Gufunga amasahani-Kubuza no kugabanya

Ikoreshwa rya Isahani yo gufunga yaguye ahanini ikoreshwa rya plaque ikosora ikosora. Ariko, imikoreshereze yabo igomba kubashyira mu gaciro no kuringaniza kubera imitego ishobora no kugarukira. Muri iki kiganiro, tuzareba ibitekerezo bya porogaramu, ibibazo byo gukuraho, hamwe nuburinganire, ibintu 3 byo gufunga amasahani.

01.Ni ibihe bintu byihariye n'ingorane zigomba kuboneka mugukoresha amasahani yo gufunga?

Intambwe ningorane zo kugabanya kuvunika hamwe nisahani yo gufunga

Intambwe zo gusubiramo isake bisanzwe. Gufunga amasahani ntibisubiramo kuvugurura. 

Bimaze gushyirwa mu gice cyamagufwa, ongeraho imigozi myinshi ntibizayimura. Niba isahani yo gufunga yemera gusa imisunga ikoreshwa, 

Ibi bivuze ko isahani ishobora gufungirwa gusa nyuma yo kuvunika.

Kubera ko gufunga amasahani yemerera amagufwa gukira nta gutakaza kwambere, 

Impamvu nyamukuru itera masana yo gufunga ibicumuba ni byo bivuguruzanya mbere. 

Kandi, imyigaragambyo mira kubera ubukanishi budahagije bushobora kuganisha ku gukira nabi nka posita yamagufa kubera gutinda gukira cyangwa kudatinda.

Kwiyongera nta gukoresha ibyapa byo gufunga biragoye cyane mugihe ukora iteye ubwoba

 inzira kuko guhura kumagufwa ni bike cyane. Bisaba uburyo butandukanye bwo gukwirakwiza (ameza yo gukurukira, abacuruzi),

 Imbaraga zinyuranye zinyuranye, hamwe na Kirsclener pin kugirango ukoreshe amagufwa no gukosora by'agateganyo. 

Mbere yo gusaba amasahani yo gufunga no gufunga imisumari, ni ngombwa kugirango ugenzure gusubiramo na flueroscopy.

Ibinyuranye, mugihe ukoresheje isahani yo gufunga nayo ifite ibyobo byateganijwe, 

Umugozi usanzwe ucuruza urashobora gushyirwa mu myobo isanzwe yo kwisubiraho kwambere ku isahani.

 Ibice by'amagufwa bishyirwa ku isahani. Niba isahani ihuye na anatomiya, irashobora gukoreshwa nkuyobora. 

Gufunga imisumari biremeza ibisubizo bihamye udahinduye reset ya mbere. Iri teka ryo kwinjiza (imigozi isanzwe, noneho gufunga imigozi) ni ngombwa (Ishusho 4).

Igishushanyo cya 4 Shyiramo imigozi isanzwe no kubakomeza.

Kubura ibitekerezo byamayeri iyo bigaruriye peges yo gufunga

Nta bitekerezo byamayeri mugihe biruye imigozi yo gufunga. Mubyukuri, 

Gukomera kwimisumari bibaho icyarimwe muburyo bukonje cyangwa butase muri kanseri no mubice byisahani yo gufunga. Kubera iyo mpamvu,

 Biroroshye kubaganga kwibeshya cyane ko gufunga imisumari ifashe neza mumagufwa co cortical cyangwa kanseri (Ishusho ya 3).

Igishushanyo 3 Uburebure bwakazi bwo gufunga imigozi ishingiye kumagufwa numubare wa cortices.

Kwikubita hasi gufunga imigozi

Gukoresha imigozi yo gufunga ibikoresho bivuze ko nta bitekerezo bya tactile biri mugihe cyo gucukura cyangwa gukomera nkuko bibaye icyarimwe.

Ibintu byabo bya mashini birasa nibyakozwe na cortex imwe yo gufunga mugihe cya porogaramu imwe ya Cortex. Niba ari ndende cyane, 

Bazavugana na cortex ya kabiri batishoboye, bikavamo umwanya utari wo gufunga imisumari yo gufunga.

Mugihe cya bicortical Porogaramu, barashobora kuba mugufi cyane, bigatuma bahuza na mashini ifunga imisumari imwe. 

