I.Njira yodzaza simenti ya mafupa
Njira yodzaza simenti ya mafupa ndi yoyenera kwa odwala omwe ali ndi vuto la mafupa amtundu wa AORI I komanso ntchito zochepa.
Ukadaulo wosavuta wa simenti wamafupa umafunikira kuyeretsa bwino chilema cha fupa, ndipo simenti ya fupa imadzaza chilema cha fupa panthawi ya mtanda, kuti athe kuyika mipata m'makona a chilemacho momwe angathere, potero kukwaniritsa zolimba ndi mawonekedwe a fupa.
Njira yeniyeni yaBimodziCchinthu +Sluso ogwira ntchito ndi bwino kuyeretsa fupa chilema, ndiye kukonza wononga pa khamu fupa, ndi kusamala kuti wononga kapu kuposa fupa pamwamba pa olowa nsanja pambuyo osteotomy; Kenako sakanizani simenti ya fupa, mudzaze chilema cha fupa mu siteji ya mtanda, ndikukulunga wononga. Ritter MA et al. adagwiritsa ntchito njirayi kuti amangenso chilema cha mafupa a tibial, ndipo makulidwe ake adafika 9mm, ndipo panalibe kumasula zaka 3 pambuyo pa opaleshoniyo. Ukadaulo wodzaza simenti wa mafupa amachotsa fupa lochepa, ndiyeno amagwiritsa ntchito kukonzanso kwa prosthesis, potero amachepetsa mtengo wamankhwala chifukwa chogwiritsa ntchito ma prostheses okonzanso, omwe ali ndi phindu linalake.
Njira yeniyeni ya teknoloji ya fupa simenti + ndi kuyeretsa bwino chilema cha fupa, kukonza wononga pa fupa lokhalamo, ndi kulabadira kuti wononga kapu sayenera kupitirira fupa pamwamba pa nsanja olowa pambuyo osteotomy; Kenako sakanizani simenti ya fupa, mudzaze chilema cha fupa mu siteji ya mtanda, ndikukulunga wononga. Ritter MA et al. adagwiritsa ntchito njirayi kuti amangenso chilema cha mafupa a tibial, ndipo makulidwe a chilema adafika 9mm, ndipo panalibe kumasula zaka 3 pambuyo pa opaleshoni. Tekinoloje yodzaza simenti ya mafupa imachotsa mafupa ochepa, kenako imagwiritsa ntchito kukonzanso kwa prosthesis wamba, potero kuchepetsa mtengo wamankhwala chifukwa chogwiritsa ntchito prosthesis yokonzanso, yomwe ili ndi phindu linalake (Chithunzi.Ine-1).
ChithunziIne-1Kudzaza simenti ya mafupa ndi kulimbitsa zomangira
II.Njira zolumikizira mafupa
Kuphatikizika kwa fupa kungagwiritsidwe ntchito kukonza zolakwika za mafupa ophatikizika kapena osaphatikizika pa opaleshoni yokonzanso mawondo. Ndizoyenera kwambiri kumangidwanso kwa AROI mtundu I mpaka III zofooka za mafupa. Mu opaleshoni yokonzanso, popeza kukula kwake ndi kuchuluka kwa zofooka za mafupa nthawi zambiri zimakhala zovuta kwambiri, kuchuluka kwa fupa la autologous lomwe limapezeka ndi laling'ono ndipo makamaka sclerotic fupa pamene prosthesis ndi simenti ya fupa zimachotsedwa panthawi ya opaleshoni kuti asunge mafupa. Choncho, granular allogeneic fupa nthawi zambiri amagwiritsidwa ntchito psinjika fupa Ankalumikiza pa kukonzanso opaleshoni.
Ubwino wa psinjika fupa Ankalumikiza ndi: kusunga fupa misa wa khamu fupa; kukonza zolakwika zazikulu zosavuta kapena zovuta za mafupa.
Zoyipa zaukadaulo uwu ndi: ntchitoyo imatenga nthawi; ukadaulo womanganso ndi wovuta (makamaka mukamagwiritsa ntchito makola akulu a MESH); pali kuthekera kwa kufalitsa matenda.
