Kusukela sculco et al. Okokuqala kwabika inani elincane le-hip arthroplasty (tha) nendlela yokulandela indlela yonyaka we-1996, sekubikwe ukuguqulwa okusha okuningana okuhlaselayo. Kulezi zinsuku, umqondo omncane onokuhlasela udluliselwe kabanzi futhi wemukelwa kancane kancane odokotela. Kodwa-ke, asisekho isinqumo esicacile sokuthi kufanele sisetshenziswe yini ukuthi ngabe inqubo engahlaseli noma evamile noma evamile kufanele isetshenziswe.
Izinzuzo zokuhlinza okuncane ngokuhlaselayo zifaka ukungezwani okuncane, ukopha okuncane, ubuhlungu obuncane, nokululama okusheshayo; Kodwa-ke, ababi bafaka inkambu yokubukwa enomkhawulo, okulula ukukhiqiza ukulimala kwe-neurovascular, isikhundla esibi kakhulu se-prosthesis, kanye nengozi eyandayo yokuhlinzwa kabusha kabusha.
Esikhathini esiningi sokuhlanza i-hip arthroplasty (Mis - Tha), ukulahleka kwemisipha ye-postoperative kuyisizathu esibalulekile esithinta ukululama, futhi indlela yokuhlinzwa iyinto ebalulekile ethinta amandla emisipha. Isibonelo, ama-anterelateral kanye nezindlela eziqondile zangaphandle zingalimaza amaqembu emisipha e-abrors, okuholela echibini elixakayo (trendelenburg limp).
Emzamweni wokuthola izindlela ezihlaselayo ezibucayi ezinciphisa ukulimala kwemisipha, uDkt Amanatullah et al. Ukusuka emtholampilo we-mayo e-United States kuqhathaniswa nezindlela ezimbili ze-mis-tha, indlela eqondile yangaphandle (DA) kanye nendlela ephakeme ephakeme (DS), ohlelweni lweCadaveric ukunquma umonakalo emisipha nasematheni. Imiphumela yalolu cwaningo ikhombisile ukuthi indlela ye-DS ayilimazi kangako emisipha nasemathanjeni kunendlela ye-DA futhi ingaba inqubo oyithandayo ye-mis-tha.
Idizayini yokuhlola
Lolu cwaningo lwenziwe kuma-cadaver amasha asanda kufakwa eqandisiwe ngamabili ayisishiyagalombili okhalweni olungu-16 ngaphandle komlando wokuhlinzwa nge-HIP. I-hip eyodwa yakhethwa ngokungahleliwe ukuthi ibhekane ne-mis-tha nge-DA indlela ye-DA enye nge-DS Indlela ye-DS e-Cadaver eyodwa, futhi zonke izinqubo zenziwa ngodokotela abanolwazi. Izinga lokugcina lokulimala kwemisipha nokulimala kwahlolwa ngudokotela ohlinzayo wamathambo owayengazibandakanyi ekusebenzeni.
Izakhiwo ze-anatomical zihlolwe zifakiwe: I-GluteUs Maximus, i-GluteUs Medimus kanye ne-tendon yayo, i-purtures minimus ne-fastenue yayo, i-piatto, i-exterus ephansi, ne-activator externus (isithombe 1). Imisipha yahlolwa ukuthi izinyembezi zezicubu kanye nesisa zibonakale esweni elinqunu.
Fig. 1 umdwebo we-anatomical womsipha ngamunye
Umphumela
1. Ukulimala kwemisipha: Kwakungekho mehluko wezibalo ngezinga lokulimala kwe-gluteus medius phakathi kwe-DA ne-DS kusondela. Kodwa-ke, ngomsipha we-putelus minimus, iphesenti lokulimala okungaphezulu okubangelwa indlela ye-DA laliphakeme kakhulu kunaleso elibangelwa yindlela ye-DS, futhi kwakungekho mehluko omkhulu phakathi kwalezi zindlela ezimbili zemisipha emibili yemisipha ye-quadriceps. Kwakungekho mehluko obalulekile ngokwezibalo phakathi kwalezi zindlela ezimbili maqondana nokulimala kwimisipha ye-quadriceps, kanye namaphesenti okulimala okungaphezulu kwe-fastus tensor fasciae Latae ne-rectus tensoris imisipha yayikhulu ngendlela ye-DA.
