Vutshunguri bya arthroscopic bya ku nga tshamiseki ka makatla ya le ndzhaku .

Ku nga tshamiseki ka makatla ya le ndzhaku hi ntolovelo ku vangiwa hi ku tshoveka ka le ndzhaku loku chavisaka kumbe ku phindha-phindha ku vaviseka loku nga ngheneriki ngopfu hi nkarhi wa ku endla vutiolori kumbe migingiriko yin’wana, hi mpimo wa ku humelela ka lembe na lembe wa 4.64 wa timhangu eka vanhu va 100000 hi lembe. Maendlelo yo hlayanyana ya vuhandzuri yo tshungula ku nga tshamiseki ka makatla ya le ndzhaku ma hlamuseriwile, ku katsa ni ku lunghisa tinyama to olova ni vuhandzuri lebyi pfulekeke ni lebyi pfulekeke ni bya arthroscopic bone block. Hambiswiritano, swiphiqo swa vuhandzuri leswi vikiweke na mimpimo ya ku pfuxetiwa a swi ri ehenhla ku fika eka 14% na 67%, hi ku landzelelana. Ngopfu ngopfu, ku vekiwa lokunene ka ti bone grafts, screw orientation xikan’we naku tshunguriwa ka swilondza leswi fambisanaka swi tekiwa swiri ntlhontlho. Hikwalaho, tindlela ta vuhandzuri ti fanele ti antswisiwa.

Magoza ya Ntirho: .

• Ntirho lowu wu endliwile ehansi ka general anesthesia leyi hlanganisiweke na regional block ya intermuscular sulcus.

• Eka nhlengeleto wa iliac crest, swidlaya-switsongwatsongwana swa ndzhawu switirhisiwile ehansi ka nhlonge na periosteal.

• Muvabyi u vekiwile eka xitulu xa le ribuweni ra lwandle a ri na le ndzhaku hi 45 ° angle ku pfumelela ku hlangana loku heleleke na iliac crest. Endzhaku ka loko ku tshoveriwa ka marhambu ku tshoveriwile, vuhandzuri byi ye emahlweni, naswona muvabyi a a tshamile eka angle ya 70 °. Muvabyi u yimisiwile hi ndlela ya standard sterile, naswona voko ro tirha ri govekile emahlweni 30 ° hiku tirhisa ntambhu ya 2 kuya eka 3 kg ya traction.

• 
  

Ku kamberiwa ka nhlangano wa arthroscopic .

• Endlelo leri ri tirhisa tindlela timbirhi kumbe tinharhu to nghena. Ku nghena ko sungula ka le mahlweni (E) ku nga tirhisiwa eka ku lavisisa loku heleleke ka nhlangano.

  
  

• Ti ranges tinga nghenisiwa hiku kongoma eka mahlangano hiku tirhisa ti rotator intervals. Eka swiyimo swin’wana, aswi koteki ku nghenisa hiku kongoma xikalo (i.e., scar tissue ku rhendzela rotator interval).

  
  

• Unga endla lateral C entrance kumbe front lateral d entrance, leswaku uta kota ku nghena eka ndzhawu yale hansi ka acromion peak, leswaku uta kota ku vona ndzhawu ya rotator muscle.

  
  

• Ku susiwa ka arthroscopic radiofrequency ablation ku tirhisiwile ku pfula nkarhi wa rotator.

  
  

• Toggle lever yi vekiwa eka nhlangano hi ku tirhisa E entry ku cinca range kuya eka joint interior view.

  
  

• Endzhaku ka nkambisiso lowu heleleke wa nhlonge, swirhumbana swa tinyama to olova na swirhumbana leswi fambelanaka na glenoid na ku lahlekeriwa hi marhambu ya humeral (i.e., posterior glenoid lip, joint capsule, glenoid marginal lesion na reverse hill sachs lesion) swi kamberiwile.

