Ukususela kwi-Sculco et al.Okokuqala ingxelo encinci ye-hip arthroplasty (THA) kunye ne-posterolateral approach ngo-1996, uhlengahlengiso olutsha oluninzi olungenabungozi luye lwabikwa.Kule mihla, ingqikelelo encinci ye-invasive iye yasasazwa ngokubanzi kwaye yamkelwa ngokuthe ngcembe ngoogqirha.Nangona kunjalo, akukabikho sigqibo sicacileyo malunga nokuba iinkqubo ezincinci okanye iinkqubo eziqhelekileyo kufuneka zisetyenziswe.
Iingenelo zotyando olungephi lubandakanya amanxeba amancinci, ukopha kancinci, iintlungu ezisezantsi, kunye nokuchacha ngokukhawuleza;nangona kunjalo, izinto ezingalunganga zibandakanya intsimi elinganiselweyo, kulula ukuvelisa ukulimala kwe-neurovascular zonyango, indawo embi yeprosthesis, kunye nomngcipheko okhulayo wokuhlinzwa ngokutsha.
Kwi-low arthroplasty ye-hip arthroplasty (MIS - THA) encinci ye-invasive (MIS - THA), ukulahleka kwamandla emisipha emva kokusebenza sisizathu esibalulekileyo esichaphazela ukubuyiswa, kwaye indlela yokuhlinzwa yinto ebalulekileyo echaphazela amandla emisipha.Ngokomzekelo, iindlela ze-anterolateral kunye nezithe ngqo zangaphambili zingonakalisa amaqela emisipha ye-abductor, ekhokelela kwi-rocking gait (i-Trendelenburg limp).
Ngomzamo wokufumana iindlela ezincinci ezinokuthi zinciphise umonakalo wemisipha, uDkt Amanatullah et al.ukusuka kwiKliniki yaseMayo e-United States iqhathanise iindlela ezimbini ze-MIS-THA, indlela ehamba phambili yangaphambili (i-DA) kunye neyona ndlela ephezulu (DS), kwiimpawu ze-cadaveric ukucacisa umonakalo kwimisipha kunye neetoni.Iziphumo zolu pho nonongo zibonise ukuba indlela ye-DS ayinakonakalisa imisipha kunye nemisipha kunendlela ye-DA kwaye ingaba yinkqubo ekhethiweyo ye-MIS-THA.
Uyilo lovavanyo
Uphononongo lwenziwe kwii-cadavers ezisibhozo ezisandul 'ukukhenkcezwa kunye neebini ezisibhozo ze-hips ze-16 ezingenambali yotyando lwe-hip.Esinye isinqe sakhethwa ngokungacwangciswanga ukuba singene kwi-MIS-THA kusetyenziswa indlela ye-DA kwaye enye kusetyenziswa indlela ye-DS kwicadaver enye, kwaye zonke iinkqubo zenziwa ngoogqirha abanamava.Iqondo lokugqibela lokulimala kwemisipha kunye ne-tendon yavavanywa ngugqirha wamathambo owayengabandakanyekanga ekusebenzeni.
Izakhiwo ze-anatomical ezivavanyiweyo zibandakanya: 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-trapezius ephezulu, i-piatto, i-trapezius ephantsi, i-obturator internus, kunye ne-obturator externus (i-figurator externus1).Izihlunu zavavanywa ngenxa yeenyembezi zemisipha kunye nokuthamba okubonakalayo kwiso lenyama.
Umzobo we-1 umzobo we-anatomical we-muscle nganye
Iziphumo
1. Ukulimala kwemisipha: Kwakungekho mmahluko wezibalo kubungakanani bomonakalo ongaphezulu kwi-gluteus medius phakathi kwe-DA kunye ne-DS.Nangona kunjalo, kwi-gluteus minimus muscle, ipesenteji yokulimala komhlaba okubangelwa yindlela ye-DA yayiphezulu kakhulu kunokuba ibangelwa yindlela ye-DS, kwaye kwakungekho nantlukwano ebalulekileyo phakathi kweendlela ezimbini ze-quadriceps muscle.Kwakungekho nantlukwano ephawulekayo phakathi kweendlela ezimbini zokulimala kwi-quadriceps muscle, kunye nepesenti yokulimala komhlaba kwi-vastus tensor fasciae latae kunye nemisipha ye-rectus femoris yayinkulu kunye nendlela ye-DA kunendlela ye-DS.
