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

Ku nga tshamiseki ka makatla ya le ndzhaku hi ntolovelo swi vangiwa hi ku tshukatshuka ka le ndzhaku loku chavisaka kumbe ku vaviseka loku phindha-phindhiwaka loku nga ngheneriki ngopfu hi nkarhi wa ku endla vutiolori kumbe migingiriko yin’wana, laha ku nga na mpimo wa lembe na lembe wa 4.64 wa timhangu eka 100000 wa vanhu hi lembe. Maendlelo yo hlayanyana ya vuhandzuri yo tshungula ku nga tshamiseki ka makatla ya le ndzhaku ya hlamuseriwile, ku katsa na ku lunghisa tinyama to olova na vuhandzuri byo pfuleka na 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 na vutshunguri bya swirhumbana leswi fambisanaka switekiwa tani hi ntlhontlho. Hikwalaho, tindlela ta vuhandzuri ti fanele ti antswisiwa.

Magoza ya ntirho:

• Vuhandzuri lebyi byi endliwe ehansi ka vutshunguri bya ku titivala lebyi hlanganisiweke ni regional block ya intermuscular sulcus.

• Eka nhlengeleto wa iliac crest, ti local anesthetics ti cheriwile ehansi ka nhlonge na periosteally.

• Muvabyi u vekiwile eka xitulu xa le ribuweni ra lwandle laha nkolo wu nga eka 45 ° angle ku pfumelela ku khumbana loku heleleke na iliac crest. Endzhaku ka loko ku rhumeriwa ka marhambu ku tshoveriwile, vuhandzuri byi ye emahlweni, naswona muvabyi a a tshame hi angle ya 70 °. Muvabyi u yimisiwile hi ndlela ya ntolovelo ya sterile, naswona voko ro endla vuhandzuri ri govekile emahlweni 30 ° hi ntambhu yo koka ya 2 kuya eka 3 kg.

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Ku kamberiwa ka mahlangano hi 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 nhlanganelo.

  
  

• Ti ranges tinga nghenisiwa hiku kongoma eka swihlanganisi hiku tirhisa ti rotator intervals. Eka swiyimo swin’wana, aswi koteki ku nghenisa hiku kongoma xikopu (i.e., scar tissue around the 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 languta ndzhawu ya rotator muscle.

  
  

• Arthroscopic radiofrequency ablation yitirhisiwile ku pfula nkarhi wa rotator.

  
  

• Toggle lever yi vekiwa eka joint hiku 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 ku lahlekeriwa hi marhambu ya glenoid na humeral (i.e., nomu wa le ndzhaku wa glenoid, capsule ya nhlonge, xirhumbana xa glenoid marginal na xirhumbana xa le ndzhaku xa Hill Sachs) swi kamberiwile.

  
  

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

  
  

Ku tshoveriwa ka ku rhumeriwa ka marhambu na ku lunghiselela

• 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 marhambu ya cortical α na β Tiphini timbirhi leti fambelanaka ta Kirschner ti nghenisiwile eka cortex yale tlhelo hiku tirhisa khumbi, leri khale ari hlomisiwile hi swikwirikiri swimbirhi swo leha swa coracoid kusuka eka xitirhisiwa xa Arthroscopic Latarjet (Fig. 1).

  
  

• Xikhomela xa guide xi kongomisiwe ehenhla leswaku bone graft yinga fambelanisiwa hi anatomically na posterior inferior glenoid neck. Ku vekiwa ka guide swipfumelela ku hlawuriwa ka ridge yale henhla tani hi tlhelo ra articular ra bone block.

  
  

• Kutani, susumeta hollow coracoid process step drill eka waya wa Kirschner kutani u bora ti holes timbirhi ta 2.9mm eka bone block. Xitirhisiwa xo bora na pini ya Kirschner swi susiwile. Loko unga se nghenisa top cap washer eka drill hole, khoma hole hi top cap tap.

  
  

• Loko xifunengeto xale henhla xiri eka ndzhawu ya xona, 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 ti long hollow coracoid process screws timbirhi titirhisiwa ku endla unit leyinga cinciwaka kuya eka xiyimo xa yona xohetelela (Fig. 4).

