Ukwelashwa kwe-arthroscopic yokungazinzi kwehlombe kwangemva

Ukungazinzi kwehlombe kwangemuva kuvame ukubangelwa ukuhluthuka kwangemuva okubuhlungu noma ukulimala okuncane okuphindaphindayo ngesikhathi sokuzivocavoca noma eminye imisebenzi, ngesilinganiso sonyaka sezigameko ze-4.64 kubantu abangu-100000 ngonyaka. Kuchazwe izindlela eziningana zokuhlinza zokwelapha ukungazinzi kwehlombe kwangemuva, okuhlanganisa ukulungiswa kwezicubu ezithambile kanye nokuhlinzwa okuvulekile kanye ne-arthroscopic bone block. Kodwa-ke, izinkinga zokuhlinzwa ezibikiwe kanye namazinga okubuyekeza ayephezulu njenge-14% kanye nama-67%, ngokulandelana. Ikakhulukazi, ukubekwa okunembile kokuxhunyelelwa kwamathambo, ukuqondiswa kwezikulufu nokwelashwa kwezilonda ezihambisanayo kuthathwa njengenselele. Ngakho-ke, izindlela zokuhlinza zidinga ukuthuthukiswa.

Izinyathelo zokusebenza:

• Ukuhlinzwa kwenziwa ngaphansi kwe-anesthesia ejwayelekile kuhlanganiswe ne-block yesifunda ye-intermuscular sulcus.

• Ukuze kuqoqwe i-iliac crest, ama-anesthetics wendawo asetshenziswa ngaphansi kwesikhumba kanye ne-periosteally.

• Isiguli sasibekwe esihlalweni sasebhishi ngemuva nge-engeli engu-45 ° ukuze sivumele ukuthintana okugcwele ne-iliac crest. Ngemva kokuvunwa kokufakelwa kwethambo, ukuhlinzwa kwaqhubeka, futhi isiguli sasihlezi nge-engeli engu-70 °. Isiguli salengiswa ngendlela evamile engazali, futhi ingalo esebenzayo yayigobele phambili ngo-30 ° ngentambo yokudonsa engu-2 kuya ku-3 kg.

• 
  

Ukuhlolwa okuhlangene kwe-arthroscopic

• Le nqubo isebenzisa iminyango emibili noma emithathu. Indawo yokungena yokuqala (E) ingasetshenziselwa ukuhlola ngokuhlanganyela.

  
  

• Ububanzi bungangeniswa ngokuqondile emalungeni ngokusebenzisa izikhawu zokujikeleza. Kwezinye izimo, akunakwenzeka ukwethula ngokuqondile ububanzi (okungukuthi, izicubu ezibomvu ezizungeze isikhawu sokujikeleza).

  
  

• Ungakha i-lateral yokungena ye-C noma i-front lateral D yokungena, ukuze ukwazi ukungena esikhaleni ngaphansi kwe-acromion peak, ukuze ukwazi ukubona isikhala se-rotator muscle.

  
  

• I-arthroscopic radiofrequency ablation yasetshenziswa ukuvula isikhawu sokujikeleza.

  
  

• I-toggle lever ibekwe endaweni ehlanganyelwe ngokungena kuka-E ukuze kushintshele ububanzi ekubukweni kwangaphakathi okuhlanganyelwe.

  
  

• Ngemva kokuhlolwa okuphelele kokuhlangana, izilonda zezicubu ezithambile kanye nezilonda ezihambisanayo ze-glenoid kanye ne-humeral bone loss (okungukuthi, i-posterior glenoid lip, i-joint capsule, i-glenoid marginal lesion kanye ne-reverse Hill Sachs lesion) yahlolwa.

  
  

• Ngemuva kokuhlolwa okuphelele kwe-arthroscopic yejoyinti le-glenohumeral kanye nokuqinisekiswa kwezinkomba ezifanele, ukufakwa kwamathambo kutholwe.

