Kusukela Sculco et al.okokuqala kubika i-small-incision total hip arthroplasty (THA) ngendlela ye-posterolateral ngo-1996, izinguquko ezimbalwa ezintsha ezihlasela kancane ziye zabikwa.Kulezi zinsuku, lo mqondo ongangeneleli kancane uye wasakazwa kabanzi futhi wamukelwa kancane kancane odokotela.Kodwa-ke, asikho isinqumo esicacile sokuthi kufanele kusetshenziswe izinqubo ezihlasela kancane noma ezivamile.
Izinzuzo zokuhlinza okuncane kakhulu zihlanganisa ukusika okuncane, ukopha okuncane, ubuhlungu obuncane, nokululama ngokushesha;nokho, ukungalungi kuhlanganisa insimu yokubuka elinganiselwe, kulula ukukhiqiza ukulimala kwe-neurovascular yezokwelapha, isimo esibi sokufakelwa, kanye nengozi eyengeziwe yokuhlinzwa kabusha.
Ngomthamo omncane we-hip arthroplasty (MIS - THA), ukulahlekelwa amandla emisipha ngemuva kokuhlinzwa kuyisizathu esibalulekile esithinta ukululama, futhi indlela yokuhlinzwa iyisici esibalulekile esithinta amandla emisipha.Isibonelo, izindlela ze-anterolateral neziqondile zangaphambili zingalimaza amaqembu emisipha ye-abductor, okuholela ekunyakazeni okunyakazayo (i-Trendelenburg limp).
Emzamweni wokuthola izindlela ezingangeneleli kancane ezinciphisa ukulimala kwemisipha, uDkt. Amanatullah et al.kusukela eMayo Clinic e-United States kuqhathanise izindlela ezimbili ze-MIS-THA, indlela eqondile yangaphambili (DA) kanye ne-direct superior approach (DS), kuma-cadaveric specimens ukuze kutholwe umonakalo emisipha nemisipha.Imiphumela yalolu cwaningo ibonise ukuthi indlela ye-DS ayilimazi kangako imisipha nemisipha kunendlela ye-DA futhi ingase ibe inqubo ekhethwayo ye-MIS-THA.
Idizayini yokuhlola
Lolu cwaningo lwenziwe kuma-cadaver ayisishiyagalombili asanda kubanda anamapheya ayisishiyagalombili ezinqulwini ezingu-16 ezingenamlando wokuhlinzwa inqulu.Enye inqulu yakhethwa ngokungahleliwe ukuba yenzelwe i-MIS-THA ngendlela ye-DA kanti enye kusetshenziswa indlela ye-DS endaweni eyodwa, futhi zonke izinqubo zenziwa odokotela abanolwazi.Izinga lokugcina lokulimala kwemisipha ne-tendon lahlolwa udokotela wamathambo owayengahileleki ekusebenzeni.
Izakhiwo ze-anatomical ezihloliwe zihlanganisa: i-gluteus maximus, i-gluteus medius kanye ne-tendon yayo, i-gluteus minimus ne-tendon yayo, i-vastus tensor fasciae latae, i-quadriceps femoris, i-trapezius ephezulu, i-piatto, i-trapezius ephansi, i-obturator internus, ne-obturator externus (i-figurator externus1).Imisipha yahlolelwa ukukhala kwemisipha nokuthamba okubonakala ngeso lenyama.
Umfanekiso 1 Umdwebo we-anatomical womsipha ngamunye
Imiphumela
1. Ukulimala kwemisipha: Awukho umehluko wezibalo ngezinga lokulimala kwendawo ku-gluteus medius phakathi nezindlela ze-DA ne-DS.Kodwa-ke, ku-gluteus minimus muscle, iphesenti yokulimala kwendawo okubangelwa indlela ye-DA yayiphakeme kakhulu kunalokho okubangelwa indlela ye-DS, futhi kwakungekho umehluko omkhulu phakathi kwezindlela ezimbili ze-quadriceps muscle.Kwakungekho umehluko ophawulekayo phakathi kwalezi zindlela ezimbili mayelana nokulimala kwemisipha ye-quadriceps, futhi iphesenti yokulimala kwendawo ku-vastus tensor fasciae latae kanye nemisipha ye-rectus femoris yayinkulu ngendlela ye-DA kunendlela ye-DS.
