Obujjanjabi bwa arthroscopic ku butabeera mu ntebenkevu bw’ebibegabega eby’emabega

Obutabeera mu ntebenkevu bw’ebibegabega eby’emabega butera okuva ku kusengulwa kw’emabega okw’ekikangabwa oba obuvune obuddiŋŋana obutayingira mu mubiri mu kiseera ky’okukola dduyiro oba emirimu emirala, nga buli mwaka omuwendo gw’abalwadde 4.64 ku buli bantu 100000 buli mwaka. Obukodyo bw’okulongoosa obuwerako obw’okujjanjaba obutabeera mu ntebenkevu bw’ebibegabega eby’emabega byogerwako, omuli okuddaabiriza ebitundu ebigonvu n’okulongoosa okuzibikira amagumba mu ngeri ey’okuggulawo n’okukebera amagumba. Wabula ebizibu ebyategeezebwa mu kulongoosa n’emiwendo gy’okuddamu okukola byali waggulu nga 14% ne 67%, okusinziira ku. Okusingira ddala, okuteeka obulungi amagumba agasimbiddwa, okulungamya sikulaapu n’okujjanjaba ebiwundu ebikwatagana bitwalibwa ng’okusoomoozebwa. N’olwekyo, obukodyo bw’okulongoosa bwetaaga okulongoosebwamu.

Emitendera gy’okukola:

• Okulongoosa kwakolebwa wansi w’okubudamya okwa bulijjo nga kugatta wamu ne regional block of intermuscular sulcus.

• Ku lw’okukung’aanya ebitundu by’omubiri ebiyitibwa iliac crest, eddagala eribudamya mu kitundu lyasiigibwa wansi w’olususu ne mu lususu.

• Omulwadde yateekebwa mu ntebe ya bbiici ng’omugongo guli mu nkoona ya 45 ° okusobozesa okukwatagana mu bujjuvu n’ekitundu ky’omubiri ekiyitibwa iliac crest. Oluvannyuma lw’okukungula amagumba, okulongoosa kwagenda mu maaso, era omulwadde yali atudde mu nkoona ya 70 °. Omulwadde yayimirizibwa mu ngeri eya bulijjo etaliimu buwuka, era omukono ogulongoosa ne gufukamizibwa mu maaso 30 ° okuyita mu muguwa ogusika ogwa kkiro 2 ku 3.

• 
  

Okukebera ebinywa mu ngeri y’okukebera ebinywa

• Enkola eno ekozesa emiryango ebiri oba esatu. Omulyango ogusooka ogw’omu maaso (E) gusobola okukozesebwa okunoonyereza mu bujjuvu mu biyungo.

  
  

• Ranges zisobola okuyingizibwa butereevu mu joints okuyita mu rotator intervals. Mu mbeera ezimu, tekisoboka kuyingiza butereevu sikopu (kwe kugamba, ebitundu by’enkovu okwetoloola ekiseera ky’okukyusakyusa).

  
  

• Osobola okukola omulyango gwa C ogw’ebbali oba omulyango gwa D ogw’ebbali mu maaso, osobole okuyingira mu kifo wansi w’entikko ya acromion, osobole okwetegereza ekifo ky’ebinywa ebikyukakyuka.

  
  

• Arthroscopic radiofrequency ablation yakozesebwa okuggulawo interval ya rotator.

  
  

• Toggle lever eteekebwa mu joint okuyita mu E entry okukyusa range okudda mu joint interior view.

  
  

• Oluvannyuma lw’okwekenneenya ekiwanga mu bujjuvu, ebiwundu by’ebitundu ebigonvu n’ebiwundu ebikwatagana n’okufiirwa amagumba g’omubiri (glenoid) n’amagumba g’omugongo (kwe kugamba, omumwa gwa glenoid ogw’emabega, kkapu y’ekiwanga, ekiwundu eky’oku mabbali g’ekiwanga n’ekiwundu kya Hill Sachs eky’emabega) byakeberebwa.

  
  

• Oluvannyuma lw’okwekenneenya obulungi ekiwanga ky’omugongo (glenohumeral joint) n’okukakasa ebiraga ebituufu, amagumba agasimbibwa gafunibwa.

