I-dysplasia yophuhliso lwe-hip (i-DDH) yintlupheko yophuhliso oluguquguqukayo olubangela ukungasebenzi kakuhle kwe-hip ngenxa ye-dysplasia yokuzalwa ye-acetabulum, i-proximal femoral deformity, i-adaptive soft tissue contracture, kunye notshintsho lwe-biomechanical. I-Total hip arthroplasty (THA) yenye yeendlela eziphambili zokwenza unyango lwe-DDH, enokunciphisa uxinzelelo lwezicubu ezithambileyo, ukubuyisela iziko lokujikeleza kunye nokuzinza kwe-hip joint, kunye nokuphucula ukukhubazeka kwamalungu angaphantsi. Xa kuthelekiswa nohlobo lweCrowe Ⅰ ~ Ⅲ izigulane ze-DDH, ububanzi be-anteroposterior ye-acetabulum buncinci kwaye buncinci, kwaye ukuhluka kwe-angle ye-anteversion kukhulu; i-dysplasia yentloko ye-femoral ide iphele, i-angle ye-anteversion angle inkulu, i-trochanter enkulu isemva, kwaye ububanzi be-anteroposterior be-femur bukhulu kunobubanzi obusekhohlo nasekunene [1-2]; Ukuchithwa kwexesha elide kwe-hip kukhokelela kwikontrakthi yezicubu ezithambileyo zendawo, okubangele ubunzima ekunciphiseni i-hip [4]. Ngoko ke, ukusekwa kwesakhiwo esidibeneyo se-hip kunye nokubuyiswa kwethambo kuye kwaba enye yeengxaki zokuhlinzwa.
1. Kutheni kufuneka utyando oluhlaziyiweyo?
Isizathu esiphambili sokuhlaziywa emva kwe-THA yokuqala kwi-Crowe uhlobo Ⅳ i-DDH yi-aseptic yokukhulula i-prosthesis.Ukongezelela, ukusuleleka kwe-periprosthetic, i-periprosthetic fracture, i-osteolysis, i-bone loss and prosthesis fracture kunye nokungazinzi nazo ziyizizathu eziqhelekileyo zokuhlaziywa..
2Ukuhlelwa kwesiphene samathambo
Icala le-acetabular kunye ne-femoral yohlobo lweCrowe Ⅳ izigulane ze-DDH zihlala zihamba kunye neqondo elithile leethambo ngexesha lokuhlaziywa, kwaye i-bone mass eseleyo kunye nesiphako se-acetabular kunye ne-proximal femur inokulinganiswa nge-X-ray kunye ne-CT ngaphambi kokuhlaziywa. Okwangoku, eyona nto isetyenziswa ngokuqhelekileyo kwikliniki yesifo se-bone defect classified standard kunye ne-paprosky classification classification kunye ne-femur classification umgangatho wohlelo ushwankathelwa.
2.1Ukuhlelwa kwe-acetabular yePaprosky
I-Bone defect classification ayikwazi ukubonisa kuphela iqondo lokulahleka kwethambo, kodwa iphinde ibonise ukuzinza kwe-acetabular prosthesis ehlonyelweyo [5-6], ukwenzela ukuba ukhethe i-prosthesis yecala elifanelekileyo le-acetabular kunye namacandelo. kwicala le-acetabular, elinokuthi lihlulwe libe ziindidi ezintathu.Uhlobo ⅰ: inani elincinci kunye nokulahleka kwethambo elilinganiselweyo malunga ne-acetabulum, enokuthi igcine imilo yangaphambili kunye nesakhiwo se-acetabulum.Uhlobo Ⅱ: ukufuduka okuncinci kwe-acetabulum ephezulu, esecaleni kunye ne-medial, kodwa i-acetabulum yangaphambili kunye ne-acetabulum igcinwe kakuhle kunye ne-acetabulum ye-acetabulum. isenozinzo oluthile, kodwa i-bone defect idinga amacandelo akhethekileyo okanye i-Cage ukulungisa nokwakhiwa kwakhona.Uhlobo lwe-III: I-acetabulum inenani elikhulu lokulahleka kwethambo le-annular, i-center of the hip joint inyuka kakhulu (> 3 cm) [7-8], kunye nokunyanzeliswa kwethambo okanye ukungazinzi kwe-pelvic, eyona nto inzima kakhulu yecala le-bonetabula yecala. Ukwakhiwa kwakhona kwe-acetabular kunye nokubuyiselwa kweziko lokujikeleza kuchaphazela ngokuthe ngqo ukuphumelela okanye ukungaphumeleli kokuhlinzwa ngokutsha.Jonga uMfanekiso 1.
