Shin kun san tarihin ƙusa intramedullary?

Zuwan ƙusa na intramedullary ya kawo sauyi game da maganin karaya mai tsayi. Ko da yake dabarar ta wanzu shekaru aru-aru, ba ta cimma matsayin da take yanzu ba sai rabin na biyu na karni na 20.

Hanyar samun nasara ba ta kasance mai sauƙi ba ko da yaushe, saboda dabarar ta fuskanci shakku da kuma musantawa daga masana da yawa a farkon rabin farkon karni na 20. A yau, ta hanyar sababbin abubuwa a cikin ƙarfe, dabarun tiyata da ƙwarewar fluoroscopic, ƙusa intramedullary ya zama ma'auni na kulawa da tsayin kashi.

Ci gaba a cikin ilimin kimiyyar halittu na ɗan adam ya sa ƙirƙirar wannan ƙirar zamani ta yiwu. Nailing intramedullary na zamani yana da ƙarancin kamuwa da cuta, ƙarancin tabo, kyakkyawan kwanciyar hankali, da motsin haƙuri nan da nan.

Binciken tarihi da aka gudanar a cikin wannan labarin yana nufin taƙaita juyin halittar ƙusa na intramedullary, haskaka mahimman matakansa, gabatar da yanayin yanayi na farkon amfani da juyin halitta na ƙusa intramedullary, da gabatar da wurin ƙusa na intramedullary a cikin ƙusa na zamani da traumatology (misali, Hoto 1).

Haihuwar ƙusa intramedullary

Masarawa na da da farko sun fara amfani da na'urar intramedullary mai kama da ƙusa. Mai yuwuwar kula da karaya mai rikitarwa ya wanzu shekaru da yawa da suka wuce.

Abin da ya tabbata, duk da haka, shi ne cewa Masarawa na dā suna da dabaru masu kyau na ƙonawa da suka samo asali daga imaninsu ga tashin jiki a lahira.

Haka lamarin ya kasance da mummy da ake kira Usermontu da aka samu a cikin kabarin Tutankhamun, inda aka saka ƙusa mai zare tsakanin mace da tibia don daidaita haɗin gwiwa (kamar yadda yake a cikin hoto na 2).

Masu binciken archaeologists sun yi hasashen cewa mummy da ke cikin sarcophagus ba Usermontu da kansa ba ne, amma wani wanda ’yan fashin kabari na dā suka maye gurbinsu a shekara ta 600 KZ.

Shekaru 2000 bayan haka, Bernardino de Sahagun, masanin ilimin ɗan adam akan balaguron Hernando Cortes, ya ba da rahoton fara amfani da ƙusa intramedullary a cikin mara lafiya mai rai a Mexico.

A shekara ta 1524, ya shaida wani likitan likitancin ƙashi na Aztec (mai suna 'Tezalo') yana yin osteotomy ta hanyar amfani da wuka na obsidian sannan ya sanya sandar guduro a cikin rami na medullary don daidaita karaya. Saboda rashin isassun dabarun tiyata da magungunan kashe kwayoyin cuta, waɗannan hanyoyin suna da yawan rikitarwa da yawan mace-mace.

1800s: Matakan Farko

Kusan tsakiyar 1800s, mujallun likitanci na farko sun ba da rahoto game da ƙusa intramedullary. Diefenbach, Langenbeck, Bardenheuer da sauran likitocin da ke magana da Jamusanci an ruwaito sun yi amfani da kusoshi na hauren giwa a cikin bargon dogayen kasusuwa don magance katsewar kashi.

A halin yanzu, Nicholas Senn na Chicago, mai bincike kuma ƙwararren likitan soja, ya gudanar da gwaje-gwaje tare da gyaran ƙwayar cuta. Zai yi amfani da tsatsa mai raɗaɗi da aka yi da ƙashin nama sannan a saka shi a cikin medulla don magance 'pseudarthrosis' bayan karaya.

A cikin 1886, Heinrich Bircher na Switzerland ya bayyana a wani taron tiyata game da shigar da kusoshi na hauren giwa a cikin medulla don tsananin maganin karaya mai rikitarwa (Hoto na 3).

