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Izehlakalo zokuhlinzwa kwe-arthroscopic ziye zanda emashumini amabili eminyaka adlule, futhi izinhlelo zokushefa kwe-arthroscopic seziphenduke ithuluzi lamathambo elisetshenziswa kakhulu.Nokho, izinsingo eziningi ngokuvamile azibukhali ngokwanele, azigqoki kalula, nokunye.Injongo yalesi sihloko iwukuphenya izici zesakhiwo sensingo ye-arthroscopic entsha ephindwe kabili ye-BJKMC (Bojin◊ Kinetic Medical).Inikeza umbono womklamo womkhiqizo kanye nenqubo yokuqinisekisa.I-BJKMC insingo ye-arthroscopic ihlanganisa idizayini yeshubhu kushubhu, ehlanganisa umkhono wangaphandle wensimbi engagqwali kanye neshubhu elingaphakathi elingenalutho elizungezayo.Igobolondo langaphandle negobolondo langaphakathi linamachweba okumunca nawokusika ahambisanayo, futhi kukhona amanotshi kumagobolondo angaphakathi nangaphandle.Ukuze kuthethelelwe idizayini, iqhathaniswe nokufakwa kwe-Dyonics◊ Incisor◊ Plus.Ukubukeka, ubulukhuni bamathuluzi, ukuhwaqa kweshubhu lensimbi, ukushuba kodonga lwamathuluzi, iphrofayili yamazinyo, i-engeli, ukwakheka okuphelele, izilinganiso ezibucayi, njll. kwahlolwa futhi kwaqhathaniswa.indawo yokusebenza kanye nethiphu eliqinile nelincane.Ngakho-ke, imikhiqizo ye-BJKMC ingasebenza ngokugculisayo ekuhlinzeni.
Ilunga elisemzimbeni womuntu liwuhlobo lokuxhumana okungaqondile phakathi kwamathambo.Ziyisakhiwo esiyinkimbinkimbi futhi esizinzile esidlala indima ebalulekile ekuphileni kwethu kwansuku zonke.Ezinye izifo zishintsha ukusatshalaliswa komthwalo ejoyintini, okuholela ekukhawulweni kokusebenza nokulahlekelwa umsebenzi1.Ukuhlinzwa kwamathambo okuvamile kunzima ukwelapha ngokunembile ukuhlasela kancane, futhi isikhathi sokululama ngemva kokwelashwa side.Ukuhlinzwa kwe-arthroscopic kuyinqubo engenele kancane edinga ukusika okuncane kuphela, kubangela ukuhlukumezeka okuncane kanye nezibazi, kunesikhathi sokululama ngokushesha, kanye nezinkinga ezimbalwa.Ngokuthuthukiswa kwemishini yezokwelapha, amasu okuhlinza angena kancane kancane kancane kancane abe inqubo evamile yokuxilongwa nokwelashwa kwamathambo.Ngokushesha ngemva kokuhlinzwa kwedolo kokuqala kwe-arthroscopic, yamukelwa ngokusemthethweni njengendlela yokuhlinza nguKenji Takagi noMasaki Watanabe eJapane2,3.I-Arthroscopy kanye ne-endoprosthetics yintuthuko emibili ebaluleke kakhulu kuma-orthopedics4.Namuhla, ukuhlinzwa kwe-arthroscopic okuncane okungavamile kusetshenziselwa ukwelapha izimo ezihlukahlukene nokulimala, okuhlanganisa i-osteoarthritis, ukulimala kwe-meniscal, ukulimala kwe-ligament yangaphambili nangemuva, i-synovitis, i-intra-articular fractures, i-patellar subluxation, i-cartilage kanye nezilonda zomzimba ezixekethile.
