Te pokanga whakahou i muri i te arthroplasty hope katoa i roto i te momo Crowe Ⅳ dysplasia whanaketanga o te hope

3Te hanganga o te acetabulum

Na te ahua o te hanganga o te momo Crowe Ⅳ nga turoro DDH me te raupapa o nga raruraru i muri i te whakakapinga tuatahi, kaore e taea e te nuinga o nga prostheses whakatikatika te whakatutuki i te pumau tuatahi o te hononga, te pai o te kapi o te wheua, te whakapai ake ranei i nga ahua kino.

3.1Te tono o te kapu pumau koiora

I te mea he Paprosky momo II ranei i runga ake i te koha wheua i roto i te acetabulum me te kapu acetabular hemispherical koiora noa e kore e taea te whakarite pumau, ka taea te whakamahi i te kapu acetabular nui (Jumbo kapu) hei whakanui ake i te waahi whakapiri ki te wheua huri noa i te acetabulum me te whakanui ake i te waahi taapiri, kia tutuki ai te pumau mo te wa roa.

3.2Te grafting wheua

He tikanga whakatikatika koha kōiwi i te whare haumanu e whakamahia nuitia ana. Mo nga turoro he iti te koha o te wheua acetabular, ka taea te whakamahi i te kopa o te wheua acetabular ranei penei i te mowhiti whakakaha, te paraka whakarewa me te Cage ki te whakaora i te papatipu wheua, ki te whakatipu i nga oko toto, ki te hanga i nga wheua me te whakapai ake i te rahui wheua i te ngoikoretanga o te wheua acetabular, kia tutuki ai te kaupapa mo te pumau mo te wa roa o te prosthesis [10].

3.3Te whakamahi i nga taputapu whakarewa

I te wa ano, ka piki ake te waahi whakapiri i waenga i te kiko wheua i te waahi koha me te paraka whakarewa, ka taea te whakatairanga i te tipu o nga wheua. te pupuri me te whakanui i te pumau.

3.4Te tono mo te whare herehere me nga kapu e toru-parirau

He iti ake te wheua i roto i te pakitara waenga me te pou o mua o te momo Crowe Ⅳ DDH nga turoro, me etahi o nga turoro he maha nga ngoikoretanga o nga wheua i te wa o te whakatikatika, ka puta te koretake o te acetabular, a kaore e taea te whakatika i te kapu acetabular i te wa o te whakatikatika, na reira ka taea te whakamahi i te Cage me te kapu acetabular e toru nga parirau i tenei wa.

3.5Hangarau tā 3D

I nga turoro me te Paprosky momo Ⅲ he ngoikoretanga o te wheua, kaore te acetabulum i te haere tonu na te nui o te mate o nga wheua, e arai ana ki te koretake o te pelvic me te uaua ki te whakaurunga prosthesis acetabular. Ka taea te whakamahi i te hangarau tuhi 3D ki te hanga i te tauira ahu-toru o te pelvis o te manawanui, na roto i tenei ka taea e te kaiwhakahaere te mohio ki nga hapa o te acetabulum, te mohio ki te hanganga tinana o te rohe me te whanui o te koha, he pai ake te whakamahere i mua i te mahi, te whiriwhiri i nga waahanga e tika ana hei whakatika i te hapa, te whakamahi ranei i te hangarau taarua 3D ki te whakarite i nga waahanga o te hope me te whakakorikori motuhake.

4Te hanganga o te taha wahine

4.1Nga uaua pokanga

.Ko te ahua o te wahine i roto i nga turoro o te DDH i whakarereketia me te tohu o te wehenga o te hip.I roto ia ratou, ko te momo Crowe IV e tohuhia ana e te nui o te wehenga o te hononga hipoki, nga huringa tino nui i roto i te morphology me te mahi o te femur proximal, me te nui o te mate o te coxa vara me te valgus [11-12]. I te wa e wetekina ana te waahanga wahine o nga turoro DDH me te taha o te kohao me te wehenga o te wheua, he uaua te whakatikatika i te taha o te wahine. Pēnei i te tangohanga o te implant, te tiaki i te papatipu wheua, te hanganga o te wahine tata, te kowhiringa o te whakaurunga prosthesis tika me te whakapumautanga kua waiho hei uaua o te pokanga whakatikatika wahine [13].