  
  

Okukungula n’okuteekateeka okusimbuliza amagumba

• Bicortical autograft yafunibwa okuva mu ipsilateral anterior iliac crest okukuuma ekitundu eky’omunda eky’ekisambi. Kola okusala olususu nga sentimita 2 emabega w’omugongo ogw’omu maaso ogw’okungulu ne sentimita 2 wansi w’olususu okuyita ku ntikko okwewala okutondebwa kw’enkovu ezibikka butereevu ekifuba.

  
  

• Oluvannyuma lw’okwetegereza eggumba ly’omubiri (cortical bone α ne β) Ppini bbiri eza Kirschner ezikwatagana zayingizibwa mu kitundu ky’omubiri eky’ebbali nga ziyita mu kinnya, ekyali kiteekeddwamu sikulaapu bbiri empanvu eza coracoid okuva mu kyuma kya Arthroscopic Latarjet (Fig. 1).

  
  

• Omukono gw’omulagirizi gutunudde waggulu olwo eggumba eryasimbibwa lisobole okukwatagana mu mubiri n’ensingo ya glenoid eya wansi ey’emabega. Okuteekebwa kw’omulagirizi kusobozesa okulonda omuggo ogwa waggulu ng’oludda lw’omugongo (articular side) olwa bbulooka y’amagumba.

  
  

• Oluvannyuma, ssika ekituli kya coracoid process step drill ku waya ya Kirschner era osima ebituli bibiri ebya mm 2.9 mu bbulooka y’amagumba. Ekintu ekisima ebyuma ne ppini ya Kirschner byaggyibwamu. Nga tonnayingiza ekyuma eky’okunaaba eky’okungulu mu kinnya ky’okusima, kwata ekituli ekyo ne taapu y’enkoofiira ey’okungulu.

  
  

• Enkoofiira ey’okungulu bw’emala okubeera mu kifo, kozesa ekiso ekiwuubaala oba ekiso ky’amagumba okukuuma ekitundu eky’omu makkati eky’omutwe gw’omugongo n’okukungula ebisimbibwa ebya sentimita 2 × sentimita emu × sentimita emu (Ebifaananyi 2 ne 3). Oluvannyuma lw’okukungula ekitundu ekisimbye, ekitundu ky’amagumba kiyungibwa ku mukono gw’enkola ya coracoid era sikulaapu bbiri empanvu eziriko ebituli eza coracoid process screws zikozesebwa okukola yuniti eyinza okukozesebwa okutuuka mu kifo kyayo ekisembayo (Fig. 4).

  
  

• Ekiwundu kya iliac crest kyaggalwa layeri ku layeri nga kiriko drainage tube era nga kikozesebwa okusiba. Oluvannyuma tereeza emabega w’emmeeza y’okulongoosa ku nkoona ya 70 °.

Ekifaananyi 1. Eggumba lya ddyo erya iliac crest lyakunganyizibwa ng’omulwadde ali mu mbeera y’entebe ya bbiici. Empiso za Kirschner ebbiri ziteekebwa wamu n’ekyuma ekilungamya emisuwa egy’emirundi ebiri, era omukono gwa kanyula guli waggulu. (Ant, mu maaso; DCG, double casing guide; Inf, wansi Post, emabega; Sup, waggulu.)

Ekifaananyi 2. Omulwadde bw’aba mu mbeera y’entebe ya bbiici, ekitundu ky’amagumba eky’omugongo ogwa ddyo kitwalibwa. Ggyawo ekintu ekisima ne waya ya Kirschner oluvannyuma lw'okusima ekifo eky'ebbali ekya iliac crest cortex, n'oluvannyuma oteekemu 'enkoofiira' 2. (Ant, mu maaso; DCG, double casing guide; Inf, wansi; Post, emabega; Sup, waggulu; TH, enkoofiira waggulu.)

Ekifaananyi 3. Omulwadde bw’aba mu mbeera y’entebe ya bbiici, ekitundu ky’amagumba eky’omugongo ogwa ddyo kitwalibwa. Ekitundu eky’omunda eky’ekikolo ky’omugongo (iliac crest) kisigala nga bwe kiri oluvannyuma lw’okukungula ekitundu ekisimbye. (Ant, mu maaso; Inf, wansi; IT, emmeeza ey’omunda; Post, emabega; Sup, waggulu.)

