Tibial Intramedullary Imisumari yo Gukosora

Imisumari yimisumari ikomeza kuba uburyo bwo guhitamo kuvunika kwa tibial stimable kandi yimuwe kubantu bakuru. Intego yo kuvura kubaga ni ukugarura uburebure, guhuza no kuzunguruka kwa tibia no kugera ku gukira kuvunika. Ibyiza byo gutera imisumari ni ihahamuka rito ryo kubaga no kubika neza amaraso kumeneka. Byongeye kandi, imisumari yimbere ya tibia itanga uburyo bukwiye bwo kuvunika ibinyabuzima kandi ikora nkigikoresho cyo kugabana imizigo itangira gukanguka hakiri kare. Iterambere muburyo bwo gushushanya imisumari no kugabanya tekinike byaguye byerekana ibimenyetso byo gukosora imisumari kugirango ushiremo tibia yegeranye ndetse no kuvunika hagati ya gatatu.

Kugeza magingo aya, kugabanya gufunga imisumari ikosorwa yo kuvunika tibial byabaye inzira isanzwe kubaga amagufwa ya orthopedic. Nubwo abantu benshi bazwiho imisumari yimisemburo yimitsi yimitsi ya tibial yimuwe, iracyari ingorabahizi kandi ifite ibibazo byinshi bishobora kuba. Ubuhanga bwo kubaga bukomeje kwiyongera. Intego yiki kiganiro ni ugusobanura imyumvire iriho mugukosora imisumari yimbere yo kuvunika imitsi ya tibial no kuvuga muri make iterambere ryagezweho murwego.

一. Isuzuma ryambere nubugenzuzi

Ku barwayi bakiri bato, kuvunika kw'ibiti bikunze guterwa no gukomeretsa imbaraga nyinshi, kandi abarwayi bagomba gusuzumwa n’ihungabana bifitanye isano n’amabwiriza agenga ubuzima bw’ihungabana (ATLS). Suzuma ibikomere byuruhu hamwe nibikomere byoroheje nkibisebe byavunitse, gukuramo uruhu, gutwikwa, ecchymose, cyangwa kuzamura uruhu; gusobanura niba kuvunika gufunguye, kandi niba aribyo bivura hamwe na tetanusi na antibiotike; hanyuma ukore isuzuma ryuzuye rya neurovasculaire kandi wandike hejuru. Suzuma ikibazo cya syndrome ya osteofascial kandi ukore ibizamini byo kwa muganga muri aba barwayi.

Ubushakashatsi buherutse gukorwa bwerekanye ko indwara ya syndrome ya osteofascial sisitemu nyuma yo kuvunika igituntu gishobora kuba hejuru ya 11.5%. By'umwihariko, amatsinda mato y'abarwayi arashobora kurwara syndrome ya osteofascial. Isuzuma rya syndrome ya osteofascial rigomba gushingira kubyavuye mu mavuriro, harimo ububabare bukabije, impinduka zifata imitsi, kubyimba kwa myofascial, no kongera ububabare buturuka ku kwagura amano. Kubera iyo mpamvu, syndrome ya osteofascial isigaye isuzumwa rya clinique kandi ibyangombwa byuzuye byo kwisuzumisha ni ngombwa. Umuvuduko uri muri myofascial compartment urashobora gupimwa hakoreshejwe urushinge rwumuvuduko (Igicapo 1) nkuburyo bwuzuzanya bwikizamini cyihariye.

Igishushanyo 1. Gupima umuvuduko muri septum interosseous ukoresheje urushinge rwumuvuduko

Kugirango ubone amakuru yizewe, imikazo yimbere igomba gupimwa mubice bine bya myofascial no ahantu hatandukanye muri buri gice cya myofascial. Ubushakashatsi bwakozwe mubuvanganzo bwerekana ko itandukaniro ryumuvuduko uri munsi ya 30 mmHg (umuvuduko wa diastolique ukuyemo umuvuduko wa fascial compartment) byerekana syndrome ya fassique. Umuvuduko wa Diastolique mubisanzwe ugabanuka mugihe cyo kubagwa, kandi umuvuduko wa diastolique mbere yo gutangira ugomba kwitabwaho mugihe ubara umuvuduko utandukanye.