Niba birebire cyane, bazagukarenga cortex kandi barashobora kwangiza imiterere kurundi ruhande rwisahani.

Uburebure bwuzuye bwo gufunga imisumari birashobora kuboneka gusa mugupima uburebure bwifuzwa nyuma yo gucukura cyangwa kubigenzura na fluoroscopi.

Ibiranga imigozi yo gufunga uniaxial

Ibibi nyamukuru byimisumari yo gufunga ni uko icyerekezo cyabo cyateganijwe mbere. 

Bashobora kugira indi stem idasanzwe cyangwa prosthetique munzira zabo, gusagura bidashoboka cyangwa kubagabanya kubikosora bidafite ishingiro.

Kubisahani yo gufunga anatomique ikoreshwa mumaguru hamwe no gufunga imisumari usibye icyerekezo cyagenwe, 

Inogamizi zibangamira impamvu za anatomical na biomenical, hari ibyago byo gufunga imisumari. 

Urugero rusanzwe ni ukuvunika Radius. Iyi ngaruka irakomeye mugihe isahani yo gufunga iri hafi yingingo cyangwa mugihe anatomiya itanzwe. 

Kubura kuvunika-artra-Arcticular bigomba kwemezwa na flueroscopy.

Mipo Technologies

Ubushobozi bwa percutaneous osteosynthesis (MOP) birimo subcut na / cyangwa submuscular 

hamwe nibisohokamo ibinyomoromo kwinjiza amagufwa ukoresheje agace gato mumagufwa nyuma yo kunyerera, nta kwerekana

 urubuga. Ibi bituma ibipimo bito, urubuga ruto rwo kubaga rwubatse, kandi rutuma inzira zindi 'biologique '

 Kuberako bidakenewe kwerekana buri gice cyamagufwa kandi nta kwivanga bifite tissue yoroshye, guhagarika umutima, cyangwa kuvunika hemama.

Irashobora kugerwaho hamwe nisahani yo gufunga hamwe nigikoresho cyateguwe cyihariye cyemerera isahani 

gukoreshwa no kunyura mu ruhu kugira ngo umenye byoroshye umwobo w'imisumari mu isahani. 

Amashusho ya fluescopic agomba gufatwa kuri buri ntambwe yo kugenzura iterambere. Buri ntambwe yubu tekinike iragoye. Ikibazo cya mbere nugusubiramo kuvunika mbere yo gukosorwa.

 Isahani yo gufunga igomba guhinduka neza muburebure bwamagufwa, bitabaye ibyo guhuza isahani yo gufunga bizaba asimmetric (Ishusho 5). Byongeye, 

Isahani yo gufunga igomba kuba ibangikanye neza na cortex yamagufa yagenewe gukurikiza kandi hafi yamagufwa nkuko 

birashoboka utarinze cyane gukomera kwimiterere. Mugihe cyanyuma cyo gufunga, biragoye kubyemeza

 Imiyoboro y'imigozi ihujwe neza ku isahani yo gufunga kandi ko imisumari yo gufunga iragira uruhare neza mugihe gikomeye.

Igishushanyo 5 Eccentric gushyira isahani yo gufunga no kubura ibitekerezo bya Haptic mugihe cyo gukomera.

Ibikomere byuruhu mugihe ukoresheje amasahani yo hanze

Gukoresha amasahani yo gufunga kugirango ukosore ibirenge byo hanze byahujwe nigipimo kinini cyuruhu rwa Necrosis. 

Ubunini bw'ibi masahani yo gufunga ikoporora uruhu no kubangamira gukwirakwiza ibintu no gukira. 

Ikintu gisa nacyo gishobora kubaho mugihe cyo gufunga amasahani gikoreshwa kubicuruzwa bya hawksbill.

Ibyago byo kwa Osteoporose no gukuramo amashusho

Mu magufwa ya osteoporotic, gufunga imisumari bifasha kugabanya ibyago byo gukuramo cyangwa kwikuramo. 

Kubaka ntabwo bihagije kubera amakosa yoroheje ya cortex hamwe nubucucike bwimyanda ya trabeculae.

Muri iki kibazo, gufunga isahani bikaba bikomeye kandi bikaba byiza mugihe ukoresheje evanescent cyangwa guhuza monolitcent cyangwa guhuza monolitChic (Ishusho ya 3).

