Gukoresha neza Isahani Ifunga!

A. gufunga isahani nigikoresho cyo gukosora kuvunika hamwe nu mwobo. Iyo umugozi ufite umutwe wumugozi winjijwe mu mwobo, isahani iba igikoresho cyo gukosora inguni. Isahani yo gufunga (inguni ihamye) irashobora kugira ibifunga byombi bidafunga kandi bidafunze kugirango imigozi itandukanye ihindurwe (nanone bita isahani ihuriweho). Kuva igitekerezo cyo gufunga amasahani cyatangwaga kandi kigashyirwa mubikorwa byo kuvura kuvunika, ryakoreshejwe cyane mugukosora imvune za periarticular, kuvunika kwa osteoporotique na osteoporotic kubera ibyiza byayo byo gutanga inkunga ihamye no gukosora imvune, umuvuduko mwinshi wo gukiza kuvunika, kwangirika kwinyama zoroshye no guhagarika amaraso. Uyu munsi gusoma mugitondo bizaguha intangiriro irambuye kumasahani yo gufunga, akwiriye kwigira!

(A) Incamake y'ibanze

1.Isahani yo gufunga ni iki?

Isahani yicyuma iyo ari yo yose ishobora guhindurwamo inguni ikosora / inguni ihindura imigozi cyangwa pin ni mubyukuri gufunga.

2. Ibyiza nibibi byo gufunga amasahani

Ibyiza

Stability Guhagarara neza, kurwanya kunama no guhindagurika

Shape Imiterere ihuriweho n'umutwe wa screw itezimbere gukwirakwiza imashini

Tanga radiyo ibanziriza, irinde amagufwa no kugabanuka kwa screw

Form Imiterere idasanzwe kugirango ihuze imiterere ya anatomique

Guhuza inyandikorugero kugirango wemererwe gukosorwa muri diaphysis (cortical imwe, kwikuramo, kwikubita wenyine)

■ Gufunga imigozi itanga icyerekezo cyiza kubiraro byoroshye no gukosora byimazeyo

■ Ntibikenewe ko umuntu ahura cyane hejuru yamagufwa, arinda amaraso

■ Kugenzura micromotion, gushigikira gukira kuvunika

■ Mubisanzwe nta magufa asabwa

Nibyiza cyane cyane kuvunika osteoporotic cyangwa kuvunika kwose kutajegajega.

Ibibi

■ Gufunga imigozi ntabwo bigira ingaruka zo kugabanya no kwikuramo, cyane cyane mubice byimbere-arctular cyangwa kuvunika byoroshye.

Isahani ntishobora gukoreshwa nkigikoresho cyo kugabanya kugirango ifashe kugabanya.

■ Imigozi ntabwo yunvikana neza nkibisanzwe bisanzwe iyo byinjijwe.

■ Icyerekezo cyimigozi ntishobora guhinduka (usibye imigozi myinshi yo gufunga).

■ Imigozi ishyizwe cyane, ishobora kuganisha kuri 'gusudira gukonje '.

Gutandukana kw'inguni> 5 °, gutakaza imbaraga; > 10 °, ingaruka zo gufunga ntacyo zikora

■ Ibishobora kubaho munsi yubutaka niba isahani idahujwe

Ibibazo byo gukomera

Hatabayeho guhuza neza cortical cyangwa kwikuramo imvune zirangiye, gukoresha ibice bifunga, cyane cyane ibyuma bidafite ingese, bizarinda icyiciro cya kabiri gukira kuvunika kubera gukomera gukabije no kurandura micromisiyo nziza kumwanya wavunitse;

Niba gukurura intraoperative bikurikizwa hanyuma gufunga splint fixe bigashyirwa mubikorwa, icyuho cyo kuvunika kizarindwa, bikaviramo gutinda cyangwa kutavunika;

Niba kuvunika kworoheje kutongeye gusubirwamo kandi kotswa igitutu, umutwaro woherezwa mu isahani, bikaviramo guhangayika bishobora gutuma byoroshye kumeneka.

3. Itandukaniro rikomeye ryibinyabuzima hagati yo gufunga amasahani asanzwe

Isahani isanzwe yishingikiriza ku guterana hejuru yamagufa-isahani kugirango igabanye isahani.