  
  

• Endzhaku ka ku kamberiwa loku heleleke ka arthroscopic ka glenohumeral joint na ku tiyisisiwa ka swikombiso leswi faneleke, ku kumiwile ti bone grafts.

  
  

Ku tshoveriwa ka marhambu na ku lulamisiwa .

• Bicortical autograft yi kumiwile kusuka eka ipsilateral anterior iliac crest ku hlayisa cortex yale ndzeni ya pelvis. Endla ku tsemiwa ka nhlonge kwalomu ka 2cm endzhaku ka anterior superior iliac spine na 2cm ehansi ka crest kuya hi iliac crest ku papalata ku endliwa ka swivati ​​leswi funengetaka crest hiku kongoma.

  
  

• Endzhaku ko languta cortical bone α na β ti pin timbirhi ta kirschner leti fambelanaka ti nghenisiwile eka lateral cortex hi ku tirhisa khumbi, leri khale a ri hlomisiwile hi swikwirikiri swimbirhi swo leha swa coracoid ku suka eka xitirhisiwa xa latarjet xa arthroscopic (Fig. 1).

  
  

• Xikhomo xa nkongomiso xi kongomisiwe ehenhla leswaku graft ya marhambu yi nga fambelanisiwa hi ndlela ya anatomically na nhamu ya le ndzhaku ya le hansi ya glenoid. Ku vekiwa ka xiletelo swi pfumelela ku hlawuriwa ka ridge yale henhla tani hi tlhelo ra articular ra bone block.

  
  

• Kutani, susumeta hollow coracoid process step drill eka Kirschner wire kutani u bora ti holes timbirhi ta 2.9mm eka bone block. Xiphemu xa drill na pini ya Kirschner swi susiwile. Loko u nga si nghenisa washer ya xifunengeto xa le henhla eka khumbi ro bora, khoma khumbi hi pompi ya xifunengeto xa le henhla.

  
  

• Loko xifunengeto xale henhla xiri kona, tirhisa swing saw kumbe bone knife ku hlayisa medial cortex ya iliac crest naku tshovela 2-cm × 1-cm × 1-cm grafts (Swifaniso 2 na 3). Endzhaku kaloko graft yi tshoveriwile, bone block yihlanganisiwa na coracoid process sleeve naswona swikwirikiri swimbirhi swo leha swa coracoid process switirhisiwa ku endla unit leyi yinga manipulated kuya eka xiyimo xa yona xohetelela (Fig. 4).

  
  

• Xilonda xa iliac crest a xi pfariwile layer hi layer na drainage tube na dressing swi tirhisiwile. kutani u lulamisa endzhaku ka tafula ro tirha eka angle ya 70 °.

Xifaniso 1. marhambu ya xinene ya iliac crest ya hlengeletiwile loko muvabyi a ri eka xiyimo xa xitulu xa le ribuweni ra lwandle. Ti needles timbirhi ta Kirschner ti vekiwa swin’we na xitirhisiwa xo kongomisa xa double cannula, naswona xikhomela xa cannula xi le henhla. (Ant, front; dcg, xiletelo xa double casing; INF, post ya le hansi, endzhaku; SUP, ehenhla.)

Xifaniso 2. Loko muvabyi a ri eka xiyimo xa xitulu xa le ribuweni ra lwandle, ku tekiwa xibokisana xa marhambu xa crest ya xinene ya iliac. Susa wire ya drill na Kirschner endzhaku ko bora lateral platform ya iliac crest cortex, kutani u nghenisa 2 'hats'. (Ant, front; dcg, double casing guide; INF, ehansi; post, rear; sup, upper; th, top hat.)

Xifaniso 3. Loko muvabyi a ri eka xiyimo xa xitulu xa le ribuweni ra lwandle, ku tekiwa xibokisana xa marhambu xa iliac crest ya xinene. Vuandlalo byale ndzeni bya iliac crest byi tshama byiri kona endzhaku kaloko graft yi tshoveriwile. (Ant, front; inf, bottom; it, tafula ra le ndzeni; post, back; sup, top.)

