I.Te tikanga whakakī sima wheua
He pai te tikanga whakakī sima wheua mō ngā tūroro he iti ake ngā hapa wheua AORI momo I, ā, he iti ake hoki ngā mahi ā-tinana.
Ko te hangarau sima wheua māmā e hiahia ana kia horoia pai te koha o te wheua, ā, ka whakakīia te koha o te wheua e te sima wheua i te wā e hangaia ana te paraoa pokepoke, kia taea ai te kuhu ki roto i ngā āputa i ngā kokonga o te koha kia rite ki te taea, kia piri ai te hononga ki te wheua manaaki.
Ko te tikanga motuhake oBkotahiCwhakataungaSKo te hangarau a te kapa he horoi pai i te koha o te wheua, kātahi ka whakapiri i te tīwiri ki te wheua manaaki, ā, kia tūpato kei neke ake te taupoki tīwiri i te mata o te wheua o te tūāpapa hononga i muri i te osteotomy; kātahi ka whakaranua te sima wheua, ka whakakīia te koha o te wheua i te wāhanga paraoa pokepoke, ka takai i te tīwiri. I whakamahia e Ritter MA me ētahi atu tēnei tikanga hei hanga anō i te koha o te wheua tibial plateau, ā, ka eke te matotoru o te koha ki te 9mm, ā, kāore i wetekina i muri i te 3 tau i muri i te pokanga. He iti ake te tango a te hangarau whakakī sima wheua i te wheua, kātahi ka whakamahia te whakatikatika prosthesis tikanga, ā, ka whakaitihia ngā utu maimoatanga nā te whakamahinga o ngā prosthesis whakatikatika, he uara mahi tōna.
Ko te tikanga motuhake o te hangarau sima wheua + tīwiri ko te horoi pai i te koha o te wheua, te whakatika i te tīwiri ki te wheua manaaki, me te aro kia kaua te taupoki tīwiri e neke ake i te mata o te wheua o te papa hononga i muri i te osteotomy; kātahi ka whakaranua te sima wheua, ka whakakīia te koha o te wheua i te wāhanga paraoa pokepoke, ka takai i te tīwiri. I whakamahia e Ritter MA me ētahi atu tēnei tikanga hei hanga anō i te koha o te wheua tibial plateau, ā, ka eke te matotoru o te koha ki te 9mm, ā, kāore i wetekina i roto i ngā tau e 3 i muri i te pokanga. Ka tangohia e te hangarau whakakī sima wheua he iti ake te wheua, kātahi ka whakamahia te whakatikatika prosthesis tikanga, ā, ka whakaitihia te utu maimoatanga nā te whakamahinga o te whakatikatika prosthesis, he uara mahi tōna (PikitiaI-1).
AhuaI-1Te whakakī i te sima wheua me te whakapakari i te tīwiri
Tuarua.Ngā tikanga honohono wheua
Ka taea te whakamahi i te tākai wheua pēhi hei whakatika i ngā hapa wheua whakauru, whakauru rānei, i roto i te pokanga whakatikatika turi. He mea tino pai mō te hanga anō i ngā hapa wheua AROI momo I ki te III. I roto i te pokanga whakatikatika, nā te mea he nui te whānuitanga me te nui o ngā hapa wheua, he iti te nui o te wheua autologous e whiwhihia ana, ā, ko te nuinga o te wheua sclerotic ina tangohia te prosthesis me te sima wheua i te wā pokanga hei tiaki i te papatipu wheua. Nō reira, he maha ngā wā ka whakamahia te wheua allogeneic granular mō te tākai wheua pēhi i te wā pokanga whakatikatika.
Ko ngā painga o te tākai wheua pēhi ko: te pupuri i te papatipu wheua o te wheua manaaki; te whakatika i ngā hapa wheua nunui, māmā rānei, uaua rānei.
