Arthroscopic kurapwa kwemashure kusagadzikana kwepfudzi

Kusagadzikana kwepashure kwepfudzi kunowanzokonzerwa nekushungurudzika kwemashure kukanganiswa kana kudzokorora kukuvadza zvishoma nezvishoma panguva yekurovedza muviri kana mamwe mabasa, nehuwandu hwegore negore hwezviitiko zve 4.64 kune 100000 vanhu pagore. Nzira dzinoverengeka dzekuvhiya dzekurapa kwemashure kusagadzikana kwepfudzi dzakatsanangurwa, kusanganisira nyoro kugadzirisa uye kuvhurika uye arthroscopic bone block kuvhiyiwa. Nekudaro, iyo yakashumwa yekuvhiya matambudziko uye yekudzokorora mitengo yaive yakakwira se14% uye 67%, zvichiteerana. Kunyanya, kuiswa kwakaringana kwemafupa egrafts, screw orientation uye kurapwa kweanobatana maronda anoonekwa seanonetsa. Nokudaro, nzira dzokuvhiya dzinoda kuvandudzwa.

Matanho ekushanda:

• Kuvhiya kwacho kwaiitwa pasi peanesthesia yakasanganiswa neregional block ye intermuscular sulcus.

• Nokuda kwekuunganidza iliac crest, anesthetics yemunharaunda yakashandiswa pasi pecutaneously uye periosteally.

• Murwere akaiswa pachigaro chemahombekombe nechekumashure kune 45 ° angle kuti abvumire kusangana kwakazara neiriac crest. Mushure mekunge pfupa rekuiswa kwave kukohwewa, kuvhiyiwa kwakaramba kuchienderera mberi, uye murwere aive akagara pakona ye70 °. Murwere akamiswa nenzira isina utachiona, uye ruoko rwekushanda rwakanga rwakakotamiswa mberi 30 ° kuburikidza ne2 kusvika ku3 kg tambo yekudhonza.

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Arthroscopic joint evaluation

• Iyi nzira inoshandisa masuo maviri kana matatu. Yekutanga pamberi (E) yekupinda inogona kushandiswa kunyatsoongorora majoini.

  
  

• Ranges inogona kuunzwa zvakananga mumajoini kuburikidza neinotenderera nguva. Mune zvimwe zviitiko, hazvibviri kusuma zvakananga chiyero (kureva, mavanga mavanga akapoteredza nguva yekutenderera).

  
  

• Iwe unogona kugadzira lateral C yekupinda kana yepamberi lateral D yekupinda, kuitira kuti iwe ugone kupinda munzvimbo iri pasi peacromion peak, kuitira kuti iwe ugone kuona iyo rotator tsandanyama nzvimbo.

  
  

• Arthroscopic radiofrequency ablation yakashandiswa kuvhura nguva yekutenderera.

  
  

• Iyo toggle lever yakamisikidzwa mujoinhi kuburikidza neE yekupinda kuti ichinje huwandu kune yakabatana yemukati maonero.

  
  

• Mushure mekuongorora kwakazara kwekubatana, zvinyoro zvinyoro zvipembenene uye zvipembenene zvinosanganiswa zveglenoid uye humeral bone kurasikirwa (kureva, posterior glenoid lip, joint capsule, glenoid marginal lesion uye reverse Hill Sachs lesion) yakaongororwa.

  
  

• Mushure mekunyatsoongorora arthroscopic yekubatana kweglenohumeral uye kusimbiswa kwezviratidzo zvakakodzera, mapfupa emapfupa akawanikwa.

  
  

Bone transplantation kukohwa nekugadzirira

• Iyo bicortical autograft yakawanikwa kubva kune ipsilateral anterior iliac crest kuchengetedza mukati cortex yepelvis. Gadzira ganda rinenge 2cm kuseri kweanterior superior iliac spine uye 2cm pazasi pecrest pamwe neiliac crest kudzivirira kugadzirwa kwevanga rinovhara zvakananga crest.