4. Kugereranya ibyiza byo gufunga isahani hamwe nicyuma gisanzwe

1.Ibishobora gukururwa byo gufunga imigozi yo gufunga irarenze cyane iy'imigozi isanzwe.

2. Imigozi yo gufunga epiphyseal iringaniye, ibyo bikaba byongera cyane imbaraga zo guhangana nogusohoka ugereranije n’imigozi ibangikanye.

(B) Amahame yo gusaba

1. Amahame yo kudahagarika umutima:

Principle Ihame ryingutu: kuvunika osteoporotic diaphysis

Principle Ihame ryo kutabogama: kuvunika osteoporotic diaphysis

Principle Ihame ryo gukemura: diaphysis yagabanijwe cyangwa kuvunika metafhyseal idasanzwe

Ihame ryubumwe: kuvunika intra-articular kuvunika metafhyseal

2. Ihame ryo gushiraho:

Approach Uburyo busanzwe: percutaneous minimally invasive plate fixing (MIPO cyangwa MIPPO tekinike)

Technique Uburyo bwo kugabanya mu buryo butaziguye

● Kugira ngo icyapa kibe gikwiye gikosorwe, imyobo 3-4 igomba gusigara ifunguye hafi yimpera.

3.Amahame y'ubumwe:

Gukoresha hamwe amahame abiri ya biomehanike yo kwikuramo no guhuza ikiraro kimwe - gufunga plaque (LCP)

Uc Ivunika ryoroshye mu gice kimwe cyavunitse kandi cyavunitse mu kindi (urugero, kuvunika kwa metafizisi, diaphysis)

● Ihame ryubumwe rigomba gukoreshwa gusa kubisahani byemerera gushyira imitwe yombi ifunga imitwe kimwe ninshuro zisanzwe.

Gufunga amasahani ntabwo yishingikiriza ku guterana amagambo hagati yamagufa-isahani kandi yishingikiriza cyane cyane hagati yimigozi nisahani hamwe ninguni ihamye kugirango ibungabunge umutekano.

Kubera ubumwe bwabo buhamye, imbaraga zo gukuramo imigozi ifunze imitwe irarenze cyane iy'imigozi isanzwe, keretse iyo imigozi yose ikikije iyakuweho cyangwa ivunitse. Mubisanzwe, biragoye ko umugozi umwe ukuramo cyangwa ukavunika wenyine. Gufunga imitwe y'umutwe ntabwo itanga igitutu hagati. Kotsa igitutu birashobora kuboneka ukoresheje igikoresho cyingutu cyangwa mugutwara imigozi isanzwe muri 'kuvanga umwobo ' (ibice bya tension mbere, hanyuma ugafunga imisumari).

1.Niba imigozi isanzwe yakoreshejwe kugirango umutekano ugabanuke (urugero 1), gusunika mumigozi yo gufunga bizoroha cyane (urugero 2).

2.Niba imigozi yo gufunga yarakoreshejwe kugirango igabanye igufwa n'amagufwa (urugero, 1), ntibisabwa ko imigozi isanzwe yinjizwa mumagufwa amwe (urugero, 2) keretse niba imigozi yo gufunga irekuwe kandi ikagumaho (LHS).

3.Igice cyo kuvunika metafhyseal kimaze gushyirwaho umugozi ufite umutwe ufunze (LHS), gukosora kwikuramo hagati yimvune bigerwaho mugusunika umugozi usanzwe mumwobo wo guhagarika amashanyarazi ya Locking Compression Plate LCP.

(C) Ibyerekana no kubirwanya

1. Ibyerekana

Ibice byinshi byavuwe kubagwa ntibisaba gufunga ibyapa. Igihe cyose amahame yo kubaga amagufwa akurikijwe, kuvunika kwinshi kurashobora gukira hakoreshejwe amasahani asanzwe cyangwa imisumari idasanzwe.

Nyamara, hari ubwoko bwihariye bwimvune zishobora gutakaza igabanuka, isahani cyangwa kuvunika imigozi, hamwe no kudahuza nyuma, bakunze kwita kuvunika 'bidakemutse ' cyangwa 'ibibazo ' bitera ibibazo, harimo kuvunika kwimbere hagati yimitsi, kuvunika kwinyuma hamwe nuduce duto twa osteoporotic. Ubu bwoko bwo kuvunika bakunze kwitwa 'ikibazo kidakemutse ' cyangwa 'ikibazo ' kandi kirimo imvune zo mu nda-arctular zavunitse, imvune ngufi ya tubariyose hamwe na osteoporotic. Ivunika ni ibimenyetso byose byerekana gufunga amasahani.

