Chithandizo cha Arthroscopic cha kusakhazikika kwapambuyo kwa mapewa

Kusakhazikika kwapambuyo kwa mapewa nthawi zambiri kumayambitsidwa ndi kusokonezeka kwapambuyo kwapambuyo kapena kuvulala kobwerezabwereza kochepa panthawi yochita masewera olimbitsa thupi kapena zochitika zina, ndi zochitika zapachaka za 4.64 pa anthu a 100000 pachaka. Njira zingapo zopangira opaleshoni zochizira kusakhazikika kwapambuyo kwapambuyo zafotokozedwa, kuphatikizapo kukonzanso minofu yofewa ndi opaleshoni yotseguka ndi ya arthroscopic bone block. Komabe, zovuta zomwe zanenedwa za opaleshoni ndi ziwerengero zokonzanso zinali zapamwamba kwambiri monga 14% ndi 67%, motsatira. Makamaka, kuyika kolondola kwa mafupa a mafupa, kuyang'ana kwa screw ndi kuchiza zotupa zomwe zimagwirizana zimaonedwa kuti ndizovuta. Choncho, njira zopangira opaleshoni ziyenera kuwongolera.

Njira zogwirira ntchito:

• Opaleshoniyo inkachitidwa pansi pa anesthesia pamodzi ndi dera la intermuscular sulcus.

• Kutolere kwa Iliac crest, mankhwala oletsa ululu am'deralo adagwiritsidwa ntchito mocheperapo komanso mwa periosteally.

• Wodwalayo adayikidwa pampando wam'mphepete mwa nyanja ndi kumbuyo kwa ngodya ya 45 ° kuti alole kukhudzana kwathunthu ndi chikhomo cha iliac. Pambuyo pa kuikidwa kwa fupa kunakololedwa, opaleshoniyo inapitilira, ndipo wodwalayo anali atakhala pakona ya 70 °. Wodwalayo adayimitsidwa mwanjira yosabala, ndipo mkono wogwirira ntchito udapindika kutsogolo 30 ° kudzera pa chingwe chokokera cha 2 mpaka 3 kg.

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Arthroscopic joint evaluation

• Njirayi imagwiritsa ntchito zipata ziwiri kapena zitatu. Pakhomo loyamba (E) khomo angagwiritsidwe ntchito kufufuza bwinobwino pamodzi.

  
  

• Mitundu imatha kulowetsedwa mwachindunji mumagulu kudzera munjira zozungulira. Nthawi zina, sikutheka kufotokoza za kukula kwake (mwachitsanzo, minofu ya chipsera mozungulira nthawi yozungulira).

  
  

• Mutha kupanga khomo lakutsogolo la C kapena khomo lakutsogolo la D, kuti mutha kulowa m'malo pansi pa nsonga ya acromion, kuti muwone danga la minofu yozungulira.

  
  

• Arthroscopic radiofrequency ablation idagwiritsidwa ntchito kutsegula nthawi yozungulira.

  
  

• The toggle lever imayikidwa mu olowa kudzera pa E entry kuti musinthe mawonekedwe amkati olumikizana.

  
  

• Pambuyo pakuwunika kwathunthu kwa mgwirizanowo, zotupa zofewa ndi zotupa zomwe zimagwirizanitsidwa ndi glenoid ndi humeral bone loss (ie, posterior glenoid lip, joint capsule, glenoid marginal lesion and reverse Hill Sachs lesion) adawunikidwa.

  
  

• Pambuyo pofufuza mozama za mgwirizano wa glenohumeral ndi kutsimikiziridwa kwa zizindikiro zoyenera, kulumikiza mafupa kunapezedwa.

  
  

Kukolola ndi kukonzekera kuyika mafupa

• The bicortical autograft inapezedwa kuchokera ku ipsilateral anterior iliac crest kusunga mkati mwa khosi la pelvis. Pangani khungu la 2cm kuseri kwa msana wapamwamba kwambiri wa iliac ndi 2cm kumunsi kwa mtsempha m'mphepete mwa nsonga kuti mupewe kupangika kwa zipsera zomwe zimakwirira msana.

  
  

• Pambuyo poyang'ana fupa la cortical α ndi β Zikhomo ziwiri zofanana za Kirschner zinalowetsedwa mu lateral cortex kupyolera mu dzenje, lomwe poyamba linali ndi zikopa ziwiri zazitali za coracoid kuchokera ku chipangizo cha Arthroscopic Latarjet (Mkuyu 1).

