Gukoresha neza isahani yo gufunga!

A Gufunga isahani nigikoresho cyo gukosorwa hamwe nu mwobo. Iyo umugozi ufite umutwe utwikiriye uhindagurika mu mwobo, isahani ihinduka igikoresho cyo gukosora (screw). Isahani (inguni ihamye) irashobora gufunga no kudafunga umwobo wa screw kugirango imigozi itandukanye kugirango ikorwe muri (nanone yitwa isahani yahujwe). Kubera ko igitekerezo cyo gufunga cyasabwe kandi gikoreshwa mu kuvura, byakoreshwaga cyane mu gukosora ibipimo bya peteroli, bicuruzwa bitewe no gutanga umusaruro uhamye, kashe yo gukosora, kwangiza imitekerereze yoroshye no guhungabanya gutanga amaraso no guhungabanya gutanga amaraso no guhungabanya amaraso. Gusoma mugitondo byuyu munsi bizaguha intangiriro irambuye yo gufunga amasahani, akwiriye kwigira!

(A) Incamake y'ibanze

1.Isahani yo gufunga ni iki?

Isahani iyo ari yo yose ishobora gukoporora inguni igakosora / inguni ihamye imigozi cyangwa amapine mubyukuri ari isahani yo gufunga.

2. Ibyiza nibibi byo gufunga

Ibyiza

Stratique ituze, kurwanya kunama no guhinduranya

■ Imiterere yimiterere yumutwe itezimbere ikwirakwizwa rya mashini

■ Tanga ubuhanga bwa Ratial, wirinde one out hamwe na screw

■ Anatomity ashishoza kugirango akire ibishushanyo bya anatomique

Guhuza Inyandikorugero kugirango wemererwe gukosorwa muri difryosi (ibijyanye na diaphysis (umuyoboro wimikorere, kwigumisha, kwiyungurura, kwikubita hasi gufunga)

■ Gufunga imigozi bitanga anchurage nziza kubintu byombi byoroshye kandi bidashidikanywaho rwose

■ Ntibikeneye guhura cyane nububiko bwamagufwa, kubungabunga amaraso

Guyoborwa imitsi, tekereza gukiza gukira

■ Mubisanzwe nta gufatwa amagufwa birakenewe

Biragira akamaro cyane kumeneka osteoporotic cyangwa kuvunika ibintu bidahungabana cyane.

Ibibi

■ Gufunga imigozi ntabwo bifitanye isano nuburyo bwo kwikuramo, cyane cyane muburyo bwa intra-Articular cyangwa kuvunika byoroshye

Plate ntishobora gukoreshwa nkigikoresho cyo kugabanya kugirango ifashe kugabanuka.

SHAKA SHAKA NTUMVE NKUNDU NK'IMIKORESHEREZE NYOBORA iyo yinjije.

Icyerekezo cyimigozi ntigishobora guhindurwa (usibye imigozi yo gufunga mumiyoboro myinshi).

SHAKA ishyirwa hejuru cyane, ishobora kuganisha kuri 'ubukonje bukonje '.

■ Angle Gutandukana> 5 °, kubura imbaraga; > 10 °, Gufunga Gufunga ntibikora

■ Birashoboka subcutaneous protrusion niba isahani idatuwe

Ibibazo bikomeye

Hatabayeho guhuza neza cyangwa kwikuramo kuvunika birangira, gukoresha ibyuma byo gufunga, cyane cyane imyifatire yicyuma, bizarinda icyiciro cya kabiri cyo gukomera no kurandura micromion;

Niba tracttraopetive ikoreshwa hanyuma igafunga ikosora ishyirwa mubikorwa, kuvunika guca icyuho bizabikwa, bikavamo gukiza cyangwa kutavunika;

Niba kuvunika kworoheje bitagurishijwe no gukandanwa, umutwaro wanduzwa mu isahani, bikaviramo kwibanda ku guhangayika bishobora kuganisha ku gusoza.

3. Itandukaniro rinini ryibinyabuzima hagati yo gufunga amasahani hamwe nisahani isanzwe

Amasahani asanzwe yishingikiriza ku guterana kw'amagufwa yo gufunga amagufwa kugira ngo agere ku magufwa.

4. Ibyiza bigereranywa byo gufunga isahani yisahani hamwe nisahani isanzwe

1.Gukurura-kureka imigozi yo gufunga ni hejuru cyane kurenza iyo migozi isanzwe.

