Isikhundla se-Prosthesis: I-UKA prosthesis Overhang izoletha miphi imiphumela?

I-Unicompartmental knee arthroplasty (UKA) iyindlela yokuhlinzwa ye-knee arthroplasty (TKA) yokwelapha i-unicompartmental osteoarthritis. Kodwa-ke, idatha yezinga lokuhluleka kwe-UKA libonisa izinga lokusinda leminyaka engu-7 lika-74%, eliphansi kakhulu kunalelo le-TKA (92%). Nakuba izici zeziguli ngokwazo zandisa ingozi yokwehluleka, njengeziguli ezisencane kanye nenani eliphezulu lesisindo somzimba (BMI) kungase kwenyuse ingozi yokwehluleka kwe-UKA, amaphutha obuchwepheshe bokuhlinzwa abhekwe njengezici ezibalulekile zengozi yokwehluleka kwangaphambi kwesikhathi. Ku-UKA, kuyinselele ukuzuza ukuqondanisa kokwenziwa kwe-prosthetic kanye ne-overhang (i-overhang). I-prosthesis ye-tibial kufanele ibe nobukhulu futhi ifakwe ngendlela enciphisa ukucasuka kwezicubu ezithambile, futhi ukukhuphuka kwe-tibial yangaphakathi okungaphezu kwe-3 mm kuboniswe ukuthi kuyingozi enkulu engozini yokuncipha kwe-Oxford Knee Score (OKS) nobuhlungu obandayo. Inhloso eyinhloko yalolu cwaningo bekuwukuhlola yonke imiphumela yomtholampilo neyomfanekiso ye-UKA. Inhloso yesibili kwakuwukuhlola umthelela wokungalungi kahle kokwenziwa kanye nokulengiswa ngokweqile ekusindeni kokufakelwa. I-Unicompartmental knee arthroplasty (UKA) iyindlela yokuhlinzwa esikhundleni se- total knee arthroplasty (TKA) yokwelapha i-unicompartmental osteoarthritis. Kodwa-ke, idatha yezinga lokuhluleka kwe-UKA libonisa izinga lokusinda leminyaka engu-7 lika-74%, eliphansi kakhulu kunalelo le-TKA (92%). Nakuba izici zeziguli ngokwazo zandisa ingozi yokwehluleka, njengeziguli ezisencane kanye nenani eliphezulu lesisindo somzimba (BMI) kungase kwenyuse ingozi yokwehluleka kwe-UKA, amaphutha obuchwepheshe bokuhlinzwa abhekwe njengezici ezibalulekile zengozi yokwehluleka kwangaphambi kwesikhathi. Ku-UKA, kuyinselele ukuzuza ukuqondanisa kokwenziwa kwe-prosthetic kanye ne-overhang (i-overhang). I-prosthesis ye-tibial kufanele ibe nobukhulu futhi ifakwe ngendlela enciphisa ukucasuka kwezicubu ezithambile, futhi ukukhuphuka kwe-tibial yangaphakathi okungaphezu kwe-3 mm kuboniswe ukuthi kuyingozi enkulu engozini yokuncipha kwe-Oxford Knee Score (OKS) nobuhlungu obandayo. Inhloso eyinhloko yalolu cwaningo bekuwukuhlola yonke imiphumela yomtholampilo neyomfanekiso ye-UKA. Inhloso yesibili kwakuwukuhlola umthelela wokungalungi kahle kwezitho zokwenziwa kanye ne-overhang ekusindeni kokufakelwa.

Izindlela

Lolu cwaningo lwaluyisifundo sesikhungo esisodwa esihlanganisa iziguli zesilisa nabesifazane abathola i-UKA ephakathi esikhungweni sethu kusukela ngoJanuwari 2008 kuya kuDisemba 2017, futhi zonke iziguli zabhekana ne-UKA zisebenzisa izindlela ezijwayelekile.Izinqubo zokukhishwa kwe-UKA zazihlanganisa ukukhubazeka kwe-valgus okulinganiselwe kuya kokubi kakhulu, i-patellofemoral compartment arthritis, i-posterior tibial displacement, nokungazinzi. Imiphumela yomtholampilo kanye ne-imaging itholwe ekubuyekezweni okuphindaphindiwe kwamarekhodi emitholampilo kanye nemininingwane yolwazi lwezikhungo. Ama-engeli e-Femoral coronal kanye ne-sagittal (i-FCA ne-FSA) kanye nama-engeli e-tibial coronal kanye ne-sagittal (TCA ne-TSA) akalwe ngama-radiographs awo wonke ama-UKA epulatifomu engaguquki kanye ne-movable-platform, njengoba kubonisiwe.

