Unyango lwe-arthroscopic lwe-postering tender

Ukungazinzi kwe-posterint Ukungazinzi kuhlala kubangelwa kukungabinamsebenzi ongasemva okanye ukuphindaphinda okuncinci ngexesha lokuzilolonga ngexesha lokuzivocavoca okanye ngeminye imisebenzi, amatyala e-100000 ngonyaka. Iindlela ezininzi zoqhawulo-mveliso kunyango lwe-postering teer aziswanga, kubandakanya nokulungiswa kwezicubu ezithambileyo kunye nokuvula i-bone upby yethambo. Nangona kunjalo, iingxaki zoqhankqalazo ezixeliweyo kunye nenqanaba lokuhlaziya zaziphezulu njenge-14% ne-67%, ngokwahlukeneyo. Ngokukodwa, ukubekwa ngokuchanekileyo kwethambo lethambo, i-screw iqhelene nonyango lwezilonda ezidibeneyo zithathwa njengezicelo zimngeni. Ke ngoko, ubuchule bokhuphiswano kufuneka luphuculwe.

Amanyathelo amanyathelo okusebenza:

• Umsebenzi wenziwa phantsi kwe-anesthesia jikelele edibene nebhloko yengingqi ye-sulmuscus stulcus.

• Ingqokelela ye-Iliac Crest, i-anesthetics yendawo yangaphantsi yasetyenziswa ngokutsha kunye ne-pround.

• Isigulana sabekwa kwisitulo esisemaphandleni ngasemva kwi-45 ° engle ukuvumela unxibelelwano olupheleleyo kunye ne-Iliac Crest. Emva kokuba kuvunwe ithambo, utyando lwaqhubeka, kwaye isigulana sasihleli kwi-angle engama-70 °. Isigulana samiswa ngendlela esemgangathweni esisezantsi, kwaye ingalo yokusebenza yayigobile nge-30 ° ukuya kwi-2 ukuya kwi-3 kg yentambo.

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Uvavanyo oludibeneyo lwe-Arthroscopic

• Le nkqubo isebenzisa amangenelo amabini okanye amathathu. Umphambili wokuqala (e) Ukungena kunokusetyenziselwa ukuhlolwa ngokudibeneyo.

  
  

• I-RAGES inokwaziswa ngokuthe ngqo kumalungu ngamaxesha eenqaba. Ngamanye amaxesha, akunakwenzeka ukuba wazise ngokuthe ngqo umda (okt, izicubu ezinqwenelekayo zijikeleze ixesha le-rototor).

  
  

• Unokwenza umnyango we-CATAL okanye umphambili we-DATALD DALL, ukuze ungene kwindawo ephantsi kwe-Acromion Peak, ukuze ungayiboni indawo yemisipha ye-acromion.

  
  

• I-Arthroscopic Adpall yeRadiafrequency yasetyenziselwa ukuvula ixesha lokuphumla le-totor.

  
  

• I-Toggle Lever ibekwe kwi-edibene ngokungena e-e ukuguqula uluhlu lwangaphakathi oluhlanganisiweyo.

  
  

• Emva kovavanyo olupheleleyo lwentsebenzo, izilonda ezithambileyo ze-tissue kunye nezilonda ze-glenoid kunye ne-humeral bone (okt, i-bimer the genesing, i-gesenoid ye-genesing, i-Glenoid ye-Gill Sasion Cossion) yavavanywa.

  
  

• Emva kovavanyo olucokisekileyo lwe-arthroscopic lwe-glenohimeral jonint kunye nokuqinisekiswa kweempawu ezifanelekileyo, amaqhinga amathambo afunyanwa.

  
  

Ukuvuna ukuvuna kunye nokulungiselela

• I-autograft ye-bicurrical yafunyanwa kwi-Iplilateral ye-Iliact Crest ukugcina i-carnet ye-pelvis. Yenza incasa ye-2cm malunga ne-2cm esemva kwe-ANTAC Spiner Spine kunye ne-2cm ngaphantsi kweCrest kwi-CRST kwiCrest kwi-Iliac Crest ukunqanda ukwenziwa kwe-crest.

