Waba uzi amateka yo gutera imisumari?

Kuza k'umusumari winjiye byahinduye uburyo bwo kuvura kuvunika amagufwa maremare. Nubwo tekinike yabayeho mu binyejana byinshi, ntabwo yageze aho ihagaze kugeza igice cya kabiri cyikinyejana cya 20.

Inzira yo gutsinda ntiyahoraga yoroshye, kuko tekinike yahuye nugushidikanya no kwangwa nintiti nyinshi mugice cya mbere cyikinyejana cya 20. Uyu munsi, binyuze mu guhanga udushya muri metallurgie, tekinike yo kubaga hamwe na fluoroscopique, imisumari yimbere yabaye urugero rwo kwita kumeneka maremare.

Iterambere mubumenyi bwibinyabuzima bwabantu ryatumye hashyirwaho iki gishushanyo kigezweho. Imisumari igezweho irangwa no kwandura gake, inkovu nkeya, kuvunika neza, no guhita byihuta byabarwayi.

Isubiramo ryamateka ryakozwe muri iki kiganiro rigamije kuvuga mu ncamake ubwihindurize bw’imisumari yimbere, kwerekana intego zingenzi zingenzi, kwerekana ibihe byigihe cyo gukoresha bwa mbere ndetse n’ihindagurika ryakurikiyeho ry’imisumari, no kumenyekanisha umwanya w’umusumari winjiye mu mikorere ya orthopedie n’ihungabana (urugero, Ishusho 1).

Ivuka ryimisumari yimbere

Abanyamisiri ba kera babanje gukoresha igikoresho kidasanzwe gisa n'umusumari. Kuvura kuvunika bigoye kubaga ntibyashobokaga kubaho mumyaka myinshi ishize.

Ikizwi ariko, ni uko Abanyamisiri ba kera bari bafite uburyo bukomeye bwo kosa umurambo bituruka ku myizerere yabo izuka ry'umubiri mu buzima bwa nyuma.

Uku niko byagenze kuri mummy witwa Usermontu wabonetse mu mva ya Tutankhamun, aho hashyizwemo umusumari w’umugozi hagati y’igitsina gore na tibia kugira ngo uhuze ivi (nkuko bigaragara ku gishushanyo 2).

Abacukuzi b'ibyataburuwe mu matongo bavuga ko mummy yari muri sarcophagusi atari Usermontu ubwe, ahubwo ko hari undi wasimbuwe n'abajura bahoze mu mva muri 600 B CE .

Nyuma yimyaka 2000, Bernardino de Sahagun, inzobere mu bijyanye n’umuntu ku rugendo rwa Hernando Cortes, yatangaje ko hakoreshejwe bwa mbere imisumari y’imbere mu murwayi muzima muri Mexico.

Mu 1524, yiboneye umuganga ubaga amagufwa ya Aztec (witwa 'Tezalo ') akora osteotomy akoresheje icyuma cya obsidian hanyuma ashyiramo inkoni ya resin mu mwobo wa medullary kugira ngo avunike. Bitewe no kubura tekiniki zihagije zo kubaga hamwe na antiseptics, ubwo buryo bwari bufite umuvuduko mwinshi kandi nimpfu nyinshi.

1800s: Intambwe Zambere

Ahagana mu myaka ya 1800 rwagati, ibinyamakuru byambere byubuvuzi byatanze raporo ku gutera imisumari. Bavuga ko Diefenbach, Langenbeck, Bardenheuer n'abandi babaga bavuga Ikidage bavuga ko bakoresheje imisumari y'inzovu mu magufa maremare kugira ngo bavure amagufwa.

Hagati aho, Nicholas Senn w'i Chicago, umushakashatsi akaba n'umuganga ubaga umusirikare ukunda cyane, yakoze ubushakashatsi hamwe no gukosora indwara. Yakoreshaga ibice bitoboye bikozwe mu magufa ya bovine akayinjiza muri medulla kugira ngo avure 'pseudarthrosis ' nyuma yo kuvunika.