4.2Whakatupato mo te mahi

He osteosclerosis pea kei roto i te uwha tata me te kohao medullary whaiti o nga turoro Crowe momo Ⅳ DDH i te wa o te pokanga whakatikatika. I te wa e tango ana i te porowhita o te kakau wahine koiora, me tango te kiko o te wheua sclerotic me te kiko kiko i takai ki roto i te uwha tata, me tino kitea te porowhita me te wehe i te atanga porowiwi-iwi ki te whakaiti i te ngaronga o nga wheua iatrogenic. Hei aukati i te puta mai o te puwhatanga cortical me te whati. Ko te korenga o te pokanga whakatikatika e whakawhirinaki ana ki te arotakenga o mua me te mahi i roto i te mahi i te tohu o te koha o te wheua wahine tata, te hoahoatanga, te kowhiringa me te whakatikatika i te prosthesis kua whakatohia, me te whakatau i te kounga o te toenga rahui wheua.

4.3Me pehea te whiriwhiri i te kakau tika?

Ko te prosthesis modular modular e whakamahia ana i roto i te pokanga whakahou o Crowe Ⅳ DDH tūroro. Ka taea e te wehenga modular prosthesis te pai ake te whakatutuki i nga hiahia tonu o te wahine o te manawanui, ka taea e te kakau wahine tawhiti te whakatutuki i te pumau urutau, a ka taea e te cuff tata te aukati i te osteolysis postoperative me te whakatika i te wewete. koha wahine, kia rite ki te whakatutuki i te hanganga wahine me te pupuri i te pūmautanga o te prosthesis hei kaupapa tuatahi.

5Me pehea te whiriwhiri i te riipene?

I tenei wa, ko te whaanui porowhita e whakamahia nuitia ana i roto i te pokanga ko te atanga whakarewa-whakarewa, te atanga whakarewa-polyethylene, te atanga ceramic-polyethylene me te atanga ceramic-ceramic [7,11]. Ko nga rauemi polyethylene te momo whiriwhiri i tenei wa. I tenei wa, kua whakakapia te riipene polyethylene tino hono i te riipene polyethylene tuku iho, he nui te whakamarumaru o te kakahu, ka whakaiti i te osteolysis me te kakahu i waenga i nga prostheses i muri i te mahi, me te pai ki te pupuri i te tohu mo te wa roa [16]. Ko te nuinga o nga turoro me te momo Crowe Ⅳ DDH he taitamariki i te wa i uru ai ratou ki te THA tuatahi, a he nui o raatau mahi o ia ra. Ki te whakaaro ki te koha o te kōiwi i ahu mai i te mau matūriki i te wa o te arotakenga me te uaua o te whakatikatika, me whiriwhiri te ararewa uku i te wa e taea ana i te THA tuatahi, i te whakahoutanga ranei. Ki te kore e taea te kowhiri na te iti o te rahi, ka taea te kowhiri i te riipene polyethylene tino honohono [17].O hei whakaroa i te oranga o te prosthesis me te whakaiti i te maha o nga mahi whakatikatika.

 

6Whakamutunga

.Ko te wetewete aseptic o te prosthesis te tino take o te whakatikatika i muri i te THA tuatahi mo te momo Crowe Ⅳ DDH. Ko te whakahekenga o te hononga, te koha o te wheua, te mate, te kore i te waahi osteotomy, me te whati o te prosthesis ka arahi ano ki te whakatikatika i te pokanga. Ko te raruraru nui tonu i roto i te pokanga whakatikatika mo nga turoro Crowe momo IV DDH. Ahakoa kua whakamatauhia te hangarau Cage, nga waahanga modular me te prosthesis kua whakaritea he pai mo te wa moata me te wa waenga i tenei waahanga, me whakamarama ake te reanga ora mo te wa roa.

Tohutoro

[1] Bilgen ÖF, Salar N, Bilgen MS, et al. Ko te paanga o te momo dislocation(Momo Crowe Ⅰ-Ⅳ) i runga i te whanaketanga pelvic i roto i te dysplasia whanaketanga o te hope: he rangahau radiologic o te anatomy. J Arthroplasty,2015, 30(5): 875-878.