  
  

• Mushure mekucherechedza cortical bone α uye β Mapini maviri akafanana eKirschner akaiswa mu lateral cortex kuburikidza negomba, iro raimbove rakagadzirwa nemakumbo maviri akareba ecoracoid kubva kuArthroscopic Latarjet device (Fig. 1).

  
  

• Mubato wemutungamiri wakanangidzirwa kumusoro kuitira kuti pfupa repfupa rigone kufananidzwa neatomically neshure repasi glenoid mutsipa. Kuiswa kwegwara kunobvumira kusarudzwa kwepamusoro ridge sechikamu che articular chebhonzo.

  
  

• Wobva wasaidzira hollow coracoid process step drill paKirschner waya woboora maburi maviri 2.9mm mubhonzo block. Chibooreso nepini yeKirschner zvakabviswa. Usati wapinza washer yekumusoro mugomba rekuboorera, baya buri nepombi yekumusoro.

  
  

• Kamwe chivharo chepamusoro chiri panzvimbo, shandisa swing saw kana pfupa banga kuti uchengetedze cortex yepakati yeiriac crest uye kukohwa 2-cm × 1-cm × 1-cm grafts (Mifananidzo 2 uye 3). Mushure mekunge girafu rakohwewa, chivharo chepfupa chinobatanidzwa kune coracoid process sleeve uye maviri marefu marefu maburi coracoid process screws anoshandiswa kuumba chikwata chinogona kushandiswa kusvika panzvimbo yayo yekupedzisira (Fig. 4).

  
  

• Iyo iliac crest ronda yakavharwa layer ne layer ine drainage chubhu uye dressing yakashandiswa. Zvadaro gadzirisa kumashure kwetafura yekushanda kune kona ye70 °.

Mufananidzo 1. Iyo yakarurama iliac crest bone yakaunganidzwa apo murwere akanga ari mumhenderekedzo yegungwa. Iwo maviri Kirschner tsono akaiswa pamwe chete neaviri cannula gwara rekushandisa, uye mubato we cannula uri kumusoro. (Ant, kumberi; DCG, kaviri casing guide; Inf, yakaderera Post, kumashure; Sup, kumusoro.)

Mufananidzo 2. Kana murwere ari panzvimbo yechigaro chegungwa, pfupa rebhokisi rekurudyi iliac crest inotorwa. Bvisa chibhorani newaya yeKirschner mushure mekuboora lateral platform yeiliac crest cortex, wozoisa 2 'heti'. (Ant, kumberi; DCG, kaviri casing guide; Inf, lower; Post, behind; Sup, top; TH, top het.)

Mufananidzo 3. Kana murwere ari panzvimbo yechigaro chegungwa, pfupa repfupa rekurudyi iliac crest inotorwa. Iro mukati meiyo iliac crest inoramba yakasimba mushure mekunge graft yakohwewa. (Masvosve, kumberi; Inf, pasi; IT, tafura yemukati; Tumira, kumashure; Sup, kumusoro.)

Mufananidzo 4. Gadzirira mapfupa emapfupa patafura yepadivi. Mushure mekunge girafu yakohwewa, pfupa repfupa rakabatanidzwa kune kaviri cannula uchishandisa maviri cannula obturators. (Ant, kumberi; DCG, kaviri cannula kutungamira; IBG, iliac bone transplantation; Inf, yakaderera; Post, kumashure; Sup, kumusoro.)

Zvikwangwani zvemumigwagwa kumashure uye migwagwa yekupinda

• Kazhinji nzira mbiri kusvika nhatu dzinoshandiswa. Chinangwa ndechekugadzirisa iyo posterior A inlet neglenohumeral joint line sezvinobvira. Nokudaro, inodzorwa neArthroscope. Naizvozvo, inonyanya kuitwa mushure mekushanda kubva kumberi lateral inlet.

