Dɔgɔtɔrɔso: Dɔgɔtɔrɔso Metropolitano de Santiago, Santiago, Chili
Opereli yɔrɔ: Jolilabanaw ni kolotugudaw labɛnni Opereli
ɲɛmɔgɔ: Dɔgɔtɔrɔ Fernando Alcántara, MD, MSc (Opereli opereli)
A bɔra don: Nowanburukalo san 2025
Kunnafoni kuncɛlen
Nin kɛnɛyaso ka ko kɛlen in bɛ banabagatɔ kɔrɔba fila jira minnu ye u ka lasigiden ye, minnu ka sɔgɔsɔgɔninjɛ gɛlɛnw bɛ u la, minnu ɲɛnabɔra ni u ye XC Medico ka wuluwuluw kɔnɔna na . Banabagatɔ fila bɛɛ ye farikolo yɔrɔw dɔgɔyali sɔrɔ, ka jɛɲɔgɔnya sabati, ani ka baarakɛcogo ɲuman sɔrɔ hali ni koloci ni kolo karilen gɛlɛyara kosɛbɛ.
Dɔgɔtɔrɔso ka sɔrɔ jɔnjɔnw:
- ✓ Kɔnɔbara basigilen bɛ biyomekaniki sabatili ɲuman di koloci kolo la ni i ye a suma ni plati sirili ye
- ✓ Fɛɛrɛ min tɛ fɛn caman kɛ, o bɛ dɔ bɔ farikolo yɔrɔ nɔgɔlenw tiɲɛni na ani opereli waati la ni 25-30% ye .
- ✓ IM nɛgɛw ka doni tila-tilacogo bɛ sira di mobilizasiyɔn ma joona k’a sɔrɔ a ma kari kɛnɛyali tiɲɛ
- ✓ San fila baarakɛcogo kɔlɔlɔw (Constant-Murley ka jate 62-64) bɛ muɲuli ni banabagatɔ wasa jira
Opereli kɛcogo Dajirali
Ni sɔgɔsɔgɔninjɛ (IM) bɛ sɔn sɔrɔ kɔkolo kɛrɛfɛla karilenw na, opereli fɛɛrɛ ɲuman faamuyali nafa ka bon[cite: 6]. A tɛ i n’a fɔ plati sirili, IM nɛgɛw bɛ baara kɛ i n’a fɔ doni tila-tila minɛnw , o kɔrɔ ye ko sabatili tɛ bɔ pewu kuru sanni na koloci kolo la[cite: 5]. Nin danfara jɔnjɔn in bɛ IM sɔgɔli kɛ nafa ye kɛrɛnkɛrɛnnenya la banabagatɔ kɔrɔbaw la minnu kolo cogoya bɛ tiɲɛ[cite: 4].
Fɛɛrɛko sariyakolo jɔnjɔnw
- Anatomic Reduction: Ka kunkolo-yɔrɔ-yɔrɔ-yɔrɔ ɲuman segin a cogo kɔrɔ la ani ka varus ka jiginni bali, o nafa ka bon kosɛbɛ [cite: 4].
- Medial Stability: Medial charnière ka kan ka segin a cogo kɔrɔ la walasa ka varus angulation bali [cite: 4].
- Load-Sharing Fixation: IM nɛgɛw bɛ sabatili teliya la k’a sɔrɔ u ma kɛ ni biologique fusion ye [cite: 5].
- Minimally Invasive Approach: A bɛ dɔ bɔ farikolo yɔrɔ nɔgɔlenw ka joginda ni opereli waati la ni i ye a suma ni plati da wulilen sirili ye [cite: 4].
Kolotugudaw kolo la, IM sɔgɔli ye biyomekanikini ka tɛmɛsira jira[cite: 5]. Load-sharing fixation bɛ a to nɛgɛ yɛrɛ ka sabatili di ka sɔrɔ ka callus formation sabati[cite: 5]. O bɛ danfara don ni plati sirili ye, o min bɛ doni ta, wa a bɛ se ka kɛ sababu ye ka degunw tanga.
