Amahame 5 yo gukoresha imisumari hamwe nubuhanga bwo kubaga!

Amahame shingiro yo gutera imisumari

1. Amateka yo gutera imisumari

Mu 1910, imisumari ya Lilienthal aluminiyumu yakoreshejwe mu kuvura imvune z'umugore.

Mu 1913, Schone yakoresheje imisumari ya feza kugirango avure kuvunika amaboko. 

Kuntscher (1900-1972) yatanze umusanzu ukomeye mugukosora imisumari. 

1960 na 1970 byari igihe cyiterambere ryihuse ryimisumari yimbere. 

igihugu cyanjye cyakoresheje byinshi kuva 1990.

2. Kugabanya gufungura no kugabanya gufunga

1. Kuvunika ingingo birashobora kugabanuka kubagwa muburyo butaziguye cyangwa gufungwa mugukurikirana X.

2. Kugabanya kumugaragaro kuvunika kuvunika igihe cyo gukira ni kirekire, kuva amaraso adakorana ni menshi, kandi kugabanuka kumugaragaro byangiza amaraso kugeza kumeneka.

3. Birasabwa gukoresha kugabanya gufunga bishoboka. Kugabanya gukurura birashobora gukoreshwa, cyangwa gutemagurwa gato ku ndege yamenetse kugirango igabanye kandi igabanye, bityo bigabanye kwivanga mumaraso kugeza kumeneka.

4. Kugabanuka kunanirwa gufunga, ibice byamagufwa bihindagurika cyangwa gutobora ingirangingo zikikije, hamwe nuduce twinshi twavunitse twimuwe, kugabanya gufungura kubaga birashobora gukoreshwa.

3. Uburyo bwo gukosora bwa imisumari

1. Uburyo bwo guteramo imisumari imbere ni guhuza hagati imbere gutandukanya ibice.

2. Gukosora kuvunika ukoresheje imisumari yimbere ni ugukwirakwiza imihangayiko, ntabwo gukosora gukingira, bifasha muburyo bwo guhamagarwa.

3. Gukosora hagati birarenze kurwego rwo hejuru rushobora gukosorwa hanze, rushobora kugabanya imbaraga zingufu, kugabanya ibyago byo kurakara kwa valgus no kunanirwa gukosora imbere.

4. Gukosora imisumari yimbere itanga ishingiro ryo kugabanuka gufunze cyangwa kugabanuka gukinguye.

4.Ingirakamaro yimisumari yimbere

1. Ingorane nke

2. Kwagura urugero rwibimenyetso byo kubaga

3. Gukosora neza

4. Amahugurwa yo guhuriza hamwe hakiri kare

5. Kwikorera ibiro hakiri kare

6. Irashobora gukoreshwa hamwe nibindi bikosorwa imbere

Ubwoko bwibanze nubuhanga

1. Gufunga no kudafunga imisumari yimbere

2. Gufunga imisumari idasanzwe kandi ihagaze neza

3. Kwagura Medullary hamwe nubuhanga bwo gukosora butari medullary

4. Gufungura no gufunga tekinike yo gukosora

Guhuza no kudahuza

Imisumari isanzwe ifite imisumari idahwitse kandi ifite imbaraga nke za torsional, ariko ifite elastique runaka kandi irashobora gukira nyuma yo guhindurwa, bigatera akantu gato kanyerera.

Guhuza imisumari yimbere ifite ingaruka nziza zo kurwanya kuzunguruka no kurwanya compression, guhagarara neza, kandi bihuye nihame ryo gutunganya ibinyabuzima. Zikoreshwa cyane mumagufa maremare yingingo. Cyane cyane kubice byinshi kandi byavunitse, bifite ituze ryiza kuruta imisumari isanzwe.

Guhindura imikorere ihamye

Gufunga imisumari ihamye itanga masike nkeya cyane kandi ubu irashyigikirwa kubikorwa bitari bisanzwe byo gukora.

