Meriana ea lipapali · Tataiso ea kaho ea ACL
Lisebelisoa tsa ho lokisa graft tsa ACL li boloka ho hlomathiseletsoa bocha ho femur le tibia ha kopanyo ea tlhaho e ntse e tsoela pele. Li-screws tsa tšitiso, likonopo tsa cortical, staples, posts, ankora, le hybrid constructs li etsa hore ho be le tokiso libakeng tse fapaneng le ka mekhoa e fapaneng. Ha ho sesebelisoa se le seng se loketseng mokuli e mong le e mong, graft, tunnel, kapa boemo ba ntlafatso.
Ho Lokisoa ha ACL le ACL Reconstruction ha se Mokhoa o Tšoanang
Mantsoe a ho lokisa ACL le ACL tsosoloso ha aa lokela ho sebelisoa ka mokhoa o fapaneng.
| Mokhoa | Ho phekoloa Mokhoa oa | ho lokisa o sebelisoa joang |
|---|---|---|
| Tokiso ea mantlha ea ACL | Meokho e khethiloeng e lekantsoe hape ka boiteko ba ho boloka mosi oa tlhaho oa mokuli. | Li-sutures, liankora, likonopo, kapa kaho ea ho eketsa li ka ts'ehetsa ligament e lokisitsoeng, ho latela mokhoa. |
| ACL tsosoloso | ACL e tabohileng e nkeloa sebaka ke autograft kapa allograft. | The graft e sirelelitsoe ka har'a lithanele tsa botšehali le li-tibial kapa li-sockets ho sebelisa aperture, suspensory, kapa hybrid fixation. |
Sengoliloeng sena se tsepamisitse maikutlo haholo ho lokisoeng ha graft nakong ea kaho bocha ea ACL . Tokiso ea mantlha e fumaneha feela bakeng sa mekhoa e khethiloeng ea likotsi 'me e na le matšoao a fapaneng, biology, lisebelisoa, le lintlha tsa tokiso.
Lisebelisoa tsa ho lokisa ha li etse hore ts'ebetso ea ACL e senyehe ka bobona. Ho fihlella ha li-arthroscopic, kotopo kapa li-socket, khetho ea graft, kalafo e amanang le meniscal kapa lefufuru, le mokhoa o akaretsang oa ho buoa o khetholla tšitiso ea lisele le ho hlaphoheloa.
Hobaneng ha Graft Fixation e le Bohlokoa ho Tsosoloso ea ACL?
Sehlomathiso sa kaho se tlameha ho hlahisa tšebetso ea botsitso ea matsoalloa a ACL. Pele ho kenyelletsoa ha likokoana-hloko ho thehoa, mohaho oa ho lokisa o jara mojaro le ho fokotsa ho falla ha graft. Sepheo ke ho boloka boemo bo reretsoeng ba ho hlomathisetsoa le tsitsipano ntle le ho senya graft kapa ho senya kotopo ea masapo.
Ho lokisa ke karolo e le 'ngoe feela ea ho tsosolosoa. Ho behoa ha kotopo, khetho ea graft le ho itokisa, boikaketsi, boemo ba lengole nakong ea ho lokisoa, phekolo ea likotsi tse amanang le eona, ho tsosolosa, le lintlha tsa mokuli le tsona li ama phello.
Aperture, Suspensory, le Supplemental Fixation
Ho lokisa sekoti
Ho lokisa lesoba ho tiisa sehlomathiso se haufi le ho buloa ha kotopo ea masapo. Sekoti sa tšitiso ke mohlala o tsebahalang haholo. Sekurufu se petelletsa sehlomathiso sa linama tse bonolo kapa boloko ba masapo khahlanong le lebota la kotopo. Sena se ka fokotsa motsamao oa kotopo ea graft, empa ho beoa ho tlameha ho qoba ho putlama ha graft, ho fapana, ho kenella ka kopanelo, le tahlehelo ea ho lokisa.
