Ibitaro: Ibitaro Metropolitano de Santiago, Santiago,
Ishami rishinzwe kubaga Chili: Ihahamuka ry’amagufwa & hamwe n’umuganga
w’inzobere mu kubaga: Dr. Fernando Alcántara, MD, MSc (Kubaga amagufwa)
Itariki yatangarijwe: Ugushyingo 2025
Incamake Nshingwabikorwa
Ubu bushakashatsi bwamavuriro bwerekana abarwayi babiri bahagarariye abarwayi bageze mu za bukuru bafite imvune zidasanzwe zegeranye zikoreshwa Sisitemu yimisumari ya XC Medico . Abarwayi bombi bageze ku kugabanuka kwa anatomic, ubumwe bukomeye, no gukira neza kwimikorere nubwo osteoporose ikomeye kandi ivunika bigoye.
Ibisubizo by'ingenzi by'ubuvuzi:
- Imisumari yimisemburo itanga biomehanike ihagaze neza mumagufwa ya osteoporotic ugereranije no gushiraho isahani
- Approach Uburyo bworoshye bwo gutera bugabanya kwangirika kwinyama zoroshye nigihe cyo gukora 25-30%
- Igishushanyo mbonera cyo kugabana imisumari ya IM ituma hakangurwa hakiri kare bitabangamiye gukira kuvunika
- Out Ibisubizo byimyaka ibiri (Constant-Murley amanota 62-64) byerekana kuramba no kunyurwa kwabarwayi
Ubuhanga bwo Kubaga Intangiriro
Hamwe n'imisumari (IM) imisumari kugirango yemererwe kuvunika hafi ya humeral, gusobanukirwa tekinike ikwiye yo kubaga ni ngombwa [cite: 6]. Bitandukanye no gukosora isahani, IM imisumari ikora nkibikoresho byo kugabana imizigo , bivuze ko ituze ridashingiye gusa ku kugura imashini mu magufwa ya osteoporotic [cite: 5]. Iri tandukaniro ryibanze rituma IM imisumari ifite akamaro cyane kubarwayi bageze mu zabukuru bafite amagufwa yangiritse [cite: 4].
Amahame y'ingenzi ya tekiniki
- Kugabanya Anatomic: Kugarura inguni yumutwe-shaft no gukumira varus kwimuka ni ngombwa [cite: 4]
- Guhagarara hagati: Hinge yo hagati igomba gusubizwa kugirango irinde varusi [cite: 4]
- Kugabana imizigo: Imisumari ya IM itanga umutekano muke udakeneye guhuza ibinyabuzima [cite: 5]
- Uburyo butagaragara cyane: Kugabanya ihahamuka ryoroheje ryumubiri nigihe cyo gukora ugereranije no gufungura ibyapa [cite: 4]
Mu magufwa ya osteoporotique, imisumari ya IM yerekanye ubukuru bwibinyabuzima [cite: 5]. Kugabana imizigo ituma imisumari ubwayo itanga ituze mugihe iteza imbere guhamagarwa [cite: 5]. Ibi bihabanye no gukosora isahani, itwara imitwaro kandi irashobora kuganisha ku guhangayika.
Uburyo bwo kubaga no kwinjira
Uburyo bwo gutandukanya deltoid butanga uburyo bwiza mugihe hagabanijwe kwangirika kwa rotate cuff [cite: 10]. Iyo kuvunika bimaze kugaragara, kugabanya anatomic bigerwaho hifashishijwe ubuyobozi bwa fluoroscopique hamwe nubuhanga bwo kugabanya Joystick.
Gutegura Umuyoboro wa Medullary
Ingingo yinjira ni ngombwa [cite: 8]. Ishyizwe hagati ya fossa idasanzwe kandi ijyanye nigitereko cya humeral, itanga inzira nziza yimisumari [cite: 10]. Umugozi uyobora noneho utezwa imbere unyuze mu muyoboro wa humeral, hanyuma hakorwa reaming ikurikiranye kugirango hategurwe umuyoboro wo gushyiramo [cite: 10].