  
  

• Chogwirizira cha kalozeracho chimayang'ana m'mwamba kuti fupa la fupa likhale lofanana ndi khosi la posterior inferior glenoid. Kuyika kwa kalozera kumalola kusankha kwamtunda wapamwamba ngati mbali ya articular ya fupa la fupa.

  
  

• Kenako, kanikizani chobowola chopanda kanthu cha coracoid pa waya wa Kirschner ndikubowola mabowo awiri a 2.9mm pafupa. Chobowola ndi pini ya Kirschner zidachotsedwa. Musanayike chochapira cha pamwamba pa bowolo, dinani bowolo ndi kapu ya pamwamba.

  
  

• Chipewa chapamwamba chikakhazikitsidwa, gwiritsani ntchito macheka kapena mpeni wa fupa kuti musunge khosi lamkati la nsonga ya iliac ndikukolola 2-cm × 1-cm × 1-cm (Zithunzi 2 ndi 3). Kumezanitsa kumakololedwa, chipika cha fupa chimalumikizidwa ndi manja a coracoid ndipo zomangira ziwiri zazitali zapabowo za coracoid zimagwiritsidwa ntchito kupanga gulu lomwe limatha kusinthidwa kuti lifike pomaliza (mkuyu 4).

  
  

• Chilonda cha Iliac Crest chidatsekedwa ndi wosanjikiza ndi chubu cha drainage ndikuvala kumagwiritsidwa ntchito. Kenako sinthani kumbuyo kwa tebulo logwiritsira ntchito pakona ya 70 °.

Chithunzi 1. Fupa lamanja la iliac crest linasonkhanitsidwa pamene wodwalayo anali pampando wa gombe. Singano ziwiri za Kirschner zimayikidwa pamodzi ndi chipangizo chowongolera cha cannula, ndipo chogwirira cha cannula chimakhala chokwera. ( Nyerere, kutsogolo; DCG, kalozera wapawiri; Inf, post post, kumbuyo; Sup, pamwamba.)

Chithunzi 2. Pamene wodwalayo ali pampando wamphepete mwa nyanja, fupa la fupa lakumanja la iliac crest limatengedwa. Chotsani chobowola ndi waya wa Kirschner mutatha kubowola nsonga yam'mbali ya cortex ya iliac crest cortex, ndiyeno ikani 2 'zipewa'. ( Nyerere, kutsogolo; DCG, kalozera wapawiri; Inf, m'munsi; Post, kumbuyo; Sup, pamwamba; TH, chipewa chapamwamba.)

Chithunzi 3. Pamene wodwalayo ali pampando wamphepete mwa nyanja, fupa la fupa lakumanja la iliac crest limatengedwa. M'kati mwa nsonga ya iliac imakhalabe yosasunthika pambuyo pokolola. ( Nyerere, kutsogolo; Inf, pansi; IT, tebulo lamkati; Post, kumbuyo; Sup, pamwamba.)

Chithunzi 4. Konzani zitsulo za mafupa patebulo lakumbali. Kumezanitsako kukakololedwa, fupa la fupa linalumikizidwa ndi cannula iwiri pogwiritsa ntchito cannula obturators awiri. (Nyerere, kutsogolo; DCG, chitsogozo cha cannula iwiri; IBG, kupatsirana fupa iliac; Inf, m'munsi; Post, kumbuyo; Sup, pamwamba.)

Zizindikiro zakumbuyo zamsewu ndi misewu yolowera

• Nthawi zambiri njira ziwiri kapena zitatu zimagwiritsidwa ntchito. Cholinga chake ndikugwirizanitsa cholowera chapambuyo cha A ndi mzere wa glenohumeral momwe zingathere. Chifukwa chake, imayendetsedwa ndi arthroscope. Choncho, makamaka anachita pambuyo opaleshoni kuchokera kutsogolo ofananira nawo polowera.

  
  

• Khomo la anterolateral E limayikidwa mu danga la minofu yozungulira pamwamba pa minofu ya biceps, yomwe imatha kuwonetsa bwino mbali yapambuyo ya m'mphepete mwa glenoid (Table 1).

  
  

• Nthawi zambiri, sipakufunikanso matchanelo; Komabe, ngati kuli kofunikira, cholowera chapambuyo cha B chowonjezera kudzera pa khafu yakumbuyo chingagwiritsidwe ntchito (mwachitsanzo, kuyang'anira ma prostheses a labial).

