Mukutanga kwema1990, nyanzvi dzekune dzimwe nyika dzakatungamira mukushandisa suture anchors kugadzirisa zvimiro zvakaita seye rotator cuff pasi pe arthroscopy. Dzidziso yakatanga kubva pasi pevhu "chinhu chinonyura" chekutsigira musimboti muSouth Texas, USA, ndiko kuti, nekudhonza tambo yesimbi yepasi pa45 ° inonyura angle kusvika pasi, chivako chepasi chakanyatsogadziriswa pane "chinhu chinonyura" kune rumwe rutivi rwetambo yesimbi.
Mishonga yemitambo yakabva kune orthopedic traumatology. Iyo yakakosha uye yekiriniki multidisciplinary yakazara yekushandisa yemushonga nemitambo. Chinangwa ndechekuwana kugadziriswa kwepamusoro kwekushanda nekushungurudzika kuduku, kusanganisira meniscus kukuvara, cruciate ligament kukuvara, rotator cuff misodzi, kuputika kwefudzi kusagadzikana, kukuvara kweSLAP, nezvimwewo zviri mukati mechikamu chekurapa kwemishonga yemitambo.
Anchor chishandiso chekurapa chinowanzoshandiswa mukurapa kwemitambo uye kuvhiyiwa kwemapfupa. Inonyanya kushandiswa kugadzirisa zvinyoro zvinyoro (zvakadai setendon, ligaments, etc.) kumapfupa kukurudzira kuporesa kwenyama uye kupora. Anchors anowanzo gadzirwa ne biocompatible zvinhu kuti ave nechokwadi chekuchengetedza uye kugadzikana mumuviri.
Zvinoenderana nemhando yezvinyorwa zveanchors, kune mapoka makuru maviri: anchors asingadzoreki uye biodegradable anchors.
Zvishandiso zvikuru zvezvisinga-biodegradable anchors titanium, nickel-titanium alloy, simbi isina tsvina, titanium uye poly-L-lactic acid; mazhinji ema anchors anoshandiswa mukiriniki maitiro anogadzirwa nesimbi zvinhu, izvo zvine zvakanakira kubata zvakanaka simba, nyore kudyara uye nyore X-ray kuongororwa.
Zvinhu zvikuru zvebiodegradable anchors i-poly-D-lactic acid, poly-L-lactic acid, polyglycolic acid, nezvimwewo. Zvichienzaniswa ne-non-biodegradable anchors, biodegradable anchors zviri nyore kudzokorora, hazvina kukanganisa kuduku nemifananidzo, uye inotorwa. Vanogonawo kushandiswa kuvana.
Zvinhu zvikuru zveanchors
1. Metal anchors
• Zvishandiso: Zvikuru zvesimbi zvakadai setitanium alloy.
• Zvimiro: Yakasimba uye yakasimba, inokwanisa kupa yakagadzikana kugadzirisa maitiro. Nekudaro, zvigadzirwa zvekufungidzira zvinogona kuitika uye pane njodzi yekudonha.
2. Zvibatiso zvinobatika
• Zvishandiso: zvinhu zvinogadziriswa zvakadai sepolylactic acid (PLLA).
• Zvimiro: Zvishoma nezvishoma zvakasvibiswa mumuviri, hapana kuvhiyiwa kwechipiri kunodiwa pakubviswa. Zvisinei, chiyero chekuora chinogona kunge chisina kugadzikana, uye simba rekugadzirisa rinogona kuderera nekufamba kwenguva.
3. Polyetheretherketone (PEEK) anchors
• Zvishandiso: high-performance polymers zvakadai se polyetheretherketone.
• Zvimiro: Inopa simba repamusoro rezvipikiri uye maitiro emagetsi, apo iine biocompatibility yakanaka uye yakanaka postoperative imaging madhara.
4. All-suture anchors
• Maumbirwo: Inonyanya kuumbwa nekuisa, anchor uye suture.
• Zvimiro: Zviduku zvikuru muhukuru, zvinyoro mukugadzirwa, zvakakodzera kune mamiriro ezvinhu apo mapfupa ekuzvarwa anorasika kana nzvimbo yekudyara ishoma.
Zvinoenderana nemaitiro ekugadzira eanchors, anogona kukamurwa kuita mapoka maviri: knotted anchors uye knotless (senge yakazara suture) anchors:
1. Zvibatiso zvine mafundo
Knotted anchors imhando dzechinyakare anchor, inoratidzirwa nechikamu chesuture chakabatana nemuswe weancho. Chiremba anoda kupfuudza suture kuburikidza nemucheka wakapfava netsono uye kusungira banga kuti agadzirise nyoro yakapfava kune anchor, kureva, pfupa pamusoro.
