I.Indlela yokugcwalisa usimende wethambo
Indlela yokugcwalisa usimende wamathambo ifaneleka ezigulini ezinezinkinga ezincane ze-AORI zohlobo lwe-I kanye nemisebenzi engasebenzi kancane.
Ubuchwepheshe bosimende obulula bethambo ngokobuchwepheshe budinga ukuhlanzwa okuphelele kwesici samathambo, futhi usimende wethambo ugcwalisa isici samathambo ngesikhathi sesiteji senhlama, ukuze igxishwe ezikhaleni ezisemakhoneni esici ngangokunokwenzeka, ngaleyo ndlela kuzuzwe ukulingana okuqinile nesixhumi esibonakalayo sethambo lomsingathi.
Indlela ethize yeBeyodwaCinto +Subuchwepheshe be-crew ukuhlanza kahle iphutha lethambo, bese ulungisa isikulufu ethanjeni lomsingathi, futhi uqaphele ukuthi ungavumeli i-screw cap yeqe indawo yethambo yesikhulumi esihlangene ngemva kwe-osteotomy; bese uxuba usimende wamathambo, ugcwalise ukukhubazeka kwamathambo esiteji senhlama, bese ugoqa isikulufu. U-Ritter MA et al. wasebenzisa le ndlela ukuze akhe kabusha i-tibial plateau bone defect, futhi ubukhulu besici bufinyelele ku-9mm, futhi akuzange kukhululwe iminyaka engu-3 ngemva kokuhlinzwa. Ubuchwepheshe bokugcwalisa usimende wethambo bususa amathambo amancane, bese busebenzisa ukubuyekezwa okuvamile kwe-prosthesis, ngaleyo ndlela kuncishiswe izindleko zokwelashwa ngenxa yokusetshenziswa kwe-prostheses yokubuyekeza, enenani elithile elisebenzayo.
Indlela ethize yethambo usimende + ubuchwepheshe besikulufu iwukuhlanza kahle iphutha lethambo, ukulungisa isikulufu ethanjeni lomsingathi, futhi unake ukuthi i-screw cap akufanele idlule indawo yethambo yesikhulumi esihlangene ngemva kwe-osteotomy; bese uxuba usimende wamathambo, ugcwalise ukukhubazeka kwamathambo esiteji senhlama, bese ugoqa isikulufu. U-Ritter MA et al. wasebenzisa le ndlela ukuze akhe kabusha i-tibial plateau bone defect, futhi ubukhulu besici bufinyelele ku-9mm, futhi kwakungekho ukuxegiswa kweminyaka engu-3 ngemva kokuhlinzwa. Ubuchwepheshe bokugcwalisa usimende wethambo bususa amathambo amancane, bese busebenzisa ukubuyekezwa okuvamile kwe-prosthesis, ngaleyo ndlela kunciphisa izindleko zokwelashwa ngenxa yokusetshenziswa kwe-prosthesis ebuyekeziwe, enenani elithile elisebenzayo (FigureI-1).
UmfanekisoI-1Ukugcwaliswa kukasimende wethambo kanye nokuqiniswa kwezikulufu
II.Amasu okuxhunyelelwa amathambo
Ukuxhunyelelwa kwethambo lokucindezelwa kungasetshenziselwa ukulungisa ukukhubazeka kwamathambo okubandakanya noma okungabandakanyi ekuhlinzweni kokubuyekezwa kwamadolo. Ilungele ukwakhiwa kabusha kokukhubazeka kohlobo lwe-AROI ukuya ku-III. Ekuhlinzweni okubukeziwe, njengoba ububanzi nezinga lokukhubazeka kwamathambo ngokuvamile kubi kakhulu, inani lethambo le-autologous elitholiwe lincane futhi ikakhulukazi ithambo le-sclerotic lapho i-prosthesis kanye ne-bone Cement kususwa phakathi nokuhlinzwa ukuze kugcinwe isisindo samathambo. Ngakho-ke, i-granular allogeneic bone ivame ukusetshenziselwa ukucindezela amathambo ngesikhathi sokuhlinzwa okubukeziwe.
Izinzuzo zokuxhunyelelwa kwethambo lokucindezelwa yilezi: ukugcina ithambo lethambo eliphethe; ukulungisa amaphutha amakhulu alula noma ayinkimbinkimbi amathambo.
Ububi balobu buchwepheshe yilezi: ukusebenza kudla isikhathi; ubuchwepheshe bokwakha kabusha bufuna (ikakhulukazi uma usebenzisa amakheji amakhulu e-MESH); akhona amathuba okudluliselwa kwezifo.
