Ekuqaleni kwawo-1990, izazi zakwamanye amazwe zazihola ekusebenziseni izikhonkwane ze-suture ukulungisa izakhiwo ezifana ne-rotator cuff ngaphansi kwe-arthroscopy. Ithiyori yasuka kumgomo wokusekela “wento ecwilayo” engaphansi komhlaba e-South Texas, e-U.S.A., okungukuthi, ngokudonsa intambo yensimbi engaphansi komhlaba nge-engeli ecwilayo engu-45° iye phansi, isakhiwo esingaphansi komhlaba sigxiliswe ngokuqinile “entweni ezikayo” ngakolunye uhlangothi lwentambo yensimbi.
Umuthi wezemidlalo usuka ku-orthopedic traumatology. Kuwuhlelo lokusebenza oluyisisekelo nolwemitholampilo olubanzi lwemithi nezemidlalo. Umgomo uwukufinyelela ukulungiswa okuphezulu kokusebenza ngokuhlukumezeka okuncane, okuhlanganisa ukulimala kwe-meniscus, ukulimala kwe-cruciate ligament, ukukhala kwe-rotator cuff, ukungazinzi kwehlombe, ukulimala kwe-SLAP, njll. konke kungaphakathi komkhakha wokwelashwa kwemithi yezemidlalo
I-Anchor iyisisetshenziswa sezokwelapha esivame ukusetshenziswa kwezemidlalo kanye nokuhlinzwa kwamathambo. Ngokuyinhloko isetshenziselwa ukulungisa izicubu ezithambile (njengama-tendon, ligaments, njll.) emathanjeni ukuze kuthuthukiswe ukuphulukiswa kwezicubu nokululama. Amahange ngokuvamile enziwa ngezinto ezihambisana ne-biocompatible ukuqinisekisa ukuphepha nokuzinza emzimbeni.
Ngokuya ngezigaba zezinto zamahange, kunezigaba ezimbili eziyinhloko: amahange angaboli kanye namahange angaboli.
Izinto eziyinhloko zamahange angaboli yi-titanium, i-nickel-titanium alloy, insimbi engagqwali, i-titanium ne-poly-L-lactic acid; amahange amaningi e-suture asetshenziswa emtholampilo akhiwe ngezinto zensimbi, ezinezinzuzo zokubamba okuhle kwamandla, ukufakwa kalula kanye nokuhlola okulula kwe-X-ray.
Izinto eziyinhloko zamahange abolayo yi-poly-D-lactic acid, i-poly-L-lactic acid, i-polyglycolic acid, njll. Uma kuqhathaniswa namahange angaboli, amahange abolayo kulula ukuwabuyekeza, awaphazamiseki kancane ezithombeni, futhi ayamuncwa. Zingasetshenziswa futhi ezinganeni.
Izinto eziyinhloko zamahange
1. Izikhonkwane zensimbi
• Izinto: Ikakhulukazi insimbi efana ne-titanium alloy.
• Izici: Iqinile futhi ihlala isikhathi eside, ikwazi ukunikeza umphumela ozinzile wokulungisa. Kodwa-ke, ubuciko be-imaging kungenzeka futhi kukhona ingozi yokuwa.
2. Amahange abambekayo
• Izinto: izinto ezimuncayo njenge-polylactic acid (PLLA).
• Izici: Kwehliswa kancane kancane emzimbeni, akukho ukuhlinzwa kwesibili okudingekayo ukuze kukhishwe. Nokho, izinga lokuwohloka lingase lingazinzi, futhi amandla okulungisa angase ehle ngokuhamba kwesikhathi.
3. Amahange e-polyetheretherketone (PEEK).
• Izinto: ama-polymers asebenza kahle njenge-polyetheretherketone.
• Izici: Inikeza amandla aphezulu omzimba wezinzipho kanye nezakhiwo zemishini, kuyilapho ine-biocompatibility enhle kanye nemiphumela emihle yokucabanga yangemva kokuhlinzwa.
4. Amahange e-All-suture
• Ukubunjwa: Ikakhulukazi yakhiwe ngesifakeli, ihange nesishubhu.
• Izici: Incane kakhulu ngosayizi, ithambile ngokuthungwa, ifanele izimo lapho kulahleka khona isisindo somdabu noma indawo yokufakelwa ilinganiselwe.
Ngokwezici zokuklama kwamahange, angahlukaniswa abe izigaba ezimbili: amahange amafindo namahange angenafindo (njengamahange aphelele):
1. Amahange anafindo
Amahange anamafindo ayizinhlobo zezikhonkwane zendabuko, ezibonakala ngesigaba se-suture esixhunywe emsileni wehange. Udokotela udinga ukudlula i-suture ngezicubu ezithambile ngenaliti futhi abophe ifindo ukuze alungise izicubu ezithambile kuhange, okungukuthi, indawo yamathambo.
