I-Dorsal Scapular Explovedonce StedAy

· Anatomy

Phambi kwe-scapula yi-possal fossa ebonakalayo, lapho kuqala khona umsipha we-subscaluris. Ngemuva kuyindawo yangaphandle nangaphezulu ebheke phezulu ye-scappar, ehlukaniswe nge-supraspinatus fossa kanye ne-infraspinatus fossa, okunamathiselwe kwe-supraspinatus kanye nemisipha ye-inraspinatus ngokulandelana. Ukuphela kwangaphandle kwe-scapular Ridge yi-Alomion, eyakha ukuhlangana kwe-acromioclavicular okuphelele kwe-clavicle end kwe-clavicle ebusweni obude be-ovoid. I-margin ephakeme ye-scapular Ridge ine-notch enomumo osheke, ewela i-suprascalur ligament emfushane kodwa eqinile, lapho i-suprascapular nertery idlula khona. Umaki we-lateral (i-axillary margin) ye-scapular Ridge yi-permiast futhi ihamba ngaphandle entanjeni yentamo ye-scarsur, lapho kwakha i-notch ye-gelleid onqenqemeni lwe-glenoid ye-glenoid ehlanganisiwe.

· Izinkomba

1. Ukuvuselelwa kwama-benign scapular tumors.

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3. I-scapula ephezulu nezinye izimo.

4. Ukususwa kwethambo elifile ku-scapur osteomyelitis.

I-5. I-Suprascapular nerve entrapement syndrome.

Isikhundla somzimba

Isikhundla esithambekele, sigxile ku-30 ​​° embhedeni. I-lingb engaphezulu ethintekile iboshwe ngethayela eliyinyumba ukuze lihanjiswe nganoma yisiphi isikhathi ngesikhathi sokusebenza.

· Esebenzayo izinyathelo

1. I-incision eguqukayo ngokuvamile yenziwa eceleni kwe-scrapur frosge ku-supraspinatus fossa kanye nengxenye engenhla ye-infraspinatus fossa, futhi ukuvela okude kungenziwa eceleni komphakathi we-scapula noma ohlangothini lwe-audial lwe-subscaluris fossa. Ukufakwa kwe-transverse kanye ne-longitudinal kungahlanganiswa ukwakha i-L-Shape, i-L-Shape, noma ukwakheka kokuqala, kuya ngesidingo sokubona izingxenye ezahlukahlukene ze-scapula. Ukube kuphela amakhona aphezulu nangaphansi we-scapula adinga ukuvezwa, ukungezwani okuncane kungenziwa ezindaweni ezihambisanayo (Umdwebo 7--5 (1)).

2. Vimbisa i-fascia evulekile futhi ejulile. Imisipha enamathiselwe kwi-scapular ridge kanye nomngcele we-medial asuswa ngokusobala noma ngokuhamba ibanga elinde ngokuqondisa kwe-incision (Fig. 7-1-5 (2)). Uma i-supraspinatus Fossa izodalulwa, imicu yemisipha ye-Middle Trapezius ifakwa kuqala. I-periosteum ifakwa ngaphansi komhlaba we-bony ye-scapular Gonad, enongqimba oluncane lwamafutha phakathi kwalezi ezimbili, futhi yonke i-supraspinatus FOSSA ivezwa yi-Supperinatus Dissect of the Supraspinatus umsipha, kanye nemisipha ye-trapeZis ngokweqile. Lapho kuthobeka imicu engenhla yomsipha we-trapezius, ukunakekelwa kufanele kuthathwe ukungalimazi ne-parasymparetic nerve.

3. Lapho i-suprascapular nerve yembulwa, kuphela imicu yengxenye ephezulu yemisipha ye-trapezius ingadonswa phezulu, futhi umsipha we-supraspinatus ungadonswa phansi ngaphandle kokuhlubula, futhi isakhiwo esimhlophe esikhanyayo esibonakalayo yi-Suprascapular Transverse Ligament. Lapho nje imikhumbi nezinzwa nama-suprascalur avikelekile, i-suprascapular transverse ligament ingahlukaniswa, futhi i-notch ye-scapular ingahlolwa kunoma yiziphi izakhiwo ezingejwayelekile, futhi izinzwa ze-suprascapular zingadedelwa. Ekugcineni, imisipha ye-trapezius ekhuphukile iyabuyiselwa emuva ndawonye ukuze ifakwe kwi-scapula.

I-4. Uma ingxenye engenhla ye-infraspinatus FOSSA izodalulwa, imicu ephansi nephakathi yemisipha ye-trapezius kanye nomsipha we-deltoid ungavunywa ekuqaleni kwe-scapular ridege futhi ubheke phezulu (umkhipheni (i-ater the infospinatus umsipha we-inforded, kungaba yi-burepeesty (i-FUSTION 7-1-5 (4)). Lapho usondela emaphethelweni aphakeme we-Axillary Margin ye-Scapular Gonad (ie, ngaphansi kwe-Glenoid), ukunakwa kufanele kukhokhwe kwi-arter yezinzwa ye-axillary ezungeze ama-teres amancane, kanye nentamo ende ye-tricepus, kanye nentamo evuthayo ye-artery edlula kunxantathu I-foramen izungezwe ezintathu zokuqala, ukuze ingabangeli ukulimala kubo (Fig. 7-1-5 (5)).

5. Ukudalula umngcele we-scapula we-scapula, ngemuva kokukhipha imicu yemisipha ye-trapezius, imisipha ye-trapezius ne-supraspinatus itholwe ngokuphakeme nangokuhlanjululwa okungaphansi kokukhipha ingxenye yempilo ye-supraspinatus fosda nengxenye engenhla yomngcele we-medial; kanye nemisipha ye-trapezius kanye ne-infraspinatus, kanye nemisipha ye-vastous latalis enamathiselwe e-angle ephansi ye-scapula, ihluthwe ngokuzithoba ukuveza ingxenye yempilo ye-infossa, nengxenye engezansi yomngcele we-scapula, nengxenye engezansi yomngcele we-scapula, kanye nengxenye engezansi yomngcele we-scapula

Umdwebo 7--5 Indlela Yokuvezwa Kwe-Dorsal Scapular

(1) ukuvela; (2) Ukuvela komugqa wemisipha; (3) ukuhlukanisa imisipha ye-deltoid kusuka ku-scapular ridge; (4) Ukuphakamisa imisipha ye-deltoid ukwembula i-infraspinatus kanye namathafa amancane; (5) Ukuhlubula izicubu ze-inforpinatus ukuveza isici se-dorsal se-scapula nge-vascular anastomosis

6 Lapho ukhulula umngcele we-medial, kufanele kuthathwe ukunakekelwa ukuze kuvikeleke igatsha lehla lomthambo we-carotid we-transverver Igatsha elisehlayo le-artery eguqukayo le-carotid livela emgodini we-thyroid temple futhi lihambe lisuka engela elingaphezulu le-scapula elisematheni ama-scapulal nge-scapula elisezingeni eliphezulu le-scapula, ngakho-ke kufanele linamathelwe ngokuqinile ebusweni be-bone ukubhebhana okuphansi.