Ubushakashatsi buherutse gukorwa bwerekanye ko kugenzura umuvuduko ukabije w’igikoresho ari igikoresho gishobora kuba ingirakamaro mu gusuzuma indwara ya syndrome ikaze ya fassique, hamwe na 94% kandi ifite umwihariko wa 98%. Icyakora, ukurikije ingaruka zishobora guteza ingaruka mbi ya syndrome de santrale, gusuzuma indwara ya syndrome yibice bigomba gushingira kubyavuye mu mavuriro, kandi gupima umuvuduko ukabije w’ibice bigomba gukoreshwa mu bihe bidasanzwe, nk'igihe umurwayi yakomeretse cyangwa igihe amakuru y’ubuvuzi adasobanutse.

Isuzuma ryerekana amashusho rigomba kuba rikubiyemo orthopantomogrammes zisanzwe hamwe nibisobanuro byerekeranye na tibia yakomeretse hamwe na radiografi yi mavi yegeranye hamwe nu maguru, ibyo bikaba bisuzumwa hifashishijwe tomografi yabazwe (CT). Mu buryo nk'ubwo, CT gusikana amaguru irashobora kuba nkenerwa kugirango ubone ishusho yimirongo ivunika igera kuri tibial plateau hamwe nibikomere bidahuye.

二. Imitego ya Clinical

Ijanisha ryinshi ryimvune yo hepfo ya gatatu ya tibia hamwe no kuvunika amaguru byavuzwe. Ukoresheje ibizamini bya CT bisanzwe, 43% byavunitse hagati na hepfo ya gatatu ya tibia yaherekejwe no kuvunika amaguru, ibyinshi muri byo bikaba byasabye kuvurwa. Ubwoko bwakunze kuvunika cyane ni ukuvunika kuzengurutse igice cyo hepfo ya gatatu ya tibia ya kure ijyanye no kuvunika gato cyangwa kutimuwe inyuma yinyuma (Ishusho 2). Bitewe no kwimuka gake kuvunika kw'ibirenge bifitanye isano, 45% gusa byimvune zishobora kuboneka kumaradiyo yoroheje. Kubwibyo, gahunda ya CT isanzwe yibirenge igomba gushimangirwa cyane mugihe havunitse tibia yo hagati yo hagati (Ishusho 3).

Igishushanyo 2.AF Ivunika rya spiral yo hepfo yo hagati ya gatatu ya tibia iburyo (A, B) Amaradiyo mbere yo gutangira kumaguru yerekana bisanzwe (C). Intraoperative C-arm fluoroscopy yerekana kuvunika kudafite aho guhuriye ninyuma yinyuma (D) Amafoto ya nyuma yo kubagwa nyuma yo kubagwa (EF) yerekana gukira neza kuvunika kwa tibial na ankle

Igishushanyo 3. AF Kuvunika kwa Spiral hagati na hepfo ya gatatu ya tibia ibumoso (AB) amaradiyo atangira; (CD) mbere yo gutangira CT scan yerekana kuvunika kwa malleolar inyuma; (EF) yerekana gukira kudasanzwe kwa tibia no kuvunika kwa malleolar

三. Uburyo bwo kubaga

01

Gushiraho ingingo nyayo yinjira bigira uruhare runini kandi ubushakashatsi bwinshi mubuvanganzo bwatanze amakuru yingenzi kubijyanye na anatomique yahantu heza ho kwinjirira kugirango imisumari yimitsi itavunika. Ubu bushakashatsi bwerekanye ko icyerekezo cyiza cyo gutondekanya giherereye kuruhande rwimbere rwibibaya bya tibial no hagati gusa kuruhande rwa tibial spur. Ikibanza cy’umutekano gifite ubugari bwa mm 22,9 mm ± 8.9 mm, kidatera kwangirika kw’inzego zegeranye, nacyo cyavuzwe. Ubusanzwe, intangiriro yo gukosora imisumari yimbere yo kuvunika imitsi ya tibial yashyizweho hakoreshejwe uburyo bwa infrapatellar, haba mugucamo ibice bya patellar (inzira ya transpatellar) cyangwa mukwambura igice cyimyanya ndangagitsina (inzira ya paratendinous).

