I.Cov txheej txheem sau cov pob txha cement
Txoj kev txhaws pob txha yog tsim rau cov neeg mob uas muaj cov pob txha me me AORI hom I thiab tsis tshua muaj zog ua ub ua no.
Cov txheej txheem cement pob txha yooj yim yuav tsum tau ntxuav cov pob txha kom huv si, thiab cov cement pob txha puv cov pob txha thaum lub sijhawm ua hmoov nplej, yog li nws tuaj yeem raug ntim rau hauv qhov sib txawv ntawm cov ces kaum ntawm qhov tsis zoo ntau li ntau tau, yog li ua tiav qhov sib haum xeeb nrog tus tswv tsev pob txha interface.
Txoj kev tshwj xeeb ntawmBib qhoCkev txhawb nqa +SCov txheej txheem ua haujlwm ntawm cov neeg ua haujlwm yog ntxuav cov pob txha kom huv si, tom qab ntawd kho lub hau ntswj rau ntawm pob txha, thiab ceev faj kom tsis txhob cia lub hau ntswj tshaj qhov chaw ntawm pob txha ntawm lub platform sib koom ua ke tom qab osteotomy; tom qab ntawd sib tov cov pob txha cement, sau cov pob txha tsis zoo hauv theem ua khob noom cookie, thiab qhwv lub hau ntswj. Ritter MA et al. siv txoj kev no los tsim kho cov pob txha tibial plateau defect, thiab qhov tuab ntawm qhov tsis zoo tau txog 9 hli, thiab tsis muaj kev xoob 3 xyoos tom qab kev phais. Cov txheej txheem sau pob txha cement tshem tawm cov pob txha tsawg dua, thiab tom qab ntawd siv cov txheej txheem kho dua tshiab, yog li txo cov nqi kho mob vim yog kev siv cov txheej txheem kho dua tshiab, uas muaj qee yam txiaj ntsig zoo.
Txoj kev tshwj xeeb ntawm kev siv tshuab cement pob txha + ntsia hlau yog los ntxuav cov pob txha puas tsuaj kom huv si, kho cov ntsia hlau rau ntawm cov pob txha, thiab xyuam xim tias lub hau ntsia hlau yuav tsum tsis txhob tshaj qhov chaw ntawm pob txha ntawm lub platform pob qij txha tom qab osteotomy; tom qab ntawd sib tov cov cement pob txha, sau cov pob txha puas tsuaj hauv theem ua khob noom cookie, thiab qhwv cov ntsia hlau. Ritter MA et al. siv txoj kev no los tsim kho cov pob txha tibial plateau defect, thiab qhov tuab ntawm qhov puas tsuaj tau txog 9 hli, thiab tsis muaj kev xoob 3 xyoos tom qab phais. Kev siv tshuab cement pob txha sau cov pob txha tshem tawm cov pob txha tsawg dua, thiab tom qab ntawd siv kev kho dua tshiab prosthesis, yog li txo cov nqi kho mob vim yog kev siv kho dua tshiab prosthesis, uas muaj qee yam txiaj ntsig zoo (Daim DuabI-1).
DuabI-1Kev sau cov pob txha cement thiab kev txhawb nqa cov ntsia hlau
II.Cov txheej txheem txuas pob txha
Kev siv cov pob txha txuas rau hauv lub hauv caug tuaj yeem siv los kho cov pob txha uas muaj tag nrho lossis tsis muaj tag nrho hauv kev phais kho lub hauv caug. Nws feem ntau yog qhov tsim nyog rau kev kho dua tshiab ntawm AROI hom I txog III cov pob txha tsis zoo. Hauv kev phais kho dua tshiab, vim tias qhov ntau thiab tsawg ntawm cov pob txha tsis zoo feem ntau hnyav, qhov ntau ntawm cov pob txha autologous tau txais yog me me thiab feem ntau yog pob txha sclerotic thaum cov khoom siv prosthesis thiab cov pob txha cement raug tshem tawm thaum lub sijhawm phais kom khaws cov pob txha loj. Yog li ntawd, cov pob txha granular allogeneic feem ntau siv rau kev siv cov pob txha txuas thaum lub sijhawm phais kho dua tshiab.
Cov txiaj ntsig ntawm kev nias pob txha grafting yog: khaws cov pob txha ntawm tus tswv tsev; kho cov pob txha loj yooj yim lossis cov pob txha nyuaj.