• Impahla: Amahange anamafindo ngokuvamile enziwa ngezinto ezingamuncwa (njenge-titanium alloy) noma izinto ezimuncayo (njenge-polylactic acid).
• Indlela yokwenza: Ihange ligxilwe ethanjeni ngemicu noma ngamaphiko okunweba, kuyilapho i-suture isetshenziselwa ukuxhuma izicubu ezithambile kuhange, futhi umphumela wokuzinza uyakhiwa ngemva kokubopha ifindo.
• Izinzuzo kanye nokubi: Inzuzo yamahange amafindo ukuthi umphumela wokulungisa uthembekile futhi ulungele izinhlobonhlobo zokulimala kwezicubu ezithambile. Kodwa-ke, inqubo yokufipha ingase ikhulise ubunkimbinkimbi nesikhathi sokusebenza, futhi ukuba khona kwefindo kungase kuholele ekugxiliseni kokucindezeleka kwendawo, okwandisa ingozi yokuphuka komthungo noma ukuxegiswa kwehange.
2. Amahange angenafindo
Amahange angenamafindo, ikakhulukazi amahange agcwele ama-suture, awuhlobo olusha lwehange oluthuthukiswe eminyakeni yakamuva. Isici salo ukuthi ihange lonke lakhiwe ngama-sutures, futhi ukulungiswa kwezicubu ezithambile kungafinyelelwa ngaphandle kokubopha amafindo.
• Izinto zokwakha: Amahange aphelele e-suture ngokuvamile asebenzisa izinto zokuthunga ezithambile neziqinile, njengemicu ye-ultra-high molecular weight polyethylene (UHMWPE).
• Indlela yokwenza: Izikhonkwane ezigcwele ze-suture zingashuthekwa ngokuqondile esicubungwini ngesakhiwo sawo esikhethekile se-suture kanye nendlela yokufakelwa, kuyilapho kusetshenziswa ukuqina komthungo ukuze kuqiniswe izicubu ezithambile endaweni yethambo. Njengoba asikho isidingo sokubopha amafindo, ubunzima kanye nesikhathi sokusebenza kuyancishiswa, futhi ingozi yokuphuka kwe-suture nokukhulula ihange nayo iyancipha.
• Izinzuzo kanye nokubi: Izinzuzo zamahange aphelele we-suture ukuhlinzwa okulula, umphumela othembekile wokulungisa kanye nokulimala okuncane esicutshini esithambile. Kodwa-ke, ngenxa yesakhiwo sayo esikhethekile, inezidingo eziphezulu zamasu okuhlinza kanye nendawo yokufakelwa. Ngaphezu kwalokho, intengo yamahange aphelele e-suture ingase ibe phezulu, okwandisa umthwalo wezezimali ezigulini.
Amahange asetshenziswa kakhulu ekuhlinzweni kwemithi yezemidlalo ehlukahlukene, njengokulungisa i-rotator cuff, ukulungiswa kwe-tendon, ukwakhiwa kabusha kwe-ligament, njll. Okulandelayo yisingeniso sokusetshenziswa kokuhlinzwa kwamahange kusetshenziswa ukulungisa ikhafu ejikelezayo njengesibonelo:
• Izinyathelo zokuhlinza: Okokuqala, udokotela uzohlanza futhi alungiselele indawo yokulimala ye-rotator cuff; bese, gxilisa ihange endaweni efanele; ke, sebenzisa i-sutures ukulungisa izicubu ze-rotator cuff kuhange; ekugcineni, i-suture ne-bandage.
• Umphumela wokuhlinza: Ngokulungiswa kwehange, ukuzinza nokusebenza kwezicubu ze-rotator cuff kungabuyiselwa, kukhuthaze ukululama kwesiguli.
Izinzuzo, Okubi kanye Nezinyathelo Zokuqaphela Zamahange
Izinzuzo
• Inikeza ukulungiswa okuzinzile.
• Isebenza ezinhlobonhlobo zokulimala kwezicubu ezithambile.
• Amanye amahange ayamunceka futhi awadingi ukuhlinzwa okwesibili ukuze asuswe.
Ukubi
• Izikhonkwane zensimbi zingase zikhiqize ama-imaging artifact.
• Izinga lokuwohloka kwezikhonkwane ezimuncwa lingase lingazinzi.
• Kukhona ingozi yokuhlukaniswa kwe-anchor noma ukuphuka komthambo.
