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Tinayesa kufufuza zotsatira za opaleshoni yathu ya anatomical-based minimal open open surgery (MCTR) ndi njira ya palmar ndikuyerekeza zotsatira zake ndi zofunikira ndi njira yachizolowezi (OCTR) . Phunziroli linali ndi odwala 100 ofanana (n = 50 MCTR, n = 50 OCTR) adatsatiridwa kwa zaka zitatu. Symptom Severity Scale (SSS), Functional Status Scale (FSC), ndi Visual Analog Scale (VAS) .Zochitika zoipa zonse zinawonedwa.Alpha ya 0.05 ndi mlingo wa chidaliro cha 95% adayikidwa kuti afufuze ziwerengero.Njira zonse ziwiri zinawonetsa zotsatira zofananira zogwira ntchito pa nthawi yayitali (zikutanthauza kutsatira MCTR: miyezi 60 MCTR: miyezi 60 ndi DASHTROC: miyezi 60 ndi DASHOC OCTR) 4.6/8.3 (p = 0.398), SSS: 1.3/1.2 (p = 0.534), FSC: 1.3/1.2 (p = 0.617), VAS: 0.4/0.7 (p = 0.246) .MCTR inali yotsimikizika ku OCTR ndi kutsika kwachiwopsezo% (MCTR/0% OCTR, vs. 10% OCTR: 0. 6/50; p = 0.007) ndi strut kupweteka, ndi kufupikitsa kuchira ndi nthawi ya ndondomeko .Kuchepa kwa zovuta zowonongeka kunawonedwa m'magulu onse awiri, ndipo zobwerezabwereza sizinalembedwe.Njira ya MCTR inasonyeza zotsatira zabwino zachipatala zofanana ndi njira zachizoloŵezi.MCTR ndi njira yochepa, yodalirika, yofulumira komanso yosavuta yomwe ili ndi phindu lomveka bwino la kukhudzidwa kwa zipsera.
Carpal tunnel syndrome (CTS) ndiyomwe imayambitsa matenda a ubongo1,2,3,4,5,6 omwe amadziwika kuti ali ndi chiwerengero cha 3.8% mwa anthu ambiri7.Kufalikira kwa CTS kumasiyanasiyana malinga ndi njira zodziwira zomwe zimagwiritsidwa ntchito7.Zimadziwika bwino kuti zifukwa zina zoopsa8 komanso zochitika za ntchito zimakhudza kufalikira kwake9.
Ma algorithms ochiritsira ochiritsira kuphatikizapo splinting, non-steroidal anti-inflammatory drugs, ndi topical corticosteroid jekeseni amayambika pambuyo pozindikira zizindikiro za khalidwe ndi electroneurograms3,5,10. Pazochitika pamene chithandizo chodziletsa chimalephera, opaleshoni ya carpal tunnel kumasulidwa (CTR) ndiyofunikira.Open carpal tunnel release (OCTR) ndiyo njira yovomerezeka yovomerezeka. ndondomeko imathandizira kuwonetsetsa kwachindunji, magawo odalirika a flexor retinaculum, ndikutha kuzindikira kusiyana kwa anatomical; kumaphatikizapo kupweteka kwa bala pambuyo pa opaleshoni, kukhudzidwa kwa zipsera, komanso kuthekera kwa kupweteka kwa strut.Kuti athetse mavutowa, njira zingapo zochepetsera zowonongeka zakhala zikugwiritsidwa ntchito m'zaka zaposachedwapa2, 11.Endoscopic carpal tunnel kumasulidwa kungathe kuchitidwa ngati njira imodzi yokha kapena njira ziwiri5. Zanenedwa kuti zimachepetsa ululu wopweteka pambuyo pa opaleshoni5, kuchepetsa mavuto okhudzana ndi bala, kupweteka kwapakhosi, kapena kupweteka kwapakhosi ( hypertrophic scarring), ndikulola kubwereranso koyambirira kuntchito ndi ntchito za tsiku ndi tsiku5,10,12.Komabe, kumaphatikizapo chiopsezo chowonjezereka cha mitsempha yapakati ndi kuvulala kwa mitsempha kapena kugawanika kosakwanira kwa retinaculum ya flexor muscles.
