I.Indlela yokugcwalisa usimende wamathambo
Indlela yokugcwalisa usimende wamathambo ifanele iziguli ezinezinkinga ezincane zamathambo zohlobo lwe-AORI I kanye nemisebenzi engasebenzi kahle.
Ubuchwepheshe obulula besimende samathambo budinga ukuhlanzwa kahle kwesici sethambo, kanti isimende samathambo sigcwalisa isici sethambo ngesikhathi sesigaba senhlama, ukuze sifakwe ezikhaleni ezisekhoneni lesisici ngangokunokwenzeka, ngaleyo ndlela sivumelane kahle ne-interface yethambo lomnikazi.
Indlela ethile yeBeyodwaCisikhungo +SUbuchwepheshe beqembu lochwepheshe buwukuhlanza ngokuphelele isici sethambo, bese ulungisa isikulufu ethanjeni lomnikazi, futhi uqaphele ukuthi isivalo sesikulufu asidluli ubuso bethambo leplatifomu elihlangene ngemva kwe-osteotomy; bese uxuba usimende wethambo, ugcwalise isici sethambo esigabeni senhlama, bese usonga isikulufu. URitter MA nabanye basebenzise le ndlela ukwakha kabusha isici sethambo se-tibial plateau, futhi ubukhulu besici bufinyelele ku-9mm, futhi akukho ukukhululeka eminyakeni emi-3 ngemuva kokuhlinzwa. Ubuchwepheshe bokugcwalisa usimende wethambo bususa ithambo elincane, bese busebenzisa ukubuyekezwa okuvamile kokufakelwa, ngaleyo ndlela kunciphisa izindleko zokwelapha ngenxa yokusetshenziswa kokufakelwa kokufakelwa, okunenani elithile elisebenzayo.
Indlela ethile yobuchwepheshe besimende samathambo + isikulufu ukuhlanza ngokuphelele isici sethambo, ukulungisa isikulufu ethanjeni elihlala kulo, nokuqaphela ukuthi isivalo sesikulufu akufanele sidlule ubuso bethambo leplatifomu elihlangene ngemva kokuhlinzwa kwe-osteotomy; bese uxuba usimende wethambo, ugcwalise isici sethambo esigabeni senhlama, bese usonga isikulufu. URitter MA nabanye basebenzise le ndlela ukwakha kabusha isici sethambo se-tibial plateau, futhi ubukhulu besici bufinyelele ku-9mm, futhi akukho ukukhululeka eminyakeni emi-3 ngemuva kokuhlinzwa. Ubuchwepheshe bokugcwalisa usimende wethambo bususa ithambo elincane, bese busebenzisa ukubuyekezwa okuvamile kokufakelwa, ngaleyo ndlela kunciphisa izindleko zokwelapha ngenxa yokusetshenziswa kokufakelwa kokufakelwa, okunenani elithile elisebenzayo (IsithombeI-1).
UmfanekisoI-1Ukugcwaliswa kwesamente yamathambo nokuqinisa izikulufo
II.Amasu okuxhunyelelwa kwamathambo
Ukufakelwa kwamathambo ngokucindezela kungasetshenziswa ukulungisa amaphutha amathambo ahlanganisa noma angahlanganisi ekuhlinzeni kokulungiswa kwamadolo. Kufanelekile kakhulu ukwakhiwa kabusha kwamaphutha amathambo ohlobo lwe-AROI kuya kolwesi-3. Ekuhlinzeni kokulungisa, njengoba ububanzi kanye nezinga lamaphutha amathambo ngokuvamile kukhulu, inani lethambo le-autologous elitholakalayo lincane futhi ikakhulukazi liyithambo le-sclerotic lapho kususwa i-prosthesis kanye ne-bone cement ngesikhathi sokuhlinzwa ukuze kulondolozwe inqwaba yamathambo. Ngakho-ke, ithambo le-allogeneic eliyi-granular livame ukusetshenziselwa ukufakelwa kwamathambo ngokucindezela ngesikhathi sokuhlinzwa kokulungisa.
Izinzuzo zokufakwa kwamathambo okucindezela yilezi: ukugcina isisindo samathambo ethambo elihlala kulo; ukulungisa amaphutha amakhulu amathambo alula noma ayinkimbinkimbi.
Ububi balobu buchwepheshe yilobu: ukusebenza kuthatha isikhathi; ubuchwepheshe bokwakha kabusha buyadinga (ikakhulukazi uma kusetshenziswa amakheji amakhulu e-MESH); kunethuba lokudluliswa kwesifo.
