Ekuqaleni kwawo-1990, izazi zakwamanye amazwe zahola ekusebenziseni izikhonkwane zokuthunga ukulungisa izakhiwo ezifana ne-rotator cuff ngaphansi kwe-arthroscopy. Lo mbono uvela esimisweni sokusekela "into ecwilayo" engaphansi komhlaba eSouth Texas, e-USA, okungukuthi, ngokudonsa ucingo lwensimbi olungaphansi komhlaba nge-engeli yokucwilayo engu-45° phansi, isakhiwo esingaphansi komhlaba siqiniswe ngokuqinile "entweni ecwilayo" ngakolunye uhlangothi locingo lwensimbi.
Imithi yezemidlalo isuka ku-traumatology yamathambo. Kuyindlela eyisisekelo neyokwelapha ebanzi yezokwelapha nezemidlalo. Umgomo ukufeza ukulungiswa kokusebenza okuphezulu ngokulimala okuncane, okuhlanganisa ukulimala kwe-meniscus, ukulimala kwe-cruciate ligament, ukudabuka kwe-rotator cuff, ukungazinzile kokuhlukana kwehlombe, ukulimala kwe-SLAP, njll. konke kungaphakathi kobubanzi bokwelashwa kwemithi yezemidlalo.
I-Anchor iyithuluzi lezokwelapha elivame ukusetshenziswa kwezokwelapha kwezemidlalo kanye nokuhlinzwa kwamathambo. Isetshenziswa kakhulu ukubopha izicubu ezithambile (njengemisipha, imisipha, njll.) emathanjeni ukuze kukhuthazwe ukuphulukiswa nokululama kwezicubu. Ama-anchor ngokuvamile enziwa ngezinto ezihambisana ne-bio ukuqinisekisa ukuphepha nokuzinza emzimbeni.
Ngokwezigaba zezinto ezisetshenziswayo zama-anchor, kunezinhlobo ezimbili eziyinhloko: ama-anchor angaboli kanye nama-anchor angaboli.
Izinto eziyinhloko zama-anchor angaboli yi-titanium, i-nickel-titanium alloy, insimbi engagqwali, i-titanium kanye ne-poly-L-lactic acid; iningi lama-anchor e-suture asetshenziswa emtholampilo enziwe ngezinto zensimbi, ezinezinzuzo zokubamba kahle, ukufakwa kalula kanye nokuhlolwa kwe-X-ray okulula.
Izinto eziyinhloko zama-anchor abola yi-poly-D-lactic acid, i-poly-L-lactic acid, i-polyglycolic acid, njll. Uma kuqhathaniswa nama-anchor angaboli, ama-anchor abola kulula ukuwabuyekeza, awaphazamisi kangako izithombe, futhi ayamuncwa. Angasetshenziswa futhi ezinganeni.
Izinto eziyinhloko zezikhonkwane
1. Izikhonkwane zensimbi
• Izinto: Izinto zensimbi ikakhulukazi njenge-titanium alloy.
• Izici: Ziqinile futhi zihlala isikhathi eside, ziyakwazi ukunikeza umphumela wokuqina ozinzile. Kodwa-ke, kungase kwenzeke izinto zobuciko zokuthwebula izithombe futhi kube nengozi yokuwa.
2. Izikhonkwane ezimuncwayo
• Izinto zokwakha: izinto ezimuncwa kalula njenge-polylactic acid (PLLA).
• Izici: Uma izicubu ziwohloka kancane kancane emzimbeni, akukho ukuhlinzwa kwesibili okudingekayo ukuze kususwe. Kodwa-ke, izinga lokuwohloka lingase lingazinzile, futhi amandla okuqina angase anciphe ngokuhamba kwesikhathi.
3. Izikhonkwane ze-Polyetheretherketone (PEEK)
• Izinto zokwakha: ama-polymer asebenza kahle kakhulu njenge-polyetheretherketone.
• Izici: Inikeza amandla aphezulu omzimba wezipikili kanye nezakhiwo zemishini, kuyilapho ine-biocompatibility enhle kanye nemiphumela emihle yokuthwebula izithombe ngemva kokuhlinzwa.
4. Izikhonkwane zokuthunga zonke
• Ukwakheka: Okwakhiwa kakhulu nge-inserter, i-anchor kanye ne-suture.
• Izici: Mncane kakhulu ngobukhulu, uthambile ngesimo, kufanelekile ezimweni lapho ithambo lemvelo lilahleka khona noma indawo yokufakelwa ilinganiselwe.
Ngokwezici zokuklama zama-anchor, angahlukaniswa ngezigaba ezimbili: ama-knotted anchors kanye nama-knotless (njenge-full suture anchors):
1. Izikhonkwane ezigoqiwe
Ama-knotted anchors ayizinhlobo ze-anchor zendabuko, ezibonakala ngengxenye ye-suture exhunywe emsileni we-anchor. Udokotela udinga ukudlulisa i-suture ezicutshini ezithambile ngenaliti bese ebopha ifindo ukuze aqinise izicubu ezithambile ku-anchor, okungukuthi, ubuso bethambo.