Incamake:

1. Koresha imigozi ntabwo yemerera kuvunika kuri plate yamagufwa kugirango usubiremo.

2. Kuvunika bigomba gusubirwamo mbere yo kongeramo screw.

3. Gukosora burundu kugirango kugabanuka bisaba ibikoresho byo gufunga. Tekini ya Mipo irasaba cyane.

02. INGORANE ZO GUSUBIZA AMAFARANGA

Kuraho isahani yo gufunga iyo kuvunika byakize biragoye kandi bitateganijwe, 

Ariko ibintu birashobora gukemurwa. Ikibazo gikomeye ni ukurekura imigozi yo gufunga.

Rimwe na rimwe, insanganyamatsiko kumutwe wimisumari yangiritse mugihe cyo kwinjiza 

. 

bivuze ko bidashobora gucogora. Kubwibyo, nibyiza kubuza iki kibazo uhita usimbuza intsinzi na a 

Imitwe yangiritse mugihe cyo gushira, ukoresheje screwdriver yuzuye kandi ikomeza guhuza byuzuye intoki (ntabwo ifite imyitozo yamashanyarazi).

 Gukoresha imiyoboro ikozwe mubikoresho bikomeye birashobora gufasha kugabanya iki kibazo.

Mubihe byinshi, hari imashini ifunga cyangwa ifatanye hagati yo gufunga imisunga yimisunga hamwe numwobo usenyutse mu isahani yo gufunga. 

Ibi bikunze kugaragara hamwe na 3.5mm Diambory Heanium Hex ishusho ya shaft imwe yo gufunga imigozi. Nta ntera imwe

 kwivanga. Imigozi ikunze kubanza gukomera kubera kunanirwa gukoresha umugozi wa torque wateguwe mubikoresho by'ibikoresho, 

ikaba ishobora guhindura imitwe kuri peg yo gufunga no gufunga. Mu bindi bihe, 

Kunanirwa gukoresha cyangwa gukoresha ubuyobozi bwimyuga butari bwo byatumye habaho imigozi idahujwe iyo akoraga, 

yateje imigozi. Kugirango ugabanye ibyago byo gusaza mugihe cyo gutunganya mbere,

 Ni ngombwa gukoresha ibikoresho byose bihari: Guyobora imyitozo hamwe na socket, gukora cyane muburyo bwuzuye ubunyangamugayo mugihe ukomeje imisumari yo gufunga.

Tekini ya Mip itwara ibyago byinshi byo gushyiramo ubuyobozi bwo guhuza, 

Nkuko nta kureba mu buryo butaziguye isahani yo gufunga. Guhuza nabi ibikorwa byimyuga bivuze ko umwobo wacukuwe 

Gufunga imisumari no kwinjiza imisumari yo gufunga bizaba nabi. Hariho kandi ibyago byo kwangiza umutwe wa

 Gufunga imisumari mugihe screwdriver idasezeranye neza na screw.

Kubera izo mpamvu, mbere yo gukuraho isahani yo gufunga, kubaga agomba kumenya ko bitaba 

Birashoboka kurekura imisumari yo gufunga, bityo bisaba gukoresha imikoreshereze yubuzima bwiza bwa hexwdonle nibindi bikoresho byinyongera.

Iyo gufunga imisumari bidashobora kurekurwa, cyangwa igishushanyo cyangiritse, 

Intambwe yambere nugushyiramo umurongo wa screw (screwdriver yakandagiye hamwe nudusedodo) mumutwe wa screw;

 Ibi birashobora kuba bihagije kugirango urekure screw. Ubundi buryo nugukata isahani yo gufunga impande zombi zo gufunga imisumari no gukoresha

 Numurongo wo kurekura imiterere yose. Niba imitekerereze idashobora kurekurwa, isahani yo gufunga irashobora kurekurwa na 

Gucukura hamwe na drill, usenya umutwe wumusumari, cyangwa muguca isaha yo kurekura imisumari yo gufunga. Nyuma yibyo, 

Vise irashobora gukoreshwa kugirango ikureho imigabane yo gufunga amata. Niba bidashobora kurekurwa (kuko byinjijwe mumagufwa cyangwa ntibisohoka bihagije), 

Irashobora gukurwaho nimpeta (Ishusho 6).