Ibimenyetso bya kera kandi byiza byerekana gufunga isahani yo gukosora ni ihame ryikiraro hamwe nihame ryubumwe kubice byinshi byavunitse - kuvunika imbaraga nyinshi kubarwayi bakiri bato cyangwa kuvunika osteoporotic kubarwayi bakuze.

2. Kurwanya

Nubwo isahani yo gufunga yakoreshejwe cyane kandi ibimenyetso byayo ni binini, tugomba kumenya kandi twirinda ibintu byinshi byangiza ibyapa. Niba gufunga amasahani akoreshwa mu buryo butarobanuye, kunanirwa gukosorwa no kudahuza kuvunika bishobora kubaho.

Ivunika ryoroshye risaba kwikuramo hagati yumuntu, nkibintu byoroheje byamaboko yamaboko yavuwe hamwe no gufunga imbere, bikunda kudahuza ubumwe.

Mu buryo nk'ubwo, gushyira muburyo butandukanye bwo gufunga amasahani yo kuvunika byoroheje ukoresheje tekinike yibasiwe na none ni ukunyuranya.

Kugabanya mu buryo butaziguye no gufunga ibyapa nabyo ntibikwiriye kuvunika kwimuka hagati yimitsi-yimitsi, bisaba kugabanya anatomique ifunguye no kwikuramo hagati yibice byavunitse no gukosorwa gukomeye.

Kugereranya kubuza gufunga amasahani, bitewe nigiciro cyinshi, ni imvune zishobora gukosorwa neza hamwe namasahani asanzwe. Kurugero, kuvunika kwa simphysis yintoki bifite igipimo cyo gukira kirenga 90% mugihe bivuwe nibisahani bisanzwe.

(D) Gushiraho icyapa gifunga

1. Shyira umwitozo bito mu mwobo wa plaque. Gutandukana kwa> 5 ° hagati ya screw nu mwobo wa screw birashobora gutera kunanirwa gufunga imigozi, kandi birasabwa gukoresha bito kugirango ucukure umwobo neza.

2. Shira isahani yicyuma hejuru yamagufwa hanyuma ucukure umwobo unyuze mumaboko.

3. Gupima ubujyakuzimu hamwe nijwi ryimbitse, witondere ko umutwe wijwi winjizwa mu mwobo.

4. Hitamo uburebure bukwiye bwa feri yo gufunga.

5. Gushiraho imigozi ikanda ni kimwe nicyapa gisanzwe.

6. Kurangiza, komeza imigozi yo gufunga ukoresheje umugozi wa torque, nugukomera, hazagaragara ibyiyumvo byo kunyerera hamwe nijwi ryumvikana, kugirango wirinde kunyerera cyane, bikavamo ingorane zo gukuraho.

(E) Gufunga gukuraho isahani

Amavomero yo gufunga isahani arakoreshwa cyane, ariko byoroshye guhura ningorane zo kuyikuramo, cyane cyane bigaragarira mu nsinga zinyerera insinga hamwe na capa yimisumari hamwe nududodo twa plaque yimisumari hagati yimyenda itari yo.

1. Kuramo ingofero yangiritse

Mugihe gisanzwe, screw cap cap groove hamwe na screwdriver ijyanye. Amashanyarazi agomba guhuzwa na capa ya screw mbere yo gushiramo cyangwa kuyikuramo, bitabaye ibyo umugozi wa shitingi ushobora guhinduka mugihe cyo kwinjira cyangwa gusohoka, bikavamo kunyerera.

Byongeye kandi, nyuma yo gukira kuvunika, icyuma gifata imigozi isanzwe kizengurutswe nigitereko cyamagufwa cyangwa fibrous fibrous, bigomba gusukurwa mbere yo kuvanaho umugozi, ariko niba bititabweho, icyuma cya shitingi hamwe nimiterere yinguni bishobora kwangirika muburyo bwubukorikori.