Xifaniso 4. Lunghiselela swibokisana swa marhambu eka tafula ra le tlhelo. Endzhaku kaloko graft yi tshoveriwile, bone graft yi hlanganisiwe na double cannula hiku tirhisa ti cannula obturators timbirhi. (Ant, front; dcg, cannula guidance ya double; IBG, ku rhumeriwa ka marhambu ya iliac; INF, ehansi; post, endzhaku; SUP, ehenhla.)

Swikoweto swa le ndzhaku swa magondzo ni magondzo yo nghena .

• Hi ntolovelo ku tirhisiwa tichannel timbirhi ku ya eka tinharhu. Xikongomelo i ku ringanisa ndlela ya le ndzhaku ya le ndzhaku na layini ya nhlangano wa glenohumeral hi laha swi kotekaka ha kona. Hikwalaho, yi lawuriwa hi arthroscope. Hikokwalaho, ngopfu ngopfu yi endliwa endzhaku ka vuhandzuri kusuka eka front lateral inlet.

  
  

• Ku nghena ka anterolateral E ku vekiwa eka ndzhawu ya misiha ya rotator ehenhla ka misiha ya biceps, leyi nga kombisaka kahle xiphemu xa le ndzhaku xa glenoid edge (Table 1).

  
  

• Hakanyingi, a ku laveki tindlela tin’wana; Kambe loko swilaveka, ku nghena ka posterolateral B loku engetelekeke hiku tirhisa cuff yale ndzhaku swinga tirhisiwa (xikombiso, ku lawula complementary labial prostheses).

  
  

• Hi ndlela leyinene, ku nghena A ku kumeka kahle-kahle eka axis ya GlenoHumeral Joint Line.

  
  

• Hiku languta emahlweni nale ndzhaku ka nyangwa wa E, nghenisa 2 wa ti needles ta nkolo endzhaku eka mpfhuka wa 2.5 kuya eka 3 cm, kutani u nghenisa nhlangano hiku fambisana eka 7 o’clock na 9 o’clock positions (makatla ya xinene).

  
  

• Endla ku tsemiwa ka nhlonge exikarhi ka ti needles ta 2 u tirhisa tani hi le ndzhaku ku nghena (Swifaniso 5a na B).

Xifaniso 5. (a) Muvabyi u ta fungha no lulamisa ku tsemiwa ka nhlonge eka xiyimo xo tshama xa 70 ° angle, makatla ya xinene na ku vona ka E yo nghena. Leswaku ku fikeleriwa ku ringanana lokunene exikarhi ka le ndzhaku ka inlet na glenohumeral joint line, ku nghenisiwa ti needles timbirhi ta nkolo endzhaku ku kumisisa xikombiso xa ku tsemiwa ka nhlonge.

(b) Ku vonakala ka arthroscopic, makatla ya xinene, na xivono xa portal ya elektroniki ya muvabyi loyi a nga na nayiti eka xiyimo xo tshama xa 70 °. (Ant, anterior; dcg, cannula guidance; GL, glenoid; INF, inferior; post, posterior; PC, posterior capsule; Sn, spinal needle; SUP, superior.)

Ku lunghiselela ka glenoid .

• Xichayachayana lexi xi nghenisiwa hi le ndzhaku (a) inlet.

  
  

• Susa labrum na posterior capsule kusuka eka 7 kuya eka 10 (makatla ya xinene) hiku tirhisa VAPR na razor (Fig. 6a na B, video 1).

  
  

• Sila nhamu ya le ndzhaku ya glenoid hi ti arthroscopic burrs kufikela loko marhambu lawa ya humaka ngati ya paluxiwa naswona plane yi lulamisiwile (Fig. 7). Loko nhamu ya glenoid yi lulamerile, ndzhawu yale ndzhaku ya inlet yi kurisiwa kuva yi pfumelela ku hundza ka graft na double coracoid cannula.

