Kumayambiriro kwa zaka za m’ma 1990, akatswiri a maphunziro akunja ankatsogolera pakugwiritsa ntchito anangula a suture kukonza zinthu monga chotchinga chotchinga pansi pa arthroscopy. Chiphunzitsocho chinachokera ku mfundo yothandizira "chinthu chomira" chapansi pa nthaka ku South Texas, USA, ndiko kuti, pokoka waya wachitsulo pansi pa nthaka pamtunda wa 45 ° pansi, nyumba yapansi panthaka imakhazikika pa "chinthu chomira" kumapeto kwa waya wachitsulo.
Mankhwala amasewera adachokera ku orthopedic traumatology. Ndilofunikira komanso lachipatala lomwe limagwiritsidwa ntchito mosiyanasiyana pazamankhwala ndi masewera. Cholinga ndi kukwaniritsa kukonzanso kwakukulu kwa ntchito ndi kuvulala kochepa, kuphatikizapo kuvulala kwa meniscus, kuvulala kwa cruciate ligament, misozi ya rotator, kusasunthika kwa mapewa, kuvulala kwa SLAP, ndi zina zotero zonse zili mkati mwa chithandizo chamankhwala a masewera
Anchor ndi chida chachipatala chomwe chimagwiritsidwa ntchito kwambiri pamankhwala azamasewera komanso opaleshoni ya mafupa. Amagwiritsidwa ntchito makamaka kukonza minofu yofewa (monga tendon, ligaments, etc.) ku mafupa kuti apititse patsogolo machiritso ndi kuchira. Nangula nthawi zambiri amapangidwa ndi zinthu zomwe zimagwirizana ndi biocompatible kuti zitsimikizire chitetezo ndi bata m'thupi.
Malinga ndi kagawidwe ka nangula, pali magulu awiri akulu: nangula zosawonongeka ndi zowononga zachilengedwe.
Zida zazikulu za nangula zosawonongeka ndi titaniyamu, nickel-titaniyamu alloy, chitsulo chosapanga dzimbiri, titaniyamu ndi poly-L-lactic acid; ambiri mwa anangula a suture omwe amagwiritsidwa ntchito pochita zachipatala amapangidwa ndi zitsulo zachitsulo, zomwe zimakhala ndi ubwino wokhala ndi mphamvu yabwino, kuyika kosavuta komanso kufufuza kosavuta kwa X-ray.
Zida zazikulu za nangula za biodegradable ndi poly-D-lactic acid, poly-L-lactic acid, polyglycolic acid, ndi zina zotero. Poyerekeza ndi anangula osawonongeka, anangula omwe amatha kusungunuka ndi osavuta kuwongolera, sasokoneza pang'ono ndi zithunzi, ndipo amatha kuyamwa. Angagwiritsidwenso ntchito kwa ana.
Zida zazikulu za nangula
1. Nangula zachitsulo
• Zipangizo: Makamaka zitsulo monga titaniyamu alloy.
• Zomwe Zilipo: Zamphamvu komanso zolimba, zokhoza kupereka zotsatira zokhazikika zokhazikika. Komabe, zithunzi zojambulidwa zimatha kuchitika ndipo pamakhala chiopsezo chakugwa.
2. Nangula zoyamwa
• Zipangizo: zinthu zomwe zingatengeke monga polylactic acid (PLLA).
• Mbali: Kuwonongeka pang'onopang'ono m'thupi, palibe opaleshoni yachiwiri yomwe imafunika kuti ichotsedwe. Komabe, chiwopsezo cha kuwonongeka chikhoza kukhala chosakhazikika, ndipo mphamvu yokonzekera ikhoza kuchepa pakapita nthawi.
3. Nangula wa Polyetheretherketone (PEEK).
• Zida: ma polima apamwamba kwambiri monga polyetheretherketone.
• Zomwe Zilipo: Amapereka mphamvu zapamwamba za thupi la msomali ndi mphamvu zamakina, pokhala ndi biocompatibility yabwino komanso zotsatira zabwino za kujambula pambuyo pa opaleshoni.
4. Nangula zonse za suture
• Mapangidwe: Amapangidwa makamaka ndi cholowetsa, nangula ndi suture.
• Zomwe Zilipo: Kukula kochepa kwambiri, kofewa, koyenera pamene fupa lachibadwidwe latayika kapena malo oikapo ndi ochepa.