  
  

Ukuvuna nokulungiswa kokufakelwa kwethambo

• I-autograft ye-bicortical yatholakala ku-ipsilateral anterior iliac crest ukuze kugcinwe i-cortex yangaphakathi ye-pelvis. Yenza isikhumba sisike cishe ngo-2cm ngemuva komgogodla wangaphambili ophakeme we-iliac kanye no-2cm ngaphansi kwe-crest eduze ne-crest crest ukuze ugweme ukwakheka kwesibazi esimboza ngokuqondile uhlaka.

  
  

• Ngemva kokubheka ithambo le-cortical α kanye no-β Izikhonkwane ezimbili ezihambisanayo ze-Kirschner zafakwa ku-lateral cortex ngembobo, ngaphambili eyayifakwe izikulufo ezimbili ezinde ze-coracoid ezivela kudivayisi ye-Arthroscopic Latarjet (Fig. 1).

  
  

• Isibambo somhlahlandlela sibheke phezulu ukuze i-glenoid yethambo ihambisane ne-posterior inferior neck ye-glenoid. Ukubekwa komhlahlandlela kuvumela ukukhethwa kwe-ridge engenhla njengengxenye ye-articular yebhulokhi yethambo.

  
  

• Bese, phusha umbobo wesinyathelo senqubo ye-coracoid ongenalutho ocingweni lwe-Kirschner bese ubhoboza izimbobo ezimbili ezingu-2.9mm ebhulokhini yethambo. I-drill bit kanye nephinikhodi ye-Kirschner zisusiwe. Ngaphambi kokufaka iwasha yekepisi ephezulu embobeni yokubhoboza, thepha imbobo ngompompi wekepisi ephezulu.

  
  

• Uma i-cap top isilungile, sebenzisa isaha noma ummese wethambo ukuze ulondoloze i-medial cortex ye-iliac crest futhi uvune ama-grafts angu-2-cm × 1-cm × 1-cm (Izibalo 2 no-3). Ngemva kokuvunwa kwe-graft, ibhulokhi yethambo ixhunywa kumkhono wenqubo ye-coracoid futhi izikulufu ezimbili ezinde ezingenalutho zenqubo ye-coracoid zisetshenziselwa ukwakha iyunithi engashintshwa endaweni yayo yokugcina (Fig. 4).

  
  

• Isilonda se-iliac crest sasivalwe ungqimba ngongqimba ngeshubhu lokudonsa amanzi futhi kwasetshenziswa ukugqoka. Bese ulungisa ingemuva letafula lokusebenza libe i-engeli engu-70 °.

Umfanekiso 1. Ithambo elingakwesokudla le-iliac crest laqoqwa lapho isiguli sisesimweni sesihlalo solwandle. Izinaliti ezimbili ze-Kirschner zibekwe ndawonye nedivaysi yomhlahlandlela we-cannula, futhi isibambo se-cannula siphezulu. (Intuthwane, ngaphambili; i-DCG, igayidi ye-double casing; Inf, iPosi ephansi, ngemuva; phezulu, phezulu.)

Umfanekiso 2. Uma isiguli sisesimweni sesihlalo solwandle, i-bone block of the right iliac crest ithathwa. Khipha i-drill bit kanye ne-Kirschner wire ngemva kokubhoboza iplathifomu esemaceleni ye-iliac crest cortex, bese ufaka 'izigqoko' ezi-2. (Intuthwane, ngaphambili; i-DCG, igayidi ye-double casing; Inf, ngaphansi; Okuthunyelwe, ngemuva; Okuphezulu, phezulu; TH, isigqoko esiphezulu.)

Umfanekiso 3. Uma isiguli sisesimweni sesihlalo solwandle, i-bone block of the right iliac crest ithathwa. Ubuso obungaphakathi be-iliac crest buhlala buqinile ngemva kokuvunwa kwe-graft. (Intuthwane, ngaphambili; Inf, phansi; IT, itafula elingaphakathi; Iposi, emuva; I-Sup, phezulu.)

Umfanekiso 4. Lungiselela amabhlogo amathambo etafuleni eliseceleni. Ngemva kokuvunwa kwe-graft, ukuxhunyelelwa kwethambo kwakuxhunywe ku-cannula ephindwe kabili kusetshenziswa ama-cannula obturators amabili. (Intuthwane, ngaphambili; i-DCG, isiqondiso se-cannula ephindwe kabili; i-IBG, i-iliac bone transplantation; i-Inf, iphansi; Iposi, ingemuva; i-Sup, ngaphezulu.)

