Gufunga Isahani-Porogaramu Kubuza no Kugarukira

Ikoreshwa rya gufunga amasahani yaguye ahanini murwego rwo gukoresha plaque imbere ikosora ibice. Ariko, imikoreshereze yabo igomba gushyirwa mu gaciro no gutezimbere kubera imitego ishobora kugarukira. Muri iyi ngingo, tuzareba ibitekerezo byo gusaba, imbogamizi zo gukuraho, hamwe nimbogamizi, ibintu 3 byo gufunga ibyapa.

01.Ni ibihe bintu bidasanzwe n'ibibazo bigomba kwitonderwa mugukoresha ibyapa bifunga?

Intambwe n'imbogamizi mukugabanya ibice hamwe no gufunga ibyapa

Intambwe zo gusubiramo kuvunika zisanzwe. Gufunga ibyapa ntibisubiramo kuvunika. 

Iyo bimaze gushyirwa mubice byamagufwa, kongeramo imigozi myinshi ntabwo bizimura. Niba isahani yo gufunga yemera gusa imisumari ikoreshwa, 

ibi bivuze ko isahani ishobora gufungwa nyuma yo kuvunika.

Kuva gufunga amasahani yemerera amagufwa gukira nta gutakaza umwanya wambere, 

impamvu nyamukuru itera malunion yo gufunga amasahani ntabwo aribwo buryo bwambere bwo kwimurwa. 

Kandi, gusubirana nabi kubera ubukanishi budahagije birashobora gutuma umuntu adakira neza kuko isahani yamagufa yaturika kubera gutinda gukira cyangwa kudakira.

Gusimbuza udakoresheje amasahani yo gufunga biragoye cyane mugihe ukora byibuze

 inzira kuko guhura namagufwa ni bike cyane. Irasaba uburyo butandukanye bwo gukwega (imbonerahamwe ikurura, retractors),

 imbaraga zitandukanye zo guhinduranya imbaraga, hamwe na Kirschner pin kugirango ukoreshe ibice byamagufwa no gukosora byigihe gito. 

Mbere yo gukoresha amasahani yo gufunga no gufunga imisumari, ni ngombwa kugenzura reset ukoresheje fluoroscopi.

Ibinyuranye, mugihe ukoresheje isahani ifunga nayo ifite ibyobo bisanzwe, 

umugozi usanzwe ushobora gukururwa urashobora gushyirwa mubyobo bisanzwe kugirango bisubizwe mbere ku isahani.

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

Gufunga imisumari byemeza ibisubizo bihamye utabanje guhindura reset yambere. Uru rutonde rwo gushiramo (imigozi isanzwe, hanyuma gufunga imigozi) ni ngombwa (Ishusho 4).

Igishushanyo cya 4 Banza ushyiremo imigozi isanzwe hanyuma uyizirikane.

Kubura Ibitekerezo Byitondewe Mugihe Ukomeza Gufunga Amababi

Nta bitekerezo byitondewe mugihe ukomye imigozi yo gufunga. Mubyukuri, 

kwizirika ku musumari ufunga bibaho icyarimwe mumagufwa ya cortical cyangwa kanseri cyangwa mubyuma bya plaque. Kubera iyo mpamvu,

 biroroshye ko umuganga yibeshya yibwira ko umusumari ufunze ufashe neza mumagufwa ya cortical cyangwa kanseri (Ishusho 3).

Igishushanyo cya 3 Uburebure bwakazi bwo gufunga imigozi ukurikije ubwoko bwamagufwa numubare wa cortices.

Kwifata wenyine

Gukoresha kwifungisha-gufunga imigozi bivuze ko nta bitekerezo byubusa mugihe cyo gucukura cyangwa gukomera nkuko bibaho icyarimwe.

Ibikoresho byubukanishi bisa nibya cortex imwe ifunga imigozi mugihe cya cortex imwe. Niba ari birebire, 

bazavugana na cortex ya kabiri idacukuwe, bikavamo guhagarara nabi kumisumari yo gufunga mumasahani yo gufunga.

Mugihe cya bicortical progaramu, zirashobora kuba ngufi cyane, bigatuma zikorana na tekinike imwe yo gufunga imisumari. 

Niba ari ndende cyane, izaguka hejuru ya cortex kandi irashobora kwangiza ibintu bikomeye kurundi ruhande rwisahani.

