I.Bone simenti yekuzadza nzira
Iyo bhonzo simende yekuzadza nzira inokodzera varwere vane madiki AORI mhando I bone kuremara uye kushoma kuita mabasa.
Nyore semendi tekinoroji tekinoroji inoda kucheneswa kwakaringana kwefupa rakaremara, uye simende yebhonzo inozadza chirema chebhonzo panguva yenhanho yehupfu, kuitira kuti igone kupfekedzwa mumipata mumakona echirema zvakanyanya sezvinobvira, nekudaro kuwana kusimba kwakasimba neanogamuchira bhonzo interface.
Iyo chaiyo nzira yeBPoshiCchinhu +Screw tekinoroji ndeyekunyatso chenesa chirema chebhonzo, wozogadzirisa sikururu pane bhonzo rekugamuchira, uye chenjera kuti usarega screw cap ichipfuura pfupa pamusoro pepuratifomu yejoint mushure me osteotomy; wobva wasanganisa simende yebhonzo, zadza chirema chebhonzo munhanho yehupfu, uye putira screw. Ritter MA et al. akashandisa nzira iyi kuvakazve tibial plateau bone defect, uye kuremara ukobvu kwakasvika 9mm, uye pakanga pasina kusunungura 3 makore mushure mekuvhiyiwa. Bone simende yekuzadza tekinoroji inobvisa bhonzo shoma, uye yobva yashandisa yakajairwa prosthesis revision, nekudaro ichidzikisa mari yekurapa nekuda kwekushandiswa kwekudzokorora prostheses, ine humwe hunokosha hunoshanda.
Iyo chaiyo nzira yebhonzo simenti + screw tekinoroji ndeyekunyatso kuchenesa chirema chepfupa, kugadzirisa screw pane bhonzo rekugamuchira, uye teerera kuti screw cap haifanire kudarika pfupa pamusoro pepuratifomu yakabatana mushure me osteotomy; wobva wasanganisa simende yebhonzo, zadza chirema chebhonzo munhanho yehupfu, uye putira screw. Ritter MA et al. akashandisa nzira iyi kuvakazve tibial plateau bone defect, uye kuremara ukobvu kwakasvika 9mm, uye pakanga pasina kusunungura 3 makore mushure mekuvhiyiwa. Bone simende yekuzadza tekinoroji inobvisa bhonzo shoma, uye yobva yashandisa yakajairwa prosthesis revision, nekudaro ichidzikisa mutengo wekurapa nekuda kwekushandiswa kwekudzokorora prosthesis, ine humwe hunokosha hunoshanda (Mufananidzo.I-1).
MufananidzoI-1Bone simende kuzadza uye screw reinforcement
II.Bone grafting maitiro
Kudzvanya pfupa kusungirirwa kunogona kushandiswa kugadzirisa kusanganisirwa kana kusinga sanganisire mapfupa ekuremara mukuvhiyazve ibvi. Iyo inonyanya kukodzera kuvakwazve kweAROI yerudzi rweI kusvika kuIII mapfupa emapfupa. Mukuvhiyiwa kwekudzokorora, sezvo chiyero uye chiyero chekuremara kwepfupa kazhinji kwakanyanya, huwandu hweautologous bone hunowanikwa idiki uye kazhinji sclerotic bone apo prosthesis uye bone simende zvinobviswa panguva yekuvhiyiwa kuchengetedza mapfupa. Naizvozvo, granular allogeneic bone inowanzoshandiswa kudzvanya pfupa yekubatanidza panguva yekuvhiya yekudzokorora.
Zvakanakira kudzvanya pfupa grafting ndeiyi: kuchengetedza bhonzo rehosi yebhonzo; kugadzirisa zvikanganiso zvakakura zviri nyore kana zvakaoma mapfupa.
Izvo zvisingabatsiri zve teknolojia iyi ndezvi: kushanda kunotora nguva; tekinoroji yekuvakazve iri kuda (kunyanya kana uchishandisa mamesh makuru eMESH); pane mukana wekutapurirwa kwechirwere.
Nyore kudzvanya pfupa grafting:Nyore kudzvanya pfupa grafting inowanzo shandiswa kubatanidza kukanganisa kwemapfupa. Musiyano uripo pakati pekudzvanya pfupa kusungirirwa uye kuumbwa kwebhonzo kubatanidza ndewekuti granular bone graft zvinhu zvinogadzirwa nekumanikidza bone kubatanidza zvinogona kukurumidza uye zvakazara revascularized.
Mesh simbi keji + compression pfupa grafting:Zvisina-inosanganisirwa bhonzo zvirema zvinowanzoda kuvakwa patsva uchishandisa mesh simbi makeji kuti uisire cancellous bone. Kugadziriswa kwechikadzi kunowanzova kwakaoma kupfuura kuvakwazve kwetibia. X-rays inoratidza kuti kubatanidzwa kwebhonzo uye kuumbwa kwebhonzo yegraft zvinhu zvinopedzwa zvishoma nezvishoma (MufananidzoII-1-1, MufananidzoII-1-2).
MufananidzoII-1-1Mesh cage yemukati yekumanikidza pfupa kusungirirwa kugadzirisa tibial bone chirema. A Intraoperative; B Postoperative X-ray
Figure II-1-2Kugadziriswa kwefemoral uye tibia bone defects ine titanium mesh yemukati compression bone gfting. A Intraoperative; B Postoperative X-ray
Munguva yekudzokorora ibvi arthroplasty, allogeneic structural bone inonyanya kushandiswa kuvakazve AORI mhando II kana III bone defects. Pamusoro pekuva nehunyanzvi hwekuvhiya hwepamusoro uye ruzivo rwakapfuma mukutsiva ibvi rakaoma, chiremba anovhiya anofanirawo kuita hurongwa hwekuvhiya hune hungwaru uye hwakadzama. Structural bone grafting inogona kushandiswa kugadzirisa cortical bone kuremara uye kuwedzera mapfupa.
