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 bidafunze kandi bidafunze kugirango imigozi itandukanye ihindurwe (nanone bita isahani ihuriweho). Kuva igitekerezo cyo gufunga amasahani cyatanzwe kandi kigashyirwa mubikorwa byo kuvura kuvunika, cyakoreshejwe cyane mugukosora imvune za periarticular, kuvunika kwa 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 gukwega gukwega gukoreshwa hanyuma ugashyiraho gukosora splint gukosorwa, icyuho cyo kuvunika kizarindwa, bikaviramo gutinda cyangwa kutavunika kuvunika;

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 ifatanye iringaniye, ibyo bikaba byongera cyane imbaraga zo kunanirwa gukuramo 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 metafhysis, 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 ifite imitwe ifunze 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. Umuvuduko urashobora kuboneka ukoresheje igikoresho cyotsa igitutu 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 ihindurwamo igufwa rimwe (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 guhonyora 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, bikunze kwitwa kuvunika 'bidakemutse ' cyangwa 'ikibazo ', harimo kuvunika kwimbere mu nda, kuvunika kwa periarticular hamwe nuduce duto twa osteoporotic. Ubu bwoko bwavunitse bakunze kwitwa 'ikibazo kidakemutse ' cyangwa 'ikibazo ' kandi harimo kuvunika imbere mu nda-articular kuvunika, kuvunika igituntu kigufi hamwe no kuvunika osteoporotic. Ivunika ni ibimenyetso byose byerekana gufunga amasahani.

Ibimenyetso bya kera kandi byiza byerekana gufunga isahani yo kuvunika ni ihame ryikiraro hamwe nihame ryubumwe kumvune zavunitse - 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 kwikinisha hagati yumuntu, nkibice byoroheje byikiganza byimbere bivurwa no gufunga imbere, bikunda kudahuza.

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 gutuma 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, bikaviramo ingorane zo gukuraho.

(E) Gufunga gukuraho isahani

Amavuriro yo gufunga amasahani arakoreshwa cyane, ariko byoroshye guhura ningorane zo kuyakuraho, cyane cyane bigaragarira mu nsinga zinyerera insinga hamwe na capa yimisumari hamwe nududodo twa plaque yimisumari hagati yimyenda idakwiye.

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 guhanagurwa mbere yo kuvanaho umugozi, ariko niba bititabweho, icyuma cya shitingi hamwe nimiterere yinguni bishobora kwangirika muburyo bwubukorikori.

Kuberako kuzenguruka umurongo wikiganza cyumukoresha udahuye nigitambambuga kirekire cya screwdriver, akenshi habaho inguni runaka, mugihe uwabikoresheje yasunitse 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 capa hamwe nu mwobo w’imisumari bidahuye, bikaba bishoboka cyane ko bibaho hagati yumutwe wumusumari hamwe nicyuma cya plaque yimisumari yomudodo idahwitse, cyangwa iyegereye hafi yicyuma mugihe umurizo wimiterere yimisumari iterwa no gukururwa gukomeye, nibindi, bishobora kuganisha ku gukuramo nyuma.

3. Gushyira mu bikorwa kwikuramo cortical gufunga imisumari

Kuberako igufwa rya cortical rikura imbere kuruhande rwumusumari bityo rikazifata umugozi, biganisha ku ngorane zo kuvanaho imigozi, cyane cyane gukoresha uburyo bwo kwikubita inshuro ebyiri zifata amagufwa, 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 imashini zifunga 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, imigozi idahwitse cyangwa guhindagura 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 uburyo bwo kubaga ibyimbere, bitewe nibikoresho byo gufata no gushushanya, cyangwa umutwe wa screw hamwe no guterana amagambo 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 yicyuma cya ion, reaction reaction, nibindi birashobora 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 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, hanyuma 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 kuvanaho urubanza, niba umugozi wumugozi wicyuma hamwe nicyuma cya plaque yimisumari yimisumari ikiri ntamakemwa, urashobora kugerageza gukoresha imiyoboro ihanitse yo gukuramo imashini ikuramo, ni ukuvuga, uhereye kumutwe wa shitingi winjizwamo winjiza mukanda hanyuma ukuzuza igikoni, mugihe cyo kuzenguruka 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 byabugenewe byo gusya ibyuma nka myitozo ya karbide, imyitozo ya diyama, cyangwa ibiziga byihuta cyane.

Gopinathan n'abandi. menyekanisha uburyo budasaba ibyo bikoresho kabuhariwe mugutangaza ikibazo cyo kuvanaho imigozi igoye kuva ku isahani yubatswe 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 n’igice cy’imisumari cy’isahani bigizwe igice gito, kandi imigozi irashobora gukurwaho byoroshye. Ubu buhanga bukoreshwa gusa kuri plaque yo gufunga titanium, gufunga amaboko hamwe nuduce duto duto, hamwe na 1/3 cyubwoko bwa tube, kandi ntishobora gukoreshwa mubyapa binini cyangwa binini cyane mugice cyo hepfo.

Uburyo bworoshye nabwo bwasobanuwe aho bito bito bito bito byifashishwa 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 igikata cy'amagufwa gishyirwa munsi y'isahani hanyuma ukagisohora hamwe n'ihame ry'imyitozo iyo irekuwe.

Birumvikana ko hari amahirwe yo kwangirika kwamagufwa hamwe nubu buryo, birasabwa rero kurinda ibiro nyuma yo kubyara. Mubyongeyeho, birakenewe kandi gutegura ibikoresho bimwe na bimwe bikoreshwa muburyo bwumwuga mbere yo kubagwa gukuramo imbere, nko gukuramo bolt, reamer, gukuramo ibyuma, T-ubwoko bwa T-pressed sock nibindi.

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 wimbure umwimerere wambere.

Ehlinger n'abandi. yamenyesheje ko mu gihe aho imashini ikuramo imashini isubira inyuma ikomeza kugira ikibazo cyo kuvanaho uwo mugozi, hasabwe ko icyuma gishobora gukurwaho mu 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 imyitozo, imyitozo ya karbide, ibiziga bya diyama, nibindi) kumyobo yimisumari ikikije uburyo bwo guca icyuma, mumasahani yicyuma yaciwe kugirango arekure umugozi, umugozi nawo biroroshye kuvanaho.

Kumar na Dunlopl batangaje mu buryo bwa kure bwo gufunga ibyuma bya femur sisitemu yo gukuraho imbere imbere, mugukoresha uburyo busanzwe bwo kwifata bwa torque screwdriver, gukuramo imashini ya conical birananirana, ariko kandi hashyizweho uburyo bushya, ni ukuvuga ko gukoresha ibiziga byihuta byihuta cyane byangiza uruzitiro rw'icyuma kugira ngo winjize 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 gufunga

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 inshuro ebyiri z'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.