Kubuvunika butarakize mumezi 6 kugeza 8 nyuma yo kubagwa, muburyo bwo guteranya amagufwa cyangwa gusimbuza imisumari yagutse yimitsi hamwe nimbaraga zikoreshwa.

Dynamisation irashobora gukoreshwa nkuburyo bwo guteza imbere gukira kuvunika. Ntabwo bisabwa buri gihe kuko bishobora kuganisha ku kugabanya ingingo no guhindagurika.

Kwagura marrow no kwaguka kutari marrow

Kwiyongera kwa marrow birashobora gushiramo imisumari idasanzwe hamwe na diameter nini nimbaraga nini, ibyo bikaba bifasha imyitozo hakiri kare kandi bikagabanya umuvuduko wimisumari yamenetse.

Kwiyongera k'umusemburo birashobora kubyara imyanda myinshi hamwe n'amagufwa ya osteoinductive, bifasha gukira kuvunika.

Kwiyongera kw'imitsi bizangiza amaraso y'amaraso y'intungamubiri hamwe na endosteal membrane, ariko imiyoboro y'amaraso irashobora kuvuka mu cyuho cy'imisumari. Kwaguka kw'imitsi birashobora kandi kongera umuvuduko w'amaraso mu mitsi yoroheje ikikije imitsi, bityo bigatuma gukira kuvunika.

Kwiyongera k'umusemburo ugereranije byongera amahirwe yo kwandura na embolisme, kandi bigomba gukoreshwa witonze kuvunika kumugaragaro, gukomeretsa byinshi, no gukomeretsa bikomeye.

Ibyiza byo kwaguka kwa medullary

① Nyuma yo kwaguka kwa medullary, ahantu ho guhurira hagati yimisumari yimbere hamwe namagufa ariyongera, bigateza imbere gukomera. 

② Nyuma yo kwaguka kwa medullary, hashobora gukoreshwa umusumari munini wa diametre intramedullary, ibyo bikaba byongera imbaraga zumusumari winjiza kandi bikagabanya umuvuduko wimisumari yamenetse. 

Imyanda yamagufa nyuma yo kwaguka kwa medullary irashobora gutera amagufwa mashya, bifasha gukira kuvunika.

Ugereranije no kwaguka kwa medullary imisumari yimisumari, imisumari itaguwe imisumari ifite ibyiza bikurikira

Time Igihe gito cyo gukora no kuva amaraso make. 

Kwivanga gake no gutembera kw'amaraso ya endosteal mugihe gikomeretse cyane.

Gushyira mu bikorwa imisumari

Humeral guhuza imisumari yimbere

Ibyerekana imisumari ya humeral

Ibimenyetso byerekana imisumari ihuza imisumari yimbere mu kuvura imvune ya humeral ni: kuvunika kwangirika kwamaraso nu mitsi, ibikomere byinshi, kuvunika kudahindagurika, kuvunika indwara, hamwe no kuvunika kwa humeral.

Urwego rushobora gukosorwa ni kuva kuri 2cm munsi yumutwe wa humeral kugeza kuri 3cm hejuru ya olecranon fossa. Urashobora guhitamo kubikosora uhereye ku rutugu hamwe na antegrade intramedullary umusumari cyangwa kuva mu nkokora ukoresheje umusumari wa retrograde.

Ibiranga imisumari ya humeral

Uburyo bwo kubaga uburyo bwo kuvunika bwa humeral shaft ni ugusana ibyapa no gutunganya imisumari.

Gukosora isahani bifite imbaraga zo kurwanya kuzunguruka no kurwanya kugonda kandi birakosowe neza, ariko ihahamuka ryo kubaga ni rinini, amahirwe yo kwandura ni menshi, kandi imitsi ya radiyo yangiritse byoroshye.

