Kusukela uSculco nabanye babike okokuqala nge-small-incision total hip arthroplasty (THA) ngendlela ye-posterolateral ngo-1996, kuye kwabikwa izinguquko eziningana ezintsha ezingavamile. Namuhla, umqondo ongavamile uye wadluliselwa kabanzi futhi wamukelwa kancane kancane odokotela. Kodwa-ke, akukabikho sinqumo esicacile sokuthi kufanele kusetshenziswe izinqubo ezingajwayelekile noma ezivamile.
Izinzuzo zokuhlinzwa okungangenisi kakhulu zihlanganisa ukusikwa okuncane, ukopha okuncane, ubuhlungu obuncane, kanye nokululama okusheshayo; nokho, ubunzima buhlanganisa indawo yokubuka elinganiselwe, ukulimala okulula kokwelashwa kwemithambo yegazi, ukuma okungekuhle kokufakelwa, kanye nengozi eyengeziwe yokuhlinzwa kabusha.
Ku-arthroplasty ye-hip ephelele engavamile (i-MIS - i-THA), ukulahlekelwa amandla emisipha ngemva kokuhlinzwa kuyisizathu esibalulekile esithinta ukululama, kanti indlela yokuhlinzwa iyisici esibalulekile esithinta amandla emisipha. Isibonelo, izindlela zangaphambili kanye nezindlela zangaphambili eziqondile zingalimaza amaqembu emisipha ye-abductor, okuholela ekuhambeni okunyakazayo (i-Trendelenburg limp).
Emzamweni wokuthola izindlela ezingangenisi kakhulu ezinciphisa umonakalo wemisipha, uDkt. Amanatullah nabanye baseMayo Clinic e-United States baqhathanise izindlela ezimbili ze-MIS-THA, indlela eqondile yangaphambili (DA) kanye nendlela eqondile ephezulu (DS), kumasampula esidumbu ukuze kutholakale umonakalo emisipheni nasemisiphani. Imiphumela yalolu cwaningo ikhombisile ukuthi indlela ye-DS ayilimazi kakhulu imisipha namathambo kunendlela ye-DA futhi ingaba inqubo ekhethwayo ye-MIS-THA.
Umklamo wokuhlola
Ucwaningo lwenziwe ezidunjini eziyisishiyagalombili ezisanda kuqandwa ezinamabhangqa ayisishiyagalombili ezinqeni eziyi-16 ezingenawo umlando wokuhlinzwa kwenqulu. Inqulu eyodwa yakhethwa ngokungahleliwe ukuze kwenziwe i-MIS-THA ngendlela ye-DA kanti enye ngendlela ye-DS kwesinye isidumbu, futhi zonke izinqubo zenziwa odokotela abanolwazi. Izinga lokugcina lokulimala kwemisipha nemisipha lahlolwa udokotela ohlinzayo wamathambo owayengahilelekile ekuhlinzweni.
Izakhiwo zomzimba ezihlolwe zifaka: i-gluteus maximus, i-gluteus medius kanye ne-tendon yayo, i-gluteus minimus kanye ne-tendon yayo, i-vastus tensor fasciae latae, i-quadriceps femoris, i-upper trapezius, i-piatto, i-lower trapezius, i-obturator internus, kanye ne-obturator externus (Isithombe 1). Imisipha yahlolwa ukuthi ayinazo yini izinsila ezidabukile kanye nobuhlungu obubonakalayo emehlweni.
Isithombe 1 Umdwebo wokwakheka kwemisipha ngayinye
Imiphumela
1. Ukulimala kwemisipha: Akukho mehluko wezibalo ezingeni lokulimala kobuso ku-gluteus medius phakathi kwezindlela ze-DA ne-DS. Kodwa-ke, kumsipha we-gluteus minimus, iphesenti lokulimala kobuso okubangelwa yindlela ye-DA laliphezulu kakhulu kunalelo elibangelwa yindlela ye-DS, futhi akukho mehluko obalulekile phakathi kwezindlela ezimbili zomsipha we-quadriceps. Akukho mehluko obalulekile ngokwezibalo phakathi kwezindlela ezimbili maqondana nokulimala komsipha we-quadriceps, kanye nephesenti lokulimala kobuso kumisipha ye-vastus tensor fasciae latae kanye ne-rectus femoris lalilikhulu ngendlela ye-DA kunangendlela ye-DS.
