Kuvura Arthroscopic yimpuguke yinyuma

Uruhu rwinyuma rwinyuma rusanzwe ruterwa no kwigomeka byihutirwa cyangwa bisubizwamo ibikomere bidafite ishingiro mugihe cyimyitozo cyangwa ibindi bikorwa, hamwe nigipimo cyumwaka rusange cyimanza 4.64 kumyaka 100000 kumwaka. Ubuhanga butandukanye bwo kubaga bwo kuvura urutugu rwinyuma rwinyuma rwasobanuwe, harimo gusana tissue yoroheje no gufungura amagufwa afunguye kandi arthroscopic yo kubaga. Icyakora, raporo yo kubaga no gusubiramo ibiciro byongeye ari hejuru ya 14% na 67%. By'umwihariko, gushira neza kw'amagufwa, icyerekezo cya screw no kuvura ibisambo byumvikana bifatwa nkibigoye. Kubwibyo, ubuhanga bwo kubaga bugomba kunozwa.

INTAMBARA:

• Iki gikorwa cyakozwe hakurikijwe anesthesia rusange yahujwe na sulcule yo mukarere ya sulcus.

• Kubyegeranyo bya Iliac Crest, anesthetike yakoreshejwe muburyo butagaragara kandi byateganijwe.

• Umurwayi yashyizwe mu ntebe y'inyanja hamwe n'umugongo kuri 45 ° kwemerera guhuza byuzuye na crest ya iliac. Nyuma yo guhindura amagufwa yasaruwe, iki gikorwa cyarakomeje, kandi umurwayi yari yicaye ku mpande 70 °. Umurwayi yahagaritswe mu buryo busanzwe bworoshye, kandi ukuboko gukorera kwaranze kujya imbere 30 ° kugeza ku mugozi wa 2 kugeza kuri 3.

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Isuzuma rya Arthroscopic

• Ubu buryo bukoresha ibirindiro bibiri cyangwa bitatu. Imbere yambere (E) Kwinjira birashobora gukoreshwa mubushakashatsi buhuje neza.

  
  

• Imvugo irashobora gutangizwa muburyo butaziguye binyuze muri rotator. Rimwe na rimwe, ntibishoboka kumenyekanisha urwego (ni ukuvuga, ibituro by'inkovu bikikije intera ya rotator).

  
  

• Urashobora gukora feri yinjira cyangwa kuruhande rwa M yimbere, kugirango ubashe kwinjira mu mwanya wa Acromair, kugirango ubashe kwitegereza umwanya wa rotator.

  
  

• Guhindura radiofrequince yakoreshejwe mugukingura intera ya rotator.

  
  

• Inguzanyo ya Toggle ihagaze neza binyuze muri e byinjira kugirango uhindure urutonde kugeza kumurongo wimbere.

  
  

• Nyuma yo gusuzuma ibintu byuzuye, ibikomere byoroshye bya tissue hamwe nibitambo byamagufwa bya glenoid na gamer.

  
  

• Nyuma yo gusuzuma neza Arthroroscopic yo gusuzuma hamwe na glenoMumera no kwemeza ibimenyetso bikwiye, byabonetse.

  
  

Gusarura amagufwa no kwitegura

• Aucortike Autograft yabonetse muri Isteriateral Andeac Crest kugirango ibungane imbere yimbere ya pelvis. Kora uruhu rwa 2cm inyuma ya 2cm inyuma yumugongo wo hejuru wa Iliac Spine na 2Cm munsi yimbere kuruhande rwa Iliac kugirango wirinde kwishyiriraho igicucu gitwikiriye neza Crest.

  
  

• Nyuma yo kwitegereza amagufwa cortical α na β β imikino ibiri ibangikanye na cortex yinjijwe mu mwobo, yaba ifite ibikoresho bibiri bya coracopique mu gikoresho cya Arthroscopic (Igishushanyo 1).

  
  

• Ikiganza cy'Ubuyobozi cyerekanwe hejuru kugirango ubukungu bushobore buhuye nijosi ryibanze rya Glenoid. Gushyira ubuyobozi bituma guhitamo umusozi wo hejuru nkuruhande rwa articular yigufwa.

  
  

• Noneho, kanda inzira ya coracoid ya coracoid yintambwe yoroheje ya kirschner wirchner wirs hanyuma ugacukura umwobo babiri 2.9mm mumagufwa. Umuyoboro bit na kirscrener pin wavanyweho. Mbere yo kwinjiza cap Cap washenguye umwobo wa drill, kanda umwobo ufite kanda ya Top.

