· Applied Anatomy
Ngaphambi kwe-scapula yi-fossa ye-subscapular, apho i-subscapularis muscle iqala khona.Ngasemva kukho i-scapular ridge yangaphandle kwaye inyuka kancinci, eyahlulahlulwe yaba yi-supraspinatus fossa kunye ne-infraspinatus fossa, yokuncamathisela kwe-supraspinatus kunye nezihlunu ze-infraspinatus ngokulandelelanayo.Ukuphela kwangaphandle kwe-scapular ridge yi-acromion, eyenza i-acromioclavicular joint kunye ne-acromion ekupheleni kwe-clavicle ngokusebenzisa i-ovoid articular surface ende.Umda ophakamileyo we-scapular ridge une-notch encinci ye-U, ewela i-short but hard transverse transverse suprascapular ligament, phantsi kwayo i-nerve ye-suprascapular idlula, kwaye phezu kwayo i-artery suprascapular idlula.Umda wecala (i-axillary margin) ye-scapular ridge yeyona nto inzima kwaye ihambela ngaphandle ukuya kwingcambu yentamo ye-scapular, apho yenza inotshi ye-glenoid kunye nomda we-glenoid yegxalaba.
· Iimpawu
1. Ukususwa kwee-benign scapular tumors.
2. Ukukhutshwa kwendawo ye-tumor eyingozi ye-scapula.
3. I-scapula ephezulu kunye nezinye iziphene.
4. Ukususwa kwethambo elifileyo kwi-scapular osteomyelitis.
5. I-Suprascapular nerve entrapment syndrome.
· Indawo yomzimba
Isikhundla se-Semi-prone, sithambekele kwi-30 ° ukuya ebhedini.Ilungu elingasentla elichaphazelekayo libhijelwe ngetawuli eyinyumba ukuze likwazi ukushukunyiswa nangaliphi na ixesha ngexesha lokusebenza.
· Amanyathelo okusebenza
1. I-incision transverse incision yenziwa ngokubanzi kunye ne-scapular ridge kwi-supraspinatus fossa kunye nenxalenye ephezulu ye-infraspinatus fossa, kunye ne-longitudinal incision ingenziwa ecaleni kwe-medial edge ye-scapula okanye i-medial side ye-subscapularis fossa.I-transverse kunye ne-longitudinal incisions inokudibaniswa ukuze yenze i-L-shape, i-L-shape inverted, okanye i-shape-class shape, kuxhomekeke kwisidingo sokubonwa kweendawo ezahlukeneyo ze-scapula.Ukuba kuphela iikona eziphezulu kunye nezisezantsi ze-scapula kufuneka zibonakaliswe, iincinci ezincinci zingenziwa kwiindawo ezihambelanayo (Umfanekiso 7-1-5 (1)).
2. Qalisa i-fascia engaphezulu kunye nenzulu.Imisipha efakwe kwi-scapular ridge kunye nomda we-medial incised transversely or longitudinally kwicala le-incision (Umfanekiso 7-1-5 (2)).Ukuba i-supraspinatus fossa kufuneka ibonakaliswe, iifayili ze-trapezius muscle ephakathi zifakwe kuqala.I-periosteum ifakwe kwi-bony surface ye-scapular gonad, kunye ne-fat fat layer phakathi kwezi zibini, kwaye yonke i-supraspinatus fossa ibonakaliswe yi-subperiosteal dissection ye-supraspinatus muscle, kunye ne-trapezius muscle.Xa ufaka imicu ephezulu ye-trapezius muscle, kufuneka kuthathelwe ingqalelo ukuba ungonakalisi i-nerve parasympathetic.
3. Xa i-nerve ye-suprascapular iza kutyhilwa, kuphela iifayili zecala eliphakathi eliphakathi kwe-trapezius muscle inokutsalwa phezulu, kwaye i-muscle ye-supraspinatus inokutsalwa ngobumnene phantsi ngaphandle kokuhluthwa, kwaye isakhiwo esimhlophe esikhanyayo sibonwa yi-suprascapular transverse. umsipha.Emva kokuba iinqanawa ze-suprascapular kunye neentsholongwane zichongiwe kwaye zikhuselwe, i-suprascapular transverse ligament inganqunyulwa, kwaye inotshi ye-scapular inokuphononongwa kuyo nayiphi na into engaqhelekanga, kwaye i-nerve ye-suprascapular ingakhululwa.Ekugqibeleni, i-muscle ye-trapezius ehlutshiweyo ixutywe kwakhona ukuze ifakwe kwi-scapula.