Izehlakalo zokuhlinzwa kwe-arthroscopic ziye zanda emashumini amabili eminyaka adlule, futhi izinhlelo zokushefa kwe-arthroscopic seziphenduke ithuluzi lamathambo elisetshenziswa kakhulu.Njengamanje, odokotela abahlinzayo banezinketho ezihlukahlukene ezitholakalayo kodokotela abahlinzayo, kuhlanganise nokwakhiwa kabusha kwe-ligament ye-cruciate, ukulungiswa kwe-meniscus, i-osteochondral grafting, i-hip arthroscopy, ne-facet joint arthroscopy, kuye ngokuthandwa ngudokotela ohlinzayo1.Njengoba izinqubo zokuhlinza i-arthroscopic zanda zibe amalunga amaningi, odokotela bangahlola amalunga e-synovial futhi belaphe iziguli ngokuhlinzwa ngezindlela ebezingacatshangwa ngaphambili.Ngesikhathi esifanayo, kwasungulwa amanye amathuluzi.Ngokuvamile ziqukethe iyunithi yokulawula, i-handpiece enenjini enamandla kanye nethuluzi lokusika.Ithuluzi lokuhlukanisa livumela ukumuncwa kanye nokukhipha kanyekanye kanye nokuqhubekayo6.
Ngenxa yobunkimbinkimbi bokuhlinzwa kwe-arthroscopic, amathuluzi amaningi avame ukudingeka.Amathuluzi okuhlinza ayinhloko asetshenziswa ekuhlinzweni kwe-arthroscopic ahlanganisa i-arthroscopic, isikere se-probe, izibhakela, amandlaps, imimese ye-arthroscopic, ama-meniscus blades nezinsingo, amathuluzi okuhlinzwa ngogesi, ama-laser, amathuluzi efrikhwensi yomsakazo nezinye izinsimbi 7.
I-razor iyithuluzi elibalulekile ekuhlinzeni.Kunezimiso ezimbili eziyinhloko zepliers yokuhlinzwa kwe-arthroscopic.Okokuqala ukususa izinsalela ze-cartilage eyonakele, okuhlanganisa imizimba exegayo kanye ne-articular cartilage entantayo, ngokumunca kanye nokuxubha ilunga ngosawoti omningi ukuze kususwe izilonda ezingaphakathi kwe-articular kanye nabalamuli abavuvukalayo.Okunye ukukhipha i-articular cartilage ehlukaniswe nethambo le-subchondral futhi kulungiswe iphutha eligugile le-cartilage.I-meniscus edabukile iyasikwa futhi kwakheka i-meniscus egugile nephukile.Izinsingo nazo zisetshenziselwa ukususa ezinye noma zonke izicubu ze-synovial ezivuvukalayo, njenge-hyperplasia kanye nokuqina1.
Ama-scalpel amaningi angena kancane anengxenye yokusika ene-cannula yangaphandle engenalutho kanye neshubhu elingaphakathi elingenalutho.Abavamile ukuba namazinyo angu-8 anhlobonhlobo onqenqema lokusika.Amathiphu ahlukene we-blade ahlinzeka ngamazinga ahlukene okusika amandla ku-razor.Amazinyo ensingo avamile e-arthroscopic awela ezigabeni ezintathu (Umfanekiso 1): (a) amashubhu abushelelezi angaphakathi nangaphandle;(b) amashubhu angaphandle abushelelezi kanye namashubhu angaphakathi anezicwili;(c) amashubhu angaphakathi nangaphandle (okungaba insingo)9. Ubukhali bazo ezicutshini ezithambile buyanda.Amandla aphezulu amaphakathi nokusebenza kahle kokusika kwesaha yesicaciso esifanayo kungcono kunebha eyi-10 eyisicaba.
Kodwa-ke, kunenani lezinkinga ngama-arthroscopic shaver atholakalayo njengamanje.Okokuqala, i-blade ayibukhali ngokwanele, futhi kulula ukuyivimba lapho usika izicubu ezithambile.Okwesibili, i-razor ingakwazi ukusika kuphela izicubu ezithambile ze-synovial-udokotela kufanele asebenzise i-burr ukupholisha ithambo.Ngakho-ke, ama-blades adinga ukushintshwa njalo ngesikhathi sokusebenza, okwandisa isikhathi sokusebenza.Ukulimala kokusika kanye nokuguga kwensingo nakho kuyizinkinga ezivamile.Ukunemba komshini nokulawula ukunemba kwakha inkomba yokuhlola eyodwa ngempela.
