Kubva Sculco et al.yakatanga kuzivisa iyo diki-incision yakazara hip arthroplasty (THA) ine posterolateral nzira mu1996, akati wandei matsva akawandisa ekugadzirisa akataurwa.Mazuva ano, pfungwa yekushomeka yave ichiparadzirwa zvakanyanya uye zvishoma nezvishoma inogamuchirwa nevarapi.Nekudaro, hapasati pasati pave nesarudzo yakanyatsojeka yekuti nzira shoma kana dzechinyakare dzinofanira kushandiswa.
Zvakanakira kuvhiyiwa kusinganyanyi kupindira zvinosanganisira kuchekwa kudiki, kubuda ropa kushoma, kurwadziwa kushoma, uye kukurumidza kupora;zvisinei, zvisingabatsiri zvinosanganisira nzvimbo shoma yekuona, nyore kubudisa kukuvara kwehutano hwehutano hwehutano, hurombo husina kunaka hweprosthesis, uye kuwedzera kwengozi yekuvhiya patsva.
Muzvishoma zvisingasviki zvachose hip arthroplasty (MIS - THA), mushure mekuvhiyiwa simba remhasuru kurasikirwa ndicho chikonzero chakakosha chinokanganisa kupora, uye nzira yekuvhiya chinhu chakakosha chinokanganisa simba remhasuru.Semuenzaniso, anterolateral uye yakananga anterior nzira dzinogona kukuvadza mapoka emhasuru dzeabductor, zvichitungamira kune kuzunguza gait (Trendelenburg limp).
Mukuedza kutsvaga nzira dzisinganyanyi kukanganisa dzinoderedza kukuvadzwa kwemhasuru, Dr. Amanatullah et al.kubva kuMayo Clinic muUnited States yakaenzanisa nzira mbiri dzeMIS-THA, iyo yakananga anterior approach (DA) uye yakananga yepamusoro yepamusoro (DS), pane cadaveric specimens kuti ione kukanganisa kwemhasuru nemarunda.Migumisiro yechidzidzo ichi yakaratidza kuti nzira yeDS haina kukuvadza kumisungo uye tendon kupfuura nzira yeDA uye inogona kunge iri nzira inosarudzwa yeMIS-THA.
Kuedza kugadzira
Chidzidzo ichi chakaitwa pamakadava masere achangobva kuomeswa nechando ane mapairi masere ehudyu gumi nematanhatu asina nhoroondo yekuvhiyiwa kwehudyu.Imwe hudyu yakasarudzwa zvisina kurongwa kuti iite MIS-THA kuburikidza neDA nzira uye imwe kuburikidza neDS nzira mune imwe cadaver, uye maitiro ese akaitwa nevarapi vane ruzivo.Chiyero chekupedzisira chekukuvara kwemhasuru uye tendon chakaongororwa nachiremba wemapfupa asina kubatanidzwa mukushanda.
Zvimiro zveatomical zvakaongororwa zvaisanganisira: gluteus maximus, gluteus medius uye tendon yayo, gluteus minimus uye tendon yayo, vastus tensor fasciae latae, quadriceps femoris, upper trapezius, piatto, trapezius yakadzika, obturator internus, uye obturator externus (Figurator externus).Nyama dzakaongororwa kuti mhasuru dzinobvaruka uye hunyoro hunoonekwa nemaziso.
Fig. 1 Anatomical diagram yemhasuru imwe neimwe
Results
1. Kukuvadzwa kwetsandanyama: Pakanga pasina mutsauko wenhamba muhuwandu hwekukuvadza kwepamusoro kune gluteus medius pakati peDA neDS nzira.Zvisinei, kune gluteus minimus muscle, chikamu chekukuvara kwepamusoro kunokonzerwa neDA nzira yakanga yakakwirira kudarika iyo yakakonzerwa neDS nzira, uye pakanga pasina kusiyana kwakasiyana pakati pemaitiro maviri e quadriceps muscle.Kwakange kusina mutsauko wakakosha pakati penzira mbiri maererano nekukuvadzwa kumusana we quadriceps, uye chikamu chekukuvara kwepamusoro kune vastus tensor fasciae latae uye rectus femoris muscles yakanga yakakura neDA nzira kupfuura nzira yeDS.
