Waba uzi amateka ya interollary imisumari?

Kugaruka kwa Intramedullary imisumari yahinduwe kuvura amagufwa maremare. Nubwo tekinike yari imaze ibinyejana, ntabwo yageze kumwanya wacyo kugeza igice cya kabiri cyikinyejana cya 20.

Inzira yo gutsinda ntabwo buri gihe yari yoroshye, kuko tekinike yahuye nubushishozi no kwamagana intiti nyinshi mugice cya mbere cyikinyejana cya 20. Uyu munsi, binyuze mu guhanga udushya muri Metalurgie, Ubuhanga bwo kubaga hamwe nubuhanga bwa fluecroscopique, imisumari ya intramedipique, intera Ese imisumari yahindutse urwego rwo kwita kumagufa maremare yamagufa.

Iterambere mubumenyi bwabantu bumenical yatumye habaho ibishushanyo mbonera bishoboka. Imisumari ya kijyambere igezweho irangwa nigipimo cyanduye buke, gukomeretsa bike, gucika intege neza, hamwe nubufatanye bwihangana.

Isubiramo ry'amateka ryakozwe muri iyi ngingo rigamije kuvuga muri make ubwihindurize bw'inkinga, rigaragaza ibihe by'ingenzi byo gukoresha imisumari ya mbere, kandi tugatangiza aho umusururo wa mu misundere ya mbere, kandi hakurikijwe ikibanza cy'imisumari ya intttttttttttttttttttttttamediclary muri orthopediclary na ihahamuka (urugero: Igishushanyo 1).

Ivuka rya Intramedillary Umusumari

Abanyamisiri ba kera bakoresheje bwa mbere ibikoresho byo mu ntambara bisa n'umusumari. Ubuvuzi bukomeye bwo kubaga ntabwo bwari bwo kubaho mumyaka myinshi ishize.

Icyizere, ariko, nuko Abanyamisiri ba kera bari bafite uburyo bwiza bwo kongerera umurambo buturuka ku kwizera kwabo mu izuka ry'umubiri ku buzima bwa nyuma.

Uku niko byagenze kuri Mummy yise Gusibamomontu aboneka mu mva ya Tutankhamun, aho imisumari yashyizwemo hagati ya femur na Tibia kugira ngo igabanye ivi (nko ku gishushanyo cya 2).

Abacukuzi b'ivya kera bavuga ko mummy uri muri Sarcofagus ntabwo yari Seadimonsu ubwe, ariko undi muntu wasimbuwe n'abajura b'imva ya kera muri 600 MIC.

Nyuma yimyaka 2000, Bernardino de Sahagun, umuhanga mu maguru kuri hernando cortes, yatangaje ko gukoresha bwa mbere mu ntera ya Intramedillar mu murwayi uzima muri Mexico.

Mu 1524, yiboneye amagufwa yo kubaga Aztec (yiswe 'Tezalo ') kora osteotomy ukoresheje icyuma cya obsidian hanyuma ushiremo inkoni isigaye mu cyuho. Bitewe no kubura tekinike ihagije na antiseptitique, ubu buryo bwari bufite igipimo kinini cyo kugorana hamwe nigipimo cyimbaho.

1800s: Intambwe Zambere

Hafi ya 1800, ibinyamakuru byambere byubuvuzi byavuzwe kuri intertavillalary. Diefenbach, Langenbeck, Bardenheuer na Bardenheuer nandi basangiraga mu kidage bavuganye ku budage bakoresheje imisumari y'inzovu mu magufa maremare yo kuvura amagufwa.

Hagati aho, Nicholas Senn wa Chicago, umushakashatsi hamwe n'umubatsi mwiza w'igisirikare, bakoze ubushakashatsi bafite ibyuma bya intramedillary. Yakoresha umurongo utoroshye ukorwa igufwa rya bovine hanyuma uyinjire muri medulla kugirango uvure 'pseudarthrose ' nyuma yo kuvunika.

Mu 1886, Heinrich Bircher wo mu Busuwisi yasobanuwe mu nama yo kubaga abaganga kwinjiza imisumari y'inzovu muri Medulla ku bijyanye no kuvura gukomeye (Ishusho 3).

Nyuma yimyaka mike, Thelisecles Gluck mu Budage yaremye intoki za mbere imisumari hamwe n'umwobo ku mpera y'umusumari, bityo utangiza igitekerezo cyo guhagarika ubwa mbere.