Opereli kɛcogo ani dondaw
Deltoid-splitting fɛɛrɛ bɛ fɛnw jiracogo ɲuman di ka sɔrɔ ka rotator cuff tiɲɛni dɔgɔya[cite: 10]. Ni kari kɛra yelen na, farikolo yɔrɔw dɔgɔyali bɛ sɔrɔ ni fluoroscopie bilasirali ni joystick dɔgɔyali fɛɛrɛw ye.
Medullary Canal Labɛnni
Donda yɔrɔ ye ko kɔrɔba ye[cite: 8]. A sigilen bɛ cɛmancɛ la ka taa supraspinous fossa la ani ka bɛn ni humeral shaft ye, a bɛ a to nail trajectory optimal[cite: 10]. O kɔfɛ, ɲɛjiralan dɔ bɛ taa ɲɛfɛ ka tɛmɛ humeral canal fɛ, ka sɔrɔ ka reaming kɛ ɲɔgɔn kɔ walasa ka kanal labɛn ka kɛ implant insertion ye[cite: 10].
Ko 1 : Kari gɛlɛn min bɛ kɛ yɔrɔ naani na ni koloci jugumanba ye
Banabagatɔ ka ɲɛfɔli
Banabagatɔ: Rosa María Escobar (tɔgɔ ma fɔ)
San: san 67 [cite: 18]
Cɛya: Muso [cite: 18]
Jogin kɛcogo: Mobili fanga dɔgɔyalen ka ɲɔgɔn sɔrɔ nɛgɛso boli la; a bɛ se ka kɛ a kiniyanfan fɛ [cite: 19]
Furakɛcogo tariku: Koloci sɛbɛnnen (T-score -2.8); bisifosifonati furakɛli kan san 6 kɔnɔ [cite: 19]
Kolow girinya: Humeral head BMD 58 HU (koloci jugumanba) .
Ja minnu bɛ kɛ ka kɔn opereli ɲɛ
Rosa María ye Hertel ka sɔgɔsɔgɔninjɛ min bɛ kɛ ni yɔrɔ naani ye, o ye [cite: 21]:
- Humeral kunkolo jiginni pewu ni varus angulation ye (18° ka bɔ anatomic axis la) [cite: 20, 21].
- Tubabufura jiginni ka bon >10mm
- Opereli kɔkolo yɔrɔ tiɲɛni
- Kolow tiɲɛni jugumanba (BMD 58 HU) .
Nail Fixation (Nɛgɛw jɔli) kɔnɔbara la
Fɛn min bɛ baara kɛ ni a ye: XC Medico Multi-Lock Humerus ka wuluw kɔnɔna na
Ni koloci jugumanba ni a yɔrɔ naani karicogo jateminɛna, IM nail fixation sugandira ka tɛmɛ plate fixation kan bawo[cite: 23]:
- Viru samali fanga bɛ 58 HU kolo la, o ye 250-350 N dɔrɔn ye ni plati fixation ye, ka sɔrɔ 600-800 N ni siman-augmented IM nailing ye
- Doni tila-tilacogo bɛ kolo karilenw kɛnɛyali sabati kolo la min man ɲi [cite: 5].
- Fɛɛrɛ min tɛ fɛn caman kɛ, o bɛ opereli waati dɔgɔya ni miniti 30-40 ye [a fɔ: 4].
- Multi-planar proximal locking bɛ doni tila-tila ka tɛmɛn kaburu saba jɔcogo kan [cite: 8].
Opereli kɔlɔlɔw
Operation Details: Opereli waati miniti 95 | 140 mL joli bɔli jateminɛlen | 3 ja minnu bɛ kɛ ni fluoroscopie ye
Opereli kɔfɛ kɛnɛyako:
- POD 1: Dimi VAS 2/10; ɲɛfɛla jiginni pasif 20°; gɛlɛya si tɛ a la [cite: 23].
