I.Njira yodzaza simenti ya mafupa
Njira yodzazira simenti ya mafupa ndi yoyenera kwa odwala omwe ali ndi vuto laling'ono la mafupa la mtundu wa AORI I komanso omwe sachita zambiri.
Ukadaulo wosavuta wa simenti ya mafupa umafuna kutsukidwa bwino kwa chilema cha mafupa, ndipo simenti ya mafupa imadzaza chilema cha mafupa panthawi ya mtanda, kuti ilowetsedwe m'mipata yomwe ili m'makona a chilema momwe ingathere, potero imagwirizana bwino ndi mawonekedwe a fupa la wolandirayo.
Njira yeniyeni yaBchimodziCement +SUkadaulo wa ogwira ntchito ndi kuyeretsa bwino vuto la fupa, kenako kukonza screw pa fupa la wolandirayo, ndikusamala kuti chivundikiro cha screw chisapitirire pamwamba pa fupa la malo olumikizirana mafupa pambuyo pa osteotomy; kenako sakanizani simenti ya fupa, mudzaze vuto la fupa mu gawo la mtanda, ndikukulunga screw. Ritter MA et al. adagwiritsa ntchito njira iyi kuti akonzenso vuto la fupa la tibial plateau, ndipo makulidwe a cholakwikacho adafika 9mm, ndipo panalibe kumasuka patatha zaka 3 opaleshoni itatha. Ukadaulo wodzaza simenti ya fupa umachotsa mafupa ochepa, kenako umagwiritsa ntchito njira yosinthira ya prosthesis, potero kuchepetsa ndalama zothandizira chifukwa chogwiritsa ntchito prostheses yokonzanso, yomwe ili ndi phindu linalake.
Njira yeniyeni ya ukadaulo wa simenti ya mafupa + screw ndi kuyeretsa bwino vuto la fupa, kukonza screw pa fupa la wolandirayo, ndikuwonetsetsa kuti chivundikiro cha screw sichiyenera kupitirira pamwamba pa fupa la pulatifomu yolumikizirana pambuyo pa osteotomy; kenako sakanizani simenti ya fupa, kudzaza vuto la fupa mu gawo la mtanda, ndikukulunga screw. Ritter MA et al. adagwiritsa ntchito njira iyi kuti akonzenso vuto la fupa la tibial plateau, ndipo makulidwe a cholakwikacho adafika 9mm, ndipo panalibe kumasuka patatha zaka 3 opaleshoni itachitika. Ukadaulo wodzaza simenti ya mafupa umachotsa mafupa ochepa, kenako umagwiritsa ntchito njira yosinthira ya prosthesis, potero kuchepetsa mtengo wochizira chifukwa chogwiritsa ntchito prosthesis yokonzanso, yomwe ili ndi phindu linalake (ChithunziI-1).
ChithunziI-1Kudzaza simenti ya mafupa ndi kulimbitsa zomangira
II.Njira zopatsira mafupa
Kupachika mafupa pogwiritsa ntchito compression grafting kungagwiritsidwe ntchito kukonza zolakwika za mafupa zomwe sizikuphatikiza kapena zomwe sizikuphatikiza mu opaleshoni yokonzanso bondo. Ndikoyenera kwambiri kukonzanso zolakwika za mafupa za mtundu wa AROI kuyambira 1 mpaka 3. Mu opaleshoni yokonzanso, popeza kukula ndi kuchuluka kwa zolakwika za mafupa nthawi zambiri zimakhala zazikulu, kuchuluka kwa fupa la autologous lomwe limapezedwa ndi laling'ono ndipo makamaka la sclerotic fupa pamene prosthesis ndi fupa simenti zimachotsedwa panthawi ya opaleshoni kuti mafupa asungidwe. Chifukwa chake, fupa la allogeneic lopangidwa ndi granular nthawi zambiri limagwiritsidwa ntchito popachika mafupa pogwiritsa ntchito compression grafting panthawi ya opaleshoni yokonzanso.
Ubwino wa kukanikiza mafupa ndi: kusunga fupa la fupa lomwe lili m'malo mwake; kukonza zolakwika zazikulu za mafupa zosavuta kapena zovuta.