Kuberako kuzenguruka umurongo wikiganza cyumukoresha udahuye nu murongo muremure wa screwdriver, akenshi usanga hari inguni runaka, mugihe uwabikoresheje yakuyemo umugozi ku gahato, byanze bikunze ko icyuma gishobora kwangirika, bikaviramo kwangirika kumutwe wa shitingi kubera imbaraga zingana. Kubwibyo, kwangirika kwicyuma gishobora kuganisha byoroshye kunyerera.

2. Guhindura imisumari cyangwa guhindura imisumari

Muburyo bwo gukorana muburyo budasanzwe bwo gufunga ibyuma bya anatomiki bifunga ibyuma, rimwe na rimwe ukurikije ibikenewe byo kunama cyangwa gushushanya icyapa, Raja nibindi. bizere ko niba igice cyo kugunama kibaye mu mwobo wo gufunga, mugihe gusunika mumigozi yo gufunga bizaba ari capage ya screw hamwe nu mwobo w’imisumari bidahuye, bikaba bishoboka cyane ko bibaho hagati yumutwe wumusumari hamwe nicyuma cya plaque yimisumari yomudodo idahwitse nabi, cyangwa ukegereye hafi yicyuma mugihe umurizo wo guhindura imisumari utewe no gukururwa gukomeye, nibindi, bishobora kuvamo ikibazo cyo gukuramo nyuma.

3. Gushyira mu bikorwa kwikuramo cortical gufunga imisumari

Kuberako igufwa rya cortical rikura imbere imbere yumwobo wumusumari bityo rikazifata umugozi, biganisha kukibazo cyo kuvanaho imigozi, cyane cyane mugukoresha kwikubita inshyi ebyiri cortical bone screw, Suzuki nibindi. ntugire inama yo gukoresha imashini yikuramo kugirango ikosorwe kabiri. Hou Yunfei n'abandi. yatanze igitekerezo ko gukosora bicortical bitari ngombwa hamwe na screw bigomba kwirindwa kuvunika hejuru, na Maehara nibindi. Yasabye kandi ko gukoresha kenshi imiyoboro yo gufunga bigomba kwirindwa mugihe ukoresheje ibyapa bifunga, kandi ko hakenewe gushyirwaho urwego rusange rwo guhitamo no gushyira mu bikorwa imigozi ifunga.

4. Imiterere n'aho biherereye

Ingano, icyerekezo, hamwe n’ahantu ho gufunga bishobora kugira ingaruka ku ikurwaho rya screw. Bamwe mu bahanga basanze niba umugozi utari hagati mu mwobo ufunze, iyo umwobo w’imisumari urenze hejuru ya 5 ° hashobora kubaho gukosorwa imigozi irekuye, urudodo rutameze neza cyangwa guhinduranya umurizo w’imisumari kandi biganisha ku kunanirwa gukosorwa cyangwa icyiciro cya kabiri cyo gukuraho ingorane.

5.Gusudira gukonje

Ubusanzwe titanium yimbere ikosora ifite urwego rwokwirinda passiwasi, murwego rwo kubaga hashyizweho uburyo bwo kubaga imbere, bitewe nibikoresho byo gufata no gushushanya, cyangwa umutwe wumugozi hamwe no guterana hagati yicyuma, nibindi, bishobora kuganisha kumyanya yo gukingira. Ubuso 2 bwo guhuza ibyuma hagati yingirakamaro zifatika bizubahirizwa, ni ukuvuga gushiraho gusudira gukonje.

Byongeye kandi, guhuza galvanic hagati yioni yicyuma, reaction yumuriro, nibindi birashobora kandi guteza imbere gushinga imbeho ikonje. Abenshi mu bakora ibikoresho byo gutunganya imbere nabo bazi iki kibazo, bityo rero ibyuma bidakoreshwa bifunga ibyuma bifata tekinoroji ya firime ya okiside hagati yimyobo yimisumari hamwe n’imigozi ihuza imiyoboro, nayo igamije kubuza ionisiyoneri no kwinjiza poroteyine mu mubiri no kugabanya ibibaho byo gusudira bikonje.

(F) Uburyo bwo gukuraho

Tekinike yo gukuraho ivugwa mubuvanganzo bwigihugu ndetse n’amahanga irashobora kugabanywamo ibyiciro 2, aribyo, byoroshye kandi bifatika kandi bigoye, ibyambere byaranzwe no kugerwaho byoroshye, bifatika, kwangirika kwinyama zoroheje, ubuhanga buke kandi ntibikeneye ibikoresho byihariye, nibindi bikenera ibikoresho byihariye nibikoresho byihariye.