Izimpawu zomgwaqo ezingemuva nemigwaqo yokungena

• Ngokuvamile kusetshenziswa iziteshi ezimbili kuya kwezintathu. Inhloso ukuvumelanisa i-posterior A yokungena nomugqa ohlangene we-glenohumeral ngangokunokwenzeka. Ngakho-ke, ilawulwa yi-arthroscope. Ngakho-ke, kwenziwa ngokuyinhloko ngemva kokuhlinzwa kusukela ekungeneni kwe-lateral yangaphambili.

  
  

• Umnyango we-anterolateral u-E ubekwe endaweni ye-rotator muscle ngaphezu kwe-biceps muscle, engabonisa kahle ingxenye engemuva yonqenqema lwe-glenoid (Ithebula 1).

  
  

• Ezimweni eziningi, awasekho amashaneli adingekayo; Kodwa-ke, uma kunesidingo, i-posterolateral B inlet eyengeziwe ngokusebenzisa i-cuff engemuva ingasetshenziswa (isibonelo, ukuphatha ama-prostheses e-labial ahambisanayo).

  
  

• Ngokufanelekile, i-Entrance A itholakala ngqo ku-eksisi yomugqa ohlangene we-glenohumeral.

  
  

• Ngokubuka okungaphambili nangemuva komnyango ongu-E, faka izinaliti ezi-2 zomgogodla emuva ebangeni elingu-2.5 kuya ku-3 cm, bese ufaka ilunga ngokuhambisana endaweni yehora lesi-7 nelesi-9 (ihlombe elingakwesokudla).

  
  

• Yenza ukusika isikhumba phakathi kwezinaliti ezi-2 bese usisebenzisa njengendawo yokungena engemuva A (Izibalo 5A kanye no-B).

Umfanekiso 5. (A) Isiguli sizomaka futhi silungise ukusika isikhumba endaweni yokuhlala e-engeli engu-70 °, ihlombe elingakwesokudla kanye nokubuka kuka-E kokungena. Ukuze kuzuzwe ukuqondanisa okungcono kakhulu phakathi kwe-inlet A yangemuva kanye nomugqa ohlangene we-glenohumeral, izinaliti ezimbili zomgogodla zifakwa emuva ukuze kunqunywe uphawu lokusikwa kwesikhumba.

(B) Ukubukwa kwe-arthroscopic, ihlombe elingakwesokudla, nokubuka kwephothali ye-elekthronikhi yesiguli esinenaliti endaweni yokuhlala engu-70 °. (Intuthwane, ingaphambili; i-DCG, isiqondiso se-cannula ephindwe kabili; I-Gl, i-glenoid; I-Inf, iphansi; Iposi, ingemuva; I-PC, i-capsule yangemuva; I-Sn, inaliti yomgogodla; Sup, superior.)

Ukulungiswa kwe-Glenoid

• Insimbi yethulwa nge-inlet engemuva (A).

  
  

• Susa i-labrum ne-posterior capsule kusuka ku-7 kuya ku-10 (ihlombe elingakwesokudla) usebenzisa i-VAPR ne-razor (Umfanekiso 6A no-B, Ividiyo 1).

  
  

• Gaya intamo ye-glenoid yangemuva nge-arthroscopic burrs kuze kube yilapho ithambo elophayo livezwa futhi indiza ilungiswa (Fig. 7). Uma intamo ye-glenoid isilungile, i-posterior A inlet iyakhuliswa ukuvumela ukudlula kwe-glenoid kanye ne-double coracoid cannula.

  
  

• I-scalpel ingasetshenziselwa ukwandisa ukuhlukaniswa kwemisipha kanye ne-cystotomy, kuyilapho i-trocar e-rectangular blunt (i-subscapular passage) ingasetshenziswa ukuze kuqhutshekwe nokwandisa isiqephu (Umfanekiso 8).