  
  

• Moyenera, Kulowera A kuli ndendende pamzere wa mzere wa glenohumeral.

  
  

• Kudzera kutsogolo ndi kumbuyo kwa khomo la E, ikani singano 2 za msana kumbuyo pamtunda wa 2.5 mpaka 3 cm, ndikuyika cholowacho mofanana pa 7 koloko ndi 9 koloko malo (phewa lakumanja).

  
  

• Pangani chocheka khungu pakati pa singano ziwiri ndikuzigwiritsa ntchito ngati khomo lakumbuyo A (Zithunzi 5A ndi B).

Chithunzi 5. (A) Wodwala azilemba ndikukonzekera kudulidwa kwa khungu mu malo a 70 ° atakhala, phewa lakumanja ndi E khomo lolowera. Kuti mukwaniritse kuyanjanitsa bwino pakati pa cholowera chakumbuyo A ndi mzere wolumikizana wa glenohumeral, singano ziwiri za msana zimayikidwa chammbuyo kuti zitsimikizire chizindikiro cha kudulidwa kwa khungu.

(B) Mawonekedwe a Arthroscopic, phewa lakumanja, ndi mawonekedwe apakompyuta a wodwalayo ali ndi singano pakukhala 70 °. ( Nyerere, anterior; DCG, double cannula guide; Gl, glenoid; Inf, inferior; Post, posterior; PC, posterior capsule; Sn, spinal singano; Sup, superior.)

Kukonzekera kwa Glenoid

• Chidacho chimayambitsidwa kudzera kumbuyo (A) cholowera.

  
  

• Chotsani labrum ndi capsule yapambuyo kuchokera ku 7 mpaka 10 (phewa lakumanja) pogwiritsa ntchito VAPR ndi lumo (Mkuyu 6A ndi B, Video 1).

  
  

• Gwirani khosi la posterior glenoid ndi arthroscopic burrs mpaka fupa la magazi likuwonekera ndipo ndegeyo imakonzedwa (mkuyu 7). Khosi la glenoid likakonzeka, cholowera chakumbuyo cha A chimakulitsidwa kuti chilole kuphatikizika ndi cannula iwiri ya coracoid.

  
  

• The scalpel ingagwiritsidwe ntchito kukulitsa magawano a minofu ndi cystotomy, pamene trocar yosaoneka bwino ya rectangular (subscapular passage) ingagwiritsidwe ntchito kupititsa patsogolo ndimeyi (Chithunzi 8).

Chithunzi 6. (AB) Kuwonetseratu kwa kukonzekera kwa glenoid pansi pa arthroscopy, wodwala atakhala pa ngodya ya 70 °, phewa lamanja, mawonedwe olowera pakompyuta. Pokonzekera glenoid, gwiritsani ntchito VAPR ndi lumo kuti mutseke milomo ya glenoid ndi kapisozi wakumbuyo kuyambira 7:00 mpaka 10:00. ( Nyerere, anterior; Gl, glenoid; Hh, humeral head; Inf, inferior; Pc, posterior capsule; Post, posterior; Sup, superior; V, VAPR.)

Chithunzi 7. Arthroscopic visualization ya glenoid kukonzekera: wodwalayo anakhala pa ngodya ya 70 °, paphewa lamanja, E-portal view. Valani khosi la posterior glenoid pokonzekera glenoid. ( Nyerere, kutsogolo; B, burr; Gl, glenoid; Inf, m'munsi; Pgn, khosi lakumbuyo la glenoid; Post, kumbuyo; Sup, pamwamba.)

Chithunzi 8. Arthroscopic visualization ya glenoid kukonzekera: wodwalayo anakhala pa ngodya ya 70 °, paphewa lamanja, E-portal view. Kulitsani cholowera chakumbuyo A ndi trocar yosamveka. ( Nyerere, kutsogolo; Bt: blunt trocar; Gl, glenoid; Inf, lower; PC, posterior capsule; Post, posterior; Sup, pamwamba.)

Kuyika kwa graft ndi kukonza

Kuphatikizikako kunalowetsedwa kudzera pakhomo lakumbuyo ndi chogwiriracho chikuyang'ana mmwamba (mkuyu 9) ndikugawanika kupyolera mu minofu ndi kapisozi yolumikizana mpaka pafupi ndi khosi la posterior glenoid ndikugwedeza ndi pamwamba pa glenoid. Gawoli liyenera kuyang'ana pakukonzekera kugawanika, makamaka kutsegula infraspinatus fascia wandiweyani komanso wamphamvu ndikuletsa kudutsa kwa graft.