  
  

• Scalpel yinga tirhisiwa ku ndlandlamuxa ku avana ka misiha na cystotomy, kasi blunt rectangular trocar (subscapular passage) yinga tirhisiwa ku yisa emahlweni ku ndlandlamuxa xiphemu (Figure 8).

Xifaniso 6. (AB) Ku vonakala ka ku lulamisiwa ka glenoid ehansi ka arthroscopy, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, xivono xo nghena xa elektroniki. Hi nkarhi wa ku lulamisiwa ka glenoid, tirhisa VAPR na razor ku susa glenoid lip na posterior capsule kusukela hi 7:00 kuya eka 10:00. (Ant, anterior; gl, glenoid; hh, nhloko ya humeral; inf, inferior; pc, capsule ya le ndzhaku; post, posterior; sup, superior; v, vapr.)

Xifaniso 7. Ku vonakala ka arthroscopic ka ku lulamisiwa ka glenoid: Muvabyi u tshamile eka angle ya 70 °, makatla ya xinene, xivono xa e-portal. Ku onhaka ka nhamu ya le ndzhaku ya glenoid hi nkarhi wa ku lulamisiwa ka glenoid. (Ant, front; b, burr; gl, glenoid; INF, ehansi; pgn, nhamu ya glenoid ya le ndzhaku; post, endzhaku; sup, ehenhla.)

Xifaniso 8. Ku vonakala ka arthroscopic ka ku lulamisiwa ka glenoid: Muvabyi u tshamile eka angle ya 70 °, makatla ya xinene, xivono xa e-portal. Ku kurisa endzeni ka yona ku nghena hi trocar leyi nga riki na nchumu. (Ant, front; Bt: trocar yo olova; GL, glenoid; INF, ya le hansi; pc, capsule ya le ndzhaku; post, posterior; SUP, ehenhla.)

Ku vekiwa ka graft na ku fixation .

Graft yi nghenisiwile hi le ndzhaku ka nyangwa na handle leyi languteke ehenhla (Fig. 9) naswona yi pandzeka hi misiha na capsule ya nhlangano kufikela loko yiri ekusuhi na nhamu ya posterior glenoid na flush na articular surface ya glenoid. Goza leri rifanele ku kongomisa eka ku lulamisiwa ka ku avana, ngopfu ngopfu ku pfula fascia yo tiya no tiya ya infraspinatus xikan’we naku sivela ku hundza ka graft.

• I swa nkoka ku tirhisa scalpel blade ku pfula fascia swinene. Loko swi laveka, eka xiyimo xa le ndzhaku xa vuhandzuri, loko ku khuluka ka flushing ku ri ka nkoka swinene ku hlayisa ntshikelelo lowu eneleke eka makatla, switirhisiwa swi nga tirhisiwa ku pfala hi xiphemu xilondza xa vuhandzuri (xikombiso, swikhomela-ndhawu swa swilondza).

  
  

• Coracoid cannula yi vekiwa parallel na articular surface leswaku ti wires ta Kirschner leti landzelaka na swikwirikiri swinga ngheni eka nhlangano hi nkarhi wo nghenisa.

  
  

• Ti wire timbirhi to leha ta kirschner to leha ta 1.5 mm ti nghenisiwile hi swikwirikiri swa hollow coracoid process ku lulamisa graft eka nhamu ya posterior glenoid (Fig. 10).

  
  

• Ku nghenisiwa ka waya wa Kirschner aswifanelanga ku tlula 40mm ku papalata ku hundza eka nhamu ya anterior glenoid, leswinga onhaka xivumbeko xa anterior neurovascular, hambi leswi kunga xiphemu xa misiha ya subscapularis ntsena exikarhi ka nhamu na xivumbeko xa neurovascular kuva xisirheleriwa.

Xifaniso 9. Muvabyi u nghenise graft eka xiyimo xo tshama xa 70 °, kutani a languta makatla ya xinene na tlhelo ra posterolateral. Graft yi nghenisiwile hi nyangwa wa le ndzhaku hi xikhomela lexi languteke ehenhla. (Ant, front; dcg, double casing guide; INF, ehansi; post, rear; sup, upper.)

