Unyango lwe-Arthroscopic yokungazinzi kwamagxa angasemva

Ukungazinzi kwegxala elingemva ngokuqhelekileyo kubangelwa ukunyanzeliswa kwe-posterior dislocation okanye ukuphindaphinda ukulimala okuncinci ngexesha lokuzilolonga okanye eminye imisebenzi, kunye nenani leziganeko zonyaka ze-4.64 kwi-100000 abantu ngonyaka. Iindlela ezininzi zokuhlinzwa zokunyanga ukungazinzi kwamagxa angasemva zichazwe, kubandakanywa ukulungiswa kwezicubu ezithambileyo kunye nokuhlinzwa okuvulekileyo kunye ne-arthroscopic bone block. Nangona kunjalo, iingxaki zotyando ezixeliweyo kunye namazinga okuhlaziya ayephezulu njenge-14% kunye ne-67%, ngokulandelanayo. Ngokukodwa, ukubeka ngokuchanekileyo ukufakwa kwamathambo, i-screw orientation kunye nokunyangwa kwezilonda ezihambelanayo zibhekwa njengomngeni. Ngoko ke, iindlela zokwenza utyando kufuneka ziphuculwe.

Amanyathelo okusebenza:

• Umsebenzi wenziwa phantsi kwe-anesthesia jikelele kunye nebhloko yengingqi ye-intermuscular sulcus.

• Ukuqokelela i-iliac crest, i-anesthetics yendawo isetyenziswe ngaphantsi kwe-subcutaneously kunye ne-periosteally.

• Isigulana sibekwe kwisitulo solwandle kunye nomva kwi-angle ye-45 ° ukuvumela ukudibanisa ngokupheleleyo kunye ne-iliac crest. Emva kokuvunwa kwethambo, utyando lwaqhubeka, kwaye isigulane sasihleli kwi-angle ye-70 °. Isigulana sanqunyanyiswa ngendlela esemgangathweni, kwaye ingalo yokusebenza yayigobelwe phambili kwi-30 ° nge-2 ukuya kwi-3 kg yentambo yokutsala.

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Uvavanyo oludibeneyo lweArthroscopic

• Le nkqubo isebenzisa ezimbini okanye ezintathu zokungena. Umnyango wokuqala (E) wokungena ungasetyenziselwa ukuphonononga ngokucokisekileyo.

  
  

• Uluhlu lungangeniswa ngokuthe ngqo kumalungu ngokusebenzisa izithuba zokujikeleza. Kwezinye iimeko, akunakwenzeka ukwazisa ngokuthe ngqo ububanzi (oko kukuthi, izicubu ezibomvu ezijikeleze isithuba sokujikeleza).

  
  

• Unokwenza i-lateral ye-C yokungena okanye i-front lateral ye-D yokungena, ukuze ukwazi ukungena kwindawo phantsi kwe-acromion peak, ukuze ukwazi ukujonga indawo ye-rotator muscle.

  
  

• I-Arthroscopic radiofrequency ablation yayisetyenziselwa ukuvula isithuba sokujikeleza.

  
  

• I-lever yokuguqula ibekwe kwindawo edibeneyo ngokungena kwe-E ukutshintshela uluhlu kwimbono yangaphakathi edibeneyo.

  
  

• Emva kovavanyo olubanzi lwe-joint, izilonda zezicubu ezithambileyo kunye nezilonda ezinxulumene ne-glenoid kunye ne-humeral bone loss (okt, i-posterior glenoid lip, i-capsule edibeneyo, i-glenoid marginal lesion kunye ne-reverse lesion ye-Hill Sachs) yavavanywa.

  
  

• Emva kokuvavanya ngokucokisekileyo kwe-arthroscopic ye-joint glenohumeral kunye nokuqinisekiswa kwezibonakaliso ezifanelekileyo, ukufakwa kwamathambo kwafunyanwa.

