihe ntanetị kọmputa 3 ọnwa mgbe ịwachara ahụ iji chọpụta ntinye aka.

  
  

Kedu ka esi azụta ihe ọkụkụ nke Orthopedic na ngwa orthopedic?

Maka CZMEDITECH , anyị nwere zuru oke ngwaahịa akara nke orthopedic ịwa ahụ implants na kwekọrọ ekwekọ ngwá, na ngwaahịa gụnyere. ọkpụkpụ azụ, mbọ intramedullary, efere trauma, efere mkpọchi, cranial-maxillofacial, prosthesis, ngwá ọrụ ike, mpụga fixators, arthroscopy, nlekọta ọgwụgwọ ọrịa anụmanụ na akụrụngwa nkwado ha.

Na mgbakwunye, anyị na-agba mbọ ịnọgide na-azụlite ngwaahịa ọhụrụ na ịgbasa ahịrị ngwaahịa, iji gboo mkpa ịwa ahụ nke ọtụtụ ndị dọkịta na ndị ọrịa, ma meekwa ka ụlọ ọrụ anyị bụrụ asọmpi na ụlọ ọrụ akụrụngwa orthopedic zuru ụwa ọnụ.

Anyị na-ebupụ ụwa niile, ka ị nwee ike kpọtụrụ anyị na adreesị ozi-e song@orthopedic-china.com maka ntinye n'efu, ma ọ bụ zipu ozi na WhatsApp maka nzaghachi ngwa ngwa + 18112515727 .

Ọ bụrụ na ịchọrọ ịmatakwu ozi, pịa CZMEDITECH ka ịchọta nkọwa ndị ọzọ.