Kuvunika ijosi ry'umugore ni kimwe mu bikomeretsa cyane amagufwa mu bikorwa byo kwa muganga, aho abarwayi benshi bageze mu zabukuru bangana na 50% by'imvune zo mu kibuno. Nk’uko imibare ibigaragaza, mu myaka yashize umubare w'abavunika ijosi ry'umugore wagiye wiyongera buhoro buhoro, aho usanga umubare munini w'abagore ugereranyije n'abagabo. Vertigo, guta umutwe, malignance n'indwara z'umutima zifata abasaza ndetse n’imvune zikomeye ku rubyiruko ni ibintu bishobora guteza ibyago byinshi byo kuvunika ijosi ry’umugore.
Mu myaka yashize, hagaragaye ibikoresho byinshi byo gukosora imbere nk'imigozi idafite umwobo, imiyoboro y'amashanyarazi (DHS), imigozi yo kunyerera (HSH), ibyapa bitandukanya femorale, imisumari yo kwiyubaka, n'imisumari ya Gamma. Muri ibyo bikoresho byo gutunganya imbere, imigozi yubusa niyo ikoreshwa cyane. Ubushakashatsi bwerekanye ko umubare munini w’abaganga babaga bahitamo imiyoboro idafite aho ivura ivunika ridafite aho rihuriye, kandi umubare munini w’abaganga babaga bahitamo gukoresha imiyoboro idafite aho ivunika ijosi ry’umugore. 3 ibangikanye igice cyahujwe na hollow screw gukosora nuburyo bwemewe bwo gukosora imbere.
Ibintu bidasanzwe biranga kuvunika ijosi ryumugore
Ubu biremewe muri rusange ko imitsi y'amaraso y'umutwe w'igitsina gore aricyo kintu cyingenzi kigira ingaruka zo gukira kuvunika hamwe na necrosis yo mumutwe. Kwangirika kumiterere yamaraso yumutwe wigitsina gore nicyo kintu nyamukuru cyindwara ya ischemic necrosis yumutwe wigitsina gore. Ubushakashatsi bwakozwe kuri anatomiya yimitsi yijosi ryigitsina gore bwerekanye ko umuyoboro wamaraso wa epiphyseal na sisitemu ya arterial ya zone idashyigikiwe bishobora kuba inzira zingenzi zo gukomeza gutanga amaraso kumutwe wigitsina gore nyuma yo kuvunika ijosi ryigitsina gore, kugirango gucukumbura imitsi no kuyitera hafi bishoboka mukarere ko hagati yimitsi yimitsi iterwa no gukomeretsa kwamaraso.
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Igishushanyo 1 Gutanga amaraso kumutwe wigitsina gore, kuruhande (a) no kureba inyuma (b). Hariho itandukaniro mumaraso atangwa kumutwe wigitsina gore, ariko arteriire na spinofemoral arterière ituruka kumitsi yimbitse ya femorale 60% byabarwayi.
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(2) Itanga amashami 3 cyangwa 4 ashyigikira imitsi. Aya mashami agenda inyuma no hejuru hejuru igice cya retroflexed ijosi rya synovial ijosi ryigitsina gore kugera kumutwe wa karitsiye yumutwe wigitsina gore. Imiyoboro iri muruziga.
(3) Bikomoka kumitsi ya foramen occulta. Kuzamuka kwishami rya rotor yo hagati ya femorale.
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Imiyoboro idakomeye yo kuvunika ijosi ryumugore
Mubuvuzi, imigozi itatu yubusa yamagufwa ya 6.5 mm cyangwa 7.0 mm cyangwa 7.3 mm irashobora gukoreshwa mugukosora abarwayi bakiri bato cyangwa kubarwayi bageze mu zabukuru cyangwa bakuru bafite amagufwa meza. Imiyoboro igomba gukoreshwa kugirango imisumari 3 yubusa ibangikanye kugirango yemere kunyerera. Mu ijosi ryigitsina gore, imigozi igomba guhurizwa kumpande, ukitondera ko imigozi yomekwa mumutwe wumugore kandi itanyuze kumurongo wavunitse, kuko aribwo buryo bwonyine bwo kubona kwikuramo hagati. Imigozi igomba gukomera no kwemezwa inshuro nyinshi. Niba igitanda gikurura gikoreshwa, igikurura kigomba kuruhuka. Imiyoboro idafite ishingiro irashobora kandi gushyirwaho muburyo butandukanye. Imbere, kuruhande, na 45 ° oblique fluoroscopi igomba gukorwa kugirango barebe ko imigozi itinjira mu kibuno.
1 techniques Uburyo bwihariye bwo kubaga.