Cholinga cha phunziroli chinali kuyesa kutsata kwa nthawi yaitali kwa MCTR pogwiritsa ntchito zizindikiro za anatomical zomwe zafotokozedwa kale14 ndi njira ya palmar ndikufanizira ndi OCTR wamba.Chotero, timaganiza kuti chitetezo ndi zofunikira pakati pa MCTR ndi OCTR ndizofanana.More makamaka, tinafuna kudziwa ngati MCTR inali yapamwamba kuposa njira zochiritsira zogwira ntchito.
Odwala makumi asanu omwe adakumana ndi unilateral MCTR pakati pa January 1, 2008 ndi December 31, 2015 mu malo athu opwetekedwa mtima a III adaphatikizidwa mu phunziroli. Odwala a 50 omwe adalandira OCTR yachidziwitso panthawi yomweyi adafananizidwa ndi msinkhu komanso kugonana kwa gulu la MCTR. ndondomeko si mwachisawawa.Nthawi yochepa yotsatizana pakati pa opaleshoni ndi ulendo wa odwala inali zaka zitatu kuti awonedwenso komaliza.
Kuzindikira kwa CTS kumachokera ku kukhalapo kwa kusokonezeka kwamaganizo ndi / kapena kufooka m'dera lomwe limaperekedwa ndi mitsempha yapakati ndi mbiri yapadera ya ululu.Odwala onse adalandira EMG asanagwiritse ntchito kutsimikizira zapakati pa mitsempha ya mitsempha ya mitsempha.
Njira zochotsera zikuphatikizapo zizindikiro za kutupa kwa m'deralo kapena kwadongosolo, kuwonongeka kwa anatomical, kuwonongeka kwa mitsempha kapena minofu yofewa, opaleshoni yam'mbuyo yam'manja ndi m'manja, komanso zizindikiro za CTS zapadziko lonse komanso nthawi ya zizindikiro zopitirira chaka.
Ma protocol okhazikika anagwiritsidwa ntchito m'magulu onse awiri.Gulu lirilonse linachitidwa opaleshoni ndi njira yokhazikika, ndi kusiyana kulikonse kwa opaleshoni iliyonse yomwe ikufotokozedwa pansipa.Njira zonse zinkachitidwa mu chipinda chopangira opaleshoni ndi anesthesia ya m'deralo ndi kugwiritsa ntchito tourniquet ya m'mwamba.Manja onse anayikidwa pa malo a supine ndipo osasunthika ndi ziboliboli zamanja zotsogola.Ikani ndondomeko ya microsuction mu drainage system ndikusiya njira imodzi ya microsuction. tsiku.Kutsekedwa kwa mabala kunkachitidwa ndi suture yosasunthika ya 5.0 {Polyamide, ETHILON 668H, Johnson & Johnson Medical GmbH, Norderstedt, Germany} popanda Leukostrips. Mabala onse anali otsekedwa ndi swabs za gauze {Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany} kuvala kopangidwa ndi swab yopyapyala kunagwiritsidwa ntchito ngati mpukutu wa pedi pambuyo pa bandeji yotambasula pang'ono {Lenkelast, Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany} asanatulutse tourniquet pa mkono wapamwamba. Pambuyo pa opaleshoniyo, manja anakhalabe mu bandeji iyi ya nkhonya kwa tsiku. kulamulira, kunachitika ndi dokotala wa opaleshoni maola 24 pambuyo pake. Kenako, kuponyedwa {Cosmopor, Hartmann AG, Heidenheim, Germany} kunagwiritsidwa ntchito ndipo wodwalayo anatulutsidwa.Yambani ntchito yaulere pambuyo pa tsiku loyamba lachidziwitso ndipo pewani kukweza kwakukulu kwa milungu iwiri. Ma sutures anachotsedwa masiku 14 pambuyo pa opaleshoni (yotsatira yoyamba).