  
  

• Iyo anterolateral yekupinda E inoiswa munzvimbo ye rotator muscle pamusoro pe biceps muscle, iyo inogona kunyatsoratidza chikamu chekupedzisira cheglenoid edge (Tafura 1).

  
  

• Kazhinji kazhinji, hapachadiwizve migero; Nekudaro, kana zvichidikanwa, imwe yekuwedzera posterolateral B inopinza kuburikidza neyekumashure cuff inogona kushandiswa (semuenzaniso, kugadzirisa inopindirana labial prostheses).

  
  

• Sezvineiwo, Entrance A inowanikwa chaizvo paaxis yeglenohumeral joint line.

  
  

• Kuburikidza nekumberi nekumashure kwemusuwo E, isa 2 musana tsono kumashure kure kure ne 2.5 kusvika 3 cm, uye isa mubatanidzwa wakafanana pa7 o'clock uye 9 o'clock nzvimbo (kurudyi).

  
  

• Ita ganda rekucheka pakati pe 2 tsono uye uishandise seyokumashure A musuo (Figure 5A uye B).

Mufananidzo 5. (A) Murwere achacherechedza uye agadzirire ganda reganda mu70 ° angle yekugara, pafudzi rekurudyi uye E yekupinda maonero. Kuti uwane kurongeka kwakanakisa pakati peshure A inlet uye glenohumeral mutsara wejoinhi, tsono mbiri dzemusana dzinoiswa kumashure kuti dzione chiratidzo cheganda rekucheka.

(B) Arthroscopic visualization, bendekete rekurudyi, uye yemagetsi portal maonero emurwere ane tsono munzvimbo ye70 ° yakagara. (Ant, anterior; DCG, double cannula guidance; Gl, glenoid; Inf, underferior; Post, posterior; Pc, posterior capsule; Sn, spinal tsono; Sup, superior.)

Glenoid kugadzirira

• Chiridzwa chinounzwa kuburikidza nekumashure (A) inlet.

  
  

• Bvisa labrum uye posterior capsule kubva ku7 kusvika ku10 (pafudzi rekurudyi) uchishandisa VAPR uye razor (Fig. 6A uye B, Vhidhiyo 1).

  
  

• Geda mutsipa weglenoid wekupedzisira ne arthroscopic burrs kusvikira pfupa rekubuda ropa richionekwa uye ndege inogadzirirwa (Fig. 7). Kana mutsipa weglenoid wagadzirira, iyo posterior A inlet inokwidziridzwa kuti ibvumire kupfuura kwegraft uye kaviri coracoid cannula.

  
  

• Iyo scalpel inogona kushandiswa kuwedzera tsandanyama division uye cystotomy, nepo blunt rectangular trocar (subscapular ndima) inogona kushandiswa kuwedzera ndima (Mufananidzo 8).

Mufananidzo 6. (AB) Kuonekwa kwekugadzirira glenoid pasi pe arthroscopy, murwere agere pa 70 ° angle, pafudzi rekurudyi, maonero emagetsi ekupinda. Panguva yekugadzirira glenoid, shandisa VAPR uye razor kubvisa muromo weglenoid uye posterior capsule kubva 7:00 kusvika 10:00. (Ant, anterior; Gl, glenoid; Hh, humeral head; Inf, inferior; Pc, posterior capsule; Post, posterior; Sup, superior; V, VAPR.)

Mufananidzo 7. Arthroscopic visualization yekugadzirira glenoid: murwere akagara paakona ye70 °, pafudzi rekurudyi, E-portal maonero. Kupfeka kwemashure glenoid mutsipa panguva yekugadzirira glenoid. (Ant, front; B, burr; Gl, glenoid; Inf, lower; Pgn, posterior glenoid neck; Post, kumashure; Sup, kumusoro.)

Mufananidzo 8. Arthroscopic visualization yekugadzirira glenoid: murwere akagara pakona ye70 °, pafudzi rekurudyi, E-portal maonero. Wedzera iyo yekumashure A inlet ine blunt trocar. (Ant, kumberi; Bt: blunt trocar; Gl, glenoid; Inf, pasi; Pc, posterior capsule; Post, posterior; Sup, kumusoro.)

