Ibyiza nubuhanga bwo gukoresha Suture Passer muri Rotator Cuff yo Kubaga

Waba warigeze wibaza ibibera inyuma mugihe umuganga ubaga asana cuff rotator yacitse? Ntabwo ari ugushushanya ibintu gusa; ni imbyino yoroheje yuburyo busobanutse, guhanga udushya, kandi rimwe na rimwe, ibikoresho byubwenge bidasanzwe. Uyu munsi, tugiye gusubiza inyuma umwenda kuri kimwe gitangaje: passer passer. Iki ntabwo ari ikindi gikoresho gusa; ni umukino uhindura umukino wahinduye mubyukuri uburyo abaganga babaga amagufwa begera imwe mubikomere bikabije kandi bitesha umutwe. Noneho rero, komera, kubera ko tugiye kwibira mu isi  yo gusana rotate cuff yo gusana, dushakisha impamvu umutambukanyi wa suture yabaye umufasha wingenzi mubyumba byo gukoreramo, nuburyo abaganga bakoresha imbaraga zabo kugirango bagarure imikorere kandi bagabanye ububabare.

Sobanukirwa na Rotator Cuff nibikomere byayo

Mbere yuko twinjira muri nitty-gritty ya suture abahisi, reka tumenye neza ko twese turi kurupapuro rumwe kubyo dusana mubyukuri. Tekereza urutugu rwawe - ni urufatiro rudasanzwe, rushobora kugenda rutangaje. Ariko hamwe nubworoherane bukomeye hazamo intege nke, sibyo?

Niki Muburyo bwa Rotator Cuff?

Tekereza rotateur cuff nkintwari itavuzwe murutugu rwawe. Ntabwo ari imitsi imwe, ahubwo ni itsinda ryimitsi ine hamwe nimitsi yabo ikikije urutugu. Iyi mitsi - supraspinatus, infraspinatus, teres ntoya, na subcapularis - ikora mubwumvikane. Akazi kabo k'ibanze? Kugirango uhagarike urutugu rwawe, rukwemerera kuzamura ukuboko, kuzunguruka, no gukora izo ngendo zose za buri munsi ufata nkukuri, nko kugera kubikombe bya kawa cyangwa guta umupira. Mubyukuri bakora 'cuff ' bazengurutse umutwe wigitereko cyawe (igufwa ryikiganza cyawe cyo hejuru), bakagifata neza mumutwe muto wicyuma cyawe. Hatariho rotateur nzima, nibikorwa byoroshye birashobora guhinduka bikabije kandi bigoye.

Ibikomere bisanzwe bya Rotator: Reba hafi

None, bigenda bite mugihe iri tsinda ryingenzi ryimyitozo ifashe icyemezo cyo kureka umuzimu? Ibikomere bya rotator nibisanzwe bidasanzwe, byibasira miriyoni yabantu kwisi yose. Birashobora gutandukana kuva kubabara bikabije kugeza kububabare bukabije, butera intege bigatuma no gusinzira bitoroshye.

Ubwoko bw'amarira: Kuva Fraying kugeza Catastrophe yuzuye

Rotator cuff amarira ntabwo arikibazo-kimwe-gikwiye. Ziza muburyohe butandukanye, buri kimwe gifite ingaruka zacyo zo kuvura no gukira.

Ubwa mbere, dufite amarira-yuzuye amarira . Tekereza umugozi utangiye gucika - imirongo imwe yaravunitse, ariko ntabwo yaciwe burundu. Iri ni amarira igice. Imitsi yangiritse, ariko ntabwo yitandukanije rwose namagufwa. Ibi birashobora gutera ububabare nintege nke, ariko akenshi byakira neza kubuvuzi butabagwa nkubuvuzi bwumubiri.

Noneho, hari amarira yuzuye . Aha niho umugozi wacitse burundu. Imitsi yatandukanijwe rwose nigufwa, irema umwobo cyangwa icyuho. Aya marira hafi ya yose arasaba ubufasha bwo kubaga kugirango yongere ahuze. Mu marira yuzuye umubyimba, urashobora kumva amagambo nka 'yakuweho ' cyangwa 'adasubiye inyuma. ' Amosozi yakuweho bivuze ko imitsi yavuye kure cyane aho ifatanye, bigatuma gusana bigorana.

Kurambura Impamvu nimpamvu

Kuki aya marira abaho? Akenshi ni ibintu byinshi, umuyaga mwiza uhuha mugitugu cyawe.

Umwe mu nyirabayazana ni igikomere gikomeye . Nibihe byawe bya kera 'oops ' - kugwa kumaboko arambuye, guterura ikintu kiremereye cyane, cyangwa gitunguranye, imbaraga zikomeye zirenze imitsi. Tekereza ikibindi cya baseball cyangwa umukozi wubwubatsi; ibitugu byabo bihora binaniwe.

Kenshi na kenshi, ariko, rotator cuff amarira nigisubizo cyimpinduka zangirika mugihe. Mugihe tugenda dusaza, imitsi yacu isanzwe irashira, igahinduka elastike kandi ikunda kurira. Niyo mpamvu rotator cuff amarira yiganje cyane mubantu bakuze. Ibikorwa byo gusubiramo inshuro nyinshi, nko gushushanya, ububaji, cyangwa no koga, birashobora kwihuta kwambara no kurira. Tekereza umugozi wa reberi urambuye kandi urekurwa inshuro ibihumbi - amaherezo, ubura icyo ufata.

Ibindi bintu bishobora guteza akaga harimo amagufwa (gukura kw'amagufwa mato ashobora gukururuka ku mitsi, bigatera uburakari n'amarira), guhagarara nabi , ndetse no gutegekwa na geneti . Rimwe na rimwe, birasa nkaho umubiri wawe uhisemo kuguhemukira, sibyo?

Glimpse muri Gakondo ya Rotator Cuff yo Gusana

Mu myaka ibarirwa muri za mirongo, gusana ibintu bya rotateur byacitse akenshi birimo ibice binini, bifunguye. Abaganga babaga bafunguye urutugu kugirango babone neza ibyangiritse, hanyuma bakoreshe inshinge gakondo kandi suture kugirango ube wongeye guhuza imitsi yacitse kumagufa. Nubwo ari byiza, ubu buryo bwaje bufite imbogamizi zikomeye: inkovu nini, ububabare bwinshi nyuma yo kubagwa, igihe kinini cyo gukira, hamwe n’impanuka nyinshi zo guhura n'ingaruka.