Suspensory fixation
Suspensory fixation e fetisetsa mojaro oa graft ho cortex e ka ntle. Konopo ea cortical e nang le loop e tsitsitseng kapa e feto-fetohang e atisa ho sebelisoa ka lehlakoreng la botšehali 'me e ka boela ea sebelisoa ka mekhoa eohle ea ka hare. Bolelele bo nepahetseng ba kotopo, tsela ea konopo, ho tsamaisoa ha cortical, taolo ea loop, le litulo tsa graft li bohlokoa.
Tlatsetso kapa hybrid fixation
A hybrid construct e kopanya mekhoa ea ho lokisa, kapa e eketsa staple, post-and-washer, ankora, kapa lisebelisoa tse ling tsa bekapo ha ngaka e buoang e e-na le matšoenyeho mabapi le tokiso ea mantlha. Supplemental fixation e eketsa li-interfaces le hardware, kahoo melemo ea eona le matšoao a ka 'nang a e-ba teng li tlameha ho nkoa bakeng sa nyeoe ea motho ka mong.
Mefuta ea Knee Ligament Fixation Devices
Li-screws tsa ho kena-kenana le
'Aperture fixation' ea botšehali kapa tibialE behiloe ka har'a kotopo ho hatella lesela kapa lesapo. Likhetho li kenyelletsa tšepe, PEEK, le lisebelisoa tsa bioabsorbable kapa biocomposite. Diameter, bolelele, moralo oa khoele, tsela ea ho kenya, le taba ea tšireletso ea graft.
Likonopo tsa cortical
Suspensory fixation Loop e tsitsitseng kapa e feto-fetohangKonopo e lula holim'a cortex e ka ntle ha lupu e tšehetsa graft. Mokhoa ona o ka amohela li-grafts tsa lisele tse bonolo le ho aha bocha, empa ho hloka hore ho behoe litulo le litulo tse netefalitsoeng.
Melaetsa le lipehelo
tlatsetso ea bekapo Khetho eaLi-staples tsa ligament kapa li-screw-and-washer li ka sireletsa li-sutures kapa tsa matlafatsa tibial fixation maemong a khethiloeng. Botumo ba Hardware le ho teneha ha lehae ke lintlha tse amehang.
Suture ankora le augmentation
Ho lokisa kapa ho matlafatsa Technique e itšetlehileng ka eonaLiankora li ka boloka lisele tse bonolo kapa li-sutures ka mekhoa e khethiloeng ea ho lokisa le ho tlatselletsa. Suture-tape augmentation ha e nke sebaka sa ponts'o e nepahetseng, ho beoa ha anatomic, tsitsipano e nepahetseng, kapa pholiso ea tlhaho.
Metallic, PEEK, le Bioabsorbable Fixation Materials
| Sehlopha sa lintho tse bonahalang | Melemo e ka bang teng | Mehopolo ea bohlokoa |
|---|---|---|
| Titanium kapa lisebelisoa tse ling tsa tšepe | Matla a phahameng, tšebeliso e thehiloeng, e bonahalang ho li-radiographs, 'me ha ho na karabelo ea ho senyeha. | Litšoantšo tsa maiketsetso, matšoao a ka bang teng a hardware, le tšitiso e ka bang teng mosebetsing oa kotopo ea ntlafatso. |
| PEKE | Radiolucent polymer, ha ho na bioabsorption, le pono e bonolo ea kotopo e potolohileng litšoantšong tse ling. | Sesebelisoa se sala 'meleng; boemo bo ka hloka matšoao a radiopaque kapa netefatso e 'ngoe. |
| Li-polymers tsa bioabsorbable kapa tsa biocomposite | E etselitsoe ho nyenyefatsa ha nako e ntse e ea 'me e ka fokotsa lisebelisoa tse kenngoeng ka ho sa feleng. | Ho senyeha ho itšetlehile ka lintho tse bonahalang; cyst, karabelo ea ho ruruha, ho robeha, ho falla, kapa liphetoho tsa kotopo li tlalehiloe. |
Tlhahlobo ea meta ea liteko tse 14 tse sa reroang ha lia ka tsa fumana phapang e kholo mosebetsing oa mangole oa boikemelo kapa ho laxity lipakeng tsa li-screws tse kenang ka har'a bioabsorbable le metallic interference, athe sehlopha sa bioabsorbable se ne se e-na le kotsi e kopaneng ea mathata. Sena ha se bolele hore sekoti se seng le se seng sa tšepe se molemo; lintho tse bonahalang, moralo, ho hlomathiseletsoa, thekeniki le maemo a mokuli li ntse li bohlokoa.