Semi-extension intramedullary imisumari yakunze kwitabwaho cyane mubuvanganzo bwa orthopedic, kandi Tornetta na Collins batanga igitekerezo cyo gukoresha uburyo bwa parapatellar yo hagati kugirango bakosore imbere yimisumari mumwanya wo kwaguka kugirango birinde kwaduka hejuru yimisumari yimbere mumyanya ndangagitsina ya papatellar. Birashoboka ko hakoreshwa uburyo bwa suprapatellar bwo gutera imisumari ya tibial intramedullary no gushyiramo umusumari winjiye binyuze mumutwe wa patellofemoral mumwanya wagutse.

Inzira ikorwa hamwe n ivi ryanyegereye kuri dogere 15-20, kandi uburebure burebure bwa santimetero 3 bukozwe hafi yubugari bwintoki imwe kugeza kuri ebyiri hejuru ya patella. Ikirangantego cya quadriceps kigabanijwe muburyo burebure kandi gutandukana bikozwe muburyo bwa patellofemoral. Isanduku idahwitse yinjizwa binyuze muri patellofemoral kugirango habeho aho binjirira aho ihurira ryimbere ya tibial cortex yimbere hamwe nubuso bwa arctular (Ishusho 4).

Igicapo 4. Ab amafoto adafitanye isano ya (a) kugabanya agace ka quadriceps no kwinjiza trocar binyuze mumutwe wa patellofemorale kugera aho tibial yinjira; (b) imikoranire idahwitse yo kureba aho yinjira

Imyitozo ya mm 3,2 ikoreshwa mukumenya aho urushinge rutangirira munsi ya C-arm. Sock isobekeranye itangwa kugirango uhuze neza ibyinjira nibisohoka. Inzira zisigaye zo kubaga zirimo reaming na tibial imisumari yinjizwamo ikorwa binyuze muri sock.

INYUNGU Z'INGENZI: Ikirenge cyagutse cyakaguru kirashobora gufasha muburyo bwo kuvunika, cyane cyane kuvunika hamwe na kimwe cya gatatu cya tibia kandi kigana imbere. , Umwanya wagutse urashobora gukuraho impagarara kumitsi ya quadriceps no gufasha mukuvunika. , Igice cyagutse cya suprapatellar uburyo bushobora nanone kuba ubundi buryo bwa infrapatellar gakondo (Ishusho 5).

Igicapo 5. Ifoto idakorana yerekana igikomere cyoroshye mu karere ka infrapatellar nkikimenyetso cyerekana uburyo bwa suprapatellar muburyo bwagutse.

Ubushakashatsi bwerekanye ko uburyo bwa suprapatellar uburyo bwo gutera imisumari ya tibial intramedullary mumwanya wagutse ni tekinike yo kubaga itekanye kandi ikora neza. Ibizamini bya kliniki bizaza birakenewe kugirango turusheho gukora iperereza ku nyungu n’ibibi byuburyo bwa suprapatellar uburyo bwo gutera imisumari no gusuzuma ibisubizo birebire bifitanye isano nubu buhanga.

02. Kugarura ikoranabuhanga

Gushyira umusumari wa tibial intramedullary wenyine ntabwo bivamo kugabanuka kuvunika bihagije; kugabanya kuvunika neza bigomba kubungabungwa mugihe cyose cyo gusubiramo no gushyira imisumari imbere. Gushyira mu bikorwa intoki byonyine ntibishobora buri gihe kugera kuri anatomic kugabanya kuvunika kwonyine. Iyi ngingo izasobanura uburyo butandukanye bwo gufunga, kwibasirwa cyane, no kugabanya uburyo bwo kugabanya.

