Arthroscopic hmanga enkawl a nih chuan a hnunglam ke ruh (posterior shoulder instability) a awm thei

Posterior shoulder instability hi exercise emaw thil dang emaw tih laiin traumatic posterior dislocation emaw repetitive minimally invasive injury vang a ni tlangpui a, kum khatah mi 100000 zingah case 4.64 an awm thin. Posterior shoulder instability enkawlna atana surgical technique hrang hrang sawi a ni tawh a, chung zingah chuan soft tissue repair leh open leh arthroscopic bone block surgery te pawh a tel. Mahse, surgical complication report leh revision rates chu 14% leh 67% vel a ni. A bik takin, ruh grafts dik taka dah te, screw orientation te leh concomitant lesions enkawl te chu thil harsa takah ngaih a ni. Chuvangin surgical technique te hi tihchangtlun a ngai a ni.

Operation step hrang hrang: 1.1.

• Operation hi general anesthesia hmanga regional block of intermuscular sulcus nena inzawm hmanga tih a ni.

• Iliac crest lakkhawmna atan hian local anesthetics chu vun hnuai leh periosteally-in an hmang a.

• Damlo chu beach chair-ah dah a ni a, a hnungzang chu 45 ° angle-ah dah a ni a, chu chuan iliac crest nen a inzawm kim thei a ni. Ruh thlak an lak hnuah operation an chhunzawm leh a, damlo chu 70 ° angle-ah a thu a ni. Damlo chu standard sterile angin an suspend a, operating arm chu 2 to 3 kg traction rope hmangin 30 ° hmalam hawiin an ben a ni.

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Arthroscopic hmanga ruh inzawmna enfiah

• Hetiang kalphung hian luhna pahnih emaw pathum emaw a hmang thin. Front (E) luhna hmasa ber chu joint exploration uluk tak neih nan hman theih a ni.

  
  

• Range hi rotator interval hmangin joint-ah direct-in a luh theih a ni. A then phei chuan scope (chu chu rotator interval vel a scar tissue) direct-a luhtir theih a ni lo.

  
  

• Lateral C entrance emaw front lateral D entrance emaw i siam thei a, chutiang chuan acromion peak hnuaia space-ah i lut thei a, chutiang chuan rotator muscle space chu i enfiah thei ang.

  
  

• Rotator interval hawn nan hian arthroscopic radiofrequency ablation hman a ni.

  
  

• Toggle lever chu E entry kaltlangin joint chhungah dah a ni a, range chu joint interior view-ah a inthlak a ni.

  
  

• Joint hi uluk taka endik a nih hnuah soft tissue lesions leh a kaihhnawih glenoid leh humeral bone loss (ie, posterior glenoid lip, joint capsule, glenoid marginal lesion leh reverse Hill Sachs lesion) te chu endik a ni.

  
  

• Glenohumeral joint chu uluk taka arthroscopic evaluation leh indication dik tak finfiah hnuah bone grafts lak a ni.

  
  

Bone transplantation lakkhawm leh buatsaih dan

• Bicortical autograft hi ipsilateral anterior iliac crest atanga lak a ni a, chu chu pelvis chhungril cortex humhalh nan a ni. Skin incision chu anterior superior iliac spine hnunglam 2cm vel leh crest hnuai lam 2cm vel chu iliac crest zawhin siam la, chu chuan crest chu direct-a khuh thei scar siam a nih loh nan.

  
  

• Cortical bone α leh β enfiah hnuah Kirschner pin pahnih parallel chu lateral cortex chhungah hian hole kaltlangin dah a ni a, a hmain Arthroscopic Latarjet device atanga coracoid screw sei pahnih hmanga thuam a ni (Fig. 1).

  
  

• Guide handle chu chunglam hawiin a awm a, chutiang chuan bone graft chu posterior inferior glenoid neck nen anatomically matched a ni thei. Guide dahna hmunah hian upper ridge chu bone block articular side atan thlan theih a ni.

  
  

• Tichuan, Kirschner wire-a hollow coracoid process step drill chu nawr la, bone block-ah 2.9mm hole pahnih drill rawh. Drill bit leh Kirschner pin chu an la chhuak ta a. Top cap washer chu drill hole chhunga i dah hmain top cap tap hmangin hole chu tap hmasa phawt ang che.