  
  

• Xilonda xa iliac crest xi pfariwile hi leyara hi leyara hi drainage tube naswona ku tirhisiwile dressing. Kutani lulamisa endzhaku ka tafula ro endla vuhandzuri 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 cannula timbirhi, naswona xikhomela xa cannula xi ya ehenhla. (Ant, emahlweni; DCG, nkongomiso wa swifunengeto swimbirhi; 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 bone block ya right iliac crest. Susa drill bit na Kirschner wire endzhaku ko bora lateral platform ya iliac crest cortex, kutani u nghenisa 2 'hats'. (Ant, emahlweni; DCG, nkongomiso wa swifunengeto swimbirhi; Inf, ehansi; Post, endzhaku; Sup, ehenhla; TH, xihuku xa le henhla.)

Xifaniso 3. Loko muvabyi a ri eka xiyimo xa xitulu xa le ribuweni ra lwandle, ku tekiwa bone block ya right iliac crest. Xiphemu xale ndzeni xa iliac crest xitshama xiri tano endzhaku kaloko graft yi tshoveriwile. (Ant, emahlweni; Inf, ehansi; IT, tafula ra le ndzeni; Post, endzhaku; Sup, ehenhla.)

Xifaniso 4. Lunghiselela swiphemu swa marhambu eka tafula ra le tlhelo. Endzhaku kaloko graft yi tshoveriwile, bone graft yi hlanganisiwile na double cannula hiku tirhisa ti cannula obturators timbirhi. (Ant, emahlweni; DCG, nkongomiso wa cannula yimbirhi; IBG, ku rhumeriwa ka marhambu ya iliac; Inf, ehansi; Post, endzhaku; Sup, ehenhla.)

Swikombiso swa magondzo ya le ndzhaku na magondzo yo nghena

• Hi ntolovelo ku tirhisiwa tichannel timbirhi ku ya eka tinharhu. Xikongomelo iku ringanisa posterior A inlet na glenohumeral joint line hilaha swinga kotekaka hakona. Hikwalaho, yi lawuriwa hi arthroscope. Hikokwalaho, ngopfu ngopfu yi endliwa endzhaku ka vuhandzuri kusuka eka front lateral inlet.

  
  

• Ndlela yo nghena ya anterolateral E yi vekiwa eka ndzhawu ya misiha ya rotator ehenhla ka misiha ya biceps, leyi nga kombisaka hi ku hetiseka xiphemu xa le ndzhaku xa tlhelo ra glenoid (Table 1).

  
  

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

  
  

• Hindlela leyinene, Entrance A yi kumeka kahle eka axis ya glenohumeral joint line.

  
  

• Hiku tirhisa xivono xale mahlweni nale ndzhaku xa 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 swiyimo swa awara ya 7 na awara ya 9 (makatleni ya xinene).

  
  

• Endla ku tsemiwa ka nhlonge exikarhi ka ti needles ta 2 kutani u tirhisa tani hi ndlela yo nghena yale ndzhaku ya A (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 xivono xo nghena xa E. Leswaku ku fikeleriwa ku ringanana lokunene exikarhi ka rear A inlet na glenohumeral joint line, ti spine needles timbirhi ti nghenisiwa endzhaku ku kumisisa xikombiso xa ku tsemiwa ka nhlonge.

(B) Ku vona hi mahlo ya arthroscopic, makatla ya xinene, na xivono xa electronic portal xa muvabyi loyi a nga na naliti eka xiyimo xo tshama xa 70 °. (Ant, ya le mahlweni; DCG, nkongomiso wa cannula yimbirhi; Gl, glenoid; Inf, ya le hansi; Post, ya le ndzhaku; Pc, capsule ya le ndzhaku; Sn, naliti ya nkolo; Sup, ya le henhla.)

Ku lulamisiwa ka glenoid

• Xitirhisiwa lexi xi nghenisiwa hi ku tirhisa xipfalo xa le ndzhaku (A).

  
  

• Susa labrum na capsule yale ndzhaku kusuka eka 7 kuya eka 10 (makatleni ya xinene) hiku tirhisa VAPR na razor (Fig. 6A na B, Video 1).

  
  

• Sila nhamu ya glenoid yale ndzhaku hi ti arthroscopic burrs kufikela loko marhambu lawa ya humaka ngati ya paluxiwa naswona plane yi lulamisiwa (Fig. 7). Loko nhamu ya glenoid yi lulamile, posterior A 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 ndlandlamuxa ku ya emahlweni (Xifaniso 8).