  
  

Ukuvunwa nokulungiswa kokutshintshwa kwethambo

• I-autograft ye-bicortical yafunyanwa kwi-ipsilateral anterior iliac crest ukuze igcine i-cortex yangaphakathi ye-pelvis. Yenza ulusu ulwenze malunga ne-2cm ngasemva kwe-iliac spine yangaphambili kunye ne-2cm ngaphantsi kwe-crest ecaleni kwe-iliac crest ukunqanda ukubunjwa kwebala eligubungela ngokuthe ngqo i-crest.

  
  

• Emva kokuqwalasela ithambo le-cortical α kunye ne-β Izikhonkwane ezimbini ze-Kirschner ezihambelanayo zifakwe kwi-cortex yecala ngokusebenzisa umngxuma, owawuxhotywe ngaphambili ngee-screws ezimbini ze-coracoid ezide ukusuka kwisixhobo se-Arthroscopic Latarjet (Umfanekiso 1).

  
  

• Umqheba wesikhokelo ujolise phezulu ukuze i-glenoid yamathambo ihambelane ne-anatomically kunye nentamo ye-glenoid engaphantsi. Ukubekwa kwesikhokelo kuvumela ukukhetha umqolo ophezulu njengecala le-articular yebhloko yethambo.

  
  

• Emva koko, tyhala inyathelo lenkqubo ye-coracoid emngxunyeni kucingo lwaseKirschner kwaye ugrumbe imingxunya emibini eyi-2.9mm kwibhloko yethambo. I-drill bit kunye ne-Kirschner pin zasuswa. Phambi kokufaka iwasha yesivalo esingaphezulu kumngxunya wokukrola, cofa umngxuma ngetephu ephezulu.

  
  

• Emva kokuba i-cap top isendaweni, sebenzisa i-swing saw okanye i-bone knife ukugcina i-cortex ye-medial ye-iliac crest kunye nokuvuna i-2-cm × 1-cm × 1-cm i-grafts (Amanani 2 kunye ne-3). Emva kokuba i-graft ivuniwe, ibhloko yethambo idityaniswe kwi-sleeve yenkqubo ye-coracoid kunye nezikrufu ezimbini zenkqubo ye-coracoid ezide zisetyenziselwa ukwenza iyunithi enokuthi isetyenziswe kwindawo yayo yokugqibela (umzobo 4).

  
  

• Inxeba le-iliac crest livaliwe ngomaleko kunye netyhubhu yokuhambisa amanzi kunye nokunxiba kwasetyenziswa. Emva koko ulungise umva wetafile yokusebenza kwi-angle ye-70 °.

Umzobo 1. Ithambo elilungileyo le-iliac crest liqokelelwe xa isigulane sisesihlalweni solwandle. Iinaliti ezimbini ze-Kirschner zibekwe kunye nesixhobo sesikhokelo se-cannula esiphindwe kabini, kwaye isibambo se-cannula siphezulu. (Imbovane, ngaphambili; DCG, isikhokelo secasing kabini; Inf, iPosi esezantsi, ngasemva; Sup, phezulu.)

Umzobo 2. Xa isigulane sisesihlalweni se-beach chair, ibhloko yethambo ye-right iliac crest ithathwa. Susa i-drill bit kunye nocingo lwaseKirschner emva kokubhola iqonga elisecaleni le-iliac crest cortex, uze ufake 2 'iminqwazi'. (Imbovane, ngaphambili; DCG, isikhokelo secasing ephindwe kabini; Inf, ngezantsi; Iposti, ngasemva; Sup, phezulu; TH, umnqwazi ophezulu.)

Umzobo 3. Xa isigulane sihlala kwindawo yesitulo solwandle, ibhloko yethambo ye-right iliac crest ithathwa. Umphezulu wangaphakathi we-iliac crest uhlala ulungile emva kokuba i-graft ivuniwe. (Imbovane, ngaphambili; Inf, ezantsi; IT, itafile engaphakathi; Iposti, ngasemva; Sup, phezulu.)