Uburebure bwo gufunga imisumari burashobora kuboneka gusa mugupima uburebure bwifuzwa nyuma yo gucukura cyangwa kubigenzura ukoresheje fluoroscopi.

Ibiranga Uniaxial Ifunga Imiyoboro

Ingaruka nyamukuru yo gufunga imisumari uniaxial nuko icyerekezo cyabo cyateganijwe mbere. 

Bashobora kugira urundi rugingo rwatewe cyangwa prothèque mu nzira yabo, bigatuma kwinjiza bidashoboka cyangwa kubibuza gukosorwa unicortical.

Kubisahani bya anatomiki bifashisha mumaguru hamwe na uniaxial gufunga imisumari hamwe nicyerekezo gihamye, 

gutezimbere kubwimpamvu zidasanzwe na biomehanike, harikibazo cyo gufunga imisumari imbere. 

Urugero rusanzwe ni kuvunika kwa radiyo kure. Izi ngaruka zirarenze iyo isahani yo gufunga iri hafi yingingo cyangwa mugihe anatomy itujuje ubuziranenge. 

Kubura kuvunika imbere-articular bigomba kwemezwa na fluoroscopi.

Ikoranabuhanga rya MIPO

Tekinike ntoya cyane ya osteosynthesis (MIPO) tekinike ikubiyemo na subcutaneous na / cyangwa submuscular 

na extraperiosteal kwinjiza isahani yamagufa unyuze mumagufwa mato nyuma yo kunyerera, utabigaragaje

 urubuga rwacitse. Ibi bituma uduce duto, uburwayi buke bwo kubaga, kandi bigatuma inzira irushaho 'biologic '

 kuberako nta mpamvu yo gushyira ahagaragara buri gice cyamagufwa kandi ntihabangamirwa nuduce tworoshye, periosteal vascularization, cyangwa hematoma yamenetse.

Irashobora kugerwaho hamwe nisahani ifunze hamwe nigikoresho cyabugenewe cyemerera isahani 

gukoreshwa no kunyura mu ruhu kugirango byoroshye kubona imyobo ifunze mu isahani. 

Amashusho ya Fluoroscopique agomba gufatwa kuri buri ntambwe kugirango hamenyekane iterambere. Buri ntambwe yubu buhanga iragoye. Ikibazo cya mbere ni ugusubiramo kuvunika mbere yo gukosorwa.

 Isahani yo gufunga igomba noneho kuba hagati yuburebure bwamagufwa, bitabaye ibyo guhuza isahani yo gufunga bizaba bitemewe (Ishusho 5). Byongeye, 

isahani yo gufunga igomba kuba ihwanye neza na cortex yamagufwa yagenewe gukurikira kandi hafi yamagufwa nk 

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

 imiyoboro y'imigozi ihujwe neza ku isahani yo gufunga kandi ko imisumari yo gufunga ikoreshwa neza mugihe cyo gukomera.

Igicapo 5 Umwanya uhagaze wa plaque yo gufunga no kubura ibitekerezo bishimishije mugihe cyo gufunga imigozi.

Ibishobora gukomeretsa uruhu mugihe ukoresheje amasahani yo hanze

Gukoresha amasahani yo gufunga kugirango ukosore kuvunika amaguru yo hanze byajyanye nigipimo cyinshi kidasanzwe cya nérosi y'uruhu. 

Ubunini bwibi byapa bifunga byashyizeho igitutu kuruhu kandi bikabangamira ikwirakwizwa ryamaraso no gukira. 

Ikintu gisa nacyo gishobora kubaho mugihe amasahani yo gufunga akoreshwa kumeneka ya hawksbill.

Ibyago bya Osteoporose no gukuramo ibice

Amagufwa ya osteoporotic, gufunga imisumari bifasha kugabanya ibyago byo gukuramo cyangwa gukuramo. 

Ubwubatsi ntibukomeye bihagije kubera cortex yoroheje kandi igabanya ubucucike bwa trabeculae.

Muri iki gihe, gufunga isahani ikosora buri gihe birakomeye kandi byiza cyane mugihe ukoresheje inyubako ya monolithic yubaka cyangwa ihuza (Ishusho 3).

