Me zai faru idan gyara na ciki na karaya mai jujjuyawar inter rotator ya kasa?

An kiyasta karayar kwatangwalo zai shafi manya 500,000 a Amurka kowace shekara. Suna da tasiri mai girma akan ingancin rayuwa, a halin yanzu suna lissafin kashi 3-7% na mace-mace a asibiti da kuma yawan mace-macen shekara guda na 19.4-58%. Kusan rabin duk karaya na hip sune raunin intertrochanteric (IT). Abubuwan da aka fi amfani da su na yau da kullun da ake amfani da su don magance raunin IT sune ƙusa cephalomedullary (CMN) da ƙusa hips (SHS).

Duk da ci gaban fasaha, katsewar kashi da gazawar gyarawa kamar shigar kan femoral har yanzu yana faruwa kuma yana iya zama mai lalacewa. Nazarin baya-bayan nan sun ba da rahoton adadin raguwa har zuwa 6% tare da dasa shuki na zamani. Abubuwan haɗari don gazawar gyarawa sun haɗa da nisa na tip-tip (TAD)> 25 mm, rashin isassun sake fasalin karaya, tsarin karaya mara ƙarfi, spikes cephalic da ke gefe ko ƙasa da tsakiyar kan femoral, da juyawa na ciki na kusurwar tushe na mahaifa. Tsufa da osteoporosis kuma suna da alaƙa da gazawar gyarawa.

Marasa lafiya da Hanyoyi

Wannan bincike ne na baya-bayan nan na marasa lafiya da aka yi wa magani a cibiyoyin biyu da ke cikin tsarin kiwon lafiya a cikin babban yanki na birni. An tambayi shari'ar likitocin likitocin biyu (JS da BC) ga duk marasa lafiya da suka sami ingantaccen gyaran siminti bayan gazawar fara gyara fashewar IT daga Janairu 2018 zuwa Satumba 2021, bayan amincewa da hukumar binciken cibiyoyi. An tabbatar da yin amfani da ƙarfafa siminti a lokacin aikin tiyata ta hanyar nazarin likitancin lantarki (EMR) na bayanan aiki da kuma radiyo na baya. Mun haɗa da duk marasa lafiya tare da alamun ƙarfafa ciminti a cikin gyaran bita bayan gazawar CMN na farko ko SHS na fashewar IT (Hoto 1). Mun cire marasa lafiya tare da wuyan mata na femoral ko raunin subtrochanteric, marasa lafiya waɗanda ba su yi gyare-gyaren gyaran gyare-gyare tare da ƙarfafa ciminti ba, da marasa lafiya waɗanda suka yi aikin arthroplasty a lokacin aikin tiyata na farko.

Hoto 1. Wata mace mai shekaru 76 ta yi amfani da ƙusa na intramedullary don fashewar intertrochanteric na femur (A), tare da ci gaba da ciwon hip bayan watanni 2 saboda ƙaddamarwa (B).

Dabarun tiyata

Ga marasa lafiya da ke karɓar gyare-gyaren farko tare da CMN, mun yi gyaran gyare-gyaren ƙusa na kai da ƙarfafa simintin kashi. Da farko, an yi shinge na 5-cm a gefen kusa na mafi girma trochanter, an sanya waya mai jagora a cikin kusa da ƙusa, kuma an cire duk kashi daga gefen ƙusa ta amfani da buɗaɗɗen reamer. Bayan haka, an yi amfani da screwdriver hexagonal don sassauta dunƙule gyarawa a saman CMN (Hoto 2).

Hoto na 2, intraoperative fluoroscopy yana nuna na'ura mai ɗaukar hoto mai ɗaukar hoto mai ɗaukar hoto da sassauta saitin ƙusa a baya.

Ana yin katsewar 1-2 cm ta hanyar iliotibial fascia (ITB). Ana cire ƙusa na asali tare da jagorar zaren baya (Hoto na 3). A cikin yanayin huɗar kai na mata, ana amfani da jagora mai raɗaɗi tare da dunƙule makullin nesa don hana zubar da siminti a cikin haɗin gwiwa (Hoto 3A). Musamman, an fara allurar matrix bayan an cire yadudduka biyu na waje na cannula sau uku sannan a saka shi cikin yankin da ya lalace ta hanyar sake shigar da yadudduka biyu na waje.

Hoto 3, Intraoperative anteroposterior (A) da kuma na gefe (B) hotuna na wani majiyyaci yana nuna kan femoral tare da lahani na tsaka-tsakin kashi.

Bayan haka, an ɗora gaɓoɓin sa'an nan kuma an mayar da karyewar zuwa ƙarin exostosis don gyarawa. A lokuta na malunion ko fibrous waraka, a percutaneous osteotomy an yi amfani da 1/4 ' gouge kashi tare da na gaba.

Sa'an nan kuma an sanya sabon dunƙule ko karkace ruwa a cikin ƙashin subchondral a cikin kan femoral tare da axis na wuyan femoral, tabbatar da kiyaye kada ku shiga kai (Hoto 4). Ana sanya dunƙulewa da gangan don guje wa sashin ƙusa na baya, amma har yanzu yana nuna ƙarewa a tsakiyar kan femoral. (Hoto na 5)

Hoto 4, Anteroposterior (A) da Hotuna na gefe (B) na wani mara lafiya yana nuna shigar da allurar kerfing tare da hanyar sabon ƙusa kai.