Imisumari ya kijyambere ihuza no kwifungisha imisumari irenga inenge yimisumari isanzwe yinjizwamo nko guhungabana kwa axial, kugenzura nabi kuzunguruka, no gukenera gukosorwa byongeweho, kugirango kuvunika gukosorwe neza, gutakaza amaraso ni bito, kwambura imyenda yoroheje ni bike, kandi kwaguka kwa medulaire bihwanye no guterwa amagufwa hakiri kare, umutwaro ugatangira kugabanwa hakiri kare, kandi imyitozo ikagabanywa hakiri kare, kandi imyitozo ikagabanywa hakiri kare.

Femoral interlocking intramedullary imisumari

Ibyerekana imisumari ihuza igitsina gore

Ubwoko bwose bwavunitse 2cm munsi ya trochanteric vertebra na hejuru ya 9cm uhereye kumavi.

Ivunika rya kera ryigice cyo hagati cyigitsina gore.

Abarwayi bafite isahani yananiwe gukosorwa imbere.

Ibiranga imisumari ihuza igitsina gore

Ibyiza bya mashini

Imbaraga zimbaraga zumugore zifatanije imisumari yimbere kugirango ikosore imvune ni ndende kuruta iy'ibyuma, kandi imbaraga zigabanywa ku murongo wo hagati w'amagufwa yose, ntibyoroshye kunama no guhindura.

Imisumari yo gufunga kumpande zombi zumusumari winjiza bituma igufwa riba ryuzuye kuva hejuru kugeza hasi, kandi imisumari yo gufunga kumpera ya kure irashobora kugabanya ukuboko kwumuriro wumusumari winjiye mumagufwa, bikarinda kugabanuka no kuzunguruka, kandi bikagera kumurongo uhamye kandi ushikamye mugukosora kuvunika.

Gamma Guhuza Imisumari

Gamma yerekana imisumari

Bikoreshwa muburyo butandukanye bwo kuvunika peritrochanteric, cyane cyane kuvunika subtrochanteric.

Kwagura imisumari ya Gamma (imisumari yo kwiyubaka)

kuvunika cyane subtrochanteric, trochanteric ihujwe no kuvunika kwumugore.

Ibyiza bya Gamma imisumari

Byakozwe muguhuza ikibuno cyo kunyerera hamwe nubuhanga bwimisumari yimisumari, umusumari nyamukuru wegereye imbere imbere yu mwobo wa medullary kuruta icyapa cya dinamike, bityo umusumari wa Gamma utwara uburemere bwumurwayi hafi ya calcora yumugore kuruta icyapa cya dinamike, byongera imbaraga za mashini zatewe. Kubuvunika bwa subtrochanteric burimo no hagati ya cortical medinal, umusumari wa Gamma wirinda gukenera kwiyubaka kwa anatomiya, bityo rero ni ingirakamaro kumeneka ya intertrochanteric cyangwa kuvunika subtrochanteric.

Retrograde intramedullary femorale imisumari

Ibimenyetso bya retrograde imisumari yumugore

Byakoreshejwe cyane cyane kuvunika kwa supracondylar femorale, harimo supracondylar yavunitse hamwe na intercondylar 'T ' na 'Y ' zavunitse zavanze zirimo ubuso bwa arctular.

Irashobora kandi gukoreshwa kumeneka yumugore munsi ya isthus ya femur.

Igiti cyigitsina gore, supracondylar femorale, na intercondylar kuvunika muri 20CM uhereye kumavi.

Abananiwe gukosora isahani.

Ibiranga retrograde femorale imisumari

Supracondylar kuvunika femorale ni kuvunika gukomeye hamwe ningorabahizi mubwa mbere, kugabanuka naho icya kabiri, gukomera imbere. Hano haribibazo byinshi byingutu nko kuvunika kudahuza hamwe no gutinda gukira.

Retrograde ihuza imisumari ya intramedullary nuburyo bukoreshwa muburyo bwo kuvura kuvunika kw’umugore kure mu myaka yashize, bifite imiterere ihamye y’imashini, birashobora kugenzura neza iyimurwa ryimbere hamwe no guhinduranya kuzenguruka kumpera ya kure yimvune, kandi bigafasha mukugenda kwambere.