[2] Yang Y, Liao W, Yi W, et al. Ko te rangahau morphological e toru nga waahanga o te wahine tata i roto i te momo Crowe Ⅳ whakawhanaketanga dysplasia o te hope. J Orthop Surg Res, 2021, 16(1): 621. doi: 10.1186/s13018-021-02789-5.

[3] Liu S, Zuo J, Li Z, et al. Ko te rangahau mo te ahua-toru o te wahine tata i roto i te dysplasia pakeke whanaketanga o te hope e tohu ana ko te prosthesis modular i runga i te papaa kaore pea i te pai mo nga turoro he momo Crowe Ⅳ hope. Int Orthop, 2017,41(4): 707-713.

[4] Kilicarslan K, Yalcin N, Cicek H, et al. He aha te mea ka tupu i te hononga o te turi e tata ana i muri i te arthroplasty hope katoa o te momo Crowe momo Ⅲ me Ⅳ hope dysplastic? J Arthroplasty, 2012, 27(2): 266-270.

[5] Gallo J, Goodman SB, Konttinen YT, et al. Te mate matūriki: nga tikanga koiora o te osteolysis periprosthetic i roto i te katoa o te arthroplasty hip. Immun Innate, 2013, 19(2): 213-224.

[6] Brown JM, Mistry JB, Cherian JJ, et al. Ko te whakatikatika i te waahanga wahine o te katoa o te arthroplasty hip. Orthopedics, 2016, 39(6): e1129-e1139.

[7] Telleria JJ, Gee AO. Whakar Clin Orthop Relat Res, 2013, 471(11):3725-3730.

[8] van der Donk S, Buma P, Slooff TJ, et al. Te whakaurunga o nga grafts kōiwi morselized: he rangahau mo nga tauira koiora 24 acetabular. Clin Orthop Relat Res, 2002(396): 131-141.

[9] Sugano N, Noble PC, Kamaric E, et al. Te morphology o te femur i roto i te dysplasia whanaketanga o te hope. J Bone Joint Surg(Br), 1998, 80(4): 711-719.

[10] Du Y, Li T, Sun J, et al. Ko te painga o te acetabulum teka i runga i te awaawa medullary proximal femoral i roto i te momo Crowe unilateral Ⅳwhakawhanaketanga o te hip. Ther Clin Risk Manag, 2020,16: 631-637.

[11] McCarthy JC, Lee JA. Te whakahounga matatini katoa o te arthroplasty hip me nga kakau tauira i te toharite o te 14 tau. Clin Orthop Relat Res, 2007, 465: 166-169.

[12] Sheth NP, Melnic CM, Rozell JC, et al. Te whakahaere i te mate kino o te wheua wahine i roto i te arotakenga katoa o te arthroplasty hip. Orthop Clin North (Am), 2015, 46(3): 329-342.

[13] Burstein G, Yoon P, Saleh KJ. Te tango i nga waahanga i roto i te whakahounga katoa o te arthroplasty hope. Clin Orthop Relat Res, 2004(420): 48-54.

[14]Wang S, Zhou Y, Ma H, et al. Nga hua o te wa-waenganui o te whakakapinga katoa o te hope me te osteotomy subtrochanteric, te kakau modular, me te mata uku i Crowe Ⅳ hip dysplasia. Arthroplast

I tenei ra, 2017, 4(3): 363-369.

[15]Bryan AJ, Calkins TE, Karas V, et al. Ko te arthroplasty hope katoa tuatahi i roto i nga turoro iti iho i te 50 tau te pakeke i te toharite o te 16 tau: ko te polyethylene tino whakawhiti ka tino whakaiti i te tupono ki te whakahou. J Arthroplasty, 2019, 34(7S): S238-S241.

[16]Amanatullah DF, Howard JL, Siman H, et al. Te whakahou i te katoa o te arthroplasty hope i roto i nga turoro me te mate nui o te koiwi wahine tata ma te whakamahi i tetahi waahanga whaeira taarua. Hononga Koiwi

J, 2015, 97-B(3): 312-317.

[17]Smith AJ, Dieppe P, Vernon K, et al. Reiti rahunga o nga whakakapinga konganuku-i-whakarewa hope: tātaritanga o nga raraunga mai i te National Joint Registry of England and Wales. Lancet, 2012, 379(9822): 1199-1204.