Hoto na 5, intraoperative fluoroscopy yana nuna shigar da sabon ƙwanƙwasa cephalomedullary tare da hanyar waya mai jagora, wanda aka ɗaure daga baya ta hanyar dunƙule.

A ƙarshe, kan femoral yana cike da siminti na kashi ta amfani da tsarin simintin kashi mai allura (Hoto na 6). Ana kulawa don kauce wa extrusion a cikin haɗin gwiwa ta hanyar yin amfani da radiyo na ainihi da kuma daidaita zurfin da kuma daidaitawa na cannula na ciminti.

Hoto 6, Hoto yana nuna karuwar ciminti da farko (A), cikawa a hankali (B) har sai an cika lahani na mata (C).

Ga marasa lafiya da ke karɓar gyaran farko na SHS, muna cire SHS kuma mu sanya dogon CMN. bayan yin yankan 5-cm a tsakiya a ƙasa mafi girma da kuma gano ITB, ƙaddamarwar an raba shi zuwa farantin gefe. Ana cire duk screws ɗin farantin ta amfani da na'urar sukudi mai dacewa sannan kuma ana cire farantin gefe. Sannan ana cire ƙusoshin tashin hankali tare da jagorar zaren baya kamar yadda aka bayyana a baya don sake mayar da karaya zuwa mafi girman matakin valgus. Ana yin yankan-cm 5 cm a saman mafi girma kamar yadda aka bayyana a baya. Ana shigar da waya mai jagora a mafi kusancin ƙarshen mafi girma kuma a ci gaba zuwa cikin tushe na femoral. An gabatar da buɗaɗɗen reamer tare da hanyar jagorar. Ana zare doguwar rigar jagorar ƙwallon ƙafa zuwa tsakiyar femur mai nisa da ke ƙasa da matakin patella. Bayan haka, ana yin reaming na ci gaba har sai an ji rawar jiki a cikin kashin baya. Dukan marasa lafiyarmu sun sami dogon ƙusa na CMN tare da tsarin TFN-ADVANCED (TFNa) na kusa da tsarin kusoshi na intramedullary na mata (DePuy-Synthes, Raynham, MA).

Tattaunawa

Fasaharmu tana amfani da ƙarfafa simintin kashi yayin gyaran bita. Ƙarfafa simintin kasusuwa don gyaran farko na osteoporotic proximal femur fractures an yi nazari kuma ya nuna kyakkyawan sakamako na biomechanical da na asibiti. Wani bita na baya-bayan nan ya ba da rahoton cewa ƙarfafa simintin kashi ya haifar da mafi girman nauyin gazawa, rage rarrabuwar kawuna, da ƙarancin rikice-rikice da sake aiki idan aka kwatanta da gyare-gyare mara ƙarfi. Wani bazuwar, bincike mai yiwuwa na tsakiya da yawa kuma ya ba da rahoton sake yin aiki ko alamun bayyanar CMN a cikin rukunin da aka ƙarfafa suminti idan aka kwatanta da lokuta shida a cikin rukunin da ba a ƙarfafa su ba.

Mutuwar karaya ta hip yana da yawa. Binciken da aka yi kwanan nan ya bayyana adadin mace-mace a cikin asibiti na 3-7%, tare da raguwar mace-mace na shekara guda daga 19.4% zuwa 58%. Musamman, an nuna raunin IT don lissafin kashi 27% na mace-mace a shekara guda. Jerin mu na asibiti ya nuna babu mace-mace a cikin asibiti da kuma yawan mace-mace na shekara guda na 13.6%, wanda ya yi ƙasa kaɗan idan aka kwatanta da wallafe-wallafe. Saboda motsin gado na farko bayan tiyata yana da alaƙa da ƙananan mace-mace, kyakkyawan ɗaukar hoto da sakamakon aiki a cikin jerinmu na iya yin bayanin ƙarancin mace-mace da aka gani a cikin marasa lafiyarmu.

Kammalawa

Ƙaddamar da gyaran gyare-gyaren ciminti yana da tasiri, mai aminci, da kuma farashi mai mahimmanci don rashin lalacewa na ƙayyadaddun ƙwayar cuta ta intertrochanteric a cikin tsofaffi marasa lafiya tare da isasshen kashi kashi acetabular.

Marasa lafiya tare da gazawar gyaran gyare-gyare na farko na raguwa na intertrochanteric wanda ya biyo bayan gyaran gyare-gyare da gyaran gyare-gyaren ciminti sun nuna kyakkyawan sakamako na asibiti na tsawon lokaci da ingancin rayuwa. An yi amfani da hanyar ne kawai a cikin lokuta inda aka kiyaye yawancin sararin samaniya na acetabular kuma ƙusa na kai ya kasance a cikin wuyan mace. Yin la'akari da iyakokin gyaran gyare-gyare na arthroplasty a cikin marasa lafiya tsofaffi marasa lafiya, wannan hanya tana nuna alƙawari a cikin aminci da kuma rage yawan rikitarwa mai tsanani yayin da rage lokacin aiki da farashi a cikin wannan rukunin marasa lafiya.

Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?

Domin CZMEDITECH , muna da cikakken samfurin layi na kayan aikin tiyata na orthopedic da kayan aiki masu dacewa, samfurori 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.

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