Bayan 'yan shekaru, Themistocles Gluck a Jamus ya ƙirƙiri ƙusa na farko na hauren giwa tare da rami a ƙarshen ƙusa, don haka ya gabatar da ra'ayi na haɗuwa a karon farko.

A daidai wannan lokacin, Julius Nicolaysen daga Norway ne ya fara rubuta game da ka'idodin biomechanical na ƙusa intramedullary na kusa da karyewar mata. Ya jaddada bukatar kara tsayin ƙusa na intramedullary don samun ƙarin fa'idar biomechanical da kuma ba da kariya ga kusan dukkanin kashi.

Shi ne kuma na farko da ya ba da shawarar manufar kusanci da ƙusa/ƙulla kashi na kusa don ƙira a tsaye. Wasu malamai suna kallonsa a matsayin uban farce a ciki.

A tsakiyar shekarun 1800, majagaba irin su Ignaz Philipp Semmelweis a Vienna da JosephLister a Glasgow sun kafa harsashin yin tiyatar tiyata. Wannan nasara ce mai ban mamaki saboda ta ba da damar haɓaka sabbin dabarun tiyata a ƙarƙashin yanayin aseptic.

1900s: Juyin Halitta

A cikin 1912, Likitan fiɗa na Burtaniya Ernest Hay Groves shine likitan fiɗa na farko da ya yi amfani da sandaƙar ƙarfe mai ƙarfi a matsayin ƙusa na intramedullary kuma ya kasance majagaba na sake fasalin ƙusa ta intramedullary.

Ya sami gogewarsa a lokacin Yaƙin Duniya na ɗaya lokacin da yake kula da marasa lafiya da ke fama da cutar pseudarthrosis waɗanda ba sa son yanke gaɓoɓinsu. Ba wai kawai ya bayyana dabarar ƙusa ta intramedullary ta farko wacce ta ba da damar haɗin gwiwa ta hanyar rauni kaɗan ba, amma kuma ya ƙware wajen yin amfani da kusoshi na intramedullary da ƙananan kusoshi don gyara karaya.

Ya yi gwaji da kayan da aka yi da aluminum, magnesium da karfe kuma ya gane mahimmancin biomechanics wajen warkar da karaya. Duk da haka, dabarar Ernest Hay Groves ta sha fama da yawan kamuwa da cuta don haka ba ta shahara da mutanen zamaninsa ba.

A cikin 1931, Smith-Petersen, wani likitan kasusuwa na Amurka, ya gabatar da dunƙule bakin karfe mai fuka-fukai uku don maganin karyewar wuyan mata ta ciki. Ya tsara wata hanya mai buɗewa wadda ta ƙaddamar da kashi na uku na ƙwanƙwasa na iliac, ya shiga filin aiki tare da gefen gaba na faffadar fasinja mai faɗi, sa'an nan kuma ya sake mayar da karaya kuma ya yi amfani da wani tasiri don fitar da bakin karfe a cikin kan femoral (Hoto 4).

Saboda nasarar gwajin Smith-Petersen, likitocin fiɗa da yawa sun fara gwaji tare da dasa ƙarfe don karaya. Sven Johansson ya ƙirƙira ƙusa mai zurfi a cikin 1932; ƙwararriyar ƙirƙirar sa ta yi amfani da allurar kerfing wanda ke ba da izinin shigar da ƙusa ta intramedullary ta hanyar radiyo. Har yanzu ana amfani da ainihin abubuwan fasaha da ya yi amfani da su a yau.

Ci gaba da mataki ɗaya, Rush da ɗan'uwansa sun gabatar da manufar ƙusa intramedullary na roba a cikin 1937.

Sun yi amfani da na roba, wanda aka riga aka lankwashe bakin karfe intramedullary ƙusa kuma yayi ƙoƙarin ƙirƙirar tsarin daidaitawa na intramedullary mai maki uku don magance yanayin ƙaurawar axial a kusa da karaya.