Xifaniso 10. Ku vonakala ka arthroscopic ka ku vekiwa ka graft, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, E yo nghena. Tiphini timbirhi leti nghenisiweke ta Kirschner ti tiyisisa xirho xa le ndzhaku xa nhamu ya glenoid ya le ndzhaku. (Ant, front; GL, glenoid; IBG, ku hlanganisiwa ka marhambu ya iliac; INF, ehansi; KW, waya wa Kirschner; post, endzhaku; SUP, ehenhla.)

Leswi 30 ° arthroscope yi langutiwaka kusuka emahlweni ka portal vein, hi ntumbuluko yitala ku rhetela graft kuya eka angle, leswi endlaka leswaku xivumbeko xale hansi xivonaka ematshan’wini yo kongoma. I swa nkoka ku kambela loko marhambu ya ha koteka endzhaku ka ku vekiwa ka graft.

• Loko graft yiri flush na posterior glenoid margin, susa coracoid screw yosungula yosungula kutani u bora 3-2mm wide bicortical glenoid tunnel eka wire ya Kirschner.

  
  

• Eka goza leri, i swa nkoka ku tshama u nga tsekatseki endzhaku ka ku titoloveta ko sungula. Vatirhi lava pfunetaka va fanele ku hlayisa hi mavoko hamambirhi (Xifaniso xa 11).

  
  

• Yifanele kuva yi lulamerile ku veka pini ya vunharhu ya Kirschner eka khumbi, hikuva pini ya Kirschner eka ndzhawu ya yona yosungula hi ntolovelo yi khomiwa hi motor hiku tirhandzela hi drill bit.

  
  

• Kufanele ku tekeriwa enhlokweni leswaku kunga susi waya wa Kirschner loko ku humesiwa xitirhisiwa xo bora hi sleeve ya coracoid. Kutani, nghenisa 4.5 mm partially threaded Latarjet screw eka Kirschner wire (Fig. 12) kutani u yi nghenisa hiku hetiseka ku sivela graft kuva yi cinca, kutani u bora xikurufu xale henhla. Hi ndlela leyinene, ku leha ka xikurufu a ku fanelanga ku tlula 32 ku ya eka 36 mm.

  
  

• Ku leha kwihi na kwihi lokukulu kutlula 40 mm swilava ku kamberiwa hi vukheta, tani hileswi swinga endlekaka hikokwalaho ka angle yo enta ya graft loko yiringanisiwa na glenoid surface, leswinga tisaka graft dislocation. Eka xiyimo lexi, levele ya graft positioning yahari kona hiku rhendzeleka ka glenoid ku rhendzela screw yale hansi.

  
  

• Endzhaku ko nghenisa xikurufu xo sungula (xa le hansi), pini yo sungula ya Kirschner yi nga susiwa. Nghenisa xikurufu xa vumbirhi hi ndlela leyi fanaka.

  
  

• Endzhaku ko nghenisa swikwirikiri swa 2 na ku susa waya wa Kirschner, tirhisa probe loko u nghena A ku kambela xiyimo xo hetelela xa graft (Xifaniso xa 13). Swiphemu swihi na swihi leswi humelaka ehandle swa graft swifanele ku tsemiwa hi ti burrs, naswona ku hava ku lulamisiwa ka tissue yo olova loku faneleke ku endliwa ku sivela ku tsana ka mahlangano.

Xifaniso 11. Graft yi vekiwile yi tlhela yi vekiwa. Muvabyi u tshame eka angle ya 70 ° laha makatla ya yena ya xinene ya langutiwaka ku suka ehenhla. Hi nkarhi na endzhaku ka ku bora ka implant, hlayisa guard still hi mavoko mambirhi ku sivela K line kuva yi ntshunxa mugodi. (Ant, front; dcg, nkongomiso wa cannula wa mbirhi; KW, Kirschner waya; post, endzhaku; SUP, ya le henhla.)