Zvakanakira tekinoroji iyi zvinosanganisira: Inogona kugadzirwa mune chero saizi uye chimiro kuti ienderane nekuremara kwemapfupa emhando dzakasiyana dzejometri; ine yakanaka inotsigira maitiro ekudzokorora prostheses; uye kwenguva yakareba biological integration inogona kuwanikwa pakati peallogeneic bone uye host bone.
Kukanganisa kunosanganisira: nguva yakareba yekushanda painocheka allogeneic bone; zvishoma zvinyorwa zveallogeneic bone; njodzi yekusabatana uye kunonoka kubatana nekuda kwezvinhu zvakadai sefupa resorption uye kuneta kuputsika musati pfupa yekubatanidza nzira yapera; matambudziko nekutora uye kutapukirwa kwezvinhu zvakasimwa; mukana wekutapurirwa kwechirwere; uye kusakwana kwekutanga kugadzikana kweallogeneic bone. Allogeneic structural bone inokohwewa kubva kune distal femur, proximal tibia, kana femoral head. Kana iyo yekusimira zvinhu yakakura, yakakwana revascularization kazhinji haigone kuitika. Allogeneic femoral heads inogona kushandiswa kugadzirisa femoral condyle uye tibial plateau bone defects, kunyanya kugadzirisa hombe-mhando yemapfupa akaremara, uye inogadziriswa nekutsikirira-kukodzera mushure mekucheka uye kuumbwa. Makiriniki ekutanga mhedzisiro yekushandisa allogeneic structural bone kugadzirisa mapfupa akaremara airatidza hupamhi hwekupora kwepfupa rakasimwa (MufananidzoII-1-3, MufananidzoII-1-4).
MufananidzoII-1-3Kugadziriswa kwechikadzi bone chirema chine allogeneic femoral musoro chimiro bone graft
MufananidzoII-1-4Kugadziriswa kwetibial bone defect ne allogeneic femoral head bone graft
III.Simbi yekuzadza tekinoroji
Modular tekinoroji Modular tekinoroji inoreva kuti simbi mafirita anogona kuunganidzwa nemaprostheses uye intramedullary stems. Iwo mafiritsi anosanganisira akasiyana mamodheru kuti afambise kuvakwazve kwemafupa akaremara ehukuru hwakasiyana.
Metallic Prosthetic Augments:Iyo modular simbi spacer inonyanya kukodzera kuAORI mhando II isina-yakagadziriswa mapfupa akaremara ane ukobvu hunosvika 2 cm.Kushandiswa kwezvikamu zvesimbi kugadzirisa zvikanganiso zvemapfupa zviri nyore, zviri nyore, uye zvine mhedzisiro yekiriniki yakavimbika.
Metal spacers inogona kuva porous kana yakasimba, uye maumbirwo awo anosanganisira wedges kana zvidhinha. Iyo simbi spacers inogona kubatanidzwa kune yejoint prosthesis ne screws kana yakagadziriswa nebone simenti. Dzimwe nyanzvi dzinotenda kuti pfupa simende kugadzirisa inogona kudzivisa kupfeka pakati pesimbi uye inokurudzira bone simenti kugadzirisa. Dzimwe nyanzvi dzinotsigirawo nzira yekushandisa simende yebhonzo kutanga uyezve kusimbisa ne screws pakati pe spacer ne prosthesis. Kuremara kwechikadzi kunowanzoitika mumashure uye distal zvikamu zvechikadzi condyle, saka simbi spacers inowanzoiswa mumashure uye distal zvikamu zve femoral condyle. Kune tibial bone defects, wedges kana zvivharo zvinogona kusarudzwa kuti zvigadziriswe kuti zvienderane nemhando dzakasiyana dzakaremara. Mabhuku anoshuma kuti yakanakisa uye yakanaka mitengo yakakwira se84% kusvika 98%.
Mabhuroko akaita seweji anoshandiswa kana chirema chebhonzo chakaita seweji, chinogona kuchengetedza mamwe bhonzo rekugamuchira. Iyi nzira inoda chaiyo osteotomy kuitira kuti osteotomy surface ienderane ne block. Pamusoro pekudzvinyirira kudzvinyirira, kune zvakare shear simba pakati peiyo yekusangana nzvimbo. Nokudaro, kona ye wedge haifaniri kudarika 15 °. Kuenzaniswa nemabhuraki-akaita seweji, cylindrical simbi zvidhinha zvine mhedzisiro yekuwedzera huwandu hweosteotomy, asi kuvhiya kwacho kuri nyore uye kuri nyore, uye mashandiro emuchina ari pedyo neyakajairwa.III-1-1A, B).
MufananidzoIII-1-1Metal spacers: A wedge-shaped spacer kugadzirisa tibial defects; B column-shaped spacer kugadzirisa tibial defects
Nekuti masimbi spacers akagadzirwa mune akasiyana maumbirwo uye saizi, anoshandiswa zvakanyanya mukusave-ine-ine mapfupa akaremara uye mapfupa akaremara eakasiyana maumbirwo, uye anopa yakanaka yekutanga mechaniki kugadzikana. Nekudaro, zvidzidzo zvenguva refu zvakaona kuti simbi spacers inokundikana nekuda kwekunetsekana kudzivirira. Kuenzaniswa nemapfupa ekubatanidza, kana simbi spacers ikakundikana uye inoda kuongororwa, inokonzera kukanganisa kukuru kwemapfupa.
Nguva yekutumira: Oct-28-2024