Mu 1886, Heinrich Bircher wo mu Busuwisi yasobanuye mu nama yo kubaga kwinjiza imisumari y'inzovu muri medula kugira ngo bivurwe bikabije kuvunika bikomeye (Ishusho 3).

Nyuma yimyaka mike, Themistocles Gluck mu Budage yakoze umusumari wambere winzovu winzovu zifite umwobo kumpera yumusumari, bityo utangiza igitekerezo cyo gufatanya kunshuro yambere.

Muri icyo gihe kimwe, Julius Nicolaysen ukomoka muri Noruveje ni we wa mbere wanditse ku mahame ya biomehanike yo gutera imisumari imbere y’imvune z’umugore. Yashimangiye ko ari ngombwa kongera uburebure bw’imisumari kugira ngo haboneke inyungu nini y’ibinyabuzima ndetse no kurinda amagufwa hafi ya yose.

Niwe kandi wambere watanze igitekerezo cyo gufunga imisumari yegeranye kandi ya kure / igufwa rihuza igishushanyo mbonera. Bamwe mu bahanga bafatwa nka se wo gutera imisumari.

Mu myaka ya 1800 rwagati, abapayiniya nka Ignaz Philipp Semmelweis i Vienne na JosephLister i Glasgow bari barashizeho urufatiro rwo kuboneza urubyaro. Ibi byari intambwe ishimishije kuko yemerera iterambere ryubuhanga bushya bwo kubaga mugihe cya aseptic.

1900: Ubwihindurize

Mu 1912, umuganga ubaga w’Ubwongereza Ernest Hay Groves ni we muntu wa mbere wabaga wakoresheje inkoni ikomeye y’icyuma nk'umusumari utemewe kandi yari intangarugero mu buryo bwo gusubiramo imisumari ya retrograde.

Yabonye ubunararibonye mu Ntambara ya Mbere y'Isi Yose ubwo yavuraga abarwayi bafite pseudarthrosis yanduye batashakaga guca amaguru. Ntabwo yasobanuye gusa uburyo bwa mbere bwo gutera imisumari yemerera osseointegration binyuze mu ihahamuka rito, ariko kandi yari afite ubuhanga bwo gukoresha imisumari yimisumari hamwe n imisumari nto kugirango akosore ibice.

Yagerageje gushiramo aluminium, magnesium nicyuma kandi amenya akamaro ka biomehanike mugukiza kuvunika. Nubwo bimeze bityo ariko, tekinike ya Ernest Hay Groves yahuye n’ubwandu bwinshi bityo ntiyakundwa cyane nabari mu gihe cye.

Mu 1931, Smith-Petersen, umuganga w’inzobere mu kubaga amagufwa w’Abanyamerika, yashyizeho icyuma gifite amababa atatu y’icyuma kitagira umuyonga kugira ngo avurwe n’imitsi yo mu nda ya capsule femorale ijosi. Yateguye uburyo bweruye bwashushanyaga igice cya gatatu cyimbere ya iliac, yinjira mu murima ukorera ku nkombe y’imbere ya tensor yagutse, hanyuma asubiramo icyuho kandi akoresha imashini kugira ngo atware ibyuma bitagira umwanda mu mutwe w’umugore (Ishusho 4).

Kubera intsinzi yikigereranyo cya Smith-Petersen, abaganga benshi batangiye kugerageza no gutera ibyuma bivunika. sven Johansson yahimbye umusumari winjiye mu 1932; guhanga kwe kwubuhanga yakoresheje urushinge rwa kerfing yemerera kugenzurwa na radiologique yinjizwamo imisumari yimbere. Ibikoresho bya tekinike yibanze yakoresheje biracyakoreshwa nubu.

Tugeze ku ntambwe imwe, Rush na murumuna we batangije igitekerezo cy’imisumari ya elastique mu 1937.

Bakoresheje umusumari wa elastike, mbere-yunamye ibyuma bidafite umusumari kandi bagerageza gukora imiterere yimiterere itatu yo gukosora kugirango barwanye imyumvire yo kwimuka kwa axial hafi kuvunika.

