Tun lokacin da Sculco da abokan aikinsa suka fara bayar da rahoton ƙaramin yankewar kugu (THA) tare da hanyar posterolateral a shekarar 1996, an bayar da rahoton sabbin gyare-gyare da dama masu ƙarancin cin zarafi. A zamanin yau, an yaɗa ra'ayin ƙaramin cin zarafi sosai kuma likitoci sun amince da shi a hankali. Duk da haka, har yanzu babu wani yanke shawara mai haske game da ko ya kamata a yi amfani da hanyoyin ƙananan cin zarafi ko na al'ada.
Fa'idodin tiyatar da ba ta da tasiri sosai sun haɗa da ƙananan yankewa, ƙarancin zubar jini, ƙarancin ciwo, da kuma murmurewa cikin sauri; duk da haka, rashin amfanin sun haɗa da ƙarancin hangen nesa, raunin jijiyoyin jijiyoyin jiki da ba a iya samu cikin sauƙi, rashin kyawun matsayin roba, da kuma ƙaruwar haɗarin sake yin tiyatar tiyata.
A cikin tiyatar gyaran hip arthroplasty mai ƙarancin shiga jiki (MIS – THA), asarar ƙarfin tsoka bayan tiyata muhimmin dalili ne da ke shafar murmurewa, kuma hanyar tiyata muhimmin abu ne da ke shafar ƙarfin tsoka. Misali, hanyoyin da ke fuskantar gaba da kuma na gaba kai tsaye na iya lalata ƙungiyoyin tsokar da ke satar tsoka, wanda ke haifar da tafiya mai ƙarfi (Trendelenburg limp).
A ƙoƙarin neman hanyoyin da ba su da tasiri sosai waɗanda ke rage lalacewar tsoka, Dr. Amanatullah da abokan aikinsa daga Asibitin Mayo da ke Amurka sun kwatanta hanyoyin MIS-THA guda biyu, hanyoyin da aka yi amfani da su a gaba (DA) da kuma hanyoyin da aka yi amfani da su a kai tsaye (DS), a kan samfuran da aka yi amfani da su a jikin gawawwaki don tantance lalacewar tsokoki da jijiyoyi. Sakamakon wannan binciken ya nuna cewa hanyar DS ba ta da illa ga tsokoki da jijiyoyi fiye da hanyar DA kuma wataƙila ita ce hanyar da aka fi so ga MIS-THA.
Tsarin gwaji
An gudanar da binciken ne a kan gawarwaki takwas da aka daskare da kuma nau'i-nau'i takwas na ƙugu 16 ba tare da tarihin tiyatar ƙugu ba. An zaɓi ƙugu ɗaya bazuwar don yin MIS-THA ta hanyar hanyar DA, ɗayan kuma ta hanyar hanyar DS a cikin gawar ɗaya, kuma ƙwararrun likitoci ne suka yi dukkan ayyukan. An tantance matakin ƙarshe na raunin tsoka da jijiya ta hanyar likitan ƙashi wanda ba shi da hannu a cikin aikin.
Tsarin halittar jiki da aka tantance sun haɗa da: gluteus maximus, gluteus medius da jijiyarsa, gluteus minimus da jijiyarsa, vastus tensor fasciae latae, quadriceps femoris, upper trapezius, piatto, lower trapezius, obturator internus, da obturator externus (Hoto na 1). An tantance tsokoki don ganin ko akwai tsagewar tsoka da kuma taushi da ido ke iya gani.
Hoto na 1: Zane-zanen jiki na kowace tsoka
Sakamako
1. Lalacewar tsoka: Babu wani bambanci na kididdiga a cikin girman lalacewar saman gluteus medius tsakanin hanyoyin DA da DS. Duk da haka, ga tsokar gluteus minimus, kashi na raunin saman da hanyar DA ta haifar ya fi wanda hanyar DS ta haifar, kuma babu wani bambanci mai mahimmanci tsakanin hanyoyin biyu na tsokar quadriceps. Babu wani bambanci mai mahimmanci a kididdiga tsakanin hanyoyin biyu dangane da rauni ga tsokar quadriceps, kuma kashi na raunin saman da aka samu ga tsokokin vastus tensor fasciae latae da rectus femoris ya fi girma tare da hanyar DA fiye da hanyar DS.
