Mai i te wā i pūrongo tuatahitia ai e Sculco me ētahi atu te pokanga hope katoa (THA) me te huarahi posterolateral i te tau 1996, kua pūrongohia ētahi whakarerekētanga hou mō te iti o te whakaekenga. I ēnei rā, kua horapa whānuitia te ariā mō te iti o te whakaekenga, ā, kua whakaaetia haeretia e ngā tākuta. Heoi, kāore anō kia whakatauhia he whakatau mārama mō te whakamahi i ngā tikanga iti o te whakaekenga, i ngā tikanga tuku iho rānei.
Ko ngā painga o te pokanga iti rawa te whakaekenga ko ngā motu iti ake, te iti o te toto, te iti o te mamae, me te tere o te ora; heoi, ko ngā ngoikoretanga ko te iti o te tirohanga, te ngāwari ki te puta he whara hauora o ngā toto toto, te tūnga ngoikore o te prosthesis, me te nui ake o te mōrearea o te pokanga hanga anō.
I roto i te pokanga hope katoa (MIS – THA) he iti noa te whakaekenga, ko te ngaronga o te kaha o te uaua i muri i te pokanga he take nui e pā ana ki te whakaoranga, ā, ko te huarahi pokanga he mea nui e pā ana ki te kaha o te uaua. Hei tauira, ko ngā huarahi anterolateral me ngā huarahi anterior tika ka kino pea i ngā rōpū uaua abductor, ka hua ake he hikoi wiri (Trendelenburg limp).
I roto i te ngana ki te kimi i ngā huarahi iti rawa te whakaekenga hei whakaiti i te kino o ngā uaua, i whakaritea e Tākuta Amanatullah me ētahi atu o te Mayo Clinic i te United States ngā huarahi MIS-THA e rua, te huarahi tika ki mua (DA) me te huarahi tika ki runga (DS), ki ngā tauira tūpāpaku hei whakatau i te kino o ngā uaua me ngā uaua. I whakaatuhia e ngā hua o tēnei rangahau he iti ake te kino o te huarahi DS ki ngā uaua me ngā uaua i te huarahi DA, ā, koinei pea te tikanga pai mō te MIS-THA.
Hoahoa whakamātautau
I whakahaerehia te rangahau ki ngā tūpāpaku e waru kua tio hou, e waru ngā takirua o ngā hope e 16, kāore anō kia pokanga hope i roto i te hītori. I whiriwhiria matapōkeretia tētahi hope kia whai MIS-THA mā te huarahi DA, ā, ko tētahi mā te huarahi DS i roto i tētahi tūpāpaku, ā, i mahia ngā tikanga katoa e ngā tākuta mohio. I aromatawaihia te taumata whakamutunga o te whara o te uaua me te uaua e tētahi taote pokanga wheua kāore i uru ki te pokanga.
Ko ngā hanganga tinana i arotakengia ko: te gluteus maximus, te gluteus medius me tōna uaua, te gluteus minimus me tōna uaua, te vastus tensor fasciae latae, te quadriceps femoris, te trapezius o runga, te piatto, te trapezius o raro, te obturator internus, me te obturator externus (Pikitia 1). I arotakengia ngā uaua mō ngā haehae uaua me te ngawari e kitea ana e te kanohi tahanga.
Pikitia 1 Te hoahoa hanganga o ia uaua
Ngā Hua
1. Te kino o te uaua: Kāore he rerekētanga tatauranga i roto i te whānuitanga o te kino o te mata o te gluteus medius i waenga i ngā huarahi DA me te DS. Heoi, mō te uaua gluteus minimus, ko te ōrau o te whara mata i puta mai i te huarahi DA he nui ake i tērā i puta mai i te huarahi DS, ā, kāore he rerekētanga nui i waenga i ngā huarahi e rua mō te uaua quadriceps. Kāore he rerekētanga tatauranga nui i waenga i ngā huarahi e rua e pā ana ki te whara o te uaua quadriceps, ā, ko te ōrau o te whara mata ki ngā uaua vastus tensor fasciae latae me te rectus femoris he nui ake i te huarahi DA i te huarahi DS.
2. Ngā whara o ngā uaua: Kāore tetahi o ngā huarahi i puta he whara nui.
3. Te werohanga o te uaua: He nui ake te roa o te werohanga o te uaua gluteus minimus i te rōpū DA i tērā i te rōpū DS, ā, he nui ake te ōrau o te whara i te rōpū DS. Kāore he rerekētanga nui i roto i ngā whara o te werohanga o te uaua i waenga i ngā rōpū e rua mō te pyriformis me te obturator internus. Kei te whakaatuhia te mahere pokanga i te Pikitia 2, e whakaatu ana te Pikitia 3 i te huarahi taha tuku iho, ā, e whakaatu ana te Pikitia 4 i te huarahi muri tuku iho.
Pikitia 2 1a. Te tango katoa o te uaua gluteus minimus i te wā o te tikanga DA nā te mea me whakapiri te femur; 1b. Te tango wāhanga o te gluteus minimus e whakaatu ana i te whānuitanga o te whara ki tōna uaua me te uaua puku. gt. te trochanter nui; * gluteus minimus.
Pikitia 3 Kauwhata o te huarahi tika ki te taha tuku iho me te acetabulum e kitea ana i te taha matau me te toia tika.
Pikitia 4 Te whakaaturanga o te uaua poto hurihuri o waho i roto i te huarahi THA muri tikanga
Whakamutunga me ngā Pānga Hauora
He maha ngā rangahau o mua kāore i whakaatu i ngā rerekētanga nui o te roa o te pokanga, te whakahaere mamae, te tere o te whakawhiti toto, te ngaronga toto, te roa o te noho hōhipera, me te haere ina whakaritea te THA tikanga ki te MIS-THA. I roto i tētahi rangahau haumanu o te THA me te urunga tikanga me te THA iti rawa te whakaekenga a Repantis et al. kāore i whakaatu i ngā rerekētanga nui i waenga i ngā mea e rua, engari he whakahekenga nui o te mamae, ā, kāore he rerekētanga nui o te toto, te manawanui ki te hikoi, te whakaora rānei i muri i te pokanga. I roto i tētahi rangahau haumanu a Goosen et al.
I whakaatuhia e te RCT a Goosen me ētahi atu he pikinga o te kaute HHS toharite i muri i te huarahi iti rawa te whakaekenga (e tohu ana i te pai ake o te whakaoranga), engari he roa ake te wā pokanga me te nui ake o ngā raruraru i te wā e pokanga ana. I ngā tau tata nei, he maha hoki ngā rangahau e tirotiro ana i te kino o te uaua me te wā whakaora i muri i te pokanga nā te urunga pokanga iti rawa te whakaekenga, engari kāore anō kia tino arohia ēnei take. I whakahaerehia hoki tēnei rangahau i runga i aua take.
I roto i tēnei rangahau, i kitea he iti ake te kino o te kiko uaua i puta mai i te huarahi DS i tērā i te huarahi DA, e whakaatuhia ana e te iti ake o te kino o te uaua gluteus minimus me tōna uaua, te uaua vastus tensor fasciae latae, me te uaua rectus femoris. I whakatauhia ēnei whara e te huarahi DA tonu, ā, he uaua ki te whakatika i muri i te pokanga. I te mea he tauira tūpāpaku tēnei rangahau, me whai rangahau haumanu hei tirotiro hohonu i te hiranga haumanu o tēnei hua.
Wā tuku: Whiringa-ā-rangi-01-2023