  
  

• Emva kokujonga ithambo lethambo le-cortical kwaye β

  
  

• Isibambo sesikhokelo sijonge phezulu ukuze ingqumbo yethambo ingakwazi ukwenziwa i-anatomical athe thesteringi engaphantsi ye-guringer intamo. Ukubekwa kwesikhokelo kuvumela ukhetho lomqolo ophezulu njengecala lobugcisa bebhloko yethambo.

  
  

• Emva koko, tyhala i-Coracoid yenkqubo ye-coracoid yenyathelo kwi-wirchner wire kunye ne-drill mibini ye-2.9mm kwibhloko yethambo. I-Drill bit kunye nePIN yeKirschner zasuswa. Ngaphambi kokufaka i-cap ye-washer emngxunyeni we-Drill, cofa umngxunya ngeplanga ephezulu.

  
  

• Nje ukuba i-cap ephezulu ikwindawo, sebenzisa i-swing saw okanye ithambo ukugcina i-cortex ye-Iliac Crest kwaye ivune i-2-CM × 1-cm × 1-cm grafts (inani 2 kunye ne-2). Emva kokuba i-graft ivuniwe, ibhloko yethambo iqhagamshelwe kwinkqubo ye-coracoid kunye neendlela ezimbini ze-coracoid ye-coracoid isetyenziselwa ukwenza iyunithi enokuthi isetyenziswe kwisikhundla sayo sokugqibela (Fig. 4).

  
  

• I-Iliac Crest Woot yayiyi-famiter evaliweyo ngomaleko ngetyhefu ye-cloinage kunye nokunxiba kwasetyenziswa. Emva koko lungisa umva wetafile yokusebenza kwi-angle ye-70 °.

Umzobo 1. Ithambo le-Iliac lasekunene i-Iliac laqokelelwa xa isigulana sasisesibini sendawo yokuhlala. Ezi zixhobo ezimbini zeKirschner zikwindawo kunye nesikhokelo se-cannula esiphindwe kabini, kunye nesiphatho se-cannula siphezulu. .

Umzobo 2. Xa isigulana sikwisikhundla esiselunxwemeni, ibhloko yethambo ye-iliac crest ithathiwe. Susa i-Drill bire kunye ne-wirchner wire emva kokuqhuba iqonga le-Iliac Crest Cost, emva koko ufake i-2 '. (Imbovane, ngaphambili; i-DCG, isikhokelo esiphindwe kabini;

Umzobo 3. Xa isigulana sikwisikhundla esiselunxwemeni, ibhloko yethambo le-Iliac crest ithathiwe. Umphezulu wangaphakathi we-Iliac uhleli ucinga emva kokuba i-graft ivuniwe. (Imbovane.

Umzobo 4. Lungisa iibhloko zethambo kwitafile esecaleni. Emva kokuba i-graft yayivunwa, ingqolowa yethambo yaqhagamshelwa kwi-cannula ephindwe kabini kusetyenziswa i-ortilators ezimbini ze-cannula. .

Ngasemva kweempawu zendlela kunye neendlela zokufikelela

• Ngokwesiqhelo izitishi ezimbini ukuya kwezintathu ziyasetyenziswa. Injongo kukuhambelana nepostalior ye-inlet kunye nomgca odibeneyo we-glenohumeral kangangoko kunokwenzeka. Ke ngoko, ilawulwa yi-arthroscope. Ke ngoko, ifakwe ikakhulu emva kotyando ukusuka kwi-Interlet yamva.

  
  

• Umnyango we-anterolateral Ibekwe kwindawo ye-rotorer ye-rotorer ngaphezulu kwemisipha ye-Biceps, enokuthi ibonise ngokugqibeleleyo i-posterity icala le-Glenoid Edge (iTheyibhile 1).