Kamoo Lingaka tsa Lingaka li Khethang Mohaho oa ho Lokisa ACL
Khetho e etsoa mahlakoreng ka bobeli a graft. Lisebelisoa tsa basali le li-tibial ha lia lokela ho sebelisa mochine o tšoanang. Lintlha tsa bohlokoa li kenyelletsa:
- Graft: bone-patellar tendon-bone, hamstring, quadriceps tendon, autograft kapa allograft, li-tissue tse bonolo-feela kapa tse thibelang masapo.
- Moralo oa kotopo: kotopo e felletseng kapa sokete, bophara, bolelele, bots'epehi ba cortical, tataiso ea kotopo, le masapo a fumanehang.
- Lintlha tsa mokuli: boleng ba masapo, lilemo, lipakane tsa mosebetsi, kholo ea masapo, opereishene e fetileng, le likotsi tse amanang le tsona.
- Opereishene ea mantlha kapa ea ntlafatso: ho atolosoa ha kotopo e teng, lisebelisoa tse bolokiloeng, bokooa ba masapo le tlhoko ea ho aha bocha.
- Litlhoko tsa kaho: tatellano e reriloeng ea tsitsipano, sebaka sa ho lokisa, ho lokisa bekapo, litlhoko tsa ho nka litšoantšo, le ntlafatso e lebelletsoeng.
- Ho tsamaellana le sistimi: boholo ba graft, litekanyo tsa ho cheka le tataiso, li-implant, bolelele ba loop, li-screw dimensions, le likhokahano tse netefalitsoeng tsa lisebelisoa.
- Boiphihlelo ba ngaka ea opereishene: ho tloaelana le ho tsamaisoa, mekhoa ea ho hloleha, likhetho tsa pholoso, le netefatso ea intraoperative.
XC Medico's Sistimi ea ho lokisa ligament ea ACL/PCL e bonts'a mehlala ea litlhophiso tsa ho kenya le lisebelisoa. Lintlha tsa sehlahisoa li lokela ho hlahlojoa khafetsa khahlano le ts'ebeliso e lumelletsoeng ea sesebelisoa le mokhoa o reriloeng oa ngaka.
Na Likonopo kapa Li-Screws tsa Tšitiso li Hlahisa Liphetho tse Betere?
Bopaki ba hona joale ha bo tšehetse boemo bo bonolo ba bokahohle. Tlhahlobo ea marang-rang e bapisang screw ea tšitiso, konopo ea cortical, le cross-pin femoral fixation bakeng sa hamstring autografts ha ea ka ea fumana liphapang tsa bohlokoa ho latela liphello tsa mantlha tsa kliniki tse ithutoang. Tlhahlobo e 'ngoe e hlophisitsoeng e fumane ts'ebetso e ts'oanang, botsoa, le ho putlama lipakeng tsa ho lokisoa ha ka hare ho tsohle le kaho e felletseng ea kotopo, athe liphuputso tse ling tsa kotopo ea radiographic li ne li fapane.
