5 Ihinduka ryamahame yimisumari nubuhanga bwo kubaga!

Amahame shingiro ya Intramedullary

1. Amateka ya Intramedillary Umusumari

Mu 1910, Lilienthal Aluminum Intramedullary Imisumari yakoreshejwe mu kuvura imivutire ya femoral.

Mu 1913, hakoreshejwe inzitizi ifeza imisumari yo kuvura amaboko. 

Kuncher (1900-1972) yatanze umusanzu munini muri intramedilary gukosora imisumari. 

1960 na 1970 ni igihe cyo guteza imbere byihuse imisumari. 

Igihugu cyanjye cyabakoresheje mubintu byinshi kuva mu myaka ya za 90.

2. Kugabanuka no kugabanya

1. Gucibwa ibirimi birashobora kubaga hakurikijwe iyerekwa ritaziguye cyangwa rifunze munsi ya X-ray.

2. Kugabanya gufungura igihe cyo gukiza ni ndende, kuva amaraso ahinnye cyane, kandi kugabanya gufungura kugirango bisenya amaraso kugirango avuze amaraso.

3. Birasabwa gukoresha kugabanya gufunga bishoboka. Guteshakira gukurungura birashobora gukoreshwa, cyangwa gucika intege gato kugirango bigabanuke kugirango uhuze kandi bigabanye, mugabanye kwivanga hamwe n'amaraso arangije.

4. Kunanirwa kugabanuka, kugabanuka kwigunga cyangwa gutobora imyenda ikikije, hamwe nibice bimeneka bimurika, kugabanuka kwubatse birashobora gukoreshwa.

3. Uburyo bwo gukosora ibyuma byimisumari

1. Uburyo bwo kuvuza imisumari yo gukosora imbere ni urwego rwo hagati rwimbere rwo gukosorwa.

2. Gukosora kuvunika imisumari ya Intramedorlay ni ugukwirakwiza imihangayiko, ntabwo ari ugukosora imihangayiko, bidakosorwa, bifasha kuzenguruka CallUs.

3. Gukosora hagati ni ibintu biruta gukosorwa hanze yo gukosora, bishobora kugabanya ukuboko kwagaciro, kugabanya indwara yo kumbaza filgus no kunanirwa imbere.

4. Intramedillary ikosora imisumari itanga ishingiro ryo kugabanya cyangwa kugabanya kumugaragaro.

4.Bibibi byimisumari yintera

1. Ingorane nke

2. Umwanya wagutse ibimenyetso byo kubaga

3. Gukosora

4. Amahugurwa ahuriweho na mbere

5. Ibiro byambere

6. Irashobora gukoreshwa hamwe nibindi bikosorwa imbere

Ubwoko bwibanze nubuhanga

1. Gufunga no kudafunga intera imisumari

2. Gufunga hamwe no gufunga intera imisumari

3. Kwaguka kwa Medillary hamwe nubuhanga bwo gukosorwa butemewe

4. Gufungura no gufunga uburyo bwo gukosora

Guhagarika no kudakomeza

Imisumari isanzwe ya Intramedullary ifite umutekano mubi kandi ifite imbaraga nkeya, ariko bafite imbaraga zimwe kandi irashobora gukira nyuma yo guhindura, bigatuma intera ntoya yaka.

Guhuza imisumari ya inttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttrodion neza no kurwanya ingaruka, gushikama neza, no guhuza n'ihame ryo gukosora ibinyabuzima. Byakoreshejwe cyane mumagufwa maremare yingingo. Cyane cyane kubice byinshi kandi bivuranganya, bafite umutekano mwiza kuruta imisumari isanzwe.

Imbaraga zo gukosorwa

Gufunga gufunga imisumari bitanga imihangayiko mike cyane kandi ubu birashyigikiwe cyane nibikorwa bitari bisanzwe byo gutera imbaraga.

Kubwububiko butaraze kumezi 6 kugeza kuri 8 nyuma yishyurwa, mu magufa yo gufata amagufwa cyangwa gusimbuza intera yaguye imisumari yaguye hamwe na dinamisation isanzwe ikoreshwa.

Imbaraga zirashobora gukoreshwa nkuburyo bwo guteza imbere kuvunika gukira. Ntabwo bisabwe bisanzwe kuko bishobora kuganisha kumurika.

Kwaguka kwa marambiyo no kwagura

Kwagura Marrow birashobora gushiramo imisumari yinkuta hamwe nimbaraga nini nini nini nini, afasha amahugurwa ya mbere kandi agabanya igipimo cyimisumari.

