I.Indlela yokuzalisa isamente yamathambo
Indlela yokuzalisa isamente yamathambo ifanelekile kwizigulana ezineziphene ezincinci zamathambo zohlobo lwe-AORI I kunye nemisebenzi engasebenzi kakhulu.
Itekhnoloji elula yesamente yamathambo ifuna ukucocwa ngokupheleleyo kwesiphene samathambo, kwaye isamente yamathambo izalisa isiphene samathambo ngexesha lesigaba sentlama, ukuze ikwazi ukufakwa kwizikhewu ezikwiikona zesiphene kangangoko kunokwenzeka, ngaloo ndlela ifezekise ukulingana okuqinileyo nojongano lwamathambo oluhlala kuyo.
Indlela ethile yokwenzaBNyeCisiseko +SIteknoloji yabasebenzi kukucoca ngokupheleleyo isiphene sethambo, emva koko ulungise isikrufu kwithambo elihlala kulo, kwaye uqaphele ukuba isigqubuthelo sesikrufu singadluli kumphezulu wethambo leqonga elidibeneyo emva kwe-osteotomy; emva koko udibanise isamente yethambo, ugcwalise isiphene sethambo kwinqanaba lentlama, kwaye ugoqe isikrufu. URitter MA nabanye basebenzise le ndlela yokwakha kwakhona isiphene sethambo le-tibial plateau, kwaye ubukhulu besiphene bufikelele kwi-9mm, kwaye akukho kukhululeka emva kweminyaka emi-3 emva kotyando. Iteknoloji yokuzalisa isamente yethambo isusa amathambo amancinci, kwaye emva koko isebenzisa uhlaziyo lwe-prosthesis oluqhelekileyo, ngaloo ndlela kunciphisa iindleko zonyango ngenxa yokusetyenziswa kwee-prostheses zohlaziyo, ezinexabiso elithile elisebenzayo.
Indlela ethile yeteknoloji yesamente yamathambo + isikrufu kukucoca ngokupheleleyo isiphene sethambo, ukulungisa isikrufu kwithambo elihlala kulo, kunye nokuqwalasela ukuba isigqubuthelo sesikrufu akufuneki sidlule kumphezulu wethambo weqonga elidibeneyo emva kwe-osteotomy; emva koko udibanise isamente yethambo, ugcwalise isiphene sethambo kwinqanaba lentlama, kwaye usonga isikrufu. URitter MA nabanye basebenzise le ndlela ukwakha kwakhona isiphene sethambo se-tibial plateau, kwaye ubukhulu besiphene bafikelela kwi-9mm, kwaye akukho kukhululeka kwiminyaka emi-3 emva kotyando. Iteknoloji yokuzalisa isamente yamathambo isusa amathambo amancinci, kwaye emva koko isebenzisa uhlaziyo lwe-prosthesis oluqhelekileyo, ngaloo ndlela kunciphisa iindleko zonyango ngenxa yokusetyenziswa kwe-prosthesis yohlaziyo, enexabiso elithile elisebenzayo (UmfanekisoI-1).
UmfanekisoI-1Ukuzaliswa kwesamente yamathambo kunye nokuqinisa izikrufu
II.Iindlela zokufakelwa amathambo
Ukufakelwa kwamathambo okucinezelwayo kungasetyenziselwa ukulungisa iziphene zamathambo eziquka konke okanye ezingabandakanyiyo kutyando lokuhlaziya amadolo. Kufanelekile kakhulu ukwakhiwa kwakhona kweziphene zamathambo zohlobo lwe-AROI ukuya kolwesiThathu. Kutyando lokuhlaziya, ekubeni ububanzi kunye nobungakanani beziphene zamathambo zihlala zinzima, ubungakanani bethambo le-autologous elifunyenweyo lincinci kwaye ikakhulu lithambo le-sclerotic xa kususwa i-prosthesis kunye nesamente yamathambo ngexesha lotyando ukugcina ubunzima bamathambo. Ke ngoko, ithambo le-allogeneic eliyi-granular lidla ngokusetyenziswa ekufakeni amathambo okucinezelwa ngexesha lotyando lokuhlaziya.
Iingenelo zokufakelwa amathambo ngokucinezela zezi: ukugcina ubunzima bamathambo ethambo elihlala kulo; ukulungisa iziphene ezinkulu zamathambo ezilula okanye ezintsonkothileyo.