A cikin ra'ayinsu, yankin nama mai laushi mara kyau yana aiki azaman ƙungiyar tashin hankali wanda ke tsayayya da tashin hankali da ƙusa na roba da aka riga aka lanƙwasa. Gine-ginen nasu ya iyakance ne da kaddarorin roba na bakin karfe, wanda ya canza da wuri daga nakasar roba zuwa nakasar filastik. Na ƙarshe na iya haifar da ƙaura na biyu da nakasa waraka.

Bugu da kari, kusoshi na intramedullary kan fita a bakin kofa ko su ratsa sassan kasusuwa da ke sokewa, ko ma huda a cikin hadin gwiwa. Duk da haka, masanin Viennese Ender ya ci gaba da yin amfani da wannan fasaha a matsayin tushen makarantar Ender na gyaran karaya kuma har yanzu ana amfani dashi a yau don sassauƙan gyaran gyare-gyare na ƙananan yara.

ƙusa maƙarƙashiya

A shekara ta 1939, Likitan fiɗa na Jamus Gerhard Küntscher, wanda ya samu lambar yabo ta Nobel, ya ƙera ƙusa na bakin ƙarfe na intramedullary na bakin karfe don maganin karyewar farar mace.

Küntscher da sauransu sun sami wahayi ta hanyar screws na bakin karfe na Smith-Petersen da aka yi amfani da su don magance karayar wuyan mata kuma sun yi imanin cewa za a iya amfani da ka'idoji iri ɗaya don karaya. Farkon intramedullary da suka ɓullo da farko mai siffa V ne a ɓangaren giciye da 7-10 mm a diamita.

Bayan nazarin cadaveric da dabba, ya gabatar da ƙusa na intramedullary da hanyar tiyata a wani taron tiyata a Berlin a 1940. Da farko, abokan aikinsa na Jamus sun yi masa ba'a, ko da yake hanyarsa ta sami farin jini bayan yakin duniya na biyu.

Hippocrates (460-370 BC), tsohon likita na zamanin Girka sau da yawa ana kiransa uban magani, ya taɓa cewa, 'Wanda yake son yin tiyata dole ne ya tafi yaƙi'; Haka lamarin yake ga Kuntscher.

A lokacin mulkin Nazi, Küntscher yana tsaye a wani asibiti da ke gaban Finnish. A can, ya sami damar yi wa marasa lafiya da fursunonin yaki aikin tiyata a yankin. Ya gabatar da ra'ayi na ƙusa ƙwanƙwasa ta hanyar amfani da rufewa da buɗe hanyar tiyata, bi da bi.

A cikin rufaffiyar tsarin, ya wuce ƙusa na intramedullary a cikin hanyar haɓakawa ta cikin mafi girma na trochanter kuma ya sanya shi a kan teburin ja da baya wanda aka sarrafa tare da majajjawa. An sake gyara karayar kuma an saka ƙusa a cikin jirage biyu ta amfani da fluoroscopy na kai. A cikin hanyar buɗewa, an shigar da ƙusa na intramedullary ta hanyar karaya a cikin medulla ta hanyar raguwa a kusa da layin karaya.

Dabarar ta Küntscher ta samu karbuwa a duniya ne bayan an dawo da fursunonin yaki na kawance.

Ta haka ne likitocin Amurka da na Biritaniya suka saba da farcen intramedullary da Küntscher ya ƙera kuma sun gane fa'idarsa a wannan zamanin na hanyoyin magance karaya.

A cikin kankanin lokaci, likitocin fida a duniya sun fara amfani da tsarinsa, kuma farcen intramedullary na Küntscher ya kawo sauyi wajen magance karaya ta hanyar rage lokacin jinyar mara lafiya da kusan shekara guda. Marasa lafiya waɗanda za a yi amfani da su a cikin simintin gyare-gyare na tsawon watanni suna iya zama ta hannu a cikin 'yan kwanaki.

Har zuwa yau, ana daukar likitan likitan Jamus a matsayin babban mai haɓaka ƙusa na intramedullary, kuma yana da matsayi mai mahimmanci a tarihin tiyatar rauni.

Fadada Intramedullary Nail

A cikin 1942, Fisher et al. da farko ya bayyana yadda ake amfani da maƙarƙashiya mai faɗaɗa niƙa don ƙara wurin hulɗar tsakanin ƙusa na intramedullary da kashi da kuma inganta kwanciyar hankali na gyaran kafa.