Supracondylar ihujwe no kuvunika uruti rwigitsina gore ikosorwa hamwe na supracondylar ndende ndende yimisumari, ikemura ikibazo kitoroshye gukemurwa no gufatisha imisumari yimbere. Igikoresho kiroroshye gukora, cyuzuye muburyo buhagaze, cyizewe mugukosora, kandi umurwayi ashobora gukora imyitozo y'amavi hakiri kare nyuma yo kubagwa.

Tibial ihuza imisumari yimbere

Ibimenyetso byo gutera imisumari

Ivunika rihamye hagati ya 1/3 cya tibia: kuvunika guhindagurika, kuvunika kugufi, pseudarthrosis.

Ivunika ridahungabana muri 60% yuburebure bwa tibia yo hagati: kuvunika hafi ya metafizisi, kuvunika kwizunguruka ndende, kuvunika igice, kuvunika kwavunitse, kuvunika hamwe nubumuga bwamagufwa.

Ibiranga imisumari ya tibial

Guhuza imisumari yimbere ya tibia ikoreshwa cyane kumeneka ya tibia yo hagati.

Nubwo ishobora no gukoreshwa kumeneka ya tibia yegeranye kandi ya kure, igipimo cyingorabahizi kiri hejuru, malunion ibaho kenshi, impera yamenetse ifite ≧ 1cm yimuka muri 1/2 cyimanza, kandi 1/4 cyo gukosora birananirana.

Ubuvanganzo bwatangaje ingaruka nziza zo kuvunika kwa tibia kure kuruta kuvunika kwa tibia hafi ya fibula isanzwe ikosorwa.

Ubuhanga bwo kubaga

Gutegura mbere y'ibikoresho bidasanzwe

Uburiri bwa orthopedic (uburiri bwo gukwega) cyangwa uburiri busanzwe bwa fluoroscopique; retrator; ishusho.

Guhitamo neza uburebure bwimisumari ya endoprostheses mbere yo gutangira

Radiografi

gupima uburebure bw'igihimba

Imirambararo yimisumari

x-ray ubugari bwa isthmus

Gupima uburebure bw'imisumari

1.Umutegetsi uhindagurika munsi ya C-mashini

Impera ya kure kandi yegeranye yamagufa yari kumurongo wo hagati wumurishyo; umutegetsi yabangikanye na diaphysis.

2.Gupima uburebure ukurikije ibimenyetso byumubiri

Femur: inama ya trochanter nini space umwanya wamavi cyangwa inkingi isumba iyindi; tiba

Ubuhanga bwo Kwinjiza Imisumari - Uburyo bwo Kwinjira

Umurongo muremure wa medullary cavit mumurongo ugororotse

Ntabwo yegereye cyane aho yinjira

Uburebure bukwiye: bwagutse - burebure; idafite aho ihuriye - ngufi

(Kwemeza mu buryo butaziguye aho binjirira; nta kwaguka kwa pulp, nta kurinda imyenda yoroshye bisabwa)

Iringaniza femoral intramedullary imisumari yinjira

Gutegura aho winjirira kugirango ubangikanye numusore wigitsina gore

Guhindura ikibuno no kwiyongera

Kurekura birebire hafi ya trochanter nini

Ntabwo ari kure cyane

Gushyira icyerekezo pin

Gushyira ingabo yoroheje

Retrograde femoral intramedullary imisumari yinjira

30 ° guhindagurika kw'ivi

Umurongo muremure wuyobora pin mu cyerekezo kimwe na medullary cavit ya stem femorale ya kure

Kwinjiza pin ya Kirschner mumugongo wa kure unyuze mumurongo wa patellar unyuze mumaboko arinda: orthogonal - hagati ya fossa ya intercondylar ya femur; kuruhande - Umurongo wa Blumensaat

Intangiriro ya PCL nta nkomere

Kuringaniza tibial intramedullary imisumari yinjira

Hagati yumurongo wa medullary

Imbere yimbere ya tibial plateau

Nibishoboka byose utarinze kwangiza ikibaya

Ivi ntarengwa

Gutemagura tibial tuberosity-munsi ya pole ya patella kuruhande rwa medullary

Fungura umwobo wa medullary: kuyobora pin kuri 15 ° kugeza ku ndege ya sagittal ya axitudinal axis ya tibial stem