Xifaniso 6. (AB) Ku vonakala ka ku lulamisiwa ka glenoid ehansi ka arthroscopy, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, xivono xa ku nghena hi elektroniki. Hi nkarhi wa ku lulamisiwa ka glenoid, tirhisa VAPR na razor ku hambanyisa nomu wa glenoid na capsule yale ndzhaku kusukela hi 7:00 kuya eka 10:00. (Ant, ya le mahlweni; Gl, glenoid; Hh, nhloko ya humeral; Inf, ya le hansi; Pc, capsule ya le ndzhaku; Post, ya le ndzhaku; Sup, ya le henhla; V, VAPR.)

Xifaniso 7. Ku voniwa ka arthroscopic ka ku lunghiselela glenoid: muvabyi u tshamile eka angle ya 70 °, makatla ya xinene, E-portal view. Ku ambala ka nhamu ya glenoid yale ndzhaku hi nkarhi wa ku lulamisiwa ka glenoid. (Ant, emahlweni; B, burr; Gl, glenoid; Inf, ehansi; Pgn, nhamu ya glenoid ya le ndzhaku; Post, endzhaku; Sup, ehenhla.)

Xifaniso 8. Ku voniwa ka arthroscopic ka ku lunghiselela glenoid: muvabyi u tshamile eka angle ya 70 °, makatla ya xinene, E-portal view. Ku kurisa ndhawu yo nghena ya le ndzhaku ya A hi trocar leyi nga vonakiki. (Ant, emahlweni; Bt: trocar leyi nga vonakiki; Gl, glenoid; Inf, ehansi; Pc, capsule ya le ndzhaku; Post, endzhaku; Sup, ehenhla.)

Ku vekiwa ka graft na ku khomiwa

Graft yi nghenisiwile hi nyangwa wa le ndzhaku laha handle yi languteke ehenhla (Fig. 9) naswona yi avanyisiwile hi misiha na capsule ya nhlangano kufikela loko yiva ekusuhi na nhamu ya glenoid yale ndzhaku naswona yi hlangana na articular surface ya glenoid. Goza leri rifanele ku kongomisa eka kululamisela ku avana, ngopfu ngopfu ku pfula infraspinatus fascia yo tiya naku tiya xikan’we naku sivela ku hundza ka graft.

• I swa nkoka ku tirhisa scalpel blade ku pfula fascia swinene. Loko swilaveka, eka xiteji xale ndzhaku xa vuhandzuri, loko ku khuluka ka flushing kuri ka nkoka swinene kuva ku hlayisa ntshikelelo lowu ringaneleke eka makatla, switirhisiwa swinga tirhisiwa ku pfala xiphemu xa xilondza xa vuhandzuri (xikombiso, swikhomo swa swilondza).

  
  

• Coracoid cannula yi vekiwa parallel na articular surface leswaku ti wires ta Kirschner leti landzelaka na ti screws tinga ngheni eka joint hinkarhi waku nghenisiwa.

  
  

• Ti wire timbirhi ta Kirschner to leha 1.5 mm ti nghenisiwile hiku tirhisa ti hollow coracoid process screws kuva ti lulamisa graft eka posterior glenoid neck (Fig. 10).

  
  

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

Xifaniso 9. Muvabyi u nghenise graft eka xiyimo xo tshama xa 70 °, naswona u langutile makatla ya xinene na tlhelo ra le ndzhaku. Graft yi nghenisiwile hi nyangwa wa le ndzhaku laha xikhomela xi languteke ehenhla. (Ant, emahlweni; DCG, nkongomiso wa swifunengeto swimbirhi; Inf, ehansi; Post, endzhaku; Sup, ehenhla.)

Xifaniso 10. Ku voniwa ka arthroscopic ka ku vekiwa ka graft, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, E entrance view. Tiphini timbirhi leti nghenisiweke ta Kirschner ti tiyisisa graft eka nhamu ya glenoid yale ndzhaku. (Ant, emahlweni; Gl, glenoid; IBG, iliac bone graft; 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 ndzhawu yale hansi yi vonaka kutlula ku kongoma. I swa nkoka ku kambela loko ku nghenisiwa ka marhambu ya ha koteka endzhaku ka ku vekiwa ka xirho xa marhambu.

• Loko graft yi flush na posterior glenoid margin, susa screw yosungula yo leha ya coracoid kutani u bora 3-2mm hiku anama bicortical glenoid tunnel eka waya wa Kirschner.