Umzobo 4. Lungisa iibhloko zamathambo kwitafile esecaleni. Emva kokuba i-graft ivuniwe, i-graft yamathambo yadityaniswa kwi-cannula ephindwe kabini kusetyenziswa ii-obturators ezimbini ze-cannula. (Imbovane, ngaphambili; i-DCG, isikhokelo se-cannula ephindwe kabini; i-IBG, i-iliac bone transplantation; i-Inf, iphantsi; i-Post, umva; i-Sup, phezulu.)

Iimpawu zendlela yangasemva kunye neendlela zokungena

• Ngokuqhelekileyo kusetyenziswa amajelo amabini ukuya kwamathathu. Injongo kukulungelelanisa i-posterior A inlet kunye ne-glenohumeral joint line kangangoko kunokwenzeka. Ngoko ke, ilawulwa yi-arthroscope. Ke ngoko, yenziwa ikakhulu emva kokusebenza ukusuka kwindawo yokungena esecaleni yangaphambili.

  
  

• Umnyango we-anterolateral u-E ubekwe kwindawo ye-rotator muscle ngaphezu kwe-biceps muscle, engabonisa ngokugqibeleleyo inxalenye yangasemva ye-glenoid edge (Itheyibhile 1).

  
  

• Kwiimeko ezininzi, akusekho mfuneko yamajelo; Nangona kunjalo, ukuba kuyimfuneko, i-posterolateral B inlet eyongezelelweyo nge-cuff yangasemva ingasetyenziselwa (umzekelo, ukulawula i-prostheses ye-labial complementary).

  
  

• Ngokufanelekileyo, i-Entrance A ibekwe kanye kwi-axis yomgca we-glenohumeral joint.

  
  

• Ngokusebenzisa imbonakalo yangaphambili nangemuva yokungena kwe-E yokungena, faka iinaliti ezi-2 zomqolo emva kumgama we-2.5 ukuya kwi-3 cm, kwaye ufake i-joint kwi-parallel kwi-7 yentsimbi kunye ne-9 izikhundla (igxalaba lasekunene).

  
  

• Yenza ukusika kwesikhumba phakathi kweenaliti ezi-2 kwaye uyisebenzise njengesango lokungena elingasemva (Amanani 5A kunye no-B).

Umzobo 5. (A) Isigulane siya kumakisha kwaye silungiselele ukukhutshwa kwesikhumba kwindawo yokuhlala ye-70 °, igxalaba lasekunene kunye nombono we-E wokungena. Ukuze ufezekise ukulungelelaniswa okuhle phakathi kwe-A inlet yangasemva kunye nomgca odibeneyo we-glenohumeral, iinaliti ezimbini zomqolo zifakwe ngasemva ukuze ziqinisekise uphawu lwesikhumba.

(B) I-Arthroscopic visualization, igxalaba lasekunene, kunye ne-electronic portal view yesigulane esinenaliti kwindawo yokuhlala ye-70 °. (Imbovane, ngaphambili; i-DCG, isikhokelo se-cannula ephindwe kabini; i-Gl, i-glenoid; i-Inf, iphantsi; i-Post, i-posterior; i-PC, i-capsule yangasemva; i-Sn, inaliti yomgogodla; i-Sup, ephezulu.)

Ukulungiswa kweGlenoid

• Isixhobo singeniswa nge-inlet yangasemva (A).

  
  

• Susa i-labrum kunye ne-capsule yangasemva ukusuka kwi-7 ukuya kwi-10 (ihlombe lasekunene) usebenzisa i-VAPR kunye ne-razor (Umfanekiso 6A kunye no-B, iVidiyo ye-1).

  
  

• Gaya intamo ye-glenoid yangasemva kunye ne-arthroscopic burrs kuze kube yilapho ithambo elophayo libonakaliswe kwaye indiza ilungiselelwe (umzobo 7). Emva kokuba intamo ye-glenoid ilungile, i-posterior A inlet yandisiwe ukuvumela ukudlula kwe-glenoid kunye ne-double coracoid cannula.