Zoyipa za ukadaulo uwu ndi izi: ntchito yake imatenga nthawi yayitali; ukadaulo wokonzanso zinthu ndi wovuta (makamaka pogwiritsa ntchito ma MESH cages akuluakulu); pali kuthekera kofalitsa matenda.
Kukanikiza mafupa mosavuta:Kulumikiza mafupa mosavuta nthawi zambiri kumagwiritsidwa ntchito pa zolakwika za mafupa. Kusiyana pakati pa kulumikiza mafupa mokakamiza ndi kulumikiza mafupa m'mapangidwe ake ndikuti zinthu zolumikizira mafupa zopangidwa ndi kulumikiza mafupa mokakamiza zimatha kubwezeretsedwanso mwachangu komanso kwathunthu.
Khola lachitsulo lokhala ndi ulusi + kulumikiza mafupa mopingasa:Zofooka za mafupa zomwe siziphatikizapo mafupa nthawi zambiri zimafuna kumangidwanso pogwiritsa ntchito zingwe zachitsulo kuti zikhazikitse fupa losawonongeka. Kukonzanso femur nthawi zambiri kumakhala kovuta kuposa kumanganso tibia. X-ray imasonyeza kuti kuphatikiza mafupa ndi kupanga mafupa a zinthu zomangira mafupa kumatsirizidwa pang'onopang'ono (Chithunzi).II-1-1ChithunziII-1-2).
ChithunziII-1-1Kulumikiza mafupa mkati mwa khola la mesh kuti akonze vuto la mafupa a tibial. A Pa opaleshoni; B Pambuyo pa opaleshoni X-ray
Chithunzie II-1-2Kukonza zolakwika za mafupa a femoral ndi tibia pogwiritsa ntchito titanium mesh internal compression bone grafting. A Intraoperative; B Postoperative X-ray
Pa nthawi yokonzanso mafupa a bondo, mafupa a allogeneic structural bone amagwiritsidwa ntchito makamaka pokonzanso zolakwika za mafupa a mtundu wa AORI II kapena III. Kuwonjezera pa kukhala ndi luso lapamwamba la opaleshoni komanso luso lotha kusintha mawondo ovuta, dokotala wa opaleshoni ayeneranso kupanga mapulani osamala komanso atsatanetsatane asanayambe opaleshoni. Kulumikiza mafupa a structural grafting kungagwiritsidwe ntchito kukonza zolakwika za mafupa a cortical ndikuwonjezera kulemera kwa mafupa.
Ubwino wa ukadaulo uwu ndi monga: Ikhoza kupangidwa kukhala kukula ndi mawonekedwe aliwonse kuti igwirizane ndi zolakwika za mafupa amitundu yosiyanasiyana; ili ndi mphamvu yabwino yothandizira ma prostheses okonzanso; ndipo kuphatikiza kwachilengedwe kwa nthawi yayitali kumatha kupezeka pakati pa fupa la allogeneic ndi fupa la host.
Zoyipa zake ndi izi: nthawi yayitali yogwirira ntchito podula fupa la allogeneic; magwero ochepa a fupa la allogeneic; chiopsezo cha kusalumikizana ndi kuchedwa kugwirizana chifukwa cha zinthu monga kusungunuka kwa fupa ndi kutopa kusweka kwa fupa lisanathe; mavuto okhudzana ndi kuyamwa ndi matenda a zinthu zoyikidwa; kuthekera kofalitsa matenda; komanso kusakhazikika koyambirira kwa fupa la allogeneic. Fupa la kapangidwe ka allogeneic limatengedwa kuchokera ku distal femur, proximal tibia, kapena femoral head. Ngati zinthu zoyikidwamo ndi zazikulu, nthawi zambiri sizimachitika. Mitu ya allogeneic femoral ingagwiritsidwe ntchito kukonza zofooka za femoral condyle ndi tibial plateau bone, makamaka pokonza zofooka zazikulu za mafupa, ndipo zimakonzedwa ndi kukanikiza pambuyo podula ndi kupanga mawonekedwe. Zotsatira zoyambirira zachipatala zogwiritsa ntchito allogeneic structural bone kukonza zofooka za mafupa zinawonetsa kuchuluka kwakukulu kwa machiritso a fupa loikidwamo (ChithunziII-1-3ChithunziII-1-4).