2. Ukulimala kwe-tendon: Akukho nanye indlela eya kubangela ukulimala okukhulu.
3. I-Tendon transection: Ubude be-gluteus minimus tendon transection yayiphezulu kakhulu kwiqela le-DA kuneqela le-DS, kwaye ipesenti yokulimala yayiphezulu kakhulu kwiqela le-DS.Kwakungekho nantlukwano ebalulekileyo kukulimala kwe-tendon transection phakathi kwamaqela amabini e-pyriformis kunye ne-obturator internus.Isicwangciso sotyando siboniswe kwi-Fig.
Isazobe 2 1a.Ukugqitywa ngokupheleleyo kwe-gluteus minimus tendon ngexesha lenkqubo ye-DA ngenxa yesidingo sokulungiswa kwe-femal;1b.Ukugqithiswa kwenxalenye ye-gluteus minimus ebonisa ubungakanani bokulimala kwi-tendon kunye nesisu se-muscle.gt.i-trochanter enkulu;* gluteus minimus.
Umzobo 3 Uyilo lwendlela yemveli ethe ngqo esecaleni kunye ne-acetabulum ebonakala ngasekunene ngokutsalwa okufanelekileyo.
Umzobo we-4 Ukubonakaliswa kwe-muscle ye-rotator yangaphandle emfutshane kwindlela eqhelekileyo ye-THA yangasemva
Isiphelo kunye neeMpembelelo zeKlinikhi
Izifundo ezininzi zangaphambili azizange zibonise umahluko omkhulu kwixesha lokusebenza, ukulawula intlungu, izinga lokutofelwa igazi, ukulahleka kwegazi, ubude besibhedlele, kunye nokuhamba xa kuthelekiswa ne-THA eqhelekileyo kunye ne-MIS-THA. Repantis et al.akazange abonise nantlukwano ephawulekayo phakathi kwezi zibini, ngaphandle kokunciphisa kakhulu intlungu, kwaye akukho ntlukwano ebalulekileyo ekuphumeni kwegazi, ukunyamezela kokuhamba, okanye ukubuyisela emva kokusebenza.Uphononongo lweklinikhi nguGoosen et al.
I-RCT yeGoosen et al.ibonise ukonyuka kwamanqaku e-HHS aphakathi emva kwendlela yokuhlasela kancinane (ecebisa ukubuyiswa okungcono), kodwa ixesha elide lokusebenza kunye neengxaki ezingakumbi ze-perioperative.Kwiminyaka yakutshanje, kukho izifundo ezininzi ezivavanya umonakalo wemisipha kunye nexesha lokubuyisela emva kokuhlinzwa ngenxa yokufikelela okuncinci kokuhlinzwa, kodwa le miba ayikaqwalaselwa ngokupheleleyo.Uphononongo lwangoku nalo lwenziwa ngokusekelwe kwimiba enjalo.
Kolu phononongo, kwafunyaniswa ukuba indlela ye-DS ibangele umonakalo omncinci kakhulu kwizicubu ze-muscle kunendlela ye-DA, njengoko kubonakaliswe ngomonakalo omncinci kakhulu kwi-gluteus minimus muscle kunye ne-tendon yayo, i-vastus tensor fasciae latae muscle, kunye ne-rectus femoris muscle. .Ezi nzakala zinqunywe yindlela ye-DA ngokwayo kwaye kwakunzima ukuyilungisa emva kokuhlinzwa.Ukuqwalasela ukuba olu phononongo luyi-cadaveric specimen, izifundo zeklinikhi ziyafuneka ukuphanda ukubaluleka kweklinikhi yesi siphumo ngobunzulu.
Ixesha lokuposa: Nov-01-2023
