Kubva Sculco nevamwe vake pavakatanga kutaura nezve small-incision total hip arthroplasty (THA) vachishandisa nzira ye posterolateral muna 1996, shanduko itsva dzinoverengeka dzakataurwa. Mazuva ano, pfungwa ye small-invasive yave ichiparadzirwa zvakanyanya uye ichigamuchirwa zvishoma nezvishoma nevanachiremba. Zvisinei, hapasati pave nesarudzo yakajeka yekuti nzira dzekurapa dzinofanira kushandiswa here kana kuti dzemazuva ano.
Zvakanakira zvekuvhiyiwa kusinganyanyi kukuvadza zvinosanganisira kucheka kudiki, kubuda ropa kushoma, kurwadziwa kushoma, uye kupora nekukurumidza; zvisinei, zvakaipa zvinosanganisira kusaona zvakanaka, kukuvara kwetsinga dzeropa kuri nyore, nzvimbo isina kunaka yeprosthesis, uye njodzi yakakura yekuvhiyiwa patsva.
Mukurapa kwe "total hip arthroplasty" (MIS - THA) kushoma, kurasikirwa nesimba remhasuru mushure mekuvhiyiwa chikonzero chakakosha chinokanganisa kupora, uye nzira yekuvhiyiwa chinhu chakakosha chinokanganisa simba remhasuru. Semuenzaniso, nzira dzepamberi nepadivi uye dzakananga dzepamberi dzinogona kukuvadza mapoka emhasuru dzeabductor, zvichikonzera kufamba-famba (Trendelenburg limp).
Mukuedza kutsvaga nzira dzisinganyanyi kukuvadza dzinoderedza kukuvara kwetsandanyama, Dr. Amanatullah nevamwe vake vekuMayo Clinic muUnited States vakaenzanisa nzira mbiri dzeMIS-THA, nzira yepamberi (DA) uye nzira yepamberi (DS), pazviyero zvechitunha kuti vaone kukuvara kwetsandanyama nemapfupa. Zvakabuda muchidzidzo ichi zvakaratidza kuti nzira yeDS haina kukuvadza tsandanyama nemapfupa zvakanyanya pane nzira yeDA uye inogona kunge iriyo nzira inofarirwa yeMIS-THA.
Dhizaini yekuedza
Chidzidzo ichi chakaitwa pamitumbi misere yakanga ichangobva kuomeswa nechando ine mapeya masere ehudyu gumi nematanhatu isina nhoroondo yekuvhiyiwa chiuno. Chiuno chimwe chakasarudzwa zvisina kurongeka kuti chiongororwe MIS-THA kuburikidza neDA approach uye chimwe kuburikidza neDS approach mune chimwe chitunha, uye maitiro ese akaitwa nevanachiremba vane ruzivo. Mwero wekupedzisira wekukuvara kwetsandanyama netsinga wakaongororwa nachiremba wemapfupa asina kubatanidzwa mukuvhiyiwa.
Maumbirwo emuviri akaongororwa aisanganisira: gluteus maximus, gluteus medius netendon yayo, gluteus minimus netendon yayo, vastus tensor fasciae latae, quadriceps femoris, upper trapezius, piatto, lower trapezius, obturator internus, uye obturator externus (Mufananidzo 1). Tsandanyama dzakaongororwa kuti dziwane tsandanyama dzakabvaruka uye kurwadza kwadzo kunoonekwa nemaziso asina kupfeka.
Mufananidzo 1. Dhayagiramu yemaumbirwo emhasuru yega yega
Mhedzisiro
1. Kukuvara kwetsandanyama: Pakanga pasina musiyano wehuwandu hwekukuvara kweganda re gluteus medius pakati penzira dzeDA neDS. Zvisinei, kune tsandanyama ye gluteus minimus, huwandu hwekukuvara kweganda re DA hwakanga hwakakwira zvakanyanya kupfuura hwakanga hwakonzerwa nenzira yeDS, uye pakanga pasina musiyano wakakura pakati penzira mbiri dzetsandanyama ye quadriceps. Pakanga pasina musiyano wakakura pakati penzira mbiri idzi maererano nekukuvara kwetsandanyama ye quadriceps, uye huwandu hwekukuvara kweganda re vastus tensor fasciae latae ne rectus femoris hwaive hwakakura nenzira yeDA kupfuura nenzira yeDS.
