Kugawana Phunziro la Nkhani | Buku Lothandizira Osteotomy Losindikizidwa ndi 3D ndi Prosthesis Yopangidwira Munthu Payekha Yopangira Opaleshoni Yosintha Mapewa Obwerera M'mbuyo "Kusintha Kwachinsinsi"

Zanenedwa kuti Dipatimenti ya Mafupa ndi Chotupa ku Wuhan Union Hospital yamaliza opaleshoni yoyamba ya "3D-printed personalized reverse shoulder arthroplasty yokhala ndi hemi-scapula reconstruction". Opaleshoni yopambanayi ikuyimira kutalika kwatsopano kwa ukadaulo wochotsa chotupa cha phewa komanso kukonzanso chotupa cha chipatalachi, zomwe zikubweretsa nkhani yabwino kwa odwala omwe ali ndi milandu yovuta.
Azakhali Liu, azaka 56 chaka chino, anali ndi ululu wa phewa lamanja zaka zingapo zapitazo. Wakula kwambiri m'miyezi 4 yapitayi, makamaka usiku. Chipatala chapafupi chinapeza "zilonda za chotupa cha mbali ya khosi lamanja" pa filimuyi. Anapita ku Orthopedics and Tumor Department of Wuhan Union Hospital kuti akalandire chithandizo. Gulu la Pulofesa Liu Jianxiang litalandira wodwalayo, mayeso a CT ndi MR a phewa adachitidwa, ndipo chotupacho chinakhudza humerus ndi scapula, zosiyanasiyana. Choyamba, biopsy ya m'deralo idachitidwa kwa wodwalayo, ndipo matenda adatsimikiziridwa kuti ndi "biphasic synovial sarcoma ya phewa lamanja". Poganizira kuti chotupacho ndi chotupa choipa ndipo wodwalayo pakadali pano ali ndi cholinga chimodzi m'thupi lonse, gululo lidapanga dongosolo la chithandizo la wodwala payekha - kuchotsa kwathunthu kumapeto kwa humerus ndi theka la scapula, ndikusintha cholumikizira cha 3D chosinthika ndi phewa lozungulira. Cholinga chake ndi kupangitsa kuti chotupa chichotsedwe komanso kuti ziwalo zoberekera zikhazikitsidwenso, potero kubwezeretsa kapangidwe kabwino ka mafupa a phewa la wodwalayo komanso momwe amagwirira ntchito.

Pambuyo pofotokozera wodwalayo za matenda ake, dongosolo la chithandizo, ndi zotsatira zake zochizira zomwe akuyembekezera kwa wodwalayo ndi banja lake, komanso kupeza chilolezo chawo, gululo linayamba kukonzekera opaleshoni ya wodwalayo mwakhama. Pofuna kuonetsetsa kuti chotupa chonse chachotsedwa, theka la scapula liyenera kuchotsedwa mu opaleshoniyi, ndipo kukonzanso kwa phewa ndi nkhani yovuta. Pambuyo poyang'ana mosamala mafilimuwo, kufufuza thupi, ndi kukambirana, Pulofesa Liu Jianxiang, Dr. Zhao Lei, ndi Dr. Zhong Binlong adapanga dongosolo la opaleshoni mwatsatanetsatane ndipo adakambirana za kapangidwe ndi kukonza kwa prosthesis ndi mainjiniya nthawi zambiri. Adayesa kuyika chotupa ndi prosthesis pa chitsanzo chosindikizidwa cha 3D, kupanga "kusintha kwachinsinsi" kwa wodwalayo - prosthesis yopangira yolumikizira mapewa yomwe ikugwirizana ndi mafupa awo a autologous mu chiŵerengero cha 1:1.

A. Yesani kuchuluka kwa opaleshoni ya mafupa. B. Pangani kapangidwe ka 3D prosthesis. C. Sindikizani 3D prosthesis. D. Ikani pasadakhale prosthesis.
Cholumikizira cha phewa chobwerera m'mbuyo chimasiyana ndi cholumikizira chachikhalidwe cha phewa chopangidwa, pomwe cholumikizira chozungulira chimayikidwa mbali ya scapular ya glenoid ndipo chikho chimayikidwa pa humerus yoyandikana ndi theka mu prosthesis ya phewa yonse yoletsa. Opaleshoni iyi ili ndi ubwino wotsatira: 1. Ikhoza kufanana kwambiri ndi zolakwika zazikulu za mafupa zomwe zimachitika chifukwa cha kuchotsedwa kwa chotupa; 2. Mabowo okonzanso ligament omwe adapangidwa kale amatha kukonza minofu yofewa yozungulira ndikupewa kusakhazikika kwa mafupa chifukwa cha kuchotsedwa kwa rotator cuff; 3. Kapangidwe ka bio-mimetic trabecular pamwamba pa prosthesis kangathandize kukula kwa mafupa ndi minofu yofewa yozungulira; 4. Cholumikizira cha phewa chobwerera m'mbuyo chomwe chimapangidwa mwamakonda chingathandize kuchepetsa kuchuluka kwa kusweka kwa prosthesis pambuyo pa opaleshoni. Mosiyana ndi kusintha kwa phewa lobwerera m'mbuyo, opaleshoniyi imafunanso kuchotsa mutu wonse wa humeral ndi theka la chikho cha scapular, ndikumanganso mutu wa humeral ndi chikho cha scapular ngati block yonse, zomwe zimafuna kapangidwe kolondola komanso njira yabwino kwambiri yopangira opaleshoni.
Pambuyo pokonzekera bwino komanso kukonzekera bwino panthawi ya opaleshoni, opaleshoniyi idachitika bwino kwa wodwalayo posachedwapa, motsogozedwa ndi Pulofesa Liu Jianxiang. Gululi linagwira ntchito limodzi bwino ndipo linachita maopaleshoni olondola kuti achotse chotupa chonse, kuchotsa mafupa molondola a humerus ndi scapula, kukhazikitsa ndi kusonkhanitsa ziwalo zopangira, zomwe zinatenga maola awiri kuti zitheke.

D: Dulani bwino kwambiri humerus ndi scapula yonse ndi mbale yodulira mafupa kuti muchotse chotupa (H: Intraoperative fluoroscopy yochotsera chotupa)
Pambuyo pa opaleshoni, wodwalayo anali bwino, ndipo anatha kuyenda mothandizidwa ndi chogwirira cha mkono chomwe chinakhudzidwa tsiku lachiwiri ndikuchita mayendedwe a phewa osachitapo kanthu. Ma X-ray otsatira adawonetsa malo abwino a chogwirira cha phewa komanso kuti anali bwino.

Opaleshoni iyi ndi yoyamba kuchitika ku Wuhan Union Hospital Department of Orthopedics yomwe imagwiritsa ntchito malangizo odulira osindikizidwa a 3D ndi ma prostheses apadera kuti agwiritsidwe ntchito m'malo mwa mapewa olumikizana ndi hemi-scapula. Kugwiritsa ntchito bwino ukadaulo uwu kudzabweretsa chiyembekezo chopulumutsa miyendo kwa odwala ambiri omwe ali ndi zotupa za mapewa, ndikupindulitsa odwala ambiri.