Duk da haka, Küntscher ya gabatar da rawar motsa jiki mai sassaucin ra'ayi wanda har yanzu ana amfani da shi a yau kuma yana goyan bayan reaming a tsawon tsayin rami na kashin kashin don sauƙaƙe shigar da manyan diamita na ƙusoshi na intramedullary.

Da farko, an ƙera reaming na intramedullary don ƙara haɓaka yankin hulɗar kashi tare da ƙusa na intramedullary don daidaitawar karyewa da saurin motsin haƙuri.

Kamar yadda Smith et al ya bayyana, kowane 1 mm na fadada medullary yana ƙara yankin lamba da 38%. Wannan yana ba da damar yin amfani da ƙusoshin intramedullary mafi girma da ƙwanƙwasa, yana haɓaka cikakkiyar kwanciyar hankali na tsarin gyaran karaya.

Duk da haka, ko da yake Küntscher intramedullary ƙusa tare da m intramedullary reaming rawar soja ya zama dace zabi na ciki gyara na'urar ga osteotomy, ilimi rasa tagomashi da shi a cikin marigayi 1960s a cikin goyon bayan da sabon raya faranti na Arbeitsgemeinschaft für Osteosynthesefragen (AO).

1960s: Zamanin Duhu

A cikin 1960s, an cire kusoshi na intramedullary ba zato ba tsammani don goyon bayan farantin karfe da gyaran karaya.

Ko da yake hanyar Küntscher tana aiki yadda ya kamata, likitocin fiɗa a duniya sun ƙi su saboda rashin sakamako mai kyau bayan tiyata.

Bugu da ƙari, wasu likitocin sun fara yin watsi da fasahar radiation, irin su fluoroscopy, saboda likitocin sun yi kyama da mummunar illa da ke tattare da radiation. Ci gaban ƙusa intramedullary bai tsaya a nan ba, duk da haɗin kai na duniya gaba ɗaya don amfani da tsarin gyaran ciki na farantin.

Küntscher, wani likitan Bajamushe, ya gane fa'idar yin cudanya da juna kuma ya samar da ƙusa mai kama da ƙusa mai siffar cloverleaf, wanda ya sanya wa suna 'ƙusa tsare'. Ƙaƙwalwar Achilles na ƙirar ƙusa na intramedullary na wancan lokacin shine rashin iya daidaita karaya ko raunin da aka yi a cikin manyan kusurwoyi Maganin wannan matsala shine amfani da kullun kullewa.

Maganin wannan matsala shine daidaita farcen intramedullary tare da dunƙule kullewa.

Ta wannan hanya, dasa shuki zai fi dacewa da juriya da lanƙwasawa da ƙarfin torsional yayin hana rage gaɓoɓi. Yin amfani da haɗin ra'ayoyi daga Küntscher, Klaus Klemm, da Wolf-Dieter Schellmann, ƙusa na intramedullary an ɓullo da shi don samar da kwanciyar hankali mafi girma ta hanyar hako ramukan dunƙule kusa da nesa zuwa ƙusa na intramedullary, wanda aka kulle a cikin dunƙule da aka saka.

A cikin 'yan shekaru masu zuwa, ci gaba a cikin tsabtar hoto na fluoroscopic ya ba da izinin sake zabar ƙulli da fasahohin raguwa.

1970s da 1980s: Farfadowa

A cikin 1970s, sha'awar tunanin ƙusa intramedullary na likitan fiɗa na Jamus Küntscher ya kasance mai tsanani.

Rufe raguwar ƙusa intramedullary na ƙusa don karyewa, tare da haɗin gwiwar sassauƙan ra'ayi da ra'ayoyi masu alaƙa da haɓaka haske na fasahohin fluoroscopic, ya haifar da ci gaba da watsa wannan fasaha mai kyau na tiyata, wanda ke da ƙarancin lalacewar nama mai laushi, kwanciyar hankali mai kyau, da motsin haƙuri nan da nan.

A wancan lokacin, duniyar ilimi ta mamaye cikin jerin sabbin abubuwa da suka haifar da ci gaban ƙarni na biyu na farcen intramedullary.