Umwanya w'ishusho ukomera

Uburyo bwo gushakisha

Kugabanuka gukoreshwa n'amashanyarazi

kuvunika gushya

Kugabanya intoki

kuvunika bishaje hamwe na pseudoarthrosis, sclerose mumyanya ya medullary

Nta marushanwa munsi yifaranga

gutembera kw'amaraso ni byiza gukonjesha

Uburyo bwo gusimbuza

Kuringaniza femorale intramedullary imisumari

Impamvu zo kugora kugarura imvune zumugore

Gupfunyika imyenda yoroheje ntishobora kwemerera igufwa

Ingingo yo kwinjiza inshinge ntishobora kugaragara neza

Kwiyongera kw'ibibuno → iliac fascia tension → kugabanya kuvunika

Kugabanya kuvunika kwa Tibial

Gukoresha

Ahanini munsi yubutaka kandi byoroshye kurigata

Ivunika rihamye - kuvunika hagati cyangwa kure A na B.

Kuvunika kwa oblique - kurenza urugero

Imisumari yimbere → ibikoresho byo kwimura

Ingamba zo kugabanya

Imbaraga zo kugabanya ingingo

tibia; gukoresha percutaneous cyangwa igikomere

Abasubiza inyuma (imirongo)

kugabanuka gutinda; kugabanya ingingo

Schanz by'agateganyo

Em Femur, tibia

② Hafi yumurongo wavunitse bishoboka

Vavunitse hafi yo gukoresha cortical imwe

④ Koresha igikoma rusange hamwe na T-ikiganza kugirango byoroshye kuyobora

Umusumari

Vavunitse Metethyseal (gukosora umurongo wingufu, guhagarika kugarura, kugarura ibikorwa)

Fract kuvunika oblique ya tibia ya kure cyangwa femur (guhagarika umutima → igitutu)

Imisumari idahagaze neza yinjira mumiyoboro ishaje ya medullary mugihe cyo kubagwa kabiri

Point Ingingo idahwitse yo kwinjiramo, guhuza imvune idahagije (screw yashyizwe perpendicular kubishobora kwimurwa kwa endoplant)

Amarushanwa yagutse

Tibia

Yuzuzwa no gukurura cyangwa gusubiza inyuma

③ Koresha witonze mugukomeretsa byoroshye

④ Gumana igihe gito

Kubuza kwaguka kwa medullary muri leta yuzuye

Gukurikirana imisumari: intera noneho yegeranye

Ibyiza

koroshya gukomanga, kwikuramo kuvunika; kurandura gutandukana; ibikorwa byo kugabanya.

Kugabanya tekinike yo gutinda & nonunion kubaga

Ibibazo bishobora guhura nogutinda kubagwa

Ubumuga bwa Axial (kugabanya, kurakara cyangwa kwimurwa)

Gukura mubice bya granulation

Amagufwa yo hambere

Sclerose yo kuvunika ivunika no gufunga umwobo wa medullary

Osteoporose

Ibibazo bishoboka

Gutandukana kwaguka no gutera imisumari → intramedullary imisumari yinjira muri cortex

Guhindura inguni → retractor

Kwimura impera zaciwe → Umusumari wumupolisi, gutunganya isahani

Uburyo bwo gukumira imirongo yingufu zidasanzwe

Ikigereranyo - gukosora aho winjirira

Intera - imisumari yimbere hagati rwagati ya medullary

Ingorane zo Gutera Imisumari

★ Indwara

★ Kwangiza imitsi

Gukiza kugoretse kuvunika

Uc Amavuriro

Kuzenguruka hanze, torsion, valgus, kuzunguruka imbere, kurakara

Ububabare bufatanye

Omb Embolism

Ossification Heterotopic

Embolism embolism

Kongera kuvunika

★ Thrombose

Gukomera hamwe

★ Kudahuza kuvunika, guhuza amagufwa

Fail kunanirwa gukosora imbere

Short Kugabanya amaguru

★ Ibindi

Ingorane - Kwandura

1.Kubanza, kuvunika gufungura byafatwaga nk'ikinyuranyo cyo gutera imisumari.