-Gufunga gusubiramo tekinike yubuhanga

Imyitozo yo kugabanya ifunze irashobora kugerwaho hakoreshejwe igikoresho cyo kugabanya nka F-fracure igabanya, igikoresho cyo kugabanya imiyoboro ya F ifite imiterere ya F ikosora kugabanuka gukosora inguni / guhinduranya kimwe no guhinduranya hagati / kuruhande (Ishusho 6).

Igishushanyo cya 6. Kugabanya kuvunika kumiterere F yavuzwe mububiko

Ariko, igikoresho kirashobora gushira impagarara zikomeye kumyenda yoroshye, kandi hagomba kwirindwa gukoresha igihe kirekire iki gikoresho cyo gusubiramo. Imbaraga zo kugabanya nazo zirashobora gushyirwaho muburyo butandukanye, nkuko bimeze kumeneka ya spiral na oblique. Ibi bikoresho birashobora gukoreshwa muburyo bworoshye bwa tissue binyuze mubice bito (Ishusho 7).

Igicapo 7. Gufatanya muburyo butandukanye kugirango usubize kuvunika

Ubwoko bwa clamp hamwe n’ahantu ho kubagwa hagomba guhitamo hashingiwe ku ngamba zo kugabanya ibyangiritse igihe kirekire cyangirika ku ngingo zoroheje ziva mu gushyira clamp (Ishusho 8).

Igishushanyo cya 8

Abasubira inyuma nabo ni kimwe mubikoresho bisanzwe byo gusubiramo bikoreshwa mugusubiza uburebure kuri tibia. Mubisanzwe bishyirwa hagati kandi kure yumwanya ugomba gushyirwaho umusumari. Amapine yegeranye arashobora gushyirwaho kugirango yigane umwanya wahagaritswe wahagaritswe, ibyo bigatuma kugabanuka byoroshye kuvunika iyo umusumari winjiye.

Rimwe na rimwe, tekinoroji yo kugabanya ifunze kandi ntoya irashobora kuba idahagije kugirango igabanye anatomic. Mu bihe nk'ibi, tekinike yo kugabanya ibice igomba gutekerezwa hamwe no gucunga neza imyenda yoroheje ikikije. Ingaruka zishobora guterwa nubuhanga bwo kugabanya zirimo ihungabana ry’inyongera ryo kubaga, rishobora kongera ibyago byo kwandura indwara zo kubaga. Byongeye kandi, kwiyambura andi maraso ahavunitse bishobora kongera ibyago byo kuvunika nyuma yo kubagwa.

-Ubuhanga bwa Tekinike bwo Gutema no Gusimbuza

Imyitozo yo kugabanya ibice ntishobora kwemerera gusa kugabanya imbaraga zo kubaga zashyizwe mumwanya ukwiye, ariko kandi no gukoresha uduce duto cyangwa duto duto twavunitse kugirango habeho kugabanuka kuvunika mugihe cyo gutera imisumari.

Isahani irinzwe kubice byavunitse byegeranye kandi byitaruye ukoresheje imigozi ya monocortical. Gutandukana bigumaho mugihe cyose cyo gusubiramo no gushyira imisumari yimbere muri tibia. Nyuma yo gushyira imisumari yimbere, isahani yakuweho cyangwa igasigara ahantu kugirango hongerwe imbaraga kumiterere ihamye (Ishusho 9). Mugusiga isahani mumwanya, umugozi umwe wa cortical ugomba guhinduranya hamwe na kabili ya cortical. Byakagombye gutekerezwa gukoreshwa mugihe cyatoranijwe aho uruti rwa tibial rusaba kubagwa kumugaragaro kugirango bigabanuke kuvunika.

Igicapo 9. Gufungura tibia kuvunika hamwe no gukomeretsa bikabije hamwe nubusembwa bwamagufwa, gukosora cortical imwe hamwe nuduce duto kumutwe wavunitse nyuma yo kugabanuka no gukuraho ibice nyuma yo gukosora imisumari.