Hanyuma haza arthroscopy , tekinike yibasiye yahinduye byose. Tekereza kubaga ukoresheje utuntu duto 'urufunguzo ' ukoresheje kamera ntoya nibikoresho byihariye. Ibi byari ugusimbuka gutera imbere, kugabanya abarwayi kutoroherwa no kwihuta gukira. Nubwo, hamwe na arthroscopie, ikibazo cyo gutambutsa neza suture binyuze mumyanya ikomeye, akenshi yakuweho ingirabuzimafatizo hanyuma ikanyura mumagufwa, yose mumwanya muto, yagumyeho. Aha niho intwari yacu, umutambukanyi wa suture, yinjira mubyukuri.

Kumenyekanisha Suture Passer: Guhindura Kubaga Orthopedic

None, nikihe gikoresho cyubumaji twagiye twerekana? Reka tumenyane na suture passer, igikoresho cyahinduye imiterere ya rotator cuff yo gusana.

Niki gituma umutambukanyi wa Suture adasanzwe?

 

Muri rusange, umutambiko wa suture ni igikoresho cyagenewe koroshya no kunoza inzira yo kunyuza suture binyuze mumyenda n'amagufwa mugihe cyo kubaga arthroscopique. Tekereza nk'urushinge rwihariye, rurerure rufite uburyo buhanitse bwo gufata cyangwa kugarura ku isonga ryarwo. Aho kugirango uhindure intoki inshinge ukoresheje tissue, zishobora kugorana bidasanzwe kandi bigatwara igihe mumwanya muto wa arthroscopique, umutambukanyi wa suture yemerera umuganga kubaga gutobora neza ingirangingo, gufata suture, no kuyinyuza mumurongo umwe. Ninkaho kugira imashini idoda ntoya, yihuta cyane imbere.

Kuki iki ari ikintu kinini? Kuberako kubaga arthroscopique, nubwo byibasiye cyane, bitanga ibibazo byihariye. Urimo gukora unyuze kumurongo muto, wishingikirije kuri ecran ya videwo kugirango urebe, kandi ukoreshe ibikoresho birebire, byoroshye. Gukoresha inshinge gakondo birashobora kuba ingorabahizi, biganisha ku gucika intege, kongera igihe cyo gukora, ndetse bishobora no kwangirika ku nyubako zikikije. Uwitambutse ya suture yavutse kubera gukenera uburyo bunoze, busobanutse, kandi budahungabana bwo gukemura ibibazo muri ibi bidukikije bigoye.

Ubwihindurize bwa Surgical Precision: Kuva inshinge kugeza abahisi

Urugendo ruva kubagwa gakondo rufunguye hamwe ninshinge nini zogusana arthroscopique igezweho hamwe nabashitsi ba suture ni gihamya yo guhanga udushya mubuvuzi. Ubuhanga bwa arthroscopique bwambere bwakomeje gushingira kuburyo butandukanye bwo kunyuza suture, akenshi burimo imyitozo igoye hamwe nibikoresho byinshi cyangwa inshinge zabugenewe zabugenewe kugenzura.

    

Igisekuru cya mbere cyabashitsi ba suture bari boroheje, akenshi basa nurushinge rugoramye hamwe nudukoni duto cyangwa gufata. Nyuma yigihe, nkuko abaganga babaga bagaragaje ibikenewe ningorabahizi, injeniyeri n’ibigo byubuvuzi byanonosoye ibyo bikoresho. Bibanze ku kunoza igishushanyo mbonera cyiza kugirango binjire neza, bongere uburyo bwo gufata neza umutekano wogushakisha umutekano, no kunoza uburyo bwo guhumuriza no kugenzura ergonomic.

Ihindagurika ntabwo ryari gusa koroshya ibintu; byari bijyanye no kubateza imbere. Buri itera ya suture passer igamije kugabanya umurongo wo kwiga kubaganga, kugabanya ingaruka ziterwa nibibazo, kandi amaherezo, kuzamura ireme ryogusana no gukira kwumurwayi. Ni urugero rwiza rwukuntu iterambere ryiyongera mubikoresho rishobora kuganisha ku iterambere ryibanze mu kwita ku barwayi.

Kugenda Isi Itandukanye Yabashitsi

Nkuko imodoka ziza muburyo butandukanye kandi zigakora, niko abahisi ba suture bakora. Hariho ibintu bitandukanye bitangaje, buri cyashizweho kugirango gikemure ibintu byihariye byo kubaga hamwe nibyo ukunda. Gusobanukirwa itandukaniro bidufasha gushima ibintu byinshi byiki gikoresho.

Ugororotse nu Mugoramye: Guhitamo Inguni Yigitero

Imwe muntandukanyirizo yibanze ni hagati ya suture igororotse kandi igoramye.

Abagenzi ba suture bagororotse , nkuko izina ribigaragaza, bagororotse. Nibyiza cyane kuburyo bworoshye bwo kubona tissue no kunyuza suture muburyo bumwe. Bitekerezeho nkawe ujya kumirimo itaziguye aho ufite umurongo ugaragara wo kureba hamwe nimbogamizi ntoya. Zitanga kwinjira byinjira kandi akenshi bikundwa kubitambuka byambere cyangwa mugihe ukorera ahantu hatagabanijwe.

abahisi ba suture bagoramye , bafite aho bahurira hafi yisonga ryabo. Ku rundi ruhande, Uyu murongo ni ingirakamaro bidasanzwe mugutembera hafi yuburyo butandukanye, kugera ahantu bigoye-kugera ahantu, cyangwa gukora ibishushanyo byihariye. Tekereza kugerageza kudoda agapira imbere imbere yikiganza - urushinge rugoramye rwagira akamaro kuruta ururwo rugororotse, sibyo? Mu buryo nk'ubwo, mu rutugu, umutambukanyi uhetamye yemerera abaganga kuzenguruka umutwe wa humeral cyangwa kugera munsi yubutaka bwa rotate cuff byoroshye kandi bitagabanije gukoresha imitsi ikikije. Urwego rwo kugabanuka rushobora kandi gutandukana, rutanga nuburyo bwihariye bwo guhitamo.