Ukufakwa kwamathambo okulula kokucindezela:Ukufakwa kwamathambo okulula kokucindezela kuvame ukusetshenziselwa amaphutha amathambo afaka wonke umuntu. Umehluko phakathi kokufakwa kwamathambo okucindezelayo kanye nokufakwa kwamathambo okwakheka ukuthi izinto zokufakwa kwamathambo ezihlanganisiwe ezenziwe ngokufakwa kwamathambo okucindezelayo zingavuselelwa ngokushesha nangokuphelele.
Ikheji lensimbi ene-mesh + ukuxhunyelelwa kwamathambo okucindezelayo:Amaphutha amathambo angahlanganisi ngokuvamile adinga ukwakhiwa kabusha kusetshenziswa amakheji ensimbi ane-mesh ukuze kufakwe ithambo elikhanseliwe. Ukwakhiwa kabusha kwe-femur kuvame ukuba nzima kunokwakhiwa kabusha kwe-tibia. Ama-X-ray abonisa ukuthi ukuhlanganiswa kwamathambo kanye nokwakheka kwamathambo kwezinto ezihlanganisiwe kuqedwa kancane kancane (IsithombeII-1-1, UmfanekisoII-1-2).
UmfanekisoII-1-1Ukufakwa kwamathambo okucindezela kwangaphakathi kwekheji ene-mesh ukuze kulungiswe iphutha lethambo le-tibial. I-Intraoperative; I-B Postoperative X-ray
Umfanekisoe II-1-2Ukulungiswa kwezinkinga zamathambo e-femoral kanye ne-tibia nge-titanium mesh internal compression bone grafting. I-Intraoperative; I-B Postoperative X-ray
Ngesikhathi sokulungiswa kwe-knee arthroplasty, ithambo lesakhiwo le-allogeneic lisetshenziswa kakhulu ukwakha kabusha amaphutha ethambo le-AORI uhlobo lwesibili noma lwesithathu. Ngaphezu kokuba namakhono amahle kakhulu okuhlinzwa kanye nokuhlangenwe nakho okucebile ekufakweni kwedolo okuyinkimbinkimbi, udokotela ohlinzayo kufanele futhi enze izinhlelo ezicophelelayo nezinemininingwane ngaphambi kokuhlinzwa. Ukufakelwa kwamathambo kwesakhiwo kungasetshenziswa ukulungisa amaphutha ethambo le-cortical nokwandisa ubukhulu bamathambo.
Izinzuzo zalobu buchwepheshe zifaka: Kungenziwa kube yinoma yiluphi usayizi nesimo ukuze kuvumelane nokukhubazeka kwamathambo ezimo ezahlukene zejometri; kunomphumela omuhle wokusekela kuma-prostheses okubuyekezwa; futhi ukuhlanganiswa kwesikhathi eside kwezinto eziphilayo kungafinyelelwa phakathi kwethambo le-allogeneic kanye nethambo lomnikazi.
Okubi kufaka phakathi: isikhathi eside sokusebenza lapho kunqunywa ithambo le-allogeneic; imithombo elinganiselwe yethambo le-allogeneic; ingozi yokungahlangani kanye nokuhlangana okulibazisekile ngenxa yezici ezifana nokumuncwa kwethambo kanye nokuphuka kokukhathala ngaphambi kokuba inqubo yokuhlanganiswa kwethambo iqedwe; izinkinga zokumuncwa kanye nokutheleleka kwezinto ezitshaliwe; amathuba okudluliselwa kwesifo; kanye nokuqina okunganele kokuqala kwethambo le-allogeneic. Ithambo lesakhiwo se-allogeneic livunwa kusukela ku-distal femur, i-proximal tibia, noma ikhanda le-femoral. Uma izinto zokufakelwa zikhulu, ukuvuselelwa okuphelele kwemithambo yegazi ngokuvamile akwenzeki. Amakhanda e-allogeneic femoral angasetshenziswa ukulungisa amaphutha ethambo le-femoral condyle kanye ne-tibial plateau, ikakhulukazi ukulungisa amaphutha amakhulu ethambo lohlobo lwe-cavity, futhi alungiswa ngokucindezela ngemva kokusika nokubumba. Imiphumela yezokwelapha yokuqala yokusebenzisa ithambo lesakhiwo se-allogeneic ukulungisa amaphutha ethambo ibonise izinga eliphezulu lokuphulukiswa kwethambo elitshaliwe (IsithombeII-1-3, UmfanekisoII-1-4).