4. Ukuba inxalenye ephezulu ye-infraspinatus fossa kufuneka ibonakaliswe, i-fibers ephantsi kunye nephakathi ye-trapezius muscle kunye ne-deltoid muscle inokuxutywa ekuqaleni kwe-scapular ridge kwaye ihlehlise phezulu nangaphantsi (Umfanekiso 7-1-). 5 (3)), kwaye emva kokuba i-infraspinatus muscle ibonakaliswe, inokuthi ihlanjululwe nge-subperiosteally (Umfanekiso 7-1-5 (4)).Xa usondela ekupheleni okuphezulu kwe-axillary margin ye-scapular gonad (oko kukuthi, ngaphantsi kwe-glenoid), ingqwalasela kufuneka ihlawulwe kwi-axillary nerve kunye ne-posterior rotator humeral artery edlula kwi-quadrilateral foramen ejikelezwe yi-teres minor, i-teres enkulu, intloko ende. ye-triceps, kunye nentamo yokuhlinzwa ye-humerus, kunye ne-rotator scapulae artery edlula kwi-foramen ye-triangular ejikelezwe yi-three yokuqala, ukwenzela ukuba ingabangeli ukulimala kubo (Umfanekiso 7-1-5 (5)).
5. Ukuveza umda ophakathi we-scapula, emva kokuqhawula imicu ye-trapezius muscle, i-trapezius kunye nemisipha ye-supraspinatus ihlaziywa ngokugqithiseleyo nangaphandle nge-subperiosteal stripping ukuveza inxalenye ephakathi ye-supraspinatus fossa kunye nenxalenye ephezulu yomda ophakathi. ;kunye nemisipha ye-trapezius kunye ne-infraspinatus, kunye ne-vastus lateralis muscle efakwe kwi-angle ephantsi ye-scapula, i-subperiosteally ihlulwe ukuveza inxalenye ephakathi ye-infraspinatus fossa, i-angle ephantsi ye-scapula, kunye nenxalenye ephantsi yomda we-medial. .
Umzobo 7-1-5 Indlela yokuvezwa kwe-scapular ye-dorsal
(1) ukusika;(2) ukusikwa komgca wezihlunu;(3) ukunqumla isihlunu se-deltoid kwi-scapular ridge;(4) ukuphakamisa i-deltoid muscle ukubonisa i-infraspinatus kunye ne-teres encinci;(5) ukuhlutha i-infraspinatus muscle ukubonisa i-dorsal aspect of the scapula nge-vascular anastomosis.
6. Ukuba i-fossa ye-subscapular kufuneka ibonakaliswe, izihlunu ezifakwe kumgca wangaphakathi womda we-medial, oko kukuthi, i-scapularis, i-rhomboids kunye ne-serratus yangaphambili, kufuneka ihlanjululwe ngexesha elifanayo, kwaye yonke i-scapula inokuphakanyiswa ngaphandle.Xa ukhulula umda ophakathi, kufuneka kuthathelwe ingqalelo ukukhusela isebe elihlayo le-carotid artery transverse kunye ne-dorsal scapular nerve.Isebe elihlayo le-carotid artery transverse livela kwi-thyroid neck trunk kwaye lihamba ukusuka kwi-angle ephezulu ye-scapula ukuya kwi-angle ephantsi ye-scapula nge-scapularis tenuissimus, i-rhomboid muscle kunye ne-rhomboid muscle, kunye ne-rotator scapulae artery yenza i-vascular rich vascular. inethiwekhi kwi-dorsal part of the scapula, ngoko ke kufuneka ibambelele ngokuqinileyo kumphezulu wethambo kwi-subperiosteal peeling.
Ixesha lokuposa: Nov-21-2023
