I.Pob txha cement filling txheej txheem
Cov pob txha cement filling yog tsim rau cov neeg mob uas muaj cov pob txha me me AORI hom I thiab tsis muaj kev ua ub ua no.
Cov pob txha pob txha yooj yim thev naus laus zis thev naus laus zis yuav tsum tau ua tib zoo tu cov pob txha tsis xws luag, thiab cov pob txha cement ua rau cov pob txha tsis xws luag thaum lub sij hawm ua khob noom cookie, kom nws tuaj yeem muab ntim rau hauv qhov khoob ntawm cov ces kaum ntawm qhov tsis xws luag ntau npaum li qhov ua tau, yog li ua tiav nruj haum nrog tus tswv tsev pob txha interface.
Txoj kev tshwj xeeb ntawmBibCib +SCov neeg ua haujlwm thev naus laus zis yog txhawm rau ntxuav cov pob txha kom huv si, tom qab ntawd kho cov ntsia hlau ntawm cov pob txha ntawm tus tswv tsev, thiab ceev faj kom tsis txhob cia lub hau ntsia hlau tshaj cov pob txha pob txha ntawm lub platform tom qab osteotomy; tom qab ntawd sib tov cov pob txha cement, sau cov pob txha tsis xws luag hauv lub khob noom cookie theem, thiab qhwv cov ntsia hlau. Ritter MA et al. siv txoj kev no los tsim kho cov pob txha tibial toj siab, thiab qhov tsis xws luag thickness mus txog 9 hli, thiab tsis muaj loosening 3 xyoos tom qab ua haujlwm. Cov pob txha cement filling tshuab tshem tawm cov pob txha tsawg dua, thiab tom qab ntawd siv cov kev kho prosthesis cov pa, yog li txo cov nqi kho mob vim yog siv cov tshuaj kho prostheses, uas muaj cov txiaj ntsig zoo.
Cov txheej txheem tshwj xeeb ntawm cov pob txha cement + ntsia hlau thev naus laus zis yog txhawm rau ntxuav cov pob txha tsis zoo, txhim kho cov ntsia hlau ntawm tus tswv tsev pob txha, thiab ua tib zoo saib xyuas tias lub hau ntswj yuav tsum tsis txhob tshaj cov pob txha ntawm qhov sib koom ua ke tom qab osteotomy; tom qab ntawd sib tov cov pob txha cement, sau cov pob txha tsis xws luag hauv lub khob noom cookie theem, thiab qhwv cov ntsia hlau. Ritter MA et al. siv txoj kev no los tsim kho cov pob txha tibial toj siab, thiab qhov tsis xws luag thickness mus txog 9 hli, thiab tsis muaj qhov xoob 3 xyoos tom qab kev phais. Cov pob txha cement filling tshuab tshem tawm cov pob txha tsawg dua, thiab tom qab ntawd siv cov kev kho kom zoo dua qub, yog li txo cov nqi kho mob vim yog siv cov kev kho prosthesis, uas muaj qee qhov txiaj ntsig (Daim duabIb-1).
Daim duabIb-1Pob txha cement filling thiab ntsia hlau reinforcement
II.Cov txheej txheem grafting pob txha
Compression pob txha grafting tuaj yeem siv los kho cov pob txha tsis xws luag hauv lub hauv caug kho dua tshiab. Nws yog qhov tsim nyog rau kev tsim kho ntawm AROI hom I rau III pob txha tsis xws luag. Hauv kev kho dua tshiab, txij li qhov muaj thiab qib ntawm cov pob txha tsis xws luag feem ntau hnyav, cov pob txha autologous tau txais me me thiab feem ntau yog cov pob txha sclerotic thaum cov pob txha thiab pob txha pob txha raug tshem tawm thaum phais kom khaws cov pob txha loj. Yog li ntawd, granular allogeneic pob txha feem ntau yog siv rau compression pob txha grafting thaum kho kho phais.
Qhov zoo ntawm compression pob txha grafting yog: khaws cov pob txha loj ntawm tus tswv tsev pob txha; kho cov pob txha yooj yooj yim lossis complex pob txha.