A cikin 1976, Grosse da Kempf sun ƙirƙiri wani ɗan ramin ƙusa na intramedullary don magance matsalar ƙwayar ƙusa ta intramedullary. Ba a saka ƙusa na intramedullary ba a cikin yankin da ke kusa kuma yana da ramin ƙusa don maƙallan kusa, wanda aka saka a kusurwar digiri 45 don ƙara ƙarfin kwanciyar hankali na intramedullary ƙusa na ciki na ciki.

Bayan 'yan shekaru, AO ya shiga cikin yanayin ci gaban ƙusa na intramedullary ta hanyar haɓaka kusoshi na intramedullary iri ɗaya (Hoto na 5)

A cikin 1984, Weinquist et al. ya ba da shawarar ingantaccen tsarin, wanda shine don haɓaka waraka ta ƙarshe ta amfani da manyan ramukan kulle kulle, cire sukukulan kulle tsaye, sannan a gyara ramukan kulle dunƙule zuwa ramukan ƙusa na ƙusa a cikin ƙirar zamani.

Manufar hanya mai mahimmanci ita ce don inganta warkar da raunin da ya faru da kuma guje wa rashin haɗin kai saboda aikin marigayi.

A halin yanzu, intramedullary nailing kuzarin kawo cikas ya rasa masu ba da shawara a matsayin fasaha mai zaman kansa kuma a halin yanzu ana amfani da shi kawai a matsayin mafita mai mahimmanci fiye da cikakken maye gurbin tsarin gyaran gyare-gyare na ciki a cikin maganin raunin da ba a warkar da shi ba.

A cikin nazarin halittu, Gimeno et al. ya ruwaito cewa yankin canzawa tsakanin sassan da ba a kwance ba da kuma raguwa na ƙusa na intramedullary ya haifar da ƙananan damuwa da gazawar tiyata na gyare-gyare na ciki.

Don magance waɗannan matsalolin, Russel da Taylor et al. An tsara ƙusa na farko wanda ba shi da rami, wanda ba shi da ƙarfi a cikin 1986, tare da sakamako mai gamsarwa.

A wannan lokacin, matsalar cudanya tsakanin kusoshi na intramedullary ita ma ta ci gaba da ci gaba, kuma kamar yadda muka sani a yau, cudanya da kusoshi ta hanyar ƙusa da aka riga aka haƙa shi ne ƙirar Klemm da Schleman a Jamus. Shigar da dunƙule za a yi amfani da shi ta hanyar fluoroscopy na hannu, wanda zai fallasa likitan fiɗa ga radiation mai yawa.

A yau, an magance wannan matsalar tare da tsarin niyya mai nisa wanda ya haɗa da fasahar sa ido na filin lantarki, fasahar hannu mai jagora ta fluoroscopically, da ainihin jagorar shigar ƙusa kusa.

1990s: Titanium intramedullary ƙusa

A cikin shekaru goma masu zuwa, Russel-Taylor intramedullary ƙusa ya zama sananne sosai a cikin al'ummar orthopedic na duniya. Matsakaicin kulawa sannu a hankali ya zama ƙusa na intramedullary tare da kulle sukurori, kamar yadda sakamakon binciken Brumback et al ya nuna.

A cikin wannan binciken mai yiwuwa, sakamakon ya ruwaito cewa kullewa ya haifar da sakamako mai kyau a mafi yawan lokuta kuma ba a haɗa shi da rashin haɗin gwiwa ba.

Ci gaban da aka samu a cikin ƙarfe ya haifar da fitowar kusoshi na intramedullary titanium, waɗanda aka yi amfani da su sosai a cikin masana'antar biomedical saboda ƙarfin su, juriya mai kyau da haɓakawa.

Tsarin ƙusa intramedullary na Alta shine farkon samuwan ƙusa intramedullary titanium, kuma jama'ar likitoci sun yi maraba da shi sosai saboda kayan aikin ƙarfe na titanium, wanda ya fi ƙarfi amma ƙasa da ƙarfi fiye da bakin karfe.

Duk da haka, wallafe-wallafen na yanzu yana da shakka game da ko titanium shine kayan da ya fi dacewa don gyaran ciki fiye da bakin karfe, musamman saboda karuwar farashin da ke hade da amfani da titanium.