  
  

• Kwiimeko ezininzi, akukho ziteshi zifunekayo; Nangona kunjalo, ukuba kukho imfuneko, i-Potrollateral eyongezelelweyo ye-Bingt nge-cuff engasemva inokusetyenziswa (umzekelo, ukulawula i-ProSTheses yeLabial).

  
  

• Ngokufanelekileyo, ukungena i-A ifumaneka ngokuchanekileyo kwi-axis yomgca odibeneyo we-glenohumeral.

  
  

• Ngombhalo wangaphambili nangasemva womnyango e, faka i-2 ye-Spine ifumene kumgama oziimitha ezi-2,5 ukuya kwi-3 cm, kwaye ifake isikhundla esithile kwi-7 ye-O'Clock Stores (igxalaba eli-9).

  
  

• Yenza incasa inzuzo phakathi kweenaliti ezi-2 kwaye uyisebenzise njenge-por ring isebe (amanani 5a kunye b).

Umzobo 5. (A) Isigulana siyakrokrela kwaye silungiselele isikhumba kwisikhundla se-70 ° Englengi ye-engle, igxalaba lasekunene kunye nembono ye-enthe. Ukuze kufezekiswe olona phawu lubalaseleyo phakathi kwe-inlet kunye ne-Glenohimeral umgca odibeneyo, iinaliti ezimbini ze-spine zifakwe ngasemva ukufumanisa uphawu lolusu.

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Ukulungiswa kwe-glenoid

• Isixhobo saziswa ngokusebenzisa ngasemva (a).

  
  

• Susa i-labrum kunye ne-Popstior Popsule ukusuka kwi-7 ukuya kwi-10 (iArder yasekunene) usebenzisa i-vapr kunye ne-razor (i-razor (fig. 6a kunye nevidiyo 1).

  
  

• Gikeza intamo yasemva kwe-gesenoid nge-arthroscopic i-arthroscopic de ithambo le-bone livezwe kwaye inqwelomoya ilungisiwe (Fig. 7). Nje ukuba intamo ye-glenoid ilungele, i-inlet ingenguye i-inlet ikhuliswe ukuba ivumele isithuba se-Graft kunye ne-Coracoid ephindwe kabini.

  
  

• Isikali singasetyenziselwa ukwandisa iCandelo leMsipha kunye ne-cystomyy, ngelixa i-trocar yoxande ye-trocar (indibano yesiseko) inokusetyenziselwa ukuphindaphinda isicatshulwa (umzobo 8).

Umzobo ongu-6 Ngexesha lokulungiswa kwe-gilenoid, sebenzisa i-vapr kunye ne-razor yokuphatha imilebe ye-glenoid kunye ne-poptule yasemva kwi-7: 00 kuye ku-10: 00. .

Umzobo 7. Umbono we-Arthroscopic wokulungiswa kwe-gilenoid: Isigulana sahlala kwi-Angle ye-70 °, egxalabeni lasekunene, umbono ofanelekileyo, umbono we-E-Portal. Ukunxiba kwi-postenoid ye-postenoid ngexesha lokulungiselela kwe-glenoid. .

Umzobo 8. Umbono we-Arthroscopic wokulungiswa kwe-glenoid: Isigulana sahlala kwi-Angle ye-70 °, ibhinqa lasekunene, umbono ofanelekileyo, umbono we-E-Portal. Yandisa ngasemva i-inlet nge-rocar ye-blunt. (Imbovane.

Indawo yokusebenza kunye nokulungiswa

I-graft ifakwe ngokungena ngaphakathi komnyango ojongene nesiphatho esijonge phezulu (umzobo 9) kwaye yahlulwe nge-guricule kunye ne-cepsule edibeneyo de ibe kufutshane ne-postenoid ye-gitter. Eli nyathelo kufuneka ligxile kulungiselelo lokwahlulahlula, ngakumbi ukuvula i-infraspinatus enkulu kunye neyomeleleyo ye-infraspinatus ifayili kunye nokuthintela ukuhamba kwe-graft.