2. Imigozi yo gufunga epiphyseal iramurika, yongera cyane kurwanya screw ikura ugereranije nimiyoboro ibangikanye.

(B) Gusaba amahame

1. Amahame yo Kwihangana:

Ihame ryo Guhuza: kuvunika diafryotike

Ihame ryo kutabogama: kuvunika diafryotike ya osteorotike

Ihame ryatsi: Ihame rya Diaphysis cyangwa ibihangano bidasanzwe bya metaphyseal

Ihame ryubumwe: Uruhushya rwabanjirije Metaphyseal kuvunika

2. Ihame ryiza:

Inzira isanzwe: Percitaneous Morenally Gukora amasahani yo gusohora (MIP cyangwa MIPPO yubuhanga)

Ubuhanga butaziguye

● Ku masahani ahagije yo gukosora, umwobo 3-4 ukwiye ibumoso ufunguye hafi yimpera zirangiye.

3.FRIS:

Gukoresha hamwe Gukoresha Amahame abiri ya Biomenical ya Compression no Kurira Isahani imwe - Gufunga Plation Plation (LCP)

Kuvunika byoroshye mu gice kimwe cyo kuvunika no kugenzurwa mu rundi (urugero, kuvunika kwa metaphysis, diaphysis)

● Ihame ry'ubumwe rigomba gukoreshwa gusa ku masahani yemerera gushyira imigozi yombi yo gufunga kimwe na screw.

Gufunga ibyapa ntabwo bishingikiriza ku guterana kwamagufwa kandi bishingikiriza cyane kuri interineti hagati ya screw nisahani ifite umutekano ku kabuza gukomeza gushikama.

Kubera ubumwe bwabo buhamye, imbaraga zo gukuramo imitwe hamwe no gufunga imitwe nini cyane kurenza iyo migozi isanzwe, keretse iyo screw zose zikikije zikuramo cyangwa zivuza. Mubisanzwe, biragoye ko umushyitsi umwe uzakurwa cyangwa gucikamo wenyine. Gufunga imitwe ntabwo bitanga agasanduku gahuza. Gutoza birashobora kuboneka ukoresheje igikoresho cyo gukanda cyangwa gutwara imiyoboro isanzwe muri 'kuvanga umwobo ' (gufunga imigozi mbere, hanyuma gufunga imisumari).

1.Niba imiyoboro isanzwe yakoreshejwe kugirango ibone ibice (urugero 1), gukoporora mumigozi yo gufunga bizaba byoroshye cyane (urugero 2).

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3.Ese frecture ya metaphyseal block yashinzwe na screw hamwe numutwe ufunze (LHS), kubirangiza hagati yimodoka imaze kugerwaho mu mwobo wa compression.

(C) kwerekana no kumenyekanisha

1. Ibimenyetso

Cyane kuvunika gukururwa ntibisaba gufunga plaque. Igihe cyose amahame yo kubaga amagufwa akurikiwe, kuvunika cyane birashobora gukira hakoreshejwe ibyapa bisanzwe cyangwa intera ngororamubiri.

Ariko, hariho ubwoko bwihariye bwo kuvunika bushobora kwibasirwa no gutakaza kugabanuka, isahani cyangwa screw, hamwe na 'cyangwa ' bivuguruzanya 'bivuguruzanya ' bivuguruzanya 'bivuguruzanya hamwe n'amagufwa mato. Ubu bwoko bwo kuvunika bukunze kuvugwa ko ari 'ikibazo kidakemutse ' cyangwa 'conctured kandi kirimo kuvunika-articular orturouct kuvunika hamwe no kuvuza osteorotic. Izi mvura nibimenyetso byose byo gufunga amasahani.

Ibimenyetso bya kera nibimenyetso byiza byo gufunga isahani ni ihame ryiza namahame yubumwe kubijyanye no kuvugurura abarwayi benshi cyangwa kuvunika kwinshi mubarwayi bakuze.

2. Kumenyekanisha

Nubwo gufunga amasahani byakoreshejwe cyane kandi ibimenyetso byabo biragutse, tugomba kumenya no kwirinda uburyohe bwinshi bwo gufunga amasahani. Niba gufunga amasahani bikoreshwa mu buryo butarenze kutarobanurwa no kutanya umusaruro no kutavunika bishobora kubaho.

