Kuvura arthroscopique yo kuvura inyuma yigitugu

Guhungabana kw'igitugu inyuma biterwa no kwimura inyuma cyangwa gukomeretsa byoroheje mu gihe cy'imyitozo ngororangingo cyangwa ibindi bikorwa, buri mwaka umubare w'abantu bandura 4.64 ku bantu 100000 ku mwaka. Uburyo bwinshi bwo kubaga uburyo bwo kuvura ibitugu byinyuma byasobanuwe, harimo gusana imyenda yoroshye no kubaga amagufwa ya arthroscopique. Nyamara, raporo zatewe no kubaga no kubisubiramo byari hejuru ya 14% na 67%. By'umwihariko, gushyira neza ibihangano byamagufwa, icyerekezo cya screw no kuvura ibikomere bihuye bifatwa nkibigoye. Kubwibyo, tekiniki zo kubaga zigomba kunozwa.

Intambwe zo gukora:

• Igikorwa cyakozwe muri anesthesia rusange hamwe no guhagarika akarere ka sulcus intermuscular.

• Kubikusanyirizo bya iliac, anesthetike yaho yakoreshwaga munsi yubutaka na periosteally.

• Umurwayi yashyizwe mu ntebe yinyanja ninyuma kuri 45 ° inguni kugirango yemere byimazeyo na iliac crest. Nyuma yo guhindurwa amagufwa, igikorwa cyarakomeje, kandi umurwayi yari yicaye ku mfuruka ya 70 °. Umurwayi yahagaritswe muburyo busanzwe bwa sterile, kandi ukuboko kubaga kwunamye imbere ya 30 ° binyuze mumugozi wa kg 2 kugeza kuri 3.

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Isuzuma rya Arthroscopic

• Ubu buryo bukoresha ibyinjiriro bibiri cyangwa bitatu. Ubwinjiriro bwambere (E) burashobora gukoreshwa mubushakashatsi bunoze.

  
  

• Impinduka zirashobora kwinjizwa muburyo butaziguye binyuze muri rotate intera. Rimwe na rimwe, ntibishoboka kumenyekanisha mu buryo butaziguye urugero (ni ukuvuga ingirangingo zinkovu zizenguruka intera).

  
  

• Urashobora gukora uruzitiro rwa C cyangwa uruhande rwimbere rwa D, kugirango ubashe kwinjira mumwanya munsi ya acromion peak, kugirango ubashe kwitegereza umwanya wimitsi ya rotator.

  
  

• Arthroscopic radiofrequency ablation yakoreshejwe mugukingura intera.

  
  

• Toggle lever ihagaze muguhuza binyuze muri E kwinjira kugirango uhindure intera ihujwe imbere.

  
  

• Nyuma yisuzumabumenyi ryuzuye ryihuriro, hasuzumwe ibibyimba byoroheje byumubiri hamwe nibisebe bifitanye isano no gutakaza amagufwa ya glenoid na humeral (ni ukuvuga umunwa winyuma wa glenoid, imitsi ya capsule, glenoid marginal lesion hamwe na Hill Sachs lesion).

  
  

• Nyuma yo gusuzuma neza arthroscopique ya glenohumeral hamwe no kwemeza ibimenyetso bikwiye, habonetse ibihangano byamagufwa.

  
  

Gusarura amagufwa no kuyitegura

• Autograft ya bicortical yabonetse mu mpande zombi imbere ya iliac kugirango ibungabunge cortex y'imbere yigitereko. Kora uruhu rugera kuri 2cm inyuma yumugongo wimbere usumba iliac na 2cm munsi yigitereko kuruhande rwa iliac kugirango wirinde inkovu zitwikiriye neza.

  
  

• Nyuma yo kwitegereza amagufwa ya cortique α na β Amapine abiri abangikanye na Kirschner yinjijwe muri cortex yegeranye anyuze mu mwobo, mbere yari afite ibikoresho bibiri birebire bya coracoid biva mu gikoresho cya Arthroscopic Latarjet (Ishusho 1).

  
  

• Ikiganza kiyobora cyerekejwe hejuru kugirango igufwa ryamagufa rishobora guhuzwa muburyo budasanzwe nijosi ryinyuma rya glenoid. Ishyirwa mu buyobozi ryemerera guhitamo umusozi wo hejuru nkuruhande rwumutwe wamagufwa.

  
  

• Noneho, kanda intambwe ya coracoid itobora intambwe kumurongo wa Kirschner hanyuma ucukure imyobo ibiri 2.9mm mumagufwa. Imyitozo ya biti na pin ya Kirschner byavanyweho. Mbere yo kwinjiza isabune yo hejuru hejuru mumwobo, kanda umwobo hamwe na kanda yo hejuru.