Ukuxhunyelelwa kwethambo lokucindezela okulula:Ukuxhunyelelwa okulula kwamathambo okucindezelwa kuvame ukusetshenziselwa ukukhubazeka kwamathambo okuhlanganisayo. Umehluko phakathi kokuxhunyelelwa kwethambo lokucindezelwa kanye nokuxhunyelelwa kwethambo lesakhiwo ukuthi i-granular bone graft material eyenziwe ngokuxhunyelelwa kwethambo lokucindezelwa ingasheshiswa futhi ifakwe kabusha ngokuphelele.
Ikheji yensimbi ye-Mesh + ukuxhunyelelwa kwethambo lokucindezelwa:Ukukhubazeka kwamathambo okungabandakanyi kuvame ukudinga ukwakhiwa kabusha kusetshenziswa amakheji ensimbi anezikhala ukuze kufakwe ithambo elikhansela. Ukwakhiwa kabusha kwe-femur ngokuvamile kunzima kunokwakhiwa kabusha kwe-tibia. Ama-X-ray akhombisa ukuthi ukuhlanganiswa kwamathambo kanye nokubunjwa kwethambo le-graft material kuyaqedwa kancane kancane (FigureII-1-1, UmfanekisoII-1-2).
UmfanekisoII-1-1I-mesh cage yangaphakathi yokucindezelwa kwethambo ukulungisa ukukhubazeka kwethambo le-tibial. I-Intraoperative; B I-X-ray yangemva kokuhlinzwa
Umfanekisoe II-1-2Ukulungiswa kokukhubazeka kwethambo le-femoral kanye ne-tibia nge-titanium mesh yokuminyanisa kwangaphakathi kwamathambo okuxhunyelelwa. I-Intraoperative; B I-X-ray yangemva kokuhlinzwa
Ngesikhathi sokubuyekezwa kwe-knee arthroplasty, ithambo lesakhiwo se-allogeneic lisetshenziselwa ukwakha kabusha uhlobo lwe-AORI uhlobo lwe-II noma lwe-III. Ngaphezu kokuba namakhono amangalisayo okuhlinza kanye nokuhlangenwe nakho okucebile ekushintsheni idolo eliyinkimbinkimbi, udokotela ohlinzayo kufanele futhi enze izinhlelo ezicophelelayo neziningiliziwe zangaphambi kokuhlinzwa. Ukuxhunyelelwa kwethambo lesakhiwo kungasetshenziselwa ukulungisa ukukhubazeka kwamathambo e-cortical nokwandisa ubukhulu bamathambo.
Izinzuzo zalobu buchwepheshe zihlanganisa:Ingenziwa kunoma yimuphi usayizi kanye nesimo ukuze ivumelane nokukhubazeka kwamathambo ezinhlobonhlobo zejometri; inomphumela omuhle wokusekela kuma-prostheses abukeziwe; kanye nokuhlanganiswa kwezinto eziphilayo zesikhathi eside kungafinyelelwa phakathi kwethambo le-allogeneic kanye nethambo lokusingatha.
Ukungalungi kuhlanganisa: isikhathi eside sokusebenza lapho usika ithambo le-allogeneic; imithombo elinganiselwe yethambo le-allogeneic; ingozi yokungabi nonunion kanye nenyunyana ebambezelekile ngenxa yezici ezifana nokukhishwa kwamathambo kanye nokuphuka kokukhathala ngaphambi kokuba inqubo yokuhlanganisa amathambo iqedwe; izinkinga zokumuncwa kanye nokutheleleka kwezinto ezitshaliwe; amathuba okudluliselwa kwezifo; kanye nokungaqini kahle kokuqala kwethambo le-allogeneic. I-allogeneic structural bone ivunwa ku-distal femur, i-proximal tibia, noma ikhanda lesifazane. Uma impahla yokufakelwa inkulu, i-revascularization ephelele ngokuvamile ayenzeki. Amakhanda e-allogeneic femoral angasetshenziswa ukulungisa amaphutha e-femoral condyle kanye ne-tibial plateau bone, ikakhulukazi ukulungisa izinkinga ezinkulu zamathambo ohlobo lwe-cavity, futhi alungiswa ngokucindezela ukucindezela ngemva kokusikwa nokubunjwa. Imiphumela yokuqala yomtholampilo yokusebenzisa ithambo lesakhiwo se-allogeneic ukulungisa ukukhubazeka kwamathambo ibonise izinga eliphezulu lokuphulukiswa kwethambo elitshaliwe (UmfanekisoII-1-3, UmfanekisoII-1-4).