Kwagura Marrow birashobora gutanga umusaruro mwinshi w'amagufwa hamwe n'ingaruka za osteoindive, bifasha gukiza gukira.

Kwagura Marrow bizangiza amaraso yibikoresho byintungamubiri na membranesteteal, ariko imiyoboro y'amaraso irashobora kuvugurura mu cyuho cyimisumari. Kwagura Marrow birashobora kandi kongera uruziga rwamaraso mukigo cyoroshye cya tissue, bityo bigatuma habaho gukiza.

Kwagura Mararow byoroshye amahirwe yo kwandura no kumena ubusomvure, kandi bigomba gukoreshwa hitonda kuvunika, ibikomere byinshi, nibikomere bigoye.

Ibyiza byo Kwagura Abadayabukira

① Nyuma yo kwagura DialulLary, agace katuje hagati yumusumari wa Intramedillary hamwe namagufwa yiyongera, bitezimbere umutekano wo gukosorwa. 

② Nyuma yo kwagura DialulLary, umusumari munini wa diamesezeram urashobora gukoreshwa, yongera imbaraga za intera intera imisumari kandi igabanya igipimo cyimisumari yacitse. 

③ imyanda y'amagufwa nyuma yo kwaguka kwadullary irashobora gutuma amagufwa mashya, afasha gukiza gukira.

Ugereranije nuburyo bwo Kwagura Ubusambanyi Intramedillary Imisumari, Imisumari idashobora kwagurwa Imisumari ifite ibyiza bikurikira

① Igihe gito cyo gukora no kuva amaraso make. 

Kwivanga bike hamwe namaraso ya softteal mu manza hamwe nibikomere bikabije bya tissue.

Gusaba Intramedilary Umusumari

Ubukorikori bwo Guhuza Intramedullary Umusumari

Ibimenyetso byerekana imisumari

Ikimenyetso cyo guhuza imisumari mumikino yo kuvura imisumari yuburyo bwa humeral ni: kuvunika hamwe na byangiritse kandi imitsi, ibikomere byinshi, kuvunika ibintu bidahungabana, no kuvunika pathimes, hamwe nububiko bwimisoro.

Urwego rushobora gukosorwa ni kuva 2cm munsi yumutwe wubuhinzi kugeza kuri 3cm hejuru ya olecran fosa. Urashobora guhitamo kubikosora uhereye ku rutugu hamwe na antegrade intera imisumari cyangwa uhereye ku nkokora hamwe na retrograde umusumari.

Ibiranga imisumari

Uburyo bwo kubaga bworoshye bwo gucuruza humeral ni plation ahanini gukosora no kuvugurura imisumari.

Gukosora isahani ifite imitungo ikomeye na anti-yunamye kandi ihamye cyane, ariko ihahamuka ridasanzwe, amahirwe yo kwandura ari muremure, kandi imitsi ya radiyo irangirika byoroshye.

Imisumari yo gushakisha ubusoni igezweho yatsinze ibitagenda neza by'imisumari isanzwe nko guhuza amagufwa, umutwaro wo kuzunguruka, bityo ugabanye ibintu byinshi, kandi ko umutwaro wo mu gace karanze, kandi ko umutwaro wo mu gace katoroshye, kandi ko umutwaro wo mu gace karanze, kandi ko umuvugizi woroshye, kandi ko umutwaro wo mu gace karanze, kandi ko umuvugizi woroshye, kandi ko umuvugizi woroshye, kandi ko umuvugizi woroshye, kandi ko umutwaro wo mu gace karanze, kandi ko umutwaro wo mu gace karanze, kandi ko umutwaro wo mu gace karanze, kandi ko umuvugizi woroshye, kandi ko umutwaro wo mu gace katoroshye, kandi ko umuvugizi woroshye, kandi ko umuvugizi woroshye, kandi hakenewe kugabanyirizwa amagufwa, kandi hakenewe kugabanyirizwa amagufwa, kandi hakenewe kugabanyirizwa amagufwa. gutangwa nyuma yo kubagwa.

Guhuza femoral Guhuza imisumari

Ibimenyetso byerekana imisumari

Ubwoko bwose bwo kuvunika 2cm munsi ya vertebra ya Trochanter na 9cm zirenga 9cm kuva kumavi.

Kuvunika kera igice cyo hagati cya shaft femoral.

Abarwayi bafite isahani yananiwe gukosora imbere.

Ibiranga imisumari yo guhuza imisumari

Ibyiza bya Rechail

The force arm of femoral interlocking intramedullary nail for fixing fractures is longer than that of steel plates, and the force is evenly distributed on the central axis of the entire bone, which is not easy to bend and deform.