Kuphatikizika kosavuta kwa mafupa:Kuphatikizika kosavuta kwa mafupa nthawi zambiri kumagwiritsidwa ntchito pophatikiza zolakwika za mafupa. Kusiyanitsa pakati pa kuponderezana kwa fupa ndi kulumikiza mafupa ndiko kuti granular fupa kumezanitsa zinthu zopangidwa ndi compression fupa Ankalumikiza akhoza mofulumira ndi kwathunthu revascularized.
Mesh zitsulo khola + compression fupa Ankalumikiza:Zosaphatikizika za mafupa nthawi zambiri zimafuna kumangidwanso pogwiritsa ntchito ma mesh zitsulo otsekera kuti akhazikitse fupa loletsa. Kukonzanso kwa femur nthawi zambiri kumakhala kovuta kuposa kukonzanso kwa tibia. Ma X-ray amawonetsa kuti kuphatikiza kwa mafupa ndi mapangidwe a mafupa azinthu zomezanitsa kumatsirizika pang'onopang'ono (ChithunziII-1-1ChithunziII-1-2).
ChithunziII-1-1Mesh khola mkati psinjika fupa Ankalumikiza kukonza tibial fupa chilema. A Intraoperative; B Postoperative X-ray
Chithunzindi II-1-2Kukonza zolakwika za fupa la femoral ndi tibia ndi titaniyamu mesh mkati mwa compression fupa. A Intraoperative; B Postoperative X-ray
Panthawi yokonzanso mawondo a arthroplasty, mafupa opangidwa ndi allogeneic amagwiritsidwa ntchito makamaka pomanganso mafupa a AORI amtundu wa II kapena III. Kuphatikiza pa kukhala ndi luso lapamwamba la maopaleshoni komanso luso lothandizira kusintha mawondo, dokotalayo ayeneranso kupanga mapulani osamala komanso atsatanetsatane. Kuphatikizika kwa mafupa apangidwe kungagwiritsidwe ntchito kukonza zolakwika za cortical mafupa ndikuwonjezera mafupa.
Ubwino waukadaulo uwu umaphatikizapo: Itha kupangidwa kukula ndi mawonekedwe aliwonse kuti igwirizane ndi zofooka za mafupa amitundu yosiyanasiyana ya geometric; imakhala ndi zotsatira zabwino pakukonzanso ma prostheses; ndi kuphatikizika kwachilengedwe kwanthawi yayitali kumatha kupezeka pakati pa fupa la allogeneic ndi fupa lokhala.
Zoyipa zimaphatikizapo: nthawi yayitali yogwira ntchito mukadula fupa la allogeneic; zochepa magwero allogeneic fupa; chiopsezo cha kusagwirizana ndi kuchedwa kwa mgwirizano chifukwa cha zinthu monga fupa la fupa ndi kusweka kwa kutopa musanayambe kugwirizanitsa mafupa; mavuto ndi mayamwidwe ndi matenda a zinthu kuziika; kuthekera kwa kufalitsa matenda; ndi kusakhazikika koyambirira kwa mafupa a allogeneic. Allogeneic structural bone amatengedwa kuchokera ku distal femur, proximal tibia, kapena mutu wa chikazi. Ngati kumuika zinthu zazikulu, wathunthu revascularization kawirikawiri sizichitika. Mitu ya allogeneic femoral imatha kugwiritsidwa ntchito kukonza zolakwika za mafupa amtundu wa femoral condyle ndi tibial plateau, makamaka pakukonza zolakwika zazikulu zamtundu wa mafupa, ndipo zimakonzedwa ndi makina osindikizira pambuyo podula ndi kupanga. Zotsatira zoyambirira zachipatala pogwiritsa ntchito mafupa opangidwa ndi allogeneic kuti akonze zolakwika za fupa zimasonyeza kuchira kwakukulu kwa mafupa oikidwa (Chithunzi.II-1-3ChithunziII-1-4).