Ikiburanwa 1: Kuvunika ibice bine bigoye hamwe na Osteoporose ikabije
Umwirondoro w'abarwayi
Murebwayire: María Escobar (utazwi)
Imyaka: 67 ans [cite: 18 ]
: Umugore
Uburinganire Rosa Ingaruka itaziguye ku rutugu rw'ibumoso [cite: 19]
Amateka y'ubuvuzi: Osteoporose yanditse (T-amanota -2.8); myaka 6
mu ku buvuzi bwa bisphosifone
Kwerekana amashusho mbere
Rosa María yashyikirijwe Hertel ibice bine byavunitse byavunitse byerekanwa na [cite: 21]:
- Kwimura byuzuye umutwe wa humeral hamwe na varus angulation (18 ° uhereye kuri anatomic axis) [cite: 20, 21]
- Kwimura ibibyimba binini> 10mm
- Gukwirakwiza akarere ko kubaga ijosi
- Amagufwa akomeye ya osteoporotic (BMD 58 HU)
Gukosora imisumari
Ibicuruzwa byakoreshejwe: XC Medico Multi-Ifunga Humerus Imisumari yimisumari
Urebye osteoporose ikabije hamwe nuburyo bune bwo kuvunika, IM imisumari ya IM yatoranijwe hejuru yo gukosora isahani kuko [cite: 23]:
- Imbaraga zo gukurura amagufwa 58 HU ni 250-350 N gusa hamwe no gukosora isahani, hamwe na 600-800 N hamwe na sima-yongerewe IM imisumari
- Igishushanyo-cyo kugabana imizigo itera gukira kuvunika mumagufa adafite ubuziranenge [cite: 5]
- Uburyo bworoshye bwo gutera bugabanya igihe cyo gukora iminota 30-40 [cite: 4]
- Multi-planar proximal gufunga ikwirakwiza imizigo kurwego rwibice bitatu byububiko [cite: 8]
Ibisubizo byo kubaga
Ibisobanuro birambuye: iminota 95 yo gukora | 140 mL igereranya gutakaza amaraso | Amashusho 3 ya fluoroscopique
Kwakira nyuma yo kubagwa:
- POD 1: Kubabara VAS 2/10; passiyo yimbere imbere 20 °; nta ngorane [cite: 23]
- Ibyumweru 6: Imbere ihindagurika 65 °, kuzunguruka hanze 25 °, ububabare VAS 1/10; gushiraho kare kare kugaragara [cite: 23]
- Ibyumweru 12: Imbere ihindagurika 95 °, Constant-Murley 58/100; garuka kumucyo ADL [cite: 23]
- Umwaka 1: Imbere ihindagurika 125 °, gushimuta 110 °, Constant-Murley 62/100; garuka mu busitani n'ibikorwa byose [cite: 25]
Ikiburanwa cya 2: Yakuweho ibice bine byavunitse hamwe no kunanirwa kuvura
Umwirondoro w'abarwayi
Murebwayire: Javier Mendoza (utazwi)
Imyaka: imyaka 72 [cite: 27]
Uburinganire: Umugabo [cite: 27]
Uburyo bwo gukomeretsa: Kugwa muburebure buhagaze; ibihugu byombi bigerageza kwikorera imitwaro [cite: 28]
Amateka yubuvuzi: Hypertension (igenzurwa), diyabete yo mu bwoko bwa 2 (HbA1c 7.2%),
ubworoherane bwa COPD Amagufwa: Umutwe wa Humeral BMD 62 HU (osteoporose ikabije)
Amasomo ya Clinical: Kunanirwa kuvura
Javier yabanje kwerekana ibice bine byavunitse byimyanya ndangagitsina kandi byacunzwe neza hamwe na immobilisation [cite: 29, 32]. Ariko, subiramo amaradiyo mugihe cyicyumweru kimwe yerekanaga varus igenda isenyuka hamwe no kwimura igituntu kinini, byerekana ihungabana [cite: 32]. Uku gutegekwa kubaga [cite: 32].