2. Kukuvara kweTendon: Hapana nzira yakakonzera kukuvara kukuru.
3. Tendon transection: Kureba kwe gluteus minimus tendon transection yakanga yakakwirira zvikuru muboka reDA kupfuura muboka reDS, uye chikamu chekukuvara chakanga chakanyanya kukwirira muboka reDS.Pakanga pasina misiyano yakakosha mukukuvara kwetendon transection pakati pemapoka maviri epyriformis uye obturator internus.Iyo yekuvhiya schematic inoratidzwa muFig. 2, Fig. 3 inoratidza tsika dzechinyakare lateral nzira, uye Fig. 4 inoratidza yakajairika posterior nzira.
Mufananidzo 2 1a.Kuzadza transection ye gluteus minimus tendon panguva yeDA maitiro nekuda kwekudiwa kwekugadziriswa kwevakadzi;1b.Partial transection ye gluteus minimus inoratidza kuwanda kwekukuvara kune tendon yayo uye tsandanyama dumbu.gt.mukuru trochanter;* gluteus minimus.
Fig. 3 Schematic of the traditional direct lateral approach ine acetabulum inoonekwa kurudyi nekudhonza kwakakodzera.
Mufananidzo 4 Kuratidzwa kwechidimbu chekunze rotator tsandanyama mune yakajairika THA posterior nzira
Mhedziso uye Clinical Implications
Zvidzidzo zvakawanda zvakapfuura hazvina kuratidza misiyano yakakura mukufamba kwenguva, kudzora marwadzo, kuisirwa ropa, kurasikirwa neropa, kureba kwekugara muchipatara, uye kufamba kana tichienzanisa yakajairika THA neMIS-THA.Chidzidzo chekiriniki cheTHA nekuwana kwakajairika uye kushoma invasive THA ne. Repantis et al.haana kuratidza kusiyana kwakakosha pakati pezviviri, kunze kwekuderera kukuru kwemarwadzo, uye hapana misiyano yakakura mukubuda ropa, kufamba kushivirira, kana kugadziriswa kwemashure.Chidzidzo chekiriniki naGoosen et al.
Iyo RCT yeGoosen et al.yakaratidza kuwedzera kwezvibodzwa zveHHS mushure mekuita zvishoma (zvichikurudzira kupora zviri nani), asi nguva yakareba yekushanda uye zvakanyanya kuoma kweperioperative.Mumakore achangopfuura, kwave kunewo zvidzidzo zvakawanda zvekuongorora kukuvara kwemhasuru uye nguva yekudzoreredza mushure mekuvhiyiwa nekuda kwekupinda zvishoma kwekuvhiya, asi nyaya idzi hadzisati dzanyatsogadziriswa.Chidzidzo chezvino chakaitwa zvakare maererano nenyaya dzakadai.
Muchidzidzo ichi, zvakaonekwa kuti nzira yeDS yakakonzera kukuvadza kuduku kune mutsara wenyama kupfuura nzira yeDA, sezvinoratidzwa nekunyanya kukuvadza ku gluteus minimus muscle uye tendon yayo, vastus tensor fasciae latae muscle, uye rectus femoris muscle. .Izvi zvinokuvadza zvakatemwa neDA nzira pachayo uye yakanga yakaoma kugadzirisa mushure mekuvhiyiwa.Tichifunga kuti chidzidzo ichi chiitiko checadaveric, zvidzidzo zvekiriniki zvinodikanwa kuongorora kukosha kwekiriniki kwemhedzisiro iyi zvakadzama.
Nguva yekutumira: Nov-01-2023