| Potso ya papiso | Tlhaloso e leka-lekaneng |
|---|---|
| Na ho lokisa aperture ho feta anatomic? | E tiisa kotopo haufi le kotopo e kopaneng ea kotopo, empa katleho ea anatomic e boetse e ipapisitse le boemo bo nepahetseng ba kotopo, boholo ba kotopo, tsitsipano le ho beoa. |
| Na suspensory fixation e matla? | Ho emisoa ha cortical ho ka fana ka matla a lekaneng a pele, empa ts'ebetso ea ho aha e ipapisitse le litulo tsa konopo, boits'oaro ba loop, cortex, kotopo le graft. |
| Na screw ea bioabsorbable e ntlafatsa sephetho? | E fokotsa lisebelisoa tsa tšepe tse sa feleng, empa bophahamo ba kliniki ha bo so thehoe mme mathata a amanang le thepa a hloka ho nahanoa. |
| Na ho lokisa bekapo kamehla hoa thusa? | E ka 'na ea e-ba molemo ha ho lokisoa ha mantlha e le ntho e amehang, empa e eketsa lisebelisoa tsa thepa' me e ka 'na ea se ke ea ntlafatsa liphello tse nang le moelelo mosebetsing o mong le o mong oa kaho. |
Qeto e sebetsang ke hore ho lokisoa ho bolokehileng, ho sebelisoang ka nepo ho tsamaellanang le graft le kotopo ho bohlokoa ho feta ho khetha sesebelisoa ka sehlopha sa papatso feela.
Kamoo Instrument e Setang Tšehetso Reproducible ACL Reconstruction
Ho kenngoa ho sebetsa e le karolo ea tsamaiso e feletseng. Litataiso tsa lithanele, li-block blocks, li-sutures tse fetang, li-reamer, li-gauge tse tebileng, li-buttons, li-screwdrivers, lipompo, lisebelisoa tsa ho lokisa graft, le mokhatlo oa literei kaofela li ama tšebetso ea mosebetsi. Tataiso e sa tsamaellaneng, mokhanni ea senyehileng, boholo bo fosahetseng ba ho cheka, kapa sesebelisoa se sieo se fetang se ka senya moralo o mong o loketseng oa ho lokisa.
Explore an all-in cruciate ligament reconstruction sete kapa sephara arthroscopy sesebelisoa-sete mefuta e fapaneng . Pele o sebelisoa, netefatsa litaba tsa terei, ho lumellana, litaelo tsa ho hloekisa le ho thibela likokoana-hloko, litekanyetso tsa tlhahlobo, le ho fumaneha ha tse ling.
Mathata a amanang le Tokiso e ka 'nang ea E-ba teng
Mathata a ka hlaha ho tsoa ho sesebelisoa, ho hlomathiseletsoa, kotopo, mokhoa, baeloji, ts'oaetso, ho khutlisa, kapa ho lematsa hape. Mathata a amanang le ho lokisa a ka kenyelletsa:
- tahlehelo ea ho lokisa, ho thella ha graft, ho lelefatsa, kapa ho lokoloha ha moaho;
- ho falla ha konopo, ho kenngoa ha cortical e sa phethahalang, ho kenngoa ha lisele tse bonolo, kapa mathata a amanang le loop;
- ho arohana ha screw, ho robeha, ho falla, ho kenella ka kopanelo, kapa ho senyeha ha graft nakong ea ho kenngoa;
- ntho e ka sehloohong, poso, washer kapa konopo e bakang ho teneha sebakeng sa heno;
- ho atolosoa ha kotopo, sebopeho sa cyst, kapa karabelo e amanang le ho ruruha e amanang le lintho tse bonahalang;
- bothata ba ho hlalosa litšoantšo kapa ho lokisa kotopo ea ntlafatso nakong e tlang;
- tšoaetso, ho satalla, arthrofibrosis, ho se tsitse ho tsitsitseng, ho hlōleha ha graft, kapa ho tsosolosa.