Pogwiritsa ntchito njira ya OCTR, 3.5 cm kutalika kwa nthawi yayitali kumapangidwira pafupi ndi palmar crease ndipo imayimitsa 0.5 cm kutali ndi dzanja lamanja.
Kwa gulu la MCTR, njira zonse za styloid zidajambulidwa ndikulumikizidwa ku mzere wopingasa pogwiritsa ntchito cholembera. Kenako, jambulani mzere wofananira pachikhatho kuchokera kumapeto kwenikweni kwa mauna oyamba, otchedwa Kaplan baseline.
Kenaka, jambulani mizere yowongoka pamtunda wa chala cha mphete.
Chiwonetsero cha schematic cha kudulidwa kwa khungu kwa MCTR ndi njira zonse ziwiri: dera lozungulira la buluu limayimira malo opangira khungu a MCTR ndipo bwalo lakuda limayimira malo odulidwa a khungu a OCTR. al.14 ali zafotokozedwa.MCTR Mini Open Carpal Tunnel Releaser, OCTR Open Carpal Tunnel Releaser.
(A) Kukonzekera koyambirira ndi (B) zotsatira za MCTR pambuyo pa ntchito: Mizere yotsatirayi inalembedwa: 1. Mzere wopingasa pakati pa njira ziwiri za styloid 2. Mzere wopingasa wofanana - Kaplans maziko: 3. Mzere wautali kumbali ya radial ya chala cha mphete. za Opaleshoni yotseguka yaying'ono-yosapitirira 1-1.5 cm-ndi malo ake monga momwe asonyezedwera.MCTR Mini Open Carpal Tunnel Release.
Kudulidwa kwa palmar kwa 1-1.5 masentimita kunapangidwa mozungulira motalikirapo, pamtundu uliwonse kuchokera ku ulna kupyolera mumtsinje wa thenar. Pambuyo pa aponeurosis ya Dupuytren itatsegulidwa, mitsempha ya carpal yodutsa imadutsa pafupi ndi pamwamba ndi pansi pake pogwiritsa ntchito Hegar dilator (onani Chithunzi 3) ndi kufotokozedwa ndi kutetezedwa (onani Chithunzi 4).
Dongosolo la zida za MCTR: Lili ndi magawo awiri: A. Mpeni wapadera wodulira, B. Sitima yowongolera yotetezedwa.{SafeGuard Mini Carpal Tunnel Release System, Art.-No. 08-0001 ndi 08-0003, INTEGRA LifeSciences Corporation, USA} "Hegar" dilators amalembedwa C. {KARL STORZ SE & Co. KG, Art.-No. 28147 SA, Germany} D. Fomon retractor, E. Mini suction chubu, F. Mosquito forceps.{MEDICON eG, Art.-No. 20.50.05, Germany; MEDICOPLAST International GmbH, Art.-No. 770 (107867), Germany; MEDICON eG, Art.-No. 15.45.12, Germany}.MCTR Mini Open Carpal Tunnel Release.
Zithunzi za MCTR: Malo otulukira a minyewa yapakatikati yotuluka imawoneka bwino m'gawo la opareshoni. Kholo lapamwamba la palmar arterial arch limatetezedwa ndikuwoneka kudzera pakhungu komanso kudera lomwe lagawanika.{MEDICON eG, Art.-No. 20 May 2005, Germany}.MCTR Mini Open Carpal Tunnel Release.
Kudulidwa koyamba mu gawo lakutali la carpal ligament yopingasa kunapangidwa pansi pa masomphenya achindunji ndi tsamba la 15 opaleshoni ya scalpel {Dahlhausen & Co. GmbH, Köln, Germany} ndi otsalira transverse carpal ligament amapindula (onani Zithunzi 3, 5, ndi 6).