• Ndikofunika kugwiritsa ntchito tsamba la scalpel kuti mutsegule kwambiri fascia. Ngati ndi kotheka, pakapita opaleshoni, ngati kutayikirako kuli kofunikira kwambiri kuti musunge kupanikizika kokwanira pamapewa, zida zitha kugwiritsidwa ntchito kutseka pang'ono bala la opaleshoniyo (mwachitsanzo, timitengo ta bala).

  
  

• Coracoid cannula imayikidwa mofananira ndi pamwamba kuti mawaya a Kirschner ndi zomangira zisalowe m'malo olowa.

  
  

• Awiri 1.5 mamilimita Kirschner mawaya anaikapo kudzera dzenje zomangira coracoid ndondomeko kukonza kumezanitsa pa posterior glenoid khosi (mkuyu. 10).

  
  

• Kuyika kwa waya wa Kirschner sayenera kupitirira 40mm kuti asadutse pakhosi la glenoid yapakatikati, yomwe ingawononge dongosolo la mitsempha yam'mbuyo, ngakhale kuti mbali yokha ya minofu ya subscapularis ilipo pakati pa khosi ndi dongosolo la mitsempha kuti liteteze.

Chithunzi 9. Wodwalayo anaikapo kumezanitsa mu 70 ° atakhala malo, ndipo anaona lamanja phewa ndi posterolateral mbali. Kumezanitsa analowetsedwa kudzera pakhomo lakumbuyo ndi chogwiriracho chikuyang'ana pamwamba. ( Nyerere, kutsogolo; DCG, kalozera wapawiri; Inf, m'munsi; Post, kumbuyo; Sup, pamwamba.)

Chithunzi 10. Kuwona kwa arthroscopy kwa kumezanitsa malo, wodwala atakhala pa ngodya ya 70 °, phewa lakumanja, mawonedwe a E pakhomo. Zikhomo ziwiri za Kirschner zimakhazikika pakhosi la posterior glenoid. ( Nyerere, kutsogolo; Gl, glenoid; IBG, iliac bone graft; Inf, m'munsi; Kw, Kirschner waya; Post, kumbuyo; Sup, pamwamba.)

Popeza 30 ° arthroscope imawonedwa kuchokera kutsogolo kwa mtsempha wa portal, mwachilengedwe imakonda kupendeketsa kumezanitsa ku ngodya, kupangitsa kuti kumunsi kukhale kowoneka bwino m'malo mowongoka. Ndikofunikira kuyang'ana ngati kumezanitsa mafupa kukadali kotheka pambuyo poyika.

• Kumezanitsako kukangogwedezeka ndi m'mphepete mwa glenoid wakumbuyo, chotsani zomangira zazitali za coracoid ndikubowola ngalande ya 3-2mm yotakata ya bicortical glenoid pawaya wa Kirschner.

  
  

• Mu sitepe iyi, ndikofunika kukhala chete pambuyo pochita koyamba. Ogwira ntchito othandizira ayenera kusunga ndi manja onse awiri (Chithunzi 11).

  
  

• Iyenera kukonzekera kuyika chikhomo chachitatu cha Kirschner mu dzenje, chifukwa pini ya Kirschner pamalo ake oyambirira nthawi zambiri imagwidwa mu injini mosasamala ndi kubowola.

  
  

• Chisamaliro chiyenera kutengedwa kuti musachotse waya wa Kirschner pokoka pobowola kudzera pa mkono wa coracoid. Kenako, ikani 4.5 mm pang'ono ulusi Latarjet wononga mu Kirschner waya (mkuyu. 12) ndi mokwanira amaikapo kuteteza kumezanitsa kusuntha, ndiyeno kubowola chapamwamba wononga. Momwemo, kutalika kwa screw sikuyenera kupitirira 32 mpaka 36 mm.

  
  

• Utali uliwonse woposa 40 mm umafunika kuwunika mosamala, chifukwa izi zitha kukhala chifukwa cha kutsetsereka kwa kumezanitsa komwe kumayenderana ndi pamwamba pa glenoid, zomwe zitha kupangitsa kuti kumezanitsa kusasunthike. Pakadali pano, mulingo wa ma graft ukhoza kuwongoleredwa pozungulira glenoid mozungulira screw.