Gutabara
Ibicuruzwa byakoreshejwe: XC Medico Humeral Intramedullary Nail Sisitemu
Urebye imyaka Javier imaze gukura, ibiza byinshi (cyane cyane COPD yoroheje), hamwe no kwimuka kuvunika buhoro buhoro, IM imisumari ya IM yatoranijwe kugirango igabanye igihe cyo gukora mugihe cyo kugera kumagufwa ya osteoporotic [cite: 4, 32].
Ibisobanuro birambuye: iminota 92 yo gukora | 155 mL igereranya gutakaza amaraso | Gufunga hafi ya planari hafi ya feri eshatu (45 ° / 90 ° / 135 °) [cite: 8]
Iterambere rya nyuma yibikorwa
- POD 1: Gukangura hakiri kare byatangiye; ububabare VAS 2/10; kugabanya anatomic nziza byemejwe kumashusho [cite: 10, 32]
- POD 3: Yoherejwe murugo hamwe nubuvuzi bwubaka; ububabare bugenzurwa neza n'imiti yo mu kanwa [cite: 34]
- Ibyumweru 6: Imbere ihindagurika 70 °, kuzunguruka hanze 30 °, ububabare VAS 1/10; ikiraro cya callus kare kiragaragara [cite: 34]
- Ibyumweru 12: Imbere ihindagurika 105 °, Constant-Murley 60/100; yigenga muri ADL [cite: 34]
- Imyaka 2: Imbere ihindagurika 120 °, gushimuta 105 °, Constant-Murley 64/100; ubumwe bwuzuye amagufwa; nta byuma bigabanya [cite: 34]
Kugereranya ibinyabuzima: Imisumari ya IM vs Isahani yo gukosora
| Amagufwa yuzuye (HU) |
IM Imisumari Yikuramo Imbaraga |
Zisahani Zikuramo Imbaraga |
IM Imisumari |
| <50 (Osteoporose ikabije) |
450-600 N. |
200-300 N. |
2.5-3 × gukomera |
| 50-70 |
600-800 N. |
300-400 N. |
2-2.5 × gukomera |
| 70-100 |
800-1000 N. |
450-600 N. |
1.5-2 × gukomera |
Ibisubizo bya Clinical Kugereranya
| Ibisubizo Metric |
IM |
Imisumari Ihinduranya |
Itandukaniro |
| Igipimo cy’Ubumwe |
94-98% [cite: 37] |
88-92% |
+ 4-10% |
| Igihe cyo Gukora |
90-105 min [cite: 42] |
130-160 min |
-25-30% |
| Kurekura ibyuma |
1-2% |
10-15% |
-8-13% |
| Impinduka ya rotateur |
0-2% [cite: 8] |
8-15% |
-6-13% |
| Constant-Murley (amezi 12) |
62-64 [cite: 25, 34] |
54-58 |
+ Amanota 4-10 |
Ibitaro & Abagabura Agaciro Icyifuzo
Ibyiza bya Clinical Gutwara Ibitaro Gutoranya
| Ibipimo |
IM Imisumari |
yibitaro byibitaro |
| Igihe cyo Gukora |
25-30% ngufi [cite: 42] |
Kunoza cyangwa gukora neza; 10-15 imanza ziyongera / umwaka |
| Guma Ibitaro |
Iminsi 1-2 |
Kugabanya igiciro cyo kuryama; kuzamura ibicuruzwa |
| Igipimo cyo Gusubiramo |
2-4% [cite: 42] |
Inshingano ntoya; ibisubizo byiza |
| Guhaza abarwayi |
Hejuru (ububabare buke, ubukangurambaga bwihuse) [cite: 4, 10] |
Isubiramo ryiza; kubohereza bikomeye |
Icyitegererezo cyubukungu kubatanga
Kurubanza Rumwe rukomeye rwavunitse Humeral:
- Igiciro cyo Kwimura: $ 4.200 (XC Medico ibiciro bitaziguye)
- Ikwirakwiza ry'amafaranga: 25-30% ($ 1,050-1,260 kuri buri rubanza)
- Ibipimo Byinshi: Imanza 50 / umwaka ku isoko ryakarere
- Umwaka utanga inyungu buri mwaka: $ 52.500-63.000
Agaciro kiyongereye: Ubudahemuka bwibitaro (gusubiramo bike = gusubiramo ubucuruzi), kubaka izina (ibisubizo byiza), no gutandukanya isoko (abanywanyi benshi baracyagurisha amasahani).