Kuvunika byoroshye bisaba kohereza interment, nko kunyerera byoroshye kunyerera bivura no gufunga ikosora imbere, bikunze kuba bitari ubumwe.

Mu buryo nk'ubwo, gushyira ahagaragara ibyapa byo gufunga kubirangagura ukoresheje tekinike ntoya nayo ifitanye isano.

Kugabanuka mu buryo butaziguye no gufunga icyapa nacyo ntabwo bikwiranye no kwimurwa-arcticular kuvunika-arctique yo kugabanya anatomical, bikaba bisaba kugabanuka kwa anatomical no kugaburira hagati yo kuvunika no gukosorwa.

Ihuriro rifitanye isano no gufunga amasahani, kubera ikiguzi kinini, ni kuvunika bishobora gushimishwa no gukosorwa hamwe nisahani isanzwe. Kurugero, kuvunika kwa Sprishm Syshysis ifite igipimo cyo gukiza kirenga 90% mugihe bivuwe nisahani isanzwe.

(D) kwishyiriraho isahani yo gufunga

1. Kuramo umutobe mu mwobo wimfuruka z'isahani. Gutandukana kw> 5 ° hagati ya screw hamwe nu mwobo wakubiswe birashobora gutuma tunanirwa gufunga, kandi birasabwa gukoresha imboro biti kugirango dutobore ibyokurya neza.

2. Shira isahani yicyuma hejuru yamagufwa hanyuma ugacukura umwobo unyuze mukinamico.

3. Gupima ubujyakuzimu hamwe nubwumvikane bwimbitse, witonde ko umutwe wumurako winjijwe mu mwobo wa screre.

4. Hitamo uburebure bukwiye bwa screw screw.

5. Kwishyiriraho imigozi y'itangazamakuru ni kimwe n'isahani isanzwe y'ibyuma.

6. Noneho ongera ugabanye imigozi yo gufunga hamwe na Torreque, mugihe yarushijeho gukomera, hazabaho kumva neza no gufata amajwi, kugirango wirinde guswera muburyo bukabije, bikavamo ibibazo byo gukuraho.

(E) gufunga isahani

Gufunga amasahani yakoreshejwe cyane, ariko byoroshye guhura ningorane zo gukuraho, cyane cyane zigaragara muri sclip insinga numuyoboro wimisungo hamwe na plaque yimitonda hagati yindogobe zitari zo.

1. Ibitekerezo bya Cap Groove

Mubihe bisanzwe, umugozi wuzuye wa cap groove hamwe na screwdriver ihuye. Umuyoboro ugomba guhuzwa na crow cap groove mbere yo kwinjiza cyangwa gukuraho, ubundi screw cap groove ishobora guhindurwa mugihe cyo gukomera cyangwa guswera, bikavamo kunyeganyega.

Byongeye kandi, nyuma yo gukiza Cap Cap Stap isanzwe ipfunyitse hamwe nigituba cyamagufwa cyangwa ibiciro bya fibrous, bigomba gukozwamo mbere yo gukuraho increw, ariko niba bidateganijwe na cap camp hamwe bishobora kwangirika.

Kuberako imirongo yo kuzunguruka yimbere yumukoresha ntabwo ihuye na axis ya screwdriver, akenshi hari inguni yakuyeho imigereka, ntabwo byanze bikunze inyeganyeza ingufu, byangiza ibyangiritse kuri cap crokore. Kubwibyo, ibyangiritse kuri screw groove birashobora gutuma byoroshye kunyerera.

2. Imyanda yimisumari cyangwa imitekerereze yo mu misumari

Muburyo bwo gukoresha imitekerereze yo gufunga ibyuma bya Anatomical, rimwe na rimwe ukurikije iby'ibifuniko bikwiriye cyangwa bituma isahani y'icyuma, Raja et al. Emera ko niba igice cyo kunyeganyega kibaye mu gufunga umwobo, iyo uhindagurika mu mbaraga zizamurika, cyangwa ngo zibe hafi y'isahani y'icyuma giterwa no gukuraho burundu ingorane.

