Indlela Yokuhlinzwa Yokuchayeka Emadolweni

· I-Anatomy Esetshenzisiwe

Ngaphambi kwe-scapula kukhona i-subscapular fossa, lapho kuqala khona umsipha we-subscapularis. Ngemuva kukhona umugqa we-scapular ohambayo ongaphandle nophezulu kancane, ohlukaniswe yi-supraspinatus fossa kanye ne-infraspinatus fossa, ukuze kunamathiselwe imisipha ye-supraspinatus kanye ne-infraspinatus ngokulandelana. Umkhawulo wangaphandle womugqa we-scapular yi-acromion, eyakha i-acromioclavicular joint ne-acromion end ye-clavicle ngokusebenzisa ubuso obude obuyi-ovoid articular. Umkhawulo ophakeme womugqa we-scapular une-notch encane efana no-U, ewela i-ligament emfushane kodwa eqinile ye-suprascapular transverse, lapho umthambo we-suprascapular udlula khona, futhi lapho umthambo we-suprascapular udlula khona. Umngcele oseceleni (umngcele we-axillary) womugqa we-scapular yiwona ojiyile kakhulu futhi udlulela ngaphandle uye empandeni yentamo ye-scapular, lapho wakha khona i-glenoid notch ngomphetho we-glenoid wejoyinti lehlombe.

· Izinkomba

1. Ukususwa kabusha kwezimila ze-scapular ezingengozini.

2. Ukususwa kwendawo kwesimila esibi se-scapula.

3. I-scapula ephezulu kanye nezinye iziphazamiso.

4. Ukususwa kwethambo elifile ku-scapular osteomyelitis.

5. Isifo sokubanjwa kwemizwa ye-Suprascapular.

· Indawo yomzimba

Indawo ethambekele kancane, ithambekele ku-30° embhedeni. Isitho esingaphezulu esithintekile sigoqwa ngethawula elihlanzekile ukuze sikwazi ukushukunyiswa nganoma yisiphi isikhathi ngesikhathi sokuhlinzwa.

· Izinyathelo zokusebenza

1. Ukusika okuphambene ngokuvamile kwenziwa eceleni komphetho we-scapular ku-supraspinatus fossa kanye nengxenye engenhla ye-infraspinatus fossa, futhi ukusika okude kungenziwa eceleni komphetho ophakathi we-scapula noma ohlangothini oluphakathi lwe-subscapularis fossa. Ukusika okuphambeneyo nokwe-longitudinal kungahlanganiswa ukuze kwakhiwe isimo se-L, isimo se-L esiphendukezelwe, noma isimo se-first-class, kuye ngesidingo sokubona izingxenye ezahlukene ze-scapula. Uma kuphela amakhona aphezulu naphansi e-scapula kudingeka avele, ukusika okuncane kungenziwa ezindaweni ezifanele (Isithombe 7-1-5(1)).

2. Sika i-fascia engaphezulu nejulile. Imisipha exhunywe ku-scapular ridge kanye nomngcele ophakathi inqunywa ngokuphambene noma ngobude ohlangothini lwe-incision (Isithombe 7-1-5(2)). Uma i-supraspinatus fossa izovezwa, imicu yomsipha we-trapezius ophakathi inqunywa kuqala. I-periosteum inqunywa ebusweni bethambo le-scapular gonad, enengqimba encane yamafutha phakathi kwalokhu okubili, futhi yonke i-supraspinatus fossa ivezwa ngokuhlukaniswa kwe-subperiosteal komsipha we-supraspinatus, kanye nomsipha we-trapezius ongaphezulu. Lapho usika imicu ephezulu yomsipha we-trapezius, kufanele kuqashelwe ukuthi ungalimazi i-parasympathetic nerve.