Chithunzi cha intraoperative cha MCTR: Kalozera woteteza wayikidwa kuti ateteze mitsempha yapakatikati.Panthawi yowonekera, ma Fomon retractor awiri adagwiritsidwa ntchito motsatana ndi imodzi ya Ragnell retractor proximally.{SafeGuard Mini Carpal Tunnel Release System, Art.-No. 08-0001, INTEGRA LifeSciences Corporation, USA; MEDICON eG, Art.-No. May 20, 2005, Katundu No.20.12.20, Germany}.MCTR Mini Open Carpal Tunnel Release.
Chithunzi cha intraoperative cha MCTR: Kutulutsidwa kwa mitsempha ya carpal ligament imatheka.Mitsempha yapakati imatha kuwonedwa kuti iwonetsetse kumasulidwa kwathunthu.Kufufuza kwina komaliza kwa minofu ya perineural scar kungathe kuchitidwa popanda mavuto.{MEDICON eG, Art.-No. May 20, 2005, Art. No.20.12.20, Germany}.MCTR Mini Open Carpal Tunnel Releaser, OCTR Open Carpal Tunnel Releaser.
Deta yoyesedwa motsatira inasonkhanitsidwa mwachidziwitso mu chipatala chapadera chachipatala.Makhalidwe oyambira okhudzana ndi zaka, kugonana, mbali yokhudzidwa, nthawi ya opaleshoni, ndi zizindikiro zoyamba zachipatala zinalembedwa kuchokera kumafayilo a odwala.
Odwala adatsatiridwa masabata awiri pambuyo pa opaleshoni.Kutsatira koyambirira kunayesedwa ndi dokotala wa opaleshoni (MP kapena AK) .Pano, kukhalapo kwa kuwonongeka kwa machiritso a mabala, matenda, kutengeka kwa zipsera ndi zofanana zowonetsera analog scale (VAS) zinayesedwa.
Kutsatira komaliza kunachitidwa ndi opaleshoni awiri ochita opaleshoni (AS ndi GH) kuti alembe kusintha kwa zizindikiro ndi zizindikiro ndi / kapena zochitika zovuta.Pa nthawi yomaliza yotsatila, odwala onse anamaliza VAS, Arm, Shoulder, and Hand Disability Score (DASH) ndi Boston Carpal Tunnel Syndrome Questionnaire, kuphatikizapo Symptom Severity Scale (Scale) Scale (Scale) Scale (Scale Scale) Odwala (Scale Scale). anafunsa za sensitivity scar sensitivity ndi / kapena kupweteka kwa mzere pamalo opangira opaleshoni.Kuwunika kwa chiwopsezo cha chiwopsezo kumatanthauzidwa motere: Wodwalayo anafunsidwa za kusapeza bwino m'dera lachilonda, monga kutentha kwapang'onopang'ono, hypersensitivity, kapena kupweteka kwapamwamba. Pakafukufuku, ululu wa strut unayesedwa mwa kukakamiza nthawi imodzi ndi thenar ndi hypothenar eminences, ngati kulekanitsa msewu wa carpal.
Kutalika kuchokera ku opaleshoni kupita ku kubwezeretsedwa ndi kubwerera kuntchito (kupatulapo opuma pantchito) kunayesedwa.Kubwezeretsedwa kunatanthauzidwa ngati nthawi yokhazikika pambuyo pa opaleshoni yomwe wodwalayo adatha kuchita ntchito za tsiku ndi tsiku popanda kupweteka.Kuchitika ndi kubwereza kwa zochitika zovuta (hematoma, matenda, kuvulala kwa mitsempha kapena tendon) zinayesedwa. kuyambiranso pambuyo pa nthawi ya Thandizo lakanthawi.Kuonjezera apo, kukonzanso mitengo ndi zomwe zimayambitsa komanso nthawi yochokera ku opaleshoni yoyamba kupita ku opaleshoni yokonzanso (ngati ikuyenera) inayesedwa.