Igishushanyo 6 yerekana ninama zo gukuraho imigozi yo gufunga yaguye mu nama.

Ibi bibazo byose birashobora kurambaga kubaga, birashobora gutera tissue yoroshye kubiro bitirirwa ibyuma byasohoye, kandi bikagira ibyago byo kwandura. 

Gukoresha imyitozo yimpeta byongera ibyago byo kuvunika kwabigenewe.

Incamake:

1. Ikibazo cyo gukuraho imisumari ibaho cyane cyane hamwe na 3.5mm Hex Umutwe Gufunga Titanium.

2.Inzira nziza yo kwirinda iki kibazo nugukoresha ibikoresho byose byatanzwe mugihe byinjije. Izi ngorane zishobora gukemurwa ukoresheje ibikoresho bikwiye.

03. Ni ubuhe buryo bugabanijwe bwo gufunga?

Clavicle Plate kuvunika kandi oseous nonnion

Mu kwemeza ko imiterere idakomeye cyane kubera uburebure budahagije bwo gukora isahani yo gufunga cyangwa umubare munini wo gufunga imisumari cyangwa kuri place ya screw / amagufwa / igufwa ryamagufwa rirashobora kugabanuka.

Igishushanyo 7 Amagufwa yagezeho nyuma yiminsi 60 ahindura umubare numwanya wo gufunga imigozi no kongera imbaraga zimiterere zikabije.

Gusuzuma amagufwa ubusanzwe byemezwa nisahani. 

Gutinda gufunga isahani yo gufunga cyangwa gufunga imisumari mugihe micromotion irashobora kubaho kuganisha kumagufwa gukira.

Mu buryo bworoshye busaba kwikuramo, biterwa n'ubwoko bwo kuvunika aho kuba igufwa ribigizemo uruhare, 

Imiterere ikomeye aho ibice bibiri bidakoraho birashobora kuganisha ku kutiha no gutsindwa no kunanirwa kw'isahani. 

Guhuza kugabanuka + gufunga imisumari + gukurura urubuga kurubuga rutanga mumagufwa nonnion.

Itandukaniro ryibi ni ukuvunika icyarimwe gufunga imisumari munsi yawo ku isahani, 

nayo iterwa nuburyo bukabije. Ibi bitera iherezo ryisahani yo gukuramo 'mu gice kimwe ' no gukira ntabwo byagezweho (Ishusho 8).

Igicapo 8 Kwanduza kabiri muburyo bukabije kandi butaringaniye: imigozi myinshi yo gufunga yakoreshejwe kure na plati ya splice plaxice ntabwo yari ndende bihagije.

Kubwibyo, bikosorwa kuvunika intera yikibuno hamwe nisahani yo gufunga irashobora kuganisha kumagufwa no kutagira amagufwa kuko imiterere irakomeye cyane kugirango indumire kurubuga. 

Hatariho micromoto isabwa gukira, umutwaro wose utwarwa nimbaraga kandi amaherezo birananirana.

Ibiti bikiza

Ibisebe bya peroineteal birashobora kuba asimmetric, 

Cyane cyane mu kuvunika kure 1/3 cya femur. Micromoto kubera elastique yemerera Uwiteka 

Gutezimbere kimwe byo gukiza ibirangira tissue ibaho gusa hejuru yisahani yo gufunga / imisumari yubaka.

 Kugirango ugenzure iki kibazo, uburebure bwakazi bwisahani yo gufunga bigomba kwiyongera, haba ukoresheje ibyapa bya titanium byoroshye cyangwa ukoresheje ibisahani bishya bya titanium. 

Ibinyuranye, cyane cyane shingiro butunguranye birashobora kuganisha kumagufwa ya hyperrophic adanion.

Guhindura plastique ibyapa

Gushyira isahani hafi ya cortex bishoboka kugabanya ibyago byo guhindura plastike hagati yisahani;

 Iyo intera iri hagati yisahani na cortex irenze mm 5,

 Imbaraga zubaka ziragabanuka cyane kandi ibyago byo guhindura plastike yisahani no kunanirwa isahani ya titanium ni ndende.