Incamake:

1. Gufunga imigozi ntabwo yemerera kuvunika kumasahani yamagufa gusubirwamo.

2. Ivunika rigomba gusubirwamo mbere yo kongeramo umugozi.

3. Gukosora muburyo bwo kugabanya kuvunika bisaba gufunga ibikoresho bya plaque. tekinike ya MIPO irasaba cyane.

02. Inzitizi zo gukuraho ibyapa bifunga

Kuraho isahani yo gufunga iyo kuvunika gukize biragoye kandi bitateganijwe, 

ariko ibintu birashobora gukemuka. Ikibazo gikomeye nukurekura umugozi wo gufunga.

Rimwe na rimwe, insinga ziri kumutwe wumusumari zifunga zangiritse mugihe cyo gushiramo 

. 

bivuze ko idashobora gukururwa. Kubwibyo, nibyiza gukumira ibyo bigoye uhita usimbuza umugozi wose na a 

kwangirika k'umutwe mugihe cyo guterwa, ukoresheje screwdriver yuzuye no kwizirika neza umugozi ukoresheje intoki (ntabwo ukoresheje imyitozo y'amashanyarazi).

 Gukoresha imigozi ikozwe mubikoresho bikomeye birashobora gufasha kugabanya iki kibazo.

Mu bihe byinshi, hariho gufunga imashini cyangwa guhuzagurika hagati yudodo two gufunga imisumari hamwe nu mwobo wometse ku isahani. 

Ibi bikunze kugaragara hamwe na 3.5mm ya diametre titanium hex ishusho imwe ya shaft ifunga imigozi. Nta buryo bumwe

 yo kwivanga. Imiyoboro ikunze kubanza gukomera cyane kubera kunanirwa gukoresha umurongo wa torque watanzwe mubikoresho byabikoresho, 

irashobora guhindura insanganyamatsiko kurupapuro rufunga hamwe nisahani yo gufunga. Mu bindi bihe, 

kunanirwa gukoresha cyangwa gukoresha ubuyobozi bwimyitozo itari yo byaviriyemo imigozi idahujwe mugihe ikomye, 

cyateye imiyoboro. Kugirango ugabanye ingaruka zo guterana mugihe cyambere cyo gutunganya,

 ni ngombwa gukoresha ibikoresho byose biboneka: kuyobora drill na socket, torque wrenches muburyo bwuzuye bwuzuye mugihe ukomye imisumari.

Tekinike ya MIPO itwara ibyago byinshi byo gushyira nabi umurongo uhuza, 

nkaho ntaho bigaragara neza icyapa gifunga. Guhuza nabi kubayobora imyitozo bisobanura ko umwobo wacukuwe 

umusumari wo gufunga no gushyiramo umusumari wo gufunga nabyo ntibikwiye. Hariho kandi ibyago byo kwangiza imitwe yumutwe wa

 gufunga imisumari mugihe icyuma kidakoreshwa neza.

Kubera izo mpamvu, mbere yo gukuraho isahani yo gufunga, umuganga agomba kumenya ko bidashoboka 

birashoboka kurekura umusumari ufunze, bityo bisaba gukoresha ikoreshwa rya screwdriver yo murwego rwohejuru hamwe nibikoresho byongeweho.

Iyo umusumari wo gufunga udashobora kurekurwa, cyangwa umutwe wangiritse, 

intambwe yambere nugushira imashini ikuramo (icyuma gifata imashini ifite imigozi ihindagurika) mumutwe wumugozi;

 ibi birashobora kuba bihagije kugirango ugabanye umugozi. Ubundi buryo ni ugukata isahani yo gufunga kumpande zombi zo gufunga no gukoresha

 ni screwdriver kugirango irekure imiterere yose. Niba umugozi udashobora kurekurwa, isahani yo gufunga irashobora kurekurwa 

kuyitobora hamwe na myitozo, gusenya umutwe wumusumari ufunga, cyangwa mugukata isahani kugirango woroshye umusumari ufunze. Nyuma yibyo, 

vise irashobora gukoreshwa mugukuraho imigabane yifunga. Niba bidashobora kurekurwa (kuko byinjijwe mumagufwa cyangwa ntibisohoka bihagije), 

irashobora gukurwaho hamwe n'imyitozo y'impeta (Ishusho 6).

Igicapo 6 Ibitekerezo hamwe ninama zo gukuraho imigozi ifunga ikibaho.

Ibi bibazo byose birashobora kongera igihe cyo kubagwa, bishobora gutera ingirabuzimafatizo zoroshye bitewe nibice byasohotse, kandi bigatera ibyago byo kwandura. 