2. Ukulimala kweTembon: Akusondelanga ngokulimala okukhulu.
3 Kwakungekho mehluko omkhulu ekulimaleni kokufakwa kwe-tendon phakathi kwala maqembu amabili e-pyriformis kanye ne-Internator Internator. Kuboniswa ucwaningo ngokuhlinzwa ku-Fig. 2, Fig. 3 Ibonisa indlela yendabuko yamuva, no-Fig. 4 ikhombisa indlela yendabuko yangemuva.
Fig. 2 1a. Ukudluliselwa okuphelele kwe-gluteus minimus tendon ngesikhathi senqubo ye-DA ngenxa yesidingo sokulungiswa kwabesifazane; 1b. Ukudluliswa okuyingxenye kwe-gluteus minimus ekhombisa ubukhulu bokulimala kwi-tendon yayo kanye nesisu semisipha. gt. i-trochanter enkulu; * I-Gluteus Minimus.
Fig. I-3 schematic yendlela yendabuko eqondile ye-acetabulum ebonakalayo ngakwesokunene ngokukhomba okufanele
Umdwebo 4 ukuvezwa komsipha omfushane wangaphandle we-rotator wangaphandle ngendlela evamile ye-THA POSTERIOR
Isiphetho kanye Nemiphumela Yomtholampilo
Izifundo eziningi zangaphambilini azikhombisanga umehluko omkhulu ngesikhathi sokusebenza, ukulawulwa kobuhlungu, isilinganiso segazi, ubude bendawo yokuhlala lapho beqhathanisa ukutadisha okujwayelekile kwe-THA nge-THA evamile kanye ne-tha nge-repantis et al. akuboniswanga umehluko obalulekile phakathi kwalokhu okubili, ngaphandle kokwehliswa okukhulu ebuhlungwini, futhi akukho mehluko ophawulekayo wokuphuma kokopha, ukubekezelelana, noma ukuvuselelwa kwe-postoperative. Isifundo somtholampilo nge-gootoset et al.
I-RCT ye-Goosetosen et al. Kubonise ukwanda kwesikolo se-HHS esithi ngemuva kwendlela yokuzihlanya okuncane (okuphakamisa ukululama okungcono), kepha isikhathi eside sokusebenza kanye nezinkinga ezinamandla kakhulu. Eminyakeni yamuva nje, kube nezifundo eziningi ezihlola ukulimala kwemisipha kanye nesikhathi sokutakula sokuvuselela ngenxa yokungenelela okuhlaselayo okuncane, kepha lezi zingqinamba azikaze zibhekwe kahle. Lolu cwaningo lwamanje lwaluqhutshwa lususelwa ezindabeni ezinjalo.
Kulolu cwaningo, kwatholakala ukuthi indlela ye-DS yabangela ukulimala okuncane kakhulu kwezicubu zemisipha kunendlela ye-DA, njengoba kufakazela ukulimala okuncane kakhulu kwemisipha ye-gluteus minimus kanye ne-tendon yayo, umsipha we-tectus. Lokhu kulimala kwakunqunywa yisondlela ye-DA uqobo futhi kwakunzima ukulungisa ngemuva kokuhlinzwa. Uma kucatshangelwa ukuthi lolu cwaningo luyi-cadaveric specimen, izifundo zemitholampilo ziyadingeka ukuphenya ukubaluleka komtholampilo kwalomphumela ngokujula.
Isikhathi sePosi: Nov-01-2023