Intego yo guhagarika imisumari ni ukugabanya umwobo wa medullary mukarere ka metafhyseal. Guhagarika imisumari bishyirwa mubice bigufi bya arctular no kuruhande rwimiterere yubumuga mbere yo gushyira imisumari imbere. Kurugero, ubumuga busanzwe bwo kuvunika kwa hafi ya gatatu ya tibia irangwa na valgus hamwe no guhindagurika imbere. Kugirango ukosore ubumuga bwa valgus, umugozi wo gufunga urashobora gushyirwa mugice cyuruhande rwigice cyavunitse cyegeranye (ni ukuvuga uruhande ruciriritse rwubumuga) muburyo bwa anteroposterior. Imisumari yimbere iyobowe kuruhande rwagati, bityo ikarinda valgus. Mu buryo nk'ubwo, ubumuga bwo kurakara burashobora kuneshwa mugushira umugozi wo gufunga hagati kuruhande kuruhande rwinyuma yumwanya wa hafi (ni ukuvuga uruhande ruciriritse rwubumuga) (Ishusho 10).

Igicapo 10. Gufasha gusubiramo kuvunika tibial mugushira imisumari

Kwagura ibikorwa

Nyuma yo kurangiza kuvunika kuvunika, medullary reaming iratoranywa kugirango utegure igufwa ryo kwinjiza imisumari. Ubuyobozi bwarangije umupira bwinjizwa mumyanya ya tibial marrow no kunyura ahavunitse, kandi imyitozo yo gusubiramo inyuzwa hejuru yumupira urangira. Umwanya wo kuyobora umupira warangiye umupira wemejwe munsi ya C-arm fluoroscopie kuba kurwego rwibihuru, kandi icyerekezo cyibanze cyane kubitekerezo byombi ndetse no kuruhande (Ishusho 11).

Igishushanyo cya 11.

Ikibazo cyagutse na medula itaguwe cyagiye impaka. Twizera ko abaganga benshi bo muri Amerika ya ruguru bahitamo kwaguka imisumari ya medullary intambedullary imisumari ya tibia kuruta kwaguka. Nyamara, byombi byaguwe kandi bitaguwe imisumari irashobora gukoreshwa nkubuhanga busanzwe bwemewe, kandi ibisubizo byiza birashobora kuboneka hamwe nuburyo bwombi.

-Gufunga gushyira screw

Gukoresha imiyoboro ihuza ibice byavunitse bigamije gukumira no kugabanuka kwa malrotation, kwagura ibimenyetso byerekana imisumari yimbere ya tibia kugeza kumeneka ya tibial yegeranye kandi ya kure irimo metafizisi. Mu kuvunika birimo akarere ka metafhyseal, imigozi ihuza imiyoboro yabaye ingenzi mugukomeza guhuza umurongo.

Imiyoboro itatu yegeranye yegeranye yazamuye cyane ituze, kandi impande zifatika zifatika zirashobora gutanga ituze rirenze imiyoboro isanzwe ihuza imiyoboro, ishobora kwemerera ihame ryimiterere imwe kuboneka hamwe numubare muto wimigozi ifatanye. Amavuriro yubuvuzi ku mubare no kugena imiyoboro ihuza imiyoboro ikenewe kugirango ikosore imbere ya tibia ikomeze kuba mike.

Gushyira imigozi yegeranye yegeranye isanzwe ikorwa hifashishijwe urwego rufatanije nu musumari wimisumari. Imiyoboro ya interineti ihuza intera yinjizwa kubuntu munsi ya fluoroscopique. Ikoreshwa rya sisitemu ya elegitoroniki ifashwa na sisitemu ya elegitoronike irasabwa gushyiramo imigozi ya interineti ihuza intera (Ishusho 12). Ubu buhanga butuma imirasire itagira imishwarara yimigozi ya interineti ihuza kandi byagaragaye ko ari uburyo bushoboka kandi bwuzuye.