Muri icyo gihe, Julius Nicolayese wo muri Noruveje niwe wa mbere wanditse ku mahame ya biomelullar yo mu misumari y'intangiriro y'imikorere myiza. Yashimangiye ko ari ngombwa kongera uburebure bw'imisumari y'intangiriro yo kubona inyungu nini zo muri bio kamenic no gutanga uburinzi hafi y'amagufwa yose.

Yabaye kandi uwambere yasabye igitekerezo cyumusaruro wa Proximinal na kure cyangwa igufwa rya kure Yasuzuwe nintiti zimwe na zimwe nka se wa intramedillary.

Hagati ya 1800, abapayiniya nka Ignaz Phisigi Semmelweis i Vienne na Josephgowis i Glasgow bari bashizeho urufatiro rwo gutanga ihohoterwa rigana. Ibi byari ibyagezweho cyane kuko byemereye iterambere ryubuhanga bushya bwo kubaga mubihe bitandukanye.

1900: Ubwihindurize

Mu 1912, umuganga wo mu Bwongereza Ernest Hay ni bwo bumugaye bwa mbere bwo gukoresha inkoni ikomeye nk'imisumari y'inyoni kandi yari umupayiniya wa retrograde intramedilllary uburyo bw'imisumari.

Yungutse uburambe bwe mu Ntambara ya Mbere y'Isi Yose ubwo yafataga abarwayi bo mu masezerano yanduye banduye banga gucika intege. Ntabwo yasobanuye gusa tekinike ya mbere yintera yemerera Osseointegration Osseointegration Binyuze mu mbaraga ntoya, ariko nanone yari umuhanga mu gukoresha imisumari n'imisumari mito kugirango ukosore imivuruke.

Yagerageje imbaraga zikozwe muri aluminimu, magnesium na steel kandi zimenya akamaro ko ibinyabuzima mu gukira. Nubwo bimeze bityo, ubuhanga bwa ernest nyakatsi 'tekinike yarwaye urugero hejuru yanduye kandi ntabwo rero yakunzwe nabagenzi be.

Mu 1931, Smith-Petersen, umuganga wo kubaga amagufwa y'Abanyamerika, yatangizaga ibyuma bitatu bya Stainless bidafite amababa atatu yo kuvura injangwe-articular capsule yo kuvura indwara z'umunya ubukorikori. Yateguye uburyo bwerekana neza mu mwanya wa gatatu mu bice bya Iliac, yinjiye mu murima ukorera ku nkombe y'imbere muri tensor rishingiye ku giti cye, hanyuma agakoresha umutego wo gutwara ibyuma bidafite ishingiro mu mutwe w'imyenda (Ishusho 4).

Kubera iburanisha ry'urubanza rwa Smith-Petersen, abaganga benshi batangiye kugerageza n'icyuma. Sven Johansson yahimbye intera inkuta z'isi mu 1932; Guhanga mu guhangayikuru ye mbere yakoresheje urushinge rwa Kerfing yemereye kwinjiza radiologique kwinjiza imvururu. Ibigize tekinike byingenzi yasabye biracyakoreshwa muri iki gihe.

Kugenda intambwe imwe, kwihuta na murumuna we byamenyesheje igitekerezo cya elastike interadlary isukari ya elastike muri 1937.

Bakoresheje imyanda ya elastike, babanjirije ibyuma bidafite imisumari kandi bagerageza gukora intera intera hakoreshejwe uburyo butatu bwo gukosora inyandiko kugirango bihangane byimazeyo kwimurwa hafi.

Mubitekerezo byabo, ahantu nyaburanga ahantu h'imiterere ikora nkitsinda rya tension ribuza impagarara zakozwe nimisumari ya elastike. Kubaka kwabo kwari gafite aho bigarukira ku mitungo ya elastique y'ibyuma bidafite ingaruka, byahindutse hakiri kare kuri delafortion ya elaforlation kuri plastike. Iyanyuma irashobora gutera kwimura kabiri no gukira.

Mubyongeyeho, imisumari yinkuta ikunda gusohoka ku bwinjiriro cyangwa kwinjira mu moko yamagufa, cyangwa no gutobora mu ngingo. Nubwo bimeze bityo ariko, intiti ya Vennese yakomeje gukoresha ubu buhanga nkishingiro ryishuri ryigihe cyo kuvunika ikosora kandi iracyakoreshwa muri iki gihe kugirango ikosorwe byoroshye.