Kusanthula kwachiwerengero kunkachitidwa pogwiritsa ntchito mapulogalamu a SPSS {IBM SPSS Statistics version 26, Armonk, USA}.Magawo opitirira amasonyezedwa ngati amatanthauza, kusiyana kwapakati (SD), ndi deta yamagulu kapena yochuluka.Ziwerengero zofotokozera zimagwiritsidwa ntchito pamitundu yosiyanasiyana ya anthu; zosinthika mosalekeza zimafupikitsidwa pogwiritsa ntchito SD ndi/kapena ndi milingo yocheperako komanso yopambana kwambiri.
Mayesero a Nonparametric anagwiritsidwa ntchito pofufuza deta kuti akhale ofunikira.Kufufuza kusiyana pakati pa magulu a MCTR ndi OCTR, kuyesa kwa Mann-Whitney U kunagwiritsidwa ntchito. Mayesero a Chi-square anagwiritsidwa ntchito kuyerekeza zolinga zotsalira ndi / kapena zochitika zovuta. A P mtengo (p) pansi pa 0.05 inayikidwa ngati yowerengeka yowerengera, ndipo kusanthula kwamphamvu kwapakati pa 95% kunagwiritsidwa ntchito pogwiritsa ntchito mphamvu ya 95%. 3.1.18.Ndi alpha ya 0.05, kukula kwachitsanzo kwa 0.88 kunawerengedwa kutengera kuyesa kofunikira kwa michira iwiri19.
Chivomerezo cha makhalidwe abwino chinaperekedwa ndi Institutional Review Board ya Austrian Workers’ Compensation Board (AUVA-EK 03/2019).
Gulu la MCTR linali ndi 72% akazi (36/50) ndi 28% (14/50) odwala amuna omwe ali ndi zaka 61.2 zaka (SD: 13.3; range: 36-81) .64% (32/50) anali dzanja lamanja ndipo 36% (18/50) anali kumanzere kwa miyezi 9. 2.2; osiyanasiyana: 3-12) anali mphindi 9.2 (SD: 2.7; osiyanasiyana: 6-18) .Kutsatira komaliza komaliza mu gulu la MCTR kunali miyezi 60 (SD: 23.1; osiyanasiyana: 36-108).
Mu gulu la OCTR, 74% (37/50) anali akazi ndipo 26% (13 / 50) anali amuna. Zaka zapakati pa tsiku la opaleshoni zinali zaka 59.0 (SD: 16.7; range: 20-84) .62% (31/50) ya manja amanja ndi 38% (19/50) (nthawi ya 19 / 50). kupatuka: 3.3; osiyanasiyana: 7-21) inali miyezi 5.4 (kusiyana kovomerezeka: 1.8; range: 4-12) .Kutsatira komaliza komaliza mu gulu la OCTR kunali miyezi 54 (SD: 24.3; range: 37-101).
Panali kusiyana kwakukulu pakati pa nthawi ya opaleshoni (p = 0.001), koma osati pakati pa magulu malinga ndi msinkhu (p = 0.621) ndi nthawi yotsatila (p = 0.623).
Mu gulu la MCTR, kutengeka kwa zipsera kunalipo kwa odwala 3 (MCTR: 3 / 50; 6%), omwe ali ndi chiwerengero cha VAS cha 1.4 (SD: 2.1; osiyanasiyana: 0-7) . 1.7 (SD: 2.8; mtundu: 0-8) . Poyerekeza magulu awiriwa potsatira koyambirira, kukhudzidwa kwa zipsera kunachepetsedwa kwambiri pambuyo pa MCTR (MCTR: 3 / 50; 6% vs OCTR: 13 / 50; 26%; p = 0.002) Panalibe kusiyana kwakukulu mu VAS (p = 0.327).
Panalibe kusiyana kwakukulu pamagulu oyesa pakati pa magulu (onani Table 1) .Kupita patsogolo konse kwapambuyo kumatha kunyalanyazidwa mu Table 2. Mwa izi, kukhudzidwa kwa zipsera kunachepetsedwa kwambiri mu gulu la MCTR (0%) poyerekeza ndi gulu la OCTR (12%, 6 / 50) (p = 0.007).
