· 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 kuzovezwa i-nerve ye-suprascapular, kuphela imicu yengxenye engenhla ephakathi ye-trapezius muscle ingadonselwa phezulu, futhi imisipha ye-supraspinatus ingadonselwa phansi ngobumnene ngaphandle kokuhlubula, futhi isakhiwo esimhlophe esicwebezelayo esibonakalayo yi-suprascapular transverse. umsipha.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 ingafakwa ekuqaleni kwe-scapular ridge futhi ihlehlise phezulu naphansi (Fig. 7-1- 5 (3)), futhi ngemva kokuba i-infraspinatus muscle ivezwe, ingahle ihlanjululwe nge-subperiosteally (Fig. 7-1-5 (4)).Lapho usondela ekupheleni okuphezulu kwe-axillary margin ye-scapular gonad (okungukuthi, ngaphansi kwe-glenoid), kufanele kuqashelwe i-axillary nerve kanye ne-posterior rotator humeral artery edlula i-quadrilateral foramen ezungezwe i-teres minor, i-teres enkulu, ikhanda elide. we-triceps, nentamo yokuhlinzwa ye-humerus, kanye nomthambo we-rotator scapulae odlula i-foramen engunxantathu ezungezwe ezintathu zokuqala, ukuze ungabangeli ukulimala kubo (Fig. 7-1-5 (5)).
5. Ukuveza umngcele ophakathi we-scapula, ngemva kokuhlanganisa imicu ye-trapezius muscle, imisipha ye-trapezius ne-supraspinatus ihlehliswa phezulu nangaphandle nge-subperiosteal stripping 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, ihlutshiwe 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 ukuze uveze 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 elehlayo lomthambo we-carotid oguquguqukayo lisuka esiqwini sentamo yegilo futhi lihamba lisuka engeli eliphezulu le-scapula liye engeli eliphansi le-scapula nge-scapularis tenuissimus, i-rhomboid muscle kanye ne-rhomboid muscle, futhi umthambo we-rotator scapulae wenza i-vascular ecebile. inethiwekhi engxenyeni yomgogodla we-scapula, ngakho-ke kufanele inamathele ngokuqinile ebusweni bethambo ukuze kukhishwe i-subperiosteal peeling.
Isikhathi sokuthumela: Nov-21-2023