  
  

• I-scalpel ingasetyenziselwa ukwandisa ukwahlukana kwe-muscle kunye ne-cystotomy, ngelixa i-trocar e-rectangular blunt (i-subscapular passage) ingasetyenziselwa ukwandisa isicatshulwa (Umfanekiso 8).

Umzobo 6. (AB) Umbono wokulungiswa kwe-glenoid phantsi kwe-arthroscopy, isigulane sihleli kwi-angle ye-70 °, igxalaba lasekunene, i-electronic entrance view. Ngethuba lokulungiswa kwe-glenoid, sebenzisa i-VAPR kunye ne-razor ukukhupha umlomo we-glenoid kunye ne-capsule yangasemva ukusuka kwi-7: 00 ukuya kwi-10: 00. (Imbovane, ngaphambili; I-Gl, i-glenoid; Hh, intloko ye-humeral; I-Inf, iphantsi; I-Pc, i-capsule yangasemva; I-Post, i-posterior; i-Sup, i-high; V, i-VAPR.)

Umzobo 7. I-Arthroscopic visualization yokulungiswa kwe-glenoid: isigulane sihleli kwi-angle ye-70 °, ihlombe lasekunene, i-E-portal view. Ukugqoka intamo ye-glenoid yangasemva ngexesha lokulungiselela i-glenoid. (Imbovane, ngaphambili; B, burr; Gl, glenoid; Inf, ngaphantsi; Pgn, intamo yeglenoid engasemva; Iposti, ngasemva; Sup, phezulu.)

Umzobo 8. I-Arthroscopic visualization yokulungiswa kwe-glenoid: isigulane sihleli kwi-angle ye-70 °, ihlombe lasekunene, i-E-portal view. Yandisa i-A inlet yangasemva ngetrocar ebuthuntu. (Imbovane, ngaphambili; Bt: blunt trocar; Gl, glenoid; Inf, ngaphantsi; I-PC, i-capsule yangasemva; I-Post, i-posterior; i-Sup, i-pper.)

Ukubekwa kwegrafti kunye nokulungiswa

I-graft yafakwa ngokungena ngasemva kunye nesibambo esijonge phezulu (umzobo 9) kwaye yahlula phakathi kwe-muscle kunye ne-capsule edibeneyo kuze kube kufuphi nentamo ye-glenoid yangasemva kunye ne-flush kunye ne-articular surface ye-glenoid. Eli nyathelo kufuneka ligxininise ekulungiseleleni ukwahlula, ngokukodwa ukuvula i-infraspinatus fascia engqingqwa kwaye eyomeleleyo kunye nokuthintela ukudlula kwe-graft.

• Kubalulekile ukusebenzisa i-scalpel blade ukuvula i-fascia ngokubanzi. Ukuba kuyimfuneko, kwinqanaba lokugqibela lotyando, ukuba ukuvuza okugungxulwayo kubaluleke kakhulu ukugcina uxinzelelo olwaneleyo egxalabeni, izixhobo zingasetyenziselwa ukuvala ngokuyinxenye inxeba lotyando (umzekelo, iikliphu zenxeba).

  
  

• I-coracoid cannula ibekwe ngokuhambelana nomgangatho we-articular ukwenzela ukuba iingcingo ze-Kirschner ezilandelayo kunye nezikrufu zingangeni kwi-joint ngexesha lokufakwa.

  
  

• Iingcingo ezimbini ze-1.5 mm ubude be-Kirschner zifakwe kwi-screws yenkqubo ye-coracoid engenanto ukulungisa i-graft kwintamo ye-glenoid yangasemva (Umfanekiso we-10).

  
  

• Ukufakwa kwentambo ye-Kirschner akufanele kudlule i-40mm ukuphepha ukudlula kwintamo ye-glenoid yangaphambili, engonakalisa isakhiwo se-neurovascular yangaphambili, nangona kuphela inxalenye ye-subscapularis muscle ikhona phakathi kwentamo kunye nesakhiwo se-neurovascular ukukhusela.