Ekifaananyi 4. Tegeka bulooka z’amagumba ku mmeeza ey’ebbali. Oluvannyuma lw’okukungula ekikuta, ekitundu ky’amagumba kyayungibwa ku kanyula ey’emirundi ebiri nga bakozesa ebyuma bibiri ebiziyiza kannyula. (Ant, mu maaso; DCG, okulungamya emisuwa ebiri; IBG, okukyusa amagumba g’omugongo; Inf, wansi; Post, emabega; Sup, waggulu.)

Ebipande by’enguudo emabega n’enguudo eziyingira

• Ebiseera ebisinga emikutu ebiri oba esatu gye gikozesebwa. Ekigendererwa kwe kukwataganya omulyango gwa A ogw’emabega ne layini y’ekiyungo kya glenohumeral nga bwe kisoboka. N’olwekyo, kifugibwa ekyuma ekikebera ebinywa. N’olwekyo, kisinga kukolebwa oluvannyuma lw’okulongoosebwa okuva mu kifo ekiyingira mu maaso eky’ebbali.

  
  

• Omulyango ogw’omu maaso E guteekebwa mu kifo ky’ebinywa ebikyukakyuka waggulu w’ekinywa kya biceps, ekiyinza okulaga obulungi ekitundu eky’emabega eky’empenda ya glenoid (Table 1).

  
  

• Emirundi egisinga, tekyetaagisa mikutu gilala; Naye bwe kiba kyetaagisa, omulyango omulala ogw’okuyingira ogwa B ogw’emabega oguyita mu kifuba eky’emabega guyinza okukozesebwa (okugeza, okuddukanya ebitundu by’omubiri ebiyitibwa complementary labial prostheses).

  
  

• Ekisinga obulungi, Entrance A esangibwa ddala ku axis ya glenohumeral joint line.

  
  

• Okuyita mu kulaba mu maaso n’emabega w’omulyango E, ssaamu empiso 2 ez’omugongo emabega ku bbanga lya sentimita 2.5 ku 3, era oyingize ekiyungo mu ngeri ey’okukwatagana mu kifo ky’essaawa 7 ne 9 (ekibegabega ekya ddyo).

  
  

• Kola olususu wakati w’empiso 2 era okikozese ng’omulyango A ogw’emabega (Ebifaananyi 5A ne B).

Ekifaananyi 5. (A) Omulwadde alina akabonero n’okuteekateeka ekitundu ky’olususu ekisaliddwa mu mbeera y’okutuula mu nkoona ya 70 °, ekibegabega ekya ddyo n’okulaba kw’omulyango gwa E. Okusobola okutuuka ku kukwatagana okusinga obulungi wakati w’omulyango gwa A ogw’emabega ne layini y’ekiyungo kya glenohumeral, empiso bbiri ez’omugongo ziteekebwa emabega okuzuula akabonero k’okutemebwa kw’olususu.

(B) Okulaba mu binywa, ekibegabega kya ddyo, n’okulaba kw’omulyango ogw’ebyuma ku mulwadde ng’alina empiso mu mbeera ya 70 ° ng’atudde. (Ant, mu maaso; DCG, okulungamya emisuwa ebiri; Gl, glenoid; Inf, wansi; Post, emabega; Pc, capsule emabega; Sn, empiso y’omugongo; Sup, waggulu.)

Okuteekateeka Glenoid

• Ekintu kino kiyingizibwa nga kiyita mu mulyango ogw’emabega (A).

  
  

• Ggyawo labrum ne posterior capsule okuva ku 7 okutuuka ku 10 (ekibegabega ekya ddyo) ng’okozesa VAPR ne razor (Fig. 6A ne B, Video 1).

  
  

• Siiga ensingo ya glenoid ey’emabega n’ebiwujjo ebiyitibwa arthroscopic burrs okutuusa ng’eggumba erivaamu omusaayi lifulumye era ennyonyi n’etegekebwa (Fig. 7). Obulago bwa glenoid bwe bumala okwetegekera, omulyango gwa A ogw’emabega gugaziwa okusobozesa okuyita kwa graft ne double coracoid cannula.