Qhov tsis zoo ntawm cov thev naus laus zis no yog: kev ua haujlwm siv sijhawm ntau; cov thev naus laus zis rov tsim kho dua tshiab yog qhov nyuaj (tshwj xeeb tshaj yog thaum siv cov tawb loj MESH); muaj peev xwm kis tau kab mob.
Kev cog pob txha yooj yim:Kev siv cov pob txha txuas yooj yim feem ntau yog siv rau cov pob txha uas muaj qhov tsis zoo. Qhov txawv ntawm kev siv cov pob txha txuas thiab kev siv cov pob txha txuas yog tias cov khoom siv txuas pob txha uas ua los ntawm kev siv cov pob txha txuas tuaj yeem kho tau sai thiab tag nrho cov hlab ntsha.
Lub tawb hlau mesh + kev sib txuas pob txha:Cov pob txha uas tsis suav nrog feem ntau yuav tsum tau kho dua tshiab siv cov hlau mesh tawb los cog cov pob txha cancellous. Kev kho dua tshiab ntawm lub femur feem ntau nyuaj dua li kev kho dua tshiab ntawm tibia. X-rays qhia tias kev sib koom ua ke ntawm pob txha thiab kev ua kom cov pob txha ntawm cov khoom siv graft tau maj mam ua tiav (Daim DuabII-1-1, Daim DuabII-1-2).
DuabII-1-1Kev siv lub mesh cage los kho qhov puas ntawm cov pob txha tibial. A Thaum phais; B X-ray tom qab phais
Duabe II-1-2Kho cov pob txha femoral thiab tibia uas puas lawm nrog titanium mesh internal compression bone grafting. A Intraoperative; B Postoperative X-ray
Thaum lub sijhawm kho dua pob txha caj qaum, cov pob txha allogeneic feem ntau yog siv los kho cov pob txha AORI hom II lossis III uas tsis zoo. Ntxiv nrog rau kev muaj peev xwm phais zoo heev thiab muaj kev paub dhau los hauv kev hloov pob txha caj qaum nyuaj, tus kws phais kuj tseem yuav tsum ua cov phiaj xwm ua ntej phais kom zoo thiab ntxaws ntxaws. Kev cog pob txha caj qaum tuaj yeem siv los kho cov pob txha cortical tsis zoo thiab ua rau pob txha loj hlob.
Cov txiaj ntsig ntawm cov thev naus laus zis no suav nrog: Nws tuaj yeem ua rau txhua qhov loj me thiab cov duab kom hloov kho rau cov pob txha tsis zoo ntawm cov duab geometric sib txawv; nws muaj cov txiaj ntsig zoo rau kev kho dua tshiab prostheses; thiab kev sib koom ua ke ntawm cov kab mob mus sij hawm ntev tuaj yeem ua tiav ntawm cov pob txha allogeneic thiab cov pob txha tswv tsev.
Qhov tsis zoo muaj xws li: lub sijhawm ua haujlwm ntev thaum txiav cov pob txha allogeneic; cov pob txha allogeneic tsawg; kev pheej hmoo ntawm kev tsis sib koom ua ke thiab kev sib koom ua ke qeeb vim muaj cov yam xws li pob txha resorption thiab qaug zog tawg ua ntej cov txheej txheem sib koom ua ke pob txha tiav; teeb meem nrog kev nqus thiab kev kis kab mob ntawm cov khoom hloov pauv; muaj peev xwm kis kab mob; thiab tsis txaus qhov ruaj khov pib ntawm cov pob txha allogeneic. Cov pob txha allogeneic raug sau los ntawm distal femur, proximal tibia, lossis femoral taub hau. Yog tias cov khoom hloov pauv loj, kev kho dua tshiab tag nrho feem ntau tsis tshwm sim. Allogeneic femoral taub hau tuaj yeem siv los kho cov pob txha femoral condyle thiab tibial plateau defects, feem ntau yog rau kev kho cov pob txha loj-hom cavity, thiab raug kho los ntawm kev nias-fitting tom qab trimming thiab shaping. Cov txiaj ntsig kho mob thaum ntxov ntawm kev siv cov pob txha allogeneic los kho cov pob txha defects qhia tau tias muaj kev kho mob siab ntawm cov pob txha hloov pauv (Daim DuabII-1-3, Daim DuabII-1-4).