Ko ngā ngoikoretanga o tēnei hangarau: he roa te wā e pau ana ki te mahi; he uaua te hangarau hanga anō (ina koa ka whakamahia ngā whare herehere MESH nui); tera pea ka horapa te mate.
Te honohono wheua pēhanga māmā:He maha ngā wā ka whakamahia te hononga wheua pēhi māmā mō ngā hapa wheua whakauru. Ko te rerekētanga i waenga i te hononga wheua pēhi me te hononga wheua hanganga ko te mea ka taea te whakahou tere me te katoa i ngā uaua o te rauemi hononga wheua kirikiri i hangaia e te hononga wheua pēhi.
Whare herehere whakarewa mata + hononga wheua pēhi:Ko ngā hapa wheua kāore e whakaurua ana, me hanga anō mā te whakamahi i ngā kēti whakarewa hei whakatō i te wheua korekore. He uaua ake te hanga anō i te femur i te hanga anō i te tibia. E whakaatu ana ngā hihi-X kua oti haere te whakaurunga wheua me te hanga wheua o te rauemi honohono (PikitiaII-1-1, PikitiaII-1-2).
AhuaII-1-1Te honohono wheua pēhanga ā-roto o te whare herehere hei whakatika i te hapa o te wheua tibial. A I te wā pokanga; B Hiko-X i muri i te pokanga
Ahuae II-1-2Te whakatikatika i ngā hapa o te wheua femur me te tibia mā te whakamahi i te hononga wheua kōpeketanga ā-roto o te titanium mesh. A I te wā pokanga; B Ira-X i muri i te pokanga
I te wā e whakatikatikahia ana te pokanga turi, ka whakamahia te wheua hanganga allogeneic hei hanga anō i ngā hapa wheua AORI momo II, III rānei. Haunga te whai pūkenga pokanga tino pai me te wheako nui ki te whakakapinga turi uaua, me whakarite hoki e te taote pokanga he mahere ātaahua, he taipitopito hoki i mua i te pokanga. Ka taea te whakamahi i te honohono wheua hanganga hei whakatika i ngā hapa wheua cortical me te whakanui ake i te papatipu wheua.
Ko ngā painga o tēnei hangarau ko: Ka taea te hanga i tētahi rahi me tētahi āhua hei urutau ki ngā hapa wheua o ngā āhua āhuahanga rerekē; he pānga tautoko pai ki te whakahou i ngā prostheses; ā, ka taea te whakatutuki i te whakaurunga koiora mō te wā roa i waenga i te wheua allogeneic me te wheua manaaki.
Ko ngā ngoikoretanga ko: te roa o te wā mahi i te wā e tapahia ana te wheua allogeneic; he iti noa ngā pūtake o te wheua allogeneic; te mōrearea o te kore hononga me te whakaroa o te hononga nā ngā āhuatanga pēnei i te mimiti wheua me te whati ngenge i mua i te otinga o te tukanga whakauru wheua; ngā raruraru ki te mimiti me te pangia o ngā rauemi kua whakatōkia; te kaha o te horapa o te mate; me te kore e tino pumau te tīmatanga o te wheua allogeneic. Ka tangohia te wheua hanganga allogeneic mai i te femur distal, te tibia proximal, te pane femoral rānei. Mena he nui te rauemi whakatōkia, kāore e puta te whakahoutanga toto katoa. Ka taea te whakamahi i ngā pane femoral allogeneic hei whakatika i ngā hapa o te wheua condyle femoral me te tibial plateau, ko te nuinga hei whakatika i ngā hapa wheua momo kōhao nui, ā, ka whakatikahia mā te pēhi-whakapiri i muri i te kutikuti me te hanga. Ko ngā hua haumanu wawe o te whakamahi i te wheua hanganga allogeneic hei whakatika i ngā hapa o te wheua i whakatōkia i whakaatu i te tere whakaora teitei o te wheua kua whakatōkia (PikitiaII-1-3, PikitiaII-1-4).