• Zvishandiso: Zvibatiso zvakakoshwa zvinowanzogadzirwa nezvinhu zvisingabatike (zvakadai setitanium alloy) kana zvinhu zvinonyura (zvakadai sepolylactic acid).
• Mechanism yekuita: Iyo anchor inogadziriswa mubhonzo kuburikidza neshinda kana mapapiro ekuwedzera, nepo suture inoshandiswa kubatanidza nyoro yakapfava kune anchor, uye yakagadzikana kugadzirisa inogadzirwa mushure mekusunga banga.
• Zvakanakira uye zvisingabatsiri: Kubatsira kweknotted anchors ndeyokuti kugadzirisa kwekugadzirisa kwakavimbika uye kwakakodzera kune zvakasiyana-siyana zvekukuvara kwezvinyoro zvinyoro. Nekudaro, iyo knotting process inogona kuwedzera kuomarara uye nguva yekuvhiya, uye kuvepo kwepfundo kunogona kutungamirira kune kushushikana kwenzvimbo, kuwedzera njodzi yekutyoka kwesuture kana kusunungura anchor.
2. Zvibatiso zvisina mafundo
Knotless anchors, kunyanya yakazara suture anchors, rudzi rutsva rweanchor yakagadzirwa mumakore achangopfuura. Chimiro chayo ndechokuti iyo yose anchor inoumbwa ne sutures, uye zvinyoro zvinyoro kugadzirisa zvinogona kuwanikwa pasina kusunga mafundo.
• Zvishandiso: Full suture anchors kazhinji inoshandisa zvinyoro uye zvakasimba suture zvinhu, zvakadai se-ultra-high molecular weight polyethylene (UHMWPE) fibers.
• Mechanism of action: Full suture anchors inogona kuiswa zvakananga mumapfupa emapfupa kuburikidza nekugadzirwa kwavo kwakakosha kwesuture uye nzira yekuisa, pavanenge vachishandisa tension ye suture kuti igadzirise zvakasimba zvinyoro zvinyoro kune pfupa pamusoro. Sezvo pasina chikonzero chekusunga mafundo, kuoma uye nguva yekushanda kunoderedzwa, uye njodzi yekuputsika kwe suture uye kusunungura anchor inoderedzwa zvakare.
• Zvakanakira uye zvisingabatsiri: Zvakanakira zvizere suture anchors ndeye nyore kuvhiya kuvhiya, yakavimbika kugadzirisa mhedzisiro uye kukuvadza kudiki kune nyoro. Nekudaro, nekuda kwechimiro chayo chakakosha, ine zvakakwirira zvinodikanwa zvehunyanzvi hwekuvhiya uye nzvimbo yekuisa. Mukuwedzera, mutengo we anchors akazara suture unogona kunge wakakwirira, izvo zvinowedzera mutoro wemari kune varwere.
Anchors anoshandiswa zvakanyanya mukuvhiya kwemishonga yakasiyana-siyana yemitambo, yakadai sekugadzirisa cuff rotator, tendon fixation, ligament reconstruction, etc. Izvi zvinotevera sumo yekuvhiya kushandiswa kwezvibatiso uchishandisa rotator cuff kugadzirisa semuenzaniso:
• Matanho ekuvhiya: Kutanga, chiremba achachenesa uye kugadzirira nzvimbo yekukuvara kwe rotator cuff; ipapo, isa chibatiso panzvimbo yakakodzera; zvino, shandisa sutures kugadzirisa rotator cuff tissue kune anchor; pakupedzisira, suture uye bhandeji.
• Kuvhiya kwekuita: Kuburikidza nekugadzirisa kwechisimbiso, kugadzikana uye kushanda kwemucheka we rotator cuff inogona kudzorerwa, ichikurudzira kupora kwemurwere.
Zvakanakira, Zvakaipa uye Kungwarira kweAnchors
Zvakanakira
• Inopa kugadzirisa kwakagadzikana.
• Inoshandiswa kune zvakasiyana-siyana zvekukuvara kwezvinyoro zvinyoro.
• Zvimwe zvinobatika zvinobatika uye hazvidi kuvhiyiwa kwechipiri kuti zvibviswe.