Amahange emithi yezemidlalo angasetshenziswa ekuhlinzeni okulandelayo:
1. I-epicondylitis ye-lateral ephindaphindiwe (i-elbow yethenisi) engazange ilashwe ngokuphumelelayo izikhathi eziningi: Uma ukwelashwa okulondolozayo kungasebenzi, ukwelashwa kokuhlinzwa kungakhethwa, futhi ihange lingasetshenziswa ukuxhuma kabusha iphuzu lokufaka i-radial extensor carpi brevis ku-epicondyle ehlangene ye-humerus.
2. Ukudabuka kwethenda ye-biceps: Izinyembezi ezibangelwa uhla olungavamile lokunyakaza, ukudonsa, umthelela, njll. zingelashwa ngamahange ocingo. Amahange amabili agqitshwe ku-radial tuberosity, futhi intambo yomsila ixhunywe esiphunzini se-biceps tendon.
3. I-elbow collateral ligament rupture: Ukugudluka ngemuva kwendololwane kuvame ukuhambisana nokulimala kwe-ulnar collateral ligament, ikakhulukazi ukulimala kwenqwaba yangaphambili. Ngokulimala kwe-elbow collateral ligament, izazi eziningi zivame ukukhetha ukwelashwa kokuqala kokuhlinzwa. Indlela yehange yocingo isetshenziselwa ukwenza roughen indawo yethambo lapho kuxhunywe khona umsipha. Ngemva kokopha okusha, ihange ligoqwa endaweni yethambo lapho kuxhunywe khona umsipha, futhi ucingo olulukiwe olusekupheleni kwesipikili lusetshenziselwa ukubopha isiphunzi se-ligament bese usiqinisa noma ukulungisa umsipha ngenaliti.
4. Ukuphuka kwephuzu lokunamathisela elingaphansi kwe-cruciate ligament: I-anterior cruciate ligament (ACL) i-attachment point avulsion fracture uhlobo olukhethekile lokulimala kwe-ACL futhi kufanele lulungiswe kusenesikhathi. Ukusetshenziswa kwendlela ye-wire anchor kunezinhlobonhlobo zezinkomba futhi akunqunyelwe ubukhulu besiqephu sokuphuka. Ayidingi i-intraoperative fluoroscopy ukulungisa isiqondiso sesikulufu. Ukusebenza kulula futhi isikhathi sokusebenza sifinyezwa ngokufanayo.
I-5.Ukungazinzi kwe-Patellar: okubangelwa ukungavamile kwe-anatomical yamathambo kanye nokuvinjelwa kwezicubu ezithambile ezinganele. Izazi eziningi zikhuthaza ukwelashwa okusebenzayo kusetshenziswa amahange ngocingo.
6. I-Patellar inferior pole fracture: Ubuchwepheshe be-anchor bungasetshenziselwa ukwelapha ukuphuka kwesigxobo esingaphansi kwe-patellar. Ngokulungisa i-patellar inferior pole fracture kanye nokweluka kanye nokuthungatha i-patellar ligament, ubuqotho be-knee extensor mechanism bungabuyiselwa futhi ubude obusebenzayo bokuphila be-knee extensor mechanism bungagcinwa.
7. Ifanele ukuxhunywa nokulungiswa kwamathambo nezicubu ezithambile emadolweni, umgogodla, ihlombe, indololwane, iqakala, unyawo, isihlakala kanye nokuhlinzwa kwesandla: Ihange linomklamo wentambo kathayela, okulula ukuwufaka futhi inikeza ukumelana okunamandla kokukhipha, futhi kufanelekile ukuhlinzwa ezingxenyeni ezihlukahlukene.
Izinyathelo zokuzivikela
• Isimo sethambo lesiguli kanye nesakhiwo se-anatomical sendawo yokuhlinza kufanele kuhlolwe ngokugcwele ngaphambi kokuhlinzwa.
• Khetha uhlobo lwehange olufanele kanye nemininingwane ukuze uqinisekise umphumela wokuhlinzwa.
• Izivivinyo ezifanele zokuvuselela kufanele zenziwe ngemva kokuhlinzwa ukuze kuthuthukiswe ukuphulukiswa kwezicubu nokubuyisela ukusebenza.
Kafushane, amahange adlala indima ebalulekile emithini yezemidlalo. Ngokukhetha uhlobo lwehange olufanele kanye nokucaciswa nokulandela izinyathelo ezifanele zokuhlinza nezinyathelo zokuphepha, umphumela wokuhlinzwa ungaqinisekiswa futhi ukululama kwesiguli kungathuthukiswa.
Isikhathi sokuthumela: Dec-17-2024
