Watya singa okunyweza okw’omunda okw’okumenya kwa inter rotator kulemererwa?

Okumenya ebisambi bibalirirwamu okukosa abantu abakulu 500,000 mu Amerika buli mwaka. Zirina kinene nnyo kye zikola ku mutindo gw’obulamu, mu kiseera kino zikola ebitundu 3-7% ku kufa mu ddwaaliro n’omuwendo gw’abafa ogw’omwaka ogumu ogwa 19.4-58%. Nga kitundu ku bitundu byonna eby’okumenyeka kw’ekisambi biba bimenyeka wakati (IT). Ebintu ebibiri ebisinga okuteekebwamu ebikozesebwa okubujjanjaba bye bitundu by’omusumaali ebiyitibwa cephalomedullary nail (CMN) ne sliding hip screw (SHS).

Wadde nga waliwo enkulaakulana mu tekinologiya, okutaataaganyizibwa kw’amagumba n’okugwa kw’okunyweza ng’okuyingira kw’omutwe gw’ekisambi kukyaliwo era kiyinza okusaanyaawo ebintu. Okunoonyereza okwakakolebwa kulaga nti emiwendo gy’okusalako ebitundu 6% nga giteekeddwamu ebyuma eby’omulembe. Ebintu ebiyinza okuvaako okulemererwa okunyweza mulimu ebanga ly’ensonga (TAD) >25 mm, okuddamu okuteeka okumenya okutali kwa maanyi, enkola z’okumenya okutali kwa nnywevu, ebisipi by’omutwe ebisangibwa ku mabbali oba wansi w’omu makkati g’omutwe gw’ekisambi, n’okuzimbulukuka okw’omunda okw’enkoona y’ekikolo ky’omumwa gwa nnabaana. Okukaddiwa n’okuzimba amagumba nabyo bikwatagana n’okulemererwa okunyweza.

Abalwadde n'enkola .

Kino kyali kinoonyereza okudda emabega ku balwadde abajjanjabirwa mu bitongole bibiri ebisangibwa mu nkola y’ebyobulamu mu kibuga ekinene. Ebiwandiiko by’abasawo babiri abalongoosa (JS ne BC) byabuuzibwa abalwadde bonna abafuna okunyweza okuddamu okutunula mu seminti nga banywezeddwa oluvannyuma lw’okulemererwa okusooka okunyweza okumenya kwa IT okuva mu January 2018 okutuuka mu September 2021, oluvannyuma lw’okukkirizibwa olukiiko olukebera ebitongole. Okukozesa okunyweza seminti mu kiseera ky’okulongoosa okuddamu kwakakasibwa okuyita mu biwandiiko by’abasawo eby’amasannyalaze (EMR) okwekenneenya ebiwandiiko by’okulongoosa n’ebifaananyi eby’oku leediyo oluvannyuma lw’okulongoosebwa. Twassaamu abalwadde bonna abalina obubonero bw’okunyweza seminti mu kunyweza okuddamu okutunula oluvannyuma lw’okulemererwa okunyweza CMN oba SHS okulemererwa kwa IT (Figure 1). Twaggyako abalwadde abalina obulwadde bw’ensingo oba okumenya kw’omugongo, abalwadde abataddamu kutunula mu kuddamu okutunula nga banyweza seminti, n’abalwadde abaalongoosebwa mu kiseera ky’okulongoosebwa okusooka okuddamu okutunula.

Ekifaananyi 1. Omukyala ow’emyaka 76 yakola emisumaali egy’omu lubuto olw’okumenya wakati w’ekisambi (A), n’obulumi obutasalako mu kisambi oluvannyuma lw’emyezi 2 olw’okutemebwako okuteekebwamu (B).

Obukodyo bw'okulongoosa .

Ku balwadde abafuna okunyweza okusooka ne CMN, twakola okukyusa omusumaali gw’omutwe ogwakyusibwa n’okunyweza seminti w’amagumba. Mu kusooka, okusalako sentimita 5 kwakolebwa ku ludda olw’okumpi olwa trochanter omunene, waya y’okulungamya yateekebwa mu ludda olw’okumpi olw’omusumaali, era eggumba lyonna ne liggyibwa ku ludda olw’okumpi olw’omusumaali nga bakozesa ekyuma ekiggule. Ekiddako, sikulaapu ey’enjuyi omukaaga yakozesebwa okusumulula sikulaapu y’okunyweza waggulu ku CMN (Ekifaananyi 2).

Ekifaananyi 2, Okulongoosa mu kulongoosa nga kulaga ekiwujjo eky’enjuyi omukaaga nga kikwatagana n’okusumulula sikulaapu eyateekebwako emisumaali emabegako.