- Dɔgɔkun 6 : Ka ɲɛfɛla kɔrɔta 65°, kɛnɛma jiginni 25°, dimi VAS 1/10; callus daminɛni daminɛ na ye [cite: 23] .
- Dɔgɔkun 12 : A bɛ ɲɛfɛla kɔrɔta 95°, Constant-Murley 58/100; segin yeelen na ADL [cite: 23] .
- San 1 : Kɔrɔta ɲɛfɛ 125°, mɔgɔ minɛni 110°, Constant-Murley 62/100; segin nakɔbaara ni baara bɛɛ kan [cite: 25] .
Ko 2nan : Kari yɔrɔ naani bɔlen kɔfɛ ni furakɛli kuntaalajan dɛsɛ ye
Banabagatɔ ka ɲɛfɔli
Banabagatɔ: Javier Mendoza (tɔgɔ ma fɔ)
San: san 72 [cite: 27]
Cɛya: Cɛ [cite: 27]
Jogin kɛcogo: Binna ka bɔ jɔlen sanfɛ; fila-fila sanfɛla dakun doni tali cɛsiri [cite: 28]
Furakɛcogo tariku: Tansiyɔn jiginni (a kɔlɔsira), sukarodunbana suguya 2 (HbA1c 7,2%), Ɲɛgɛnɛsiraw ka dɔgɔn
Kolow hakɛ: Humeral head BMD 62 HU (koloci jugumanba)
Kɛnɛyaso kalan: Furakɛli min bɛ kɛ ni kɔrɔlen ye, o dɛsɛli
Javier y’a jira a daminɛ na ni a ɲɛda karilen ye yɔrɔ naani ye, wa a ɲɛnabɔra cogo kɔrɔlen na ni a lamagacogo ye[cite: 29, 32]. Nka, segin-ka-bɔnyew kɛra dɔgɔkun kelen kɔnɔ, o y’a jira ko varus (varus) bɛ bin ka taa a fɛ ani ka tuberosity (tuberosité) jiginni caya, o b’a jira ko kari tɛ sabati[cite: 32]. O tun ye opereli wajibiya[cite: 32].
Opereli kɛcogo
Fɛn min bɛ baara kɛ ni a ye: XC Medico Humeral Sistɛmu Intramedullaire Nail
Ni an y’a jateminɛ ko Javier kɔrɔla, bana caman wɛrɛw (kɛrɛnkɛrɛnnenya la Ɲɛgɛnɛsiraw nɔgɔman), ani karilenw jiginni ka taa a fɛ, IM sɔgɔli sugandira walasa ka opereli waati dɔgɔya ka sɔrɔ ka se ka jɔli sabatilen sɔrɔ koloci kolo la[cite: 4,
Operation Details: Opereli waati miniti 92 | 155 mL joli bɔli jateminɛlen | Kɔrɔsili min bɛ kɛ ni plan caman ye ni juru saba ye (45°/90°/135°) [cite: 8].
Opereli kɔfɛ ɲɛtaa
- POD 1 : Lajɛba daminɛna joona ; dimi VAS 2/10 ye; farikolo yɔrɔw dɔgɔyali ɲumanba min sinsinnen don ja lajɛ kan [cite: 10, 32].
- POD 3 : A bɛ bɔ so kɔnɔ ni farikoloɲɛnajɛ furakɛli ye min labɛnna; dimi min bɛ kunbɛn ka ɲɛ fura minnu bɛ ta da la [cite: 34] .
- Dɔgɔkun 6 : A bɛ ɲɛfɛla kɔrɔta 70°, kɛnɛma jiginni 30°, dimi VAS 1/10; callus bridging fɔlɔ bɛ ye [cite: 34] .
- Dɔgɔkun 12 : A bɛ ɲɛfɛla kɔrɔta 105°, Constant-Murley 60/100; yɛrɛmahɔrɔnyalen don ADL kɔnɔ [cite: 34].
- San 2 : Kɔrɔta ɲɛfɛ 120°, mɔgɔ minɛni 105°, Constant-Murley 64/100; kolotugudaw ka jɛɲɔgɔnya dafalen; fɛnɲɛnɛmafagalanw lajɔli tɛ [cite: 34].