Graft chinzvimbo uye kugadzirisa

Iyo girafu yakaiswa mukati memusuwo weshure nemubato wakatarisa kumusoro (Fig. 9) uye yakapatsanurwa nemusuru uye majoini capsule kusvikira yava pedyo nemutsipa we posterior glenoid uye inoputika ne articular surface ye glenoid. Iyi nhanho inoda kutarisa pakugadzirira kwekutsemura, kunyanya kuvhura iyo gobvu uye yakasimba infraspinatus fascia uye kudzivirira kupfuura kwegraft.

• Zvakakosha kushandisa scalpel blade kuti uzarure fascia zvakanyanya. Kana zvichidikanwa, muchikamu chekupedzisira chekuvhiyiwa, kana kudonha kwemvura kwakakosha zvakanyanya kuchengetedza kudzvanywa pabendekete, zviridzwa zvinogona kushandiswa kuvhara zvishoma ronda rekuvhiya (semuenzaniso, zvimedu zvemaronda).

  
  

• Iyo coracoid cannula inoiswa yakaenzana kune articular surface kuitira kuti inotevera Kirschner waya uye screws zvisapinda mujoini panguva yekuisa.

  
  

• Waya mbiri dzeKirschner mbiri dzakareba 1.5 mm dzakapinzwa nepaburi rekoracoid process screws kugadzirisa gireti pamutsipa weglenoid wepashure (Fig. 10).

  
  

• Kuiswa kweKirschner wire hakufaniri kudarika 40mm kuti irege kupfuura nemutsipa weglenoid anterior, iyo inogona kukuvadza anterior neurovascular structure, kunyange zvazvo chikamu che subscapularis muscle chiripo pakati pemutsipa uye neurovascular structure kuti idzivirire.

Mufananidzo 9. Murwere akaisa girafu munzvimbo ye70 ° yakagara, uye akacherechedza bendekete rekurudyi uye posterolateral side. Graft yaipinzwa nepamukova wekumashure mubato wakatarisa kumusoro. (Ant, kumberi; DCG, kaviri casing guide; Inf, lower; Post, behind; Sup, top.)

Mufananidzo 10. Arthroscopic visualization yegraft positioning, murwere agere pa 70 ° angle, pafudzi rekurudyi, E kupinda maonero. Mapini maviri akaiswa eKirschner anodzikamisa graft pamutsipa weglenoid. (Ant, mberi; Gl, glenoid; IBG, iliac bone graft; Inf, yakaderera; Kw, Kirschner waya; Post, kumashure; Sup, kumusoro.)

Sezvo iyo 30 ° arthroscope ichitariswa kubva kumberi kweiyo portal vein, inogarorerekera kurerekera pakona, ichiita yepasi pasi ive yakakurumbira kwete kuti yakatwasuka. Zvakakosha kutarisa kana pfupa rinosungirirwa richiri kuitika mushure mekuiswa kwegraft.

• Kana gireti ranyungudutswa nechekumashure kweglenoid margin, bvisa siruu yekutanga refu yekoracoid woboora 3-2mm yakafara bicortical glenoid tunnel paKirschner waya.

  
  

• Mudanho iri, zvakakosha kuramba wakanyarara mushure mekuita kwekutanga. Vashandi vekubatsira vanofanira kuchengetedza nemaoko maviri (Mufananidzo 11).

  
  

• Inofanirwa kugadzirira kuisa yechitatu Kirschner pini mugomba, nekuti pini yeKirschner munzvimbo yayo yepakutanga inowanzobatwa mumotor isingadiwe nechibooreso.

