Ukususela oko uSculco nabanye baxele okokuqala nge-small-incision total hip arthroplasty (THA) ngendlela ye-posterolateral ngo-1996, kuye kwaxelwa utshintsho olutsha oluncinci olungena emzimbeni. Kule mihla, ingcamango encinci isasazeke kakhulu kwaye yamkelwe kancinci kancinci ngoogqirha. Nangona kunjalo, akukabikho sigqibo sicacileyo sokuba kufuneka kusetyenziswe iinkqubo ezincinci okanye eziqhelekileyo.
Iingenelo zotyando olungenalo utyando oluncinci ziquka ukunqunyulwa okuncinci, ukopha okuncinci, iintlungu ezingaphantsi, kunye nokuphola ngokukhawuleza; nangona kunjalo, iingxaki ziquka umbono olinganiselweyo, ukwenzakala kwemithambo-luvo ngokulula, ukuma kakubi kweprosthesis, kunye nomngcipheko ophezulu wotyando lokuphinda utyando.
Kwi-arthroplasty ye-hip epheleleyo (i-MIS - i-THA) engaphantsi kakhulu, ukulahleka kwamandla emisipha emva kotyando sisizathu esibalulekileyo esichaphazela ukuchacha, kwaye indlela yotyando yinto ebalulekileyo echaphazela amandla emisipha. Umzekelo, iindlela zangaphambili kunye nezangaphambili ezithe ngqo zingonakalisa amaqela emisipha ye-abductor, nto leyo ekhokelela ekuhambeni okushukumayo (iTrendelenburg limp).
Kwimizamo yokufumana iindlela ezingangenisi kakhulu ezinciphisa umonakalo wezihlunu, uGqr. Amanatullah nabanye abavela kwiKliniki yaseMayo eMelika bathelekise iindlela ezimbini ze-MIS-THA, indlela ethe ngqo ngaphambili (DA) kunye nendlela ethe ngqo ephezulu (DS), kwiisampuli zesidumbu ukuze kuchongwe umonakalo kwizihlunu kunye neethambo. Iziphumo zolu phononongo zibonise ukuba indlela ye-DS ayonakalisi kangako izihlunu kunye neethambo kunendlela ye-DA kwaye isenokuba yeyona ndlela ikhethwayo ye-MIS-THA.
Uyilo lovavanyo
Olu phononongo lwenziwe kwizidumbu ezisibhozo ezisandul’ ukuqanduselwa ezinezibini ezisibhozo zezinqe ezili-16 ezingenambali yotyando lwesinqe. Esinye isinqe sakhethwa ngokungacwangciswanga ukuba senziwe i-MIS-THA ngendlela ye-DA kwaye esinye ngendlela ye-DS kwesinye isidumbu, kwaye zonke iinkqubo zenziwa ngoogqirha abanamava. Umgangatho wokugqibela wokwenzakala kwemisipha kunye nemisipha wahlolwa ngugqirha wamathambo owayengabandakanyekanga kolu tyando.
Izakhiwo zomzimba ezivavanyiweyo ziquka: i-gluteus maximus, i-gluteus medius kunye ne-tendon yayo, i-gluteus minimus kunye ne-tendon yayo, i-vastus tensor fasciae latae, i-quadriceps femoris, i-upper trapezius, i-piatto, i-lower trapezius, i-obturator internus, kunye ne-obturator externus (Umfanekiso 1). Imisipha ihlolwe ukukrazuka kwemisipha kunye nokuthamba okubonakalayo emehlweni.
Umfanekiso 1 Umzobo wokwakheka komsipha ngamnye
Iziphumo
1. Umonakalo wemisipha: Akukho mahluko wezibalo kubungakanani bomonakalo womphezulu kwi-gluteus medius phakathi kwendlela ye-DA kunye ne-DS. Nangona kunjalo, kwimisipha ye-gluteus minimus, ipesenti yokulimala komphezulu okubangelwe yindlela ye-DA yayiphezulu kakhulu kuneyo ebangelwe yindlela ye-DS, kwaye akukho mahluko mkhulu phakathi kwendlela ezimbini zemisipha ye-quadriceps. Akukho mahluko mkhulu phakathi kwendlela ezimbini ngokubhekiselele kukulimala kwimisipha ye-quadriceps, kwaye ipesenti yokulimala komphezulu kwimisipha ye-vastus tensor fasciae latae kunye ne-rectus femoris yayinkulu kwindlela ye-DA kunakwindlela ye-DS.