2. Raunin jijiyoyi: Babu ɗayan hanyoyin da aka bi wajen magance matsalar.
3. Juyawar Jijiyoyin Jijiyoyi: Tsawon juyi na jijiyoyin gluteus minimus ya fi girma sosai a cikin ƙungiyar DA fiye da ta ƙungiyar DS, kuma kaso na raunin ya fi girma sosai a cikin ƙungiyar DS. Babu wani bambanci mai mahimmanci a cikin raunin juyi na jijiyoyin tsakanin ƙungiyoyi biyu na pyriformis da kuma obturator internus. An nuna tsarin tiyata a Hoto na 2, Hoto na 3 yana nuna hanyar gefe ta gargajiya, kuma Hoto na 4 yana nuna hanyar baya ta gargajiya.
Hoto na 2 1a. Cikakken juyewar jijiyar gluteus minimus a lokacin aikin DA saboda buƙatar gyara ƙafa; 1b. Juyewar wani ɓangare na gluteus minimus yana nuna girman raunin da ya samu a jijiyarsa da cikin tsoka. gt. babban trochanter; * gluteus minimus.
Hoto na 3 Tsarin hanyar kai tsaye ta gargajiya tare da acetabulum da ake gani a dama tare da jan hankali mai dacewa
Hoto na 4 Bayyanar gajeriyar tsokar juyawa ta waje a cikin hanyar THA ta gargajiya
Kammalawa da Tasirin Asibiti
Nazarce-nazarce da yawa da aka yi a baya ba su nuna wani bambanci mai mahimmanci ba a tsawon lokacin tiyata, maganin ciwo, yawan zubar jini, asarar jini, tsawon lokacin zama a asibiti, da kuma tafiya yayin kwatanta THA na gargajiya da MIS-THA. Wani bincike na asibiti na THA tare da hanyar shiga ta al'ada da kuma THA mai ƙarancin shiga ta hanyar Repantis et al. bai nuna wani bambanci mai mahimmanci tsakanin su biyun ba, sai dai raguwar zafi mai yawa, kuma babu wani bambanci mai mahimmanci a cikin zubar jini, jure tafiya, ko gyaran jiki bayan tiyata. Wani bincike na asibiti da Goosen et al.
Wani RCT na Goosen da abokan aikinsa sun nuna ƙaruwa a matsakaicin maki na HHS bayan an yi amfani da hanyar da ba ta da tasiri sosai (yana nuna cewa an sami ingantaccen murmurewa), amma tsawon lokacin tiyata da kuma ƙarin matsaloli a lokacin tiyata. A cikin 'yan shekarun nan, an kuma yi bincike da yawa da ke bincika lalacewar tsoka da lokacin murmurewa bayan tiyata saboda ƙarancin damar yin tiyata, amma har yanzu ba a magance waɗannan matsalolin sosai ba. An kuma gudanar da wannan binciken bisa ga irin waɗannan matsalolin.
A cikin wannan binciken, an gano cewa hanyar DS ta haifar da ƙarancin lalacewa ga tsoka fiye da hanyar DA, kamar yadda aka tabbatar ta hanyar ƙarancin lalacewa ga tsokar gluteus minimus da jijiyar ta, tsokar vastus tensor fasciae latae, da tsokar rectus femoris. Waɗannan raunuka an gano su ne ta hanyar hanyar DA kanta kuma suna da wahalar gyarawa bayan tiyata. Ganin cewa wannan binciken samfurin gawawwaki ne, ana buƙatar nazarin asibiti don bincika mahimmancin wannan sakamakon a cikin zurfi.
Lokacin Saƙo: Nuwamba-01-2023