  
  

• Scalpel esobola okukozesebwa okugaziya okugabanya ebinywa n’okusalako cystotomy, ate blunt rectangular trocar (subscapular passage) esobola okukozesebwa okwongera okugaziya omukutu (Figure 8).

Ekifaananyi 6. (AB) Okulaba okuteekateeka glenoid wansi w’okukebera ebinywa, omulwadde ng’atudde ku 70 ° angle, ekibegabega kya ddyo, okulaba okuyingira okw’ebyuma. Mu kiseera ky’okuteekateeka glenoid, kozesa VAPR ne razor okwawula glenoid lip ne posterior capsule okuva ku ssaawa 7:00 okutuuka ku ssaawa 10:00. (Ant, mu maaso; Gl, glenoid; Hh, omutwe gw’omugongo; Inf, wansi; Pc, capsule ey’emabega; Post, emabega; Sup, waggulu; V, VAPR.)

Ekifaananyi 7. Arthroscopic visualization of glenoid preparation: omulwadde yatuula ku angle ya 70 °, ekibegabega kya ddyo, E-portal view. Okwambala ensingo ya glenoid ey’emabega mu kiseera ky’okuteekateeka glenoid. (Ant, mu maaso; B, burr; Gl, glenoid; Inf, wansi; Pgn, ensingo ya glenoid ey’emabega; Post, emabega; Sup, waggulu.)

Ekifaananyi 8. Arthroscopic visualization of glenoid preparation: omulwadde yatuula ku angle ya 70 °, ekibegabega kya ddyo, E-portal view. Gaziya omulyango oguyingira A emabega n’ekintu ekiyitibwa trocar ekitali kya maanyi. (Ant, mu maaso; Bt: blunt trocar; Gl, glenoid; Inf, wansi; Pc, capsule ey’emabega; Post, emabega; Sup, waggulu.)

Okuteeka graft mu kifo n’okuginyweza

Ekisimbibwa kyayingizibwa nga kiyita mu mulyango ogw’emabega ng’omukono gutunudde waggulu (Fig. 9) ne kyawulwamu okuyita mu kkapu y’ebinywa n’ennyondo okutuusa lwe kyatuuka okumpi n’ensingo ya glenoid ey’emabega era nga kikwatagana n’ekitundu ky’omubiri ekiyitibwa articular surface of the glenoid. Omutendera guno gwetaaga okussa essira ku kutegeka okwawukana naddala okuggulawo ekitundu ekinene era ekigumu ekya infraspinatus fascia n’okuziyiza okuyita kw’ekisengejjero.

• Kikulu okukozesa ekyuma ekiyitibwa scalpel blade okuggulawo ennyo fascia. Bwe kiba kyetaagisa, mu mutendera ogw’oluvannyuma ogw’okulongoosa, singa okukulukuta kw’okufuuwa kuba kukulu nnyo okusobola okukuuma puleesa emala ku kibegabega, ebikozesebwa bisobola okukozesebwa okuggalawo ekitundu ekiwundu eky’okulongoosa (okugeza, ebisiba ebiwundu).

  
  

• Coracoid cannula eteekebwa parallel ne articular surface waya ne sikulaapu za Kirschner eziddako zireme kuyingira mu kiyungo nga ziyingizibwa.

  
  

• Waya za Kirschner bbiri obuwanvu mm 1.5 zayingizibwa nga ziyita mu sikulaapu z’enkola ya coracoid eziriko ebituli okutereeza ekikuta ku bulago bwa glenoid obw’emabega (Fig. 10).

  
  

• Okuyingiza waya ya Kirschner tekulina kusukka mm 40 okwewala okuyita mu bulago bwa glenoid obw’omu maaso, ekiyinza okwonoona ensengekera y’emisuwa gy’obusimu egy’omu maaso, wadde ng’ekitundu kyokka eky’ekinywa kya subscapularis kye kiri wakati w’ensingo n’ensengekera y’emisuwa gy’obusimu okugikuuma.