DuabII-1-3Kho qhov tsis zoo ntawm pob txha femoral nrog kev hloov pob txha taub hau femoral allogeneic
DuabII-1-4Kho qhov tsis zoo ntawm pob txha tibial nrog cov pob txha taub hau allogeneic femoral graft
III.Kev siv tshuab ua kom puv hlau
Kev siv tshuab modular Kev siv tshuab modular txhais tau tias cov hlau fillers tuaj yeem sib dhos nrog cov prostheses thiab intramedullary stems. Cov fillers suav nrog ntau yam qauv los pab txhawb kev kho dua tshiab ntawm cov pob txha tsis zoo ntawm ntau qhov ntau thiab tsawg.
Xim hlau Kev kho hniav cuav Kev Txhim Kho：Lub modular hlau spacer feem ntau yog tsim rau AORI hom II tsis-containment pob txha tsis zoo nrog tuab txog li 2 cm.Kev siv cov khoom siv hlau los kho cov pob txha puas yog qhov yooj yim, yooj yim, thiab muaj cov txiaj ntsig zoo rau kev kho mob.
Cov hlau spacers tuaj yeem muaj qhov porous lossis khov kho, thiab lawv cov duab suav nrog wedges lossis blocks. Cov hlau spacers tuaj yeem txuas nrog cov pob qij txha prosthesis los ntawm cov ntsia hlau lossis kho los ntawm cov pob txha cement. Qee cov kws tshawb fawb ntseeg tias kev kho pob txha cement tuaj yeem zam kev hnav ntawm cov hlau thiab pom zoo kom kho pob txha cement. Qee cov kws tshawb fawb kuj tawm tswv yim txoj kev siv cov pob txha cement ua ntej thiab tom qab ntawd txhawb nqa nrog cov ntsia hlau ntawm spacer thiab prosthesis. Cov qhov tsis zoo ntawm femoral feem ntau tshwm sim hauv cov qhov tom qab thiab distal ntawm femoral condyle, yog li cov hlau spacers feem ntau raug tso rau hauv cov qhov tom qab thiab distal ntawm femoral condyle. Rau cov pob txha tibial tsis zoo, wedges lossis blocks tuaj yeem xaiv rau kev tsim kho dua tshiab kom hloov kho rau ntau yam tsis zoo. Cov ntaub ntawv qhia tias cov nqi zoo heev thiab zoo yog siab txog 84% txog 98%.
Cov blocks zoo li wedge siv thaum qhov pob txha tsis zoo li wedge, uas tuaj yeem khaws cov pob txha ntau dua. Txoj kev no xav tau kev kho pob txha kom raug kom qhov chaw kho pob txha phim lub block. Ntxiv nrog rau kev ntxhov siab compressive, kuj tseem muaj lub zog shear ntawm qhov sib cuag. Yog li ntawd, lub kaum sab xis ntawm wedge yuav tsum tsis pub tshaj 15 °. Piv nrog cov blocks zoo li wedge, cov blocks hlau cylindrical muaj qhov tsis zoo ntawm kev nce qhov ntau ntawm osteotomy, tab sis kev phais mob yooj yim thiab yooj yim, thiab cov nyhuv kho tshuab ze rau qhov ib txwm muaj (III-1-1A, B).
DuabIII-1-1Cov hlau spacers: Ib qho wedge-puab spacer los kho cov teeb meem tibial; B column-puab spacer los kho cov teeb meem tibial
Vim tias cov hlau spacers tau tsim los ntawm ntau yam duab thiab qhov ntau thiab tsawg, lawv tau siv dav hauv cov pob txha tsis muaj qhov tsis zoo thiab cov pob txha tsis zoo ntawm ntau yam duab, thiab muab kev ruaj khov zoo thaum pib. Txawm li cas los xij, kev tshawb fawb ntev tau pom tias cov hlau spacers ua tsis tiav vim yog kev tiv thaiv kev ntxhov siab. Piv nrog rau cov pob txha grafts, yog tias cov hlau spacers ua tsis tiav thiab xav tau kev kho dua tshiab, lawv yuav ua rau cov pob txha loj dua.
Lub sijhawm tshaj tawm: Lub Kaum Hli-28-2024