Mubitekerezo byabo, agace koroheje koroheje kameze nkigice cyumubyigano urwanya impagarara zatewe numusumari wa elastike mbere. Ubwubatsi bwabo bwagarukiraga kumiterere ya elastike yicyuma idafite ingese, yahindutse hakiri kare kuva ihindagurika rya elastike ihinduka plastike. Iyanyuma irashobora kuganisha kumurongo wa kabiri no gukira ubumuga.

Byongeye kandi, imisumari yimbere ikunda gusohoka ku bwinjiriro cyangwa kwinjira mu magufwa ya kanseri, cyangwa no gutobora mu ngingo. Nubwo bimeze bityo ariko, intiti ya Viennese Ender yakomeje gukoresha ubu buhanga nk'ishingiro ry'ishuri rya Ender ryo gukosora imvune kandi n'ubu iracyakoreshwa mu gukosora byoroshye kuvunika kw'abana.

Umusumari w'amagufwa

Mu 1939, umudage ubaga umudage Gerhard Küntscher, watowe igihembo cyitiriwe Nobel, yashyizeho umusumari w’icyuma udafite ingese kugira ngo avurwe n’imvune z’uruti rw’umugore.

Küntscher n'abandi batewe inkunga na Smith-Petersen ibyuma bitagira umuyonga byakoreshwaga mu kuvura kuvunika kw'ijosi ry'umugore kandi bizeraga ko amahame amwe ashobora gukoreshwa no kuvunika. Imisumari yimbere yateje imbere yabanje kumera V muburyo butandukanye na mm 7-10 z'umurambararo.

Nyuma y’ubushakashatsi bwa cadaveric n’inyamaswa, yerekanye umusumari w’imbere n’uburyo bwo kubaga mu nama yo kubaga yabereye i Berlin mu 1940. Ku ikubitiro, udushya twashinyaguriwe na bagenzi be b'Abadage, nubwo uburyo bwe bwamamaye nyuma y’Intambara ya Kabiri y'Isi Yose.

Hippocrates (460-370 mbere ya Yesu), umuganga wa kera w’Abagereki bakunze kwita se w’ubuvuzi, yigeze kuvuga ati: '' Ushaka kubaga agomba kujya ku rugamba '; kimwe no kuri Küntscher.

Mu gihe cy'Abanazi, Küntscher yashyizwe mu bitaro biri imbere ya Finilande. Agezeyo, yashoboye kubaga abarwayi n'imfungwa z'intambara muri ako karere. Yatangije igitekerezo cyo kumanika amagufwa akoresheje uburyo bwo kubaga bufunze kandi bufunguye.

Mu buryo bufunze, yambukije umusumari winjiye mu cyerekezo cya prograde anyuze muri trocanter nini ayishyira ku meza yo gusubiza inyuma akoresheje umuhoro. Ivunika ryongeye gushyirwaho kandi umusumari winjizwa mu ndege ebyiri ukoresheje fluoroscopi. Muburyo bweruye, umusumari winjizwemo winjizwa muvunika muri medulla unyuze hafi yumurongo wavunitse.

Ubuhanga bwa Küntscher bwamenyekanye ku rwego mpuzamahanga nyuma yo gutahuka kw'imfungwa z’intambara zunze ubumwe.

Muri ubwo buryo, abaganga b’abanyamerika n’abongereza bamenyereye imisumari yimbere yakozwe na Küntscher kandi bamenya ibyiza byayo muri iki gihe cyo kuvura kuvunika.

Mu gihe gito, abaganga benshi babaga ku isi batangiye gukoresha uburyo bwe, maze imisumari ya Küntscher ihindura uburyo bwo kuvura imvune igabanya igihe cyo gukira k'umurwayi hafi umwaka. Abarwayi baba bagomba guhagarikwa mumukino mumezi barashobora noneho kuba mobile muminsi mike.