ChithunziII-1-3Kukonza vuto la mafupa a femoral pogwiritsa ntchito allogeneic femoral head structure bone graft
ChithunziII-1-4Kukonza vuto la mafupa a tibial pogwiritsa ntchito allogeneic femoral head bone graft
III.Ukadaulo wodzaza zitsulo
Ukadaulo wa Modular Ukadaulo wa Modular umatanthauza kuti zodzaza zitsulo zitha kupangidwa ndi ma prostheses ndi intramedullary stems. Zodzazazo zimaphatikizapo mitundu yosiyanasiyana kuti zithandize kukonzanso zolakwika za mafupa a kukula kosiyanasiyana.
Zachitsulo Zopangira Zowonjezera：Cholumikizira chachitsulo chozungulira chimagwiritsidwa ntchito makamaka pa zolakwika za mafupa za mtundu wa AORI II zomwe sizimasunga mafupa zomwe zimakhala ndi makulidwe okwana 2 cm.Kugwiritsa ntchito zitsulo pokonza zolakwika za mafupa n'kosavuta, kosavuta, ndipo kuli ndi zotsatira zodalirika zachipatala.
Ma spacer achitsulo amatha kukhala ndi mabowo kapena olimba, ndipo mawonekedwe awo amaphatikizapo ma wedge kapena ma block. Ma spacer achitsulo amatha kulumikizidwa ku prosthesis yolumikizirana ndi zomangira kapena kukhazikika ndi simenti ya mafupa. Akatswiri ena amakhulupirira kuti kukhazikika kwa simenti ya mafupa kumatha kupewa kuwonongeka pakati pa zitsulo ndipo amalimbikitsa kukhazikika kwa simenti ya mafupa. Akatswiri ena amalimbikitsanso njira yogwiritsira ntchito simenti ya mafupa kaye kenako ndikulimbitsa ndi zomangira pakati pa spacer ndi prosthesis. Zofooka za femoral nthawi zambiri zimachitika m'malo a kumbuyo ndi akutali a femoral condyle, kotero ma spacer achitsulo nthawi zambiri amaikidwa m'malo a kumbuyo ndi akutali a femoral condyle. Pa zolakwika za tibial bone, ma wedge kapena ma block amatha kusankhidwa kuti amangenso kuti agwirizane ndi mawonekedwe osiyanasiyana a zomangira. Mabuku amanena kuti mitengo yabwino komanso yabwino ndi yokwera kufika pa 84% mpaka 98%.
Mabuloko ooneka ngati wedge amagwiritsidwa ntchito pamene vuto la fupa lili ngati wedge, zomwe zingasunge fupa lochulukirapo. Njirayi imafuna osteotomy yolondola kuti pamwamba pa osteotomy pagwirizane ndi block. Kuwonjezera pa kupsinjika, palinso mphamvu yodula pakati pa malo olumikizirana. Chifukwa chake, ngodya ya wedge siyenera kupitirira 15°. Poyerekeza ndi mabuloko ooneka ngati wedge, mabuloko achitsulo ozungulira ali ndi vuto lowonjezera kuchuluka kwa osteotomy, koma opaleshoniyi ndi yosavuta komanso yothandiza, ndipo zotsatira zake zimakhala pafupi ndi zachizolowezi (III-1-1A, B).
ChithunziIII-1-1Zolumikizira zitsulo: Cholumikizira chooneka ngati wedge chokonzera zolakwika za tibial; Cholumikizira chooneka ngati mizati B chokonzera zolakwika za tibial
Popeza ma spacer achitsulo amapangidwa m'mawonekedwe ndi makulidwe osiyanasiyana, amagwiritsidwa ntchito kwambiri pa zolakwika za mafupa ndi mafupa amitundu yosiyanasiyana, ndipo amapereka kukhazikika kwabwino koyambirira kwa makina. Komabe, kafukufuku wa nthawi yayitali wapeza kuti ma spacer achitsulo amalephera chifukwa cha chitetezo cha kupsinjika. Poyerekeza ndi ma grafts a mafupa, ngati ma spacer achitsulo alephera ndipo amafunika kukonzedwanso, amayambitsa zolakwika zazikulu za mafupa.
Nthawi yotumizira: Okutobala-28-2024