  
  

• Kuchengetedza kunofanira kutorwa kuti usabvisa Kirschner wire paunenge uchidhonza kunze kwechibooreso kuburikidza nekoracoid sleeve. Zvadaro, isa 4.5 mm zvishoma zvakarukwa Latarjet sikuruu muKirschner wire (Fig. 12) woiisa zvizere kudzivirira girafu kubva pakushanduka, wozoboora sikuruu yekumusoro. Sezvineiwo, kureba sikururu haifanire kudarika 32 kusvika 36 mm.

  
  

• Chero hurefu hunopfuura 40 mm hunoda kunyatsoongororwa, sezvo izvi zvingave zvichikonzerwa nekukwira kwekona yegraft maererano nepamusoro peglenoid, iyo inogona kutungamirira kugraft dislocation. Panguva ino, nhanho yekumisikidzwa kwegraft inogona kuramba ichigadziriswa nekutenderedza glenoid kutenderedza screw yepasi.

  
  

• Mushure mekuisa iyo yekutanga (yepasi) screw, yekutanga Kirschner pini inogona kubviswa. Isa chechipiri screw nenzira imwecheteyo.

  
  

• Mushure mekuisa 2 screws uye kubvisa Kirschner waya, shandisa probe paEntrance A kuti utarise nzvimbo yekupedzisira yegraft (Mufananidzo 13). Chero zvikamu zvakabuda zvegraft zvinofanira kuchekwa nemaburrs, uye hapana kugadziriswa kwenyama yakapfava kunofanira kuitwa kudzivirira kuoma kwemajoini.

Mufananidzo 11. Iyo graft yakaiswa uye yakagadziriswa. Murwere akagara pakona ye70 ° bendekete rake rekurudyi richionekwa kubva kumusoro. Munguva uye mushure mekuchera kwekudyara, chengetedza muperekedzi achiri nemaoko maviri kudzivirira mutsetse weK kubva pakusunungura mugero. (Ant, kumberi; DCG, kaviri cannula kutungamira; Kw, Kirschner waya; Post, kumashure; Sup, kumusoro.)

Mufananidzo 12. Arthroscopic visualization yegraft fixation, murwere agere pa 70 ° angle, pafudzi rekurudyi, magetsi ekupinda maonero. Iyo yepasi 4.5mm yakarukwa muchidimbu Latarjet screw inotanga kuwanikwa pamusoro peKirschner pin. (Ant, front; Gl, glenoid; IBG, iliac bone graft; Inf, lower; S, screw; Post, kumashure; Sup, kumusoro.)

Mufananidzo 13. Arthroscopic visualization yegraft positioning, murwere agere pa 70 ° angle, pafudzi rekurudyi, E kupinda maonero. Mushure mekuisa screws mbiri uye kubvisa iyo Kirschner waya, tarisa yekupedzisira transplant chinzvimbo. Rudzi urwu rwekusungirirwa kwebhonzo kune yakanaka compressibility uye hapana chinzvimbo chekudada. (Ant, anterior; Gl, glenoid; Hh, humeral head; IBG, iliac bone graft; Inf, pasi; Post, posterior; Sup, kumusoro.)

Mushure mekuvhiyiwa, bendekete rakagadziriswa ne 20 ° abduction angle uye kusarerekera kutenderera kwemavhiki matanhatu:

• Zuva rinotevera mushure mekuvhiyiwa, tanga kungoita pfudzi, gokora uye ruoko rwakasiyana-siyana rwekufamba. Kutaura uye kufamba kunorwadza kunofanira kudziviswa.

  
  

• Pamasvondo matatu, tanga kushanda kwemaitiro ekufambisa.

  
  

• Mushure mekugadzikana kwegraft kunosimbiswa nekutora mafoto mavhiki matanhatu mushure mekuvhiyiwa, kurovedza muviri kwakanyanya kunogona kutangwa.

  
  

• Kune vatambi vari kutsvaga kukurumidza kupora, computerized tomography inofanira kuitwa 3 mwedzi mushure mekuvhiyiwa kuti iongorore kubatanidzwa kwegraft.

  
  

Nzira yeKutenga Orthopedic Implants uye Orthopedic Instruments?

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