Kugeza ubu, umuganga ubaga w’Abadage afatwa nk’iterambere ry’imisumari y’imbere, kandi afite umwanya w’ingenzi mu mateka yo kubaga ihahamuka.

Kwagura Umusumari wo mu musokoro w'amagufa

Mu 1942, Fisher n'abandi. ubanza wasobanuye ikoreshwa ryimyitozo yo gusya kwagura urusyo kugirango wongere aho uhurira hagati yimisumari yimbere hamwe namagufwa no kunoza ituze ryo gukosorwa.

Nubwo bimeze bityo ariko, Küntscher yashyizeho uburyo bworoshye bwo kuyobora imyitozo ikoreshwa kugeza na n'ubu kandi igashyigikira gusubiramo uburebure bwose bw’imitsi y’amagufwa kugira ngo byoroherezwe kwinjiza imisumari nini ya diameter.

Mu ikubitiro, reaming intramedullary reaming yateguwe kugirango hongerwe cyane ubuso bwamagufwa hamwe numusumari winjiye kugirango bikosorwe neza kuvunika no kugenda byihuse byabarwayi.

Nkuko byasobanuwe na Smith n'abandi, buri mm 1 yo kwaguka kwa medullary byongera aho bahurira na 38%. Ibi bituma hakoreshwa imisumari minini kandi itajenjetse, yongerera imbaraga muri rusange imiterere yo kuvunika.

Nubwo, nubwo Küntscher yometseho imisumari hamwe nu myitozo yoroheje yo guhinduranya reaming yahindutse uburyo bwiza bwo gukoresha ibikoresho byo gutunganya imbere muri osteotomie, academiya yataye agaciro mu mpera za 1960 kugirango ishyigikire amasahani mashya ya Arbeitsgemeinschaft für Osteosynthesefragen (AO).

1960: Ibihe Byijimye

Mu myaka ya za 1960, imisumari yimbere yarahagaritswe buhoro buhoro kugirango ishyireho isahani hamwe no kuvunika.

Nubwo uburyo bwa Küntscher bwakoraga neza, abaganga babaga ku isi barabyanze kubera ibisubizo bibi nyuma yo kubagwa.

Byongeye kandi, bamwe mu babaga batangiye kureka tekinike y’imirasire, nka fluoroscopi yo mu mutwe, kubera ko abaganga babaga batewe ishozi n'ingaruka mbi ziterwa n'imirasire. Iterambere ryimisumari yimbere ntiryagarukiye aho, nubwo muri rusange ubwumvikane mpuzamahanga bwo gukoresha sisitemu yo gutunganya amasahani imbere.

Küntscher, umuganga w’Ubudage, yamenye ibyiza byo gufatanya maze ategura umusumari umeze nka cloverleaf uhuza umusumari w’imbere, yise 'umusumari wo gufunga '. Agatsinsino ka Achilles yimiterere yimisumari yimbere yicyo gihe kwari ukudashobora guhagarika imvune zavunitse cyane cyangwa kuvunika byimuwe muburyo bunini Umuti wiki kibazo ni ugukoresha Imigozi ifunga .

Igisubizo cyiki kibazo kwari uguhindura umusumari winjiye hamwe na Sikulufu ifunga .

Muri ubu buryo, uwatewe ashobora kunanira neza kunama n'imbaraga za torsional mugihe arinda kugabanya ingingo. Hifashishijwe guhuza ibitekerezo biva kuri Küntscher, Klaus Klemm, na Wolf-Dieter Schellmann, umusumari winjiye mu rwego rwo hejuru kugira ngo utange umutekano muke mbere yo gucukura umwobo w’imigozi yegeranye kandi uri kure y’umusumari winjiye, wari ufungiye ku mugozi winjijwemo.

Mu myaka mike iri imbere, iterambere mu mashusho ya fluoroscopique ryemerewe kongera guhitamo uburyo bwo gufunga no kugabanya tekinike.

1970 na 1980: Ububyutse

Mu myaka ya za 70, abantu bashishikajwe cyane n’igitekerezo cyo gutera imisumari cy’umudage ubaga Küntscher.