  
  

• Iyo umupira wo hejuru umaze gushyirwaho, koresha icyuma cya swing cyangwa icyuma cyamagufwa kugirango ubungabunge cortex yo hagati yigitereko cya iliac hanyuma usarure cm-2 × 1-cm × 1-cm (ibishushanyo 2 na 3). Nyuma yo gusarura, igufwa ryamagufwa rihuzwa nintoki ya coracoide kandi imigozi ibiri miremire ya coracoid itunganijwe ikoreshwa mugukora igice gishobora gukoreshwa kumwanya wacyo wanyuma (Ishusho 4).

  
  

• Igikomere cya iliac cyafunzwe kumurongo hamwe numuyoboro wamazi kandi kwambara byarakoreshejwe. Noneho hindura inyuma yimeza ikora kumurongo wa 70 °.

Igicapo 1. Iburyo bwa iliac crest igufwa ryegeranijwe mugihe umurwayi yari mumwanya wintebe yinyanja. Inshinge ebyiri za Kirschner zishyizwe hamwe hamwe nibikoresho bibiri byo kuyobora urumogi, kandi ikiganza cya cannula kiri hejuru. (Ikimonyo, imbere; DCG, icyerekezo cya kabiri; Inf, Post yo hepfo, inyuma; Sup, hejuru.)

Igishushanyo 2. Iyo umurwayi ari mumwanya wintebe yinyanja, hafatwa igufwa ryamagufa yiburyo bwa iliac. Kuraho umwitozo wa biti na Kirschner nyuma yo gucukura urubuga rwa cortex ya iliac, hanyuma ushyiremo 2 'ingofero '. (Ikimonyo, imbere; DCG, icyerekezo cya kabiri;

Igishushanyo 3. Iyo umurwayi ari mumwanya wintebe yinyanja, hafatwa igufwa ryamagufa yiburyo bwa iliac. Ubuso bwimbere bwigitereko cya iliac buguma butameze neza nyuma yo gusarura. (Ikimonyo, imbere; Inf, hepfo; IT, imbonerahamwe y'imbere; Post, inyuma; Sup, hejuru.)

Igishushanyo 4. Tegura amagufwa kumeza kuruhande. Igiti kimaze gusarurwa, igufwa ryamagufwa ryahujwe na kanyanga ebyiri ukoresheje kanseri ebyiri. .

Kurikirana ibyapa byumuhanda no kugera kumihanda

• Mubisanzwe imiyoboro ibiri kugeza kuri itatu irakoreshwa. Intego ni uguhuza inyuma A inlet hamwe na glenohumeral umurongo uhuriweho bishoboka. Kubwibyo, iyobowe na arthroscope. Kubwibyo, bikorwa cyane cyane nyuma yimikorere kuva imbere yimbere.

  
  

• Ubwinjiriro bwimbere E bushyirwa mumwanya wimitsi ya rotator hejuru yimitsi ya biceps, ishobora kwerekana neza igice cyinyuma cyuruhande rwa glenoid (Imbonerahamwe 1).

  
  

• Mu bihe byinshi, ntayindi miyoboro ikenewe; Ariko, nibiba ngombwa, inyongera ya B yinyuma yinyuma yinyuma yinyuma irashobora gukoreshwa (kurugero, gucunga prothèse yuzuzanya).

  
  

• Byiza, Kwinjira A biherereye neza kumurongo wa glenohumeral.

  
  

• Binyuze imbere n'inyuma kureba ubwinjiriro E, shyiramo inshinge 2 z'umugongo inyuma ya cm 2,5 kugeza kuri 3, hanyuma ushyiremo ingingo ibangikanye saa moya na saa cyenda (urutugu rw'iburyo).

  
  

• Kora uruhu hagati yinshinge 2 hanyuma ukoreshe inyuma yinyuma (Ishusho 5A na B).

Igicapo 5. (A) Umurwayi azashyiraho akamenyetso kandi ategure uruhu mu mwanya wa 70 ° wicaye, urutugu rw'iburyo na E. Kugirango ugere ku guhuza neza hagati yinyuma yinyuma yumurongo wa glenohumeral, inshinge ebyiri zumugongo zinjizwa inyuma kugirango hamenyekane ikimenyetso cyuruhu.

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Glenoid

• Igikoresho gitangizwa binyuze mumurongo winyuma (A).

  
  

• Kuraho labrum na capsule yinyuma kuva 7 kugeza 10 (urutugu rwiburyo) ukoresheje VAPR nurwembe (Ishusho 6A na B, Video 1).