Inkinga yokuqala ukuthi i-razor blade ayibushelelezi ngokwanele ngenxa yegebe elikhulu phakathi kwama-blade angaphakathi nangaphandle.Isixazululo senkinga yesibili kungaba ukwandisa i-angle ye-razor blade nokwandisa amandla ezinto zokwakha.
I-razor entsha ye-arthroscopic ye-BJKMC ene-double serrated blade ingaxazulula izinkinga zemiphetho yokusika ebuthuntu, ukuvaleka okulula nokugqokwa kwamathuluzi okusheshayo.Ukuhlola ukusebenza komklamo omusha we-razor we-BJKMC, yaqhathaniswa nozakwabo we-Dyonics◊, i-Incisor◊ Plus Blade.
I-razor entsha ye-arthroscopic ifaka idizayini yeshubhu-in-tube, okuhlanganisa umkhono wangaphandle wensimbi engagqwali kanye neshubhu elingaphakathi elingenalutho elizungezayo elinamachweba afanayo okumunca kanye nokusika kumkhono ongaphandle neshubhu elingaphakathi.Amakesi angaphakathi nangaphandle awaphawuliwe.Ngesikhathi sokusebenza, uhlelo lwamandla lubangela ukuthi ithubhu elingaphakathi lijikeleze, futhi ithubhu yangaphandle iluma ngamazinyo, isebenzisana nokusika.Ukusika kwezicubu eziqediwe kanye nemizimba exegayo kukhishwa ejoyintini ngeshubhu elingaphakathi elingenalutho.Ukuze kuthuthukiswe ukusebenza kokusika nokusebenza kahle, kwakhethwa isakhiwo sezinyo le-concave.I-laser welding isetshenziselwa izingxenye ezihlanganisiwe.Ukwakheka kwekhanda elijwayelekile lokushefa amazinyo amabili kuboniswe kuMfanekiso 2.
Ngokuklama okujwayelekile, ububanzi bangaphandle bomkhawulo ongaphambili we-arthroscopic shaver buncane kancane kunomkhawulo ongemuva.I-razor akufanele iphoqelelwe endaweni ehlangene, ngoba kokubili ithiphu kanye nomkhawulo wefasitela lokusika kugezwa futhi kulimaze indawo ye-articular.Ngaphezu kwalokho, ububanzi befasitela le-shaver kufanele libe likhulu ngokwanele.Lapho iwindi liba banzi, i-shaver ihlela ukusika futhi imunca, futhi ivimbela kangcono ukuvala iwindi.
Xoxa ngomthelela wephrofayili yezinyo kumandla okusika.Imodeli ye-3D ye-razor idalwe kusetshenziswa isofthiwe ye-SolidWorks (SolidWorks 2016, SolidWorks Corp., Massachusetts, USA).Amamodeli wegobolondo langaphandle anamaphrofayili ahlukene wamazinyo angeniswe kuhlelo lwesici esilinganiselwe (ANSYS Workbench 16.0, ANSYS Inc., USA) ukuze kuhlaziywe i-meshing nokucindezeleka.Izakhiwo zemishini (modulus of elasticity kanye ne-Poisson's ratio) yezinto zinikezwe kuThebula.1. I-mesh density esetshenziselwa izicubu ezithambile yayingu-0.05 mm, futhi sicwengisise ubuso beplanethi engu-11 buxhumene nezicubu ezithambile (Fig. 3a).Imodeli yonke inama-node angama-40,522 kanye nama-meshes angama-45,449.Ezilungiselelweni zesimo somngcele, sicindezela ngokugcwele amadigri enkululeko angu-6 anikezwe izinhlangothi ezi-4 zezicubu ezithambile futhi i-razor blade izungeziswa ngo-20° eduze kwe-x-eksisi (Fig. 3b).