2. Ukulimala kwemisipha: Akukho nanye kwezi ndlela eyabangela ukwenzakala okukhulu.
3. Ukususwa kwemisipha ye-tendon: Ubude bokususwa kwemisipha ye-gluteus minimus tendon buphezulu kakhulu kwiqela le-DA kunakwiqela le-DS, kwaye ipesenti yokwenzakala yayiphezulu kakhulu kwiqela le-DS. Akukho mahluko mkhulu kwimiphumo yokulimala kwemisipha ye-tendon phakathi kwamaqela amabini e-pyriformis kunye ne-obturator internus. I-schematic yotyando iboniswe kuMfanekiso 2, uMfanekiso 3 ubonisa indlela yendabuko esecaleni, kwaye uMfanekiso 4 ubonisa indlela yendabuko engasemva.
Umzobo 2 1a. Ukususwa ngokupheleleyo kwe-tendon ye-gluteus minimus ngexesha lenkqubo ye-DA ngenxa yesidingo sokulungiswa kwe-femoral; 1b. Ukususwa okuncinci kwe-gluteus minimus kubonisa ubungakanani bokulimala kwi-tendon yayo kunye nesisu semisipha. gt. greater trochanter; * gluteus minimus.
Umzobo 3 Isicwangciso sendlela yendabuko ethe ngqo ecaleni kunye ne-acetabulum ebonakala ngasekunene ngokutsalwa okufanelekileyo
Umfanekiso 4 Ukuvezwa kwemisipha emfutshane yangaphandle ye-rotator kwindlela eqhelekileyo ye-THA yangasemva
Isiphelo kunye neziphumo zeKlinikhi
Izifundo ezininzi zangaphambili azibonisanga mahluko mkhulu ngexesha lotyando, ulawulo lweentlungu, izinga lotofelo-gazi, ukulahleka kwegazi, ubude bokuhlala esibhedlele, kunye nokuhamba xa kuthelekiswa i-THA eqhelekileyo ne-MIS-THA. Uphononongo lweklinikhi lwe-THA olunendlela eqhelekileyo yokufikelela kunye ne-THA engaphantsi kakhulu nguRepantis et al. alubonisanga mahluko mkhulu phakathi kwezi zimbini, ngaphandle kokuncipha okukhulu kwentlungu, kwaye akukho mahluko mkhulu ekuphumeni kwegazi, ukunyamezela ukuhamba, okanye ukuvuselelwa emva kotyando. Uphononongo lweklinikhi lukaGoosen et al.
I-RCT kaGoosen et al. ibonise ukunyuka kwamanqaku aphakathi e-HHS emva kwendlela yokungenelela kancinci (ibonisa ukuba ngcono ukuchacha), kodwa ixesha elide lotyando kunye neengxaki ezingaphezulu kakhulu emva kotyando. Kwiminyaka yakutshanje, kuye kwakho nezifundo ezininzi ezihlola umonakalo wezihlunu kunye nexesha lokubuyela umva emva kotyando ngenxa yokufikelela kancinci kotyando, kodwa le micimbi ayikajongwa ngokupheleleyo. Olu phononongo lwangoku lwenziwe ngokusekelwe kwimiba enjalo.
Kolu phononongo, kufunyenwe ukuba indlela ye-DS ibangele umonakalo omncinci kakhulu kwizihlunu kunendlela ye-DA, njengoko kuboniswe kumonakalo omncinci kakhulu kwimisipha ye-gluteus minimus kunye ne-tendon yayo, kwimisipha ye-vastus tensor fasciae latae, nakwimisipha ye-rectus femoris. Ezi nzakala zichongiwe yindlela ye-DA ngokwayo kwaye kwakunzima ukuzilungisa emva kotyando. Ekubeni olu phononongo luluphawu lwesidumbu, kufuneka izifundo zeklinikhi ukuze kuphandwe ukubaluleka kweklinikhi kwesi siphumo ngokunzulu.
Ixesha lokuthumela: Novemba-01-2023