  
  

• Eka goza leri, i swa nkoka ku tshama u miyerile endzhaku ka ku titoloveta ko sungula. Vatirhi vo pfuneta va fanele ku hlayisa hi mavoko hamambirhi (Xifaniso 11).

  
  

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

  
  

• Kufanele ku tekeriwa enhlokweni leswaku unga susi waya wa Kirschner loko ku humesiwa drill bit hiku tirhisa coracoid sleeve. Kutani, nghenisa 4.5 mm xiphemu xa threaded Latarjet screw eka Kirschner wire (Fig. 12) kutani u yi nghenisa hiku hetiseka ku sivela graft kuva yi cinca, kutani u bora screw yale henhla. Hindlela leyinene, ku leha ka screw akufanelanga kutlula 32 kuya eka 36 mm.

  
  

• Ku leha kwihi na kwihi lokukulu kutlula 40 mm swilava ku kamberiwa hi vukheta, tani hileswi leswi swinga vangiwa hi steep angle ya graft loko yi pimanyisiwa na glenoid surface, leswinga tisaka graft dislocation. Eka xiyimo lexi, levele ya graft positioning yaha lulamisiwa hiku rhendzeleka ka glenoid ku rhendzela screw yale hansi.

  
  

• Endzhaku ko nghenisa screw yosungula (yale hansi), pini yosungula ya Kirschner yinga susiwa. Nghenisa xikurufu xa vumbirhi hi ndlela leyi fanaka.

  
  

• Endzhaku ko nghenisa 2 wa swikwirikiri naku susa waya wa Kirschner, tirhisa probe eka Entrance A ku kambela ndzhawu yohetelela ya graft (Figure 13). Swiphemu swihi na swihi leswi humelaka ehandle swa graft swifanele ku tsemiwa hi ti burrs, naswona akuri hava ku lunghisa ti soft tissue kufanelanga ku endliwa ku sivela ku tsana ka mahlangano.

Xifaniso 11. Graft yi vekiwile no lulamisiwa. Muvabyi u tshame hi angle ya 70 ° a langute makatla ya yena ya xinene ku suka ehenhla. Hi nkarhi na endzhaku ka ku bora ka implant, hlayisa guider yi tshama yi ri kona hi mavoko hamambirhi ku sivela layini ya K ku olovisa mugodi. (Ant, emahlweni; DCG, nkongomiso wa cannula yimbirhi; Kw, waya wa Kirschner; Post, endzhaku; Sup, ehenhla.)

Xifaniso 12. Ku voniwa ka arthroscopic ka graft fixation, muvabyi a tshamile eka 70 ° angle, makatla ya xinene, xivono xa ku nghena xa elektroniki. Xikurufu xale hansi xa 4.5mm lexinga threaded xiphemu xa Latarjet xisungula ku kumeka ehenhla ka pini ya Kirschner. (Ant, emahlweni; 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 entrance view. Endzhaku ko nghenisa swikwirikiri swimbirhi na 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, emahlweni; Gl, glenoid; Hh, nhloko ya humeral; IBG, iliac bone graft; Inf, ehansi; Post, endzhaku; 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. Ku pronation na ku famba-famba loku vavaka swifanele ku papalatiwa.

  
  

• Eka mavhiki ya 3, sungula switoloveto leswi tirhaka swa range of motion.

  
  

• Endzhaku kaloko ku tshamiseka 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, computerized tomography yifanele ku endliwa 3 wa tinhweti endzhaku ka vuhandzuri ku kambela ku hlanganisiwa ka graft.

  
  

Ndlela Yo Xava Switirhisiwa Swa Marhambu Ni Switirhisiwa Swa Marhambu!

Swa CZMEDITECH , hi na layini ya swikumiwa leyi heleleke swinene ya switirhisiwa swa vuhandzuri bya marhambu na switirhisiwa leswi fambelanaka, swikumiwa ku katsa ku nghenisiwa ka nkolo, swipikiri swa le ndzeni ka medullary, pulati ya khombo, ku pfala pulati, cranial-maxillofacial ya xikandza, xirho xa xitekela, switirhisiwa swa gezi, switirhisiwa swo khoma swilo swa le handle, ku kamberiwa ka marhambu, nhlayiso wa swifuwo na tisethi ta switirhisiwa swa vona swo seketela.

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

Hi rhumela ehandle emisaveni hinkwayo, leswaku u nga swi kota tihlanganisi na hina eka email address 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,click CZMEDITECH ku kuma vuxokoxoko byo tala.