Umzobo 9. Isigulane sifake i-graft kwindawo yokuhlala ye-70 °, kwaye yaqaphela ihlombe lasekunene kunye necala le-posterolateral. I-graft yafakwa kwisango elingasemva kwaye umqheba ujonge phezulu. (Imbovane, ngaphambili; DCG, isikhokelo secasing kabini; Inf, ngezantsi; Iposti, ngasemva; Sup, phezulu.)

Umzobo 10. Umbono we-arthroscopic we-graft positioning, isigulane sihleli kwi-angle ye-70 °, igxalaba lasekunene, ukujonga kwe-E yokungena. Izikhonkwane ezimbini ezifakwe kwi-Kirschner zizinzisa i-glenoid entanyeni ye-glenoid yangasemva. (Imbovane, ngaphambili; Gl, glenoid; IBG, iliac bone graft; Inf, ezantsi; Kw, Kirschner wire; Iposi, ngasemva; Sup, phezulu.)

Ukusukela ukuba i-30 ° i-arthroscope ijongwa ngaphambili kwi-portal vein, ngokwendalo ithande ukutshekisa i-graft kwi-engile, isenza umphezulu osezantsi ubonakale endaweni yokuba uthe tye. Kubalulekile ukujonga ukuba uxhulumaniso lwethambo lusenokwenzeka na emva kokufakwa kwegrafti.

• Nje ukuba igrafti igungxulwe ngomda ongasemva weglenoid, susa isikrufu sokuqala eside secoracoid uze ubhobhoze itonela eyi-3-2mm ebanzi yebicortical glenoid kucingo lweKirschner.

  
  

• Kweli nyathelo, kubalulekile ukuba uhlale uthule emva koqheliselo lokuqala. Abasebenzi abancedisayo kufuneka bagcine ngezandla zombini (Umfanekiso 11).

  
  

• Kufuneka ilungiselelwe ukubeka i-pin ye-Kirschner yesithathu emngxunyeni, kuba i-Kirschner pin kwindawo yayo yokuqala idla ngokubanjwa kwi-motor ngokungazithandiyo nge-drill bit.

  
  

• Kufuneka kuthatyathwe unonophelo ukuba ungalususi ucingo lweKirschner xa ukhupha i-drill bit ngokusebenzisa umkhono wecoracoid. Emva koko, faka i-4.5 mm i-screw ye-Latarjet ephothiweyo ngokuyinxenye kwintambo ye-Kirschner (Umfanekiso we-12) kwaye uyifake ngokupheleleyo ukukhusela i-graft ekutshintsheni, uze uqhube i-screw ephezulu. Ngokufanelekileyo, ubude be-screw akufanele budlule kwi-32 ukuya kwi-36 mm.

  
  

• Nabuphi na ubude obungaphezu kwe-40 mm bufuna uviwo olunenyameko, njengoko oku kusenokuba ngenxa ye-engile engumnqantsa wegrafti xa kuthelekiswa nomphezulu weglenoid, nto leyo enokukhokelela ekususweni kwegrafti. Kweli nqanaba, inqanaba lokumiswa kwegrafti isenokulungiswa ngokujikelezisa iglenoid ejikeleze isikrufu esisezantsi.

  
  

• Emva kokufaka i-screw yokuqala (ephantsi), i-pin yokuqala ye-Kirschner inokususwa. Faka isikrufu sesibini ngendlela efanayo.

  
  

• Emva kokufaka izikrufu ezi-2 kunye nokususa ucingo lwe-Kirschner, sebenzisa i-probe kwi-Entrance A ukujonga indawo yokugqibela ye-graft (Umfanekiso 13). Naziphi na iindawo eziphumayo ze-graft kufuneka zichetywe ngee-burrs, kwaye akukho kulungiswa kwezicubu ezithambileyo kufuneka zenziwe ukuthintela ukuqina kwamalungu.