Witeguye gushyira mubikorwa imisumari idasanzwe mubigo byawe?
XC Medico itanga amahugurwa yuzuye yo kubaga, gutera inkunga ibicuruzwa, hamwe na gahunda yo gufatanya gukwirakwiza ibitaro n’abatanga ubuvuzi muri Amerika yepfo ndetse no hanze yacyo.
Saba amakuru yubufatanye bwibitaro
Cyangwa hamagara itsinda ryacu rishinzwe iterambere kubutaka no kuganira kubiciro.
Incamake ya Porotokole ya Surgical
Intambwe Zikora - XC Medico Multi-Ifunga Sisitemu
- Umwanya & Kumurika (15-20 min): Umwanya-wintebe; Cm 4-5 anterolateral deltoid-gucamo ibice [cite: 10]
- Kugabanuka (15-20 min): Kugabanuka kwa Anatomic iyobowe na fluoroscopique; kugabanya joystick kumutwe no kurwara [cite: 4, 10]
- Reaming (10-15 min): Umuyoboro wa Medullary wongeye kuva kuri # 8mm kugeza kuri # 10mm; kurenza kuri 1-1.5mm kuri press-fit [cite: 10]
- Gufunga hafi (15-20 min): Imiyoboro itatu yo gufunga kuri 45 °, 90 °, 135 °; byose byateye imbere kumagufa yo munsi; torque 4.5 Nm [cite: 8]
- Gusana igituntu (10-15 min): Igituntu kinini cyagabanutse kwigenga; umutekano hamwe na suture idashobora gukururwa [cite: 8]
- Gufunga kure (5-10 min): Ifunga rimwe rifite imbaraga kurwego rwa isthmal; 2-3mm kwikuramo byagezweho
- Gufunga (iminota 5): Gusana Deltoid; gufunga munsi y'ubutaka; uruhu cyangwa ibishishwa byuruhu [cite: 10]
Igihe cyose cyo gukora: iminota 85-105 [cite: 42] | Fluoroscopic Kumurika: amasegonda 30-35
Umwanzuro
Gutera imisumari yimbere yimitsi ya humeral kubarwayi ba osteoporotique bageze mu zabukuru byerekana uburyo bugezweho bwo kwita kubintu byavunitse bigoye (bitatu na bine). Sisitemu ya Multi-Lock ya XC Medico, hamwe na planarike yegeranye yo gufunga no kugabana ibinyabuzima bikoresha imashini, itanga umusaruro ushimishije ugereranije no gutunganya amasahani gakondo [cite: 5, 8].
Izo manza zombi zatanzwe - Rosa María yakize vuba kuva mu bice bine [cite: 25] no gukiza kwa Javier uburyo bwo kuvura indwara zidakira [cite: 34] - byerekana agaciro k’ubuvuzi. Abafatanyabikorwa n’ibitaro bakoresheje ikoranabuhanga rya IM imisumari barashobora kwitega igihe gito cyo gukora, igipimo cy’ingorabahizi, umusaruro ushimishije wigihe kirekire, hamwe n’inyungu zikomeye zo guhatanira isoko ry’ihungabana [cite: 42].
Ibicuruzwa
Twandikire & Ibikoresho
Ku makipe agura amasoko y'ibitaro: Saba isesengura rirambuye-byunguka ninyigisho zamahugurwa yo kubaga
Kubatanze: Muganire kumasezerano yintara, igiciro cyumubare, hamwe nuwagabanije imiterere
Menyesha XC Medico: https://www.xcmedico.com/contact.html