UmfanekisoII-1-3Ukulungiswa kwesici samathambo esifazane nge-allogeneic femoral head structure bone graft
UmfanekisoII-1-4Ukulungiswa kwesici samathambo e-tibial nge-allogeneic femoral head bone graft
III.Ubuchwepheshe bokugcwalisa insimbi
Ubuchwepheshe be-Modular Ubuchwepheshe be-Modular busho ukuthi izigcwalisi zensimbi zingahlanganiswa ngezitho zokufakelwa kanye neziqu zangaphakathi kwe-medullary. Izigcwalisi zifaka amamodeli ahlukahlukene ukuze kube lula ukwakhiwa kabusha kweziphambeko zamathambo ezinobukhulu obuhlukahlukene.
Insimbi Okwenziwa ngokufakelwa Ukwandisa：I-modular metal spacer ifaneleka kakhulu kumaphutha ethambo angagcini uhlobo lwe-AORI II anobukhulu obufika ku-2 cm.Ukusetshenziswa kwezingxenye zensimbi ukulungisa amaphutha ethambo kulula, kulula, futhi kunemiphumela ethembekile yezokwelapha.
Ama-spacer ensimbi angaba nezimbobo noma aqine, futhi izimo zawo zifaka phakathi ama-wedge noma amabhlogo. Ama-spacer ensimbi angaxhunywa ku-prosthesis ehlangene ngezikulufo noma aqiniswe nge-bone cement. Ezinye izazi zikholelwa ukuthi ukuqinisa i-bone cement kungagwema ukuguguleka phakathi kwezinsimbi futhi zincoma ukuqinisa i-bone cement. Ezinye izazi ziphinde zikhuthaze indlela yokusebenzisa i-bone cement kuqala bese iqiniswa ngezikulufo phakathi kwe-spacer kanye ne-prosthesis. Ama-femoral defects avame ukwenzeka ezingxenyeni ezingemuva nezikude ze-femoral condyle, ngakho-ke ama-spacer ensimbi avame ukufakwa ezingxenyeni ezingemuva nezikude ze-femoral condyle. Kuma-tibial bone defects, ama-wedge noma amabhlogo angakhethwa ukuze akhiwe kabusha ukuze avumelane nezimo ezahlukene zama-defect. Izincwadi zibika ukuthi amazinga amahle namahle aphezulu afinyelela ku-84% kuya ku-98%.
Amabhlogo amise okwe-wedge asetshenziswa lapho isici sethambo simise okwe-wedge, okungagcina amathambo amaningi aphethwe yi-host. Le ndlela idinga i-osteotomy eqondile ukuze ubuso be-osteotomy bufane ne-block. Ngaphezu kokucindezeleka okucindezelayo, kukhona namandla okusika phakathi kwezixhumanisi zokuxhumana. Ngakho-ke, i-engeli ye-wedge akufanele idlule u-15°. Uma kuqhathaniswa namabhlogo amise okwe-wedge, amabhlogo ensimbi ayindilinga anokungathandeki kokwandisa inani le-osteotomy, kodwa ukuhlinzwa kulula futhi kulula, futhi umphumela womshini useduze nokujwayelekile (III-1-1A, B).
UmfanekisoIII-1-1Izihlukanisi zensimbi: Isihlukanisi esimise okwesikwele sokulungisa amaphutha e-tibial; Isihlukanisi esimise okwekholomu B sokulungisa amaphutha e-tibial
Ngenxa yokuthi ama-spacer ensimbi aklanywe ngezimo nobukhulu obuhlukahlukene, asetshenziswa kabanzi kumaphutha amathambo angaqukethwe kanye namaphutha amathambo ezimo ezahlukahlukene, futhi ahlinzeka ngokuqina okuhle kokuqala komshini. Kodwa-ke, izifundo zesikhathi eside zithole ukuthi ama-spacer ensimbi ayahluleka ngenxa yokuvikela ukucindezeleka. Uma kuqhathaniswa nama-graft ethambo, uma ama-spacer ensimbi ehluleka futhi edinga ukubuyekezwa, azobangela amaphutha amakhulu ethambo.
Isikhathi sokuthunyelwe: Okthoba-28-2024