Imisumari yo gufunga kumpande zombi zinjira mumisumari kora igufwa ryuzuye kugeza hasi, kandi imisumari yo gufunga igabanuka ryimisumari, irinde umutekano, kandi ushikame, ushikamye kugirango ucike intege.

Gamma ihuza intera intera umusumari

Gamma Inganda

Bikoreshwa muburyo butandukanye bwibicuruzwa bya pertrochanterIc, cyane cyane kuvunika subrochanterIc.

Ikirangantego cya gamma (ubwitoraba bwabasuka) ibimenyetso

kuvunika subtrochanterIc, guhagarika igituba hamwe no kuvunika femoral.

Ibyiza bya Gamma Umusumari

Yateye imbere mu guhuza ibihano binyeganyega hamwe n'ikoranabuhanga ry'imiturire y'inyoni, umusumari munini wegereye isahani y'ibisimbanyi kuruta iki cy'isahani y'ibisimba, yongera imbaraga zamashini zo kudaharanira inyungu. Ku miterere yisumbuye irimo ubwinjiriro bwo hagati, umusumari yirinda gucika intege gucika intege kwa anatomy, ni ko ari byiza kuvunika gutandukanya cyangwa kuvunika subtrochanter.

Retrograde Intramedilllary Umusumari wa femoral

Yerekana gusubiramo imisumari ya femoral

Ahanini ikoreshwa kuri Francral Furmoral Flamorlar, harimo na Supracondylar yashinzwe kuvugurura no guteranira 't ' na 'y ' y 'yashizwemo birimo ubuso bwa articular.

Irashobora kandi gukoreshwa mugutanga femoral munsi ya Isthmus ya femur.

Shaft femoral, femorale ya supracondy, hamwe na intercondylar muri 20cm kuva kumavi.

Abafite amalaya yananiwe kurangiza.

Ibiranga gusubiramo imisumari ya femoral

Kuvunika urugero rwa Frimorallar nigice gikomeye hamwe ningorabahizi muburyo bwa mbere, kugabanya no kuba icya kabiri, gukosora imbere. Hariho ibibazo byinshi byo gukomera nko kuvunika bitari ubumwe no gutinda gukira.

Retrograde ihuza intera imisumari nuburyo busanzwe bwo kuvura kure mumyaka yashize, bifite imbaraga nziza zo kwimura hamwe no kwimura ibintu byakanje

Supracondylar yahujwe na Stemle Stem yashizweho na Suptracondy Umusumari wa Ragtramecondy, ikemura ikibazo kigoye gukemurwa mugukemura ibibazo intera imisumari ya femur. Igikoresho cyoroshye gukora, nukuri mumwanya, wizewe mugukosora, kandi umurwayi arashobora gukora imyitozo ina ivi nyuma yo kubagwa.

Tibial guhuza intera imisumari

Ibimenyetso byerekana imisumari ya tibial

Kuvunika bihamye hagati ya 1/3 cya Tibia: Guhindura ibiranga, kuvunika bigufi, pseudarthrose.

Kuvunika bidahungabana muri 60% yuburebure bwa tibia yo hagati: kuvunika hafi ya metaphysis, kuvunika igihe kirekire, kuvunika gutandukanya, kuvunika hamwe nimbuzi zamagufwa.

Ibiranga imisumari yo muri tibial

Guhuza intera intera imisumari ya Tibia ikoreshwa ahanini mubice bya tibia.

Nubwo nayo ishobora gukoreshwa mubice bya tibia, igipimo cyo kugorana kiri hejuru, amaduka yibasiwe cyane, kuvunika iherezo afite ≧ 1CM yo kugenda muri 1/2 cyimikorere yananiwe.

Ubuvanganzo bwatangaje ibyavuye mu kuvunika amavuta ya kure kuruta kuvunika kwa tibia nyuma yo gukosora fibula.

Ubuhanga bwo kubaga

Gutegura ibikoresho byihariye

Uburiri bwa orthopedic (uburiri bwo gukururika) cyangwa ibisanzwe bya fluescopic; retractor; Ishusho.

Guhitamo neza inzitizi yuburebure bwa endoprosthes

Radiograph

gupima ibipimo byinshi

Intramedillary Imisumari

X-Ray Isthmus Ubugari

Gupima imisumari yuburebure

1.Kwitambagiza umutegetsi wemeze munsi yimashini ya C-Amm

Iherezo rya kure kandi ryinshi ryamagufwa ryari kumurongo wa Ray; Umutegetsi yari ahwanye na diaphysis.