Umuyoboro umwe na Multi-Umutwaro: Gukora neza muri buri Kanda

Iri tandukaniro rivuga uburyo suture yapakiwe kandi ikanyuzwa.

Gutwara umutwaro umwe gusa byashizweho kugirango unyuze kumurongo umwe icyarimwe. Uremerera suture, unyuze muri tissue, uyisubize, hanyuma usubiremo inzira kumurongo ukurikira. Akenshi usanga byoroshye mubishushanyo kandi birashobora kuba byukuri kubudodo bwihariye.

Multi-umutwaro (cyangwa yihuta-umutwaro) suture abahisi ni intambwe yo gukora neza. Ibi bikoresho byashizweho kugirango unyuze imirongo myinshi ya suture, cyangwa mbere yabanje gutwarwa na suture loop, hamwe no gushiramo no gukora. Tekereza ikintu gishobora kurasa ibintu byinshi hamwe no gukanda. Ibi birashobora kugabanya cyane igihe cyo gukora, cyane cyane mugusana bigoye bisaba pasiporo nyinshi. Ariko, barashobora gusaba ubuhanga buke kugirango bamenye.

Kongera gukoreshwa na Disposable: Ibitekerezo bifatika

Ibi nibikorwa bifatika, ariko ntabwo ari ngombwa cyane, gutandukanya, akenshi biterwa na politiki yibitaro, ikiguzi, hamwe na protocole protocole.

Gusubiramo byongeye gukoreshwa bikozwe mubikoresho biramba, mubisanzwe ibyuma bitagira umwanda, kandi byashizweho kugirango bihindurwe kandi bikoreshwa inshuro nyinshi. Zerekana ishoramari ryambere ariko rishobora kubahenze mugihe kirekire kubigo byinshi byo kubaga byinshi. Ariko, bakeneye uburyo bwogusukura no kuboneza urubyaro kugirango birinde kwandura no gukomeza imikorere yabo.

Kujugunywa (cyangwa gukoresha inshuro imwe) suture abahisi bagenewe gukoreshwa inshuro imwe hanyuma bakajugunywa. Baza mbere yo kuboneza urubyaro no gukuraho ibikenewe mu kuboneza urubyaro mu rugo, bigabanya ibyago byo kwanduzanya no koroshya ibikoresho by’abakozi babaga. Mugihe igiciro cyabo kuri buri gice gishobora kuba kinini, barashobora gutanga inyungu mubijyanye numutekano, kuborohereza, no gukora neza. Abaganga benshi babaga bahitamo ibikoresho bikoreshwa muburyo bukomeye kubera ubukana bwizewe.

Ibishushanyo byihariye: Iyo udushya duhuye na Anatomy (urugero, Inyoni y'Inyoni, Scorpion, Viper)

Kurenga ibyiciro byibanze, isi yabatambutse suture yuzuyemo ibihangano kabuhariwe, buri kimwe cyitondewe kugirango kigaragaze imikorere yacyo idasanzwe. Ibi bikoresho akenshi byateguwe kugirango bikemure ibibazo byihariye byahuye nabyo mugihe cyo gusana rotate cuff.

Fata inyoni ya BirdBeak , kurugero. Izina ryayo risobanura neza inama yaryo - ntoya, ityaye, igoramye imeze nk'urwasaya rushobora gufata neza no kunyuza suture binyuze mumyenda yuzuye kandi ihungabana rito. Nibyiza cyane kugarura suture ahantu hafunganye.

Uwatambutse Scorpion . nurundi rugero rushimishije Iki gikoresho gikunze kwerekana uburyo bwihariye bwurwasaya rushobora gufata no kugarura umugozi wa suture uturutse kuruhande rwinyama, bigatuma ukora neza kuburyo budasanzwe bwo gukora ibiraro bya suture cyangwa kunyuza suture unyuze mumitsi yimbitse. 'Stinger ' nkigikorwa cyo gufata suture niho ikura izina ryayo.

Noneho hariho Viper passer, ishobora kuba ifite uburyo bwa jaw-jaw cyangwa inama idasanzwe yemerera icyarimwe icyarimwe kwinjira no kudoda kugarura, bikarushaho kunoza inzira. Ibishushanyo kabuhariwe ni gihamya yo gukomeza guhanga udushya mu kubaga amagufwa, guhora dushakisha uburyo bwo gukora neza, gukora neza, kandi amaherezo, bikagenda neza kubarwayi. Ku bigo byubuvuzi bisaba ibikoresho nkibi byateye imbere, XCMedico (xcmedico.com) itanga ibicuruzwa bitandukanye bya sisitemu yubuvuzi bwa siporo yo mu rwego rwo hejuru, harimo ibyuma bya suture hamwe na sisitemu yo gukosora ligament, bikwiranye no gushyigikira ibikorwa byo kubaga rotator bigoye.

Inyungu Zidashidikanywaho zo Kwakira Umuyoboro Utambutse

Noneho ko tumaze gusobanukirwa icyo umutambukanyi wa suture aricyo nuburyo butandukanye, reka tuvuge impamvu ari ikintu kinini. Ni ukubera iki abantu benshi babaga amagufwa bakiriye iki gikoresho bakinguye? Ibyiza birakomeye kandi bigera kure, bigira ingaruka kubintu byose kuva kubagwa neza kugeza gukira kwabarwayi.

Icyerekezo Cyuzuye kandi Ntagereranywa

Tekereza kugerageza guhuza urushinge unyuze mu mwobo muto iyo ureba kuri televiziyo, ukoresheje amacupa maremare. Ibyo ni nkibintu byo kubaga arthroscopique bidafite ibikoresho byiza. Uwitambutse ya suture yongerera cyane ubushobozi bwo kubaga gushyira suture neza aho igomba kuba. Igiti cyacyo gikomeye hamwe ninama itomoye ituma igenzurwa ryimyanya ndangagitsina yinjira hamwe na suture neza, ndetse no mubice bigoye cyane. Ubu busobanuro nibyingenzi kugirango ugere ku buryo bukomeye, butekanye buteza imbere gukira neza. Turimo kuvuga kuri milimetero hano, no kubaga, milimetero zifite akamaro.