Qhov tsis zoo ntawm cov thev naus laus zis no yog: kev ua haujlwm yog siv sijhawm ntev; kev tsim kho tshuab yog xav tau (tshwj xeeb tshaj yog thaum siv MESH tawb loj); muaj peev xwm kis tau tus kab mob.
Yooj yim compression pob txha grafting:Yooj yim compression pob txha grafting feem ntau yog siv rau cov pob txha tsis xws luag. Qhov txawv ntawm compression pob txha grafting thiab structural pob txha grafting yog hais tias cov granular pob txha graft khoom ua los ntawm compression pob txha grafting yuav sai sai thiab tag revascularized.
Mesh hlau tawb + compression pob txha grafting:Cov pob txha tsis suav nrog feem ntau xav tau kev tsim kho dua tshiab siv cov hlau mesh rau cog cov pob txha. Reconstruction ntawm tus femur feem ntau nyuaj tshaj li reconstruction ntawm tibia. X-rays qhia tau hais tias kev sib koom ua ke ntawm pob txha thiab pob txha shaping ntawm cov khoom graft yog maj mam ua tiav (Daim duabII-1-1, Daim duabII-1-2).
Daim duabII-1-1Mesh tawb internal compression pob txha grafting los kho tibial pob txha tsis xws luag. Ib Intraoperative; B Postoperative X-ray
Daim duabib II-1-2Kho cov pob txha femoral thiab tibia tsis xws luag nrog titanium mesh internal compression pob txha grafting. Ib Intraoperative; B Postoperative X-ray
Thaum kho lub hauv caug arthroplasty, allogeneic structural pob txha yog tsuas yog siv los kho AORI hom II lossis III pob txha tsis xws luag. Ntxiv nrog rau kev muaj kev phais zoo tshaj plaws thiab kev paub nplua nuj hauv kev hloov hauv lub hauv caug, tus kws phais yuav tsum tau ua tib zoo saib xyuas thiab nthuav dav cov phiaj xwm ua ntej. Cov pob txha grafting tuaj yeem siv los kho cov pob txha cortical tsis xws luag thiab nce pob txha loj.
Qhov zoo ntawm cov thev naus laus zis no suav nrog: Nws tuaj yeem ua rau txhua qhov loj thiab cov duab los hloov kho cov pob txha ntawm cov duab geometric sib txawv; nws muaj kev txhawb nqa zoo ntawm kev hloov kho prostheses; thiab kev sib xyaw ua ke mus sij hawm ntev tuaj yeem ua tiav ntawm cov pob txha allogeneic thiab tus tswv tsev pob txha.
Qhov tsis zoo suav nrog: lub sijhawm ua haujlwm ntev thaum txiav cov pob txha allogeneic; txwv qhov chaw ntawm cov pob txha allogeneic; kev pheej hmoo ntawm nonunion thiab ncua union vim muaj tej yam xws li pob txha resorption thiab qaug zog fracture ua ntej cov txheej txheem pob txha ua tiav; teeb meem nrog kev nqus thiab kis ntawm cov ntaub ntawv hloov pauv; muaj peev xwm kis tau tus kab mob; thiab tsis txaus pib stability ntawm allogeneic pob txha. Allogeneic structural pob txha yog sau los ntawm lub distal femur, proximal tibia, los yog femoral taub hau. Yog tias cov khoom hloov pauv loj, ua tiav revascularization feem ntau tsis tshwm sim. Allogeneic femoral hau tuaj yeem siv los kho femoral condyle thiab tibial plateau pob txha tsis xws luag, feem ntau yog kho cov kab noj hniav loj-hom pob txha tsis xws luag, thiab kho los ntawm nias-haum tom qab trimming thiab shaping. Cov txiaj ntsig ntawm kev kho mob thaum ntxov ntawm kev siv cov pob txha allogeneic los kho cov pob txha tsis xws luag tau pom tias muaj kev kho mob siab ntawm cov pob txha hloov pauv (Daim duabII-1-3, Daim duabII-1-4).