  
  

• Top cap chu a hmunah a awm tawh chuan swing saw emaw bone knife emaw hmangin iliac crest medial cortex chu humhim la, 2-cm × 1-cm × 1-cm grafts te chu harvest rawh (Figure 2 leh 3). Graft an lakkhawm hnuah bone block chu coracoid process sleeve-ah an thlunzawm a, coracoid process screw sei tak tak pahnih hmangin unit pakhat an siam a, chu chu a tawp ber thlengin manipulate theih a ni (Fig. 4).

  
  

• Iliac crest hliam chu layer khat hnu layer khatin drainage tube hmangin khar a ni a, dressing hman a ni. Tichuan operating table hnunglam chu 70 ° angle-ah siamrem rawh.

Figure 1. Damlo chu beach chair position-a a awm laiin right iliac crest bone an la khawm a. Kirschner needle pahnih hi double cannula guide device nen an dah dun a, cannula handle chu chunglam hawiin a awm bawk. (Ant, hmalam; DCG, double casing guide; Inf, hnuai lam Post, hnunglam; Sup, chunglam.)

Figure 2. Damlo chu beach chair position-a a awm chuan dinglam iliac crest bone block chu lak a ni. Iliac crest cortex lateral platform drill zawhah drill bit leh Kirschner wire chu la chhuak la, chutah chuan 'hats' 2 dah rawh. (Ant, hmalam; DCG, double casing guide; Inf, hnuai lam; Post, hnunglam; Sup, chunglam; TH, chunglam hat.)

Figure 3. Damlo chu beach chair position-a a awm chuan dinglam iliac crest-a bone block chu lak a ni. Graft an lakkhawm hnuah pawh iliac crest chhung lam chu a awm reng a ni. (Ant, hmalam; Inf, hnuai lam; IT, chhung lam dawhkan; Post, hnunglam; Sup, chunglam.)

Figure 4. Side table-ah ruh block siam rawh. Graft an lakkhawm hnuah bone graft chu cannula obturator pahnih hmangin double cannula-ah an connect a. (Ant, hmalam; DCG, double cannula kaihhruaina; IBG, iliac ruh thlak; Inf, hnuai lam; Post, hnunglam; Sup, chunglam.)

Hnung lam kawngpui chhinchhiahna leh luhna kawngpui te

• A tlangpuiin channel pahnih atanga pathum vel hman a ni. A tum ber chu posterior A inlet chu glenohumeral joint line nen a theih ang anga align a ni. Chuvangin arthroscope hmanga control a ni. Chuvangin, hmalam lateral inlet atanga operation hnuah tih a ni ber.

  
  

• Anterolateral entrance E hi biceps muscle chunga rotator muscle space-ah dah a ni a, chu chuan glenoid edge hnunglam chu a tilang chiang hle (Table 1).

  
  

• A tam zawkah chuan channel dang a ngai tawh lo; Mahse, a tul chuan rear cuff kaltlangin posterolateral B inlet dang hman theih a ni (entir nan, complementary labial prostheses enkawl nan).

  
  

• A tha ber chu Entrance A hi glenohumeral joint line axis-ah chiah a awm a ni.

  
  

• Entrance E hma leh hnung lam atang chuan spine needle 2 chu cm 2.5 atanga 3 inkar a hlaah hnunglam hawiin dah la, dar 7 leh dar 9 position-ah (right shoulder) joint chu parallel-in dah rawh.

  
  

• Needle 2 inkarah vun incision siam la, rear A entrance atan hmang rawh (Figure 5A leh B).

Figure 5. (A) Damlo chuan vun incision chu 70 ° angle sitting position, right shoulder leh E entrance view-ah a mark ang a, a buatsaih ang. Rear A inlet leh glenohumeral joint line inkara alignment tha ber neih theih nan spine needle pahnih hnunglam hawiin dahin vun incision chhinchhiahna hriat theih a ni.

(B) Arthroscopic visualization, a ke dinglam, leh electronic portal view hmanga damlo needle hmanga 70 ° sitting position-a a awm. (Ant, hmalam; DCG, double cannula kaihhruaina; Gl, glenoid; Inf, hnuai lam; Post, hnunglam; Pc, hnunglam capsule; Sn, spinal needle; Sup, chunglam.)

Glenoid buatsaih dan tur

• Instrument hi hnunglam (A) inlet hmangin a luhtir a ni.

  
  

• VAPR leh razor hmangin labrum leh posterior capsule chu 7 atanga 10 (right shoulder) thlengin la chhuak rawh (Fig. 6A leh B, Video 1).