Kuvunika bya diaphysis cyangwa metaphysis kumpera yisahani yo gufunga

Ibyago byo gutaka kumpera yisahani yo gufunga diaphysis cyangwa metaphysis, 

Cyane cyane muri osteoporotic igufwa, rirashobora kugabanuka mu kwinjiza imisumari imwe co gufunga imisumari cyangwa imiyoboro isanzwe ya bingortike kumpera yisahani kugirango igabanye imihangayiko muri kano karere.

Kunanirwa kw'imashini

Ibintu bikurikira byongera ibyago byo kunanirwa kwicyuma bifunze:

1. Gukosora ibisasu bya difral bisaba gukoresha imisumari ine yo gufunga kumpande zombi zurukuta kugirango urwanye torsion kandi wongere ubukanishi; na

2. Gukosora ibipimo epiphyseal biragoye kuko akenshi bidahungabana, 

Cyane cyane kubera ko urubuga rwo kuvunika ntirushobora kumpagarikwa nimisumari yo gufunga n'amagufwa ni osteoorotic;

3.

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4. Kwinjira mu metafiya by'ibicuruzwa bikunda kwimura ihindagurika (urugero, humerus ya proxima, femur femur, hamwe na tibia proximity).

 Amasahani yo gufunga yashimangiye kuruhande rwigufwa atanga imiterere ikomeye ihagije 

Kugirango uhagarike ibyo kuvunika adakeneye kongeramo amasahani-yubwoko cyangwa kongera amagufwa mugihe ukomeje kuvunika ibinyabuzima. 

Guhagarara biterwa gusa ku isahani yo gufunga / gufunga imisumari, 

Bikaba bishimangiwe cyane nyuma yo gusubiramo mugihe epiphysis yahinduwe cyangwa iyo konsole yo hagati itakiriwe. Isahani yo gufunga irashobora noneho kunanirwa kwa kabiri kubananirana.

Kubwibyo, gukosora ibibaya bya bicondylar bikoreshwa ukoresheje isahani yo gufunga gusa kuruhande rwinyuma bigomba gusuzumwa bitewe nubwoko.

 Ku miterere ya humerus, umubare wo kuvunika, gutakaza inkunga yo hagati,

 no kugota epiphysis kugirango ikosorwe ni ibintu bizwi. Kugabanya ibyago byo kubaka gutsindwa, 

Imisungali yo gufunga ishyigikiwe cyane kugirango yishyure kugirango ashyigikire ko adashyigikiwe no kugabanya imivurungano yahinduwe iteka

Kunanirwa kw'ibinyabuzima byo gufunga

Uburyo bwo kunanirwa ibinyabuzima bwo gufunga amasahani yaciwe no kuvunika cyangwa kudashimangira imisumari yo gufunga. 

Izi ngaruka nini mugihe amagufwa osteoporose iri muri skeleton, 

bivuze ko gusubiza mu buzima busanzwe no gusubira mu kaga bigomba gukorwa neza mbere yuko gukiza amagufwa bigerwaho.

(1) Gukuraho imigozi yo gufunga

Gukuramo ibintu bihuye na 'byose ' byose 'kandi icyarimwe gukuraho imisumari yo gufunga igufwa kuri kimwe cyangwa byombi byisahani. Rimwe na rimwe, 

Gufunga imisumari bikuyemo agamishijwe igufwa hirya no hino.

Mukarere ka epiphyseal, igice kimwe cyo gufunga amasahani mubisanzwe gitanga umutekano uhagije kuberako yatatanye cyangwa guhuza imisumari, 

Kandi imiterere yinshyi zinyuranye zongera imbaraga kugirango dukuremo amagufwa.

Mu karere ka diafuseal, guhuza no gufunga gufunga imisumari no kubyutsa ibyapa birebire bifunga bifite imbaraga nziza. 

Ubu bwoko bwubwubatsi burakwiriye kubiranganya periprosthetic. Mu magufwa ya Osteoporotic, 

Bicortical Stem yatsinze ikosora iruta imitekerereze ya monocortical. Ku miterere ya periprosthetic, imitwe imeze neza imitsi igabanya ubufasha kwirinda guhura na IntramediLlary.

Uku gutsindwa gukosorwa bifitanye isano nubunini bwamagufwa, nubwo imiterere ihinduka neza.

(2) gukata cyangwa gutandukanya imigozi yo gufunga

Gukata cyangwa kudashimangira gufunga imisumari hamwe na Intra-Articular Prenetration ashobora kubaho mukarere ka kanseri.