Olwo ekitundu kya sentimita 1-2 ekisalasala (transverse incision) kikolebwa wansi nga kiyita mu fascia (ITB) eky’omumwa gwa nnabaana (ITB). Omusumaali gw’omutwe ogwasooka guggyibwamu n’ekiragiro ekiwandiikiddwako obuwuzi obudda emabega (Figure 3). Mu mbeera y’okukutuka kw’omutwe gw’ekisambi, ekiragiro ekirina ekituli ekirina sikulaapu ekugira ewala ekozesebwa okusobola okuziyiza okukulukuta kwa seminti mu kiyungo (Figure 3A). Okusingira ddala, matrix yasooka kufuyirwa oluvannyuma lw’okuggyawo layers bbiri ez’ebweru eza triple cannula n’oluvannyuma n’eteekebwa mu kifo ekirimu ebituli nga ziddamu okuyingiza layers bbiri ez’ebweru.

Ekifaananyi 3, ebifaananyi eby’omu maaso (a) n’eby’ebbali (b) eby’omulwadde omulala ng’alaga omutwe gw’ekisambi nga guliko ekitundu ky’amagumba eky’omu makkati.

Ekiddako, ekitundu ky’omubiri kisitulwa olwo okumenya ne kiddamu okuteekebwa mu kifo ekisingawo eky’okunyweza eky’okuddamu okutunula mu nsonga. Mu mbeera y’okuwona okutali kwa malunion oba okuwona okw’obuwuzi, okusala amagumba okuyita mu lususu kukolebwa nga tukozesa 1/4' bone gouge n’enkola ey’omu maaso. Kino tekitera kwetaagisa, naye nga kikola nnyo nga kyetaagisa okukola enkoona y’ekikolo ky’omumwa gwa nnabaana erongooseddwa (target >130°).

Olwo sikulaapu empya oba ekyuma ekiwujjo (spiral blade) kiteekebwa mu ggumba erya subchondral mu mutwe gw’ekisambi okuyita ku kikondo ky’ensingo y’ekisambi, ng’okakasa nti weegendereza obutayingira mu mutwe (Ekifaananyi 4). Sikulaapu eteekebwa mu bugenderevu okwewala omusumaali ogwasooka, naye nga gukyasonga ku nkomerero wakati mu mutwe gw’ekisambi. (Ekifaananyi 5) .

Ekifaananyi 4, ebifaananyi eby’omu maaso (a) n’eby’ebbali (b) eby’omulwadde omulala ebiraga okuyingiza empiso y’okusimbula mu kkubo ly’omusumaali gw’omutwe omupya.

Ekifaananyi 5, Okulongoosa mu kulongoosa nga kulaga okuyingiza ekyuma ekipya eky’omubiri ekiyitibwa cephalomedullary blade okumpi n’ekkubo lya waya ezilungamya, oluvannyuma ne kinywezebwa sikulaapu eteekeddwawo.

N’ekisembayo, omutwe gw’ekisambi gujjula seminti w’amagumba nga tukozesa enkola ya seminti w’amagumba agakubwa empiso (Figure 6). Obulabirizi bukolebwa okwewala okufulumya mu kiyungo nga tukozesa ebifaananyi ebikuba ebifaananyi mu kiseera ekituufu n’okutereeza obuziba n’obuwanvu bwa kanyula ya seminti.

Ekifaananyi 6, okukuba ebifaananyi ebiraga okweyongera kwa seminti mu kusooka (a), okujjuza mpolampola (b) okutuusa ng’omutwe gw’ekisambi gujjudde (c).

Ku balwadde abafuna okunyweza okusooka kwa SHS, tuggyawo SHS ne tuteeka CMN empanvu. Oluvannyuma lw’okukola okusalako sentimita 5 wakati wansi w’ekitundu ekinene eky’obutiti n’okuzuula ITB, okusala kusalwako wansi ku pulati ey’ebbali. Sikulufu za pulati zonna ziggyibwamu nga tukozesa sikulaapu y’omukono entuufu olwo ebbakuli ey’ebbali n’eggyibwamu. Olwo ebikulukusi ebisika biggyibwawo n’ekiragiro ky’obuwuzi obudda emabega nga bwe kyayogerwako emabegako okuddamu okuteeka okumenya ku ddaala erisingawo erya valgus. Olwo okusalako sentimita 5 ne kukolebwa ku ntikko y’ekitundu ekinene eky’obutiti nga bwe kyayogerwako emabegako. Waya eraga ekiragiro (guide wire) eyingizibwa ku nkomerero esinga okubeera okumpi ey’ekitundu ekinene eky’obutiti (greater trochanter) n’egenda mu maaso mu kikolo ky’ekisambi. Reamer enzigule eyingizibwa mu kkubo lya ndagiriro. Olwo ekyuma ekiwanvu ekiyitibwa ball-tipped guidewire ne kiyingizibwa mu makkati g’omugongo ogw’ewala wansi w’omutindo gwa patella. Ekiddako, progressive reaming yakolebwa okutuusa okukankana lwe kwawulirwa mu mugongo. Abalwadde baffe bonna baafuna omusumaali omuwanvu ogwa CMN nga guliko enkola ya TFN-advanced (TFNA) proximal femoral intramedullary nailing system (Depuy-Synthes, Raynham, MA).