Fata 'inyabutatu ihindagurika ' gushyira imisumari, ikunze gukoreshwa mubikorwa byubuvuzi, nkurugero.
a. Mbere ya byose, munsi ya fluoroscopi, koresha X-ray mu ndege ebyiri za fluoroscopi kugirango umenye imiterere ya pin yo hepfo no hagati.
b. Uruhu rukozwe rugera kuri cm 2-3 hafi.
c. Igice cya fassiyale gitandukanijwe no gutemagura kandi Cobb itandukanya ikoreshwa mugutandukanya fibre ndende kumitsi yinyuma yumugore.
d. Shira urushinge ruyobora ahantu indege zombi zuzuye.
e. Igikoresho kimwe kiyobora cyashyizwe kuruhande rwimbere yijosi ryumugore hamwe numufasha kugirango bamenye inguni yimbere.
f. Nyuma yo gukosora pin yambere yo kuyobora, pin ya posterosuperior na anterosuperior yamenyekanye hifashishijwe icyerekezo kibangikanye kugirango ubone inkunga yinyuma ninyuma imbere yijosi ryumugore.
g. Ibi bikorwa mugushyiramo pin iyobora hejuru ya trochanter ntoya kuruhande rwa cortex ya femorale ya kure ikoresheje uruti rwumugongo; ibikurikira bibiri biyobora byinjijwe hafi muburyo bubangikanye, kugeza kure hashoboka na mm 5 uhereye imbere ninyuma yinyuma; ubujyakuzimu bwinjira mubuyobozi bwa pin noneho burahindurwa kugirango bugere kuri mm 5 munsi ya karitsiye; amaherezo, umwobo urasubirwamo, urapimwa, hanyuma umugozi wuzuye uringaniye.
h. Witondere kutinjira inshinge munsi ya trocanter ntoya hanyuma ukagenda hafi yumugongo wumugore.
i. Menya neza ko umurongo uyobora pin ushyizwe munsi yumutwe.
j. Ntukemere kuyobora pin kwinjira mubuso bwa arctular.
k. Menya uburebure bukwiye mugupima uburebure bwa pin hanyuma ukureho mm 5.
l. Mubisanzwe kwikubita hasi, kwifashisha imiyoboro yo kwifashisha, ariko rimwe na rimwe birasabwa mbere yo gucukura cortex kuruhande bisabwa kubarwayi b'indahemuka bafite amagufwa manini.
m. Niba umwanya ubyemereye, space irashobora gukoreshwa.
n. Umugozi wa 4 (gahunda ya diyama) urashobora gukenerwa kubayoboke b'indahemuka bafite ibice byavunitse bikabije by'inyuma y'ukuboko.
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Nubwo imigozi idafite ishingiro yo kuvunika ijosi ryigitsina gore ubu iramenyerewe cyane, haracyari itandukaniro ryibitekerezo bijyanye numubare hamwe nuburyo bwimiterere yabagenewe kubagwa, mubisanzwe bitewe nibyo umukoresha akunda; ibintu nkubwinshi bwamagufwa yumurwayi, imbaraga za screw, hamwe nubutsinzi bwo kuvura nabyo bigira ingaruka.
1 、 Umubare wimigozi idafite akamaro.
Ivunika ry'ijosi ry'umugore mubisanzwe rikosorwa hamwe n'imigozi 2-4.
Kenshi na kenshi, imiyoboro 3 ikoreshwa kubera ko ishobora kwihanganira imihangayiko ikomeye imbere, kongera umutekano, no kugabanya kwimura impera.
Kuvunika ijosi ryigitsina gore hamwe na Pauwells inguni> 50 °, imigozi 2 irumvikana.
Ku barwayi bafite imvune zikomeye zavunitse ijosi ryinyuma yinyuma yumugore, hashyizweho imigozi 4 yubusa.
Nyamara, imyitozo yiganje iracyakoresha imiyoboro 3 yubusa kugirango ikosorwe.
2 、 Iboneza rya screw.
Iyo imiyoboro 3 idafite akamaro ikoreshwa mugukosora imbere kuvunika ijosi ryigitsina gore, muri rusange abantu bemeza ko igitekerezo cya 'kunyerera kunyerera ' kigomba gukurikizwa, kugirango imigozi 3 yatewe ihwanye nundi muburyo bwa orthogonal kandi ifite ibinyabutatu muburyo bwo kureba kuruhande.
Muri ubu buryo, imigozi itatu ibangikanye irashobora gutanga ubufasha bwiza bwubukanishi no gukora inzira yo kunyerera, kugirango igice cyo kuvunika gishobora kunyerera ku ijosi ryigitsina gore munsi yimitsi yimitsi yibibuno, bigatera umuvuduko kumutwe wacitse kandi bigatera gukira kuvunika.