2. Kukuvara kweTsononi: Hapana kana imwe yenzira dzakakonzera kukuvara kwakakura.
3. Kubviswa kweTendon: Kureba kwekubvisa tendon yegluteus minimus kwaive kwakanyanya muboka reDA pane muboka reDS, uye huwandu hwekukuvara hwaive hwakakwira zvakanyanya muboka reDS. Pakanga pasina musiyano wakakosha mukukuvara kwekubvisa tendon pakati pemapoka maviri epyriformis neobturator internus. Chirongwa chekuvhiya chinoratidzwa muMufananidzo 2, Mufananidzo 3 unoratidza nzira yechinyakare yedivi, uye Mufananidzo 4 unoratidza nzira yechinyakare yekumashure.
Mufananidzo 2 1a. Kubviswa kwetendon yegluteus minimus panguva yekuvhiyiwa kweDA nekuda kwekudiwa kwekugadziriswa kwefemoral; 1b. Kubviswa kwechikamu chegluteus minimus kunoratidza kukura kwekukuvara kwetendon yayo nedumbu remhasuru. gt. greater trochanter; * gluteus minimus.
Mufananidzo 3. Chimiro chenzira yechinyakare yakananga padivi ine acetabulum inoonekwa kurudyi nekubata kwakakodzera.
Mufananidzo 4 Kuratidzwa kwemhasuru pfupi yekunze inotenderera munzira yakajairika yekumashure yeTHA
Mhedziso uye Zvazvinoreva paKliniki
Zvidzidzo zvakawanda zvekare hazvina kuratidza mutsauko wakakosha panguva yekuvhiyiwa, kudzora marwadzo, mwero weropa, kurasikirwa neropa, nguva yekugara muchipatara, uye kufamba kana tichienzanisa THA yechinyakare neMIS-THA. Chidzidzo chekiriniki cheTHA chine nzira yekushandiswa kwemishonga yechinyakare uye THA isinganyanyi kupindira mumuviri naRepantis et al. hachina kuratidza mutsauko wakakosha pakati pezviviri izvi, kunze kwekunge paine kudzikira kwakakosha kwemarwadzo, uye hapana mutsauko wakakosha mukubuda ropa, kushivirira kufamba, kana kugadziriswa mushure mekuvhiyiwa. Chidzidzo chekiriniki chakaitwa naGoosen et al.
RCT yakaitwa naGoosen nevamwe yakaratidza kuwedzera kweavhareji yeHHS score mushure mekuvhiyiwa kushoma (zvichiratidza kuti kupora kuri nani), asi nguva yakareba yekuvhiyiwa uye matambudziko akawanda mushure mekuvhiyiwa. Mumakore achangopfuura, kwave nezvidzidzo zvakawanda zvinoongorora kukuvara kwetsandanyama uye nguva yekupora mushure mekuvhiyiwa nekuda kwekuvhiyiwa kushoma, asi nyaya idzi hadzisati dzanyatsogadziriswa. Chidzidzo ichi chakaitwawo zvichibva pamatambudziko akadaro.
Muchidzidzo ichi, zvakaonekwa kuti nzira yeDS haina kukonzera kukuvara kwakanyanya kwetsandanyama pane nzira yeDA, sezvinoratidzwa nekukuvara kushoma kwetsandanyama yegluteus minimus netendon yayo, tsandanyama yevastus tensor fasciae latae, uye tsandanyama yerectus femoris. Kukuvara uku kwakatsanangurwa nenzira yeDA pachayo uye kwaive kwakaoma kugadzirisa mushure mekuvhiyiwa. Tichifunga kuti chidzidzo ichi chinoratidza chitunha, zvidzidzo zvekiriniki zvinodiwa kuti tiongorore kukosha kwekiriniki kwemhedzisiro iyi zvakadzama.
Nguva yekutumira: Mbudzi-01-2023