2.2Ukuhlelwa kwePaprosky yecala lobufazi
Ukuhlelwa kwe-Paprosky yecala le-femoral lisekelwe kubungakanani besiphako sethambo kwi-proximal and distal isthmus ye-femur, kubandakanywa nendawo ye-bone defect, ubungakanani bethambo elihlala lihlala, ubude be-isthmus kunye ne-distal residual bone ithambo elixhasayo, kwaye lihlukaniswe kwiindidi ezintathu. kulula ukujongana nayo ngexesha lohlaziyo.Uhlobo lwe-III: i-proximal defect enzima, kodwa ithambo le-femoral shaft lihlala lilungile, kuxhomekeke ekubeni ubude bethambo eliseleyo kwi-isthmus ye-femur lifikelela kwi-4 cm [9].
3Ukwakhiwa kwakhona kwe-acetabulum
Ngenxa yokukhubazeka kwesakhiwo sohlobo lweCrowe Ⅳ izigulane ze-DDH kunye nochungechunge lweengxaki emva kokutshintshwa kokuqala, uninzi lweeprostheses ezihlaziyiweyo azikwazi ukufezekisa ukuzinza kokuqala kokubambisana, ukugubungela okwaneleyo kwamathambo okanye ukuphucula ukukhubazeka kwe-morphological.
3.1Ukusetyenziswa kwekomityi esisigxina yebhayoloji
Xa kukho uhlobo lwe-Paprosky II okanye ngaphezulu kwe-bone defect kwi-acetabulum kunye ne-standard standard biological hemispherical acetabular cup ayikwazi ukubonelela ukulungiswa okuzinzile, i-cup prosthesis enkulu ye-acetabular (i-Jumbo cup) ingasetyenziselwa ukunyusa indawo yoqhagamshelwano kunye nethambo elijikeleze i-acetabulum kunye nokwandisa indawo yokunamathisela, ukuze ufezekise ukuzinza kwexesha elide.
3.2Ukufakwa kwamathambo
Ukufakelwa kwamathambo okuchaphazelekileyo yindlela eqhelekileyo esetyenziswayo yokulungisa iziphene eklinikhi. Kwizigulane ezine-acetabular bone defect encinci, i-acetabular bone defect okanye i-prosthesis efana ne-ring yokuqinisa, ibhloko yensimbi kunye ne-Cage ingasetyenziselwa ukubuyisela ubunzima bethambo, i-ingrow blood vessels, ithambo lokumila kunye nokuphucula ukugcinwa kwethambo kwi-acetabular bone defect, ukwenzela ukufezekisa injongo yokuzinza kwexesha elide le-prosthesis [10].
3.3Ukusetyenziswa kwezandiso zetsimbi
Kwangaxeshanye, indawo yoqhagamshelwano phakathi kwethambo lesiphene kwindawo enesiphako kunye nebhloko yesinyithi yanda, enokukhuthaza i-ingrowth.Iibhloko zetsimbi zinemilo eyahlukeneyo kunye nobukhulu obuhlukeneyo, kwaye zinokuthi zifakwe i-inosculated kunye ne-bone defect part ukuya kwinqanaba elikhulu ngokukhetha ibhloko yentsimbi efanelekileyo. Ukugcinwa kwekomityi ye-acetabular kunye nokuphucula uzinzo.