2. gupima no gupima ukurikije ibimenyetso byumubiri

Femur: Inama ya Crochanter Trochante → Umwanya w'ivi cyangwa inkingi isukuye ya patella; Tibia: Hagati-hagati ya ivi → Imbere yimbere ya Akle ihuriweho na dorsiflexion yamaguru.

Intramedullary Umuyoboro wo kwinjizamo - Uburyo bwo kwinjira

Indwara ndende ya cacullary yo mu murongo ugororotse

Ntabwo ari hafi yicyinjira

Uburebure bukwiye: byagusaguwe - birebire; Kudashidikanywaho - Bigufi

.

Ibangikanye na femoramed femoramedlary umusumari yinjira

Gutegura ingingo yinjira kumurongo wa femoral

HIP Flexion no Kwiyegurira

LongituDinal Gucika intege Kuri Crochanter Nkuru

Ntabwo ari kure cyane

Gushyira Pin

Gushyira ingabo yoroshye

Retrograde intera ya femoral

30 ° ivi

Indwara ndende ya PIN ya PIN imwe mu cyerekezo kimwe nigituba cyagutse cyuruti rwibinyabuzima

Kwinjiza Kirschner PIN muri Femur ya kure ikoresheje patellar ligament binyuze mu ntoki zo kurinda: orthogonal - hagati ya intercondylar fomur; kuruhande - umurongo wa Blumensaat

Gutangira pcl nta gukomeretsa

Ibangikanye tibial intttttttttttttramediat motit

Kurubuga rwagati rwabasambanyi

Imbere yimbere ya tibial plateau

Hejuru ishoboka utangiza ikibaya

Igicucu ntarengwa

Gukuramo tibial tuberotity-inkongi y'umuriro wa patella kuruhande rwa gicuruni

Fungura cavity cavity: Kuyobora PIN kuri 15 ° kugeza ku ndege ya SAGITLAL YINYURANYEORY AXIS ZISANZWE ZA TIBUL

Umwanya wishusho

Tekinike yo kwambere

Kugabanya amashanyarazi

kuvunika gushya

Kugabanuka kw'intongo

Kuvunika kera hamwe na pseudoartrosise, sclerose mububiko bwa gicururizwamo

Nta bundito munsi yifaranga

kuzenguruka amaraso ni coolant nziza

Tekinike

Kubara intera femoral

Impamvu zigoye zo kugarura imiyoboro yubugizi bwa femoral

Gupfunyika byoroheje byo guhinga ntabwo byemerera uburyo bworoshye bwo kugera kumagufa

Ingingo yinjira idashidikanywaho ntishobora kugaragara muburyo butaziguye

Hip guhuza hamwe → iliac fascia impagarara → Kugabanuka

Kugabanya Tibial Gucika intege

Manipulation

Ahanini subcutaneus kandi byoroshye kuripakira

Kuvunika neza - Hagati cyangwa kure ya Tar

Oblique Froctures - Kenshi

Intramedullary ingendo → ibikoresho byo kwimura

Ingamba zo kugabanya

Kugabanya ingingo

tibia; Imikoreshereze ya Per

Abasubiramo benshi (Brace)

kugabanuka; Kugabanya LOMB

Imiyoboro y'agateganyo

① Femur, Tibia

② hafi yumurongo uvunika uko bishoboka

③ gucika intege mbere yo gukoresha cortique

④Use Chuck Yose hamwe na T-Ikiganza cyoroshye

Umusumari

Kuvunika Kuvunika (Gukosora umurongo wingufu, Guhungabanya Kugarura, Kugarura Igikorwa)

Kuvunika oblique ya tibia ya kure cyangwa femur (imidugararo yogosha → igitutu)

Imisumari ihagaze neza Intera Inyuma Yinjire Umuyoboro wa Medullary Mububatsi

④ Ingingo ikennye, Guhuza Byinshi Byinshi

Ikirenga

① Tibia

② byunganirwa no gukurura cyangwa retractor

③ Koresha witonze mubikomere bikabije bya tissue

Komeza Bigufi

Kubuza kwaguka kwa Madullary muri leta yazamutse

Imisumari ifunga: kure noneho proximal

Ibyiza

Korohereza gukomanga, kwikuramo kuvunika; Kuratandukanya; Ibikorwa byo kugabanya.