Amagufwa marrow umusumari

Mu 1939, Gergeon Gergeon Gerhard Küntsche, igihembo cy'ibitimbo cy'utizera, cyateje imbere imisumari ihindagurika idahwitse yo kuvura imivurungano z'ibiti by'umunya femore.

Küntschers nabandi bahumekewe nibyuma bya Stith-Peterth-Peters Flat byakoreshwaga kuvuza ijosi kandi bizera ko amahame amwe ashobora gukoreshwa kumuvuza. Umusumari wa Intramedillary Bateye imbere wabayenza V-ikozwe mu gice cyambukiranya na mm 7-10 muri diameter.

Nyuma yimyigire ya CADAVANDIKO N'inyamaswa, yerekanye umusumari wo mu mujyi n'uburyo bwo kubaga mu nama yo kubaga i Berlin mu 1940. Nubwo uburyo bwe bwarasenyutse na bagenzi be b'Abadage, nubwo uburyo bwe bwarabyaye nyuma y'Intambara ya Kabiri y'Isi Yose.

Hippocrates (460-370 mbere ya Yesu), umuganga wa kera w'Abagereki wakunze kuvuga ko ari se w'ubuvuzi, yigeze kuvuga ati: 'Ushaka kubaga agomba kubaga agomba kubagwa '; Ni nako byari bimeze kuri küntscher.

Mu gihe cy'Abanazi, Küntsches yari ahagaze mu bitaro byo ku rugamba rwo mu gifinilande. Ngaho, yashoboye gukorera abarwayi n'imfungwa z'intambara muri ako karere. Yatangije amagufwa yangiza imisumari akoresheje uburyo bufunze kandi bufunguye.

Mu buryo bufunze, yatsinze intera imisumari muri prograde icyerekezo binyuze mu karoriba ikomeye, abishyira kumeza yo gusubira inyuma yakoraga hamwe no kunyereza. Kuvunika bisubirwamo kandi umusumari yinjijwe mu ndege ebyiri ukoresheje Head Fluoscopy. Mu buryo bwuguruye, umusumari wa Intramedillary winjijwe mu kuvunika muri Medulla unyuze hafi y'umurongo wavumbuye

Tekinike ya Küntsche yamenyesheje amakuru mpuzamahanga nyuma yo gutahuka imfungwa zibogamye.

Muri ubu buryo, abaganga b'Abongereza n'abanditsi b'Abongereza bamenyereye imisumari ya Küntscher kandi bamenye inyungu zayo zisobanutse muri iki gihe cyo kuvura imiti.

Mu gihe gito, byinshi kandi abaganga benshi ku isi batangiye kugira uburyo bwe, kandi inttchcher mu misumari ya Küntsche yahinduwe kuvura imivuza mu gihe cy'abarwayi hafi umwaka. Abarwayi bari kugomba guhitanwa mumezi amezi menshi bashobora kuba mobile muminsi mike.

Kugeza ubu, umuganga wo kubaga mu Budage afatwa nk'ubwubanjirije intera y'umusumari, kandi afite umwanya munini mu mateka yo kubaga ihahamuka.

Kwagura IntramediLlary Umusumari

Mu 1942, Fisher et al. Bwa mbere yasobanuye gukoresha imbohe yo gusya kugirango yongere aho ihurira hagati yimbere mumisumari n'amagufwa no kunoza umutekano wo gukosorwa.

Nubwo bimeze bityo ariko, Küntsche yamenyesheje imyitozo yo kugabanuka zikoreshwa muri iki gihe kandi igashyigikira kongera kwinjiza imisumino yo koroshya imisumari minini ya diaamer.

Mu ikubitiro, intramedillary reamud yateguwe kugirango yongere ubuso bw'amagufwa hamwe na IntramediLary umusumari uhamye wo gukosorwa no kugenda kw'abarwayi byihuse.

Nkuko byasobanuwe na smith et al, buri mm 1 yo kwaguka kwadudullary yongera aho ihurira na 38%. Ibi bituma ikoreshwa ryimisumari nini kandi ikomeye intera imisumari, kuzamura umutekano rusange kumiterere yo gukosora.

Ariko, nubwo KünScher Intramedillary hamwe na Intramedible ya Rettttttttttttomer yongeye gukosora ibikoresho bya Osteotomy kuri Osteotomy, yatakaje ubutoni bwayo muri ArbeitsyCemersefragengn (AO).

1960s: Imyaka Yijimye

Mu myaka ya za 1960, imisumari yo mu ntangiriro zahise yishimira gutegeraho amasahani no gucogora.