2. Ukulimala kwemisipha: Akukho ukusondela okuholele ekulimaleni okukhulu.
3. Ukususwa kwemisipha ye-tendon: Ubude bokususwa kwemisipha ye-gluteus minimus babuphezulu kakhulu eqenjini le-DA kunaseqenjini le-DS, futhi iphesenti lokulimala laliphezulu kakhulu eqenjini le-DS. Kwakungekho mehluko obalulekile ekulimaleni kokususwa kwemisipha ye-tendon phakathi kwamaqembu amabili e-pyriformis kanye ne-obturator internus. Uhlelo lokuhlinzwa luboniswe ku-Fig. 2, i-Fig. 3 ikhombisa indlela yendabuko eseceleni, kanti i-Fig. 4 ikhombisa indlela yendabuko yasemuva.
Isithombe 2 1a. Ukususwa okuphelele kwe-tendon ye-gluteus minimus ngesikhathi senqubo ye-DA ngenxa yesidingo sokulungiswa kwe-femoral; 1b. Ukususwa okuyingxenye kwe-gluteus minimus okubonisa izinga lokulimala kwe-tendon yayo kanye nesisu semisipha. gt. greater trochanter; * gluteus minimus.
Isithombe 3 Isimiso sendlela yendabuko eqondile eseceleni lapho i-acetabulum ibonakala ngakwesokudla ngokudonsa okufanele
Umfanekiso 4 Ukuvezwa kwemisipha emfushane yangaphandle ye-rotator ngendlela evamile yangemuva ye-THA
Isiphetho kanye Nemiphumela Yezokwelapha
Izifundo eziningi zangaphambilini azibonisanga mehluko obalulekile esikhathini sokuhlinzwa, ukulawula ubuhlungu, izinga lokumpontshelwa igazi, ukulahlekelwa igazi, ubude bokuhlala esibhedlela, kanye nokuhamba lapho kuqhathaniswa i-THA evamile ne-MIS-THA. Ucwaningo lwezokwelapha lwe-THA olunokufinyelela okuvamile kanye ne-THA engangenisi kakhulu nguRepantis et al. alubonisanga mehluko obalulekile phakathi kwalokhu okubili, ngaphandle kokuncipha okukhulu kobuhlungu, kanye nomehluko obalulekile ekuphumeni kwegazi, ukubekezelela ukuhamba, noma ukuvuselelwa ngemva kokuhlinzwa. Ucwaningo lwezokwelapha lukaGoosen et al.
I-RCT kaGoosen nabanye ibonise ukwanda kwesilinganiso se-HHS ngemuva kwendlela yokungenelela okuncane (okuphakamisa ukululama okungcono), kodwa isikhathi eside sokuhlinzwa kanye nezinkinga eziningi kakhulu ngaphambi kokuhlinzwa. Eminyakeni yamuva nje, kube nezifundo eziningi ezihlola ukulimala kwemisipha kanye nesikhathi sokuphumula ngemva kokuhlinzwa ngenxa yokufinyelela okuncane kokuhlinzwa, kodwa lezi zinkinga azikaxazululwa ngokuphelele. Ucwaningo lwamanje lwenziwe futhi ngokusekelwe ezindabeni ezinjalo.
Kulolu cwaningo, kutholakale ukuthi indlela ye-DS ibangele umonakalo omncane kakhulu ezicutshini zemisipha kunendlela ye-DA, njengoba kufakazelwa umonakalo omncane kakhulu emsipheni we-gluteus minimus kanye ne-tendon yawo, emsipheni we-vastus tensor fasciae latae, kanye nomsipha we-rectus femoris. Lokhu kulimala kunqunywe yindlela ye-DA uqobo futhi kwakunzima ukuyilungisa ngemva kokuhlinzwa. Uma kubhekwa ukuthi lolu cwaningo luyisibonelo sesidumbu, kudingeka izifundo zezokwelapha ukuze kuhlolwe ukubaluleka kwezokwelapha kwalomphumela ngokujulile.
Isikhathi sokuthunyelwe: Novemba-01-2023
