· I-Anatomy esetyenzisiweyo
Phambi kwe-scapula kukho i-subscapular fossa, apho kuqala khona umsipha we-subscapularis. Ngasemva kukho i-ridge ye-scapular ehambayo engaphandle nenyuka kancinci, eyahlulwe yi-supraspinatus fossa kunye ne-infraspinatus fossa, ukuze kuncamathiselwe imisipha ye-supraspinatus kunye ne-infraspinatus ngokulandelelana. Isiphelo sangaphandle se-ridge ye-scapular yi-acromion, eyenza i-acromioclavicular joint kunye nesiphelo se-acromion se-clavicle ngokusebenzisa umphezulu omde we-ovoid articular. Umda ophezulu we-ridge ye-scapular une-notch encinci efana ne-U, ewela yi-ligament emfutshane kodwa eqinileyo ye-suprascapular transverse, apho i-nerve ye-suprascapular idlula khona, kwaye apho i-artery ye-suprascapular idlula khona. Umda osecaleni (umda we-axillary) we-scapular ridge ngowona mkhulu kwaye uhambela ngaphandle uye kwingcambu yentamo ye-scapular, apho wenza khona i-glenoid notch kunye nomphetho we-glenoid yejoyinti yegxalaba.
· Izalathiso
1. Ukususwa kweethumba ze-scapular ezingenobungozi.
2. Ukususwa kwethumba elibi le-scapula kwindawo yasekuhlaleni.
3. I-scapula ephezulu kunye nezinye iziphene.
4. Ukususwa kwethambo elifileyo kwi-scapular osteomyelitis.
5. Isifo sokubanjwa kwemithambo-luvo yeSuprascapular.
· Indawo yomzimba
Indawo ethambekele kancinci, ithambekele kwi-30° ukuya ebhedini. Umlenze ongasentla ochaphazelekayo ugqunywa ngetawuli engenazintsholongwane ukuze ukwazi ukushukunyiswa nangaliphi na ixesha ngexesha lotyando.
· Amanyathelo okusebenza
1. Ukusika okunqamlezileyo ngokuqhelekileyo kwenziwa ecaleni kwe-scapular ridge kwi-supraspinatus fossa nakwinxalenye ephezulu ye-infraspinatus fossa, kwaye ukusika okujikeleze i-longitudinal kungenziwa ecaleni kwe-medial edge ye-scapula okanye kwicala le-medial ye-subscapularis fossa. Ukusika okujikeleze i-transverse kunye ne-longitudinal kunokudityaniswa ukwenza i-L-shape, i-inverted L-shape, okanye i-first-class shape, kuxhomekeke kwisidingo sokubona iindawo ezahlukeneyo ze-scapula. Ukuba kuphela iikona eziphezulu nezisezantsi ze-scapula kufuneka zivele, ukusika okuncinci kungenziwa kwiindawo ezifanelekileyo (Umfanekiso 7-1-5(1)).
2. Sika i-fascia engaphezulu nenzulu. Izihlunu ezinamathele kwi-scapular ridge kunye nomda we-medial zisikwa ngendlela enqamlezileyo okanye ende kwicala le-incision (Umzobo 7-1-5(2)). Ukuba i-supraspinatus fossa iza kuvezwa, imicu ye-middle trapezius muscle iyasikwa kuqala. I-periosteum isikwa ngokuchasene nomphezulu wamathambo we-scapular gonad, kunye nomaleko omncinci wamafutha phakathi kwezi zimbini, kwaye yonke i-supraspinatus fossa ibonakaliswa ngokuqhekeka kwe-subperiosteal kwe-supraspinatus muscle, kunye ne-overlay trapezius muscle. Xa usika imicu ephezulu ye-trapezius muscle, kufuneka kuthathwe ingqalelo ukuba ungonakalisi i-parasympathetic nerve.
