ʻOiai ʻo Sculco et al.Ua hōʻike mua i ka liʻiliʻi-incision total hip arthroplasty (THA) me ka posterolateral approach ma 1996, ua hōʻike ʻia kekahi mau hoʻololi hou minimally invasive.I kēia mau lā, ua hoʻolaha nui ʻia ka manaʻo minimally invasive a ʻae ʻia e nā kauka.Eia nō naʻe, ʻaʻohe manaʻo hoʻoholo akaka no ka hoʻohana ʻana i nā kaʻina hana maʻamau a liʻiliʻi paha.
ʻO nā mea maikaʻi o ka hōʻoki liʻiliʻi invasive ʻo ia nā ʻoki liʻiliʻi, liʻiliʻi ke koko, liʻiliʻi ka ʻeha, a me ka wikiwiki o ka hoʻōla;akā naʻe, ʻo nā hemahema e pili ana i ka palena o ka nānā ʻana, maʻalahi ka hana ʻana i nā ʻeha neurovascular lapaʻau, kūlana prosthesis maikaʻi ʻole, a me ka piʻi nui ʻana o ka hana hou ʻana.
I ka liʻiliʻi invasive total hip arthroplasty (MIS - THA), postoperative muscle strength loss is a important reason e pili ana i ka hoʻihoʻi hou ʻana, a ʻo ke kaʻina hana he mea nui ia e pili ana i ka ikaika o ka ʻiʻo.No ka laʻana, hiki ke hōʻino i nā pūʻulu ʻiʻo abductor a me nā ʻaoʻao mua pololei, e alakaʻi ana i kahi ala haʻalulu (Trendelenburg limp).
I ka hoʻāʻo ʻana e ʻimi i nā ala liʻiliʻi invasive e hōʻemi i ka pōʻino o ka ʻiʻo, ʻo Dr. Amanatullah et al.mai ka Mayo Clinic ma ʻAmelika Hui Pū ʻIa i hoʻohālikelike ʻia i ʻelua ala MIS-THA, ke ala pololei mua (DA) a me ke ala kiʻekiʻe kiʻekiʻe (DS), ma nā kikoʻī cadaveric e hoʻoholo ai i ka pōʻino o nā ʻiʻo a me nā tendon.Ua hōʻike ʻia nā hopena o kēia haʻawina ʻaʻole i hōʻino ʻia ke ala DS i nā ʻiʻo a me nā tendon ma mua o ke ala DA a ʻo ia paha ke kaʻina hana i makemake ʻia no MIS-THA.
Hoʻolālā hoʻokolohua
Ua mālama ʻia ke aʻo ʻana ma luna o ʻewalu mau kino make hou me ʻewalu mau pūhaka o 16 pūhaka me ka mōʻaukala ʻole o ka ʻoki ʻāʻī.Ua koho wale ʻia kekahi ʻūhā e hana i ka MIS-THA ma o ke ala DA a ʻo kekahi ma o ke ala DS i hoʻokahi cadaver, a ua hana ʻia nā kaʻina hana a pau e nā kauka loea.ʻO ka pae hope loa o ka ʻiʻo a me ka ʻeha tendon i loiloi ʻia e ke kauka orthopedic i komo ʻole i ka hana.
ʻO nā hale anatomical i loiloi ʻia: gluteus maximus, gluteus medius a me kona tendon, gluteus minimus a me kona tendon, vastus tensor fasciae latae, quadriceps femoris, trapezius luna, piatto, trapezius haʻahaʻa, obturator internus, a me obturator externus (Figure 1).Ua loiloi ʻia nā ʻiʻo no ka waimaka ʻiʻo a me ka palupalu i ʻike ʻia e ka maka.
Fig. 1 Anatomical diagram o kēlā me kēia ʻiʻo
Nā hualoaʻa
1. ʻO kaʻinoʻino:ʻAʻoheʻokoʻa helu helu i ka nui o ka pōʻino o ka honua i ka gluteus medius ma waena o ka DA a me DS.Eia naʻe, no ka puʻupuʻu gluteus minimus, ʻoi aku ka kiʻekiʻe o ka pākēneka o ka ʻeha o ka ʻili e ka hoʻokokoke DA ma mua o ka mea i hana ʻia e ka hoʻokokoke DS, a ʻaʻohe ʻokoʻa nui ma waena o nā ala ʻelua no ka ʻiʻo quadriceps.ʻAʻohe ʻokoʻa koʻikoʻi ma waena o nā ala ʻelua e pili ana i ka hōʻeha ʻana i ka ʻiʻo quadriceps, a ʻo ka pākēneka o ka ʻeha o ka ʻili i ka vastus tensor fasciae latae a me nā ʻiʻo rectus femoris i ʻoi aku ka nui me ka hoʻokokoke DA ma mua o ke ala DS.