2. Ukulimala kwe-tendon: Ayikho indlela ebangele ukulimala okukhulu.
3. I-Tendon transection: Ubude be-gluteus minimus tendon transection babuphakeme kakhulu eqenjini le-DA kuneqembu le-DS, futhi iphesenti lokulimala laliphezulu kakhulu eqenjini le-DS.Kwakungekho umehluko ophawulekayo ekulimaleni kwe-tendon transection phakathi kwamaqembu amabili we-pyriformis kanye ne-obturator internus.I-schematic yokuhlinzwa iboniswa ku-Fig. 2, Umfanekiso wesi-3 ubonisa indlela yendabuko ye-lateral, futhi i-Fig. 4 ibonisa indlela yendabuko yangemuva.
Umfanekiso 2 1a.I-transection ephelele ye-gluteus minimus tendon ngesikhathi senqubo ye-DA ngenxa yesidingo sokulungiswa kwabesifazane;1b.Ukunqamuka kwengxenye ye-gluteus minimus ebonisa izinga lokulimala ku-tendon yayo nesisu semisipha.gt.i-trochanter enkulu;* i-gluteus minimus.
Umdwebo 3 Isikimu sendlela yendabuko eqondile ehlangothini ene-acetabulum ebonakalayo kwesokudla ngokudonsa okufanele
Umfanekiso wesi-4 Ukuvezwa kwemisipha yangaphandle ejikelezayo emfushane ngendlela evamile ye-THA yangemuva
Isiphetho kanye Nemiphumela Yomtholampilo
Ucwaningo oluningi lwangaphambilini aluzange lubonise umehluko ophawulekayo esikhathini sokusebenza, ukulawula ubuhlungu, izinga lokumpontshelwa, ukulahlekelwa igazi, ubude besikhathi sokuhlala esibhedlela, kanye nokuhamba uma kuqhathaniswa i-THA evamile ne-MIS-THA. Repantis et al.abonisanga umehluko ophawulekayo phakathi kwalaba ababili, ngaphandle kokunciphisa okuphawulekayo kobuhlungu, futhi akukho umehluko omkhulu ekuphumeni kwegazi, ukubekezelelana kokuhamba, noma ukuvuselelwa ngemuva kokuhlinzwa.Ucwaningo lwezempilo lukaGoosen et al.
I-RCT kaGoosen et al.ibonise ukwenyuka kwesilinganiso sesikolo se-HHS ngemva kokuhlasela kancane (okusikisela ukululama okungcono), kodwa isikhathi eside sokusebenza kanye nezinkinga ze-perioperative.Eminyakeni yamuva nje, kuye kwaba nezifundo eziningi ezihlola ukulimala kwemisipha kanye nesikhathi sokululama ngemuva kokuhlinzwa ngenxa yokufinyelela okuncane kokuhlinzwa, kodwa lezi zinkinga azikakaxazululwa kahle.Ucwaningo lwamanje lwenziwe futhi lusekelwe ezindabeni ezinjalo.
Kulolu cwaningo, kutholakale ukuthi indlela ye-DS ibangele ukulimala okuncane kakhulu kwezicubu ze-muscle kunendlela ye-DA, njengoba kuboniswa umonakalo omncane kakhulu we-gluteus minimus muscle kanye ne-tendon yayo, i-vastus tensor fasciae latae muscle, kanye ne-rectus femoris muscle. .Lokhu kulimala kunqunywe indlela ye-DA uqobo futhi kwakunzima ukuyilungisa ngemuva kokuhlinzwa.Uma kucatshangelwa ukuthi lolu cwaningo luyisibonelo se-cadaveric, izifundo zomtholampilo ziyadingeka ukuze kuphenywe ukubaluleka komtholampilo kwalo mphumela ekujuleni.
Isikhathi sokuthumela: Nov-01-2023