Nubwo uburyo bwa Küntschescher bwakozwe neza, abaganga ku isi barayanze kubera ibisubizo bidatinze nyuma.

Byongeye kandi, abaganga bamwe batangiye guterera tekinike y'imyanda, nk'ururimi rwamavugo, kubera ko abaganga babaga bangwa n'ingaruka mbi zijyanye nimirasire. Iterambere ry'imisumari y'isi ntirwagarukirayo, nubwo bwumvikane rusange mu rwego mpuzamahanga rwo gukoresha isahani sisitemu yo gukosora imbere.

Küntsche, umuganga w'Ubudage, yamenye ibyiza byo gukomeza no guteza imbere ihungabana rifite imisumari y'inkuta, yise 'imisumari ifungwa '. Achilles Heel Igishushanyo mbonera cy'imisumari y'icyo gihe ni ukudashobora gutuza cyane kuvuza cyangwa kuvunika kwimurwa mu mirimo minini igisubizo cyiki kibazo ni ugukoresha imigozi yo gufunga.

Igisubizo cyiki kibazo kwari uguhungabanya imisumari yinjira hamwe na screw.

Muri ubu buryo, imbaraga zishobora kurushaho kurwanya ingabo zinanaga kandi zikagira uruhare mugihe zibuza kugabanya ingingo. Ukoresheje ibitekerezo bya Küntscher, Klaus Klemm, hamwe na Wolter Shalter, umusumari wateguwe kugira ngo ashyire imbere imitangire y'inzibacyuho ya prefimal kandi itandukanya imisumari y'inyoni, yari ifunzwe.

Mu myaka mike yakurikiyeho, gutera imbere mu ishusho ya flushscopique yemerewe kongera guhitamo tekinike yo gufunga no kugabanya.

1970 na 1980: Ububyutse

Mu myaka ya za 70, inyungu mu gitekerezo cy'imisumari y'umusuka cyo mu Budage kubaga Küntsche yari ikomeye.

Kugabanuka Kugabanuka Intramedullary Gukosora imisumari, hamwe no guhuza ibitekerezo byoroshye no guhagarika ubuhanga bwa fluoscopique, bikaba byaranzwe na tekinike yo kubaga

Muri kiriya gihe, isi ishinzwe amasomo yatwarwaga no guhanga udushya twiterambere ryigisekuru cya kabiri cyimisumari ya intramedillar.

Mu 1976, Grosse na Kempf bashizeho inzitizi zipiganwa igice kugirango bakemure ikibazo cya Molastike Modulus ya Intramedillar. Umusumari wa Intramedillary ntabwo yashyizwe mu karere ka Proxima kandi yari afite umwobo w'imisumari wa Proximine, yinjijwe ku mpande rusange 45 kugira ngo imbaraga zihamye zongere imbaraga zo gutunganya imisumari yo gukosora imisumari y'imbere.

Nyuma yimyaka mike, Ao yinjiye mu iterambere ry'imisuka imisumari atezimbere mu buryo nk'ubwo imisumari (ishusho 5)

Mu 1984, weinquist et al. proposed the dynamic approach, which was to enhance fracture end healing by applying larger locking screw holes, removing static locking screws, and subsequently modifying the locking screw holes to oval nail holes in a more modern design.

Intego yuburyo bufite imbaraga nugutezimbere gukiza no kwirinda amagufwa no kutagira amagufwa kubera ibikorwa byatinze.

Kugeza ubu, imbaraga z'imisumari zinjira zabuze abunganira nk'ubuhanga bwonyine kandi bukoreshwa gusa igisubizo kidasanzwe kuruta gusimbuza burundu uburyo bwo gukosora imbere mu kuvura ibitaramo.

Mu bushakashatsi bwa biomenical, Gimeno et al. yatangaje ko akarere k'inzibacyuho hagati y'ibice bidashidikanywaho kandi byashyizwe ku gice cy'imisumari ya Intramedullary byavuyemo kwibanda no kubaga no kubaga byoherejwe imbere.

Gukemura ibyo bibazo, Russel na Taylor et al. Yashizeho iwambere idahwitse, idahwitse intera imisumari mu 1986, hamwe nibisubizo bishimishije.

