I.Ubuchule bokuzaliswa kwesamente yethambo
Indlela yokuzalisa i-samente yethambo ifanelekile kwizigulane ezine-AORI ezincinci zohlobo lwe-I iziphene zethambo kunye nemisebenzi engaphantsi.
Itekhnoloji yesamente elula yethambo ngobuchule ifuna ukucocwa ngokucokisekileyo kwesiphene samathambo, kunye nesamente yethambo igcwalisa isiphene sethambo ngexesha lenqanaba lentlama, ukuze ifakwe kwizikhewu kwiikona zesiphene kangangoko kunokwenzeka, ngaloo ndlela kufezekiswe ukuqina okuqinileyo kunye nojongano lwethambo lomkhosi.
Indlela ethile yeBNyeCinto +Sitekhnoloji ye-crew kukucoca ngokucokisekileyo isiphene samathambo, emva koko ulungise i-screw kwithambo lomkhosi, kwaye uqaphele ukuba ungavumeli i-screw cap igqithe ithambo leqonga elidibeneyo emva kwe-osteotomy; uze udibanise i-samente yethambo, gcwalisa isiphene samathambo kwinqanaba lentlama, kwaye ubophe isikrufu. URitter MA et al. wasebenzisa le ndlela ukuvuselela i-tibial plateau bone defect, kwaye ubukhulu besiphako bufikelele kwi-9mm, kwaye kwakungekho kukhulula iminyaka emi-3 emva kokuhlinzwa. Itekhnoloji yokuzalisa i-samente ye-Bone isusa ithambo elincinci, kwaye emva koko isebenzisa ukuhlaziywa kwe-prosthesis eqhelekileyo, ngaloo ndlela inciphisa iindleko zonyango ngenxa yokusetyenziswa kwe-prostheses yokuhlaziywa, enexabiso elithile elisebenzayo.
Indlela ethile ye-bone sement + iteknoloji ye-screw kukucoca ngokucokisekileyo isiphene samathambo, ukulungisa i-screw kwithambo lomkhosi, kwaye ubeke ingqalelo ukuba i-screw cap ayifanele idlule ithambo leqonga elidibeneyo emva kwe-osteotomy; uze udibanise i-samente yethambo, gcwalisa isiphene samathambo kwinqanaba lentlama, kwaye ubophe isikrufu. URitter MA et al. wasebenzisa le ndlela ukuvuselela i-tibial plateau bone defect, kwaye ubukhulu besiphako bufikelele kwi-9mm, kwaye kwakungekho kukhulula iminyaka emi-3 emva kokuhlinzwa. Itekhnoloji yokuzalisa i-samente yethambo isusa ithambo elincinci, kwaye emva koko isebenzisa ukuhlaziywa kweprosthesis eqhelekileyo, ngaloo ndlela inciphisa iindleko zonyango ngenxa yokusetyenziswa kweprosthesis yokuhlaziya, enexabiso elithile elisebenzayo (FigureI-1).
UmzoboI-1Ukuzaliswa kwesamente yethambo kunye nokuqiniswa kwe-screw
II.Ubuchule bokuxhunyelelwa amathambo
Ukunyanzeliswa kwethambo lokuxinzelela kungasetyenziselwa ukulungisa iziphene zamathambo ezibandakanyayo okanye ezingabandakanyiyo kutyando lokuhlaziya idolo. Ikakhulu ilungele ukwakhiwa ngokutsha kwe-AROI yohlobo lwe-I ukuya ku-III iziphene zamathambo. Kutyando oluhlaziyiweyo, ekubeni i-scope kunye ne-degree of bone defects inzima ngokubanzi, inani le-autologous bone lifunyenwe lincinci kwaye ubukhulu becala ithambo le-sclerotic xa i-prosthesis kunye ne-samente yethambo zisuswa ngexesha lotyando ukuze kugcinwe ubunzima bamathambo. Ke ngoko, ithambo le-granular allogeneic lihlala lisetyenziselwa ukunyanzeliswa kwamathambo ngexesha lotyando oluhlaziyiweyo.
Iingenelo zokuxhunyelelwa kwethambo loxinzelelo zezi: ukugcina ubunzima bethambo lethambo lomkhosi; ukulungisa iziphene ezinkulu ezilula okanye ezinzima zamathambo.