Okuteesa

Enkola yaffe ekozesa okunyweza seminti w’amagumba mu kiseera ky’okuddamu okutunula mu nsonga. Okunyweza seminti w’amagumba okusobola okunyweza okusooka okumenya kw’omugongo ogw’okumpi n’amagumba kubadde kusomeseddwa era kulaze ebivaamu ebirungi eby’obulamu n’eby’obujjanjabi. Okuddamu okwetegereza okwakakolebwa kwalaga nti okunyweza seminti w’amagumba kwavaamu emigugu egy’okulemererwa egy’amaanyi, okukendeera kw’okusengulwa kw’ebintu ebiteekebwa mu mubiri, n’okuzibuwalirwa okutono n’okuddamu okulongoosebwa bw’ogeraageranya n’okunyweza okutali kwa kunyweza. Okunoonyereza okwakolebwa mu ngeri ey’ekifuulannenge, okusuubirwa mu bifo bingi era kwalaga nti tewali kuddamu kulongoosebwa oba ebiseera eby’obubonero bwa CMN okusengulwa mu kibinja ekinyweza seminti bw’ogeraageranya n’emisango mukaaga mu kibinja ekitali kinywevu.

Okufa kw’emmeeme okumenya ekisambi kuli waggulu. Okunoonyereza okwakakolebwa kunnyonnyodde omuwendo gw’abafa mu ddwaaliro ebitundu 3-7%, ng’okufa kw’omwaka gumu kukendeera okuva ku bitundu 19.4% okutuuka ku 58%. Okusingira ddala, okumenya kwolesebwa nti kukola ebitundu 27% ku kufa ku mwaka gumu. Series yaffe ey’obujjanjabi yalaga nti tewali kufa mu ddwaaliro n’okufa kw’omwaka ogumu okwa 13.6%, ekintu ekitono ennyo bw’ogeraageranya n’ebiwandiiko. Olw’okuba okutambula kw’ekitanda nga bukyali oluvannyuma lw’okulongoosebwa kukwatagana n’okufa okutono, okutambula okulungi n’ebiva mu mirimu mu lunyiriri lwaffe biyinza okunnyonnyola okufa okutono ennyo okwalabiddwa mu balwadde baffe.

Mu bufunzi

Okunyweza okuddamu okunyweza seminti nkola nnungi, ya bulabe, era ekendeeza ku nsimbi ku kulemererwa kw’okumenya okumenya wakati w’ebitundu ebitali bikwatiddwa mu balwadde abakadde abalina amagumba agamala ag’omu bbanga.

Abalwadde abalina okulemererwa okunyweza okumenya kwa primary intertrochanteric nga bagobererwa okuddamu okutereeza okuddamu okutunula n’obujjanjabi obunyweza seminti balaze ebirungi eby’ekiseera ekiwanvu eby’obujjanjabi n’omutindo gw’obulamu. Enkola eno yakozesebwa mu mbeera zokka nga ekitundu ekisinga obunene eky’ekitundu ky’omubiri ekiyitibwa acetabular articular surface kyakuumibwa era omusumaali gw’omutwe ne gusigala nga gubeera mu bulago bw’ekisambi. Okulowooza ku buzibu bw‟okuddamu okulongoosa ebitundu by‟omubiri mu balwadde abakadde aba frailer, enkola eno eraga okusuubiza mu kukendeeza ku buzibu obw‟amaanyi era obulungi ate nga bakendeeza ku budde bw‟okulongoosa n‟omuwendo mu kibinja kino eky‟abalwadde.

Engeri y'okugulamu amagumba agateekebwamu amagumba n'ebikozesebwa mu kuzimba amagumba) .

A CZMEDITECH , tulina ekintu ekijjuvu ennyo eky'ebintu ebiteekebwa mu kulongoosa amagumba n'ebikozesebwa ebikwatagana, ebintu omuli Ebisimbibwa omugongo ., Emisumaali egy'omu lubuto ., Ekipande ky’okulumwa obuvune ., Essowaani y’okusiba ., Omutwe-Maxillofacial ., Prosthesis ., Ebikozesebwa mu maanyi ., Abatereeza eby’ebweru ., Okukebera ebinywa ., Obulabirizi bw’ebisolo n’ebikozesebwa byabwe ebibayamba.

Okugatta ku ekyo, twewaddeyo okukola ebintu ebipya obutasalako n’okugaziya layini z’ebintu, okusobola okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde abawera, era n’okufuula kkampuni yaffe okuvuganya ennyo mu nsi yonna ey’amagumba n’amakolero g’amagumba.

Tufulumya ebweru mu nsi yonna, kale osobola . Tukwasaganye ku email address song@orthopedic-china.com okufuna quote ey'obwereere, oba weereza obubaka ku WhatsApp okufuna eky'okuddamu eky'amangu +86- 18112515727 .

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