I.Dabarar cika simintin kashi
Hanyar cika simintin kashi ya dace da marasa lafiya tare da ƙaramin nau'in AORI I na ƙashi da ƙarancin ayyukan aiki.
Fasahar simintin kashi mai sauƙi a fasaha tana buƙatar cikakken tsaftace ƙashi, kuma simintin kashi yana cika lahanin kashi yayin matakin kullu, ta yadda za a iya cushe shi a cikin ɓangarorin da ke cikin kusurwoyin lahani gwargwadon yiwuwa, ta yadda za a cimma matsattsauran ra'ayi tare da mahaɗan ƙashi.
Hanyar musamman naBdayaCamsa +SFasahar ma'aikata ita ce tsaftace ƙashin ƙashi sosai, sannan a gyara dunƙule a kan kashin mai masaukin, kuma a yi hattara kada ku bari hular dunƙule ta wuce saman kashin dandalin haɗin gwiwa bayan osteotomy; sai a haxa simintin kashi, a cika nakasar kashi a matakin kullu, sannan a nade dunƙule. Ritter MA et al. ya yi amfani da wannan hanyar don sake gina ƙashi na tibial plateau, kuma kauri ya kai 9mm, kuma babu sassautawa bayan shekaru 3 da aikin. Fasahar cika simintin kashi na kawar da ƙarancin kashi, sannan ta yi amfani da bita na gyaran gyare-gyare na al'ada, ta yadda za a rage farashin jiyya saboda amfani da na'urorin gyaran gyare-gyare, wanda ke da takamaiman ƙima.
Hanyar ƙayyadaddun hanyar simintin kashi + fasahar dunƙulewa ita ce tsaftace ƙashin ƙashi sosai, gyara dunƙule a kan kashin rundunar, da kula da cewa hular dunƙule bai kamata ya wuce kashin kashin dandalin haɗin gwiwa ba bayan osteotomy; sai a haxa simintin kashi, a cika nakasar kashi a matakin kullu, sannan a nade dunƙule. Ritter MA et al. ya yi amfani da wannan hanyar don sake gina ƙashi na tibial plateau, kuma kauri ya kai 9mm, kuma babu sassautawa shekaru 3 bayan tiyata. Fasahar cika simintin kashi na kawar da ƙarancin kashi, sannan yayi amfani da bita na gyaran fuska na al'ada, wanda hakan zai rage farashin jiyya saboda yin amfani da na'urar gyaran gyare-gyare, wanda ke da takamaiman ƙima (Hoto).I-1).
HotoI-1Cika simintin kashi da ƙarfafa dunƙule
II.Dabarun grafting kashi
Za a iya amfani da dasawar kasusuwa don gyara lahani mai haɗaka ko mara haɗawa a cikin aikin gyaran gwiwa. Ya fi dacewa don sake gina nau'in AROI I zuwa III lahani. A cikin tiyatar bita, tun da iyaka da ƙimar lahani na ƙashi gabaɗaya mai tsanani ne, adadin kashin da aka samu yana ƙarami kuma galibi ƙashi na sclerotic lokacin da aka cire prosthesis da simintin kashi yayin tiyata don adana yawan kashi. Saboda haka, granular allogeneic kashi ne sau da yawa amfani da matsawa kashi grafting lokacin bita.
Abubuwan da ake amfani da su na matsawa kashi grafting sune: riƙe da yawan kashi na kashi mai masauki; gyaran manyan lahani mai sauƙi ko hadaddun kashi.
Rashin amfanin wannan fasaha shine: aikin yana ɗaukar lokaci; fasahar sake ginawa yana buƙatar (musamman lokacin amfani da manyan cages MESH); akwai yiwuwar yada cututtuka.
Sauƙaƙan matsawa kashi grafting:Sauƙaƙan ƙwanƙwasa ƙashi sau da yawa ana amfani dashi don haɗaka da lahani na kashi. Bambanci tsakanin matsawa kashi grafting da tsarin kashi grafting shi ne cewa granular kashi grafting abu da aka yi ta hanyar matsawa kashi grafting iya zama da sauri da kuma gaba daya revascularized.
raga karfe keji + matsawa kashi grafting:Marasa lahani na kashi yawanci yana buƙatar sake ginawa ta amfani da kejin ƙarfe na raga don dasa kashi mai sokewa. Sake gina femur yawanci ya fi wuya fiye da sake gina tibia. Rayukan X-ray sun nuna cewa haɗin kashi da gyaran kashi na kayan aikin an gama a hankali (HotoII-1-1, HotoII-1-2).
HotoII-1-1Rukunin cage na ciki na matse kashi don gyara lahani na tibial. A Intraoperative; B X-ray bayan tiyata
Figurda II-1-2Gyaran lahani na mata da na tibia tare da ragamar titanium na ciki na matse kashi. A Intraoperative; B X-ray bayan tiyata
A lokacin gyaran gyare-gyaren gwiwa na gwiwa, ana amfani da ƙashin tsarin allogeneic don sake gina lahani na nau'in AORI II ko III. Baya ga samun ƙwararrun ƙwararrun tiyata da ƙware mai ƙware wajen maye gurbin gwiwa, likitan fiɗa ya kamata kuma ya yi taka tsantsan da tsare-tsare na gaba-gaba. Za a iya amfani da gyaran ƙashi na tsari don gyara lahani na cortical kashi da ƙara yawan kashi.