Uku kwimura ni kwimura ibice bya epiphyseal byamagufwa make yimuwe hafi yo gufunga imisumari.

 Ibi bivamo gutakaza epephyseal kugabanya ibicuruzwa. Mu rubanza rwiza, epiphyseal ifunga imisumari ihinduka kandi

 yinjira mu magufa ya kanseri. Mubibazo bibi cyane, epiphyseal ifunga imisumari isohoza epiphysis no gutembera mu ngingo.

Ibi biro byombi bibaho kenshi mubihe bya Rarius na kure ya Rarius. 

Kuri Gufunga Isahani Gukosora Kuvunika Byihuse, birasabwa ko uburebure bwa 

Epiphyseal ifunga imisumari igarukira kugirango igabanye ibyago byo kwisiga no kwipimisha kabiri.

Ibi bipimo byo gukosora biterwa nubunini budahagije hamwe no kwimurwa cyane ibice byavunitse mbere yo kugabanya, 

Nubwo imiterere ifite imashini.

Gusana hamwe no kubyara ibiro byihuse

Gusana no kubyara ibiro biremewe gusa nyuma yo gukosorwa neza byagezweho kandi bigenzurwa kuri X-Imirasire ya nyuma.

Ubushakashatsi bwibinyabuzima bwerekanye ko mumagufwa asanzwe, niba icyuho kiri hagati yimpande zitari mm 1, 

Kwitwara ibiro birashoboka nta ngaruka. Nyuma yimisozi miriyoni, gukomera ni kimwe no mumagufwa asanzwe, bihagije kugirango akire.

Iyo amajwi yubatswe, gufunga amasahani hamwe ningofero zifunze-inguni zemerera kugaruka hakiri kare 

Uburemere kuko umutwaro wimuwe uva mumisumari ujya ku isahani yo gufunga, udafite ibyago byo gukosora kunanirwa kwigitanyagusulaya.

Ariko, iyo inyuguti yo gufunga multiaxial ifunzwe ntabwo iri perpendicular kuri plaque yo gufunga, kwitwarwa hakiri kare ntabwo byemewe.

Kuri MIP, biremereye hakiri kare byemewe kubidasanzwe-bidasanzwe kandi byoroshye na / cyangwa byoroshye. 

Inzego ndende cyane zirahinduka bihagije hamwe no gusinda ifunga imisumari no gufungura kugirango binjire no gukwirakwiza.

Umwanzuro:

1.Inyigisho za 1.biomenical zasuzumye ubwoko butandukanye bwa zubaka hamwe nubutaka bwabo.

Ubuvanganzo bufasha kwemeza ibyiringiro byukuri bifitanye isano nubu bwoko bwo gukosorwa. 

Ariko, ibitabo byanyuma kandi byerekana ingorane za tekiniki no gutsindwa zijyanye no gufunga.

2.Impamvu nyamukuru yo gutsindwa ni gahunda idahagije ya tekinike yo kubaga, 

bikaba bisaba cyane, cyane cyane mugihe ukora inzira zidakunze.

3.Kuvunika bigomba gusubirwamo mbere, udafunze imigozi ku isahani,

Nkuko bitaziguye byo gusubiramo isahani mugufunga imigozi ntibishoboka.

4.Ibigo bigomba kuba muburebure n'imbaraga nziza, 

bivuze ko umuganga agomba kuba amenyereye amahame n'amategeko ayobora gukoresha aya masahani. 

Imiterere rero igomba kuba elastike, ifite umubare muto wa screst yo gufunga buri gihe hamwe nu mwobo.

5.Getanga ibyiza byambere bitewe no gufunga amasahani, 

Gukosora imiterere bigarukira ku buryo bukomeye bwo kuvunika, ireme ryo kugabanuka, hamwe nubwiza bwa aologiya byamagufwa.

6.Niba imiterere itondekanya imashini, ireme ryamagufwa nibyiza kandi kuvunika ni articular, 

Umurwayi ufite ubwigenge buhagije arashobora kwemererwa kwizirika kumubiri wavunitse. Mubihe byinshi, gufunga isahani yo gukosora impamyabumenyi ishingiye ku buzima busanzwe.