Zochitika zowonongeka zowonongeka zikuwonetsedwa mu Table 3.Palibe kubwereza komwe kunawonedwa mu gulu lirilonse.Kubwerezabwereza kunali 2% (1/50) mu gulu la MCTR ndi 4% (2/50) mu gulu la OCTR.Zitsanzo zonse ziwiri, odwala omwe ali ndi matenda adachitidwa opaleshoni imodzi yokonzanso.Nthawi yowonjezereka kuchokera ku opaleshoni yoyamba kupita ku opaleshoni yokonzanso inali masabata a MCTR mu gulu la 6 OCTR ndi masabata a 6 mu gulu la OCTR. 3.5-9).
Pagulu lonselo, palibe kuvulala kwa mitsempha ya iatrogenic, mitsempha ya mitsempha, kapena tendon. kuchuluka kwa zovuta kunali 4% (4/100 yonse kapena 2/50 pagulu lililonse).
Cholinga cha phunziroli chinali kuyesa kutsata kwanthawi yayitali kwa CTR yocheperako pang'onopang'ono ndi njira ya palmar ndikuyerekeza zotsatira zake ndi opaleshoni yachizoloŵezi.Panalibe kusiyana kwakukulu pamagulu ogwira ntchito pakati pa magulu a zitsanzo zathu.Kukhudzidwa kwa Scar kunachepetsedwa kwambiri pambuyo pa MCTR poyerekeza ndi OCTR kumayambiriro (p = 0.002) ndi kutsata kwa nthawi yaitali (p = 0.002).
Paine20 imalongosola chipangizo choyamba mu 1955 chomwe chimagwiritsidwa ntchito ngati chodula lamba wothandizira.Chida ichi chakhala chikugwiritsidwa ntchito mpaka pano, monga posachedwapa Fernandes et al. 21 .Olemba21 adayang'ana zotsatira zaufupi komanso za nthawi yayitali ndipo adawonetsa zotsatira zabwino zachipatala kwa odwala oposa 500 pazaka za 17. Kudulidwa kwa Palmar kwa CTR kwagwiritsidwa ntchito kwa nthawi yaitali, ndipo njira zosiyanasiyana zakhala zikufotokozedwa m'kupita kwa nthawi.Aryan et al22 adanena za zochitika zoyimilira kuchokera ku 1977 zomwe odwala 429 adapeza kuti adiresi ya retinal yakhala bwino. mabuku.Pali maphunziro ochepa omwe alipo23,24 pa zotsatira za nthawi yayitali pambuyo pa MCTR.
Bai et al2 anachita kafukufuku wobwerezabwereza wa deta yomwe inasonkhanitsidwa yomwe ikuphatikizapo odwala 85 omwe adakhalapo ndi MCTR kapena OCTR, kuphatikizapo zolemba zofanana ndi zomwe zachitika mu phunziroli. palibe kusiyana kwakukulu pakati pa magulu awiri (p = 0.130) (MCTR: Mphindi 25.1; OCTR: Mphindi 23.5), zomwe zimasiyana mu gulu lathu (MCTR: 9.2 mphindi; OCTR: 12.0 mphindi; p = 0.001) .Muchitsanzo chathu, olemba sanapeze kusiyana kwakukulu kwa chiwerengero mu VAS ndi DASH pakati pa magulu awiri: p6 = DASHS: p6 = DASHS 0.398). Pa miyezi 12 kutsatiridwa, chiwerengero cha ululu wa chilonda chinali 4.7% mu gulu la OCTR, pamene palibe odwala omwe adamva kupweteka kwa bala pambuyo pa MCTR (p = 0.490) . Momwemonso, muzotsatira zathu za nthawi yayitali, kukhudzidwa kwa chilonda kunawonjezeka kwambiri mu gulu la OCTR (12%) poyerekeza ndi gulu lathu la MCTR (0%) (p = 0.007).