Zvakaipa
• Metal anchors inogona kugadzira imaging artifacts.
• Mwero wekuderera kwezvibatiso zvinobatika zvinogona kunge zvisina kugadzikana.
• Pane njodzi yeanchor detachment kana suture breakage.
Mishonga yemishonga anchors inogona kushandiswa pakuvhiya kunotevera:
1. Recurrent lateral epicondylitis (tennis elbow) iyo isina kunyatsogadziriswa kakawanda: Kana kurapwa kwekuchengetedza kusingabatsiri, kurapwa kwekuvhiya kunogona kusarudzwa, uye anchor inogona kushandiswa kubatanidza nzvimbo yekuisa yeradial extensor carpi brevis kune lateral epicondyle yehumerus.
2. Distal biceps tendon misodzi: Misodzi inokonzerwa nemhando isina kujairika yekufamba, kudhonza, kukanganisa, nezvimwewo inogona kurapwa netambo anchors. Zvibatiso zviviri zvakavigwa muradial tuberosity, uye waya yemuswe inosungirirwa kune biceps tendon chigutsa.
3. Elbow collateral ligament rupture: Posterior dislocation yegokora inowanzoperekedzwa neurnar collateral ligament kukuvadzwa, kunyanya kukuvara kweanterior bundle. Kune elbow collateral ligament kukuvara, nyanzvi dzakawanda dzinowanzofarira kurapwa kwekutanga kwekuvhiya. Iyo nzira yewaya anchor inoshandiswa kuita roughen pamusoro pebhonzo panosungirirwa ligament. Mushure mekubuda ropa kutsva, anchor inonamirwa mukati mebhonzo panosungirirwa ligament, uye tambo yakarukwa iri panoperera chipikiri inoshandiswa kuruka chitsiga che ligament nekuisunga kana kugadzirisa ligament netsono.
4. Kuputsika kweiyo yakaderera yekunamatira point of the cruciate ligament: Anterior cruciate ligament (ACL) tibial attachment point avulsion fracture imhando yakakosha yekukuvara kwe ACL uye inofanira kugadziriswa kare. Kushandiswa kwetambo anchor nzira ine hupamhi hwezviratidzo uye haina kuganhurirwa nehukuru hwekuputsika fragment. Hazvidi kuti intraoperative fluoroscopy igadzirise nzira ye screw. Kuvhiya kwacho kuri nyore uye nguva yekuvhiya inopfupikiswa.
5.Patellar kusagadzikana: kunokonzerwa ne bony anatomical abnormalities uye kusakwana kwekugadzirisa zvinyoro zvinyoro. Nyanzvi zhinji dzinokurudzira kurapa kwekuvhiya vachishandisa waya.
6. Patellar inferior pole fracture: The wire anchor technology inogona kushandiswa kurapa patellar inferior pole fracture. Nokugadzirisa patellar inferior pole fracture uye kuruka uye suturing patellar ligament, kutendeseka kwemabvi extensor mechanism inogona kudzorerwa uye hurefu hwehupenyu hwemabvi extensor mechanism inogona kuchengetedzwa.
7. Inokodzera kubatanidzwa nekugadzirisa mapfupa uye zvinyoro zvinyoro mumabvi, musana, pfudzi, gokora, chidzitiro, tsoka, wrist uye kuvhiyiwa kwemaoko: Anchor ine tambo yakagadzirwa nemarara, iyo iri nyore kuisa uye inopa simba rakasimba rekudhonza-kunze, uye inokodzera kuvhiyiwa munzvimbo dzakasiyana-siyana.
Zvekungwaririra
• Mamiriro emapfupa emurwere uye chimiro cheanatomical chenzvimbo yekuvhiya inofanira kuongororwa zvakakwana vasati vavhiyiwa.
• Sarudza yakakodzera anchor mhando uye zvakatemwa kuti uve nechokwadi chekuvhiya.
• Maitiro ekugadzirisa akakodzera anofanira kuitwa mushure mekuvhiyiwa kuti akurudzire kuporesa kwenyama uye kudzorera basa.
Muchidimbu, anchors anoita basa rinokosha mumishonga yemitambo. Nekusarudza iyo yakakodzera anchor mhando uye zvakatemwa uye nekutevera kwakaringana nhanho dzekuvhiya uye dziviriro, mhedzisiro yekuvhiya inogona kuve nechokwadi uye kupora kwemurwere kunogona kusimudzirwa.
Nguva yekutumira: Zvita-17-2024