Biomecanique Comparaison: IM Nails vs Plate Fixation
| Bone Density (HU) |
IM Nail Pullout Strength |
Plate Screw Pullout Strength |
IM Nail Advantage |
| <50 (Koloci jugumanba) . |
450-600 N. Bamako |
200-300 N. Ɲɛjirali dɔw |
2,5-3× fanga ka bon |
| 50-70 kɔnɔ |
600-800 N. Bamako |
300-400 N. Bamako |
2-2,5× fanga ka bon |
| 70-100 kɔnɔ |
800-1000 N. Bamako, Mali |
450-600 N. Bamako |
1,5-2× fanga ka bon |
Dɔgɔtɔrɔso ka
| sɔrɔw sangali kɔlɔlɔw Metric |
IM Nailing |
Plate Fixation |
Difference |
| Union Taux (Union Taux). |
94-98% [a fɔ: 37]. |
88-92% ye . |
+4-10% ye. |
| Baarakɛwaati |
Sanga 90-105 [a fɔ: 42]. |
130-160 miniti kɔnɔ |
-25-30% ye. |
| Hardware (Matériel) Lajɔli |
1-2% ye . |
10-15% ye . |
-8-13% ye. |
| Rotateur Manchette Impingement (Mɔgɔjibɔlan). |
0-2% [a fɔ: 8]. |
8-15% ye . |
-6-13% ye. |
| Constant-Murley (kalo 12) . |
62-64 [a fɔ: 25, 34]. |
54-58 la |
+4-10 jate |
Dɔgɔtɔrɔso & Jagokɛlaw ka nafa jiracogo
Nafa minnu bɛ kɛnɛyaso la Bololabaarakɛlaw ka dɔgɔtɔrɔso sugandili
| jateminɛ |
IM Nail Advantage |
Hospital Impact |
| Baarakɛwaati |
25-30% ka surun [cite: 42]. |
OR baarakɛcogo ɲuman ɲɛnabɔlen; 10-15 wɛrɛw ka banaw/san |
| Dɔgɔtɔrɔso Toli |
Tile 1-2 ka surun |
Dilan musakaw dɔgɔyara; jagokɛlaw ka jago ɲɛnabɔlen don |
| Opereli seginni hakɛ |
2-4% [a fɔ: 42]. |
Jalaki dɔgɔyali; sɔrɔli ɲumanw |
| Banabagatɔ wasa |
A ka bon (dimi ka dɔgɔn, mobilizasiyɔn teliya) [cite: 4, 10]. |
Seginkanni ɲumanw; cikan barikamaw |
Sɔrɔko misali min bɛ kɛ ka ɲɛsin jatebɔlaw ma
Per Single Proximal Humeral Fracture Case (kari kelen-kelen bɛɛ la:
- Implant musaka: $4200 (XC Medico ka sɔngɔ tilennen)
- Jagokɛlaw ka hakɛ: 25-30% ($1 050-1260 ko kelen na)
- Volume Assumption: 50 cases/san mara sugu la
- San o san, jatebɔla ka tɔnɔ: $52.500-63.000
Nafa wɛrɛ : Dɔgɔtɔrɔso kantigiya ka bon (seginkanni dɔgɔyali = jago segin-segin), tɔgɔ ɲuman sɔrɔli (a sɔrɔcogo ɲuman), ani suguya danfara (sɔrɔɲɔgɔn fanba bɛ tabali feere hali bi).
Yala aw labɛnnen don ka Intramedullary Nailing kɛ aw ka baarada la wa?
XC Medico bɛ operelikɛlaw kalan dafalen di, ka furaw dɛmɛ, ani ka tila-tila jɛkuluw ka jɛɲɔgɔnya porogaramuw di dɔgɔtɔrɔsow ni kɛnɛyabaarakɛlaw ma Ameriki Saheliyanfan na ani a kɔkan.