Igicapo 12.AB Gufunga imigozi ukoresheje C-ukuboko; CD Gufunga imigozi ukoresheje electromagnetic ya mudasobwa ifasha gufunga

Gushyira imigozi yegeranye kandi yitaruye ni inzira yo kubaga itekanye kandi imigozi ihuza igomba kwinjizwa muburyo bwuzuye kandi bworoshye.

Ubushakashatsi bwa Anatomic bwerekanye ko hakiri ibyago byo kurwara imitsi ya peroneal mugihe ushyize imiti igereranya impande zombi zifatanije. Kugira ngo ibyo byago bigabanuke, abaganga bagomba gutekereza ku gucukura imiyoboro iyobowe na C-ukuboko, hamwe na fluoroscopique inguni ya C-ukuboko gutambitse ku ndege ya biti. Imyitozo yinjira muri cortex ya tibia ya kure irashobora kugorana kubitahura kubitekerezo byubusa, kandi kuba hafi yumutwe wa fibular birashobora guhisha imitekerereze ya tactile kandi bigaha umuganga kubaga ko ari '' mumagufa 'mugihe mubyukuri umutwe wa fibular winjiye. Uburebure bw'imigozi ntibugomba kugenwa gusa n'umwitozo urangije gusa ahubwo no kubipimo byimbitse. Ibipimo byose bya drill cyangwa screw bipima uburebure bwa mm 60 bigomba gutera amakenga yo gukura inyuma, bishobora gushyira imitsi isanzwe ya peroneal ishobora gukomeretsa.

Imiyoboro ya kure ninyuma ihuza intera ishyirwa mukurinda kurinda imitsi ya neurovasculaire bundle, tibialis imbere yimbere, na extensor digitorum longus. Nubwo gushyira ibice bya percutaneous mubisanzwe bifite umutekano, kubaga bakeneye kumenya ingaruka ziterwa ningingo zoroshye. Kubice byinshi byavunitse byuruti, ibice bibiri byegeranye hamwe ninshuro ebyiri zuzuzanya zitanga ituze rihagije. Ivunika ryegeranye kandi ryitaruye rishobora kungukirwa no gushyira imigozi yinyongera ihuza indege zitandukanye kugirango byongere ituze ryiyi miterere (Ishusho 13).

Igicapo 13. Ibice byinshi bya tibia, bivura imisumari yimbere hamwe ninshuro ebyiri zegeranye kandi eshatu zegeranye, hamwe na x-imirasire yerekana gukira kuvunika.

-Gukosora neza

Ibishushanyo by'imisumari bigezweho hamwe n'imigozi ya interineti ihuza intera byaguye byerekana ibimenyetso byo gutera imisumari ya tibia kugirango hashyirwemo imvune yegeranye kandi ya kure irimo akarere ka metafhyseal.

Ibikoresho bitandukanye bya interineti bifatanye byakoreshwaga mubushakashatsi (imiyoboro 2 kuva hagati kugeza kuruhande na verisiyo 2 zashyizwe kuri perpendikulari hamwe ninshuro 3 zose zuzuzanya hamwe ninshuro 1 gusa). Ku barwayi babazwe fibular na tibial intramedullary imisumari, igipimo cyo kubura reset cyari gito cyane. Abagera kuri 13% by'abarwayi bafite imisumari itavanze nta fibular ikosowe bagaragaje igihombo nyuma yo kubagwa, ugereranije na 4% by'abarwayi bafite imisumari ya tibial badakosowe.

Mu kindi kigeragezo kigereranya imikorere ya tibial intramedullary ikosora imisumari hamwe na fibular fixation hamwe na tibial intramedullary imisumari ikosorwa nta na fibular ikosorwa, abarwayi bavuwe na fibular fixe hamwe no gutera imisumari ya tibial bagaragaje iterambere muguhinduranya no guhinduranya / guhinduranya.