3. Gushyira mu bikorwa kwikuramo imisumari

Kuberako igufwa rya cortique rikura imbere kuruhande rwumusumari bityo ruzafata imigozi, biganisha ku ngorane zo gukuraho, cyane cyane gusaba kwikuramo amagufwa, suzuki et al. Ntukagirire inama yo gukoresha imigozi yo kwikubita hasi kugirango ukosore bikonje. Hou Yunfei et al. yatanze igitekerezo cyo gukosora bitotical bitari ngombwa hamwe na strew igomba kwirindwa kuvuza hejuru, na Maehara et al. Yasabye kandi ko gukoresha imigozi yo gufunga bigomba kwirindwa mugihe ukoresheje amasahani yo gufunga, kandi ko hakenewe gushyiraho amahame rusange yo guhitamo no gushyira mubikorwa imigozi ifunze.

4. Imiterere hamwe na screw

Ingano, icyerekezo, n'aho gufunga imitekerereze irashobora kugira ingaruka ku gukuraho screw. Intiti zimwe zabonye ko iyo screw itari iri hagati yumwobo ufunga, hashobora kubaho gukosora imiyoboro irenze 5 ° cyangwa imiyoboro itarangwamo cyangwa imisumari ikaba yatsinzwe kandi icyiciro cya kabiri cyo gukuraho ingorane.

5.cold gusudira

Ubusanzwe Titanium ikosorwa imbere ifite urwego ruringaniza ruringaniye, mugikorwa cyo kubaga byimbere, kubera ibikoresho byo gufata no guterana amagambo, cyangwa guterana amagambo, cyangwa guterana amagambo yo gukingira imyenda. 2 Ubuso bwa Metal Hagati Hagati aho hazakurikizwa, ni ukuvuga gushiraho gusudira gakonje.

Byongeye kandi, guhuza galvanic hagati yicyuma, reaclamato, nibindi birashobora guteza imbere ishyirwaho ryinshi. Abakora cyane ibikoresho byo gutunganya imbere nabo bazi iki kibazo, bityo ibyapa byo gufunga amabuye yicyuma bitwikiriye imiyoboro ya oxide hagati yumubiri no kwamamaza kuri poroteyine mu mubiri no kugabanya ibitaramo bikonje.

(F) gukuraho tekinike

Ubuhanga bwo gukuraho bwavuzwe mu buvanganzo bw'igihugu ndetse n'amahanga bushobora kugabanywa mu byiciro 2, aribyo, bifatika kandi bidakenewe mu bikoresho byihariye, kandi ibyangiritse byoroheje bifatika.

Maehara et al. Tanga igitekerezo cyo gukoresha ibitagenda neza hamwe na shanki nini igihe cyose bishoboka. Iyo uhuye na screw screw, pattison et al. yatangaje uburyo bworoshye bwo gukuraho imigozi yatemye apfunyika umutwe wa screwdriver hamwe nicyuma cya platinum no kuyishyira mu rubuga rwa chapre ya screw. Ubu buryo bwuzuye kuzura igikomango cya cap croove hamwe nicyuma kandi byongera aho uhurira no guterana amagambo hagati ya screwdriver na groove, byorohereza gukuraho imigozi hamwe nudusimba twinshi. Muri ubu buryo buracyagoye gukuraho urubanza, niba harakaze ingofero yimitonda yometseho, ni ukuvuga kuva ku gihirahiro gishya, ukaba, mu buryo bwo kuzunguruka no kuzuza ibihano no gukatirwa guswera.

Ku buryo bubi, imigozi imwe yo gufunga iracyagora neza gukoresha imiyoboro ishimishije ya scrector ya progaramu ya screw, nka ehngurur et al. na bae et al. Ninde wasanze ubu buryo bukunze kuba bwiza kuri 3.5 mm yatsinze inyenzi, ariko akenshi ntacyo ikora kuri mm 4.5 ya strew screw. Muri uru rubanza, ntabwo buri cyiciro cya orthopedietique gifite ibikoresho byihariye byo gusya yicyuma nkimyitozo ya karbide, imyitozo ya diyama, cyangwa ibiziga byihuta byo gusya.

Gopinathan et al. Menyesha uburyo budasaba ibi bikoresho byihariye utanga ikibazo cyo gukumira ibintu bigoye kuva ku isahani yo kubaka, ni ukuvuga imiyoboro igabanuka yisahani yisahani. Ubu buhanga bukoreshwa gusa kuri titanium yo gufunga titanium, gufunga amaboko hamwe nisahani yo hasi, naho isahani 1/3

Uburyo bworoshye kandi bwasobanuwe aho bitoroshye gato binini bikoreshwa mu mwobo usanzwe kuruhande rwamagufa, hanyuma infore na screw na screw barabohorwa bakoresheje amagufwa bashya, hanyuma infore na srew barabohorwa bakoresheje amagufwa banyuze munsi yisahani mugihe kitarambuwe.