Kugabanya gufunga imisumari yimbere yo kuvunika, hamwe no guhuza ibitekerezo byoroshye no guhuza ibitekerezo hamwe no kurushaho kumvikanisha tekinike ya fluoroscopique, byatumye iterambere ryogukwirakwizwa nubuhanga buhebuje bwo kubaga, burangwa no kwangirika kwinyama zoroheje, gutuza neza, no guhita byihuta by’abarwayi.

Muri kiriya gihe, isi y’amasomo yariyongereye mu ruhererekane rwo guhanga udushya rwateje imbere igisekuru cya kabiri cyo gutera imisumari.

Mu 1976, Grosse na Kempf bakoze umusumari igice cyometseho umusumari kugirango bakemure ikibazo cya moderi ya elastique yimisumari yimbere. Umusumari winjiye ntabwo washyizwe mu karere kegeranye kandi wari ufite umwobo w’imisumari wa screw, washyizwemo inguni ya dogere 45 kugirango wongere imbaraga zihamye zimiterere yimisumari yimbere.

Nyuma yimyaka mike, AO yifatanije niterambere ryimisumari yimitsi itera imisumari itekerejweho (Ishusho 5)

Mu 1984, Weinquist n'abandi. yatanze igitekerezo cyogukoresha imbaraga, kwari ukongera imbaraga zo kuvunika kurangiza ukoresheje umwobo munini Sikulufu ifunga , ukuraho static Imigozi ifunga , hanyuma ugahindura imyobo ya Sikulufu ifunga kuri oval umwobo wimisumari muburyo bugezweho.

Intego yuburyo bukomeye ni uguteza imbere gukira kuvunika no kwirinda guhuza amagufwa kubera ibikorwa byatinze.

Kugeza ubu, imisumari yimisumari yabuze abayunganira nkubuhanga bwonyine kandi kuri ubu ikoreshwa nkigisubizo cyigiciro cyinshi kuruta gusimbuza burundu sisitemu yo gukosora imbere mugukiza imvune zidakira.

Mu bushakashatsi bwibinyabuzima, Gimeno n'abandi. yatangaje ko akarere k'inzibacyuho kari hagati y’ibice bitagabanijwe kandi byerekanwe ku musumari winjiye mu mitsi byaviriyemo guhangayika no kunanirwa kubagwa byatewe imbere.

Kugira ngo ibyo bibazo bikemuke, Russel na Taylor n'abandi. yateguye umusumari wa mbere udashizwemo, utaguwe imisumari yimbere mu 1986, hamwe nibisubizo bishimishije.

Muri kiriya gihe, ikibazo cyo gufunga imisumari yimbere nacyo cyakomeje gutera imbere, kandi nkuko tubizi uyumunsi, guhuza umugozi unyuze mumisumari yimbere yabanje gucukurwa byari igishushanyo cya Klemm na Schleman mubudage. Kwinjiza umugozi byayoborwa na fluoroscopi yubusa, ibyo bikaba byerekana ko umuganga abaga imirase myinshi.

Uyu munsi, iki kibazo cyakemuwe hamwe na sisitemu yo kurebera kure ikubiyemo ikoranabuhanga rya electromagnetic yumurima ukurikirana, tekinoroji ya fluoroscopique iyobowe nubuntu, hamwe nubuyobozi bwuzuye bwo gushiraho imisumari.

1990: Titanium imisumari yimbere

Mu myaka icumi yakurikiyeho, imisumari ya Russel-Taylor yamenyekanye cyane mu muryango mpuzamahanga w'amagufwa. Igipimo cyubuvuzi cyahindutse buhoro buhoro imisumari hamwe no gufunga static, nkuko bigaragazwa n'ibyavuye mu bushakashatsi bwakozwe na Brumback n'abandi.

Muri ubu bushakashatsi buteganijwe, ibisubizo byatangaje ko gufunga byatanze umusaruro mwiza muri byinshi kandi bitajyanye no kudahuza kuvunika.

