I.Dabarar cika simintin ƙashi
Hanyar cika simintin ƙashi ta dace da marasa lafiya da ke da ƙananan lahani na ƙashi na AORI nau'in I da kuma ayyukan da ba su da ƙarfi.
Fasaha mai sauƙi ta simintin ƙashi a fasaha tana buƙatar tsaftace lahani na ƙashi sosai, kuma simintin ƙashi yana cike lahani na ƙashi a lokacin matakin kullu, ta yadda za a iya cusa shi cikin gibin da ke cikin kusurwoyin lahani gwargwadon iyawa, ta haka ne za a cimma daidaito mai kyau tare da haɗin ƙashi mai masaukin baki.
Hanyar musamman taBɗayaCaiki +SFasahar ma'aikata ita ce a tsaftace matsalar ƙashi sosai, sannan a gyara sukurori a kan ƙashin mai masaukin baki, kuma a yi taka-tsantsan kada a bar murfin sukurori ya wuce saman ƙashin da ke kan dandamalin haɗin gwiwa bayan osteotomy; sannan a haɗa simintin ƙashi, a cika lahanin ƙashi a matakin kullu, sannan a naɗe sukurori. Ritter MA et al. sun yi amfani da wannan hanyar don sake gina lahani na ƙashin tibial plateau, kuma kauri lahani ya kai 9mm, kuma babu sassautawa shekaru 3 bayan tiyatar. Fasahar cike simintin ƙashi tana cire ƙarancin ƙashi, sannan ta yi amfani da gyaran prosthesis na gargajiya, don haka rage farashin magani saboda amfani da gyaran prosthesis, wanda ke da takamaiman amfani.
Hanyar musamman ta fasahar simintin ƙashi + sukurori ita ce a tsaftace matsalar ƙashi sosai, a gyara sukurori a kan ƙashin mai masaukin baki, sannan a kula cewa murfin sukurori bai kamata ya wuce saman ƙashin da ke kan dandamalin haɗin gwiwa ba bayan osteotomy; sannan a haɗa simintin ƙashi, a cika lahanin ƙashi a matakin kullu, sannan a naɗe sukurori. Ritter MA et al. sun yi amfani da wannan hanyar don sake gina lahani na ƙashin tibial plateau, kuma kauri lahani ya kai 9mm, kuma babu sassautawa shekaru 3 bayan tiyata. Fasahar cike simintin ƙashi tana cire ƙarancin ƙashi, sannan ta yi amfani da gyaran prosthesis na gargajiya, don haka rage farashin magani saboda amfani da gyaran prosthesis, wanda ke da takamaiman amfani (Hoto)I-1).
SiffaI-1Cika simintin ƙashi da ƙarfafa sukurori
II.Dabaru na dasa ƙashi
Ana iya amfani da dashen ƙashi na matsewa don gyara lahani na ƙashi wanda ya haɗa ko wanda ba ya haɗa da shi a tiyatar gyaran gwiwa. Ya fi dacewa da sake gina lahani na ƙashi na nau'in AROI zuwa nau'in III. A tiyatar gyaran gwiwa, tunda girman lahani da matakin lahani na ƙashi gabaɗaya suna da tsanani, adadin ƙashin da aka samu ƙarami ne kuma galibi ƙashin sclerotic ne lokacin da aka cire prosthesis da simintin ƙashi yayin tiyata don kiyaye yawan ƙashi. Saboda haka, ana amfani da ƙashin allogeneic granular sau da yawa don dashen ƙashi na matsewa yayin tiyatar gyaran gwiwa.
Fa'idodin dashen ƙashi mai matsewa sune: riƙe nauyin ƙashi na ƙashin mai masaukin baki; gyara manyan lahani na ƙashi masu sauƙi ko masu rikitarwa.
Rashin kyawun wannan fasaha shine: aikin yana ɗaukar lokaci; fasahar sake ginawa tana da wahala (musamman lokacin amfani da manyan keji na MESH); akwai yuwuwar yaɗuwar cututtuka.
Sauƙin dashen ƙashi mai matsewa:Sau da yawa ana amfani da dashen ƙashi mai sauƙi don magance lahani na ƙashi. Bambancin da ke tsakanin dashen ƙashi mai matsewa da dashen ƙashi mai tsari shine cewa kayan dashen ƙashi mai siffar granular da aka yi ta hanyar dashen ƙashi mai matsewa za a iya sake farfaɗo da su cikin sauri da kuma gaba ɗaya.
Keke na ƙarfe mai raga + dashen ƙashi mai matsewa:Lalacewar ƙashi wanda ba ya haɗa da juna yawanci yana buƙatar sake ginawa ta amfani da kejin ƙarfe don dasa ƙashi mai ƙashi. Sake gina ƙashi yawanci yana da wahala fiye da sake gina ƙashi. Hotunan X-ray sun nuna cewa haɗin ƙashi da siffanta ƙashi ana kammala su a hankali (Hoto)II-1-1, SiffaII-1-2).
SiffaII-1-1Dashen ƙashi na ciki na keji mai matsewa don gyara lahani na ƙashin tibial. A A Lokacin Aiki; B X-ray Bayan Aiki
Siffae II-1-2Gyaran lahani na ƙashin ƙugu na femoral da tibia ta hanyar amfani da dashen ƙashi na ciki na titanium mesh. A A A lokacin tiyata; B Bayan tiyatar X-ray
A lokacin gyaran gwiwa, ana amfani da ƙashin allogeneic don sake gina lahani na ƙashi na AORI na nau'in II ko III. Baya ga samun ƙwarewa mai kyau a fannin maye gurbin gwiwa mai rikitarwa, likitan fiɗa ya kamata ya kuma yi tsare-tsare masu kyau da cikakken bayani kafin tiyata. Ana iya amfani da dashen ƙashi na tsarin don gyara lahani na ƙashi na cortical da kuma ƙara yawan ƙashi.