Aslani et al25 adagawanitsa zitsanzo zawo za odwala 105 m'magulu atatu (MCTR, OCTR, ndi gulu lomwe limalandira endoscopic CTR) .Nthawi yobwerera kuntchito inali yaitali kwambiri (p = <0.05) mu OCTR (kutanthauza: masiku 21.1) poyerekeza ndi MCTR (kutanthauza: 12.7 masiku) . (MCTR: amatanthauza masiku a 14; OCTR: amatanthauza masiku a 20; p = 0.142) . Pamaziko a kuyambiranso ntchito koyambirira, izi zikhoza kuonedwa ngati phindu la mtengo wapatali.
Zhang et al23 adasanthula odwala a 207 osankhidwa mwachisawawa kudzera m'magulu awiri ang'onoang'ono (n = 73) kupita ku MCTR, OCTR (n = 65), ndi endoscopic CTR (n = 69) . kutsata kwa zaka zitatu, panalibe zowerengera zofunikira kusiyana pakati pa MCTR ndi OCTR muzotsatira za Boston Carpal Tunnel Syndrome Questionnaire.Pano, tanthauzo la SSS ndi FSC kwa magulu onsewa linali mfundo za 1.2. Izi ndizofanana kwambiri ndi zotsatira zathu.
Kupanikizika kwa mitsempha yobwerezabwereza kumachitika m'munsi mwa 2% mpaka kufika ku 25% 26, 27, 28, 29, 30, 31 ndipo zikhoza kuchitika zaka zambiri pambuyo pa opaleshoni.Kubwerezabwereza kwa maphunziro otsatila kwa nthawi yaitali kwanenedwa kuti kumachokera ku 3.7% 27 mpaka 57% 32. kubweranso kwa zizindikiro zilizonse zisanachitike32, ena amatanthauzira kufunika kwa reoperation27 kuti iganizidwe kuti ndi yobwerezabwereza.Cresswell et al24 inanena kuti chiwerengero chazovuta chofulumira komanso chowonjezereka chowonjezereka kwa odwala pambuyo pa MCTR poyerekeza ndi opaleshoni yachizoloŵezi.Olemba24 adafufuza zotsatira pa zaka 7 pambuyo pa opaleshoni. Mosiyana ndi zimenezi, palibe kubwereza komwe kunawonedwa m'magulu athu awiri, ndi kutsata kochepa kwa MC kwazaka zomaliza za 3 ndi kufufuza komaliza kwa 3 zaka zomaliza zomaliza: Miyezi 60, OCTR: 54 miyezi) .Izi zikhoza kutsatiridwa ku nthawi yathu yaifupi yotsatila ndi kukondera mu mafunso omwe abwezedwa ndi Cresswell et al24, omwe sangasonyeze gulu lonse.
Chizindikiro chodziwika bwino komanso chachikulu cha kupsinjika kwa mitsempha yobwerezabwereza kungapangitse kugawanika kosakwanira kwa mitsempha yodutsa ndi / kapena postoperative fibrosis30,33.Zimakhulupirira kuti pambuyo pa opaleshoni fibrosis ikhoza kukhala ndi zotsatira zabwino, monga momwe tinachitira ndi machitidwe oyambirira ochita masewera olimbitsa thupi kuyambira tsiku loyamba la postoperative. CTS sizingatheke pambuyo pa kugawanika kokwanira kwa ligament transverse.Kuonjezera apo, zochitika zochepa zofanana zofanana zinawonedwa m'magulu onse awiri.Mosasamala kanthu, mfundozi zimasonyeza kutsimikizika kwabwino ndipo zimalola kuti MCTR ikuyimira njira yodalirika ya CTR.