Iterambere muri metallurgie ryatumye havuka imisumari ya titanium intramedullary, ikoreshwa cyane mu nganda zikomoka ku binyabuzima bitewe n'imbaraga zabo, kurwanya ruswa ndetse no guhuza ibinyabuzima.

Sisitemu ya Alta intramedullary yimisumari niyo yambere yabonetse ya titanium intramedullary, kandi yakiriwe neza nabaganga kubera imiterere yubukanishi bwa titanium, nicyuma gikomeye ariko kidakomeye kuruta ibyuma bitagira umwanda.

Nyamara, ubuvanganzo buriho burashidikanya ku kumenya niba titanium ari ibikoresho bikwiriye gukosorwa imbere kuruta ibyuma bitagira umwanda, cyane cyane bitewe n’ibiciro byiyongereye bijyanye no gukoresha titanium.

Nyamara, ibyiza bimwe na bimwe bya titanium, nka moderi ya elastike yegereye amagufwa ya cortical na magnetiki resonance yerekana amashusho, bituma ihitamo neza.

Mubyongeyeho, titanium nigikorwa cyiza cyane mugihe hakenewe imisumari ntoya ya diametre intramedullary.

Ibigezweho

Nyuma yo gutsinda no kunanirwa mu myaka yashize, abaganga babaga amagufwa bafite uburambe burenze kubijyanye no gutera imisumari.

Gutera imisumari imbere yimitsi yumugore, tibial na humeral byahindutse urwego rwo kwita kubintu byinshi byafunzwe ndetse no kuvunika gufunguye. Sisitemu nshya yo guhitamo no gushyira imyanya yatumye inzira yoroshye kandi yororoka kubantu babaga badafite uburambe.

Ibigezweho biheruka kwerekana ko ibyuma bya titanium hamwe nicyuma bidafite ingese bifite modulus nyinshi cyane ya elastique kandi ibyo bishimangira guhishira imihangayiko itera gukenera amagufwa. Ibinyabuzima bishya nka magnesium alloys, imiterere yibikoresho byo kwibuka hamwe nibikoresho bisubirwamo birimo kugeragezwa muri kaminuza.

Imisumari yimbere ikozwe muri karubone fibre ikomeza-polymer hamwe na moderi nziza ya elastique hamwe numunaniro mwinshi urahari. Amavuta ya magnesium afite modulus ya elastique isa n'iy'amagufwa ya cortique kandi irashobora kwangirika.

Ubushakashatsi buherutse gukorwa na Li n'abandi. bagaragaje ibyiza byingenzi mu kuvura imvune za osteoporotique mubyitegererezo byinyamanswa biterwa no guhuza magnesium na zoledronate coating yo gusana kuvunika, uburyo bushobora kuba imiti ivunika osteoporotic mugihe kizaza.

Umwanzuro

Mu myaka yashize, hamwe niterambere ryibonekeje muburyo bwo gushushanya imisumari, tekinike ya metallurgjique, hamwe nubuhanga bwo kubaga, imisumari yimbere yateye imbere muburyo bugezweho bwo kuvura amagufwa maremare maremare kandi ni uburyo bwiza, butera cyane, kandi bwororoka.

Ariko, kubera imisumari myinshi yashizwemo imisumari, amakuru menshi arabura kubijyanye nibikorwa byabo nyuma yibikorwa. Ubushakashatsi burakenewe kugirango hamenyekane ingano yimisumari yuburyo bwiza, ibiranga na radiyo yo kugabanuka.

Turateganya ko guhanga udushya mubijyanye na biomaterial bizabyara kuvuka kwishusho yimisumari mishya.

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

Kuri CZMEDITECH , dufite umurongo wuzuye wibicuruzwa byatewe no kubaga amagufwa hamwe nibikoresho bijyanye, ibicuruzwa birimo umugongo, imisumari, icyapa cy'ihungabana, Icyuma gifunga, cranial-maxillofacial, prothèse, ibikoresho by'ingufu, External Fixators, arthroscopy, ubuvuzi bwamatungo nibikoresho byabo bifasha.

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