Maehara n'abandi. tekereza gukoresha amashanyarazi agabanya amashanyarazi hamwe na shanki nini igihe cyose bishoboka. Iyo uhuye n'imigozi inyerera, Pattison n'abandi. yatangaje uburyo bworoshye bwo kuvanaho imigozi inyerera mu gupfunyika umutwe wa screwdriver hamwe nicyuma cya platine hanyuma ukayinjiza mu gikoni cyumutwe. Ubu buryo ni bwenge kugirango wuzuze icyuma cya shitingi hamwe na fayili yicyuma kandi wongere aho uhurira no guterana hagati ya screwdriver na groove, byorohereza kuvanaho imigozi hamwe nududodo twanyerera. Muri ubu buryo biracyakomeye gukuraho urubanza, niba umugozi wumugozi wicyuma hamwe nicyuma cya plaque icyuma cyumusumari ukomeje kuba ntamakemwa, urashobora kugerageza gukoresha imiyoboro ihanamye yo gukuramo imashini, ni ukuvuga kuva kumutwe wa shitingi winjizwamo winjizamo gukanda hanyuma ukuzuza igikoni, mugihe cyo kuzunguruka no gukanda igitutu hanze.

Kubibi, imigozi imwe yo gufunga iracyagoye gukora neza ukoresheje imashini ikuramo ibyuma bisubiza inyuma, nka Ehlinger nibindi. na Bae n'abandi. ninde wasanze ubu buryo bwakunze kugira akamaro kuri 3,5 mm kunyerera, ariko akenshi ntibigire ingaruka kuri 4,5 mm kunyerera. Muri iki gihe, ntabwo buri cyiciro cy’amagufwa y’ibitaro gifite ibikoresho byihariye byo gusya ibyuma nka myitozo ya karbide, imyitozo ya diyama, cyangwa ibiziga byihuta cyane.

Gopinathan n'abandi. menyekanisha uburyo budasaba ibyo bikoresho kabuhariwe utanga raporo yikibazo cyo kuvanaho imigozi igoye ku isahani yo kwiyubaka ya clavicular, ni ukuvuga, ukoresheje agace gato k’isahani yo kwiyubaka, icyuma kinini cyifashishwa mu kogosha igice kigufi cy’isahani hagati y’imyobo y’imisumari, kugira ngo imigozi hamwe n’igice cy’imisumari cy’isahani bigizwe igice gito, kandi imigozi ishobora gukurwaho byoroshye. Ubu buhanga bukoreshwa gusa kuri plaque yo kwubaka ya titanium, ibyuma bifunga amaboko hamwe nuduce duto duto, hamwe na 1/3 cyubwoko bwa tube, kandi ntibishobora gukoreshwa kubisahani binini cyangwa binini cyane mugice cyo hepfo.

Uburyo bworoshye nabwo bwasobanuwe aho bito bito bito bito bikoreshwa mu gucukura umwobo mu mwobo usanzwe iruhande rw'umugozi ufunze, hanyuma isahani hamwe na screw bigashyirwa mu cyerekezo cy'umwobo mushya umaze gucukurwa, hanyuma isahani hamwe na screw bigakurwaho ukoresheje igufwa ry'amagufa ryashyizwe munsi y'isahani hanyuma ukarigata hamwe n'ihame ry'imyitozo iyo rifunguye.

Birumvikana ko hari amahirwe yo kwangirika kwamagufwa hamwe nubu buryo, birasabwa rero kurinda ibiro nyuma yo kubyara. Byongeye kandi, birakenewe kandi gutegura ibikoresho bimwe na bimwe bikoreshwa muburyo bwumwuga mbere yo kubagwa gukuramo imbere imbere, nko gukuramo bolt, umwobo reamer, gukuramo ibyuma, imashini yo mu bwoko bwa T ikanda cyane.

Imbere yo gufunga ingorane zo gukuraho insinga zinyerera, intiti zimwe zo murugo zasabye guhindura uburyo bwa groove, ni ukuvuga, gukoresha imashini yangiza amenyo ya mashini yo gusya ibyuma byumucanga wumucanga kugirango uhindure umugozi wa shitingi ya shitingi ya mpande esheshatu cyangwa impande enye zingana kuri 'umwe ' cyangwa 'icumi ', cyangwa wimbike umwimerere wambere.