Kugabanya Ikirenge: Ihahamuka Rito, Gukiza Byihuse

Imwe mumyumvire yibanze yo kubaga byibasiye cyane ni ukugabanya ibyangiritse. Gucisha inshinge gakondo birashobora rimwe na rimwe gutera ihahamuka ridakenewe kumubiri ukikije umubiri, biganisha kumaraso menshi, kubyimba, no kubabara nyuma yo kubagwa. Gutambuka neza, hamwe ninama zabo zihariye hamwe nibikorwa bigenzurwa, byashizweho kugirango habeho inzira isukuye, yuzuye inyuze mumutwe. Ihungabana ryimyanya ndangagitsina risobanura mu nyungu nyinshi ku murwayi: ububabare buke nyuma yo kubagwa, kugabanya umuriro, hamwe nuburyo bwo gukira byihuse. Nukwitonda nkuko bishoboka mugihe ugikora neza.

Igihe ni Icy'ingenzi: Uburyo bukoreshwa neza

Mucyumba cyo gukoreramo, buri munota ubara. Igihe gito cyo gukora gisobanura anesthesia nkeya kumurwayi, kugabanya ibyago byo kwandura, no gukoresha neza umutungo wokubaga ufite agaciro. Gutambutsa suture byerekana neza inzira yo gutambutsa. Aho kugirango intambwe nyinshi zirimo ibikoresho bitandukanye byo gufata, gutobora, no kugarura, abahisi benshi badoda barashobora kurangiza iyi mirimo muburyo bumwe cyangwa bubiri. Iyunguka ryiza rirashobora kogosha iminota yagaciro, cyangwa niminota mirongo, kuruhande rwo gusana ibintu bigoye, bikagirira akamaro umurwayi nitsinda ryabaganga. Ninkaho kuzamura kuva mumaboko yintoki kugeza kuri mudasobwa - itandukaniro ryihuta ntirishobora guhakana.

Ubuhanga bwo gucunga neza: Kworoshya Ikibazo

Niba warigeze ugerageza guhambira ipfundo numugozi utose, uzashima ingorane zo gucunga suture imbere. Guhambira ipfundo rya Arthroscopique nuburyo bwubuhanzi ubwabwo, kandi gucunga imigozi idoze irashobora kuba inzozi. Abahisi badoda bafasha cyane nibi. Mugutanga neza suture binyuze mumyenda no kwemerera kugenzurwa, bigabanya amahirwe yo gufatira suture, gucika intege, cyangwa gukata kubwimpanuka. Ibi bituma inzira ihambiriye ipfundo ryoroshye kandi ryizewe, ryemeza gusanwa gukomeye kandi kuramba. Nukuzana gahunda kubishobora kuba akajagari.

Ergonomique kumpuguke: Ihumure no kugenzura kubaga

Abaganga babaga bakora akazi gasaba bidasanzwe, akenshi bahagarara amasaha mumwanya mubi, bakora imirimo isubiramo, nziza ya moteri. Uburyo gakondo bwo gutambutsa suture burashobora gusora kumubiri, biganisha kumunaniro wintoki no kutamererwa neza. Abahisi badoda bakunze gukoreshwa hamwe na ergonomic hamwe nuburyo bwihuse bugabanya imbaraga kumaboko yabaganga no kuboko. Uku guhumurizwa kunonosoye ntabwo ari ibintu byiza gusa; irashobora gutuma umuntu agira umunaniro muke wo kubaga, kugenzura neza inzira zose, kandi amaherezo, kubaga neza kandi neza kubarwayi. Kubaga neza ni umuganga ubaga.

Kurenga Icyumba cyo gukoreramo: Isezerano ryibisubizo byiza byabarwayi

Kurangiza, ibyo byiza byose bihuriza hamwe intego imwe yibanze: ibisubizo byiza byabarwayi. Iyo gusana bisobanutse neza, bitera ihungabana rito, birangiye neza, kandi bihujwe neza, amahirwe yo gukira neza yiyongera. Abarwayi barashobora kugira ububabare buke nyuma yo kubagwa, bagasaba imiti mike y'ububabare, kandi bagashobora gutangira kubakira vuba. Gusana gukomeye, kurushaho gukosora kandi bigabanya ibyago byo kongera kurira, biganisha ku ntsinzi ndende no gusubira mubikorwa bisanzwe. Nukugusubiza mubuzima bwawe, nta bubabare.

Gutsinda Ibidashoboka: Gukemura Ibibazo Bitoroshye

Igitugu cyigitugu gifite umugabane mwiza wimpande zifatika kandi zinguni. Ibice bimwe bya rotateur cuff, cyane cyane inyuma cyangwa imbere, birashobora kuba bigoye kubona no gusana hamwe nibikoresho gakondo. Aha niho ibishushanyo kabuhariwe hamwe na manuuverability ya suture abahanyura. Abahanyuze bagoramye, kurugero, barashobora kugendagenda mumutwe wa humeral cyangwa izindi nyubako zamagufa kugirango bagere ahantu nyaburanga aho suture igomba gushyirwa. Ubu bushobozi bwo kugera no gusana ahantu hagoye anatomique bivuze ko n'amarira atoroshye ashobora gukemurwa arthroscopique, ukirinda gukenera inzira nini, itera cyane. Ninkaho kugira igikoresho gishobora kugoreka impande zose, bikwemerera gukosora ibintu utigeze utekereza ko ushobora kugeraho.

Kumenya ubuhanzi: Ubuhanga bwo gukoresha Suture Passers muri Rotator Cuff Gusana

None, nigute abaganga babaga bakoresha ibi bikoresho byubwenge? Ntabwo ari ukwerekana gusa no gukanda; ni ibihangano binonosoye bihuza ubumenyi bwa anatomique, ubuhanga bwo kubaga, no gusobanukirwa byimbitse ubushobozi bwigikoresho. Reka tunyure mubikorwa bisanzwe.

