· I-Anatomy Esetshenziswayo
Ngaphambi kwe-scapula yi-fossa ye-subscapular, lapho i-subscapularis muscle iqala khona. Ngemuva kukhona ukhakhayi oluhambayo oluya ngaphandle nangaphezulu oluya phezulu, oluhlukaniswe lwaba yi-supraspinatus fossa kanye ne-infraspinatus fossa, ukuze kunamathiselwe imisipha ye-supraspinatus kanye ne-infraspinatus ngokulandelanayo. Ukuphela kwangaphandle kwe-scapular ridge yi-acromion, eyenza i-acromioclavicular joint ne-acromion ekupheleni kwe-clavicle ngokusebenzisa indawo ende ye-ovoid articular. I-margin ephakeme ye-scapular ridge ine-notch encane efana ne-U, ewela i-ligament emfushane kodwa eqinile eguquguqukayo ye-suprascapular, lapho i-nerve ye-suprascapular idlula khona, futhi lapho umthambo we-suprascapular udlula khona. I-lateral margin (i-axillary margin) ye-scapular ridge iwugqinsi futhi iqhubekela ngaphandle impande yentamo ye-scapular, lapho yenza inothi ye-glenoid enqenqemeni ye-glenoid yejoyinti lehlombe.
· Izinkomba
1. Ukukhishwa kabusha kwezimila ze-scapular eziyingozi.
2. Ukukhishwa kwendawo kwe-tumor eyingozi ye-scapula.
3. I-scapula ephezulu kanye nokunye ukukhubazeka.
4. Ukususwa kwethambo elifile ku-scapular osteomyelitis.
5. I-Suprascapular nerve entrapment syndrome.
· Ukuma komzimba
Indawo ethambekele kancane, itshekele ku-30° embhedeni. Isitho esingaphezulu esithintekile sisongwe ngethawula elingenalutho ukuze sikwazi ukunyakaza noma nini phakathi nokuhlinzwa.
· Izinyathelo zokusebenza
1. Ukusika okuphambene ngokuvamile kwenziwa eduze kwe-scapular ridge ku-supraspinatus fossa kanye nengxenye engenhla ye-infraspinatus fossa, futhi ukusika kwe-longitudinal kungenziwa eceleni komkhawulo ophakathi we-scapula noma ohlangothini oluphakathi lwe-subscapularis fossa. I-transverse kanye ne-longitudinal incision ingahlanganiswa ukuze yakhe umumo we-L, umumo we-L ohlanekezelwe, noma umumo wesigaba sokuqala, kuye ngesidingo sokuboniswa kwezingxenye ezahlukene ze-scapula. Uma kuphela amakhona angaphezulu naphansi e-scapula adinga ukudalulwa, ukucutshungulwa okuncane kungenziwa ezindaweni ezihambisanayo (Umfanekiso 7-1-5 (1)).
2. Gcoba i-fascia ekha phezulu nejulile. Imisipha exhunywe ku-scapular ridge kanye nomngcele we-medial incised transversely noma longitudinally ekuqondeni kwe-incision (Fig. 7-1-5 (2)). Uma i-supraspinatus fossa izodalulwa, imicu ye-trapezius muscle ephakathi ifakwa kuqala. I-periosteum incised ngokumelene ne-bony surface ye-scapular gonad, ne-layer encane yamafutha phakathi kokubili, futhi yonke i-supraspinatus fossa ivezwa yi-subperiosteal dissection ye-supraspinatus muscle, kanye ne-trapezius muscle. Lapho ufaka imicu engenhla ye-trapezius muscle, ukunakekelwa kufanele kuthathwe ukuze ungalimazi inzwa ye-parasympathetic.