Umfanekiso 6. (AB) Ukubona ngeso lengqondo ukulungiswa kwe-glenoid ngaphansi kwe-arthroscopy, isiguli sihlezi ku-engeli engu-70 °, ihlombe elingakwesokudla, ukubuka kokungena kwe-elekthronikhi. Ngesikhathi sokulungiswa kwe-glenoid, sebenzisa i-VAPR ne-razor ukuze ukhiphe udebe lwe-glenoid ne-posterior capsule kusukela ngo-7:00 kuya ku-10:00. (Intuthwane, ngaphambili; I-Gl, i-glenoid; Hh, i-humeral head; I-Inf, iphansi; I-PC, i-capsule yangemuva; Okuthunyelwe, okungemuva; I-Sup, ephakeme; V, i-VAPR.)

Umfanekiso 7. Ukubukwa kwe-arthroscopic yokulungiswa kwe-glenoid: isiguli sasihlezi nge-engeli ye-70 °, ihlombe elingakwesokudla, ukubuka kwe-E-portal. Ukugqokwa kwentamo ye-glenoid engemuva ngesikhathi sokulungiselela i-glenoid. (Intuthwane, ngaphambili; B, burr; Gl, glenoid; Inf, low; Pgn, posterior glenoid neck; Post, ngemuva; Sup, top.)

Umfanekiso 8. Ukubukwa kwe-arthroscopic yokulungiswa kwe-glenoid: isiguli sasihlezi nge-engeli ye-70 °, ihlombe elingakwesokudla, ukubuka kwe-E-portal. Khulisa indawo engemuva engu-A nge-trocar ebuthuntu. (Intuthwane, ngaphambili; Bt: i-trocar blunt; Gl, glenoid; Inf, low; Pc, posterior capsule; Post, posterior; Sup, top.)

Ukuma kwe-graft nokulungiswa

I-graft yafakwa ngomnyango ongemuva isibambo sibheke phezulu (Fig. 9) futhi yahlukaniswa phakathi kwe-capsule ye-muscle ne-joint kuze kube yilapho iseduze nentamo ye-glenoid yangemuva futhi ishaywa nge-articular surface ye-glenoid. Lesi sinyathelo sidinga ukugxila ekulungiseleleni ukuhlukanisa, ikakhulukazi ukuvula i-infraspinatus fascia eqinile futhi eqinile nokuvimbela ukudlula kwe-graft.

• Kubalulekile ukusebenzisa i-scalpel blade ukuvula i-fascia kakhulu. Uma kunesidingo, esigabeni sakamuva sokuhlinzwa, uma ukuvuza okuguquguqukayo kubaluleke kakhulu ukugcina ingcindezi eyanele ehlombe, amathuluzi angasetshenziswa ukuvala ingxenye yesilonda sokuhlinzwa (isibonelo, iziqeshana zamanxeba).

  
  

• I-cannula ye-coracoid ibekwe ngokuhambisana nendawo ye-articular ukuze izintambo nezikulufi ze-Kirschner ezilandelayo zingangeni ekuhlanganyeleni ngesikhathi sokufakwa.

  
  

• Izintambo ezimbili ze-Kirschner ezinobude obungu-1.5 mm zafakwa ngezikulufu zenqubo ye-coracoid ezingenalutho ukuze kulungiswe ukuxhunyelelwa entanyeni ye-glenoid engemuva (Fig. 10).

  
  

• Ukufakwa kocingo lwe-Kirschner akufanele kudlule i-40mm ukugwema ukudlula entanyeni ye-glenoid yangaphambili, engalimaza isakhiwo se-neurovascular sangaphambili, nakuba ingxenye ye-subscapularis muscle ikhona phakathi kwentamo kanye nesakhiwo se-neurovascular ukuze siyivikele.

Umfanekiso 9. Isiguli safaka igraft endaweni yokuhlala engu-70 °, futhi sabona ihlombe elingakwesokudla kanye nohlangothi lwe-posterolateral. I-graft yafakwa ngesango elingemuva isibambo sibheke phezulu. (Intuthwane, ngaphambili; i-DCG, igayidi ye-double casing; Inf, ngaphansi; Okuthunyelwe, ngemuva; Okuphezulu, phezulu.)