  
  

• Gusya ijosi ryinyuma ya glenoid hamwe na arthroscopique burrs kugeza igufwa riva amaraso ryerekanwe kandi indege yateguwe (Ishusho 7). Ijosi rya glenoid rimaze gutegurwa, inyuma ya A inlet yagutse kugirango yemererwe kunyura hamwe na kanseri ya coracoid ebyiri.

  
  

• Scalpel irashobora gukoreshwa mu kwagura imitsi hamwe na cystotomie, mugihe trocar itagaragara neza (trocular passage) irashobora gukoreshwa mugukomeza kwagura igice (Ishusho 8).

Igishushanyo cya 6. Mugihe cyo gutegura glenoid, koresha VAPR nurwembe kugirango utandukanye iminwa ya glenoid na capsule yinyuma kuva 7h00 kugeza 10h00. .

Igishushanyo cya 7. Arthroscopic visualisation yo gutegura glenoid: umurwayi yicaye ku mfuruka ya 70 °, urutugu rw'iburyo, E-portal reba. Kwambara ijosi ryinyuma rya glenoid mugihe cyo gutegura glenoid. .

Igishushanyo cya 8. Arthroscopic visualisation yo gutegura glenoid: umurwayi yicaye ku mfuruka ya 70 °, urutugu rw'iburyo, E-portal reba. Kwagura inyuma A inlet hamwe na trocar itagaragara. .

Shushanya imyanya no gukosora

Igiti cyinjijwe mu bwinjiriro bw’inyuma hamwe n’umutwe ureba hejuru (Igicapo 9) hanyuma ugabanyamo imitsi hamwe na capsule ihuriweho kugeza igihe yegereye ijosi rya glenoide yinyuma hanyuma igatwarwa nubuso bwa glenoide. Iyi ntambwe igomba kwibanda ku itegurwa ryo gutandukana, cyane cyane gufungura fassiya yuzuye kandi ikomeye kandi ikabuza kunyura.

• Ni ngombwa gukoresha icyuma cya scalpel kugirango ufungure fassiya cyane. Nibiba ngombwa, mugice cyanyuma cyo kubagwa, niba kumeneka gutemba ari ngombwa cyane kugirango ugumane igitutu gihagije ku rutugu, ibikoresho birashobora gukoreshwa muguhagarika igice igikomere cyo kubaga (urugero, clip clip).

  
  

• Urumogi rwa coracoid rushyizwe hamwe nubuso bwa arctular kugirango insinga za Kirschner zikurikiraho ntizinjire mu gihimba mugihe cyo gushiramo.

  
  

• Insinga ebyiri za mm 1.5 z'uburebure bwa Kirschner zinjijwe binyuze mu miyoboro ya coracoid yuzuye kugira ngo ikosore igiti ku ijosi rya glenoid inyuma (Ishusho 10).

  
  

• Kwinjiza insinga ya Kirschner ntibigomba kurenza 40mm kugirango wirinde kunyura mu ijosi ryimbere rya glenoid, rishobora kwangiza imiterere yimbere yimbere, nubwo igice cyimitsi ya subcapularis kibaho hagati yijosi nuburyo bwimitsi iva mumitsi kugirango ikingire.

Igicapo 9. Umurwayi yashizemo igiti mu mwanya wa 70 ° yicaye, maze yitegereza urutugu rw'iburyo n'uruhande rw'inyuma. Igishushanyo cyinjijwe mu muryango winyuma hamwe nigitoki kireba hejuru. (Ikimonyo, imbere; DCG, icyerekezo cya kabiri; Inf, hepfo; Post, inyuma; Sup, hejuru.)

Igishushanyo 10. Arthroscopic visualisation yerekana ibihingwa, umurwayi wicaye kuri 70 ° inguni, urutugu rwiburyo, E yinjira. Ibice bibiri byinjijwemo Kirschner bihindura ibihingwa ku ijosi ryinyuma rya glenoid. (Ikimonyo, imbere; Gl, glenoid; IBG, igufwa rya iliac;

Kubera ko arthroscope ya 30 ° ireba imbere yumuvuduko wururubuga, mubisanzwe ikunda guhinduranya igiti ku nguni, bigatuma ubuso bwo hasi bugaragara aho kugororoka. Ni ngombwa kugenzura niba igufwa ryamagufa rigishoboka nyuma yo gushyirwaho.

• Iyo igihangano kimaze guhanagurwa inyuma ya glenoide yinyuma, kura umugozi wa mbere muremure wa coracoid hanyuma ucukure umuyoboro wa bicortical glenoid ya 3-2mm kuri wire ya Kirschner.