Gushiraho Urufatiro: Gutegura mbere yo gukora no guhitamo abarwayi

Kimwe nubutumwa ubwo aribwo bwose bwatsinze, gusana rotate cuff itangira kera mbere yo guterwa bwa mbere. Igenamigambi mbere yo gukora ni ngombwa. Umuganga ubaga asuzuma ibizamini bya MRI by'umurwayi, agasuzuma ingano n'ubwoko bw'amarira, akanagena uburyo bwiza bwo gusana. Ibi bikubiyemo guhitamo inanga (ibikoresho bito byinjijwe mumagufwa kugirango ufate suture) bizakoreshwa, umubare wa suture bizakenerwa, nuwatambutse suture bizagira akamaro cyane kuri anatomiya idasanzwe yigitugu cyuwo murwayi.

Imyanya y'abarwayi irakomeye. Kubaga urutugu rwa arthroscopique, abarwayi basanzwe bashyizwe mumwanya wa 'intebe yinyanja ' (bicaye bahagaze neza hamwe numubiri wicaye gato, cyane nkintebe yinyanja) cyangwa mumwanya wa decubitus (kuryama kuruhande). Imyanya yombi itanga inyungu zitandukanye zo kubona no kubona amashusho. Guhagarara neza byemeza ko umuganga abaga afite uburyo bwiza bwo kugera ku rutugu kandi ko uburemere bushobora gufasha mu gufungura umwanya uhuriweho, byoroshye gukora.

Binyuze muri Keyhole: Arthroscopic Portal na Visualisation

Iyo umurwayi amaze guhagarara, umuganga abaga akora uduce duto, mubisanzwe munsi ya santimetero z'uburebure, hafi yigitugu. Ibi byitwa arthroscopic portal . Binyuze kumurongo umwe, kamera ntoya, yitwa arthroscope. Iyi kamera yohereza ishusho nini yimbere yimbere ihuriweho na monite-ibisobanuro bihanitse mubyumba bikoreramo. Nuburyo umuganga ubaga 'abona ' ibyo bakora.

Binyuze ku zindi portal, ibikoresho bitandukanye byihariye, harimo na suture passer, byinjijwe. Umuganga ubaga akora yitegereza moniteur, akayobora ibikoresho bigenda neza byamaboko yabo. Nibyiza nko gukina umukino wa videwo utoroshye, ariko hamwe ningaruka zubuzima! Kugumana amashusho asobanutse nibyingenzi; rimwe na rimwe, amazi ahora ashyirwa mu gihimba kugirango akomeze kandi yameshe imyanda cyangwa amaraso.

Imyitozo Yibanze: Imyitozo Yibanze Yumupaka

Noneho, reka tumanuke mubice nyabyo 'kudoda '. Gukoresha umutambiko wa suture bikubiyemo urukurikirane rwimikorere yibanze, iyo imaze gutozwa, ihinduka kamere ya kabiri kubaga babimenyereye.

Gufata no Kwinjira: Imbyino Nziza hamwe na Tissue

Intambwe yambere nugufata neza tissue hanyuma ukayinjiramo nisonga rya suture passer. Ibi bisaba ijisho ryinshi n'ukuboko gushikamye. Umuganga ubaga ayobora uwanyuze ku nkombe y’imitsi yatanyaguwe, agashyira umutwe wacyo ahantu hifuzwa kugirango ushireho suture. Hamwe nigikorwa kigenzurwa, isonga ityaye yuwatsinze iratera imbere binyuze mumurongo. Intego ni inzira isukuye, atraumatike, kwemeza ko suture izakomeza gufata neza nta yandi yangiza fibre nziza. Aha niho igishushanyo cyihariye cyinama yuwatsinze - cyaba ingingo ityaye, umunwa, cyangwa urwasaya rwihariye - bigira uruhare runini.

Gukuramo no Gutambuka: Urugendo rwa Suture

Iyo uwanyuze amaze kwinjira muri tissue, intambwe ikurikira ni suture kugarura . Aha niho amarozi yumunyenzi wa suture amurikira. Igikoresho cyimbere cyimbere (ifuni ntoya, urwasaya rufata, cyangwa insinga ya shitingi) ikora kugirango ifate suture. Ibi birashobora kubamo gusunika buto cyangwa gukanda imbarutso. Suture yafashwe noneho ikururwa inyuma yinyuma, ikora loop.

Tekereza gusunika urushinge unyuze mu mwenda, hanyuma ufite robot ntoya kurundi ruhande ufate urudodo hanyuma urukuremo. Nibyo mubyukuri ibibaho. Suture ubu inyuze muri tendon, yiteguye intambwe ikurikira yo gusana. Ibi bigenzurwa, igikoresho kimwe kigabanya amahirwe yo kudoda gufatwa, gucika intege, cyangwa gutakara mugice.

Kubaka ibiraro: Ubuhanzi bwo Kurema Umuzingo

Akenshi, kubaga bakeneye gukora udukingirizo twihariye cyangwa 'ibiraro ' kugirango bakingire igufwa. Ibi birimo passes nyinshi hamwe na suture passer. Kurugero, tekinike isanzwe ikubiyemo kunyuza urugingo rumwe rwa suture binyuze mumitsi, hanyuma ukanyuza urundi rugingo unyuze mugice gitandukanye cyigice cyangwa unyuze mumagufa, kurema ibintu bikomeye. Umuyoboro wa suture yorohereza kurema utwo tuzingo dusobanutse, dukenewe muburyo butandukanye bwo gusana, cyane cyane bwagenewe kwagura ahantu hahurira hagati yigitereko nigufwa kugirango gikire neza. Buri muzingo ni inyubako yubatswe mugusana muri rusange, kandi uwanyuze aremeza ko ibyo bice byashyizwe neza.

Ingamba zihanitse: Uburyo bwihariye bwo gusana hamwe nabashitsi

Gutambuka suture ntabwo ari igikoresho rusange gusa; nibyingenzi mubikorwa byihariye, byo gusana byateye imbere cyane ibisubizo kuri rotator cuff amarira.