3.4Ukusetyenziswa kwekheji kunye neekomityi ezinamaphiko amathathu
Kukho ithambo elincinci kudonga oluphakathi kunye nekholamu yangaphambili yohlobo lweCrowe Ⅳ izigulane ze-DDH, kwaye ezinye izigulane zineziphene ezininzi zamathambo ngexesha lokuhlinzwa ngokutsha, okubangelwa ukuchithwa kwe-acetabular, kwaye indebe ye-acetabular ayikwazi ukulungiswa ngokufanelekileyo ngexesha lokuhlaziywa, ngoko ke i-Cage okanye i-acetabular cup yamaphiko amathathu ingasetyenziselwa i-acetabular ye-acetabulum ngeli xesha.
3.5Itekhnoloji yoshicilelo ye-3D
Kwizigulane ezinohlobo lwePaprosky Ⅲ iziphene zamathambo, i-acetabulum ayiqhubeki ngenxa yokulahleka okukhulu kwamathambo, okukhokelela ekungazinzini kwe-pelvic kunye nobunzima bokufakelwa kwe-acetabular prosthesis. Itekhnoloji yokushicilela ye-3D ingasetyenziselwa ukwenza imodeli ye-3-dimensional ye-pelvis yesigulane, apho umqhubi angakwazi ukuqonda ngokucacileyo iziphene ze-anatomical ze-acetabulum, ukuqonda isakhiwo se-anatomical yendawo kunye nobubanzi besiphako, isicwangciso esingcono ngaphambi kokusebenza, khetha amacandelo afanelekileyo ukulungisa i-defect, okanye asebenzise i-3D yokushicilela iteknoloji ekhethekileyo ye-maxize yokushicilela inkxaso, ukuhamba kunye nokuzinza.
4Ukwakhiwa kwakhona kwecala lobufazi
4.1Ubunzima botyando
.Ukukhubazeka kwe-Femoral kwizigulane ze-DDH zatshintshile kunye neqondo lokuchithwa kwe-hip.Phakathi kwabo, uhlobo lwe-Crowe lwe-IV lubonakaliswe ngokuchithwa okuphezulu kwe-hip joint, utshintsho olubi kakhulu kwi-morphology kunye nomsebenzi we-proximal femur, kunye nesiganeko esiphezulu se-coxa vara kunye ne-valgus [11-12]. Xa i-femoral component yezigulane ze-DDH zikhululekile kwaye zihamba kunye ne-cavity kunye ne-segmental bone loss of segmental, ukuhlaziywa kwecala le-femoral lucelomngeni.Njengokuba ukususwa kokufakelwa, ukugcinwa kwamathambo, ukwakhiwa kwakhona kwe-femur proximal, ukukhethwa kwe-prosthesis efanelekileyo yokufakelwa kunye nokuzinza kube nzima kokuhlinzwa kokuhlaziywa kwe-femoral [13].
4.2Imiqathango yokusebenza
Kusenokubakho i-osteosclerosis kwi-proximal femur kunye ne-medullary cavity emxinwa yohlobo lweCrowe Ⅳ yezigulane ze-DDH ngexesha lotyando oluhlaziyiweyo. Xa ukhupha i-biological femoral stem prosthesis, i-sclerotic bone tissue kunye ne-fibrous tissue esongelwe kwi-femur ehamba phambili kufuneka isuswe kangangoko kunokwenzeka, kwaye i-prosthesis kufuneka ibonakaliswe ngokupheleleyo kwaye i-interface ye-bone-prosthesis kufuneka yahlulwe ukunciphisa ukulahleka kwethambo le-iatrogenic. [14-15] .Impumelelo okanye ukungaphumeleli kotyando oluhlaziyiweyo kuxhomekeke kuvavanyo lwangaphambili kunye novavanyo lwe-intraoperative yeqondo le-proximal femoral bone defect, ukuyila, ukukhethwa kunye nokulungiswa kweprosthesis ehlonyelweyo, kunye nesigwebo somgangatho wokugcinwa kwamathambo aseleyo.
4.3Indlela yokukhetha isiqu esichanekileyo?