Muri kiriya gihe, ikibazo cyo guhagarika imisumari ya Intramedullary nacyo cyakomeje gutera imbere, kandi nkuko tubizi muri iki gihe, duhuza na screw binyuze mu mwobo w'imisumari wangiritse mbere yacukuwe mu Budage. Kwinjiza imigozi byayoborwa na Freehand Fluoroscopy, byagaragaza ko umuganga ubaga imirasire nyinshi.

Uyu munsi, iki kibazo cyakemuwe hamwe na sisitemu yibasira ya kure ikubiyemo tekinoroji yo gukurikirana ikoranabuhanga rya elegital.

1990: Titanium Intramedillary Umusumari

Mu myaka icumi yakurikiyeho, Umugwaneza wa Russel-Taylor Intramedullary, umusumari wamenyekanye cyane mu muryango mpuzamahanga w'amagufwa. Igipimo cyo kwitabwaho buhoro buhoro cyahindutse intera ihinduka hamwe no gufunga imigozi, nkuko bigaragazwa nibisubizo byubushakashatsi bwa Brumback et al.

Muri ibi bitekerezo, ibisubizo byavuzwe ko gufunga byatanze ibisubizo byiza mubihe byinshi kandi ntabwo bifitanye isano no kudahuza kuvunika.

Iterambere muri Metalurgigy ryatumye habaho kugaragara kwa titanium imisumari, ikoreshwa cyane mu nganda za Biomedical kubera imbaraga zabo, irwanya imyanda.

Sisitemu ya Alta Intramedullary nicyo cyambere cyabonetse titanium intera imisumari, kandi byakiriwe neza nabaganga kubera imitungo ya titanium ya titanium, nikintu gikomeye ariko gito cyane kuruta ibyuma.

Ariko, ubuvanganzo bwubu burashidikanya kugirango niba titanium ibintu bikwiye byo gukosora imbere yicyuma, cyane cyane kubera ibiciro byiyongereye bifitanye isano no gukoresha Titanium.

Ariko, ibyiza bimwe bya titanium, nka elastique modulus hafi yamagufwa na magnetic resonance imaging guhuza, bigire amahitamo ashimishije.

Byongeye kandi, Titanium nuburyo bwiza cyane iyo imisumari mito ya diamesezera irakenewe.

Inzira

Nyuma yo gutsinda no gutsindwa mu myaka ibarirwa muri za mirongo, abaganga borozi bafite uburambe bwinshi hamwe na intramedillary imisumari.

Intramedillary ikosora imisumari y'imyenda, Tibial na Makomali yahindutse urwego rwo kwita ku kuvunika cyane hamwe no kuvunika. Gahunda nshya na sisitemu yo gushyira mubikorwa byakoze uburyo bworoshye kandi bwororoka kubantu benshi badafite uburambe.

Inzira ziheruka zerekana ko ibyuma bya titanium na stiant bidafite imbaraga bya elastique kandi bishimangira imihangayiko irakaze ikenewe mumagukira. Biomaterial nshya nka magnesium alloys, imiterere yibuka ibirimo nibikoresho regorwa birageragezwa muri kaminuza.

Imisumari ya Intramedullary yakozwe muri karube zihoraho za karubone-yashimangiwe polymers hamwe nimbaraga za elastike kandi imbaraga zumunani nziza zirahari. Magnesium alloys ifite modulus ya elastique isa nimagufwa corcal kandi biodegraduable.

Ubushakashatsi buherutseho na Li et al. berekanye ibyiza byingenzi mugufata osteoporotic kuvunika osteoporotic muburyo bwinyamanswa bwimiterere ya magnesium hamwe no gukomatanya kugirango basuzume ibirego bya osteoporotic mugihe kizaza.

Umwanzuro

Mu myaka yashize, hamwe no kunonosora imisumari yimisumari, uburyo bwo kubaga, imisumari yo kubaga yateye imbere mububiko burebure kandi ni ikintu cyiza, giteye ubwoba, giteye ubwoba, no gutanga.

Ariko, kubera intera nini yimisumari, amakuru menshi arabuze kubyerekeye ibisubizo byabo nyuma. Ubushakashatsi bwinshi burakenewe kugirango tumenye uburyo bwiza bwo mu bwoko bwimisumari, imiterere na radiyo ya curvature.

Turahanura ko udushya mu murima wa biomateril tuzitanga umusaruro w'ibishushanyo bishya bya Intramedillary.

Nigute wagura amagufwa hamwe nibikoresho bya orthopedic?

Kuri Czmeditech , Dufite Umurongo wuzuye wibicuruzwa byabasabwe kumagufwa 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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