AhuaII-1-3Te whakatikatika i te hapa o te wheua femur me te hononga wheua hanganga pane femur allogeneic
AhuaII-1-4Te whakatikatika i te koha o te wheua tibial me te tārai wheua upoko femoral allogeneic
III.Hangarau whakakī whakarewa
Hangarau ā-pūrua Ko te tikanga o te hangarau ā-pūrua ka taea te whakakotahi i ngā whakakī whakarewa me ngā prostheses me ngā kakau intramedullary. Kei roto i ngā whakakī ngā tauira maha hei whakahaere i te hanga anō i ngā hapa wheua o ngā rahi rerekē.
Whakarewa Pūeru Ngā Whakanui：He pai te whakawehe konganuku modular mō ngā hapa wheua kore-pupuri AORI momo II tae atu ki te 2 cm te matotoru.He watea, he māmā noa iho te whakamahi i ngā wāhanga whakarewa hei whakatika i ngā hapa o te wheua, ā, he pono hoki ngā pānga haumanu.
Ka taea e ngā whakawehe konganuku te pūwero, te totoka rānei, ā, kei roto i ō rātou āhua he poro, he poraka rānei. Ka taea te hono i ngā whakawehe konganuku ki te hononga prosthesis mā te tīwiri, te whakau rānei mā te sima wheua. E whakapono ana ētahi tohunga mā te whakau sima wheua ka taea te karo i te pakaru i waenga i ngā konganuku, ā, ka tūtohu kia whakau sima wheua. E tautoko ana hoki ētahi tohunga i te tikanga o te whakamahi i te sima wheua i te tuatahi, kātahi ka whakakaha mā te tīwiri i waenga i te whakawehe me te prosthesis. He maha ngā wā ka puta ngā hapa o te femur i ngā wāhanga o muri me te tawhiti o te condyle femur, nō reira ka whakanohoia ngā whakawehe konganuku ki ngā wāhanga o muri me te tawhiti o te condyle femur. Mō ngā hapa o te wheua tibial, ka taea te whiriwhiri i ngā poro, i ngā poraka rānei mō te hanga anō kia urutau ki ngā āhua hapa rerekē. E ai ki ngā tuhinga, ko ngā reiti pai me te pai he teitei ki te 84% ki te 98%.
Ka whakamahia ngā poraka āhua porowhita ina he āhua porowhita te hapa o te wheua, ā, ka taea te tiaki i te wheua manaaki. Me tika te tango wheua kia ōrite ai te mata o te tango wheua ki te poraka. Haunga te ahotea pēhi, kei reira anō te kaha kutikuti i waenga i ngā atanga whakapā. Nō reira, kaua te koki o te porowhita e neke ake i te 15°. Ki te whakatauritea ki ngā poraka āhua porowhita, he ngoikoretanga ngā poraka whakarewa porowhita, arā, ko te whakanui ake i te nui o te tango wheua, engari he watea, he māmā hoki te mahi pokanga, ā, he tata te pānga miihini ki te noa (III-1-1A, B).
AhuaIII-1-1Ngā mokowā whakarewa: He mokowā āhua poro hei whakatika i ngā hapa tibial; he mokowā āhua pou B hei whakatika i ngā hapa tibial
Nā te mea he rerekē ngā āhua me ngā rahi o ngā whakawehenga whakarewa, he whānuitia te whakamahinga mō ngā hapa wheua kāore i te mau, me ngā hapa wheua o ngā āhua rerekē, ā, he pai te pumau o te tīmatanga. Heoi, kua kitea e ngā rangahau roa ka rahua ngā whakawehenga whakarewa nā te ārai ahotea. Ki te whakaritea ki ngā whakapiringa wheua, ki te rahua ngā whakawehenga whakarewa, ā, me whakahou, ka nui ake ngā hapa wheua.
Wā tuku: Oketopa-28-2024