Ukuhlaziywa kwamamodeli amathathu e-razor (Fig. 4) kubonise ukuthi iphuzu lokucindezeleka okukhulu kwenzeka ekushintsheni okungazelelwe kwesakhiwo, okuhambisana nezakhiwo zemishini.I-razor iyithuluzi elilahlwayo4 futhi kunengozi encane yokuphuka kwe-blade ngesikhathi sokusetshenziswa kanye.Ngakho-ke, sigxila ikakhulukazi ekhonweni layo lokusika.Ubukhulu bengcindezi obulinganayo obusebenza esicutshini esithambile bungase bubonise lesi sici.Ngaphansi kwezimo ezifanayo zokusebenza, lapho ukucindezeleka okulingana okuphezulu kukhulu kakhulu, kubhekwa kuqala ukuthi izakhiwo zayo zokusika zingcono kakhulu.Mayelana nokucindezeleka kwezicubu ezithambile, i-razor yephrofayela yezinyo engu-60 ° ikhiqize ukucindezeleka okukhulu kwezicubu ezithambile (39.213 MPa).
Ukusabalaliswa kokucindezeleka kwezicubu ezigundayo nezithambile lapho amashefa ensingo anamaphrofayili ahlukene amazinyo esika izicubu ezithambile: (a) 50° iphrofayili yamazinyo, (b) iphrofayili yezinyo engu-60°, (c) iphrofayili yezinyo engu-70°.
Ukuze kuthethelelwe idizayini yeblade entsha ye-BJKMC, yaqhathaniswa ne-Dyonics◊ Incisor◊ Plus blade (Fig. 5) enokusebenza okufanayo.Izinhlobo ezintathu ezifanayo zomkhiqizo ngamunye zisetshenziswe kukho konke ukuhlola.Zonke izinsingo ezisetshenzisiwe zisha futhi azilimele.
Izinto ezithinta ukusebenza kwe-razor zihlanganisa ubulukhuni nokujiya kwensingo, ukukhahlamezeka kweshubhu lensimbi, kanye nephrofayili kanye ne-engeli yezinyo.Ukuze ulinganise ama-contour nama-engeli amazinyo, i-contour projector enesixazululo esingu-0.001 mm ikhethiwe (uchungechunge lwe-Starrett 400, Fig. 6).Ezivivinyweni, ukushefa amakhanda abekwe phezu kwebhentshi lokusebenza.Linganisa iphrofayili yezinyo kanye ne-engeli ngokuhlobene nezinqamuleli esikrinini sokubonisa futhi usebenzise i-micrometer njengomehluko phakathi kwemigqa emibili ukuze unqume ukulinganisa.Usayizi wephrofayili wezinyo wangempela utholakala ngokuwuhlukanisa ngokukhuliswa kwenhloso ekhethiwe.Ukuze ulinganise i-engeli yezinyo, qondanisa amaphoyinti angashintshi nhlangothi zombili ze-engeli elinganisiwe nendawo engaphansi yomugqa kusikrini esichanyuselwe futhi usebenzise ama-engeli ama-engeli kuthebula ukuze ufunde.
Ngokuphinda lokhu kuhlolwa, izilinganiso eziyinhloko zobude bokusebenza (amashubhu angaphakathi nangaphandle), amadayamitha angaphandle angaphambili nangemuva, ubude bewindi nobubanzi, nokuphakama kwamazinyo kukalwa.
Hlola ubulukhuni bendawo nge-pinpointer.Ithiphu yethuluzi ihanjiswa ngokuvundlile ngaphezu kwesampula, ngokuqondana nendawo yokusanhlamvu okucutshunguliwe.Isilinganiso sobunzima obungu-Ra butholakala ngokuqondile ethuluzini.Emkhiwaneni.7 ikhombisa insimbi enenaliti (Mitutoyo SJ-310).
