Kugawana Nkhani |3D Printed Osteotomy Guide and Personality Prosthesis for Reverse Shoulder Replacement Opaleshoni "Makonda Pawekha"

Akuti Dipatimenti ya Orthopedics and Tumor ya Wuhan Union Hospital yamaliza opaleshoni yoyamba ya "3D-printed personalized reverse shoulder arthroplasty yokhala ndi hemi-scapula reconstruction" opaleshoni.Opaleshoni bwino chizindikiro cha msinkhu watsopano mu chipatala phewa olowa chotupa resection ndi kukonzanso luso, kubweretsa uthenga wabwino kwa odwala milandu zovuta.
Azakhali a Liu, azaka 56 chaka chino, anali ndi ululu paphewa lakumanja zaka zingapo zapitazo.Zakula kwambiri m'miyezi 4 yapitayi, makamaka usiku.Chipatala chakomweko chidapeza "zotupa zakumanja za humeral cortical side" pafilimuyo.Adabwera ku dipatimenti ya Orthopedics and Tumor ku Wuhan Union Hospital kuti akalandire chithandizo.Gulu la Pulofesa Liu Jianxiang litalandira wodwalayo, kuyezetsa kwa mapewa a CT ndi MR kunachitika, ndipo chotupacho chinali ndi proximal humerus ndi scapula, yokhala ndi mitundu yosiyanasiyana.Choyamba, kuphulika kwapang'onopang'ono kunachitidwa kwa wodwalayo, ndipo matenda opatsirana adatsimikiziridwa ngati "biphasic synovial sarcoma ya phewa lakumanja".Poganizira kuti chotupacho ndi chotupa choopsa ndipo wodwalayo ali ndi cholinga chimodzi m'thupi lonse, gululo linapanga ndondomeko yothandizira payekha kuti wodwalayo achotsedwe kumapeto kwa humerus ndi theka la scapula, ndi 3D- kusindikizidwa yokumba reverse phewa olowa m'malo.Cholinga ndi kukwaniritsa chotupa resection ndi prosthesis kumangidwanso, potero kubwezeretsa yachibadwa wodwalayo phewa olowa dongosolo ndi ntchito.

Pambuyo polankhulana za mkhalidwe wa wodwalayo, ndondomeko ya chithandizo, ndi zotsatira zochiritsira zomwe zimayembekezeredwa ndi wodwalayo ndi banja lawo, ndikupeza chilolezo chawo, gululo linayamba kukonzekera opaleshoni ya wodwalayo mwamphamvu.Pofuna kuonetsetsa kuti chotupa chonse chikuchotsedwa, theka la scapula liyenera kuchotsedwa pa opaleshoniyi, ndipo kukonzanso mgwirizano wa mapewa ndizovuta.Pambuyo poyang'anitsitsa bwino mafilimu, kufufuza thupi, ndi kukambirana, Pulofesa Liu Jianxiang, Dr. Zhao Lei, ndi Dr. Zhong Binlong anapanga ndondomeko yatsatanetsatane ya opaleshoni ndikukambirana za mapangidwe ndi kukonza kwa prosthesis ndi injiniya nthawi zambiri.Iwo adatengera chotupa osteotomy ndi prosthesis kukhazikitsa pa 3D kusindikizidwa chitsanzo, kupanga "zokonda makonda" kwa wodwala - yokumba mmbuyo olowa olowa prosthesis amene amafanana autologous mafupa awo mu chiŵerengero cha 1: 1.

A.Yezerani kuchuluka kwa osteotomy.B. Pangani 3D prosthesis.C. 3D kusindikiza prosthesis.D. Kuyikiratu prosthesis.
Kulumikizana kwa phewa lakumbuyo ndi kosiyana ndi komwe kumalumikizidwa kwachikhalidwe kumapewa, komwe kumakhala kozungulira komwe kumayikidwa kumbali ya scapular ya glenoid ndipo kapu imayikidwa pa proximal theka-restricted humer mu prosthesis yoletsa mapewa.Opaleshoniyi ili ndi ubwino wotsatirawu: 1. Ikhoza kufanana kwambiri ndi vuto lalikulu la mafupa chifukwa chochotsa chotupa;2. Mabowo opangidwa kale a ligament amatha kukonza minofu yofewa yozungulira ndikupewa kusasunthika pamodzi komwe kumayambitsidwa ndi rotator cuff resection;3. The bio-mimetic trabecular dongosolo pamwamba pa prosthesis akhoza kulimbikitsa ingrowth ya fupa lozungulira ndi minofu yofewa;4. Mgwirizano wapawekha womwe umadutsa pamapewa ukhoza kuchepetsa kusokonezeka kwa postoperative kwa prosthesis.Mosiyana ndi ochiritsira reverse phewa m'malo, opaleshoni imeneyi amafunanso kuchotsa lonse humeral mutu ndi theka la scapular chikho, ndi kumangidwanso kwa humeral mutu ndi scapular chikho monga chipika lonse, amene amafuna kukonzedwa molondola ndi wapamwamba njira opaleshoni.
Pambuyo pokonzekera bwino komanso kukonzekera panthawi ya opaleshoni, opaleshoniyo inachitidwa bwino kwa wodwalayo posachedwa, motsogozedwa ndi Pulofesa Liu Jianxiang.Gululo linagwira ntchito limodzi ndikuchita maopaleshoni enieni kuti amalize kuchotsa kwathunthu chotupacho, osteotomy yolondola ya humerus ndi scapula, kuika ndi kusonkhanitsa prosthesis yochita kupanga, yomwe inatenga maola a 2 kuti amalize.

D: Dulani bwinobwino humerus ndi scapula ndi mbale yodulira mafupa kuti muchotse chotupacho (H: Intraoperative fluoroscopy yochotsa chotupa)
Pambuyo pa opaleshoni, mkhalidwe wa wodwalayo unali wabwino, ndipo adatha kusuntha mothandizidwa ndi chingwe pa mwendo womwe wakhudzidwa pa tsiku lachiwiri ndikuchita mayendedwe osagwirizana ndi mapewa.Kutsatira X-ray kunawonetsa malo abwino a prosthesis ya mapewa komanso kuchira bwino.

Opaleshoniyi ndi nkhani yoyamba ku Wuhan Union Hospital Department of Orthopedics yomwe imatenga kalozera wodulira wosindikizidwa wa 3D ndi ma prostheses amunthu payekhapayekha polumikizana ndi mapewa ndikusintha kwa hemi-scapula.Kukhazikitsa bwino kwaukadaulowu kudzabweretsa chiyembekezo chopulumutsa miyendo kwa odwala ambiri omwe ali ndi zotupa pamapewa, ndikupindulitsa odwala ambiri.