Ekifaananyi 9. Omulwadde yayingiza ekitundu ekissiddwa mu mbeera y’okutuula mu 70 °, era n’alaba ekibegabega ekya ddyo n’oludda olw’emabega. Ekisenge kino kyayingizibwa nga kiyita mu mulyango ogw’emabega ng’omukono gutunudde waggulu. (Ant, mu maaso; DCG, omukulembeze w’ekisenge eky’emirundi ebiri; Inf, wansi; Post, emabega; Sup, waggulu.)

Ekifaananyi 10. Okulaba mu ngeri y’okukebera mu binywa (arthroscopic visualization of graft positioning), omulwadde ng’atudde ku 70 ° angle, ekibegabega ekya ddyo, okulaba omulyango gwa E. Ppini za Kirschner bbiri eziyingiziddwa zitebenkeza ekikuta ku bulago bwa glenoid obw’emabega. (Ant, mu maaso; Gl, glenoid; IBG, okusimbibwa kw’amagumba g’omugongo; Inf, wansi; Kw, waya ya Kirschner; Post, emabega; Sup, waggulu.)

Okuva 30 ° arthroscope bwetunuulirwa okuva mu maaso g’omusuwa gw’omulyango, mu butonde etera okulengejja ekisimbibwa ku nkoona, ekifuula ekitundu ekya wansi okubeera ekirabika obulungi okusinga okugolokofu. Kikulu okukebera oba okusimbuliza amagumba kukyasoboka oluvannyuma lw’okuteekebwamu amagumba.

• Ekisimbi bwe kimala okukwatagana n’olukonko lwa glenoid olw’emabega, ggyawo sikulaapu empanvu esooka eya coracoid era osima omukutu gwa bicortical glenoid obugazi bwa mm 3-2 ku waya ya Kirschner.

  
  

• Mu mutendera guno, kikulu okusigala nga osirise oluvannyuma lw’okwegezangamu okusooka. Abayambi balina okulabirira n’emikono gyombi (Ekifaananyi 11).

  
  

• Kiteekwa okuba nga kyetegefu okuteeka ppini ya Kirschner ey’okusatu mu kinnya, kubanga ppini ya Kirschner mu kifo kyayo ekyasooka etera okukwatibwa mu mmotoka mu ngeri etaali ya kyeyagalire n’ekintu ekisima.

  
  

• Okwegendereza kulina okutwalibwa obutaggyawo waya ya Kirschner ng’oggyayo ekintu ekisima okuyita mu mukono gwa coracoid. Oluvannyuma, ssaamu sikulaapu ya Latarjet eya mm 4.5 eriko obuwuzi obutonotono mu waya ya Kirschner (Fig. 12) era ogiyingize mu bujjuvu okuziyiza ekikuta okukyuka, n’oluvannyuma osima sikulaapu eya waggulu. Ekirungi obuwanvu bwa sikulaapu tebulina kusukka mm 32 ku 36.

  
  

• Obuwanvu bwonna obusukka mm 40 bwetaaga okwekenneenya n’obwegendereza, kubanga kino kiyinza okuba nga kiva ku nkoona empanvu ey’ekisengejjero okusinziira ku ngulu w’ekisengejja, ekiyinza okuvaako okusereba kw’ekisengejjero. Ku mutendera guno, omutendera gw’okuteekebwa mu kifo kya graft gukyayinza okutereezebwa nga okyusakyusa glenoid okwetoloola sikulaapu eya wansi.

  
  

• Oluvannyuma lw’okuyingiza sikulaapu esooka (eya wansi), ppini ya Kirschner esooka esobola okuggyibwamu. Teekamu sikulaapu eyookubiri mu ngeri y’emu.

  
  

• Oluvannyuma lw’okuyingiza sikulaapu 2 n’okuggyawo waya ya Kirschner, kozesa ekipima ku mulyango A okukebera ekifo ekisembayo eky’okusimba (Figure 13). Ebitundu byonna ebifulumye eby’ekikuta birina okusalibwako ebiwujjo, era tewali kuddaabiriza bitundu bigonvu kulina kukolebwa okuziyiza okukaluba kw’ennyondo.