Gukoresha imyitozo yimpeta byongera ibyago byo kuvunika perioperative.

Incamake:

1. Ikibazo cyo gukuraho imisumari ifunga kibaho cyane cyane hamwe na 3.5mm ya hex umutwe ufunga titanium.

2.Uburyo bwiza bwo kwirinda iki kibazo ni ugukoresha ibikoresho byose byatanzwe mugihe winjizamo umugozi. Izi ngorane zirashobora gukemurwa ukoresheje ibikoresho bikwiye.

03. Ni ubuhe buryo bugarukira bwo gusaba Isahani yo gufunga?

Kuvunika isahani ya clavicle hamwe na osseous nonunion

Mugukora ibishoboka byose kugirango imiterere idakomera cyane kubera uburebure bwakazi budahagije bwisahani yo gufunga cyangwa umubare munini w’imisumari ifunga (Igicapo 7), ibyago byo gufunga icyapa gifunga munsi y’imyobo cyangwa ku masangano ya plaque / amagufwa birashobora kugabanuka.

Igicapo 7 Gukiza amagufwa byagezweho nyuma yiminsi 60 uhindura umubare numwanya wo gufunga imigozi no kongera ubworoherane bwimiterere ikabije.

Gupima amagufwa adahuza ubusanzwe byemezwa no kumena amasahani. 

Kumeneka gutinda kumasahani yo gufunga cyangwa gufunga imisumari mugihe gikwiye kuko micromotion ishobora kubaho iganisha kumagufa.

Mu kuvunika kworoheje bisaba kwikuramo, biterwa nubwoko bwavunitse kuruta igufwa ririmo, 

imiterere itajenjetse ibice byombi bidakoraho birashobora gutuma umuntu adakira kandi ananiwe umunaniro. 

Gukomatanya gukomeye gukomeye + gufunga imisumari + gukwega ahavunitse bivamo guhuza amagufwa.

Itandukaniro ryibi ni uguturika icyarimwe icyarimwe cyo gufunga umusumari munsi yacyo ku isahani, 

bikaba nabyo biterwa nuburyo bukabije. Ibi bitera impera imwe yisahani gukuramo 'mugice kimwe ' kandi gukira ntabwo kugerwaho (Ishusho 8).

Igicapo 8 Kunanirwa kwa kabiri kunanirwa gukabije kandi kutaringaniye: imigozi myinshi yo gufunga yakoreshejwe kure kandi isahani yo kugabana yegeranye ntabwo yari ndende bihagije.

Kubwibyo rero, gukosora imvune zidasanzwe zifata ikibuno hamwe nisahani ifunze birashobora gutuma umuntu adahuza amagufwa kuko imiterere irakomeye kuburyo idashobora kwinjirira ahavunitse. 

Hatabayeho micromotion isabwa kugirango ikire, umutwaro wose utwarwa nuwatewe kandi amaherezo birananirana.

inyama zidakira

Ibibyimba byamagufwa yigihe gishobora kuba kidasanzwe, 

cyane mu kuvunika kwa 1/3 cya femur. Micromotion bitewe na elastique yemerera the 

iterambere rimwe ryimitsi ikiza ivunika iboneka gusa hejuru yuburinganire bwa plaque ifunga / imisumari.

 Kugirango ugabanye ibi byago, uburebure bwakazi bwibisahani bifunga bigomba kongerwa, haba ukoresheje plaque ya titanium yoroheje cyangwa ukoresheje ibishushanyo bishya bifunga imisumari. 

Ibinyuranye, inyubako zoroshye zirashobora kuganisha kuri hypertrophique amagufwa adahuza.

Guhindura plastike yibyuma

Gushyira isahani hafi ya cortex ishoboka bigabanya ibyago byo guhindagurika kwa plastike hagati yisahani;

 iyo intera iri hagati yisahani na cortex irenze mm 5,

 imbaraga zimiterere ziragabanuka cyane kandi ibyago byo guhindura plastike ya plaque no kunanirwa kwa plaque ya titanium ni byinshi.

Ivunika ryatinze rya diaphysis cyangwa metaphysis kumpera yisahani ifunze

Ibyago byo gutinda gutinda kurangiza icyapa gifunga diaphysis cyangwa metaphysis, 

cyane cyane mumagufwa ya osteoporotic, arashobora kugabanuka mugushyiramo umusumari umwe wa cortical gufunga umusumari cyangwa umugozi usanzwe wa bicortical kumpera yisahani kugirango ugabanye imihangayiko muri kano karere.