• Kubalulekile ukusebenzisa i-scalpel blade ukuvula i-fascia kakhulu. Ukuba kukho imfuneko, kwinqanaba elilandelayo lotyando, ukuba ukuvuza okugungxulayo kubaluleke kakhulu ukugcina uxinzelelo olwaneleyo egxalabeni, izixhobo zingasetyenziselwa ukuvala inxeba lokuhlimela (umzekelo, iziqendu).

  
  

• I-Coracoid canula ifakwe kumhlaba wobugcisa ukuze i-serschner ye-kirschner ilandelayo kunye nezikrelemnqa aziyingene kwi-raint ngexesha lokufakelwa.

  
  

• Iintambo ezimbini ze-1,5 ze-kirschner ezimde ze-kirschner zafakwa kwi-Corancoid yenkqubo ye-coracoid ukulungisa ubumfihlo kwi-postenoid intamo (Fig. 10).

  
  

• Ukufakwa kwe-cire ye-kirschner akufuneki idlule kwi-40mm ukunqanda ukudlula kwintamo engaphandle ye-Glenodi, enokulimaza ubume be-neurovascular, nangona kuphela inxalenye yomsipha weplavapula, nangona i-neurovascular ikhusela.

Umzobo 9. Isigulana sifake i-graft kwi-70 ° Ukuhlala indawo yokuhlala, kwaye yabona igxalaba lasekunene kunye necala lendawo yeposti. I-Graft ifakwe ngokungena-umqolo kunye nesiphatho esijonge phezulu. (Umbondlo, ngaphambili; i-DCG, isikhokelo esiphindwe kabini;

Umzobo we-10. Ukuboniswa kwe-10 I-pins ezimbini ezifakilisiweyo zeKirschner uzinzile i-gleft yentamo yasekhaya. .

Ukususela kwi-30 ° Arthroscope ijongwa phambi kwethambo le-portal, ngokwemvelo idla ngokutsala i-Graft kwi-engile, esenza umhlaba ongezantsi kunokuba uthe tye. Kubalulekile ukujonga ukuba i-bone greft isenokwenzeka emva kokubekwa kwemali.

• Nje ukuba i-graft igungxule i-posteroid glenoid umda, susa isikrelemnqa sokuqala kunye ne-Tlecoid Glenodi ye-Glenodi ye-Glenodi.

  
  

• Kweli nyathelo, kubalulekile ukuba uhlale emva kwento yokuqala. Abasebenzi abancedisayo kufuneka bagcine ngezandla zombini (umzobo 11).

  
  

• Kuya kufuneka ilungiselelwe ukubeka iPIN yeKirschner yesithathu emngxunyeni, kuba iPIN yeKirschner kwindawo yayo yoqobo ihlala ibanjwa kwimoto ngokubhekisele kwi-Drill.

  
  

• Inkathalo kufuneka ithathwe ungayisusi i-wirchner wire xa ikhupha i-drill bir bill bir nganye kwi-coracoid. Emva koko, faka i-4.5 mm ye-itread ye-Laserjet screw kwi-wire ye-kirchner kwi-kirschner wire (Fig. Ngokufanelekileyo, ubude be-screw akufuneki budlule kwi-32 ukuya kwi-36 mm.

  
  

• Nakuphi na ubude bungaphezulu kwe-40 mm kufuna uviwo ngononophelo, njengoko oku kunokuba kungenxa ye-angle ye-graft enomgangatho we-glenodi, onokukhokelela ekunikezelweni kwe-glenore. Kweli nqanaba, inqanaba lemigangatho ye-Graft isenokulungiswa ngokujikeleza i-glenoid ijikeleze isikrini esisezantsi.

  
  

• Emva kokufaka isikhafu sokuqala (esezantsi), i-pirchner ye-kirchner yokuqala inokususwa. Faka isikrikhi sesibini ngendlela efanayo.