Malinga ndi mapangidwe a nangula, atha kugawidwa m'magulu awiri: nangula zomangidwa ndi knotless (monga suture yathunthu) nangula:
1. Nangula zokhala ndi mfundo
Nangula zomangika ndi mitundu ya nangula yachikhalidwe, yodziwika ndi gawo la suture lolumikizidwa ndi mchira wa nangula. Dokotala amayenera kudutsa suture kudzera mu minofu yofewa ndi singano ndikumanga mfundo kuti akonze minofu yofewa ku nangula, ndiko kuti, pamwamba pa fupa.
• Zida: Anangula okhala ndi mfundo nthawi zambiri amapangidwa ndi zinthu zomwe sizingatengeke (monga titaniyamu alloy) kapena zinthu zomwe zimatha kuyamwa (monga polylactic acid).
• Njira yochitirapo kanthu: Nangula amakhazikika mu fupa kupyolera mu ulusi kapena mapiko okulitsa, pamene suture imagwiritsidwa ntchito kugwirizanitsa minofu yofewa ku nangula, ndipo mphamvu yokhazikika yokhazikika imapangidwa pambuyo pomanga mfundo.
• Ubwino ndi kuipa: Ubwino wa anangula opangidwa ndi knotted ndikuti kukonzanso kumakhala kodalirika komanso koyenera kuvulala kosiyanasiyana kofewa. Komabe, knotting ndondomeko akhoza kuonjezera zovuta ndi nthawi ya opareshoni, ndi kukhalapo kwa mfundo kungachititse kuti m`deralo mavuto ndende, kuonjezera ngozi ya suture kusweka kapena kumasula nangula.
2. Nangula wopanda mfundo
Nangula zopanda mfundo, makamaka ma suture anchor, ndi mtundu watsopano wa nangula womwe wapangidwa m'zaka zaposachedwa. Chikhalidwe chake ndi chakuti nangula yonse imapangidwa ndi sutures, ndipo kukonza minofu yofewa kungapezeke popanda kumanga mfundo.
• Zipangizo: Anangula a suture nthawi zambiri amagwiritsa ntchito zida zofewa komanso zolimba za suture, monga ultra-high molecular weight polyethylene (UHMWPE) ulusi.
• Njira yochitirapo kanthu: Nangula wokwanira wa suture akhoza kulowetsedwa mwachindunji mu minofu ya fupa kudzera m'mapangidwe awo apadera a suture ndi njira yopangira implantation, pamene akugwiritsa ntchito mphamvu ya suture kuti akonze mwamphamvu minofu yofewa pamwamba pa fupa. Popeza palibe chifukwa chomangirira mfundo, zovuta ndi nthawi ya opaleshoni zimachepetsedwa, ndipo chiopsezo cha kusweka kwa suture ndi kumasula nangula kumachepetsedwanso.
• Ubwino ndi kuipa: Ubwino wa nangula wathunthu wa suture ndi opaleshoni yosavuta, yodalirika yokhazikika komanso kuwonongeka pang'ono kwa minofu yofewa. Komabe, chifukwa cha kapangidwe kake kapadera, ili ndi zofunika kwambiri pazamankhwala opangira opaleshoni komanso malo oyika. Kuphatikiza apo, mtengo wa nangula wathunthu wa suture ukhoza kukhala wokwera kwambiri, zomwe zimawonjezera zovuta zachuma kwa odwala.
Nangula amagwiritsidwa ntchito kwambiri pa maopaleshoni osiyanasiyana amankhwala amasewera, monga kukonza makapu a rotator, kukonza tendon, kukonzanso ligament, ndi zina zotere.
• Njira za Opaleshoni: Choyamba, dokotala adzayeretsa ndi kukonza malo ovulala a rotator cuff; ndiye, ikani nangula pamalo oyenera; ndiye, gwiritsani ntchito sutures kukonza minofu ya rotator cuff ku nangula; potsiriza, suture ndi bandeji.
• Kuchita opaleshoni: Kupyolera mu kukhazikitsidwa kwa nangula, kukhazikika ndi ntchito ya minofu ya rotator cuff ikhoza kubwezeretsedwa, kulimbikitsa kuchira kwa wodwalayo.
Ubwino, Kuipa ndi Kusamala kwa Nangula
Ubwino wake
• Amapereka kukhazikika kokhazikika.
• Zogwiritsidwa ntchito kuvulala kosiyanasiyana kofewa.
• Anangula ena amatha kuyamwa ndipo safuna opaleshoni yachiwiri kuti achotsedwe.
Zoipa
• Nangula zachitsulo zimatha kupanga zojambula.
• Kuwonongeka kwa anangula omwe angatengeke akhoza kukhala osakhazikika.