• Izinto: Ama-knotted anchors ngokuvamile enziwa ngezinto ezingenakumuncwa (njenge-titanium alloy) noma izinto ezimuncwayo (njenge-polylactic acid).
• Indlela yokusebenza: I-anchor iqiniswe ethanjeni ngemicu noma amaphiko okunweba, kuyilapho i-suture isetshenziselwa ukuxhuma izicubu ezithambile ne-anchor, futhi kwakheka umphumela wokuqina ozinzile ngemva kokubopha ifindo.
• Izinzuzo kanye nokungalungi: Inzuzo yama-knotted anchors ukuthi umphumela wokuqinisa uthembekile futhi ufanelekela ukulimala okuhlukahlukene kwezicubu ezithambile. Kodwa-ke, inqubo yokubopha ingase yandise ubunzima nesikhathi sokusebenza, futhi ukuba khona kwe-knot kungaholela ekuxinekeni kwendawo, okwandisa ingozi yokuphuka kwe-suture noma ukukhululeka kwe-anchor.
2. Izikhonkwane ezingenamafindo
Ama-knotless anchors, ikakhulukazi ama-full suture anchors, awuhlobo olusha lwe-anchor olwakhiwe eminyakeni yamuva nje. Isici salo ukuthi lonke i-anchor lakhiwe ngama-sutures, futhi ukuqina kwezicubu ezithambile kungafinyelelwa ngaphandle kokubopha amafindo.
• Izinto Ezisetshenziswayo: Ama-shuture agcwele ngokuvamile asebenzisa izinto zokuthunga ezithambile neziqinile, njengezintambo ze-polyethylene (UHMWPE) ezinesisindo esiphezulu kakhulu.
• Indlela yokusebenza: Ama-shuture agcwele angafakwa ngqo ezicutshini zethambo ngesakhiwo sawo esikhethekile se-suture kanye nendlela yokufaka, kuyilapho kusetshenziswa ukucindezeleka kwe-suture ukuze kuqiniswe izicubu ezithambile ebusweni bethambo. Njengoba kungekho sidingo sokubopha amafindo, ubunzima nesikhathi sokusebenza kuyancishiswa, futhi ingozi yokuphuka kwe-suture kanye nokuxegiswa kwe-anchor nayo incishisiwe.
• Izinzuzo kanye nokungalungi: Izinzuzo zama-full suture anchors ukusebenza okulula kokuhlinzwa, umphumela wokuqina othembekile kanye nomonakalo omncane ezicutshini ezithambile. Kodwa-ke, ngenxa yesakhiwo sayo esikhethekile, inezidingo eziphezulu zamasu okuhlinzwa kanye nendawo yokufaka. Ngaphezu kwalokho, intengo yama-full suture anchors ingaba phezulu, okwandisa umthwalo wezezimali ezigulini.
Izikhonkwane zisetshenziswa kabanzi ekuhlinzeni okuhlukahlukene kwezokwelapha kwezemidlalo, njengokulungiswa kwe-rotator cuff, ukulungiswa kwemisipha, ukwakhiwa kabusha kwemisipha, njll. Okulandelayo yisingeniso ekusetshenzisweni kokuhlinzwa kwezikhonkwane kusetshenziswa ukulungiswa kwe-rotator cuff njengesibonelo:
• Izinyathelo zokuhlinzwa: Okokuqala, udokotela uzohlanza futhi alungise indawo yokulimala kwe-rotator cuff; bese efaka i-anchor endaweni efanele; bese esebenzisa ama-sutures ukuze aqinise izicubu ze-rotator cuff ku-anchor; ekugcineni, i-suture kanye ne-bandage.
• Umphumela wokuhlinzwa: Ngokufakwa kwe-anchor, ukuzinza kanye nokusebenza kwezicubu ze-rotator cuff kungabuyiselwa, okukhuthaza ukululama kwesiguli.
Izinzuzo, Ukungalungi kanye Nezinyathelo Zokuqapha Zezikhonkwane
Izinzuzo
• Inikeza ukuqina okuzinzile.
• Isebenza ekulimaleni okuhlukahlukene kwezicubu ezithambile.
• Ezinye izikhonkwane ziyamuncwa futhi azidingi ukuhlinzwa kwesibili ukuze zisuswe.
Ukungalungi
• Ama-anchor ensimbi angakhiqiza izinto zobuciko zokudweba izithombe.
• Izinga lokuwohloka kwezikhonkwane ezimuncwayo lingase lingazinzile.
• Kukhona ingozi yokuqhekeka kwe-anchor noma ukuphuka kwe-suture.
