Tun da Sculco et al.na farko ya ba da rahoton ƙananan ƙaƙƙarfan ƙaƙƙarfan ƙwanƙwasa ƙwanƙwasa (THA) tare da tsarin bayan bayan gida a cikin 1996, an ba da rahoton sauye-sauye da yawa kaɗan.A zamanin yau, ra'ayi kaɗan ya yadu sosai kuma likitocin asibiti sun yarda da su a hankali.Duk da haka, har yanzu babu wani takamaiman yanke shawara game da ko ya kamata a yi amfani da ƙarancin cin zarafi ko na al'ada.
Fa'idodin aikin tiyata kaɗan sun haɗa da ƙarami, ƙarancin zubar jini, ƙarancin zafi, da saurin murmurewa;duk da haka, rashin amfani sun haɗa da iyakanceccen ra'ayi, mai sauƙi don samar da raunin neurovascular na likita, matsayi mara kyau na prosthesis, da kuma haɗarin sake sake ginawa.
A cikin ƙananan jimlar da ba a iya amfani da shi ba a ɗan arthroplasty (boy - asarar karfin tsoka mai mahimmanci yana shafar murmurewa, kuma hanyar tiyata muhimmin abu ne da ke shafar ƙarfin tsoka.Misali, hanyoyin gaba da kai tsaye na iya lalata ƙungiyoyin tsokar masu sacewa, wanda zai haifar da rawar jiki (Trendelenburg limp).
A ƙoƙari na nemo ƙananan hanyoyi masu cin zarafi waɗanda ke rage lalacewar tsoka, Dr. Amanatullah et al.daga Mayo Clinic a Amurka idan aka kwatanta da hanyoyi guda biyu na MIS-THA, hanyar kai tsaye ta gaba (DA) da kuma kai tsaye m (DS), akan samfurori na cadaveric don ƙayyade lalacewar tsokoki da tendons.Sakamakon wannan binciken ya nuna cewa hanyar DS ba ta da lahani ga tsokoki da tendons fiye da tsarin DA kuma yana iya zama hanyar da aka fi so don MIS-THA.
Zane na gwaji
An gudanar da binciken ne a kan cadaver takwas da aka daskare tare da nau'i-nau'i takwas na hips 16 ba tare da tarihin tiyata ba.An zaɓi ɗayan hip ɗin ba tare da izini ba don ɗaukar MIS-THA ta hanyar tsarin DA kuma ɗayan ta hanyar hanyar DS a cikin wani cadaver ɗaya, kuma duk hanyoyin da kwararrun likitoci suka yi.An tantance matakin ƙarshe na tsoka da rauni na jijiyoyi ta hanyar likitan orthopedic wanda ba ya cikin aikin.
Sifofin anatomical da aka kimanta sun haɗa da: gluteus maximus, gluteus medius da tendon, gluteus minimus da tendon, vastus tensor fasciae latae, quadriceps femoris, trapezius na sama, piatto, ƙananan trapezius, obturator internus, da obturator externus (Figure 1).An tantance tsokoki don hawaye na tsoka da taushi da ake gani a ido tsirara.
Hoto 1 Hoton Halitta na kowace tsoka
Sakamako
1. Lalacewar tsoka: Babu wani bambanci na ƙididdiga a cikin girman lalacewa ga gluteus medius tsakanin hanyoyin DA da DS.Duk da haka, ga gluteus minimus tsoka, yawan raunin da ya faru ta hanyar DA tsarin ya kasance mafi girma fiye da yadda tsarin DS ya haifar, kuma babu wani bambanci mai mahimmanci tsakanin hanyoyin biyu don tsokar quadriceps.Babu wani bambanci mai mahimmanci tsakanin hanyoyin biyu dangane da rauni ga tsokar quadriceps, da kuma yawan raunin da ya faru ga vastus tensor fasciae latae da kuma tsokoki na femoris na mata sun fi girma tare da tsarin DA fiye da tsarin DS.
2. Raunin tendon: Babu wata hanya da ta haifar da manyan raunuka.
3. Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙadda ) ya yi ya kasance mafi girma a cikin ƙungiyar DA fiye da ƙungiyar DS, kuma yawan raunin da ya faru ya kasance mafi girma a cikin ƙungiyar DS.Babu wani bambanci mai mahimmanci a cikin raunin raunin jijiya tsakanin ƙungiyoyi biyu don pyriformis da obturator internus.An nuna tsarin aikin tiyata a cikin hoto na 2, Fig. 3 yana nuna tsarin al'ada na al'ada, kuma Fig. 4 yana nuna tsarin gargajiya na baya.
Hoto 2 1 a.Cikakken juzu'i na gluteus minimus tendon a lokacin aikin DA saboda buƙatar gyaran femoral;1 b.Juyawa juzu'i na gluteus minimus yana nuna girman rauni ga jijiya da cikin tsoka.gt.mafi girma trochanter;* Gluteus minimus.
Hoto 3 Tsarin tsari na al'ada ta kai tsaye ta gefe tare da acetabulum da ake gani a dama tare da raɗaɗi mai dacewa.
Hoto 4 Bayyanar ɗan gajeren tsokar rotator na waje a cikin al'ada ta baya ta THA
Kammalawa da Ma'anar Asibiti
Yawancin binciken da aka yi a baya ba su nuna wani bambance-bambance a cikin tsawon lokacin aiki ba, kula da ciwo, yawan zubar jini, asarar jini, tsawon zaman asibiti, da kuma tafiya lokacin da aka kwatanta THA na al'ada tare da MIS-THA.A nazarin asibiti na THA tare da samun dama ta al'ada da kuma ƙarancin THA ta hanyar. Repantis et al.bai nuna wani bambance-bambance ba tsakanin su biyun, sai dai don rage yawan ciwo, kuma babu wani bambance-bambance a cikin zubar da jini, haƙurin tafiya, ko gyaran bayan tiyata.Nazarin asibiti na Goosen et al.
RCT na Goosen et al.ya nuna karuwa a cikin ma'aunin HHS bayan mafi ƙanƙantar hanya (yana ba da shawarar mafi kyawun murmurewa), amma tsawon lokacin aiki da ƙarin rikice-rikice na ɓarna.A cikin 'yan shekarun nan, akwai kuma binciken da yawa da ke nazarin lalacewar tsoka da kuma lokacin dawowa bayan tiyata saboda rashin samun damar yin amfani da ƙananan ƙwayar cuta, amma waɗannan batutuwa ba a magance su sosai ba.An kuma gudanar da binciken na yanzu bisa irin wadannan batutuwa.
A cikin wannan binciken, an gano cewa hanyar DS ta haifar da ƙarancin lalacewa ga ƙwayar tsoka fiye da tsarin DA, kamar yadda aka tabbatar da ƙarancin lalacewa ga tsokar gluteus minimus da tendon sa, tsokar tsokar tsokar fasciae latae vastus, da tsokar femoris na dubura. .Wadannan raunin da aka ƙaddara ta hanyar tsarin DA kanta ne kuma suna da wuya a gyara bayan tiyata.Yin la'akari da cewa wannan binciken shine samfurin cadaveric, ana buƙatar nazarin asibiti don bincika mahimmancin asibiti na wannan sakamakon a cikin zurfi.
Lokacin aikawa: Nov-01-2023