3. Xa kufuneka kutyhilwe umthambo we-suprascapular, yimicu yenxalenye ephezulu ephakathi yomthambo we-trapezius kuphela enokutsalwa phezulu, kwaye umthambo we-supraspinatus unokutsalwa kancinci ezantsi ngaphandle kokukrazula, kwaye isakhiwo esimhlophe esikhazimlayo esibonwayo yi-suprascapular transverse ligament. Nje ukuba imithambo yegazi kunye nemithambo-luvo ye-suprascapular ichongiwe kwaye ikhuselwe, umthambo we-suprascapular transverse ligament unokunqunyulwa, kwaye i-scapular notch inokujongwa kuzo naziphi na izakhiwo ezingaqhelekanga, kwaye umthambo we-suprascapular unokukhululwa. Ekugqibeleni, umthambo we-trapezius ohlutyiweyo uyagotywa ukuze unamathele kwi-scapula.
4. Ukuba inxalenye ephezulu ye-infraspinatus fossa iza kuvezwa, imicu esezantsi nephakathi yemisipha ye-trapezius kunye nemisipha ye-deltoid inokunqunyulwa ekuqaleni kwe-scapular ridge kwaye ibuyele umva phezulu nasezantsi (Umzobo 7-1-5(3)), kwaye emva kokuba imisipha ye-infraspinatus iveziwe, inokuhlutywa phantsi kwe-periosteal (Umzobo 7-1-5(4)). Xa usondela kwisiphelo esiphezulu se-axillary margin ye-scapular gonad (oko kukuthi, ngaphantsi kwe-glenoid), kufuneka kunikwe ingqalelo kwi-axillary nerve kunye ne-posterior rotator humeral artery edlula kwi-quadrilateral foramen ejikelezwe yi-teres minor, i-teres major, intloko ende ye-triceps, kunye nentamo yotyando ye-humerus, kunye ne-rotator scapulae artery edlula kwi-triangular foramen ejikelezwe zizintathu zokuqala, ukuze zingabangeli monakalo kuzo (Umzobo 7-1-5(5)).
5. Ukuze kubonakale umda ophakathi we-scapula, emva kokutyumza imicu yemisipha ye-trapezius, imisipha ye-trapezius kunye ne-supraspinatus irhoxiswa phezulu nangaphandle ngokuhluba i-subperiosteal ukuze kubonakale inxalenye ephakathi ye-supraspinatus fossa kunye nenxalenye ephezulu yomda ophakathi; kwaye imisipha ye-trapezius kunye ne-infraspinatus, kunye nemisipha ye-vastus lateralis enamathele kwi-angle engaphantsi ye-scapula, ihlutywa i-subperiosteally ukuze kubonakale inxalenye ephakathi ye-infraspinatus fossa, i-angle engaphantsi ye-scapula, kunye nenxalenye esezantsi yomda ophakathi.
Umfanekiso 7-1-5 Indlela yokuchayeka kwi-dorsal scapular
(1) ukunqunyulwa; (2) ukunqunyulwa komgca wemisipha; (3) ukunqumla umsipha we-deltoid kwi-scapular ridge; (4) ukuphakamisa umsipha we-deltoid ukuze kubonakale i-infraspinatus kunye ne-teres minor; (5) ukususa umsipha we-infraspinatus ukuze kubonakale icala elingasemva le-scapula nge-vascular anastomosis
6. Ukuba i-subscapular fossa iza kuvezwa, izihlunu ezinamathele kumaleko angaphakathi omda we-medial, oko kukuthi, i-scapularis, i-rhomboids kunye ne-serratus anterior, kufuneka zixotyulwe ngaxeshanye, kwaye yonke i-scapula inokuphakanyiswa ngaphandle. Xa kukhululwa umda we-medial, kufuneka kuthathwe ingqalelo ukukhusela isebe elihlayo lomthambo we-carotid onqamlezileyo kunye nomthambo we-scapular ongasemva. Isebe elihlayo lomthambo we-carotid onqamlezileyo livela kwisiqu sentamo ye-thyroid kwaye lihamba ukusuka kwi-angle ephezulu ye-scapula ukuya kwi-angle esezantsi ye-scapula nge-scapularis tenuissimus, umsipha we-rhomboid kunye nomsipha we-rhomboid, kwaye umthambo we-rotator scapulae wenza inethiwekhi etyebileyo yemithambo yegazi kwinxalenye ye-dorsal ye-scapula, ngoko ke kufuneka inamathele ngokuqinileyo kumphezulu wethambo ukuze i-subperiosteal peeling ixotyulwe.
Ixesha lokuthumela: Novemba-21-2023