  
  

• Posterior glenoid neck chu arthroscopic burrs hmangin grind la, thisen chhuak ruh chu a lang chhuak a, plane a inpeih thlengin grind rawh (Fig. 7). Glenoid neck a inpeih chuan posterior A inlet chu tihzauh a ni a, chu chuan graft leh double coracoid cannula te chu a paltlang thei a ni.

  
  

• Scalpel hmang hian taksa ruh inthen darh leh cystotomy tihzauh theih a ni a, blunt rectangular trocar (subscapular passage) hmang hian a kalna chu a tizau lehzual thei bawk (Figure 8).

Figure 6. (AB) Arthroscopy hnuaia glenoid buatsaih dan hmuh theih, damlo 70 ° angle-a thu, a ke dinglam, electronic entrance view. Glenoid siam chhung hian VAPR leh razor hmangin glenoid lip leh posterior capsule chu dar 7:00 atanga 10:00 thlenga lak chhuah tur a ni. (Ant, hmalam; Gl, glenoid; Hh, humeral lu; Inf, hnuai lam; Pc, hnunglam capsule; Post, hnunglam; Sup, chunglam; V, VAPR.)

Figure 7. Glenoid buatsaih dan arthroscopic visualization: damlo chu angle 70 °-ah a thu a, a ke dinglam, E-portal view. Glenoid buatsaih laiin posterior glenoid neck a inbel thin. (Ant, hmalam; B, burr; Gl, glenoid; Inf, hnuai lam; Pgn, hnunglam glenoid kawr; Post, hnunglam; Sup, chunglam.)

Figure 8. Glenoid buatsaih dan arthroscopic visualization: damlo chu angle 70 °-ah a thu a, a ke dinglam, E-portal view. Rear A inlet chu trocar blunt hmangin ti lian rawh. (Ant, hmalam; Bt: blunt trocar; Gl, glenoid; Inf, hnuai lam; Pc, hnunglam capsule; Post, hnunglam; Sup, chunglam.)

Graft positioning leh fixation te a awm bawk

Graft chu hnunglam luhna kaltlangin a handle chu chunglam hawiin (Fig. 9) dahin, muscle leh joint capsule hmangin posterior glenoid kawr hnaih a, glenoid articular surface nena inmil thlengin an inthen a ni. He step hian splitting buatsaih dan tur ngaihtuah a ngai a, a bik takin infraspinatus fascia thick leh chak tak hawn leh graft kal tlang tur venna lam a ngaihtuah a ngai a ni.

• Fascia zau taka hawn nan scalpel blade hman a pawimawh. A tul chuan, operation hnuhnung zawkah chuan, flushing leakage chu a pawimawh lutuk a, shoulder-ah pressure tling tak a awm theih loh chuan, instrument hmangin surgical wound chu a then chu khar theih a ni (entir nan, wound clips).

  
  

• Coracoid cannula hi articular surface nen parallel-in dah a ni a, chutiang chuan a hnu lama Kirschner wire leh screw te chu insertion laiin joint chhungah an lut lo.

  
  

• 1.5 mm sei Kirschner wire pahnih chu hollow coracoid process screw hmangin dahin graft chu posterior glenoid neck-ah fix turin an dah a (Fig. 10).

  
  

• Kirschner wire dahna hi 40mm aia tam lo tur a ni a, chu chuan anterior glenoid neck a paltlang loh nan, hei hian anterior neurovascular structure a tichhe thei a, mahse subscapularis muscle thenkhat chauh hi neck leh neurovascular structure inkarah hian a venghim thei a ni.

Figure 9. Damlo chuan graft chu 70 ° sitting position-ah a dah a, a ke dinglam leh posterolateral side a en a. Graft chu hnunglam luhna atang chuan a handle chu a chung lam hawiin dah a ni. (Ant, hmalam; DCG, double casing guide; Inf, hnuai lam; Post, hnunglam; Sup, chunglam.)

Figure 10. Graft positioning arthroscopic visualization, damlo 70 ° angle-a thu, a ke dinglam, E entrance view. Kirschner pin pahnih dah chuan posterior glenoid neck-a graft chu a stabilize a. (Ant, hmalam; Gl, glenoid; IBG, iliac bone graft; Inf, hnuai lam; Kw, Kirschner wire; Post, hnunglam; Sup, chunglam.)