2.Indwara zanduye nyuma yo kubagwa zavunitse bivana nuburyo imvune yimitsi yoroheje no kwanduza

Umubare wubwandu nyuma yo kuvunika kumugaragaro biterwa nuburyo bwo gukomeretsa ingirangingo zoroshye no kwanduza ndetse nuburyo uburyo bworoshye bworoshye.

3.Imisumari yimbere yongerera amahirwe yo kwandura; kutaguka gufunga imisumari yimisumari ikosorwa irakennye, kandi amagufwa afite

Gufunga imisumari itaguwe neza ni bike cyane, hamwe na microscopique igenda iva kumagufa yamenetse kimwe nu mwobo usigaye, byoroshye gukura kwa bagiteri.

.

Indwara ya Embolism

1.Ibibazo bya FES byo kuvunika amagufwa maremare ni 0.5% kugeza 2%.

2. Kwaguka kwa medula no kutaguka kwa medula nta ngaruka nini bigira ku guhumeka ibihaha.

3.Iyo kwagura medulla, tekinike igomba kuba yoroheje buhoro, wirinda imbaraga nyinshi nigikorwa gikomeye.

4.isuzumabumenyi rya FES riracyakurikiza ibipimo byasabwe na Gurd mu 1974, kandi kuvura nyuma yo kwisuzumisha bizadindiza igihe cyiza cyo kwivuza kandi bishobora kugira ingaruka zikomeye.

Gutinda kuvunika gukira no kudahuza amagufwa

Impamvu zitandukanye zigira ingaruka zo gukira kuvunika nyuma yo gukosora imisumari, kandi ibitera bishobora gusesengurwa kuburyo bukurikira.

1.imyenda yoroheje yashyizwe mumutwe wavunitse

2. Gutandukanya kuvunika kwa transvers birangira

3. Ubusaza bwumurwayi

4. Gufungura kuvunika, gukomeretsa ingirabuzimafatizo zikomeye, hemodialysis ikomeye cyangwa kwandura.

5. Gukosora imisumari idahwitse

6. Diyabete ihuriweho na mellitus cyangwa izindi ndwara zifata.

Ivunika ry'ubuvuzi

Ivunika ryatewe nubuvuzi ahanini ni ibice bya kabiri byatewe no gukoreshwa nabi mugihe cyo gutunganya imisumari.

Imikoranire idahwitse igomba kwitabwaho

1. Guhitamo nabi guhitamo imisumari bishobora gutera kuvunika hafi.

2. Ntugasunike ku gahato kwaguka kwa medula.

3. Ubwinjiriro bwo kwagura pulp bugomba kuba mucyerekezo kimwe nicyerekezo cyo kwinjiza imisumari.

4. Ntukoreshe imbaraga mugihe winjizamo imisumari yimbere mumpera ya kure.

Kubabara mu ngingo zituranye

1. Gushyira umusumari winjizwemo harimo imyenda yoroshye ndetse na capsule ihuriweho hafi ya byibuze 1.

2. Niba aho imisumari yegereye cyane cyangwa hejuru yumurambararo wimisumari nini cyane, irashobora kwangiza imiterere yimbere yimbere, bikaviramo kubabara ivi nyuma yibikorwa.

3. Kwiyegereza hafi yimisumari yimbere hamwe na osifiseri ya heterotopique nimpamvu nyamukuru zitera ububabare bwibibuno nyuma yo kubagwa imisumari ya femorale.

4. Kwiyegereza hafi yimisumari yimbere, gufunga hafi yimisumari no kwivanga kwa rotateur nimpamvu nyamukuru itera ububabare bwigitugu nyuma yimisumari yimitsi.