Inzira imwe-Inzira: Inzira itaziguye yo gusana

Gusana umurongo umwe ni bumwe muburyo bworoshye. Muri ubu buryo, imitsi yacitse isubizwa mu magufwa ukoresheje umurongo umwe wa ankeri na suture. Tekereza kudoda umwenda ku kibaho. Uwitonze ya suture akoreshwa mugutambutsa suture kumpande yacagaguritse, hanyuma ubwo budodo noneho bugashyirwa kumatako ashyizwe kumagufwa. Mugihe ari ingirakamaro kumarira mato, adakuwe inyuma, inzira yumurongo umwe itanga ikirenge gito cyo guhuza imitsi nigufwa. Umudozi utambitse yemerera gushyira neza kandi neza neza iyi suture yumurongo umwe, itanga impagarara zihagije kandi zikosorwa neza.

Impinduramatwara ya Double-Row: Tekinike yikiraro cya tekinike yo gukira neza

Gusana imirongo ibiri , cyane cyane tekinike yikiraro cya suture , byerekana iterambere ryingenzi mugusana rotate cuff. Ubu buryo bugamije gukora ibirenge byagutse, bikomeye cyane byo guhuza imitsi hagati yigitereko nigufwa, bigana ibyinjijwe bisanzwe.

Dore uko muri rusange ikora: Umurongo wambere wa ankeri ushyirwa kuruhande rwa articular (gufatanya) kuruhande rwacitse, hafi yingingo. Imyenda inyuzwa muri tendon ukoresheje suture passer hanyuma ikomezwa kuri ankeri. Noneho, impera yubusa yiyi suture izanwa hejuru yigitereko hanyuma igashyirwa kumurongo wa kabiri wa ankeri zashyizwe kuruhande (kure yinyuma) kumagufwa. Ibi birema 'ikiraro cya suture ' gikanda imitsi kumanuka kumagufwa hejuru yubuso bunini, bigatera gukira kwuzuye. Gutambuka kwa suture biranenze rwose hano, kuko byemerera kunyuramo neza kandi neza kunyuramo binyuze mumurongo no hejuru kumurongo wa kabiri wa ankeri, akenshi bisaba abahisi bagoramye cyangwa kabuhariwe kugirango bayobore inguni.

Gusana bihwanye no gusana: Kwigana imbaraga za Kamere

Gusana transosseous ihwanye (TOE) nubundi buhanga buhanitse bukoresha amahame yikiraro cya suture kugirango tugere no gusana anatomique kandi ikomeye. Yitwa 'transosseous ihwanye ' kubera ko igamije kwigana ubugari bwagutse, bukwirakwizwa bwo gusana ibintu bisanzwe (aho suture yanyujijwe mu mitsi yamagufwa) ariko binyuze muburyo bwa arthroscopique.

Muri TOE, suture passer ikoreshwa mugukora agace kagutse. Ibishishwa byanyuze mumutwe kandi bigashyirwa ku nkuge haba hagati (hafi yingingo) no kuruhande (kure yinyuma) kumagufwa. Ubudodo noneho bubohewe muburyo butuma habaho kwaguka kwagutse, guhuza imitsi kumagufwa, bikagabanya imbaraga zo gukira. Ubu buhanga bukunze kubamo inzira nyinshi zo kudoda no guhagarika umutima witonze, bigatuma ubusobanuro nubushobozi bwa passer passer ari ngombwa. Nibijyanye no gusubiramo bisanzwe 'igikumwe ' cya tendon kumagufwa.

Kurenga Gusana: Kwiyongera hamwe nibinyabuzima

Rimwe na rimwe, rotator yatanyaguwe na cuff tendon yangiritse cyane, cyangwa ubwiza bwimyenda iba mibi, kuburyo gusana byonyine bidashobora kuba bihagije. Mu bihe nk'ibi, abaganga bashobora gukoresha tekinike yo kongera cyangwa ibinyabuzima kugirango bashimangire gusana. Ibi bishishwa, akenshi bikozwe mubice byabaterankunga cyangwa ibikoresho bya sintetike, bishyirwa hejuru yisanwa ryasanwe kugirango bitange imbaraga zinyongera kandi biteze imbere kubyara.

Gutambuka suture bigira uruhare runini mugukingira ibishishwa kumitsi iriho / cyangwa amagufwa. Yemerera gushyira neza no gutunganya neza patch, ikemeza ko ihuza neza nuduce kavukire kandi igatanga inkunga igenewe. Ubu ni gihamya yuburyo butandukanye bwabashitsi - ntabwo ari ugusana ibanze gusa ahubwo ni no kongera imbaraga muri rusange.

Impanuro Zimbere hamwe nuburiganya bwo Gutsindira Passer Intsinzi

Ndetse nibikoresho byiza, ubuhanga buzana imyitozo no gusobanukirwa nuance. Hano hari inama abaganga bakunze gutekereza kubijyanye no gukoresha neza suture passer.

Agace ka Goldilocks: Kugumana impagarara zikwiye

Kimwe mu bintu byingenzi byingenzi byo gusana rotate cuff ni ukugera kuri 'iburyo ' suture. Kurekura cyane, kandi gusana ntibizakomeza; bikabije, kandi ushobora guhitanwa no kuniga imitsi cyangwa gukurura suture ukoresheje tissue. Suture passer, mugihe yorohereza pass, ntabwo ihita yemeza impagarara nziza. Abaganga babaga bagomba gusuzuma neza impagarara mugihe bagaruye kandi bakarinda buri suture. Ibi bikunze kuba bikurura ubwitonzi kumpera ya suture no kugenzura amashusho yerekana igereranya ryamagufwa. Nuburinganire bworoshye, kandi uwanyuze afasha kurema intangiriro yukuri kuriyi ntambwe ikomeye.