Ukungalungi kobu buchwepheshe kukuba: ukusebenza kuthatha ixesha; iteknoloji yokuvuselela ifuna (ingakumbi xa usebenzisa iikheji ezinkulu ze-MESH); kukho ithuba lokusasazeka kwezifo.
Uxinzelelo olulula lwethambo lokuxhunyelelwa:Uxinzelelo olulula lwethambo lokuxhunyelelwa luhlala lusetyenziselwa iziphene ezibandakanya amathambo. Umahluko phakathi koxinzelelo lwethambo lokuxinzelela kunye nolwakhiwo lwamathambo olwelo kukuba i-granular bone graft material eyenziwe ngoxinzelelo lwethambo lokuxinzelela inokukhawuleza kwaye ihlaziywe ngokupheleleyo.
Umnatha wekheji yentsimbi + ukufakwa kwethambo lokunyanzeliswa:Iziphene zamathambo ezingabandakanyiyo zihlala zifuna ukwakhiwa ngokutsha kusetyenziswa iikheji zentsimbi ezinemesh ukuze kufakwe ithambo elirhoxisiweyo. Ukwakhiwa kwakhona kwe-femur ngokuqhelekileyo kunzima kunokwakhiwa kwakhona kwe-tibia. I-X-reyi ibonisa ukuba ukudityaniswa kwamathambo kunye nokubunjwa kwamathambo ezinto ezixutywayo kugqitywa ngokuthe ngcembe (UmfanekisoII-1-1, UmfanekisoII-1-2).
UmzoboII-1-1I-Mesh cage yangaphakathi yokunyanzeliswa kwethambo ukulungisa i-tibial bone defect. Utyando lwangaphakathi; B IX-reyi yasemva kotyando
Umzoboe II-1-2Ukulungiswa kweziphene zamathambo e-femoral kunye ne-tibia kunye ne-titanium mesh yoxinzelelo lwangaphakathi lwethambo lokuxhunyelelwa. Utyando lwangaphakathi; B IX-reyi yasemva kotyando
Ngexesha lokuhlaziywa kwe-knee arthroplasty, i-allogeneic structural bone isetyenziselwa ukuvuselela i-AORI uhlobo lwe-II okanye i-III iziphene zamathambo. Ukongezelela kubuchule botyando obugqwesileyo kunye namava atyebileyo ekutshintsheni idolo elintsonkothileyo, ugqirha wotyando ufanele enze izicwangciso zangaphambi kotyando ngononophelo nezineenkcukacha. Ukufakelwa kwethambo lokwakhiwa kungasetyenziselwa ukulungisa iziphene ze-cortical bone kunye nokunyusa amathambo.
Izibonelelo zale teknoloji ibandakanya: Ingenziwa kuyo nayiphi na isayizi kunye nemilo ukuze ihambelane neziphene zamathambo zeemilo zejometri ezahlukeneyo; inefuthe elihle elixhasayo kwiiprotheses ezihlaziyiweyo; kunye nokudityaniswa kwexesha elide lebhayoloji kunokufezekiswa phakathi kwethambo le-allogeneic kunye nethambo lomkhosi.
Ukungalungi kubandakanya: ixesha elide lokusebenza xa usika ithambo le-allogeneic; imithombo elinganiselweyo yethambo le-allogeneic; umngcipheko wokungahambelani kunye nokulibaziseka komanyano ngenxa yezinto ezifana nokuchithwa kwamathambo kunye nokuphuka kokukhathala ngaphambi kokuba inkqubo yokuhlanganiswa kwamathambo igqitywe; iingxaki zokufunxa kunye nokusuleleka kwezinto ezitshintshiweyo; amathuba okusasazeka kwezifo; kunye nokungonelanga kozinzo lokuqala lwethambo le-allogeneic. I-allogeneic structural bone ivunwa kwi-distal femur, i-proximal tibia, okanye intloko ye-femoral. Ukuba i-transplant material inkulu, i-revascularization epheleleyo ngokuqhelekileyo ayinakwenzeka. Iintloko ze-allogeneic femoral zingasetyenziselwa ukulungisa iziphene ze-femoral condyle kunye ne-tibial plateau bone, ngakumbi ukulungiswa kweziphene ezinkulu zethambo lomgodi, kwaye zilungiswa ngokucofa-ukufakwa emva kokucheba kunye nokumila. Iziphumo zakwangoko zeklinikhi zokusebenzisa ithambo lolwakhiwo lwe-allogeneic ukulungisa iziphene zamathambo zibonise izinga eliphezulu lokuphilisa ithambo elitshintshwayo (FigureII-1-3, UmfanekisoII-1-4).