Amfanin wannan fasaha sun haɗa da: Ana iya yin ta zuwa kowane girma da siffa don dacewa da lahani na kashi na siffofi na geometric daban-daban; yana da tasiri mai kyau na goyan baya akan gyaran gyare-gyare; kuma za'a iya samun haɗin gwiwar ilimin halitta na dogon lokaci tsakanin kashi na allogeneic da kashi mai masauki.
Rashin hasara sun haɗa da: tsawon lokacin aiki lokacin da yanke kashi na allogeneic; ƙayyadaddun tushen ƙasusuwan allogeneic; haɗarin rashin haɗin kai da jinkirta haɗin gwiwa saboda dalilai irin su raguwar kashi da raunin gajiya kafin a kammala tsarin haɗin kai; matsaloli tare da sha da kamuwa da kayan da aka dasa; yuwuwar watsa cututtuka; da rashin isasshen kwanciyar hankali na farko na allogeneic kashi. Allogeneic tsarin kashi ana girbe daga distal femur, proximal tibia, ko kan femoral. Idan kayan da aka dasa yana da girma, cikakken revascularization yawanci ba ya faruwa. Za a iya amfani da kawunan mata na Allogeneic don gyara magudanar mata da lahani na tibial plateau, musamman don gyara manyan lahani irin na rami, kuma ana gyara su ta hanyar latsawa bayan gyarawa da siffa. Sakamakon asibiti na farko na yin amfani da ƙashin tsarin allogeneic don gyara lahani na kashi ya nuna yawan waraka na kashi da aka dasa (Hoto).II-1-3, HotoII-1-4).
HotoII-1-3Gyaran ƙashi na mata tare da allogeneic femoral head tsarin tsarin kashi
HotoII-1-4Gyaran lahani na tibial tare da allogeneic femoral head kashin kashi
III.Fasahar cika ƙarfe
Fasahar Modular Fasaha ta zamani tana nufin ana iya haɗa masu cika ƙarfe tare da ƙwanƙwasa da tsini mai tushe. Masu cikawa sun haɗa da nau'o'i daban-daban don sauƙaƙe sake gina lahani na kashi na nau'i daban-daban.
Karfe Prosthetic Augments:Modular karfe spacer ya dace da nau'in AORI nau'in II mara lahani na kashi tare da kauri har zuwa 2 cm.Yin amfani da sassan ƙarfe don gyara lahani na kashi yana dacewa, mai sauƙi, kuma yana da abin dogara na asibiti.
Ƙarfe na iya zama mai ƙura ko mai ƙarfi, kuma sifofinsu sun haɗa da ƙugiya ko tubalan. Ana iya haɗa masu sararin samaniya da haɗin gwiwa ta hanyar screws ko gyarawa ta hanyar siminti na kashi. Wasu malaman sun yi imanin cewa gyaran simintin kashi na iya guje wa lalacewa tsakanin karafa kuma suna ba da shawarar gyara simintin kashi. Wasu malaman kuma suna ba da shawarar hanyar yin amfani da simintin kashi da farko sannan a ƙarfafa su tare da screws tsakanin spacer da prosthesis. Sau da yawa lahani na mace yana faruwa a bayansa da na nesa na condyle na mata, don haka ana sanya masu sarari na karfe a cikin na baya da na nesa na condyle na mata. Don lahani na kashin tibial, za a iya zaɓar ƙugiya ko tubalan don sake ginawa don dacewa da siffofi daban-daban na lahani. Littattafai sun ba da rahoton cewa mafi kyawun farashi mai kyau ya kai 84% zuwa 98%.
Ana amfani da tubalan masu siffa lokacin da lahanin kashi ya kasance mai siffa, wanda zai iya adana ƙarin kashi mai masaukin baki. Wannan hanya tana buƙatar daidaitaccen osteotomy ta yadda saman osteotomy ya dace da toshe. Baya ga damuwa mai matsawa, akwai kuma ƙarfi mai ƙarfi tsakanin mu'amalar tuntuɓar juna. Sabili da haka, kusurwar wedge bai kamata ya wuce 15 ° ba. Idan aka kwatanta da tubalan da aka yi da wedge, tubalan ƙarfe na cylindrical suna da lahani na ƙara yawan osteotomy, amma aikin tiyata ya dace kuma mai sauƙi, kuma aikin injiniya yana kusa da al'ada (III-1-1A, B).
HotoIII-1-1Metal spacers: Mai siffa mai siffa don gyara lahani na tibial; Mai sarari mai siffa B don gyara lahani na tibial
Domin an ƙera na'urorin ƙarfe na ƙarfe a cikin siffofi da girma dabam dabam, ana amfani da su sosai a cikin rashin lahani na kashi da lahani na nau'i daban-daban, kuma suna samar da kyakkyawan kwanciyar hankali na farko. Duk da haka, binciken da aka yi na dogon lokaci ya gano cewa na'urorin sararin samaniya suna kasawa saboda kariya ta damuwa. Idan aka kwatanta da dashen kashi, idan na'urorin sararin ƙarfe sun gaza kuma suna buƙatar sake dubawa, za su haifar da lahani mafi girma.
Lokacin aikawa: Oktoba-28-2024