  
  

• Muri iyi ntambwe, ni ngombwa kuguma nyuma yimyitozo ya mbere. Abakozi b'abafasha bagomba kubungabunga n'amaboko yombi (Ishusho 11).

  
  

• Igomba kuba yiteguye gushyira pin ya gatatu ya Kirschner mu mwobo, kubera ko pin ya Kirschner mumwanya wambere wambere ifatwa muri moteri kubushake na biti ya myitozo.

  
  

• Ugomba kwitondera kudakuraho insinga ya Kirschner mugihe ukuramo umwitozo unyuze mumaboko ya coracoid. Noneho, shyiramo mm 4,5 mm igice cya Latarjet cyometse kumurongo wa Kirschner (Igicapo 12) hanyuma winjizemo byuzuye kugirango wirinde kwimuka, hanyuma utobore umugozi wo hejuru. Byiza, uburebure bwa screw ntibugomba kurenza mm 32 kugeza kuri 36.

  
  

• Uburebure buri hejuru ya mm 40 busaba gusuzumwa neza, kuko ibi bishobora guterwa nu mpande zihanamye zijyanye nubuso ugereranije na glenoid, bishobora kuganisha ku kwimura. Kuri iki cyiciro, urwego rwimiterere rushobora gukosorwa mukuzenguruka glenoid ikikije umugozi wo hasi.

  
  

• Nyuma yo gushiramo umugozi wambere (hepfo), pin ya mbere ya Kirschner irashobora gukurwaho. Shyiramo umugozi wa kabiri muburyo bumwe.

  
  

• Nyuma yo gushiramo imigozi 2 no gukuraho insinga ya Kirschner, koresha iperereza kuri Entrance A kugirango urebe aho wanyuma (Ishusho 13). Ibice byose bisohotse bigomba gutondekwa na burrs, kandi nta gusana imyenda yoroshye bigomba gukorwa kugirango birinde gukomera.

Igishushanyo cya 11. Igishushanyo cyari gishyizwe hamwe kandi gikosowe. Umurwayi yicaye ku nguni ya 70 ° igitugu cye cy'iburyo kireba hejuru. Mugihe na nyuma yo gushiramo, komeza uyobore ukoresheje amaboko yombi kugirango wirinde umurongo wa K kurekura umuyoboro. (Ikimonyo, imbere; DCG, kuyobora kabiri kanseri; Kw, Kirschner wire; Post, inyuma; Sup, hejuru.)

Igishushanyo cya 12. Arthroscopic visualisation yo gutunganya ibihingwa, umurwayi wicaye kuri 70 ° inguni, urutugu rw'iburyo, kureba ibikoresho bya elegitoroniki. Hasi ya 4.5mm yohasi igice cya Latarjet icyuma kibanza hejuru ya pin ya Kirschner. (Ikimonyo, imbere; Gl, glenoid; IBG, iliac amagufwa;

Igishushanyo 13. Arthroscopic visualisation yerekana ibihingwa, umurwayi wicaye kuri 70 ° inguni, urutugu rwiburyo, E yinjira. Nyuma yo gushiramo imigozi ibiri no kuvanaho insinga ya Kirschner, reba umwanya wanyuma wo guhindurwa. Ubu bwoko bwamagufwa afite compressible nziza kandi nta mwanya wishimye. (Ikimonyo, imbere; Gl, glenoid; Hh, umutwe wa humeral; IBG, igufwa rya iliac;

Nyuma yo kubagwa, igitugu cyashyizwe hamwe na 20 ° gushimuta no kuzenguruka kutagira aho bibogamiye mu byumweru 6:

• Umunsi ukurikira nyuma yo kubagwa, tangira urutugu rutambutse, inkokora hamwe nintoki zimyitozo ngororamubiri. Kwirinda no kugenda bibabaza bigomba kwirindwa.

  
  

• Mugihe cibyumweru 3, tangira urutonde rwimyitozo ngororamubiri.

  
  

• Nyuma yo gukomera kwibihingwa byemejwe no gufata amafoto nyuma yibyumweru 6 nyuma yo kubagwa, imyitozo ikomeye irashobora gutangira.

  
  

• Ku bakinnyi bashaka gukira byihuse, tomografi ya mudasobwa igomba gukorwa nyuma y'amezi 3 nyuma yo kubagwa kugirango basuzume ibihingwa.

  
  

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

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Twongeyeho, twiyemeje gukomeza guteza imbere ibicuruzwa bishya no kwagura imirongo y’ibicuruzwa, kugira ngo duhuze ibyifuzo byo kubaga abaganga n’abarwayi benshi, kandi tunatuma uruganda rwacu rirushanwa cyane mu nganda zose z’imyororokere n’ibikoresho by’inganda.

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