Ukuqina kwama-razor blades kukalwa ngokuhlola ubulukhuni be-Vickers ISO 6507-1:20055.I-indenter yedayimane icindezelwa ebusweni besampula isikhathi esithile ngaphansi kwamandla athile okuhlola.Bese ubude be-diagonal bokuhlehlisa kukalwa ngemva kokususwa kwe-indenter.Ubulukhuni be-Vickers bulingana nesilinganiso samandla okuhlola endaweni yombono.
Ukuqina kodonga lwekhanda lokushefa kukalwa ngokufaka inhloko yebhola eyicylindrical enembayo engu-0.01 mm kanye nebanga lokulinganisa elicishe libe ngu-0-200 mm.Ukuqina kodonga kuchazwa njengomehluko phakathi kwamadayamitha angaphandle nangaphakathi ethuluzi.Inqubo yokuhlola yokulinganisa ukujiya iboniswa ku-Fig. 8.
Ukusebenza kwesakhiwo kwensingo ye-BJKMC kwaqhathaniswa nalokho kwe-Dyonics◊ insingo yokucaciswa okufanayo.Idatha yokusebenza yengxenye ngayinye yomkhiqizo iyalinganiswa futhi iqhathaniswe.Ngokusekelwe kudatha yobukhulu, amandla okusika ayo yomibili imikhiqizo ayabikezelwa.Yomibili imikhiqizo inezakhiwo ezinhle kakhulu zesakhiwo, ukuhlaziya okuqhathanisayo kokusebenza kukagesi kuzo zonke izinhlangothi kusadingeka.
Ngokokuhlolwa kwe-engeli, imiphumela iboniswa kuThebula 2 kanye neThebula 3. Incazelo kanye nokuchezuka okujwayelekile kwedatha ye-engeli yephrofayela yemikhiqizo emibili bekungahlukanga ngokwezibalo.
Ukuqhathaniswa kwamanye amapharamitha abalulekile emikhiqizo emibili kukhonjiswe kuMfanekiso 9. Ngokobubanzi nobude beshubhu yangaphakathi nangaphandle, i-Dyonics◊ amafasitela amashubhu angaphakathi nangaphandle made kancane futhi aba banzi kunalawo e-BJKMC.Lokhu kusho ukuthi i-Dyonics◊ ingaba nendawo eyengeziwe yokusika futhi ishubhu mancane amathuba okuba livaleke.Le mikhiqizo emibili ayizange ihluke ngokwezibalo kwezinye izici.
Izingxenye ze-razor ye-BJKMC zixhunywe nge-laser welding.Ngakho-ke, akukho ukucindezela kwangaphandle ku-weld.Ingxenye okufanele ishiselwe ayikho ngaphansi kokucindezeleka okushisayo noma ukuguqulwa kokushisa.Ingxenye yokushisela incane, ukungena kukhulu, amandla omshini wengxenye ye-welding aphakeme, ukudlidliza kunamandla, ukumelana komthelela kuphezulu.Izingxenye ze-laser-welded zithembeke kakhulu ekuhlanganiseni14,15.
Ubulukhuni bobuso isilinganiso sokuthungwa kwendawo.Izingxenye ze-high-frequency kanye ne-short-wave yendawo elinganiselwe, enquma ukusebenzisana phakathi kwento nendawo yayo, iyacatshangelwa.Umkhono wangaphandle wommese wangaphakathi kanye nendawo yangaphakathi yeshubhu yangaphakathi yizindawo eziyinhloko zokusebenza ze-razor.Ukunciphisa ukuqina kwezindawo ezimbili kunganciphisa ngempumelelo ukuguga ku-razor futhi kuthuthukise ukusebenza kwayo.