I-prosthesis yemodyuli yemodyuli isoloko isetyenziselwa utyando oluhlaziyiweyo lweCrowe Ⅳ izigulane ze-DDH.I-prosthesis ye-modular ye-segmental ingakwazi ukuhlangabezana neemfuno zangempela ze-femur yesigulane, i-distal femoral stem inokufikelela ukuzinza okuguquguqukayo, kunye ne-cuff esondeleyo inokuthintela ngokufanelekileyo i-postoperative osteolysis kunye ne-fixation yokuhlinzwa, i-Crowes femoral imele i-revisionation. ekhethiweyo ngokwesiphene somfazi wesigulane, ukwenzela ukuba kuphunyezwe ukuvuselelwa kwe-femal kunye nokugcina ukuzinza kwe-prosthesis njengeyona njongo ephambili.
5Indlela yokukhetha i-liner?
Okwangoku, i-prosthesis ye-prosthesis esetyenziswa ngokuqhelekileyo kwi-utyando ibandakanya i-metal-metal interface, i-metal-polyethylene interface, i-ceramic-polyethylene interface kunye ne-ceramic-ceramic interface [7,11] .I-Polyethylene uhlobo oluphambili olukhethiweyo ngoku. Okwangoku, umgca we-polyethylene odibeneyo onqamlekileyo uye watshintsha ngokuthe ngcembe umgca we-polyethylene yendabuko, enokumelana nokugqoka okuphezulu, ukunciphisa i-osteolysis kunye nokugqoka phakathi kweeprotheses emva kokusebenza, kwaye kukulungele ukugcina i-prognosis yexesha elide [16].Izigulana ezininzi ezinohlobo lwe-Crowe Ⅳ DDH zaziselula xa zifumana umlinganiselo omkhulu we-THA imihla ngemihla, kwaye zenza umsebenzi omkhulu wemihla ngemihla. Ukuqwalasela isiphene samathambo esibangelwa ngamaqhekeza okugqoka ngexesha lokuhlaziywa kunye nobunzima bokuhlaziywa, i-ceramic lining kufuneka ikhethwe ngokusemandleni ngexesha le-THA yokuqala okanye ukuhlaziywa. Ukuba akunakwenzeka ukukhetha ngenxa yokunciphisa ubungakanani, i-polyethylene edibeneyo enqamlekileyo ingakhethwa [17] .O njengokwandisa ubomi benkonzo yeprosthesis kunye nokunciphisa inani lemisebenzi yokuhlaziya.
6Ukuqukumbela
.Ukukhulula iAseptic yeprosthesis ngoyena nobangela uqhelekileyo wohlaziyo emva kwe-THA yokuqala yohlobo lweCrowe Ⅳ DDH. Ukutshatyalaliswa ngokuphindaphindiweyo kwe-joint, i-bone defect, i-infection, i-nonunion kwindawo ye-osteotomy, kunye ne-prosthesis fracture inokukhokelela ekuhlaziyweni kokuhlinzwa.Ukwakhiwa ngokutsha kwe-hip joint kunye nokufakelwa kwe-femoral prosthesis yizona ngxaki ziphambili ekuhlaziyeni utyando kwizigulane ezinjalo, ezifuna uvavanyo olubanzi kunye oluchanekileyo lwangaphambi kokuhlinzwa kunye nokulinganisa, ukuthatha i-akhawunti epheleleyo yethambo kunye ne-anamical defect akhawunti. iimeko ze-intraoperative.Kuyafaneleka ukuba uqaphele ukuba i-bone defect iseyeyona ngxaki ibaluleke kakhulu ekuhlaziyeni utyando lweCrowe uhlobo lwe-IV yezigulane ze-DDH. Nangona iteknoloji yeCage, izakhi zemodyuli kunye neprosthesis eyenziwe ngokwezifiso zibonakaliswe ukuba zisebenza kakuhle kwangethuba nakwixesha eliphakathi kweli nqanaba, izinga lokusinda kwexesha elide lisafuna ukucaciswa ngakumbi.
Iimbekiselo
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Ixesha lokuposa: Apr-16-2024