Nzira yekuvhiyiwa yeDorsal Scapular Exposure

· Kushandiswa kweAnatomy

Pamberi pescapula pane subscapular fossa, uko kunotangira tsandanyama ye subscapularis. Kumashure kune ridge ye scapular inofamba ichienda kunze uye zvishoma kumusoro, iyo yakakamurwa kuita supraspinatus fossa uye infraspinatus fossa, yekubatanidza tsandanyama dze supraspinatus ne infraspinatus zvakateerana. Mugumo wekunze we scapular ridge i acromion, iyo inoumba acromioclavicular joint ne acromion mugumo we clavicle kuburikidza nehupamhi hwakareba hwe ovoid articular. Muganho wepamusoro we scapular ridge une notch diki yakaita seU, iyo inoyambuka ne ligament pfupi asi yakasimba ye suprascapular, iyo tsinga ye suprascapular inopfuura pasi payo, uye iyo tsinga ye suprascapular inopfuura pamusoro payo. Muganho weparutivi (muganho weaxillary) we scapular ridge ndiwo wakakora uye unoenda kunze kumudzi we scapular neck, uko unoumba glenoid notch nemucheto we glenoid yejoin yefudzi.

· Zviratidzo

1. Kubviswa kwebundu risina njodzi rema scapular.

2. Kuchekwa kwenzvimbo kwegomarara remapundu emusana.

3. Mafudzi akareba uye mamwe marema.

4. Kubviswa kwepfupa rakafa mu scapular osteomyelitis.

5. Chirwere cheSuprascapular nerve entrapment.

· Nzvimbo yemuviri

Nzvimbo isina kugadzikana, yakakotama pa30° kusvika pamubhedha. Gumbo repamusoro rakakanganiswa rinoputirwa netauro risina utachiona kuitira kuti rikwanise kutamiswa chero nguva panguva yekuvhiyiwa.

· Matanho ekushanda

1. Kucheka kwakachinjika kunowanzoitwa pamwe chete nemucheto wescapular musupraspinatus fossa nechikamu chepamusoro cheinfraspinatus fossa, uye kucheka kwenguva refu kunogona kuitwa pamwe chete nemucheto wepakati wescapula kana divi repakati resubscapularis fossa. Kucheka kwakachinjika nekuchinjika kunogona kubatanidzwa kuti kugadzire chimiro cheL, chimiro cheL chakachinjika, kana chimiro chekirasi yekutanga, zvichienderana nekudiwa kwekuona zvikamu zvakasiyana zvescapula. Kana makona epamusoro neapasi escapula achingoda kuratidzwa, kucheka kudiki kunogona kuitwa munzvimbo dzakakodzera (Mufananidzo 7-1-5(1)).

2. Baya nzvimbo yepamusoro uye yakadzika yefascia. Tsandanyama dzakabatana ne scapular ridge ne medial border dzinochekwa zvakachinjika kana kuti zvakareba munzira yekuchekwa (Mufananidzo 7-1-5(2)). Kana supraspinatus fossa ichizoonekwa, shinda dze trapezius tsandanyama dzepakati dzinotanga dzachekwa. Periosteum inochekwa pamusoro pemapfupa e scapular gonad, ine mafuta matete pakati padzo, uye supraspinatus fossa yese inoonekwa nekupatsanurwa kwe subperiosteal kwetsandanyama ye supraspinatus, pamwe chete netsandanyama ye trapezius iri pamusoro. Pakuchekwa shinda dzepamusoro dzetsandanyama ye trapezius, chenjerera kuti usakuvadze tsinga ye parasympathetic.

3. Kana tsinga yesuprascapular yave kuda kuratidzwa, tsinga dzechikamu chepamusoro chepakati chetsandanyama yetrapezius chete ndidzo dzinogona kudhonzwa kumusoro, uye tsandanyama yesupraspinatus inogona kudhonzwa zvinyoro nyoro pasi pasina kubvisa, uye chimiro chichena chinopenya chinoonekwa ndicho tsinga yesuprascapular transverse ligament. Kana tsinga dzesuprascapular netsinga zvaonekwa uye zvadzivirirwa, tsinga yesuprascapular transverse ligament inogona kuchekwa, uye scapular notch inogona kuongororwa kuti ione chero zvivako zvisina kujairika, uye tsinga yesuprascapular inogona kusunungurwa. Pakupedzisira, tsandanyama yetrapezius yakabviswa inosungirirwa pamwe chete kuitira kuti ibatanidzwe nescapula.

4. Kana chikamu chepamusoro che infraspinatus fossa chichizoonekwa, tsinga dzepasi nedzepakati dze trapezius tsandanyama ne deltoid tsandanyama dzinogona kuchekwa pakutanga kwe scapular ridge dzodzoserwa kumusoro nekudzika (Mufananidzo 7-1-5(3)), uye mushure mekunge infraspinatus tsandanyama yaonekwa, inogona kubviswa pasi peperiosteally (Mufananidzo 7-1-5(4)). Pakusvika kumagumo epamusoro e axillary margin ye scapular gonad (kureva, pasi pe glenoid), kutarisirwa kunofanira kupihwa kune axillary nerve uye posterior rotator humeral artery inopfuura nepakati pe quadrilateral foramen yakakomberedzwa ne teres minor, teres major, musoro murefu we triceps, uye mutsipa wekuvhiya we humerus, pamwe ne rotator scapulae artery inopfuura nepakati pe triangular foramen yakakomberedzwa ne nhatu dzekutanga, kuitira kuti dzisakuvadze (Mufananidzo 7-1-5(5)).

5. Kuti pave pachena muganhu wepakati we scapula, mushure mekuchekwa shinda dzemusungo we trapezius, musungo we trapezius ne supraspinatus unodzoserwa kumashure zvakanyanya uye kunze ne subperiosteal stripping kuti pave pachena chikamu chepakati che supraspinatus fossa nechikamu chepamusoro che medial border; uye musungo we trapezius ne infraspinatus, pamwe chete ne vastus lateralis muscle yakabatana ne inferior angle ye scapula, zvinobviswa pasi peperiosteally kuti pave pachena chikamu chepakati che infraspinatus fossa, inferior angle ye scapula, uye chikamu chezasi che medial border.

Mufananidzo 7-1-5 Nzira yekubuda kwe dorsal scapular

(1) kuchekwa; (2) kuchekwa kwemutsara wemhasuru; (3) kucheka tsandanyama yedeltoid kubva pamucheto wescapular; (4) kusimudza tsandanyama yedeltoid kuti ibudise pachena infraspinatus neteres minor; (5) kubvisa tsandanyama yeinfraspinatus kuti ibudise pachena chikamu chemusana chescapula ne vascular anastomosis.

6. Kana subscapular fossa ichizoonekwa, tsandanyama dzakanamirwa nemukati memuganhu wepakati, kureva, scapularis, rhomboids uye serratus anterior, dzinofanira kubviswa panguva imwe chete, uye scapula yese inogona kusimudzwa kunze. Pakusunungura medial border, kungwarira kunofanira kutorwa kuchengetedza bazi rinodzika re transverse carotid artery ne dorsal scapular nerve. Deceading branch ye transverse carotid artery inotangira pamutsipa we thyroid uye inofamba kubva pakona yepamusoro ye scapula kuenda kukona yepasi ye scapula kuburikidza ne scapularis tenuissimus, rhomboid muscle ne rhomboid muscle, uye rotator scapulae artery inoumba network yakapfuma ye vascular muchikamu che dorsal che scapula, saka inofanira kunamirwa zvakasimba pamusoro pebhonzo kuti subperiosteal peeling ikwanise kupeuka.