Ama-anchor emithi yezemidlalo angasetshenziswa ekuhlinzeni okulandelayo:
1. I-epicondylitis ephindaphindayo ehlangothini (i-tennis elbow) engakaze iphathwe kahle izikhathi eziningi: Uma ukwelashwa okulondolozayo kungasebenzi, ukwelashwa ngokuhlinzwa kungakhethwa, futhi i-anchor ingasetshenziswa ukuxhuma kabusha indawo yokufaka ye-radial extensor carpi brevis ku-lateral epicondyle ye-humerus.
2. Ukudabuka kwemisipha ye-biceps ekude: Izinyembezi ezibangelwa ukuhamba okungavamile, ukubambelela, ukushayisana, njll. zingelashwa ngezikhonkwane zensimbi. Izikhonkwane ezimbili zingcwatshwe ku-radial tuberosity, kanti ucingo lomsila luboshwe esiqwini semisipha ye-biceps.
3. Ukuqhuma kwe-elbow collateral ligament: Ukuhlukana kwe-backterior ye-elbow kuvame ukuhambisana nokulimala kwe-ulnar collateral ligament, ikakhulukazi ukulimala kwe-anterior bundle. Ngokulimala kwe-elbow collateral ligament, izazi eziningi zivame ukukhetha ukwelashwa kokuhlinzwa kusenesikhathi. Indlela ye-wire anchor isetshenziselwa ukugoqa ubuso bethambo lapho i-ligament inamathele khona. Ngemva kokuphuma kwegazi okusha, i-anchor ifakwa ku-screw ebusweni bethambo lapho i-ligament inamathele khona, bese i-braided wire ekugcineni kwe-nail isetshenziselwa ukuluka i-ligament stump bese iyiqinisa noma ukulungisa i-ligament ngenaliti.
4. Ukuphuka kwephuzu lokunamathisela elingaphansi kwe-cruciate ligament: Ukuphuka kwephuzu lokunamathisela le-anterior cruciate ligament (ACL) tibial attachment avulsion uhlobo olukhethekile lokulimala kwe-ACL futhi kufanele kulungiswe kusenesikhathi. Ukusetshenziswa kwendlela ye-wire anchor kunezinkomba eziningi futhi akunqunyelwe ubukhulu be-fragment yokuqhekeka. Akudingi i-fluoroscopy yangaphakathi kokuhlinzwa ukuze kulungiswe isiqondiso sesikulufu. Ukusebenza kulula kakhulu futhi isikhathi sokusebenza sifinyeziwe ngokufanayo.
5. Ukungazinzi kwe-Patellar: okubangelwa ukungasebenzi kahle kwesimo somzimba samathambo kanye nokunganele kokuvinjelwa kwezicubu ezithambile. Iningi lezazi likhuthaza ukwelashwa okusebenzayo kokuhlinzwa kusetshenziswa izikhonkwane zensimbi.
6. Ukuphuka kwe-Patellar inferior pole: Ubuchwepheshe be-wire anchor bungasetshenziswa ukwelapha ukuphuka kwe-patellar inferior pole. Ngokulungisa ukuphuka kwe-patellar inferior pole kanye nokuluka nokuthungela i-patellar ligament, ubuqotho bendlela yokwandisa idolo bungabuyiselwa futhi ubude obusebenzayo bomzimba bendlela yokwandisa idolo bungagcinwa.
7. Ifanele ukuxhumanisa nokuqinisa amathambo nezicubu ezithambile edolweni, emgogodleni, ehlombe, endololwaneni, eqakaleni, onyaweni, esihlakaleni kanye nasezinhlwini zezandla: I-anchor inomklamo wentambo ehlanganisiwe, okulula ukuyifakela futhi inikeza ukumelana okunamandla kokudonsa, futhi ifanele ukuhlinzwa ezingxenyeni ezahlukene.
Izinyathelo zokuzivikela
• Isimo sethambo lesiguli kanye nesakhiwo somzimba sendawo yokuhlinzwa kufanele kuhlolwe ngokugcwele ngaphambi kokuhlinzwa.
• Khetha uhlobo lwe-anchor olufanele kanye nemininingwane ukuqinisekisa umphumela wokuhlinzwa.
• Kufanele kwenziwe izivivinyo zokuvuselela ezifanele ngemva kokuhlinzwa ukuze kukhuthazwe ukuphulukiswa kwezicubu nokubuyisela ukusebenza kwazo.
Ngamafuphi, ama-anchor adlala indima ebalulekile kwezokwelapha kwezemidlalo. Ngokukhetha uhlobo lwe-anchor olufanele kanye nemininingwane kanye nokulandela izinyathelo zokuhlinzwa ezifanele kanye nezinyathelo zokuphepha, umphumela wokuhlinzwa ungaqinisekiswa futhi ukululama kwesiguli kungathuthukiswa.
Isikhathi sokuthunyelwe: Disemba 17-2024