Kurambura Urubuga: Irinde Kwishongora

Imyenda ni ndende, yoroheje, kandi mumwanya wa arthroscopique ufunzwe, birashobora guhita byuzuzanya, hamwe nibikoresho, cyangwa na kamera. Ibi nibisanzwe kandi birashobora kongera igihe cyo gukora. Abaganga babaga bakoresha ingamba nyinshi kugirango birinde 'suture spaghetti. '

Urufunguzo rumwe nugucunga neza impera yubusa ya suture. Nyuma ya buri cyiciro, umuganga abaga ashobora kurinda by'agateganyo suture irangiye hanze cyangwa gukoresha ibikoresho byihariye byo gucunga suture. Ubundi buriganya nukuzirikana gahunda ya suture pass no gukomeza umurima ukora neza nkuko bishoboka. Igishushanyo mbonera cya suture, mugutanga pasiporo igenzurwa, mubisanzwe bigabanya bimwe muribi byago, ariko buri gihe birasabwa kuba maso. Ninkaho kugumisha imirongo yawe yuburobyi - imbaraga zihoraho!

Gukemura ibibazo ku Isazi: Kumenya imikorere idahwitse

Kimwe nibikoresho byose bya mashini, abahisi ba suture barashobora rimwe na rimwe gukora nabi. Inama irashobora kunama, uburyo bwo gufata bushobora kunanirwa kwishora, cyangwa suture irashobora gukomera. Inzobere mu kubaga zifite ubuhanga bwo kumenya ibyo bibazo vuba no kubikemura. Ibi birashobora gukuramo ubwitonzi igikoresho, kugenzura, cyangwa guhinduranya undi muntu utambutse. Kugira ibikoresho byabigenewe byoroshye kuboneka ni imyitozo isanzwe. Nubwo bidakunze kubaho, gusobanukirwa nuburyo byakemura ibibazo nkibi birinda umutekano wumurwayi no gukomeza inzira neza. Nukwitegura kubintu byose, nubwo ibintu bitagenda neza nkuko byari byateganijwe.

Kugenda kuri Nuances: Inzitizi zishobora kubaho hamwe nibitekerezo byingenzi

Mugihe umutambukanyi utanga inyungu nyinshi, ntabwo aruko atabitekereje. Kimwe nigikoresho icyo aricyo cyose cyateye imbere, kizana hamwe nikibazo cyacyo hamwe na ssenariyo aho ikoreshwa rishobora gukenera gutekereza neza.

Kwiga Gukata: Gushora Ubuhanga bwo Kubaga

Nubwo igikoresho cyaba intiti gute, burigihe hariho umurongo wo kwiga ugira uruhare mukumenya neza. Mugihe abahisi ba suture borohereza ibintu bimwe na bimwe byo kubaga arthroscopique, baracyasaba ubuhanga bukomeye nimyitozo yo gukoresha neza. Abaganga babaga bakeneye gutezimbere ibyiyumvo byo kurwanya tissue, biga kwerekeza igikoresho neza kuri ecran ya 2D, no kumenya uburyo bwihariye bwo gukora bwubwoko butandukanye. Ibi akenshi bikubiyemo amahugurwa manini muri laboratoire ya cadaver, moderi yo kwigana, hamwe nuburwayi bwo kubaga. Kubaganga bashya, ishoramari ryambere mukwiga rirashobora kuba ryinshi, ariko inyungu zigihe kirekire mubikorwa no mubisubizo byabarwayi birakwiye.

Gupima ikiguzi: Ingaruka zamafaranga yibikoresho bigezweho

Ibikoresho bigezweho byo kubaga, harimo ubwoko bwinshi bwabashitsi, birashobora kuba bihenze. Ingero zikoreshwa, mugihe zitanga ubworoherane nubusembure, zitanga umusanzu muri rusange kubiciro. Ibikoresho byongeye gukoreshwa bifite igiciro cyo hejuru ariko kiri hasi yikoreshwa, mugihe bibungabunzwe neza kandi bigahinduka. Ibitaro n’ibigo byo kubaga bigomba gupima ingaruka z’amafaranga ku nyungu z’ubuvuzi. Nubwo umutekano w’abarwayi n’ibisubizo ari byo byingenzi, ubukungu bw’ubuzima ntibushobora kwirengagizwa. Nuburinganire hagati yikoranabuhanga rigezweho ninshingano zamafaranga.

Inkota y'amaharakubiri: Kugabanya ibyago byo gukomeretsa Iatrogène

Mugihe cyateguwe kugirango hagabanuke ihahamuka, igikoresho cyose gityaye cyinjijwe hamwe gitwara ibyago byo gukomeretsa iatrogène - bivuze gukomeretsa kwatewe nubuvuzi ubwabwo. Ibi bishobora kubamo kwangirika utabishaka kwangirika, imitsi, cyangwa imiyoboro yamaraso mugihe uwanyuze muri suture adakorewe ubwitonzi bukabije kandi bwuzuye. Umwanya ufungiwe hamwe hamwe no kwishingikiriza kuri ecran ya videwo bivuze ko abaganga bagomba guhora bamenye neza isonga ryibikoresho byabo kandi byegeranye ninzego zingenzi. Niyo mpamvu tekinike yitonze, igaragara neza, hamwe no gusobanukirwa neza anatomiya yigitugu ntibishobora kuganirwaho mugihe ukoresheje suture passer.

Kumenya Igihe Kuri Pivot: Scenarios Aho Passure Passure ishobora kuba itari nziza

Mugihe abahisi ba suture bahindagurika kuburyo budasanzwe, hari ibintu bimwe na bimwe aho umuganga ubaga ashobora guhitamo ubundi buryo cyangwa guhuza tekinike. Kurugero, mugihe amarira manini cyane, karande, kandi yakuweho amarira aho ubwiza bwumubiri bwangiritse cyane, cyangwa niba hari uduce twinshi twinkovu, umutambukanyi wa suture ashobora guhatanira kubona kugura neza kuri tendon. Mubihe nkibi bidasanzwe, uburyo bwuguruye burashobora gutekerezwa, cyangwa ubundi bwoko bwibikoresho bishobora guhitamo kubanza gukoreshwa. Nukugira agasanduku k'ibikoresho byuzuye no kumenya igikoresho cyiza kumurimo uriho, aho kwishingikiriza kumuti umwe kuri buri kibazo.

Horizon Imbere: Ejo hazaza h'abatambutsa Suture mu kubaga amagufwa

Urugendo rwabatambuka suture ruri kure. Mugihe ikoranabuhanga rikomeje gutera imbere, turashobora kwitega ndetse nuburyo bukomeye kandi bwubwenge bwiki gikoresho kimaze kugaragara. Ejo hazaza hasezeranya iterambere rishimishije rizarushaho kunoza neza, gukora neza, nibisubizo byabarwayi mugusana rotate cuff.