Kunanirwa kwa mashini

Ibikurikira bikurikira byongera ibyago byo kunanirwa kumashini yo gufunga:

1. Gukosora kuvunika kwa diaphysis humeral bisaba gukoresha imisumari ine ifunze kumpande zombi zavunitse kugirango irwanye kandi yongere kunanirwa;

2. Gukosora ibice bya epiphyseal biragoye kuko akenshi bidahinduka, 

cyane kubera ko ikibanza cyacitse kidashobora guhagarikwa n imisumari ifunga kandi igufwa ni osteoporotic;

3. Gukomeretsa imbere-articular na extra-articular ivunika ya epiphysis ntabwo ihagaze

 (eg

4. Gutangira hagati yimvune ya metafhyseal ikunda kwimuka kugirango ihindurwe (urugero, humerus yegeranye, femur yegeranye, hamwe no kuvunika kwa tibia hafi).

 Gufunga amasahani yometse kumpande zamagufa bitanga imiterere ikomeye ikunze kuba ihagije 

guhagarika ibyo byavunitse bitabaye ngombwa ko wongeramo amasahani yo mu bwoko bwa konsole hagati cyangwa kongeramo amagufwa mugihe ukomeza ibidukikije byavunitse. 

Guhagarara biterwa gusa no gufunga isahani / gufunga imisumari, 

bikaba bishimangirwa cyane nyuma yo gusubiramo mugihe epiphysis ikomeje guhindagurika cyangwa mugihe konsole yo hagati itongeye kubakwa. Isahani yo gufunga irashobora kunanirwa kumwanya wa kabiri.

Kubwibyo, gukosora bicondylar tibial plateau yamenetse ukoresheje amasahani yo gufunga kuruhande gusa bigomba gusuzumwa bitewe n'ubwoko.

 Kuvunika hafi ya humerus, umubare wibice byavunitse, gutakaza inkunga yo hagati,

 no guhinduranya epiphysis yo gukosorwa bizwi ko ari ibintu bishobora guteza ingaruka. Kugabanya ingaruka zo kubaka kunanirwa, 

imisumari imwe yo gufunga izashyigikirwa muburyo bwo kwishyura kugirango hatabaho inkunga yo hagati mukugabanya kuvunika kwahinduwe hanze

Kunanirwa kw'ibinyabuzima byo gufunga ibyapa

Uburyo bwo kunanirwa kwa biologiya uburyo bwo gufunga amasahani yaciwe kandi avunika cyangwa abuza umusumari. 

Izi ngaruka ninshi iyo amagufwa osteoporose aboneka muri skeleton, 

bivuze ko gusubirana hakiri kare no gusubira muburemere bigomba gukorwa neza mbere yo gukira amagufwa.

(1) Gukuraho imigozi yo gufunga

Gukuramo ibice bihuye na 'byose ' no kuvanaho icyarimwe umusumari ufunga kumagufwa kumutwe umwe cyangwa kumpande zombi. Rimwe na rimwe, 

umusumari ufunga ukuramo igice cyamagufwa yacyo.

Mu karere ka epiphyseal, igice kimwe cyo gufunga isahani isanzwe itanga ituze rihagije kubera gutatanya cyangwa guhuza gufunga imisumari, 

nuburyo butatu buringaniza byongera imbaraga zo gukuramo imigeri kumagufwa ya kanseri.

Mu karere ka diaphyseal, guhuza no gutatanya imisumari yo gufunga no kubaka hamwe namasahani maremare yo gufunga bifite imbaraga zo gukurura. 

Ubu bwoko bwubwubatsi burakwiriye kuvunika periprosthetic. Amagufwa ya osteoporotic, 

bicortical stem screw fixation iruta monocortical screw fixation. Kuvunika kwa periprosthetic, imigozi iringaniye-umutwe unicortical screw ifasha kwirinda guhura nimbuto zatewe.

Kunanirwa gukosora bifitanye isano nubwiza bwamagufwa, nubwo imiterere yaba idahwitse.

(2) Gukata cyangwa kubangamira imigozi yo gufunga

Gukata cyangwa kubuza gufunga imisumari hamwe no kwinjira mu nda bishobora kugaragara mu karere ka epiphyseal kanseri.