Daim duabII-1-3Kho cov pob txha femoral tsis xws luag nrog allogeneic femoral taub hau qauv pob txha graft
Daim duabII-1-4Kho cov pob txha tibial tsis xws luag nrog allogeneic femoral taub hau pob txha graft
III.Hlau filling tshuab
Modular thev naus laus zis Modular thev naus laus zis txhais tau tias cov khoom siv hlau tuaj yeem sib sau ua ke nrog prostheses thiab intramedullary stems. Cov fillers suav nrog ntau yam qauv los pab txhawb kev tsim kho cov pob txha ntawm qhov sib txawv.
Hlau Prosthetic Augments:Modular hlau spacer yog tsim rau AORI hom II uas tsis yog-containment pob txha tsis xws luag nrog ib tug tuab txog li 2 cm.Kev siv cov khoom siv hlau los kho cov pob txha tsis xws luag yog qhov yooj yim, yooj yim, thiab muaj cov txiaj ntsig kho mob txhim khu kev qha.
Hlau spacers tuaj yeem ntxeem tau lossis khoom, thiab lawv cov duab muaj xws li cov npoo lossis cov blocks. Cov hlau spacers tuaj yeem txuas nrog kev sib koom tes prosthesis los ntawm cov ntsia hlau los yog kho los ntawm cov pob txha cement. Qee cov kws tshawb fawb ntseeg tias kev kho pob txha pob txha tuaj yeem zam kev hnav ntawm cov hlau thiab pom zoo kom pob txha cement fixation. Qee cov kws tshawb fawb tseem tawm tswv yim txog kev siv cov pob txha pob txha ua ntej thiab tom qab ntawd ntxiv nrog cov ntsia hlau nruab nrab ntawm lub spacer thiab prosthesis. Femoral defects feem ntau tshwm sim nyob rau hauv lub posterior thiab distal qhov chaw ntawm lub femoral condyle, yog li hlau spacers feem ntau yog muab tso rau hauv lub posterior thiab distal qhov chaw ntawm lub femoral condyle. Rau tibial pob txha tsis xws luag, wedges lossis blocks tuaj yeem xaiv rau kev tsim kho kom haum rau cov duab sib txawv. Cov ntaub ntawv qhia tias qhov zoo thiab zoo tus nqi yog siab li 84% mus rau 98%.
Wedge-shaped blocks yog siv thaum cov pob txha tsis zoo yog cov kab zoo li, uas tuaj yeem khaws cov pob txha ntau dua. Txoj kev no yuav tsum tau osteotomy meej kom cov osteotomy nto phim lub thaiv. Ntxiv nrog rau kev ntxhov siab compressive, kuj tseem muaj zog shear ntawm qhov kev sib cuag. Yog li ntawd, lub kaum sab xis ntawm lub wedge yuav tsum tsis txhob ntau tshaj 15 °. Muab piv nrog cov kab nrib pleb, cov cylindrical hlau blocks muaj qhov tsis zoo ntawm kev ua kom cov osteotomy, tab sis kev ua haujlwm phais yog yooj yim thiab yooj yim, thiab cov nyhuv mechanical yog ze li qub (III-1-1A, B).
Daim duabIII-1-1Hlau spacers: Ib lub voj voos kheej kheej los kho tibial qhov tsis xws luag; B kem-shaped spacer kho tibial qhov tsis xws luag
Vim cov hlau spacers yog tsim los ntawm ntau yam duab thiab qhov ntau thiab tsawg, lawv tau siv dav hauv cov pob txha tsis muaj pob txha thiab cov pob txha tsis xws luag ntawm ntau yam duab, thiab muab cov khoom zoo hauv kev ruaj ntseg. Txawm li cas los xij, kev tshawb fawb mus sij hawm ntev tau pom tias hlau spacers ua tsis tiav vim muaj kev ntxhov siab tiv thaiv. Piv nrog rau cov pob txha grafts, yog tias hlau spacers ua tsis tiav thiab yuav tsum tau hloov kho, lawv yuav ua rau cov pob txha loj dua.
Post lub sij hawm: Oct-28-2024