Iingxaki zale teknoloji zezi: ukusebenza kuthatha ixesha elide; iteknoloji yokwakha ngokutsha inzima (ingakumbi xa kusetyenziswa iikheyiji ezinkulu ze-MESH); kukho ithuba lokudluliselwa kwesifo.
Ukudityaniswa kwamathambo okulula kokucinezelwa:Ukufakelwa kwamathambo okulula kokucinezela kudla ngokusetyenziswa kwiziphene zamathambo ezibandakanya wonke umntu. Umahluko phakathi kokufakelwa kwamathambo okucinezela kunye nokufakelwa kwamathambo okubumbeneyo kukuba izinto zokufakelwa kwamathambo ezihlanganisiweyo ezenziwe ngokudityaniswa kwamathambo okucinezela zinokuvuselelwa ngokukhawuleza nangokupheleleyo.
Ikheyiji yesinyithi enemingxuma + ukufakelwa kwamathambo okucinezelwa:Iziphene zamathambo ezingabandakanyiyo zihlala zifuna ukwakhiwa ngokutsha kusetyenziswa iikheyiji zesinyithi ezineemesh ukuze kufakwe ithambo elirhoxisayo. Ukwakhiwa ngokutsha kwe-femur kudla ngokuba nzima kunokwakhiwa kwakhona kwe-tibia. Ii-X-ray zibonisa ukuba ukuhlanganiswa kwamathambo kunye nokumila kwamathambo kwezinto ezifakelweyo kugqitywa kancinci kancinci (UmfanekisoII-1-1, UmfanekisoII-1-2).
UmfanekisoII-1-1Ukufakelwa kwamathambo okucinezelwa ngaphakathi kwekheji ye-mesh ukulungisa isiphene sethambo le-tibial. A Intraoperative; B Postoperative X-ray
Umfanekisoe II-1-2Ukulungiswa kweziphene zamathambo e-femoral kunye ne-tibia nge-titanium mesh internal compression bone grafting. I-Intraoperative; I-B Emva kotyando lwe-X-ray
Ngexesha lokulungiswa kwe-knee arthroplasty, ithambo lesakhiwo se-allogeneic lisetyenziswa kakhulu ukwakha kwakhona iziphene zethambo ze-AORI uhlobo lwesibini okanye lwesithathu. Ukongeza ekubeni nezakhono zotyando ezibalaseleyo kunye namava atyebileyo ekutshintsheni idolo elintsonkothileyo, ugqirha wotyando kufuneka enze izicwangciso ezicwangcisiweyo nezineenkcukacha ngaphambi kotyando. Ukufakelwa kwamathambo kwisakhiwo kungasetyenziselwa ukulungisa iziphene zethambo le-cortical kunye nokwandisa ubunzima bamathambo.
Iingenelo zale teknoloji ziquka: Ingenziwa ibe yiyo nayiphi na isayizi kunye nemilo ukuze ivumelane neziphene zamathambo eemilo ezahlukeneyo zejometri; inempembelelo entle yokuxhasa kwi-revision prostheses; kwaye ukuhlanganiswa kwexesha elide kwebhayoloji kunokufezekiswa phakathi kwethambo le-allogeneic kunye nethambo lomninimzi.
Izinto ezingalunganga ziquka: ixesha elide lokusebenza xa kusikwa ithambo le-allogeneic; imithombo embalwa yethambo le-allogeneic; umngcipheko wokungadibani kunye nokudibana okulibazisekayo ngenxa yezinto ezinje ngokufunxwa kwethambo kunye nokudinwa kwamathambo ngaphambi kokuba inkqubo yokuhlanganiswa kwethambo igqitywe; iingxaki zokufunxwa kunye nosulelo lwezinto ezityaliweyo; amathuba okudluliselwa kwesifo; kunye nokungonelanga ukuzinza kokuqala kwethambo le-allogeneic. Ithambo lesakhiwo se-allogeneic livunwa kwi-distal femur, i-proximal tibia, okanye intloko ye-femoral. Ukuba izinto zokufakelwa zikhulu, ukuvuselelwa okupheleleyo kwemithambo yegazi akuqhelekanga ukwenzeka. Iintloko ze-allogeneic femoral zingasetyenziselwa ukulungisa iziphene zethambo le-femoral condyle kunye ne-tibial plateau, ikakhulu ukulungiswa kweziphene ezinkulu zethambo lohlobo lwe-cavity, kwaye zilungiswa ngokucinezela emva kokusika nokubumba. Iziphumo zokuqala zeklinikhi zokusebenzisa ithambo lesakhiwo se-allogeneic ukulungisa iziphene zethambo zibonise izinga eliphezulu lokuphiliswa kwethambo elityaliweyo (UmfanekisoII-1-3, UmfanekisoII-1-4).