• Pali chiopsezo cha kutsekedwa kwa nangula kapena kusweka kwa suture.
Nangula wamankhwala amasewera angagwiritsidwe ntchito maopaleshoni awa:
1. Epicondylitis yobwerezabwereza (chigoba cha tenisi) chomwe sichinachiritsidwe bwino kangapo: Pamene chithandizo chokhazikika sichigwira ntchito, chithandizo cha opaleshoni chingasankhidwe, ndipo nangula angagwiritsidwe ntchito kugwirizanitsanso malo olowetsamo radial extensor carpi brevis ku lateral epicondyle ya humerus.
2. Distal biceps tendon misozi: Misozi yobwera chifukwa cha kusuntha kwachilendo, kukokera, kugunda, ndi zina zambiri. Anangula awiri amakwiriridwa mu radial tuberosity, ndipo waya wa mchira umalumikizidwa ku chitsa cha biceps tendon.
3. Elbow collateral ligament rupture: Kusuntha kumbuyo kwa chigongono nthawi zambiri kumatsagana ndi kuvulala kwa ulnar collateral ligament, makamaka kuvulala kwa mtolo. Chifukwa cha kuvulala kwa elbow collateral ligament, akatswiri ambiri amakonda kukonda chithandizo choyambirira cha opaleshoni. Njira ya nangula wawaya imagwiritsidwa ntchito kukhwimitsa fupa pamwamba pomwe ligament imalumikizidwa. Pambuyo pa kukhetsa magazi kwatsopano, nangula amalowetsedwa m'mafupa omwe amamangiriridwa ndi ligament, ndipo waya woluka kumapeto kwa msomali amagwiritsidwa ntchito kulumikiza chitsa cha ligament ndikuchilimbitsa kapena kukonza ligament ndi singano.
4. Kuphwanyika kwa malo otsika kwambiri a cruciate ligament: Anterior cruciate ligament (ACL) tibial attachment point avulsion fracture ndi mtundu wapadera wa kuvulala kwa ACL ndipo uyenera kukonzedwa mofulumira. Kugwiritsiridwa ntchito kwa njira ya nangula ya waya kumakhala ndi zizindikiro zambiri ndipo sikumangokhala ndi kukula kwa fragment fragment. Sikutanthauza intraoperative fluoroscopy kusintha mmene wononga. Opaleshoniyo ndi yosavuta ndipo nthawi yake imafupikitsidwa.
5.Kusakhazikika kwa Patellar: chifukwa cha kuperewera kwa mafupa a anatomical ndi kusakwanira kwa minofu yofewa. Akatswiri ambiri amalimbikitsa chithandizo cha maopaleshoni pogwiritsa ntchito anangula a waya.
6. Patellar inferior pole fracture: Ukadaulo wa nangula wa waya ungagwiritsidwe ntchito pochiza fracture ya patellar inferior pole fracture. Mwa kukonza patellar inferior pole fracture ndi kuluka ndi suturing patellar ligament, umphumphu wa mawondo a mawondo amatha kubwezeretsedwa ndipo kutalika kwa thupi la mawondo a mawondo kumatha kusungidwa.
7. Oyenera kugwirizana ndi kukonza mafupa ndi minofu yofewa mu bondo, msana, phewa, chigoba, bondo, phazi, mkono ndi manja opaleshoni: Nangula ali ndi mapangidwe a ulusi wa corrugated, omwe ndi osavuta kuyikapo ndipo amapereka kukana kwamphamvu kokakoka, ndipo ndi koyenera kuchita maopaleshoni m'madera osiyanasiyana.
Kusamalitsa
• Matenda a mafupa a wodwalayo ndi mawonekedwe a anatomical a malo opangira opaleshoni ayenera kuyesedwa mokwanira asanachite opaleshoni.
• Sankhani mtundu wa nangula woyenera ndi ndondomeko kuti muwonetsetse kuti opaleshoni ikuchitika.
• Zochita zolimbitsa thupi zoyenera ziyenera kuchitidwa pambuyo pa opaleshoni kulimbikitsa machiritso a minofu ndi kubwezeretsa ntchito.
Mwachidule, anangula amagwira ntchito yofunika kwambiri pamankhwala amasewera. Posankha mtundu wa nangula woyenera ndi ndondomeko ndikutsatira njira zoyenera zopangira opaleshoni ndi zodzitetezera, zotsatira za opaleshoni zimatha kutsimikiziridwa ndipo kuchira kwa wodwalayo kungathe kulimbikitsidwa.
Nthawi yotumiza: Dec-17-2024