Xifaniso 12. Ku vonakala ka arthroscopic ka graft fixation, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, xivono xo nghena xa elektroniki. Xikurufu xa latarjet lexi nga na 4.5mm xa latarjet xa le hansi xi sungula ku kumeka ehenhla ka pini ya Kirschner. (Ant, front; gl, glenoid; ibg, iliac bone graft; INF, ehansi; s, xikurufu; post, endzhaku; sup, ehenhla.)

Xifaniso 13. Ku vonakala ka arthroscopic ka ku vekiwa ka graft, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, E yo nghena. Endzhaku ko nghenisa swikwirikiri swimbirhi ni ku susa waya wa Kirschner, kambela xiyimo xo hetelela xa ku rhumeriwa. Muxaka lowu wa bone graft wuna compressibility ya kahle naswona awuna xiyimo xo tinyungubyisa. (Ant, anterior; gl, glenoid; hh, nhloko ya humeral; IBG, iliac bone graft; INF, ehansi; post, posterior; sup, ehenhla.)

Endzhaku ka vuhandzuri, makatla ya lulamisiwile hi 20 ° abduction angle na neutral rotation kuringana 6 wa mavhiki:

• Hi siku leri landzelaka endzhaku ka vuhandzuri, sungula passive shoulder, elbow na hand range of motion exercise. Pronation na ku famba famba loku vavaka swifanele ku papalatiwa.

  
  

• Eka 3 wa mavhiki, sungula ku endla vutiolori bya ku famba-famba hi ku gingiriteka.

  
  

• Endzhaku kaloko ku tiya ka graft ku tiyisisiwile hiku teka swifaniso endzhaku ka 6 wa mavhiki endzhaku ka vuhandzuri, ku endla vutiolori lebyikulu swinga sunguriwa.

  
  

• Eka vatlangi lava lavaka ku hola hi xihatla, tomography ya khompyuta yi fanele ku endliwa endzhaku ka tin’hweti ta 3 endzhaku ka vuhandzuri ku kambela ku hlanganisiwa ka graft.

  
  

Ndlela Yo Xava Switirhisiwa Swa Marhambu Na Switirhisiwa Swa Marhambu.

Swa CzMediTech , hi na layini ya swikumiwa leyi heleleke swinene ya switirhisiwa swa vuhandzuri bya marhambu na switirhisiwa leswi fambelanaka na swona, switirhisiwa ku katsa na . Swilo leswi nghenisiwaka hi nkolo ., Swipikiri swa le ndzeni ka khwiri ., Xiphepherhele xa khombo ., Xiphepherhele xo pfala ., Cranial-maxillofacial ., Prosthesis ., Switirhisiwa swa Matimba ., Vahlayisi va le handle ., Arthroscopy ., Nkhathalelo wa Swiharhi na tisethi ta vona ta switirhisiwa swo seketela.

Ku engetela kwalaho, hi tiyimiserile ku ya emahlweni hi tumbuluxa swikumiwa leswintshwa na ku ndlandlamuxa milayeni ya swikumiwa, leswaku hi ta fikelela swilaveko swa vuhandzuri bya madokodela yo tala na vavabyi, na ku tlhela hi endla leswaku khamphani ya hina yi phikizana swinene eka indasitiri hinkwayo ya misava hinkwayo ya marhambu ya marhambu na switirhisiwa.

Hi rhumela ehandle emisaveni hinkwayo, leswaku u ta kota ku . Tihlanganisi na hina eka adirese ya email song@orthopedic-china.com ku kuma xikombelo xa mahala, kumbe u rhumela rungula eka WhatsApp ku kuma nhlamulo ya xihatla +86- 18112515727 .

Loko u lava ku tiva vuxokoxoko byo tala,Tiklika . CzMediTech ku kuma vuxokoxoko byo tala.