Iyimurwa ni iyimurwa ryibice bya epiphyseal yamagufa mato mato yimuwe hafi yimisumari ifunga imisumari.

 Ibi bivamo gutakaza igabanuka rya epiphyseal. Mugihe cyiza, epiphyseal ifunga imisumari kandi

 yinjira mu magufwa. Mugihe kibi cyane, epiphyseal ifunga imisumari isohoka muri epiphysis hanyuma ikajya mubice.

Izi ngorane zombi zibaho kenshi mumyanya ndangagitsina yegeranye no kuvunika kwa radiyo ya kure. 

Gufunga isahani yo gukosora hafi ya humerus yamenetse, birasabwa ko uburebure bwa 

epiphyseal gufunga imisumari bigarukira kugirango ugabanye ingaruka zo kwinjira no kwinjiza kabiri.

Kunanirwa gukosora biterwa nubwiza bwamagufwa adahagije hamwe no kwimura kwambere kwimiterere yibice byavunitse mbere yo kugabanuka, 

niyo imiterere yaba idahwitse.

Gufatanya gusubiza hamwe no kwihanganira ibiro ako kanya

Gusubiza mu buzima busanzwe no kuremerera biremewe gusa nyuma yo gukosorwa neza kugerwaho no kugenzurwa kuri X-X nyuma yo kubagwa.

Ubushakashatsi bwibinyabuzima bwerekanye ko mumagufwa asanzwe, niba ikinyuranyo cyibice kiri munsi ya mm 1, 

kwikorera ibiro birashoboka nta ngaruka. nyuma ya miriyoni 1 yinzinguzingo, gukomera ni kimwe n'amagufwa asanzwe, arahagije kugirango gukira bibeho.

Iyo byubatswe neza, gufunga amasahani hamwe no gufunga-gufunga imisumari byemerera gusubira hakiri kare 

kwikorera ibiro kubera ko umutwaro wimurwa mu buryo butaziguye kuva ku musumari ufunga ukajya ku isahani yo gufunga, nta kibazo cyo kunanirwa gukosorwa ku ihuriro ry’imisumari.

Ariko, mugihe umurongo wibikoresho byinshi bifunga peg ntabwo ari perpendicular kuri plaque yo gufunga, uburemere bwambere ntibyemewe.

Kuri MIPO, kubyara kare biremewe kubirenze-articular, byoroshye na / cyangwa byoroshye kuvunika. 

Inzira ndende cyane yihariye ihindagurika bihagije hamwe no guhinduranya imisumari ya bicortical gufunga imisumari no gufungura imitwaro no gukwirakwiza.

Umwanzuro:

1.Ubushakashatsi bwibinyabuzima bwasuzumye ubwoko butandukanye bwubwubatsi hamwe nuburyo bukoreshwa.

Ubuvanganzo bufasha kwemeza ibyiringiro byerekeranye nubu bwoko bwo gukosora. 

Ariko, ubuvanganzo bwa vuba burerekana kandi ibibazo bya tekiniki no kunanirwa bijyana no gufunga amasahani.

2.Impamvu nyamukuru yo gutsindwa ni igenamigambi ridahagije rya tekinike yo kubaga, 

ikaba isaba cyane, cyane cyane iyo ikora inzira zidasanzwe.

3.Ivunika rigomba kubanza gusubirwamo, udafunze imigozi ku isahani,

nko gusubiramo mu buryo butaziguye isahani mugufunga imigozi ntibishoboka.

4.Imiterere igomba kuba ifite uburebure n'imbaraga bikwiye, 

bivuze ko umuganga abaga agomba kuba amenyereye amahame namategeko agenga ikoreshwa ryibi byapa. 

Imiterere rero igomba kuba yoroheje, hamwe numubare ntarengwa wimigozi ifunze buri gihe isimburana nu mwobo wubusa.

5.Nuburyo bwiza bwibanze bwambere bwo gutekera ibyapa, 

gutunganya imiterere bigarukira kubibazo bigoye kuvunika, ubwiza bwo kugabanuka, nubwiza bwibinyabuzima bwamagufwa.

6.Niba imiterere idahwitse, ubwiza bwamagufwa nibyiza kandi kuvunika ni art-articular, 

umurwayi ufite ubwigenge buhagije arashobora kwemererwa kwikorera uburemere kumubiri wavunitse. Mubihe byinshi, gufunga ibyapa byemerera gusubizwa hakiri kare.