Amfanin wannan fasaha sun haɗa da: Ana iya yin ta a kowace girma da siffa don daidaitawa da lahani na ƙashi na siffofi daban-daban na geometric; tana da kyakkyawan tasiri ga gyaran ƙashi; kuma ana iya cimma haɗin kai na dogon lokaci tsakanin ƙashi na allogeneic da ƙashin mai masauki.
Rashin amfani sun haɗa da: tsawaita lokacin aiki lokacin yanke ƙashin allogeneic; ƙarancin tushen ƙashin allogeneic; haɗarin rashin haɗuwa da jinkiri saboda abubuwa kamar su resorption na ƙashi da karyewar gajiya kafin a kammala tsarin haɗa ƙashi; matsaloli tare da sha da kamuwa da kayan da aka dasa; yuwuwar yaɗuwar cuta; da rashin kwanciyar hankali na farko na ƙashin allogeneic. Ana ɗebo ƙashin tsarin allogeneic daga nesa na femur, proximal tibia, ko kan femoral. Idan kayan dasawa sun yi girma, cikakken sake farfaɗo da jijiyoyin jini yawanci ba ya faruwa. Ana iya amfani da kawunan femoral na allogeneic don gyara lahani na femoral condyle da tibial plateau, galibi don gyara manyan lahani na ƙashi irin na rami, kuma ana gyara su ta hanyar dannawa bayan gyara da siffa. Sakamakon farko na asibiti na amfani da ƙashin tsarin allogeneic don gyara lahani na ƙashi ya nuna babban saurin warkar da ƙashin da aka dasa (HotoII-1-3, SiffaII-1-4).
SiffaII-1-3Gyaran lahani na ƙashin ƙugu ta hanyar amfani da tsarin kan ƙugu na allogeneic
SiffaII-1-4Gyara lahani na ƙashin tibial tare da dashen ƙashin kan cinyar mace ta allogeneic
III.Fasahar cika ƙarfe
Fasaha ta zamani Fasaha ta zamani tana nufin cewa ana iya haɗa kayan cika ƙarfe da prostheses da kuma tushen intramedullary. Kayan cika sun haɗa da samfura daban-daban don sauƙaƙe sake gina lahani na ƙashi na girma dabam-dabam.
ƙarfe Ƙwaƙwalwar roba Ƙarawa:Na'urar spacer ta ƙarfe mai sassauƙa ta fi dacewa da lahani na ƙashi na nau'in AORI II wanda ba shi da kauri har zuwa cm 2.Amfani da kayan ƙarfe don gyara lahani na ƙashi abu ne mai sauƙi, mai sauƙi, kuma yana da tasirin asibiti mai inganci.
Masu rarraba ƙarfe na iya zama masu ramuka ko masu ƙarfi, kuma siffofinsu sun haɗa da sanduna ko tubalan. Ana iya haɗa masu rarraba ƙarfe zuwa ga haɗin gwiwa ta hanyar sukurori ko kuma a gyara su da simintin ƙashi. Wasu masana sun yi imanin cewa daidaita simintin ƙashi na iya guje wa lalacewa tsakanin ƙarfe kuma suna ba da shawarar a gyara simintin ƙashi. Wasu masana kuma suna ba da shawarar hanyar amfani da simintin ƙashi da farko sannan a ƙarfafa su da sukurori tsakanin mai rarraba da mai rarraba. Lalacewar ƙashi galibi tana faruwa a ɓangarorin baya da na nesa na mai rarraba femur, don haka galibi ana sanya masu rarraba ƙarfe a ɓangarorin baya da na nesa na mai rarraba femur. Don lahani na ƙashi na tibial, ana iya zaɓar masu rarraba ko tubalan don sake ginawa don daidaitawa da siffofi daban-daban na lahani. Littattafai sun ba da rahoton cewa ƙimar da ta dace da kyau tana da girma har zuwa 84% zuwa 98%.
Ana amfani da tubalan da suka yi kama da tsini idan lahani na ƙashi yana da siffar tsini, wanda zai iya adana ƙarin ƙashi mai masaukin baki. Wannan hanyar tana buƙatar daidaitaccen osteotomy don saman osteotomy ya dace da toshe. Baya ga matsin lamba mai matsewa, akwai kuma ƙarfin yankewa tsakanin hanyoyin hulɗa. Saboda haka, kusurwar tsini bai kamata ta wuce 15° ba. Idan aka kwatanta da tubalan da suka yi kama da tsini, tubalan ƙarfe masu silinda suna da rashin amfani na ƙara yawan osteotomy, amma aikin tiyata yana da sauƙi kuma mai sauƙi, kuma tasirin injiniya yana kusa da al'ada (III-1-1A, B).
SiffaIII-1-1Masu raba ƙarfe: Mai raba siffa mai siffar yanki don gyara lahani na tibial; Mai raba siffa mai siffar ginshiƙi na B don gyara lahani na tibial
Saboda an tsara na'urorin spacer ƙarfe a siffofi da girma dabam-dabam, ana amfani da su sosai a cikin lahani na ƙashi da lahani na ƙashi na siffofi daban-daban, kuma suna ba da kyakkyawan kwanciyar hankali na farko. Duk da haka, bincike na dogon lokaci ya gano cewa na'urorin spacer ƙarfe sun gaza saboda kariyar damuwa. Idan aka kwatanta da na'urorin spacer ƙarfe, idan na'urorin spacer ƙarfe suka gaza kuma suna buƙatar a sake duba su, za su haifar da manyan lahani na ƙashi.
Lokacin Saƙo: Oktoba-28-2024