Gusunika Imipaka: Udushya mugushushanya ibikoresho

Tegereza kubona udushya dukomeje mugushushanya ibikoresho . Ibi bishobora kubamo:

• Miniaturisation: Ndetse ntoya, nini cyane ya suture passers ishobora kugendagenda ahantu hakeye no kugabanya ubunini bwa portal arthroscopique ndetse ikagera kure.

• Kunonosora neza: Ibikoresho bifite impamyabumenyi nyinshi zubwisanzure, byemerera ndetse impande zingorabahizi hamwe na manuveri mubice. Tekereza umuhisi ushobora kunama no kugoreka nk'inzoka!

• Kwishyira hamwe Kwiyunvikana: Gutambutsa abahisi hamwe na sensor yubatswe itanga ibitekerezo-nyabyo kubaganga kubijyanye no guhagarika ingirabuzimafatizo, ubujyakuzimu bwinjira, cyangwa ubwiza bwinyama. Ibi birashobora kuba umukino-uhindura kugirango uhindure imbaraga zo gusana.

• Ibikoresho byubwenge: Gutezimbere ibikoresho bishya bitanga imbaraga zisumba izindi, guhinduka, hamwe na biocompatibilité, biganisha kubikoresho biramba kandi byiza.

Iterambere ryibishushanyo rishobora gutuma akazi kabaga karushijeho gusobanuka no gusora gake, amaherezo bikagirira akamaro umurwayi.

Impinduramatwara ya Robo: Abashitsi ba Suture mububiko bwikora

Umwanya wo kubaga ubufasha bwa robo urimo kwaguka byihuse, kandi kubaga amagufwa nabyo ntibisanzwe. Mugihe ubwigenge bwuzuye rotator cuff gusana bishobora kuba ejo hazaza, guhuza abahisi ba suture hamwe na sisitemu ya robo ni ibintu byukuri kandi bishimishije.

Tekereza ukuboko kwa robo, iyobowe na muganga ubaga, ishobora gukora suture passe itajegajega kandi igabanuka. Sisitemu ya robo irashobora gutanga amashusho meza, ibitekerezo bishimishije (kumva gukoraho), ndetse na progaramu zateguwe mbere yimirimo isubiramo. Abashitsi bashushanya byabugenewe byabigenewe byabigenewe bigomba kuba bikomeye cyane kandi bigahuza hamwe nimbaraga za robo. Ibi birashobora gushikana no muburyo bunoze, cyane cyane mubihe bigoye, kandi birashoboka ko byemerera abaganga gukora progaramu bafite imbaraga nke zumubiri. Nibijyanye no guhuza ubuhanga bwabantu nibisobanuro bya robo.

Kubona Hanze: Kwishyira hamwe hamwe na tekinoroji yo Kwerekana Amashusho

Kugeza ubu, abaganga bashingira cyane cyane kuri arthroscopi optique (kamera) kugirango babone amashusho. Ariko, ahazaza hashobora kubona kwishyira hamwe hamwe nubuhanga bugezweho bwo gufata amashusho muri suture passer ubwayo cyangwa ibidukikije byo kubaga.

Ibi bishobora kubamo:

• Ukuri kwukuri (AR): Gupfukirana moderi ya anatomiki ya 3D cyangwa amakuru yerekana amashusho mbere yo kubaga kubireba umuganga ubaga, bitanga 'GPS ' imbere yimbere. Tekereza kubona inzira nyayo suture yawe igomba kunyuramo mbere yuko ukora pass.

• Fluorescence Kwerekana: Gukoresha amarangi adasanzwe n'umucyo kugirango ugaragaze ibice byihariye, nk'ahantu hatangwa amaraso make cyangwa inzira y'imitsi, bigatuma gusana birushaho kuba byiza kandi bifite umutekano.

• Ultrasound Kwishyira hamwe: Miniature ultrasound transducers hejuru yisonga rya suture irashobora gutanga igihe nyacyo, amashusho yubutaka, bigatuma umuganga abaga 'kureba ' hejuru yubuso bwinyuma.

Uku kwishyira hamwe byatanga kubaga urwego rutigeze rubaho rwamakuru nubuyobozi, bigatuma rotate cuff yo gusana irushijeho guhanurwa no gutsinda. Nibijyanye no guhindura icyumba cyo gukoreramo mubuhanga buhanitse bwo kuyobora.

Umwanzuro: Kuzamura Rotator Cuff Gusana Hejuru Nshya hamwe nabashitsi

Noneho, ngaho ufite. Uwicisha bugufi suture passer, kure yo kuba urushinge rworoshye gusa, ahagarara nkubuhamya bwubwenge bwabantu no guharanira ubudahwema kuvura neza abarwayi. Kuva kumurimo wibanze wo koroshya inzira ya suture kugeza kuruhare rwayo mugushoboza tekiniki zo gusana ibintu bigoye, byibasiwe cyane, ingaruka zabyo kubaga rotate cuff kubaga ntawahakana.

Twasuzumye uburyo byongera ubusobanuro, bigabanya ihahamuka ryumubiri, bigatwara igihe cyagaciro cyo gukora, kandi amaherezo, dusezeranya umusaruro mwiza kubarwaye ububabare bwigitugu. Twibanze kandi ku buhanga bwibishushanyo byayo bitandukanye hamwe nubuhanga buhanitse bwo kubaga bakoresha kugirango babukoreshe neza. Kandi urebye imbere, ahazaza h'iki gikoresho, gifatanije na robo na mashusho yateye imbere, bisa nkaho ari byiza kuruta mbere hose.

Ubutaha iyo wunvise ibijyanye no gusana rotate cuff, uzamenye ko inyuma yinyuma, igikoresho gito cyubwenge kigira uruhare runini, gifasha kubaga kubaga kudoda ubuzima hamwe, suture imwe isobanutse icyarimwe. Nibutsa ko rimwe na rimwe, udushya duto dushobora gukora itandukaniro rinini.

Ibicuruzwa bisabwa