Ubukhulu obungaphezulu begobolondo langaphandle, kanye nezindawo zangaphakathi nezingaphandle ze-blade yangaphakathi yamashubhu amabili ensimbi, kutholwe ngokuhlola.Amanani awo aphakathi aboniswa kuMfanekiso 10. Indawo engaphakathi yomgodla wangaphandle kanye nengaphandle lommese wangaphakathi yizindawo zokusebenza eziyinhloko.Ubulukhuni bendawo yangaphakathi ye-scabbard kanye nengaphandle lombese wangaphakathi we-BJKMC buphansi kunemikhiqizo efanayo ye-Dyonics◊ (ukucaciswa okufanayo).Lokhu kusho ukuthi imikhiqizo ye-BJKMC ingaba nemiphumela egculisayo mayelana nokusika ukusebenza.
Ngokusho kokuhlolwa kokuqina kwe-blade, idatha yokuhlola yamaqembu amabili ama-razor blades iboniswa ku-Figure 11. Izinsingo eziningi ze-arthroscopic zenziwe nge-austenitic stainless steel ngenxa yamandla aphezulu, ukuqina kanye ne-ductility edingekayo kuma-razor blades.Kodwa-ke, amakhanda okushefa e-BJKMC enziwe ngensimbi engagqwali engu-1RK91 martensitic.Izinsimbi ezingenasici ze-Martensitic zinamandla aphezulu kanye nokuqina kunezinsimbi ezingenasici ze-austenitic17.Izakhi zamakhemikhali emikhiqizweni ye-BJKMC zihlangabezana nezidingo ze-S46910 (ASTM-F899 Surgical Instruments) phakathi nenqubo yokwenza.Impahla ihlolelwe i-cytotoxicity futhi isetshenziswa kabanzi kumishini yezokwelapha.
Kungabonakala emiphumeleni yokuhlaziywa kwesici esilinganiselwe ukuthi ukugxilwa kwengcindezi ye-razor kugxile kakhulu kuphrofayela yamazinyo.I-IRK91 iyinsimbi engagqwali enamandla amakhulu ayi-supermartensitic enokuqina okuphezulu namandla aqinile aqinile kuwo womabili izinga lokushisa legumbi nezinga lokushisa eliphakeme.Amandla aqinile ekushiseni kwekamelo angafinyelela ngaphezu kuka-2000 MPa, futhi inani eliphakeme lokucindezeleka ngokokuhlaziywa kwesici esilinganiselwe lingaba ngu-130 MPa, okude nomkhawulo wokuphuka kwempahla.Sikholelwa ukuthi ingozi yokuphuka kwe-blade incane kakhulu.
Ubukhulu be-blade buthinta ngqo ikhono lokusika le-razor.Ukuqina kodonga oluncane, ngcono ukusebenza kokusika.I-razor entsha ye-BJKMC inciphisa ukujiya kodonga lwamabha amabili ajikelezayo aphikisanayo, futhi ikhanda linodonga oluncanyana kunozakwabo abavela ku-Dyonics◊.Imimese emincane ingakhuphula amandla okusika ithiphu.
Idatha ekuThebula lesi-4 ibonisa ukuthi ukujiya kodonga lwensingo ye-BJKMC elinganiswa ngendlela yokulinganisa ukujiya kodonga ngokuminyanisa kuncane kunaleyo ye-Dyonics◊ insingo yesicaciso esifanayo.
Ngokokuhlola okuqhathanisayo, insingo entsha ye-arthroscopic ye-BJKMC ayizange ibonise umehluko osobala wedizayini kusukela kumodeli efanayo ye-Dyonics◊.Uma kuqhathaniswa nokufakwa kwe-Dyonics◊ Incisor◊ Plus ngokwezakhiwo zezinto ezibonakalayo, i-BJKMC yokufaka amazinyo aphindwe kabili inendawo yokusebenza ebushelelezi kanye nethiphu eliqinile nelincane.Ngakho-ke, imikhiqizo ye-BJKMC ingasebenza ngokugculisayo ekuhlinzeni.Lolu cwaningo lwaklanywa ngendlela engenzeka futhi ukusebenza okukhethekile kufanele kuhlolwe ekuhloleni okulandelayo.
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