Ubwino wina waukadaulo umayimira chiwonetsero chachindunji cha nthambi ya thenar ya mitsempha yapakatikati.Kuonjezera apo, kuvulala kwa iatrogenic kumtunda wapamwamba wa palmar sikuchitika chifukwa cha kumasulidwa kwapakatikati. Odwala a 53. Lee ndi Strickland17 adawona kuvulala kwa mitsempha yapakati pa 694 kumasulidwa kwawo pogwiritsa ntchito mpeni wothandizira.Kufotokozera mwachidule zomwe tapeza ndi maphunziro awiriwa, matenda a ubongo wamkati anali vuto lalikulu lodziwika bwino, lomwe limapezeka m'magulu osachepera 1% mwa magulu atatu a maphunziro.
Phunziroli lili ndi malire angapo.Tinangofanizira MCTR ndi OCTR, kupatulapo gulu la endoscopic.Kuonjezera apo, ntchito zosawerengeka sizinawerengedwe kwa magulu amtundu uliwonse.Kuwonjezera apo, ngakhale kuti tinagwiritsa ntchito zomwe tasonkhanitsa deta, phunziroli linali lachiwonetsero. zisankho zokhudzana ndi chithandizo chamankhwala.Zinthuzi sizinayankhidwe mu phunziroli.Potsirizira pake, palibe ndemanga yomwe inapangidwa ponena za mtengo wa zipangizo kapena malo opangira opaleshoni yochitidwa kapena kukhudzidwa kwachuma kwa odwala ogona ndi odwala kunja.
Monga mphamvu ya phunziroli ndi nthawi yayitali.Kutsimikizira mwachindunji njira yopangira opaleshoni, tinagwiritsa ntchito odwala ofananira ndi kafukufuku wochita opaleshoni mmodzi wopangidwa ndi akatswiri odziwa bwino ntchito.Kuonjezera apo, opaleshoniyi ndi yophweka kubwereza chifukwa imachokera ku zizindikiro zowoneka bwino za anatomical.Kufunika kwina kwa njira yochepetsetsayi kumayimira kuphweka kwa dongosolo lachiwopsezo, mawonekedwe omwe ali pachiopsezo ndi mawonekedwe achiwiri. Nthambi ya thenar ya mitsempha yapakati ndi pamwamba pa palmar arch.Njira yathu inapangidwa potengera zizindikiro za anatomical zomwe zili ndi zone zodziwika bwino za chitetezo cha anatomical ndi njira zotsegula zazing'ono, monga momwe Hohenberger et al.In Anatomical Studies 14 adawonetsera.
Pomaliza, njira yathu yopangira MCTR yomwe timakonda komanso yomwe timakonda kudzera mu njira ya palmu yawonetsedwa kuti ndi yothandiza.Odwala pambuyo pa MCTR amapeza zotsatira zofanana zogwira ntchito kwa nthawi yayitali monga opaleshoni yachizoloŵezi.Mlingo wovuta wa opaleshoni ya MCTR ndi wochepa, ndipo njira ziwirizi zikufanana pankhaniyi.Kuchulukitsa kwapakhungu kumalimbikitsidwa kwa odwala omwe ali ndi zomatira kwambiri.
Pogwiritsa ntchito njira yomwe tafotokozera, palibe odwala omwe amabwereranso kapena akuvutika ndi ululu wa strut omwe adawonedwa.Kuonjezera apo, amaphatikiza ubwino wafupikitsa kuchira ndi nthawi ya opaleshoni. Phindu lapadera la odwala linachepetsedwa chifukwa cha 1-1.5 masentimita ndi malo ake, omwe anali otsimikizika owerengeka poyerekeza ndi gulu la OCTR pamene kubwezeretsedwa kwa minofu yofewa kungathandize kuchepetsa kuwonongeka kwa OCTR. moyandikana Choncho, MCTR ndi njira yachangu, yothandiza, yosokoneza pang'ono, komanso yocheperako mwaukadaulo yomwe imalola kuti munthu azitha kuwoneratu zomwe zili pachiwopsezo cha anatomy.
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Nthawi yotumiza: Jun-07-2022