Dɔgɔtɔrɔso jɛkulu ka kunnafoniw ɲini
Walima ka kuma an ka Distributeur Development Team fɛ walasa ka baro kɛ waajulikɛyɔrɔ ni hakɛ sɔngɔko kan.
Opereli kɛcogo ɲɛfɔli kuncɛlen
Baara kɛcogo - XC Medico Multi-Lock System
- Positioning & Exposition (miniti 15-20): Kɔgɔjida-sigilan jɔyɔrɔ; Santimɛtɛrɛ 4-5 ɲɛfɛla la, deltoïde tilalen tigɛcogo [cite: 10].
- Dɔgɔyali (miniti 15-20): Farikoloɲɛnajɛ dɔgɔyali ni fluoroscopie ɲɛminɛni ye; joystick dɔgɔyali kunkolo ni tubabufura kan [cite: 4, 10].
- Reaming (miniti 10-15): Medullary canal reaming ka bɔ #8mm na ka se #10mm ma; a bonya ka ca ni milimɛtɛrɛ 1-1,5 ye walasa ka presse-fit [cite: 10] .
- Kɔrɔbɔli kɛrɛfɛ (miniti 15-20): Dadon juru saba bɛ kɛ 45°, 90°, 135° kɛrɛw la; bɛɛ taara ɲɛ fo ka se subchondral kolo ma; torque 4,5 Nm [a fɔ: 8].
- Tubabufura dilancogo (miniti 10-15): Tubabufura belebeleba bɛ dɔgɔya a yɛrɛma; a sirilen don ni suturaw ye minnu tɛ se ka minɛ [cite: 8] .
- Distal Locking (miniti 5-10): Distal lock dynamique kelen isthmal nivo la; 2-3mm degun sɔrɔla
- Dadon (miniti 5): Deltoid dilancogo; farikolo jukɔrɔla dadonni; farilajɛ walima suturaw [cite: 10] .
Opereli waati bɛɛ lajɛlen: miniti 85-105 [cite: 42] | Fluoroscopie (Fluoroscopie) tali : segin 30-35
Kuncɛli
Kolocibanabagatɔ kɔrɔbaw ka kɔkolo karilenw sɔgɔli senkɔniw kɔnɔ, o bɛ ladonni sariya jira sisan karicogo gɛlɛnw (yɔrɔ saba ni naani) la[cite: XC Medico ka Multi-Lock sitɛmu, n’a ka multi-planar proximal locking ani load-sharing biomechanics, o bɛ nafa caman di ni i y’a suma ni laadala plati fixation ye[cite: 5,
Nin ko fila bɛɛ minnu jirala — Rosa María ka kɛnɛya teliya la ka bɔ a karilen na, yɔrɔ naani [cite: 25] ani Javier ka furakɛli kɔrɔlen dɔ kisi min ma ɲɛ [cite: 34] — olu b’a jira ko nin fɛɛrɛ in nafa ka bon kɛnɛyako la. Dɔgɔtɔrɔso ni feerekɛlaw jɛɲɔgɔn minnu bɛ IM nailing fɛɛrɛ ta, olu bɛ se ka opereli waati surunw makɔnɔ, gɛlɛyaw hakɛ bɛ dɔgɔya, ka baarakɛcogo ɲuman sɔrɔ kuntaalajan na, ani ka nafa barikama sɔrɔ ɲɔgɔndan na bɔnɛ sugu la[cite:
Fɛn dilannenw ka ɲɛfɔliw
Ladilikanw & Nafolosɔrɔsiraw
Dɔgɔtɔrɔso sanni jɛkuluw kama: Aw ye musaka ni nafa sɛgɛsɛgɛli caman ɲini ani operelikɛlaw ka kalan bolodalen
Ka ɲɛsin jatebɔlaw ma: Baro kɛ waajulikɛyɔrɔ bɛnkanw kan, hakɛ sɔngɔko, ani jatebɔlaw ka margin sigicogo kan
Aw ye kuma XC Medico fɛ: https://www.xcmedico.com/kunnafoni.html