Ekifaananyi 11. Ekisengejja kyateekebwa mu kifo era ne kinyweza. Omulwadde yatuula mu nkoona ya 70 ° ng’ekibegabega kye ekya ddyo kitunudde waggulu. Mu kiseera ky’okusima n’oluvannyuma lw’okusima ekintu ekisimbibwa, kuuma omukulembeze ng’asigala ng’olina emikono gyombi okutangira layini ya K okusumulula omukutu. (Ant, mu maaso; DCG, obulagirizi bwa cannula emirundi ebiri; Kw, waya ya Kirschner; Post, emabega; Sup, waggulu.)

Ekifaananyi 12. Okulaba mu binywa eby’okunyweza okusimbibwa, omulwadde ng’atudde ku 70 ° angle, ekibegabega ekya ddyo, okulaba okuyingira okw’ebyuma. Sikulufu ya Latarjet eya wansi eya mm 4.5 eriko obuwuzi obutonotono esooka kubeera waggulu wa ppini ya Kirschner. (Ant, mu maaso; Gl, glenoid; IBG, okusimbibwa kw’amagumba g’omugongo; Inf, wansi; S, sikulaapu; Post, emabega; Sup, waggulu.)

Ekifaananyi 13. Okulaba mu ngeri y’okukebera mu binywa (arthroscopic visualization of graft positioning), omulwadde ng’atudde ku 70 ° angle, ekibegabega ekya ddyo, okulaba ku mulyango gwa E. Oluvannyuma lw’okuyingiza sikulaapu bbiri n’okuggyawo waya ya Kirschner, kebera ekifo ekisembayo eky’okusimbuliza. Ekika kino eky’okusimba amagumba kirina okunyigirizibwa okulungi ate nga tekirina kifo kya kwenyumirizaamu. (Ant, mu maaso; Gl, glenoid; Hh, omutwe gw’omugongo; IBG, okusimbibwa kw’amagumba g’omugongo; Inf, wansi; Post, emabega; Sup, waggulu.)

Oluvannyuma lw’okulongoosebwa, ekibegabega kyatereezebwa ne 20 ° abduction angle ne neutral rotation okumala wiiki 6:

• Enkeera ng’omaze okulongoosebwa, tandika dduyiro w’okutambula kw’ekibegabega, enkokola n’emikono (passive motion exercise). Okufukamira n’okutambula nga obulumi olina okwewalibwa.

  
  

• Ku wiiki 3, tandika okukola dduyiro ow’okutambula (active range of motion exercises).

  
  

• Oluvannyuma lw’okukakasibwa okutebenkera kw’ekikuta nga bakubye ebifaananyi nga wayise wiiki 6 nga balongooseddwa, dduyiro ow’amaanyi asobola okutandika.

  
  

• Ku bannabyamizannyo abaagala okuwona amangu, okukebera kompyuta (computerized tomography) kulina okukolebwa nga wayise emyezi 3 oluvannyuma lw’okulongoosebwa okwekenneenya okugatta kwa graft.

  
  

Engeri y'okugulamu ebyuma ebiteekebwa mu magumba n'ebikozesebwa mu kulongoosa amagumba?

A CZMEDITECH , tulina layini y’ebintu ebijjuvu ennyo eby’ebiteekebwa mu kulongoosa amagumba n’ebikozesebwa ebikwatagana, ebintu omuli okuteekebwamu omugongo, emisumaali egy’omu lubuto (intramedullary nails)., essuuka y’okulumwa, ebbakuli y’okusiba, cranial-maxillofacial mu maaso, okuzimba omubiri (prosthesis)., ebikozesebwa eby’amasannyalaze, ebinyweza eby’ebweru, okukebera ebinywa, okulabirira ebisolo n’ebikozesebwa byabwe ebibiwagira.

Okugatta ku ekyo, twewaddeyo okugenda mu maaso n’okukola ebintu ebipya n’okugaziya layini z’ebintu, tusobole okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde bangi, era n’okufuula kkampuni yaffe okuvuganya ennyo mu mulimu gwonna ogw’ensi yonna ogw’okussaamu amagumba n’ebikozesebwa.

Tutwala ebweru w’eggwanga mu nsi yonna, kale osobola tukwatagane ku email address song@orthopedic-china.com okufuna quote ku bwereere, oba weereza obubaka ku WhatsApp okufuna eky'amangu +86- 18112515727 .

Bwoba oyagala okumanya ebisingawo,nyiga CZMEDITECH okumanya ebisingawo.