Umfanekiso 10. Ukubonakala kwe-arthroscopic yokuma kwegraft, ukuhlala kwesiguli ku-engeli engu-70 °, ihlombe elingakwesokudla, ukubuka kuka-E kokungena. Izikhonkwane ezimbili ze-Kirschner ezifakiwe ziqinisa i-glenoid entanyeni ye-glenoid engemuva. (Intuthwane, ngaphambili; Gl, glenoid; IBG, iliac bone graft; Inf, ngaphansi; Kw, Kirschner wire; Post, ngemuva; Sup, upper.)

Njengoba i-arthroscope engu-30 ° ibukwa ngaphambili kwe-portal vein, ngokwemvelo ijwayele ukutshekisa i-graft ibe i-engeli, okwenza indawo engezansi ivelele kunokuba iqonde. Kubalulekile ukuhlola ukuthi ukuxhunyelelwa kwethambo kusengenzeka yini emva kokufakwa kwegraft.

• Uma igraft isigxusha ngemajini engemuva ye-glenoid, susa isikulufu sokuqala eside se-coracoid bese ubhoboza umhubhe obanzi ongu-3-2mm we-bicortical glenoid ocingweni lwe-Kirschner.

  
  

• Kulesi sinyathelo, kubalulekile ukuthi unganyakazi ngemva kokusebenza kokuqala. Abasebenzi abasizayo kufanele banakekele ngezandla zombili (Umfanekiso 11).

  
  

• Kumelwe kulungiselelwe ukufaka iphinikhodi yesithathu ye-Kirschner emgodini, ngoba iphinikhodi ye-Kirschner endaweni yayo yasekuqaleni ngokuvamile ibanjwe injini ngokuzenzakalelayo yi-drill bit.

  
  

• Kufanele kuqashelwe ukuthi ungalususi ucingo lwe-Kirschner lapho ukhipha ucezu lokubhoboza ngomkhono we-coracoid. Bese, faka isikulufu se-Latarjet esilungene kancane esingu-4.5 mm ocingweni lwe-Kirschner (Fig. 12) bese usifaka ngokugcwele ukuze uvimbele ukuxhunyelelwa ukuthi ungagudluki, bese ubhoboza isikulufu esingaphezulu. Ngokufanelekile, ubude besikulufa akumele budlule ku-32 ukuya ku-36 mm.

  
  

• Noma yibuphi ubude obungaphezu kuka-40 mm budinga ukuhlolwa ngokucophelela, njengoba lokhu kungase kube ngenxa ye-engeli ewumqansa ye-glenoid ehlobene nendawo ye-glenoid, okungase kuholele ekugudlukeni kweglenodi. Kulesi sigaba, izinga lokuma kwegraft lisengalungiswa ngokuzungezisa i-glenoid eduze nesikulufu esingezansi.

  
  

• Ngemva kokufaka isikulufu sokuqala (esiphansi), iphinikhodi yokuqala ye-Kirschner ingasuswa. Faka isikulufu sesibili ngendlela efanayo.

  
  

• Ngemva kokufaka izikulufu ezi-2 nokukhipha intambo ye-Kirschner, sebenzisa i-probe Entubeni A ukuze uhlole indawo yokugcina yokuxhunyelelwa (Umfanekiso 13). Noma yiziphi izingxenye eziphumile zokuxhunyelelwa kufanele zisikwe ngama-burrs, futhi akukho kulungiswa kwezicubu ezithambile okufanele kwenziwe ukuze kuvinjelwe ukuqina kwamalunga.

Umfanekiso 11. I-graft yabekwa futhi yalungiswa. Isiguli sasihlezi nge-engeli engu-70 ° ihlombe laso langakwesokudla libhekwa phezulu. Ngesikhathi nangemva kokubhoboza okufakelwayo, gcina umhlahlandlela unganyakazi ngezandla zombili ukuze uvimbele umugqa we-K ukuthi ungaxegi umhubhe. (Intuthwane, ngaphambili; i-DCG, isiqondiso se-cannula ephindwe kabili; i-Kw, i-Kirschner wire; Iposi, ingemuva; I-Sup, phezulu.)