  
  

• Emva kokufaka i-Tricks ezi-2 kwaye ususe ucingo lwe-kirschner wire, sebenzisa iProbe ekungeneni kwe-A ukukhangela indawo yokugqibela (umzobo 13). Naziphi na iinxalenye ezivela kwi-graft kufuneka zincitshiswe ngabarhafi, kwaye akukho kulungiswa kwezicubu ezithambileyo kufuneka zenziwe ukukhusela ukungaphumi.

Umzobo we-11. I-Graft ibekwe kwaye ilungisiwe. Isiguli sahlala kwi-Angle ye-70 ° egxalabeni lakhe lasekunene lijongwa ngaphezulu. Ngexesha nasemva kokuphelisa ukuqhuba, gcina umgundu usezandleni zozibini ukukhusela umgca wokukhulula umjelo. (Imbovane.

Umzobo we-12. Umbono we-Arthroscopic wokulungiswa kweGraft, isigulana esihleli ngo-70 ° Engle, igxalaba elifanelekileyo, ukujonga nge-elektroniki. I-4.5mm esezantsi ye-4,5mm ye-Laturjet screw bokuqala ikwindawo yokuqala ephezulu kwiPIN yeKirschner. .

Umzobo 13. Ukuboniswa kwe-Arthroscopic ye-Retfing, isigulana esihleli ngo-70 ° Engle, igxalaba lasekunene, ukujonga okungeneyo. Emva kokufaka izikrelem ezimbini kwaye ususe ucingo lwe-kirschner, jonga indawo yokugqibela ye-transkent. Olu hlobo lwethambo lobuchopho lunendlela elungileyo kwaye akukho sikhundla sinekratshi. .

Emva kotyando, igxalaba lalilungelelaniswe nge-20 ° Ukujikeleza okungathathi hlangothi kwiiveki ezi-6:

• Ngosuku olulandelayo emva kotyando, qala igxalaba, i-elbow kunye nenqanaba lokuzilolonga. Ukuhlela kunye nokuhamba kobuhlungu kufuneka kuthintelwe.

  
  

• Kwiiveki ezi-3, qala uluhlu olusebenzayo lokuzilolonga.

  
  

• Emva kozinzo lwe-greft uqinisekisiwe ngokuthatha iifoto ezi-6 emva kotyando, umthambo onzulu unokuqaliswa.

  
  

• Kwiimbaleki ezifuna ukubuyela kwakhona ngokukhawuleza, i-tomography ye-toography kufuneka yenziwe kwiinyanga ezi-3 emva kotyando lokuvavanya ukudityaniswa kweCraft.

  
  

Ungayithenga njani i-orphopents kunye nezixhobo ze-orthopedic?

Kuba I-CZMEDICH , sinomgca opheleleyo wemveliso ye-Orthoric utyanSpents kunye nezixhobo ezihambelana nayo, iimveliso kubandakanya i-spine ifakinti, izipikili ze-intramellary, Iplate ye-Mouma, Ukutshixa iplate, I-cranial-maxillofacial, I-Prosthesis, izixhobo zombane, Abalungisi bangaphandle, I-Arthroscopy, Inkathalo yonyango lwezilwanyana kunye neeseti zesixhobo zazo.

Ukongeza, sizimisele ukuqhubeka nokuphuhlisa iimveliso ezintsha kunye nokwandisa imigca yemveliso, ukuze kuhlangatyezwane neemfuno zonyango noogqirha kunye nezigulana, kwaye zenze ukuba inkampani yethu ikhuphisane kwishishini le-Orthopenic yeHlabathi yeHlabathi.

Sithumela ilizwe liphela, ukuze unakho Nxibelelana nathi kwi-imeyile ye-imeyile Ingoma Ingoma Ingoma ye-imeyile I-Ngcebiso yasimahla, okanye uthumele umyalezo kwi-whatsapp yokuphendula ngokukhawuleza + 86- 18112515727 .

Ukuba ufuna ukwazi ngakumbi ulwazi, cofa I-Czemedch ukufumana iinkcukacha ezininzi.