Twanzuye ko gukosora fibular kugerwaho bigera kandi bigakomeza kugabanya kuvunika kwa tibial kugabanuka kure ya kimwe cya gatatu cya tibia ivunika ikozwe mumisumari. Nubwo bimeze bityo ariko, ikibazo cyingaruka ziterwa no gukomeretsa mu gice cy’imitsi yahahamutse kiracyahari. Turasaba rero kwitonda mugukoresha fibular ikosorwa.

03. Ibisubizo

Intramedullary imisumari ikosorwa ya tibial stem yamenetse irashobora gutanga umusaruro mwiza. Ubushakashatsi butandukanye bwo gukomeretsa imisumari ya tibia byagaragaye mubushakashatsi butandukanye. Hamwe nogukoresha ibigezweho hamwe nubuhanga bukwiye bwo kubaga, ibipimo byo gukira biteganijwe kurenga 90%. Igipimo cyo gukiza kuvunika uruti rwa tibial rwananiwe gukira nyuma yo gutunganya imisumari yimbere yateye imbere kuburyo bugaragara nyuma yo gukosorwa imbere hamwe numusumari wa kabiri wagutse.

Isuzumabumenyi ryakozwe mu mwaka umwe nyuma yo kubagwa ryerekanye ko abarwayi bagera kuri 44% bakomeje kugira imbogamizi z’imikorere mu gice cyo hasi cy’abakomeretse, naho abagera kuri 47% bakomeje kwerekana ubumuga bujyanye n’akazi mu mwaka umwe nyuma yo kubagwa. Ubushakashatsi bwerekana ko abarwayi bavuwe bafite imisumari ya tibia bakomeje kugira imbogamizi zikomeye mu gihe kirekire. Abaganga babaga bagomba kumenya ibyo bibazo kandi bakagira inama abarwayi uko bikwiye!

四. Ingorane nyuma yo kubagwa

01. Ububabare mbere ya patellar

Ububabare bwa patellofemorale ni ingorane zisanzwe nyuma yimisumari yimbere yimitsi yo kuvunika tibial stem. Ubushakashatsi bwerekanye ko abarwayi bagera kuri 47% nyuma yo gutera imisumari imbere bashobora gutera ububabare bwimbere, etiologiya ikaba itarasobanutse neza. Impamvu zishobora kugira ingaruka zishobora kuba zirimo gukomeretsa no kuvura indwara zubatswe imbere, gukomeretsa ishami rya infrapatellar yumutima wa saphenous nervice, intege nke zimitsi yibibero bya kabiri kugeza guhagarika ububabare buterwa na neuromuscular reflexes, fibrosis ya padi yibinure biganisha ku kwangirika, kwangirika kwa patellar tendonitis, hafi yumusemburo wa hafi ya hafi ya tib.

Iyo wiga etiologiya yububabare bwa preatellar nyuma yo gutera imisumari imbere, inzira ya transpatellar tendon yagereranijwe nuburyo bwa parapatellar. Uburyo bwa transpatellar tendon bushobora kuba bufitanye isano no kubabara ivi nyuma yo kubagwa. Nyamara, ibyifuzo byubuvuzi byateganijwe ntabwo byagaragaje itandukaniro rinini hagati yuburyo bwa transpatellar tendon nuburyo bwa parapatellar.

Ingaruka zo gutoranya guhitamo gukuramo imbere kugirango bikemure ububabare bwimbere nyuma yo gutera imisumari ya tibial intramedullary. Turasaba ko kuvanaho imisumari ya tibial intramedullary byasuzumwa niba hashobora kumenyekana etiologiya ya mashini, nka imisumari cyangwa imisumari isohoka. Nyamara, inyungu zo gukuramo imisumari ya tibial intramedullary ku barwayi bafite ibimenyetso bikomeje kwibazwaho.

Kubyerekeranye n'ububabare bwa nyuma yo kubagwa, icyateye ububabare ntigishobora kugaragara neza mubushakashatsi bwambere bwubuvuzi bwerekeranye no gutunganya imisumari ya intramedullary yimisumari ya tibial kuri patella mumwanya wagutse. Kubwibyo, ubushakashatsi bunini bwamavuriro hamwe nubushakashatsi bwigihe kirekire burakenewe kugirango hemezwe ingaruka zo gukomeretsa imisumari mu buryo bwa suprapatellar kububabare bwa nyuma yo kubagwa.