  
  

• Iyo igisimba cyo hejuru kimaze kubamo, koresha icyuma cyabonye cyangwa amagufwa kugirango uzigame cortex yo hagati ya crest kandi gusarura 2-cm × 1-cm × 1-cm × 1-1 na 3). Nyuma ya Graft imaze gusarurwa, igufwa ihujwe na coracoid sleeve hamwe na coracoid ebyiri ndende ya coracoid ikoreshwa mugukora igice gishobora gushyirwaho igice cyanyuma (Ishusho 4).

  
  

• Igikomere cya Iliac cyari gifunze igice kimwe nigituba cyamazi no kwambara byakoreshejwe. Noneho hindura inyuma yameza yo gukora kugeza kuri Angle ya 70 °.

Igishushanyo 1. Amagufwa meza ya Crest yakusanyirijwe mugihe umurwayi yari mumwanya wa Beach. Abashitsi bombi bakurikiranwa hamwe nibikoresho bibiri biyobora bwa cannula, kandi ikiganza cya onnula kiri hejuru. .

Igishushanyo cya 2. Iyo umurwayi ari mumwanya wa Beach, amagufwa yiburyo bwa Iliac Iburyo bwafashwe. Kuraho drill Bit na Kirscner Wire nyuma yo gucukura urubuga rwa Iliac Crest Cortex, hanyuma ushiremo 2 'ingofero '. .

Igishushanyo cya 3. Iyo umurwayi ari mumwanya wa Beach, amagufwa yiburyo bwa Iliac Iburyo bwafashwe. Ubuso bwimbere bwa Iliac Crest bukomeza kuba bwiza nyuma yuburyo busarurwa. (Ikimonyo, imbere; inf, hepfo; ni, imbonerahamwe yimbere; post, inyuma; sup, hejuru.)

Igishushanyo cya 4. Tegura amagufwa kumeza kuruhande. Ubuyobozi bumaze gusarurwa, mu rugendo rw'amagufwa yahujwe na karnula ebyiri akoresheje abajura babiri ba cannura. .

Indogobe yumuhanda winyuma no kubona imihanda

• Mubisanzwe imiyoboro ibiri kugeza kuri eshatu irakoreshwa. Intego ni uguhuza inyuma yinyuma hamwe numurongo wa GlenoMaral uhuriweho uko bishoboka. Kubwibyo, igenzurwa na Arthroscope. Kubwibyo, bikozwe ahanini nyuma yo gukora kuva kuruhande rwimbere.

  
  

• Kwinjira muri Anterolate e bishyirwa mu mitsi yo muri Rotator hejuru yimitsi ya Biceps, ishobora kwerekana neza igice cyinyuma cyuruhande rwa Glenoid (Imbonerahamwe 1).

  
  

• Mubihe byinshi, nta miyoboro ikenewe; Ariko, nibiba ngombwa, inyongera yinyongera b urubuga binyuze muri cuff yinyuma irashobora gukoreshwa (urugero, gucunga prostate yuzuzanya).

  
  

• Nibyiza, ubwinjiriro A iherereye neza kumurongo wumurongo wa GlenoMumeral.

  
  

• Unyuze imbere kandi inyuma yinjira e, shyiramo urushinge rwa 2 uruti rw'umugongo ku ntera ya cm 2,5 kugeza kuri 3, hanyuma ushiremo imyanya ihwanye na saa moya n'igice cy'iburyo).

  
  

• Kora uruhu hagati yinshinge 2 hanyuma uyikoreshe nkurwego rwinyuma (imibare 5a na b).

Igicapo 5. Kugirango ugere ku guhuza neza inyuma yinyuma hamwe numurongo uhuriweho numurongo wa glenoMuzabaga, inshinge ebyiri zinjijwe inyuma kugirango umenye ikimenyetso cyuruhu.

. (Ikimonyo, Imbere; DCG, ubuyobozi bubiri bwa kansela; Gle

Gutegura Glenoid

• Igikoresho cyatangijwe binyuze inyuma (a) inlet.

  
  

• Kuraho labrum na capsule yinyuma kuva 7 kugeza 10 (igitugu iburyo) ukoresheje impfabusa na ozor (Ishusho 6a na b, amashusho 1).

