Ala ʻokiʻoki hōʻike ʻana o ka dorsal Scapular

· Anatomy i hoʻopili ʻia

Ma ke alo o ka scapula ka fossa subscapular, kahi e hoʻomaka ai ka ʻiʻo subscapularis. Ma hope aku ka ʻaoʻao scapular e hele ana i waho a piʻi iki i luna, kahi i māhele ʻia i ka fossa supraspinatus a me ka fossa infraspinatus, no ka hoʻopili ʻana o nā ʻiʻo supraspinatus a me infraspinatus. ʻO ka hopena waho o ka ʻaoʻao scapular ʻo ia ka acromion, ka mea e hana ana i ka hui acromioclavicular me ka hopena acromion o ka clavicle ma o kahi ʻili articular ovoid lōʻihi. ʻO ka palena kiʻekiʻe o ka ʻaoʻao scapular he notch liʻiliʻi U-ʻano, kahi i keʻa ʻia e kahi ligament suprascapular transverse pōkole akā paʻakikī, ma lalo o ia mea e hele ai ke aʻalolo suprascapular, a ma luna o ia mea e hele ai ke aʻa suprascapular. ʻO ka palena ʻaoʻao (axillary margin) o ka ʻaoʻao scapular ka mānoanoa loa a neʻe i waho i ke kumu o ka ʻāʻī scapular, kahi e hana ai i kahi notch glenoid me ka lihi o ka glenoid o ka hui poʻohiwi.

· Nā hōʻailona

1. Ka ʻoki ʻana i nā ʻōpū scapular maikaʻi ʻole.

2. ʻO ka ʻoki kūloko ʻana o ka puʻupuʻu ʻino o ka scapula.

3. ʻO ke scapula kiʻekiʻe a me nā kīnā ʻē aʻe.

4. Ka wehe ʻana i ka iwi make i ka osteomyelitis scapular.

5. ʻO ka maʻi paʻa ʻana o ke aʻalolo suprascapular.

· Kūlana kino

Kūlana moe hapa, hoʻokiʻekiʻe ʻia ma 30° i ka moena. Ua ʻōwili ʻia ka lālā o luna i hoʻopilikia ʻia me kahi kāwele sterile i hiki ke hoʻoneʻe ʻia i kēlā me kēia manawa i ka wā o ke ʻoki ʻana.

· Nā ʻanuʻu hana

1. Hana ʻia kahi ʻoki transverse ma ke kualono scapular ma ka fossa supraspinatus a me ka ʻaoʻao o luna o ka fossa infraspinatus, a hiki ke hana ʻia kahi ʻoki longitudinal ma ka lihi medial o ka scapula a i ʻole ka ʻaoʻao medial o ka fossa subscapularis. Hiki ke hoʻohui ʻia nā ʻoki transverse a me longitudinal e hana i kahi ʻano L, ʻano L i hoʻohuli ʻia, a i ʻole ke ʻano papa mua, ma muli o ka pono no ka nānā ʻana i nā ʻāpana like ʻole o ka scapula. Inā pono e hōʻike ʻia nā kihi o luna a me lalo o ka scapula, hiki ke hana ʻia nā ʻoki liʻiliʻi ma nā wahi like (Kiʻi 7-1-5(1)).

2. E ʻoki i ka fascia superficial a me ka fascia hohonu. ʻO nā ʻiʻo i hoʻopili ʻia i ka scapular ridge a me ka palena medial e ʻoki ʻia ma ke ʻano transverse a longitudinal paha ma ke kuhikuhi o ka ʻoki ʻana (Kiʻi 7-1-5(2)). Inā e hōʻike ʻia ka fossa supraspinatus, e ʻoki mua ʻia nā olonā o ka ʻiʻo trapezius waena. E ʻoki ʻia ka periosteum e kūʻē i ka ʻili iwi o ka scapular gonad, me kahi papa momona lahilahi ma waena o nā mea ʻelua, a ʻo nā fossa supraspinatus āpau e hōʻike ʻia e ka dissection subperiosteal o ka ʻiʻo supraspinatus, me ka ʻiʻo trapezius ma luna. I ka wā e ʻoki ai i nā olonā o luna o ka ʻiʻo trapezius, pono e mālama pono ʻaʻole e hōʻino i ke aʻalolo parasympathetic.