Umfanekiso 12. Ukubonwa kwe-arthroscopic yokulungiswa kwegraft, isiguli sihlezi ku-engeli engu-70 °, ihlombe elingakwesokudla, ukubuka kokungena nge-elekthronikhi. Isikulufu se-Latarjet esingaphansi esingu-4.5mm esiluchungechunge kancane sitholakala kuqala ngaphezu kwephinikhodi ye-Kirschner. (Intuthwane, ngaphambili; I-Gl, i-glenoid; i-IBG, i-iliac bone graft; i-Inf, ngezansi; S, isikulufu; Okuthunyelwe, ngemuva; Okuphezulu, phezulu.)

Umfanekiso 13. Ukubukwa kwe-arthroscopic yokuma kwegraft, ukuhlala kwesiguli ku-engeli engu-70 °, ihlombe elingakwesokudla, ukubuka u-E kokungena. Ngemva kokufaka izikulufu ezimbili nokukhipha intambo ye-Kirschner, hlola indawo yokugcina yokufakelwa. Lolu hlobo lokuxhunyelelwa kwethambo lunokucindezelwa okuhle futhi alunasikhundla sokuziqhenya. (Intuthwane, ngaphambili; I-Gl, i-glenoid; Hh, i-humeral head; I-IBG, i-iliac bone graft; I-Inf, ephansi; Okuthunyelwe, okungemuva; Okuphezulu, phezulu.)

Ngemuva kokuhlinzwa, ihlombe lalungiswa nge-engeli yokuthumba engu-20 ° kanye nokuzungeza okungathathi hlangothi amasonto ayi-6:

• Ngosuku olulandelayo ngemva kokuhlinzwa, qala ihlombe elingashintshiwe, indololwane kanye nohlu lwesandla lokuzivocavoca umzimba. Ukuphimisela nokunyakaza okubuhlungu kufanele kugwenywe.

  
  

• Emavikini angu-3, ​​qala uhla olusebenzayo lokuzivocavoca umzimba.

  
  

• Ngemuva kokuthi ukuzinza kwe-graft kuqinisekiswa ngokuthatha izithombe emavikini angu-6 ngemuva kokuhlinzwa, ukuzivocavoca okunamandla kungaqalwa.

  
  

• Kubadlali abafuna ukululama ngokushesha, i-tomography yekhompiyutha kufanele yenziwe izinyanga ezi-3 ngemuva kokuhlinzwa ukuze kuhlolwe ukuhlanganiswa kwe-graft.

  
  

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

Ngoba I-CZMEDITECH , sinomugqa womkhiqizo ophelele kakhulu wezimila zokuhlinza amathambo nezinsimbi ezihambisanayo, imikhiqizo ehlanganisa izimila zomgogodla, izipikili ze-intramedullary, ipuleti lokuhlukumezeka, ipuleti lokukhiya, i-cranial-maxillofacial, izitho zokufakelwa, amathuluzi amandla, izilungisi zangaphandle, i-arthroscopy, ukunakekelwa kwezilwane kanye namasethi amathuluzi asekelayo.

Ngaphezu kwalokho, sizibophezele ekuthuthukiseni imikhiqizo emisha ngokuqhubekayo nokwandisa imigqa yemikhiqizo, ukuze sihlangabezane nezidingo zokuhlinzwa zodokotela abaningi neziguli, futhi senze inkampani yethu iqhudelane kakhulu kuwo wonke umkhakha womhlaba wonke wokufakwa kwamathambo nezinsimbi.

Sithumela emhlabeni wonke, ukuze ukwazi xhumana nathi ekhelini le-imeyili elithi song@orthopedic-china.com ukuze uthole isilinganiso samahhala, noma uthumele umlayezo ku-WhatsApp ukuze uthole impendulo esheshayo +86- 18112515727 .

Uma ufuna ukwazi okwengeziwe, chofoza CZMEDITECH ukuthola imininingwane eyengeziwe.