  
  

• Gusya Ijosi rya Glenoid Imbere hamwe na Arthroscopique kugeza amagufwa yo kuva amaraso ahagaragara kandi indege yateguwe (Ishusho 7). Ijosi rya Glenoid rimaze kwitegura, inyuma yinyuma iragukara kugirango yemererwe kunyuramo na kamere ya coracoid.

  
  

• Igicapo kirashobora gukoreshwa muguka kwagura imitsi na Cystotomy, mugihe trokar yumye ya crokar (subscapilar igice) irashobora gukoreshwa mukwiyamamaza (Ishusho 8).

Igicapo cya 6. Mugihe cyo gutegura glenoid, koresha impfabusa na ozor kugirango utandukane iminwa ya glenoid hamwe na capsule yinyuma kuva 7h00 kugeza 10h00. (Ikimonyo, imbere; gl, glenoid; hh, umutwe wubuto;

Igishushanyo cya 7. Kwerekana Arthroscopique yo gutegura Glenoid: Umurwayi yicaye ku nguni ya 70 °, urutugu rwiburyo, ebral. Kwambara ijosi rya Glenoid yinyuma mugihe cyo gutegura Glenoid. (Ikimonyo, imbere; b, burr; gle, glenoid; inf, hepfo; pgn, inyuma, inyuma

Igishushanyo cya 8. Kwerekana Arthroscopique yo gutegura Glenoid: Umurwayi yicaye ku nguni ya 70 °, urutugu rwiburyo, ebral. Kwagura uruzitiro rwinyuma hamwe na crokar ihindagurika. (Ikimonyo, imbere; bt: glcar; gle

GUKURIKIRA NO GUSOHORA

Urwego rwashyizwemo ubwinjiriro bwinyuma hamwe nintoki zireba (Ishusho 9) kandi zigabanyijemo imitsi na capsule ya glenoid hanyuma ikongerera hamwe nubuso bwa articular ya glenoid. Iyi ntambwe ikeneye kwibanda kugutegura kugabana, cyane cyane ifungura infraspinatus kandi ikomeye infraspinatus kandi ikumira igice cya graft.

• Ni ngombwa gukoresha icyuma cyo gufungura faecia cyane. Nibiba ngombwa, mugice cyakurikiyeho kubagwa, niba kunyerera ari ngombwa cyane kubungabunga igitutu gihagije ku rutugu, ibikoresho birashobora gukoreshwa mu gufunga igice cyo kubaga (urugero, amashusho ya gikomere).

  
  

• Cannula ya coracoid irashyirwa hejuru yubuso bwa articular kugirango insinga za Kirsclene zikurikira kandi imigozi idahwitse mugihe cyo kwinjiza.

  
  

• Imitsi miremire ya MM ebyiri 1.5 yashyizwemo binyuze muri coracoid ya coracoid kugirango ukosore ikibuno ku ijosi rya posteri Ijosi rya Glenoid (FIG. 10).

  
  

• Kwinjiza insinga za kirscrean ntigomba kurenga 40mm kugirango wirinde kunyura mu ijosi rya Glenoid Imbere, nubwo igice cyimitsi yimbere yimbere, nubwo igice cyimitsi yinyuma iri hagati yijosi nuburyo bwa neurovascular kugirango birinde.

Igishushanyo cya 9. Umurwayi yinjijegamo ubumuga mumwanya wa 70 ° wicaye, maze yitegereza urutugu rwiburyo hamwe nimpande zibi. Graft yinjijwe mu bwinjiriro bwinyuma hamwe nintoki zireba hejuru. .

Igishushanyo cya 10. Kwerekana Arthroscopique yo gukurikiranya ikibanza, umurwayi yicaye kuri 70 ° inguni, urutugu rwiburyo, e kwinjira. Ibikoni bibiri byinjijwemo pin biratera imbaraga ku ijosi rya posteri Imbere. .

Kuva 30 ° arthroscope ireba imbere yimitsi yimbunda, mubisanzwe ikunda guhindagurika ku mpande, bigatuma ubuso bwo hepfo bugaragara aho kugororoka. Ni ngombwa kugenzura niba graft igufwa iracyashoboka nyuma yo gushyira mu rungano.

• Ubuyobozi bumaze kurasa hamwe na pornoid ya Glenoid, kura muri coracoid ndende ndende hanyuma igakuramo umuyoboro wa 3-2 mugari wa bicortique glenoid kuri win.

  
  

• Muri iyi ntambwe, ni ngombwa gukomeza gukomeza imyitozo ya mbere. Abakozi b'abafasha bagomba gukomeza amaboko yombi (Ishusho 11).