Matšoao le ho hlaphoheloa ho ke ke ha boleloa esale pele ho tloha sesebelisoa sa ho lokisa feela. Ho se tsitse ho hocha, feberu, metsi a maqeba, ho ruruha ho ntseng ho eketseha, bohloko ba namane, ho lahleheloa ke ho sisinyeha, kapa bohloko bo ntseng bo mpefala bo sa lebelloang bo hloka tlhahlobo ea sehlopha sa lingaka.
Na ho Lokisoa ka Matla ho Bolela ho Tsosolosoa ka Potlako?
Ho lokisoa ha pele ho sireletsehileng ho thusa ho ts'ehetsa lenaneo le reriloeng la ntlafatso, empa ha le khutsufatse ho hlaphoheloa. Ho jara boima ba 'mele, ho tiisa, ho tsamaea, ho matlafatsa, ho matha, ho pota-pota, le tsoelo-pele ea ho khutlela papaling ho itšetlehile ka mokhoa oa graft, o amanang le meniscal kapa cartilage, ho lokisa, ho ruruha, matla, taolo ea neuromuscular, tlhahlobo ea bongaka, le protocol ea ngaka e buoang.
Tataiso ea AAOS e totobatsa tlhahlobo ea ts'ebetso pele e khutlela papaling mme e khothaletsa tokiso ea motho ka mong. Sesebelisoa sa ho lokisa ha sea lokela ho sebelisoa e le lona feela lebaka la ho potlakisa ho kenya kapa ho tlosa brace. Liphetoho tse ngata tsa ACL li etsoa e le mekhoa ea bakuli ba ka ntle, empa nako ea ho qeta nako e khethoa ke boemo bo feletseng ba kliniki ho e-na le sehlopha sa ho kenngoa.
Lipetlele le Bafani ba Lipetlele ba Lokela ho Hlahloba eng?
Tlhahlobo ea theko ea thepa e lokela ho hokahanya kemiso e 'ngoe le e' ngoe le lisebelisoa tsa eona, ho ngola mangolo, litokomane tsa taolo le ho latelloa. Lethathamo le bentšitsoeng kapa tseko e pharaletseng ea ho lumellana ha machaba ha ea lekana.
- Netefatsa ts'ebeliso e reriloeng le tumello ea 'maraka Bapisa sesebediswa hantle, moetso, thepa, moetsi oa molao, lihlopha, le 'maraka oa sebaka.
- Hlahloba tšebelisano ea lisebelisoa tsa li-implant Lekola li-interface tsa mokhanni, boholo ba liboro le lithanele, li-inserters, li-gauge tse tebileng, likonopo, li-loops, screws, staples, le likhetho tsa ho boloka.
- Netefatsa lisebelisoa le bopaki ba mochini Kopa litlhaloso, litifikeiti tse amanang le lotho, liteko tse amehang, mekhoa ea tlhahlobo le mekhoa ea ho amoheloa.
- Lekola boemo ba ho paka le ho thibela likokoana-hloko Hlakisa phepelo e hlapa kapa e sa bolaeeng, shelofo ea bophelo moo ho hlokahalang, ho ngola, ho lateloa, le litaelo tse netefalitsoeng tsa ho sebetsa hape.
- Lekola terei e felletseng Sebelisa leqephe la ho bala le laoloang, netefatsa matšoao le boemo, le tšebetso ea sesebelisoa sa teko pele ho tumello.
- Hlahloba taolo ea liphetoho le tšehetso ea litletlebo Hlalosa tsebiso mabapi le liphetoho ho thepa, moralo, mofani oa thepa, ts'ebetso, ho ngola, ho paka, kapa ho thibela likokoana-hloko.
Bareki ba ka hlahloba XC Medico's taolo ya boleng le tshebetso ya ho hlahloba le ho kopa bopaki bo kgethehileng ka sesebediswa nakong ya ho fumana mangolo.
Related XC Medico Sports Medicine Lisebelisoa
Lipotso Tse Botsoang Hangata
Ke eng e tšoereng ACL graft sebakeng?