3. Ke hōʻike ʻia ke aʻalolo suprascapular, hiki ke huki ʻia i luna nā olonā o ka ʻaoʻao waena o luna o ka ʻiʻo trapezius, a hiki ke huki mālie ʻia i lalo ka ʻiʻo supraspinatus me ka ʻole o ka wehe ʻana, a ʻo ke ʻano keʻokeʻo ʻālohilohi i ʻike ʻia ʻo ia ka ligament transverse suprascapular. Ke ʻike ʻia a pale ʻia nā kīʻaha koko a me nā aʻalolo suprascapular, hiki ke ʻoki ʻia ka ligament transverse suprascapular, a hiki ke ʻimi ʻia ka scapular notch no kekahi mau ʻano ʻē, a laila hiki ke hoʻokuʻu ʻia ke aʻalolo suprascapular. ʻO ka hope loa, ua humuhumu ʻia ka ʻiʻo trapezius i wehe ʻia i hoʻopili ʻia i ka scapula.

4. Inā e hōʻike ʻia ka ʻaoʻao o luna o ka fossa infraspinatus, hiki ke ʻoki ʻia nā olonā haʻahaʻa a me waena o ka ʻiʻo trapezius a me ka ʻiʻo deltoid ma ka hoʻomaka ʻana o ke kualono scapular a hoʻihoʻi ʻia i luna a i lalo (Kiʻi 7-1-5(3)), a ma hope o ka hōʻike ʻia ʻana o ka ʻiʻo infraspinatus, hiki ke ʻili ʻia ma lalo o ka ʻili (Kiʻi 7-1-5(4)). Ke hoʻokokoke aku nei i ka hopena kiʻekiʻe o ka palena axillary o ka gonad scapular (ʻo ia hoʻi, ma lalo o ka glenoid), pono e uku ʻia ka nānā ʻana i ke aʻalolo axillary a me ke aʻa hope o ka rotator humeral e hele ana ma o ka foramen quadrilateral i hoʻopuni ʻia e ka teres minor, teres major, ke poʻo lōʻihi o ka triceps, a me ka ʻāʻī ʻoki o ka humerus, a me ke aʻa rotator scapulae e hele ana ma o ka foramen triangular i hoʻopuni ʻia e nā mea mua ʻekolu, i ʻole e hōʻeha iā lākou (Kiʻi 7-1-5(5)).

5. No ka hōʻike ʻana i ka palena waena o ka scapula, ma hope o ke ʻoki ʻana i nā olonā o ka ʻiʻo trapezius, ua huki ʻia nā ʻiʻo trapezius a me supraspinatus i luna a i waho ma o ka wehe ʻana o ka subperiosteal e hōʻike i ka ʻāpana medial o ka fossa supraspinatus a me ka ʻāpana o luna o ka palena medial; a ʻo nā ʻiʻo trapezius a me infraspinatus, me ka ʻiʻo vastus lateralis i hoʻopili ʻia i ke kihi haʻahaʻa o ka scapula, ua wehe ʻia i lalo e hōʻike i ka ʻāpana medial o ka fossa infraspinatus, ke kihi haʻahaʻa o ka scapula, a me ka ʻāpana haʻahaʻa o ka palena medial.

Kiʻi 7-1-5 Ala o ka hōʻike ʻana o ka dorsal scapular

(1) ʻoki ʻana; (2) ʻoki ʻana i ka laina ʻiʻo; (3) ʻoki ʻana i ka ʻiʻo deltoid mai ke kualono scapular; (4) hāpai ʻana i ka ʻiʻo deltoid e hōʻike i ka infraspinatus a me ka teres minor; (5) wehe ʻana i ka ʻiʻo infraspinatus e hōʻike i ka ʻaoʻao dorsal o ka scapula me ka anastomosis vascular

6. Inā e hōʻike ʻia ka fossa subscapular, pono e ʻili ʻia nā ʻiʻo i hoʻopili ʻia i ka papa o loko o ka palena medial, ʻo ia hoʻi, scapularis, rhomboids a me serratus anterior, i ka manawa like, a hiki ke hāpai ʻia ka scapula holoʻokoʻa i waho. I ka wā e hoʻokuʻu ai i ka palena medial, pono e mālama pono e pale i ka lālā iho o ke aʻa carotid transverse a me ke aʻalolo scapular dorsal. Hoʻomaka ka lālā iho o ke aʻa carotid transverse mai ke kumu o ka ʻāʻī thyroid a hele mai ke kihi o luna o ka scapula a i ke kihi o lalo o ka scapula ma o ka scapularis tenuissimus, ka ʻiʻo rhomboid a me ka ʻiʻo rhomboid, a ʻo ke aʻa rotator scapulae e hana i kahi pūnaewele vascular waiwai ma ka ʻaoʻao dorsal o ka scapula, no laila pono e hoʻopili pono ʻia i ka ʻili o ka iwi no ka ʻili ʻana o ka subperiosteal.