30 ° arthroscope hi portal vein hmalam atanga thlir a nih avangin a pianphungah chuan graft chu angle-ah a tilt duh a, a hnuai lam chu a dinglam aiin a langsar zawk a ni. Graft dah hnuah pawh bone graft hi a la tih theih leh theih loh enfiah a pawimawh.

• Graft chu posterior glenoid margin nen a flush zawh chuan coracoid screw sei hmasa ber chu la chhuakin Kirschner wire-ah 3-2mm zau bicortical glenoid tunnel drill rawh.

  
  

• He step-ah hian practice hmasa ber hnuah pawh kan ding reng a pawimawh. Auxiliary personnel te chuan kut pahnih hmangin an enkawl tur a ni (Figure 11).

  
  

• Kirschner pin pathumna chu khur chhungah dah turin a inpeih a ngai a, a chhan chu a awmna hmuna Kirschner pin chu a duh loh zawngin drill bit hian motor chhungah a man tlangpui a ni.

  
  

• Coracoid sleeve hmanga drill bit lak chhuah dawnin Kirschner wire hi lakchhuah loh nan fimkhur a ngai a ni. Tichuan, 4.5 mm partially threaded Latarjet screw chu Kirschner wire-ah (Fig. 12) dah la, graft chu a inthlak loh nan a pumin dah la, chutah chuan upper screw chu drill rawh. A tha ber chu screw sei zawng hi 32 atanga 36 mm aia tam lo tur a ni.

  
  

• 40 mm aia sei zawng zawng chu uluk taka enfiah a ngai a, hei hi glenoid surface nena khaikhin chuan graft angle sang lutuk vang a ni thei a, chu chuan graft dislocation a thlen thei a ni. Hetiang dinhmunah hian graft positioning level chu glenoid chu lower screw vel ah rotate hmangin siamthat theih a la ni tho.

  
  

• Screw hmasa ber (hnuai zawk) i dah hnuah Kirschner pin hmasa ber chu lakchhuah theih a ni. Screw pahnihna pawh chutiang bawk chuan dah lut rawh.

  
  

• Screw 2 i dah hnuah Kirschner wire i lakchhuah hnuah Entrance A-a probe hmangin final graft position enfiah rawh (Figure 13). Graft atanga a chhuak zawng zawng chu burrs hmanga trim tur a ni a, joint stiffness ven nan soft tissue repair tih loh tur a ni.

Figure 11. Graft chu dahin a nghet a. Damlo chu a ke dinglam chu chunglam atanga thlirin 70 ° angle-ah a thu a. Implant drilling neih lai leh zawh hnuah pawh K line-in tunnel a tihzauh loh nan guider chu kut pahnih hmangin a ding reng tur a ni. (Ant, hmalam; DCG, cannula pahnih kaihhruaina; Kw, Kirschner wire; Post, hnunglam; Sup, chunglam.)

Figure 12. Graft fixation arthroscopic visualization, damlo 70 ° angle-a thu, a ke dinglam, electronic entrance view. A hnuai lam 4.5mm partially threaded Latarjet screw chu Kirschner pin chungah dah hmasak a ni. (Ant, hmalam; Gl, glenoid; IBG, iliac bone graft; Inf, hnuai lam; S, screw; Post, hnunglam; Sup, chunglam.)

Figure 13. Graft positioning, damlo 70 ° angle-a thu, a ke dinglam, E entrance view-a arthroscopic visualization. Screw pahnih i dah hnuah Kirschner wire i lakchhuah hnuah final transplant position chu enfiah rawh. Hetiang bone graft hian compressibility tha tak a nei a, proud position a nei lo. (Ant, hmalam; Gl, glenoid; Hh, humeral lu; IBG, iliac bone graft; Inf, hnuai lam; Post, hnunglam; Sup, chunglam.)

Operation hnuah chuan shoulder chu 20 ° abduction angle leh neutral rotation hmangin kar 6 chhung an fix a:

• Operation zawh a tuk zingah passive shoulder, elbow leh hand range of motion exercise tan tur a ni. Pronation leh chet na tak tak te hi pumpelh tur a ni.

  
  

• Kar 3 hnuah active range of motion exercise tan la.

  
  

• Operation atanga kar 6 hnua thlalak lak atanga graft stability tih chian a nih hnuah intensive exercise tan theih a ni.

  
  

• Infiammi dam chak duh tan chuan graft integration tehna atan operation hnu thla 3 hnuah computerized tomography tih a ngai a ni.

  
  

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