  
  

• Igomba kwitegura gushyira umurwanyi wa gatatu pin mu mwobo, kuko krscrener pin mumwanya wambere ufatwa nabi kubushake na drill bit.

  
  

• Ubuvuzi bugomba gukorwa kugirango budakuraho insinga ya kirscreand iyo bakuramo drill bic bikubiye mumaboko ya coracoid. Noneho, shyiramo MM ya 4.5 Urutonde rwa Ladorjet yashinze insinga ya kirscrener (fig. 12) Kandi shyiramo byimazeyo kugirango wirinde guhindurwa kwimura, hanyuma ugacisha imigozi yo hejuru. Byaba byiza, uburebure bwakubitwa ntibukwiye kurenga mm 32 kugeza kuri 36.

  
  

• Uburebure burenze mm 40 burasaba gusuzuma neza, kuko ibi bishobora guterwa ninguni ihanamye ugereranije nubuso bwa glenoid, bushobora gutuma yibasiye uruzitiro. Kuri iki cyiciro, urwego rwa Graft rushobora gukosorwa mu kuzunguruka glenoid kuzenguruka hasi.

  
  

• Nyuma yo gushyiramo screw (hepfo), pin ya mbere ya Kirschner irashobora kuvaho. Shyiramo screw ya kabiri muburyo bumwe.

  
  

• Nyuma yo kwinjiza imigozi 2 kandi ukureho insinga za kirscreane, koresha ikipe yinjira kugirango urebe imyanya yanyuma (Ishusho 13). Ibice byose byateganijwe bya Graft bigomba gutondekwa na burrs, kandi nta gusanwa byoroshye tissue bigomba gukorwa kugirango birinde gukomera.

Igishushanyo cya 11. Inyenzi yari ihagaze kandi ikosowe. Umurwayi yicaye ku nguni ya 70 ° hamwe n'urutugu rwe rw'iburyo rwarekuwe hejuru. Mugihe na nyuma yo gukomangirira, komeza Guyingabo aracyari amaboko yombi kugirango abuze k umurongo wo kurekura umuyoboro. .

Igicapo cya 12. Kwerekana Arthroscopique yo gukosora Urubingo, umurwayi yicaye kuri 70 ° angle, urutugu rwiburyo, kureba ireme. Hepfo 4.5mm igice cyigice cya ladoriet screw screw izaba yambere hejuru ya kirschner pin. .

Igishushanyo cya 13. Kwegera Arthroscopique yo gukurikiranya ikibanza, umurwayi yicaye kuri 70 ° inguni, urutugu rwiburyo, e kwinjira. Nyuma yo kwinjiza imigozi ibiri no gukuraho Kirchner Wire, reba umwanya wanyuma. Ubu bwoko bwamagufwa afite uburyo bwiza kandi nta mwanya wishimye. .

Nyuma yo kubagwa, igitugu cyashizweho na 20 ° gushimuta no kuyobya ibyumweru 6:

• Bukeye bwaho, tangira urutugu rwa pasiporo, inkokora hamwe nimyitozo yimyitozo ngororamubiri. Kugaragaza no kugenda bibabaza bigomba kwirindwa.

  
  

• Mugihe cibyumweru 3, tangira inzira zifatika.

  
  

• Nyuma yo gushikama kwemezwa no gufata amafoto ibyumweru 6 nyuma yo kubagwa, imyitozo ikomeye irashobora gutangira.

  
  

• Kubakinnyi bashaka gukira vuba, tomografiya ya mudasobwa igomba gukorerwa amezi 3 nyuma yo kubagwa kugirango usuzume inderution.

  
  

Nigute wagura amagufwa hamwe nibikoresho bya orthopedic?

Kuri Czmeditech , dufite umurongo wuzuye wibicuruzwa byubasaguro orthopperic bitera kandi nibikoresho bihuye, ibicuruzwa birimo Umugongo, Intramedillary Imisumari, Isahani, gufunga isahani, cranial-maxillofacial, prostas, ibikoresho by'ingufu, ibicuruzwa byo hanze, arthroscopy, Kwitaho ku matungo n'ibikoresho byabo byo gushyigikira.

Byongeye kandi, twiyemeje guhora dukura ibicuruzwa bishya no kwagura imirongo yibicuruzwa, kugirango duhuze ibyifuzo byabaganga nabarwayi benshi, kandi binatuma sosiyete yacu irushanwa mubicurarango byose bya orttopedic.

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