  
  

• Pambuyo poyika wononga yoyamba (yotsika), pini yoyamba ya Kirschner ikhoza kuchotsedwa. Ikani chowononga chachiwiri chimodzimodzi.

  
  

• Mukalowetsa 2 zomangira ndikuchotsa waya wa Kirschner, gwiritsani ntchito kafukufuku pa Entrance A kuti muwone malo omaliza a graft (Chithunzi 13). Zigawo zilizonse zotuluka za kumezanitsa ziyenera kudulidwa ndi ma burrs, ndipo palibe kukonzanso minofu yofewa kuyenera kuchitidwa pofuna kupewa kuuma kwa mafupa.

Chithunzi 11. Kumezanitsa kunayikidwa ndikukhazikika. Wodwalayo anakhala pa ngodya ya 70 ° ndi phewa lake lamanja limawoneka kuchokera pamwamba. Pobowola komanso pambuyo pake, sungani wotsogolerayo ali ndi manja onse awiri kuti mzere wa K usamasule ngalandeyo. (Nyerere, kutsogolo; DCG, kuwongolera kwa cannula; Kw, Kirschner waya; Post, kumbuyo; Sup, chapamwamba.)

Chithunzi 12. Arthroscopic visualization of graft fixation, wodwala atakhala pa 70 ° angle, paphewa lamanja, mawonedwe apakompyuta. Zomangira zapansi za 4.5mm zokongoletsedwa pang'ono za Latarjet zimayamba kupezeka pamwamba pa pini ya Kirschner. ( Nyerere, kutsogolo; Gl, glenoid; IBG, iliac bone graft; Inf, lower; S, screw; Post, back; Sup, upper.)

Chithunzi 13. Arthroscopic visualization of graft positioning, wodwala atakhala pa 70 ° angle, paphewa lakumanja, E polowera. Mukayika zomangira ziwiri ndikuchotsa waya wa Kirschner, yang'anani malo omaliza oyika. Mtundu uwu wa kumezanitsa fupa uli ndi compressibility wabwino ndipo palibe malo onyada. ( Nyerere, anterior; Gl, glenoid; Hh, humeral head; IBG, iliac bone graft; Inf, lower; Post, posterior; Sup, upper.)

Pambuyo pa opaleshoni, phewa lidakhazikika ndi 20 ° abduction angle ndikuzungulira osalowerera kwa milungu 6:

• Tsiku lotsatira mutatha opaleshoni, yambani kuchita masewera olimbitsa thupi, mapewa ndi manja. Matchulidwe ndi mayendedwe opweteka ayenera kupewedwa.

  
  

• Pamasabata atatu, yambani masewera olimbitsa thupi osiyanasiyana.

  
  

• Pambuyo kukhazikika kwa kumezanitsa kumatsimikiziridwa mwa kutenga zithunzi masabata 6 pambuyo pa opaleshoni, masewera olimbitsa thupi amatha kuyambika.

  
  

• Kwa othamanga omwe akufuna kuchira msanga, makompyuta a tomography ayenera kuchitidwa miyezi 3 pambuyo pa opaleshoni kuti awone kusakanikirana kwa ma graft.

  
  

Kodi Mungagule Bwanji Ma Implant a Orthopedic ndi Orthopedic Zida?

Za CZMEDITECH , tili ndi mzere wathunthu wa mankhwala opangira opaleshoni ya mafupa ndi zida zofanana, zomwe zimaphatikizapo implants za msana, misomali ya intramedullary, trauma plate, mbale yotsekera, cranial-maxillofacial, prosthesis, zida zamagetsi, okonza kunja, arthroscopy, chisamaliro cha ziweto ndi zida zawo zothandizira.

Kuphatikiza apo, tadzipereka kupitiliza kupanga zinthu zatsopano ndikukulitsa mizere yazogulitsa, kuti tikwaniritse zosowa za maopaleshoni a madokotala ndi odwala ambiri, ndikupangitsanso kampani yathu kukhala yopikisana pamakampani onse apadziko lonse oyika mafupa ndi zida zamagetsi.

Timatumiza kunja padziko lonse lapansi, kuti mutha tilankhule nafe imelo adilesi song@orthopedic-china.com pa mtengo waulere, kapena tumizani uthenga pa WhatsApp kuti muyankhe mwachangu +86- 18112515727 .

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