Umfanekiso we-11. I-graft yabekwa kwaye yalungiswa. Isigulana sasihleli kwi-engile ye-70 ° igxalaba lasekunene lijongwe phezulu. Ngexesha nasemva kokugrumba i-implant, gcina isikhokheli sisenezandla zozibini ukunqanda umgca we-K ekubeni ukhulule itonela. (Imbovane, ngaphambili; DCG, isikhokelo secannula ephindwe kabini; Kw, Kirschner wire; Iposti, ngasemva; Sup, phezulu.)

Umzobo 12. Ukuboniswa kwe-arthroscopic yokulungiswa kwe-graft, isigulane sihleli kwi-angle ye-70 °, igxalaba lasekunene, imbono yokungena kwi-elektroniki. Isikrufu esisezantsi se-4.5mm esithungelwe ngokuyinxenye seLatarjet sibekwe kuqala ngentla kwephini yeKirschner. (Imbovane, ngaphambili; Gl, glenoid; IBG, iliac bone graft; Inf, ezantsi; S, screw; Iposti, ngasemva; Sup, phezulu.)

Umzobo 13. I-Arthroscopic visualization of graft positioning, isigulane sihleli kwi-70 ° angle, igxalaba lasekunene, umbono we-E wokungena. Emva kokufaka izikrufu ezimbini kunye nokususa ucingo lweKirschner, khangela indawo yokugqibela yokutshintshwa. Olu hlobo lokufakelwa kwamathambo lunokunyanzeliswa kakuhle kwaye akukho sikhundla sebhongo. (Imbovane, ngaphambili; i-Gl, i-glenoid; Hh, intloko ye-humeral; i-IBG, i-iliac bone graft; i-Inf, iphantsi; i-Post, i-posterior; i-Sup, ingaphezulu.)

Emva kotyando, igxalaba lalungiswa nge-angle yokuxhwila eyi-20 ° kunye nokujikeleza okungathathi hlangothi kwiiveki ze-6:

• Ngosuku olulandelayo emva koqhaqho, qalisa igxalaba, ingqiniba kunye noluhlu lwezandla lomthambo. I-Pronation kunye neentshukumo ezibuhlungu kufuneka ziphetshwe.

  
  

• Kwiiveki ezi-3, qalisa uluhlu olusebenzayo lokuzilolonga.

  
  

• Emva kokuzinza kwe-graft kuqinisekiswa ngokuthatha iifoto kwiiveki ezi-6 emva kokusebenza, ukuzivocavoca okunamandla kunokuqaliswa.

  
  

• Kubadlali abafuna ukubuyiswa ngokukhawuleza, i-tomography yekhompyutheni kufuneka yenziwe kwiinyanga ezi-3 emva kokuhlinzwa ukuvavanya ukuhlanganiswa kwe-graft.

  
  

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

Kuba I-CZMEDITECH , sinomgca wemveliso ogqityiweyo kakhulu wokufakelwa kotyando lwe-orthopedic kunye nezixhobo ezihambelanayo, iimveliso ezibandakanya ukufakelwa komqolo, iinzipho ze-intramedullary, ipleyiti yokwenzakala, ipleyiti yokutshixa, i-cranial-maxillofacial, iprosthesis, izixhobo zamandla, izilungisi zangaphandle, arthroscopy, ukhathalelo lwezilwanyana kunye neeseti zezixhobo ezixhasayo.

Ukongeza, sizibophelele ekuqhubekeni siphuhlisa iimveliso ezintsha kunye nokwandisa imigca yemveliso, ukuze sihlangabezane neemfuno zotyando zoogqirha abaninzi kunye nezigulana, kwaye senze inkampani yethu ikhuphisane ngakumbi kulo lonke ilizwe lehlabathi lokufakelwa kwamathambo kunye nezixhobo.

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