UmzoboII-1-3Ukulungiswa kwe-femoral bone defect kunye ne-allogeneic femoral head structure ithambo lokuxhunyelelwa
UmzoboII-1-4Ukulungiswa kwe-tibial bone defect kunye ne-allogeneic femoral head bone graft
III.Iteknoloji yokuzalisa isinyithi
Itekhnoloji yeModyuli Itekhnoloji yeModular ithetha ukuba izizalisi zetsimbi zinokudityaniswa kunye neeprotheses kunye neziqu ze-intramedullary. Iifayile zibandakanya iimodeli ezahlukeneyo ukuququzelela ukwakhiwa kwakhona kweziphene zamathambo zobukhulu obuhlukeneyo.
Metallic Iprothetiki Izandiso:I-modular metal spacer ifaneleka kakhulu kwi-AORI uhlobo lwe-II lweziphene zamathambo ezingabonakaliyo kunye nobukhulu obufikelela kwi-2 cm.Ukusetyenziswa kwamacandelo ensimbi ukulungisa iziphene zamathambo zilungele, zilula, kwaye zineempembelelo ezithembekileyo zeklinikhi.
I-Metal spacers ingaba yi-porous okanye iqinile, kwaye iimilo zazo ziquka i-wedges okanye iibhloko. I-spacers yensimbi inokudibaniswa kwi-prosthesis edibeneyo ngezikrufu okanye zilungiswe ngesamente yamathambo. Abanye abaphengululi bakholelwa ukuba ukulungiswa kwesamente yethambo kunokuphepha ukunxiba phakathi kweentsimbi kunye nokucebisa ukulungiswa kwesamente yamathambo. Abanye abaphengululi bakhuthaza indlela yokusebenzisa isamente yethambo kuqala kuze kuqiniswe ngezikrufu phakathi kwe-spacer kunye neprosthesis. Iziphene ze-Femoral zivame ukuvela kwiindawo ezingasemva kunye nezikude ze-condyle ye-femoral, ngoko ke i-spacers yensimbi idla ngokubekwa kwiindawo ezingasemva kunye ne-distal ye-condyle ye-femal. Kwiziphene zethambo le-tibial, i-wedges okanye iibhloko zingakhethwa ukwakhiwa kwakhona ukuze zilungelelanise iimilo zesiphako ezahlukeneyo. Iingxelo zoncwadi ezithi awona mazinga agqwesileyo namahle afikelela kuma-84% ukuya kuma-98%.
Iibhloko ezimile okwe-Wedge zisetyenziswa xa ithambo lesiphako limile okwe wedge, elinokugcina ithambo lomkhosi. Le ndlela idinga i-osteotomy echanekileyo ukwenzela ukuba i-osteotomy surface ihambelane nebhloko. Ukongeza kuxinzelelo loxinzelelo, kukwakho amandla okucheba phakathi kojongano lonxibelelwano. Ngoko ke, i-angle ye-wedge akufanele idlule i-15 °. Xa kuthelekiswa neebhloko ezimise okwe-wedge, iibhloko zetsimbi ze-cylindrical zinobugwenxa bokunyusa umthamo we-osteotomy, kodwa utyando lulula kwaye lulula, kwaye umphumo womatshini usondele kwisiqhelo.III-1-1A, B).
UmzoboIII-1-1I-Metal spacers: I-spacer ene-wedge yokulungisa iziphene ze-tibial; I-spacer enemilo yekholamu yokulungisa iziphene ze-tibial
Ngenxa yokuba izikhewu zentsimbi ziyilwe ngokweemilo kunye nobukhulu obahlukeneyo, zisetyenziswa ngokubanzi kwiziphene zamathambo ezingaqulathwanga kunye neziphene zamathambo zeemilo ezahlukeneyo, kwaye zibonelela ngozinzo olulungileyo lomatshini. Nangona kunjalo, izifundo zexesha elide zifumene ukuba izikhewu zentsimbi ziyasilela ngenxa yokhuseleko loxinzelelo. Xa kuthelekiswa nokufakelwa kwamathambo, ukuba i-metal spacers iyasilela kwaye ifuna ukuhlaziywa, iya kubangela iziphene ezinkulu zamathambo.
Ixesha lokuposa: Oct-28-2024