3. Lapho kuzokwembulwa umthambo we-suprascapular, imicu yengxenye ephakathi ephezulu yomsipha we-trapezius kuphela engadonswa phezulu, futhi umsipha we-supraspinatus ungadonswa kancane phansi ngaphandle kokukhumula, futhi isakhiwo esimhlophe esicwebezelayo esibonakalayo yi-suprascapular transverse ligament. Uma imithambo nezinzwa ze-suprascapular sezitholiwe futhi zavikelwa, i-suprascapular transverse ligament inganqunywa, futhi i-scapular notch ingahlolwa kunoma yiziphi izakhiwo ezingavamile, bese umthambo we-suprascapular ungakhululwa. Ekugcineni, umsipha we-trapezius ohlutshiwe uyaxhunywa ndawonye ukuze unamathele ku-scapula.

4. Uma ingxenye engenhla ye-infraspinatus fossa izovezwa, imicu engezansi nephakathi yomsipha we-trapezius kanye nomsipha we-deltoid ingasikwa ekuqaleni komphetho we-scapular bese ibuyiselwa emuva phezulu naphansi (Isithombe 7-1-5(3)), futhi ngemva kokuba umsipha we-infraspinatus usuveziwe, ungahlutshwa ngaphansi kwe-periosteal (Isithombe 7-1-5(4)). Lapho usondela ekugcineni okuphezulu komphetho we-axillary we-scapular gonad (okungukuthi, ngaphansi kwe-glenoid), kufanele kuqashelwe i-axillary nerve kanye ne-posterior rotator humeral artery edlula ku-quadrilateral foramen ezungezwe yi-teres minor, i-teres major, ikhanda elide le-triceps, kanye nentamo yokuhlinzwa ye-humerus, kanye nomthambo we-rotator scapulae odlula ku-triangular foramen ezungezwe yizintathu zokuqala, ukuze zingabangeli ukulimala kuzo (Isithombe 7-1-5(5)).

5. Ukuze kuvezwe umngcele ophakathi we-scapula, ngemva kokusika imicu yomsipha we-trapezius, imisipha ye-trapezius ne-supraspinatus ihoxiswa phezulu nangaphandle ngokususa imisipha ukuze kuvezwe ingxenye ephakathi ye-supraspinatus fossa kanye nengxenye ephezulu yomngcele ophakathi; kanye nemisipha ye-trapezius ne-infraspinatus, kanye nomsipha we-vastus lateralis onamathele ekhoneni elingaphansi le-scapula, ihlutshulwa ngaphansi kwe-periosteally ukuze kuvezwe ingxenye ephakathi ye-infraspinatus fossa, i-angle engaphansi ye-scapula, kanye nengxenye engezansi yomngcele ophakathi.

Umfanekiso 7-1-5 Indlela yokuchayeka kwe-dorsal scapular

(1) ukusikwa; (2) ukusikwa komugqa wemisipha; (3) ukunqamula imisipha ye-deltoid kusuka ku-scapular ridge; (4) ukuphakamisa imisipha ye-deltoid ukuze kwembulwe i-infraspinatus kanye ne-teres minor; (5) ukususa imisipha ye-infraspinatus ukuze kwembulwe ingxenye yangemuva ye-scapula nge-vascular anastomosis

6. Uma i-subscapular fossa izovezwa, imisipha enamathele kungqimba lwangaphakathi lomngcele ophakathi, okungukuthi, i-scapularis, i-rhomboid kanye ne-serratus anterior, kufanele ihlutshulwe ngesikhathi esifanayo, futhi yonke i-scapula ingaphakanyiswa ngaphandle. Lapho kukhululwa umngcele ophakathi, kufanele kuthathwe ukunakekelwa ukuvikela igatsha elihlayo lomthambo we-carotid ojikelezayo kanye nomthambo we-scapular ongemuva. Igatsha elihlayo lomthambo we-carotid ojikelezayo livela esiqwini sentamo ye-thyroid futhi lihamba lisuka ekhoneni eliphezulu le-scapula liye ekhoneni elingezansi le-scapula nge-scapularis tenuissimus, umsipha we-rhomboid kanye nomsipha we-rhomboid, kanti umthambo we-rotator scapulae wakha inethiwekhi ecebile yemithambo engxenyeni engemuva ye-scapula, ngakho-ke kufanele inamathele ngokuqinile ebusweni bethambo ukuze kuhlutshulwe i-subperiosteal.