Uburyo bwo kugabanya bwatinze & kubaga kubaga

Ibibazo bishobora guhura nabyo kubagwa

Ubumuga bwa Axial (kugabanya, kurakaza no kwimura)

Gukura muri granulation tissue

Amagufwa yo hakiri kare

Sclerose yo kuvunika ivunika hamwe no gufunga umwobo

Osteoporose

Ibibazo bishoboka

Gutandukanya kwaguka hamwe na IntramediLary Umusumari → Intramedillary Umusumari Kwinjira muri Cortex

Imyuga ya angular → retractor

Kwirinda iherezo ryaciwe → Umusumari wa Porori, Gukosora Amasahani

Uburyo bwo gukumira imirongo idasanzwe

Proximal - Ingingo yo Kwinjira

Madal - Intramedillary umusumari hagati yigituba cya gicururizwamo

Ingorabahizi za Intramedillary Imisumari

Kwandura

Amashanyarazi

Gufungura gukira

Kuvunika mu buvuzi

Guhinduranya hanze, torsion, valgus, kuzunguruka imbere, kurakara

Ububabare buhuriro

Ibinure bya Finbolism

Ossiropic

★ Pulmonary Embolism

Kongera kuvugurura

★ Thrombose

★ NINGANO

★ NTUMVE KUBARA, AMAFARANGA ARINION

Kunanirwa kwimbere imbere

★ Lindb

★ Bindi

Ingorane - Indwara

1.Barahurijwe, gufungurwa byafatwaga nkibintu byavugishije intera.

2.Ibintu byanduye nyuma yo kuvunika biterwa nuburyo bwo gukomeretsa byoroshye no kwanduza

INGABIRWA kwandura nyuma yo kuvunika biterwa na leta yo gukomeretsa byoroshye no kwanduza kimwe nuburyo bworoshye tissue yoroshye.

3.Imisumari ya intramedullary yongera amahirwe yo kwandura; Gufunga Gufunga Intramedillary Imisumari ikomangirika ni abakene, kandi igufwa rifite

Gufunga ifunga imisumari ikosowe ni umukene, hamwe na microscopique yimpera yavunitse igufwa ryamagufa kimwe nubusago busigaye, buroroshye gukura kwa bagiteri.

4. Gukoresha kwaguka kandi bike byagutse byagutse ntibizamura gusa ituze, ariko nanone yirinda kurema umwanya wapfuye.

Ibinure bya embromem

1.Indwara ya FE ya TUBINLON ndende ya tubular ni 0.5% kugeza 2%.

2. Kwagura Medulla no Kudagura Medulla ntaho bigira ingaruka zikomeye kuri Ventilation ya Pulnary.

3.Ibika byagutse Medulla, tekinike igomba kwikubita hasi, yirinda imbaraga nyinshi kandi ikora neza.

.

Gutinda kuvuza gukiza no kumagufa nonnion

Ibintu bitandukanye bigira ingaruka kubihagarika nyuma yo gukosora imisumari, kandi ibitera birashobora gusesengurwa kuburyo bukurikira.

1.sopsoft tissue yashyizwe mu mpera

2. Gutandukanya kuvuka k'amashanyarazi birangira

3. Imyaka myinshi yumurwayi

4. Gufungura Gukuramo, gukomeretsa bikomeye

5. Inter RATTANDEVELLARLARS

6. Yahujije diyabete mellitus cyangwa izindi ndwara zibishakiye.

Kuvunika kwa muganga

Gucikamo ubuvuzi biterwa ahanini ni kuvunika kabiri biterwa na manipulation idahwitse mugihe cyo gukosora imisumari.

Gutahura ibintu bigomba kwishyurwa

1. Guhitamo bidahwitse byinjira mumusumari bishobora gutera kuvunika kwa proximine.

2. Ntugasunike ku gahato mu kwagura Medulla.

3. Ubwinjiriro bwa Pulp Kwagura bigomba kuba mu cyerekezo kimwe nkicyerekezo cyimisumari.

4. Ntukoreshe imbaraga mugihe winjije intera intera imisumari mu mpera za kure.

Ububabare mu ngingo zituranye

1. Gushyira umusumari intera birimo tissue yoroshye ndetse na capsule ihuriweho hagati ya byibuze byibuze 1.

2. Ikibaya cya Tibial gihujwe numwanya wimbere wa meniscus ya meniscus na ivi ryamavi nagize akarere keza hejuru yumutwe wuburiri kugeza kuriyi ngingo. Niba intera ndende iri hafi cyane cyangwa diameter yumusumari ni kinini cyane, birashobora kwangiza imiterere yinzitizi, bikavamo ububabare bwa posita.

3. Proximal protrusion yo muri Intemere ya Intramediclary na heterotopic

4. Proximal protrusion yintera, ifunga imisumari kandi ifunga imisumari ya kaburimbo nimpamvu nyamukuru itera ububabare nyuma yo kubabara imisumari yububiko.