Koyaya, wasu fa'idodin titanium, irin su na'urorin roba kusa da kashin cortical da daidaitawar tasirin maganadisu, sun sa ya zama zaɓi mai ban sha'awa.

Bugu da kari, titanium wani zaɓi ne mai ban sha'awa sosai lokacin da ake buƙatar ƙaramin diamita na kusoshi na intramedullary.

Halin Yanzu

Bayan nasarori da gazawar shekaru da suka gabata, likitocin orthopedic suna da ƙarin gogewa game da ƙusa intramedullary.

Gyaran ƙusa na intramedullary na femoral, tibial da humeral fractures ya zama ma'auni na kulawa ga mafi yawan rufaffiyar karaya da wasu karaya a buɗe. Sabbin tsarin niyya da sakawa sun sanya hanya mai sauƙi da sake sakewa ga ma mafi yawan ƙwararrun likitocin tiyata.

Abubuwan da ke faruwa na baya-bayan nan sun nuna cewa titanium da baƙin ƙarfe na ƙarfe suna da maɗaukakiyar elasticity sosai kuma hakan yana damuwa da damuwa mai ban haushi da ake buƙata don warkar da kashi. A halin yanzu ana gwada sabbin abubuwan halitta kamar su magnesium alloys, sifofin ƙwaƙwalwar ajiya da kayan da za a iya sakewa a halin yanzu a cikin ilimin kimiyya.

Kusoshi na intramedullary da aka yi da ci gaba da haɓakar polymers na fiber carbon tare da ingantattun modules na roba da ƙarfin gajiya mai girma a halin yanzu. Magnesium alloys suna da modules na elasticity kama da na cortical kashi kuma suna da biodegradable.

Nazarin kwanan nan na Li et al. sun nuna gagarumin abũbuwan amfãni a cikin zalunta osteoporotic fractures a cikin dabba model dangana ga hade da magnesium da zoledronate shafi don gyara karaya, wani yanayin da zai iya zama magani ga osteoporotic fractures a nan gaba.

Kammalawa

A cikin shekaru da yawa, tare da gagarumin ci gaba a cikin ƙirar ƙusa na intramedullary, dabarun ƙarfe, da dabarun tiyata, ƙusa intramedullary ya haɓaka cikin ma'auni na kulawa na yanzu don yawancin raunin kashi mai tsawo kuma yana da tasiri, ƙananan ɓarna, kuma hanya mai sauƙi.

Koyaya, saboda yawan ƙirar ƙusa na intramedullary, yawancin bayanai sun rasa game da sakamakon bayan aikin su. Ana buƙatar ƙarin bincike don tantance mafi kyawun nau'in ƙusa na intramedullary, halaye da radius na curvature.

Mun yi hasashen cewa sabbin abubuwa a fagen abubuwan da suka shafi halittu za su haifar da fitowar sabbin ƙirar ƙusa ta intramedullary.

Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?

Domin CZMEDITECH , muna da cikakken layin samfur na kayan aikin tiyata na orthopedic da kayan aikin da suka dace, samfuran ciki har da kashin baya implants, intramedullary kusoshi, farantin rauni, farantin kulle, cranial-maxillofacial, prosthesis, kayan aikin wuta, masu gyara waje, arthroscopy, kula da dabbobi da saitin kayan aikinsu.

Bugu da kari, mun himmatu wajen ci gaba da bunkasa sabbin kayayyaki da fadada layin samfur, ta yadda za a iya biyan bukatun tiyata na karin likitoci da marasa lafiya, da kuma sa kamfaninmu ya kara yin gasa a cikin dukkan masana'antar sarrafa kasusuwa ta duniya da masana'antar kayan aiki.

Muna fitarwa a duk duniya, don haka za ku iya Tuntuɓe mu a adireshin imel song@orthopedic-china.com don faɗakarwa kyauta, ko aika sako ta WhatsApp don amsa cikin gaggawa +86- 18112515727 .

Idan kuna son ƙarin bayani, danna CZMEDITECH don samun ƙarin cikakkun bayanai.