3. Lapho i-nerve ye-suprascapular izodalulwa, izintambo kuphela zengxenye engenhla ephakathi ye-trapezius muscle ingadonselwa phezulu, futhi imisipha ye-supraspinatus ingadonsela phansi ngobumnene ngaphandle kokukhumula, futhi isakhiwo esimhlophe esicwebezelayo esibonakalayo yi-suprascapular transverse ligament. Uma imikhumbi ye-suprascapular kanye nezinzwa sezihlonziwe futhi zavikelwa, i-suprascapular transverse ligament ingahlukaniswa, futhi inothi ye-scapular ingahlolwa nganoma yiziphi izakhiwo ezingavamile, futhi inzwa ye-suprascapular ingakhululwa. Ekugcineni, i-trapezius muscle ehlutshiwe ihlanganiswe ndawonye ukuze ihlanganiswe ne-scapula.
4. Uma ingxenye engenhla ye-infraspinatus fossa izodalulwa, imicu ephansi nephakathi ye-trapezius muscle kanye ne-deltoid muscle ingacutshungulwa ekuqaleni kwe-scapular ridge futhi ihlehliswe phezulu naphansi (Fig. 7-1-5 (3) ), futhi ngemva kokuba i-infraspinatus muscle ibonakalisiwe (i-fiber periogized peeled) ingavezwa ngaphansi kwe-periosteally. 7-1-5(4)). Lapho usondela ekupheleni okuphezulu kwe-axillary margin ye-scapular gonad (okungukuthi, ngaphansi kwe-glenoid), ukunakwa kufanele kukhokhwe ku-axillary nerve kanye ne-posterior rotator humeral artery edlula i-quadrilateral foramen ezungezwe i-teres minor, i-teres enkulu, inhloko ende ye-triceps, kanye ne-scaerus neck of scamerus. umthambo odlula ku-foramen engunxantathu ezungezwe ezintathu zokuqala, ukuze ungabalimazi (Fig. 7-1-5(5)).
5. Ukuveza umngcele ophakathi we-scapula, ngemva kokuhlanganisa imicu ye-trapezius muscle, imisipha ye-trapezius ne-supraspinatus ihlehliswa ngokuphakeme nangaphandle ngokukhipha i-subperiosteal ukuze uveze ingxenye ephakathi ye-supraspinatus fossa kanye nengxenye engenhla yomngcele ophakathi; kanye nemisipha ye-trapezius kanye ne-infraspinatus, kanye ne-vastus lateralis muscle ehlanganiswe ne-angle engaphansi ye-scapula, ihlulwe kancane ukuze iveze ingxenye ephakathi ye-infraspinatus fossa, i-angle ephansi ye-scapula, kanye nengxenye engezansi yomngcele ophakathi.
Umfanekiso 7-1-5 Indlela yokuchayeka ku-scapular
(1) ukusikwa; (2) ukusika umugqa womsipha; (3) ukunqamula umsipha we-deltoid onqenqemeni lwe-scapular; (4) ukuphakamisa umsipha we-deltoid ukuveza i-infraspinatus ne-teres minor; (5) ukuhlubula umsipha we-infraspinatus ukuze uveze isici somgogodla we-scapula nge-vascular anastomosis
6. Uma i-subscapular fossa izodalulwa, imisipha ehlanganiswe nongqimba lwangaphakathi lomngcele ophakathi, okungukuthi, i-scapularis, i-rhomboids ne-serratus anterior, kufanele ikhishwe ngesikhathi esifanayo, futhi yonke i-scapula ingaphakanyiswa ngaphandle. Lapho ukhulula umngcele ophakathi, kufanele kuqashelwe ukuvikela igatsha elehlayo lomthambo we-carotid onqamulayo kanye ne-dorsal scapular nerve. Igatsha elihlayo lomthambo we-carotid oguquguqukayo livela esiqwini sentamo yegilo futhi lihamba lisuka engeli eliphezulu le-scapula liye endaweni ephansi ye-scapula nge-scapularis tenuissimus, imisipha ye-rhomboid kanye nemisipha ye-rhomboid, futhi umthambo we-rotator scapulae wakha inethiwekhi ecebile ye-vascular engxenyeni ye-scapula ye-scapula kufanele inamathele engxenyeni yethambo le-scapula. i-subperiosteal peeling.
Isikhathi sokuthumela: Nov-21-2023