02. Guhuza ibikorwa bibi nyuma yo gutangira

Osteoarthritis nyuma yo guhahamuka ikomeje kuba ikibazo gikomeye nyuma yo kuvura imvune zo mu bwoko bwa tibial hamwe no gutera imisumari. Ubushakashatsi bwibinyabuzima bwerekanye ko indwara ya tibial malalignment ishobora kuvamo impinduka zikomeye zumuvuduko wo guhura kumaguru yegeranye hamwe n ivi.

Ubushakashatsi bw’amavuriro busuzuma ibyavuye mu mavuriro n’amashusho maremare nyuma yo kuvunika uruti rwa tibial byatanze amakuru avuguruzanya ku ruhererekane rw’imitsi mibi, nta myanzuro isobanutse kugeza ubu.

Raporo ya malalignment nyuma yo kubagwa nyuma yo gutera imisumari ya tibia ikomeje kuba mike, hamwe n’imibare mike yavuzwe. Indwara ya malrotation ikomeje kuba ikibazo gikunze kugaragara mu gutera imisumari ya tibial intramedullary, kandi isuzumabumenyi ridasubirwaho ryizunguruka rya tibial riracyari ingorabahizi. Kugeza ubu, nta kizamini cy’amavuriro cyangwa uburyo bwo gufata amashusho cyashyizweho nkurwego rwa zahabu rwo kugena imikoranire idahwitse yo kuzunguruka kwa tibial.Isuzuma ry’ibizamini bya CT ryerekanye ko igipimo cya malrotation nyuma yo gutera imisumari ya tibia gishobora kugera kuri 19% kugeza kuri 41%. By'umwihariko, guhinduranya ibintu hanze bisa nkibisanzwe kuruta guhinduranya imbere. Isuzuma rya Clinical kugirango risuzume malrotation nyuma yo kubagwa byavuzwe ko ridahwitse kandi ryerekanye isano rito hamwe nisuzuma rya CT.

Twizera ko malalignment ikomeje kuba ikibazo kirekire mugihe cyo kuvunika uruti rwa tibial bivurwa no gutera imisumari ya tibia. Nubwo amakuru avuguruzanya yerekeye isano iri hagati yimikorere mibi nigisubizo cyamavuriro n’amashusho, turasaba ko abaganga bagomba guharanira kugera ku guhuza ibice by’imvune kugira ngo bagenzure iyi mpinduka kandi babone ibisubizo byiza.

五. Umwanzuro

Gufunga bihamye kwagura medullary intramedullary imisumari bikomeza kuba uburyo busanzwe bwo kuvunika imitsi ya tibial yimuwe. Ingingo yukuri yinjira iracyari igice cyingenzi muburyo bwo kubaga. Uburyo bwa suprapatellar muburyo bwagutse bwagutse bufatwa nkuburyo bwizewe kandi bunoze, kandi ubushakashatsi buzaza bugomba kurushaho gusuzuma ingaruka ninyungu zubu buryo. Abaganga babaga bitabiriye inama bagomba kuba bamenyereye uburyo bwo guhinduranya ibintu. Niba guhuza ibice bya anatomic bidashobora kugerwaho binyuze muburyo bufunze, hagomba gutekerezwa uburyo bwo kugabanya ibice. Igipimo cyiza cyo gukira kirenga 90% kirashobora kugerwaho hamwe no kwaguka no kutaguka imisumari. Nubwo igipimo cyiza cyo gukira, abarwayi baracyafite ubushobozi buke bwo gukora. By'umwihariko, ububabare bwa preatellar bukomeza kuba ikibazo nyuma yo gutera imisumari ya tibial intramedullary. Byongeye kandi, malrotation nyuma yo gukosora imbere imbere ikomeje kuba ikibazo rusange.

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