UmfanekisoII-1-3Ukulungiswa kokukhubazeka kwethambo lesifazane nge-allogeneic femoral head structure ithambo lokuxhunyelelwa
UmfanekisoII-1-4Ukulungiswa kwe-tibial bone defect nge-allogeneic femoral head bone graft
III.Ubuchwepheshe bokugcwalisa insimbi
Ubuchwepheshe be-Modular Ubuchwepheshe be-Modular busho ukuthi izigcwalisi zensimbi zingahlanganiswa nama-prostheses kanye neziqu ze-intramedullary. Ama-fillers ahlanganisa amamodeli ahlukahlukene ukuze kube lula ukwakhiwa kabusha kwamathambo osayizi abahlukene.
Insimbi I-Prosthetic Ama-Augments:I-modular metal spacer ifaneleka kakhulu i-AORI uhlobo lwe-II lweziphambeko zamathambo ezingagcini ngokuqina okungafika ku-2 cm.Ukusetshenziswa kwezingxenye zensimbi ukulungisa ukukhubazeka kwamathambo kulula, kulula, futhi kunemiphumela ethembekile yomtholampilo.
I-metal spacers ingaba yi-porous noma iqinile, futhi izimo zazo zihlanganisa ama-wedges noma amabhlogo. Izikhala zensimbi zingaxhunywa ku-joint prosthesis ngezikulufo noma zilungiswe usimende wethambo. Ezinye izazi zikholelwa ukuthi ukulungiswa kukasimende wamathambo kungagwema ukuguga phakathi kwezinsimbi futhi kuncoma ukulungiswa kwe-samente yamathambo. Ezinye izazi nazo zikhuthaza indlela yokusebenzisa usimende wamathambo kuqala bese iqiniswa ngezikulufo phakathi kwe-spacer ne-prosthesis. Ukukhubazeka kwabesifazane kuvame ukuvela ezingxenyeni ezingemuva nezikude ze-condyle ye-femoral, ngakho-ke ama-spacers ensimbi ngokuvamile afakwa ezingxenyeni ezingemuva nezikude ze-condyle yesifazane. Ngokukhubazeka kwamathambo e-tibial, ama-wedges noma amabhulokhi angakhethwa ukuze kwakhiwe kabusha ukuze avumelane nokubunjwa kwesici esihlukile. Izincwadi zibika ukuthi amanani amahle kakhulu namahle aphezulu kakhulu afinyelela ku-84% kuya ku-98%.
Amabhulokhi amise okwe-wedge asetshenziswa lapho ukukhubazeka kwethambo kumise okwe-wedge, okungagcina ithambo lokusingatha. Le ndlela idinga i-osteotomy enembile ukuze indawo ye-osteotomy ifane ne-block. Ngaphezu kwengcindezi ecindezelayo, kukhona futhi amandla okugunda phakathi kwezindawo zokuxhumana. Ngakho-ke, i-angle ye-wedge akufanele idlule i-15 °. Uma kuqhathaniswa namabhulokhi amise okwe-wedge, amabhlogo ensimbi angama-cylindrical anesimo esibi sokukhulisa inani le-osteotomy, kepha ukuhlinzwa kokuhlinzwa kulula futhi kulula, futhi umphumela wemishini usondele kokujwayelekile (III-1-1A, B).
UmfanekisoIII-1-1Ama-metal spacers: I-spacer emise okwe-wedge yokulungisa amaphutha e-tibial; I-spacer emise okwekholomu engu-B ukulungisa amaphutha e-tibial
Ngenxa yokuthi ama-spacers ensimbi aklanywe ngezindlela ezihlukahlukene nobukhulu obuhlukahlukene, asetshenziswa kakhulu ekukhubazekeni kwamathambo okungaqukethe kanye nokukhubazeka kwamathambo okubunjwa okuhlukahlukene, futhi anikeze ukuzinza okuhle kokuqala kwemishini. Kodwa-ke, izifundo zesikhathi eside zithole ukuthi izikhala zensimbi ziyehluleka ngenxa yokuvikela ingcindezi. Uma kuqhathaniswa nokuxhunyelelwa kwamathambo, uma izikhala zensimbi zihluleka futhi zidinga ukubuyekezwa, zizobangela ukukhubazeka okukhulu kwamathambo.
Isikhathi sokuthumela: Oct-28-2024