UmfanekisoII-1-3Ukulungiswa kwe-femoral bone defect nge-allogeneic femoral head structure bone graft
UmfanekisoII-1-4Ukulungiswa kwe-tibial bone defect nge-allogeneic femoral head bone graft
III.Itekhnoloji yokuzalisa isinyithi
Iteknoloji yeModular Iteknoloji yeModular ithetha ukuba izizalisi zesinyithi zinokuhlanganiswa ngeeprostheses kunye neziqu ze-intramedullary. Izizalisi ziquka iimodeli ezahlukeneyo zokwenza lula ukwakhiwa kwakhona kweziphene zamathambo ezinobukhulu obahlukeneyo.
Isinyithi I-Prosthetic Ukwandisa：I-modular metal spacer ifanelekile kakhulu kwiziphene zamathambo ezingaguqukiyo zohlobo lwe-AORI II ezinobukhulu obufikelela kwi-2 cm.Ukusetyenziswa kwezixhobo zesinyithi ukulungisa iziphene zamathambo kulula, kulula, kwaye kunemiphumo ethembekileyo yeklinikhi.
Ii-spacers zentsimbi zinokuba nemingxuma okanye ziqine, kwaye iimilo zazo ziquka ii-wedges okanye iibhloko. Ii-spacers zentsimbi zinokudityaniswa kwi-prosthesis edibeneyo ngezikrufu okanye zilungiswe ngesamente yamathambo. Ezinye iingcali zikholelwa ukuba ukufakwa kwesamente yamathambo kunokuthintela ukuguguleka phakathi kweentsimbi kwaye zicebisa ukufakwa kwesamente yamathambo. Ezinye iingcali zikwakhuthaza indlela yokusebenzisa isamente yamathambo kuqala uze emva koko uqinise ngezikrufu phakathi kwe-spacer kunye ne-prosthesis. Iimpazamo ze-femoral zihlala zenzeka kwiindawo ezingasemva nezikude ze-femoral condyle, ngoko ke ii-spacers zesinyithi zihlala zifakwa kwiindawo ezingasemva nezikude ze-femoral condyle. Kwiimpazamo zethambo le-tibial, ii-wedges okanye iibhloko zinokukhethwa ukuze zakhiwe ngokutsha ukuze zilungele iimilo ezahlukeneyo zeziphene. Uncwadi lubika ukuba amazinga amahle nalungileyo aphezulu ukuya kwi-84% ukuya kwi-98%.
Iibhloko ezimile okwe-wedge zisetyenziswa xa isiphene sethambo simile okwe-wedge, nto leyo enokugcina amathambo amaninzi omntu osiphetheyo. Le ndlela ifuna i-osteotomy echanekileyo ukuze umphezulu we-osteotomy uhambelane nebhloko. Ukongeza kuxinzelelo oluxinzelelweyo, kukwakho namandla okucheba phakathi kweendawo zokunxibelelana. Ke ngoko, i-engile ye-wedge akufuneki idlule kwi-15°. Xa kuthelekiswa neebhloko ezimile okwe-wedge, iibhloko zesinyithi ezisilinda zinobunzima bokwandisa ubungakanani be-osteotomy, kodwa utyando lotyando lulula kwaye lulula, kwaye isiphumo somatshini sisondele kwisiqhelo (III-1-1A, B).
UmfanekisoIII-1-1I-metal spacers: I-spacer efana ne-wedge yokulungisa iziphene ze-tibial; I-spacer efana ne-B column yokulungisa iziphene ze-tibial
Ngenxa yokuba ii-metal spacers zenzelwe iimilo ezahlukeneyo kunye nobukhulu, zisetyenziswa kakhulu kwiingxaki zamathambo ezingabandakanyiyo kunye neziphene zamathambo zemilo eyahlukeneyo, kwaye zibonelela ngozinzo oluhle lokuqala loomatshini. Nangona kunjalo, uphando olude lufumanise ukuba ii-metal spacers ziyasilela ngenxa yokukhusela uxinzelelo. Xa kuthelekiswa nee-bone grafts, ukuba ii-metal spacers ziyasilela kwaye kufuneka zihlaziywe, ziya kubangela iziphene ezinkulu zamathambo.
Ixesha leposi: Okthobha-28-2024