Umphumela

Isilinganiso sokulandelela kwakuyiminyaka engu-4.9 (iminyaka engu-0.03 kuya kweyi-10.2). Sihlonze ukuhlinza okubukeziwe okungu-36 okuneminyaka engu-3.7 (iminyaka engu-0.03 kuye kwengu-8.7) ngemva kokuhlinzwa kanye nezinga lokuhluleka elikhulayo elingu-14.2%. Ukusinda kweminyaka engu-5 kwaba ngu-88.0% (95% isikhawu sokuzethemba [CI]=82.0% kuya ku-91.0%) kanti ukusinda kweminyaka engu-10 kwaba ngu-70.0% (95% CI=56.0% kuya ku-80.0%).

Izizathu ezivame kakhulu zokubuyekezwa kwakungalungile / ukungazinzi kwe-prosthesis alignment (31%), ukwehluleka kwemishini (22%), ukuqhubeka kwe-osteoarthritis (14%), nobuhlungu obungachazeki (8%).

Kuphela u-11.9% wama-UKAs azuze konke ukuqondanisa okufiswayo kanye nokufakwa kwezitho zokufakelwa. I-Anterior oversthesis bekungeyona into eyingozi enkulu yokwehluleka kwe-UKA (izinga lokuhluleka elingu-10.0%, p=0.090), kanye ne-posterior overhang ye-prosthesis (25.0%, p=0.006) kanye ne-medial overhang ye-prosthesis (38.2%, p<0.001) kwakuyizici ezibalulekile zengozi ye-UKA.

Xoxa

Kulolu cwaningo, sihlole imiphumela yomtholampilo neyomfanekiso ye-UKA emaphakathi kanye nomthelela wokulungiswa kwezitho zokwenziwa kanye ne-overhang. Amazinga okusinda kweminyaka engu-5 kanye ne-10 ayengama-88% kanye nama-70%, ngokulandelana, futhi ayephansi kakhulu kune-TKA. izinkomba ezivame kakhulu zokubuyekezwa kwakuwukungalungi kahle kokufakelwa, ukwehluleka kwemishini, nokuqhubeka kwe-osteoarthritis. Ukuqondanisa okungalungile kwe-prosthesis kanye ne-posterior ne-medial overhang yizici ezibalulekile zengozi yokubuyekezwa kwe-UKA.

Ezincwadini ezishicilelwe, izimbangela ezimbili eziyinhloko zokwehluleka kwe-UKA ukuxega kwe-aseptic kanye nokuqhubekela phambili kwe-osteoarthritic, kokubili okunokusabalalisa komthwalo ongalingani, okuphakamisa ukuthi izimbangela ezibalulwe ngenhla zokwehluleka kwe-UKA zingase zibe yimishini ngokwemvelo. Lobu bufakazi buphakamisa ukuthi ukuqondanisa okungalungile kwe-prosthesis kuyimbangela engaba khona yokwehluleka kwe-UKA kwasekuqaleni. Ngakho-ke, sikholelwa ukuthi kufanele kwenziwe imizamo yokuthuthukisa amasu okuhlinza ukuze kuthuthukiswe ukuqondaniswa kwe-UKA prosthesis nokunciphisa ukuvela kwe-overhang.

Okutholakele kwamanje kusikisela ukuthi ukuhlobana okuqinile phakathi kokuqondaniswa okungalungile kwe-prosthesis/overhang kanye nengozi yokubuyekeza kuphakamisa indlela engaba khona yezinga eliphezulu lokuhluleka elibonwe kulolu cwaningo. Ikhono likadokotela ohlinzayo lokunemba ngokungaguquki ekubekweni kwe-prosthesis liyisici esibalulekile ekusizeni ukuthuthukisa amazinga okusinda e-UKA.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

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