ChithunziII-1-3Kukonza chilema cha fupa lachikazi ndi allogeneic femoral mutu kapangidwe ka mafupa a mafupa
ChithunziII-1-4Kukonza vuto la fupa la tibial ndi allogeneic femoral mutu fupa kumezanitsa
III.Ukadaulo wodzaza zitsulo
Tekinoloje ya modular Tekinoloje ya Modular imatanthawuza kuti zodzaza zitsulo zimatha kuphatikizidwa ndi ma prostheses ndi ma intramedullary zimayambira. Ma fillers amaphatikizapo zitsanzo zosiyanasiyana kuti athe kukonzanso zofooka za mafupa amitundu yosiyanasiyana.
Chitsulo Prosthetic Zowonjezera:The modular metal spacer ndi yoyenera makamaka kwa AORI mtundu II wopunduka wa mafupa omwe ali ndi makulidwe mpaka 2 cm.Kugwiritsiridwa ntchito kwa zigawo zachitsulo kukonza zolakwika za mafupa ndizosavuta, zosavuta, ndipo zimakhala ndi zotsatira zodalirika zachipatala.
Zitsulo zopangira zitsulo zimatha kukhala porous kapena zolimba, ndipo mawonekedwe ake amakhala ndi ma wedge kapena midadada. Zitsulo zachitsulo zimatha kulumikizidwa ndi prosthesis yolumikizana ndi zomangira kapena zokhazikika ndi simenti ya fupa. Akatswiri ena amakhulupirira kuti kukonza simenti ya mafupa kungapewe kuvala pakati pa zitsulo ndikulimbikitsa kukonza simenti ya mafupa. Akatswiri ena amalimbikitsanso njira yogwiritsira ntchito simenti ya mafupa kaye ndiyeno kumangirira ndi zomangira pakati pa spacer ndi prosthesis. Zowonongeka zachikazi nthawi zambiri zimachitika kumadera akumbuyo ndi akutali a condyle yachikazi, kotero kuti zitsulo zachitsulo nthawi zambiri zimayikidwa kumbuyo ndi mbali zakutali za condyle yachikazi. Kwa zofooka za mafupa a tibial, ma wedges kapena midadada amatha kusankhidwa kuti amangenso kuti agwirizane ndi mawonekedwe osiyanasiyana. Zolemba zimanena kuti mitengo yabwino kwambiri ndi yokwera mpaka 84% mpaka 98%.
Mipiringidzo yooneka ngati mphako imagwiritsidwa ntchito ngati chilema cha fupacho chili ngati mphero, chomwe chimatha kusunga mafupa ambiri. Njirayi imafuna osteotomy yeniyeni kuti osteotomy pamwamba ifanane ndi chipikacho. Kuphatikiza pa kupsinjika kwapakatikati, palinso mphamvu yakumeta ubweya pakati pa zolumikizirana. Choncho, mbali ya mphero sikuyenera kupitirira 15 °. Poyerekeza ndi midadada yooneka ngati mphero, midadada cylindrical zitsulo ndi kuipa kuonjezera kuchuluka kwa osteotomy, koma opaleshoni ndi yabwino ndi yosavuta, ndipo mawotchi zotsatira ali pafupi yachibadwa (III-1-1A, B).
ChithunziIII-1-1Zitsulo zachitsulo: Chombo chopangidwa ndi mphero kuti chikonze zolakwika za tibial; B ndime yooneka ngati spacer kukonza zolakwika za tibial
Chifukwa ma spacers achitsulo amapangidwa m'mawonekedwe ndi makulidwe osiyanasiyana, amagwiritsidwa ntchito kwambiri m'mafupa osagwirizana ndi mafupa amitundu yosiyanasiyana, ndipo amapereka kukhazikika kwamakina koyambirira. Komabe, kafukufuku wanthawi yayitali apeza kuti ma spacers achitsulo amalephera chifukwa choteteza kupsinjika. Poyerekeza ndi mafupa a mafupa, ngati zitsulo zakuthambo zimalephera ndipo ziyenera kukonzedwanso, zidzachititsa kuti mafupa awonongeke.
Nthawi yotumiza: Oct-28-2024