2. Nā ʻeha tendon: ʻAʻohe ala i loaʻa i nā ʻeha nui.
3. Tendon transection: Uaʻoi aku ka kiʻekiʻe o ka lōʻihi o ka gluteus minimus tendon transection ma ka hui DA ma mua o ka hui DS, aʻoi aku ka kiʻekiʻe o ka hapa o kaʻeha ma ka hui DS.ʻAʻohe ʻokoʻa koʻikoʻi i nā ʻeha transection tendon ma waena o nā hui ʻelua no ka pyriformis a me ka obturator internus.Hōʻike ʻia ka schematic hana ma ka Fig.
Kii 2 1a.Hoʻopau i ka transection o ka gluteus minimus tendon i ka wā o ke kaʻina hana DA ma muli o ka pono o ka hoʻoponopono ʻana i ka femoral;1b.ʻO ka transection hapa o ka gluteus minimus e hōʻike ana i ka nui o ka hōʻeha i kona tendon a me ka ʻōpū ʻiʻo.gt.ʻoi aku ka nui o ka trochanter;* gluteus minimus.
Fig. 3 Hoʻolālā o ke ala pololei kuʻuna kuʻuna me ka acetabulum e ʻike ʻia ma ka ʻākau me ka huki kūpono.
Kiʻi 4 Ka hōʻike ʻana o ka ʻiʻo rotator waho pōkole i kahi ala hope THA maʻamau
Ka hopena a me nā hopena lapaʻau
He nui nā haʻawina mua i hōʻike ʻole i nā ʻokoʻa koʻikoʻi o ka lōʻihi o ka hana, ka mālama ʻana i ka ʻeha, ka nui o ka hoʻololi ʻana, ke kahe o ke koko, ka lōʻihi o ka noho ʻana i ka haukapila, a me ka hele ʻana i ka wā e hoʻohālikelike ai i ka THA maʻamau me MIS-THA. ʻO Repanis et al.ʻaʻole i hōʻike i nā ʻokoʻa koʻikoʻi ma waena o nā mea ʻelua, koe wale nō ka hōʻemi nui o ka ʻeha, a ʻaʻohe ʻokoʻa koʻikoʻi i ke koko, ka hoʻomanawanui hele ʻana, a i ʻole ka hoʻoponopono hou ʻana.ʻO kahi haʻawina hauʻoli e Goosen et al.
He RCT o Goosen et al.hōʻike i ka piʻi ʻana o ka helu HHS mean ma hope o ke ala liʻiliʻi invasive (e hōʻike ana i ka hoʻihoʻi maikaʻi ʻana), akā ʻoi aku ka lōʻihi o ka manawa hana a ʻoi aku ka nui o nā pilikia perioperative.I kēia mau makahiki i hala iho nei, ua nui nā noiʻi e nānā ana i ka pōʻino o ka ʻiʻo a me ka manawa hoʻihoʻi postoperative ma muli o ke komo ʻana o ka ʻokiʻoki liʻiliʻi, akā ʻaʻole i hoʻoponopono pono ʻia kēia mau pilikia.Ua hana ʻia kēia haʻawina ma muli o ia mau pilikia.
I loko o kēia noiʻi ʻana, ua ʻike ʻia ʻo ke ala DS i hōʻemi loa i ka pōʻino o ka ʻiʻo ʻiʻo ma mua o ke ala DA, e like me ka hōʻike ʻia e ka liʻiliʻi loa o ka pōʻino i ka ʻiʻo gluteus minimus a me kona tendon, ka vastus tensor fasciae latae muscle, a me ka rectus femoris muscle. .Ua hoʻoholo ʻia kēia mau hōʻeha e ka DA ponoʻī a paʻakikī ke hoʻoponopono ma hope o ke kaʻina.I ka noʻonoʻo ʻana he ʻano cadaveric kēia haʻawina, pono nā noiʻi lapaʻau e noiʻi i ke koʻikoʻi o kēia hopena i ka hohonu.
Ka manawa hoʻouna: Nov-01-2023