Birumvikana, hari ubushobozi bwo kwangirika kumagufa hamwe nuburyo bwo kwirinda ibiro byanyuma. Byongeye kandi, birakenewe kandi gutegura ibikoresho bimwe na bimwe byakoreshwaga mbere yo kubagwa imbere, ukomoka muri bolt reamer, twohereza ibicuruzwa, t-porticker porketizes nibindi.

Imbere yo gufunga insinga yo gukuraho insinga, intiti zimwe zo mu rugo zasabye guhindura uburyo bw'imashini ya stove. '

Ehllingter et al. yatangaje ko mu gihe aho ababaye ba sporen bakubise inshyi ryatsi baracyafite ikibazo cyo gukuraho umutware w'icyuma mu isahani yo guhagarika imigenzo, hanyuma umurambo wa screw wakuweho ukoresheje impeta.

Georgiriadis et al. na Raia et al. Ibisabwa muri screw hamwe na plate ihuza cyane kandi biragoye gukuraho, ibikoresho byihariye (nkimikino yihuta, ibiziga bya karbide, ibiziga bya karbide.

Kumar na Dunlopl bavuzwe muri Femur yo gufunga ibyuma bya kure bya sisitemu yo gukosora imbere, mukoresha ibiziga bisanzwe, ariko bikaba byaramenyesheje imitsi minini yatsinzwe, ariko, ikoreshwa ryimiterere yihuta yatsinzwe, ariko, ikoreshwa ryimiti minini yoroheje yatsinzwe, hanyuma igakoresha imiyoboro yijimye yicyuma, hanyuma igakoresha amagufwa yoroheje ya screw yinjijwemo Mu buryo bwo gutemagura, ntukingure ikibanza cyicyuma kugirango uruhuke cap, kugirango ukureho neza imigozi ifunze.

Ni ngombwa kumenya ko uburyo bwavuzwe haruguru bugomba gutera imbere bushoboka mugihe cyo gukata cyangwa gusya isahani yihuta yo gukata kugirango wirinde gukata umutwe wa screw no kwangiza amagufwa no mu ngingo zoroshye. Byongeye kandi, ubwo buhanga bushobora kubyara ubushyuhe bwimbitse nimyanda yicyuma, ishobora kuvamo ibyago byo kongera kuvuka kwongeye kuvuka, muri tiscrosis the scrosil necrosial necrosial, kandi kwandura.

(G) Incamake

Emera guhuza amalapo bitunganijwe hamwe na perosteum

Plate igomba gusubirwamo mbere yo gufunga, nkuko kuvunika ntibishobora gusubirwamo nyuma yo gufunga.

Gufunga isahani ntibishobora guhabwe, gukenera gukoresha umukiriya cyangwa centrifugali guswera mu mwobo usanzwe, kotswa umukiriya wa mbere, hanyuma ufunge

Urubuga rwo kuvunika 3 ~ 4 Ubwobo butagira imigozi kugirango ukwirakwize imihangayiko; Urubuga rwo kuvunika 3 ~ 4 Ubwobo butagira imigozi kugirango ukwirakwize imihangayiko; kandi

Gukosora monocortike ya diaphysis cyangwa amagufwa yijimye, kandi aho ubwiza bwamagufwa ari cyiza; kandi

Bimaze gufunga, ntigishobora gusubirwamo, mugihe imigozi isanzwe ishobora gufatwa

Gukosora gukomeye kandi imigozi myinshi irashobora kuganisha kuri Nonunion; Ihame nuko aya masahani agomba kuba ndende kandi nkeya zigomba gukoreshwa; mugufata ibicuruzwa bya periartticular, imigozi mike igomba gukoreshwa kuruti nimigozi myinshi igomba gukoreshwa mugukosora hejuru yuburinganire

■ Uburebure bwisahani yo gushushanya igomba kuba kabiri uburebure bwakarere kavunitse, imigozi igomba kugabanywa cyane, kandi ikosora ryiza rigomba kuba-the-aperture ikosora

■ Imbaraga zikwirakwizwa hejuru yisahani ndende, kandi ikosore imigozi mike irashobora gushishikariza guterana no guteza imbere ubukungu.