Ariko, niba imigozi 3 yubusa yashyizwe muburyo bwa mpandeshatu cyangwa ihindagurika ya mpandeshatu ya mpaka zagiye impaka.
Iterambere muri tekinike yo gukosora tekinike yo kuvunika ijosi ryumugore
Yuenyongviwat n'abandi. yateguye uburyo bushya bwo guhinduranya buringaniza bwo gucukura kugirango hashyirwe imigozi idafite aho ihuriye no kuvura imvune z’ijosi ry’umugore hakoreshejwe gukosora imbere, maze isanga iki gitabo gishya gishobora kugabanya igihe cyo gukora n’umubare w’ibitekerezo bya fluoroscopique ugereranije n’uburyo gakondo, bityo bikagera ku bisubizo bishimishije byo kubaga.
Filipov n'abandi. yateguye biplane inshuro ebyiri zishyigikiwe na screw fixe (BDSF), aho aho hinjirira imigozi itatu yubusa iherereye mubice byimbitse bya corticale yumusemburo wa femorale yegeranye, kandi imigozi itatu iringaniye neza kuruhande rwumutwe wigitsina gore, bityo ikora indege ebyiri. Ubu buryo butuma habaho inkunga ya cortical ebyiri, bityo igatanga imbaraga zihagije zo gukosora mugihe cyo kugenda.
Ubushakashatsi bwibinyabuzima ukoresheje ingero za cadaveric bwerekanye ko uburyo bwa BDSF bwo gukosora butanga gukosorwa neza kuruta uburyo bwa gakondo butatu bwo guhinduranya. Ibisubizo byubushakashatsi bwibinyabuzima hakoreshejwe ingero za cadaveric bwerekanye ko cisiyumu ya fosifate ya sima yashimangiye gushimangira imiyoboro ya hollow screw yazamuye neza ituze ryimiterere ya hollow screw ikosora ivunika ry ijosi ryigitsina gore, byongera imbaraga zo kwikuramo ijosi ryigitsina gore, kandi binonosora ubukana bwa torsional, bifite agaciro gakomeye mubuvuzi.
Kubera amahirwe menshi yo kwandura umutwe wa femorale nyuma yo gukosora imisumari yubusa yo kuvunika ijosi ryigitsina gore, ubundi buryo bwakoreshejwe muburyo bwo gufasha imisumari yimbere imbere kugirango bigabanye ingorane nka necrosis head femorale. Intandaro yo gutera umutwe wa femorale femorale nyuma yo kuvunika ijosi ryigitsina gore ni ugutakaza amaraso kumutwe wigitsina gore, kubwibyo rero kwibandwaho ni uburyo bwo kunoza amaraso. Kwinjiza ibibyimba bitangwa n'amaraso mu gice cya necrotic cy'umutwe w'igitsina gore no kuzuza hanze kuziba mu mwobo usigaye n'igiti kimera bizorohereza gutandukanya periosteum yatewe muri osteoblasts kimwe no kuvugurura imikurire y'amaraso, ifite ingaruka za osteogeneque na revascularizing.
Incamake
Hollow screw fixation yo kuvunika ijosi ryigitsina gore nuburyo bwiza cyane bwo gukosora, bufite ibyiza byo gukora byoroshye, igihe gito cyo gukora, ihahamuka rito, gukosorwa kwizewe no gukira vuba nyuma yibikorwa. Ariko, kubera imiterere idasanzwe yavunitse ijosi ryigitsina gore, ingorane za ischemic necrosis yumutwe wigitsina gore no kudahuza kuvunika ntigishobora kwirindwa rwose no gukosorwa imbere kugirango kuvunika ijosi ryumugore. Kubwibyo rero, ibimenyetso byerekana ikoreshwa ryubu buryo bwo gukosora bigomba gusobanurwa mbere yo kubikoresha, kandi abarwayi bageze mu zabukuru bafite imvune zo mu ijosi zimuwe cyane n’imiterere mibi isaba ibikorwa hakiri kare bagomba kwirinda gukoresha gukosora imbere mu kuvunika ijosi ry’umugore bishoboka. Impamvu zishobora kugira ingaruka ku iteganyagihe ry’umurwayi, nk'ubwoko bwavunitse, ubwinshi bw'amagufwa, n'imikorere y'umurwayi, na byo bigomba kwitabwaho kugira ngo bigabanye ibibazo by'igihe kirekire nyuma yo kubagwa bityo bikazamura ibisubizo byo kuvura kuvunika kw'ijosi ry'umugore.
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