Hangata graft e sirelelitsoe mahlakoreng a botšehali le a tibial ka li-screws tsa tšitiso, likonopo tsa cortical, cross-pins, posts, staples, kapa motsoako. Mohaho o itšetlehile ka mofuta oa graft, moralo oa kotopo, boleng ba masapo le mokhoa.
Phapano ke efe lipakeng tsa screw ea ho kena-kenana le konopo ea cortical?
Sekoti sa tšitiso se fana ka ho lokisa aperture ka ho hatella graft kapa lesapo la masapo ka har'a kotopo. Konopo ea cortical e fana ka suspensory fixation ka ho lula karolong e ka ntle ea cortex le ho tšehetsa graft ka loop.
Na li-screws tsa ACL tse absorbable li molemo ho feta li-screws tsa tšepe?
Eseng hohle. Bopaki ba teko e sa reroang bo fumane ts'ebetso e ts'oanang ea boikemelo le bofokoli, ha litlhahlobo tse ling tse kopaneng li tlaleha mathata a mangata ka li-screw tse absorbable. Lintho tse bonahalang, moralo, mokhoa, litšoantšo, le lintlha tsa ntlafatso li bohlokoa.
Na sesebelisoa sa ho lokisa se tšoanang se ka sebelisoa bakeng sa graft e 'ngoe le e' ngoe?
Che. Li-graft tsa masapo le li-tissue tse bonolo li na le lihokelo tse fapaneng, 'me bophara ba graft, bolelele, moralo oa kotopo le cortical bone li ama ho lumellana. Latela litaelo tsa lisebelisoa tse lumelletsoeng le mokhoa o reriloeng oa ho buoa.
Na brace e ka hare e nkela sebaka sa ACL graft?
Eseng ka bo eona. Suture-tape augmentation e ka matlafatsa mohaho o khethiloeng oa ho lokisa kapa oa ho tsosolosa, empa karolo ea eona e itšetlehile ka mokhoa le pontšo. Ha e lokise boleng bo fokolang ba linama, ho beoa ha nonanatomic, kapa ho se lokisehe hoa mantlha.
Na lisebelisoa tsa ho lokisa ACL li hloka ho tlosoa?
Ha ho hlokahale hore kamehla ho tlosoe. Ho tlosoa ho ka nahanoa bakeng sa lisebelisoa tse nang le matšoao kapa tse hlahelletseng, ts'oaetso, ho falla, ho buuoa ka ntlafatso, kapa lebaka le leng le itseng la kliniki.
Qetello
Lisebelisoa tsa ho lokisa ACL li etsa hore ho tsosolosoa ha sejoale-joale ho khonehe ka ho tsitsisa graft ha kopanyo ea baeloji e etsahala. Boleng ba bona bo tsoa ho kopantseng pontšo e nepahetseng, ho beoa ha kotopo ea anatomic, lisebelisoa tse tsamaellanang, tsitsipano e loketseng ea graft, phepelo e netefalitsoeng ea sesebelisoa, le tokiso e hlophisitsoeng. Li-screws tsa ho kena-kenana, likonopo tsa cortical, le li-hybrid constructs li na le mesebetsi e molemo; khetho e lokela ho ba ea motho ka mong ho fapana le ho ipapisa le tseko e akaretsang ea 'sesebelisoa se setle ka ho fetisisa'.
Litšupiso le Motheo oa Bohlophisi
- American Academy of Orthopedic Surgeons. Tsamaiso ea Anterior Cruciate Ligament Injuries Clinical Practice Guideline.
- Anterior Cruciate Ligament Reconstruction: Mekhoa ea ho Lokisa.
- Ho bapisa li-Screws tsa Interference tsa Bioabsorbable le Metallic bakeng sa Graft Fixation Nakong ea ho tsosolosoa ha ACL.
- Papiso ea Interference Screw, Cortical Button, le Cross-Pin Femoral Fixation.
- Tsohle Ka hare ho Suspensory Cortical Button Fixation Versus Full-Tunnel ACL Reconstruction.