Ehlinger n'abandi. yatangaje ko mu gihe aho imashini ikuramo imashini isubira inyuma ikomeza kugira ikibazo cyo gukuraho iyo miyoboro, hasabwe ko icyuma gishobora gukurwaho no gusenya umutwe w’umugozi ukoresheje tungsten drill gusya no kwagura umwobo w’imisumari mu isahani y’icyuma, hanyuma umubiri w’umugozi ushobora kuvanwaho ukoresheje impeta y’impeta.

Georgiadis n'abandi. na Raia n'abandi. byasabwe mumashanyarazi hamwe nicyuma cyo guhuza ibyuma birakomeye kandi biragoye kuvanaho, ibikoresho bidasanzwe (nka pneumatike yihuta yo gukata byihuta, imyitozo ya karbide, ibiziga bya diyama, nibindi) kumyobo yimisumari ikikije uburyo bwo guca icyuma, mumasahani yicyuma yaciwe kugirango yorohereze umugozi, umugozi nawo biroroshye kuvanaho.

Kumar na Dunlopl batangaje mu buryo bwa kure bwo gufunga ibyuma bya sisitemu ya sisitemu yo gukuraho imbere imbere, mu gukoresha imashini isanzwe yo kwifata ya torque screwdriver, imashini ikuramo imashini yananiwe, ariko inashyiraho uburyo bushya, ni ukuvuga ko gukoresha ibiziga byihuta byihuta byangiza ibipande byicyuma kugira ngo winjize icyuma cya radiyo, hanyuma ntuzinjize icyuma cya radiyo. kuruhura umupira, kugirango ukureho neza imigozi yo gufunga.

Ni ngombwa kumenya ko uburyo bwavuzwe haruguru bugomba gutera imbere gahoro gahoro gashoboka mugihe cyo gutema cyangwa gusya isahani ukoresheje disiki yihuta yo gukata kugirango wirinde guca mumutwe wumugozi no kwangiza amagufwa nuduce tworoshye. Byongeye kandi, ubwo buhanga bushobora kubyara ubushyuhe bwinshi n’imyanda y’ibyuma, ibyo bikaba byaviramo ibyago byinshi byo kongera kuvurwa n’ubuvuzi, kuvunika umubiri, no kwandura indwara.

(G) Incamake

. Emerera isahani ituzuye guhura na periosteum

Isahani igomba guhindurwa mbere yo gufunga, kuko kuvunika bidashobora gusubirwamo nyuma yo gufunga.

■ Gufunga isahani ntishobora gukandamizwa, ukeneye gukoresha pressurizer cyangwa centrifugal screw mu mwobo wubumwe mumashanyarazi asanzwe, ubanza gukanda, hanyuma ugafunga

Site Ikibanza cyacitse 3 ~ 4 imiyoboro idafite imigozi yo gukwirakwiza imihangayiko; Site Ikibanza cyacitse 3 ~ 4 imiyoboro idafite imigozi yo gukwirakwiza imihangayiko; na

Fix monocortical fixation ya diaphysis cyangwa cortex yijimye, kandi aho ubwiza bwamagufwa ari bwiza; na

■ Iyo imaze gufungwa, ntishobora gusubira inyuma, mugihe imigozi isanzwe irashobora gusubira inyuma

Fix Gukosora gukomeye hamwe ninshuro nyinshi zirashobora kuganisha ku kudahuza; ihame nuko amasahani agomba kuba maremare kandi hagomba gukoreshwa imiyoboro mike; mukuvura kuvunika kwa periarticular, hagomba gukoreshwa imiyoboro mike kuruti kandi hagomba gukoreshwa imiyoboro myinshi kugirango ikosorwe hejuru yubuso.

■ uburebure bwa plaque yikiraro bugomba kuba bwikubye kabiri uburebure bwavunitse, imigozi igomba kugabanwa neza, kandi gukosora neza bigomba kuba binyuze muri aperture

■ Imbaraga zigabanywa neza ku isahani ndende, kandi gukosorwa hamwe n’imigozi mike birashobora gutuma habaho ibisebe kandi bigatera gukira amagufwa.