Ivunika ryimyanya ndangagitsina ni imwe mu mvune zikunze kugaragara mu magufwa y’amagufwa, kandi hafi y’imvune ya humerus yegeranye ni imbaraga nkeya osteoporotic ivunika ku bageze mu zabukuru.
Nubwo igice kinini cyimyanya ndangagitsina ishobora kuvurwa muburyo budasubirwaho, 10-15% byavunitse biracyasaba ubuvuzi bwo kubaga, burimo gukosora ibyapa byo kugabanya, kugabanya gufunga imisumari yimbere imbere, no gusimburana hamwe.
Icyemezo cyo kuvura kigomba gushingira kumiterere yumurwayi wumubiri, uko yiyumva, ibyifuzo bye mumitekerereze, nubwoko bwavunitse.
Gusubiramo no gukosora kuvunika byihutirwa
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2. Kurwanya ububabare bukabije mbere yo gutangira
【Icyifuzo】 Abarwayi bafite kuvunika hafi ya humerus bakunda guhitamo analgesia mbere yo gutangira hamwe na acetaminofeni yo mu kanwa cyangwa NSAIDs, kandi opioide yo mu kanwa irashobora kongerwamo niba ingaruka atari nziza (igipimo cy’impuguke: 100%; igipimo gikomeye cyo gusaba: 73.8%).
3. Kwigisha abamisiyoneri mbere yo gutangira
[Icyifuzo] Uburezi mbere yo gutangira bugomba gukorwa muburyo butandukanye kandi butandukanye. (Igipimo cyifuzo cyinzobere: 100%; igipimo gikomeye cyo gusaba: 83.8%)
4. Gusuzuma imirire mbere yo gutangira no kuvura inkunga
【Icyifuzo】 Kurangiza gusuzuma imirire y’abarwayi mu masaha 24 yinjira no gutanga imirire ku barwayi bafite ibibazo by'imirire. (Igipimo cyifuzo cyinzobere: 98.5%; igipimo gikomeye cyo gusaba: 55.9%)
5. Isuzuma rya glucose mugihe no kugenzura abarwayi ba diyabete
Ation Icyifuzo target Intego yo kurwanya indwara ya glycemic kubarwayi benshi ba diyabete barimo kubagwa ni 7.8 kugeza 10.0 mmol / L.
6. Gucunga ibibyimba byoroshye kubyimba mugihe cya perioperative
Ation Icyifuzo】 Ku barwayi barimo kubagwa batoranijwe kugirango bavunike hafi ya humerus, uburyo bwinshi bwumubiri butangwa kugirango hagabanuke kubyimba mugihe cya perioperative. (Igipimo cyifuzo cyinzobere: 98.5%; igipimo gikomeye cyo gusaba: 80.9%)
7. Gucunga imirire mbere yo gutangira
Icyifuzo】 Abarwayi bafite kubagwa batoranijwe barashobora kurya ibinyobwa bisobanutse 2 h mbere yo kubagwa, ibiryo birimo ibinyamisogwe cyangwa ibikomoka ku mata 6 h mbere yo kubagwa. (Igipimo cyifuzo cyinzobere: 100%; igipimo gikomeye cyo gusaba: 76.5%)
8. Gucunga neza inkari
Com Icyifuzo】 Routine perioperative inkari catheterisiyoneri ntabwo isabwa kubagwa hafi yimitsi yimitsi (igipimo cyimpuguke: 100%; Igipimo gikomeye: 78,6%)
9. Gukoresha uburyo bwo gukumira imiti igabanya ubukana bwa mikorobe
【Icyifuzo】 Ku barwayi bafite imvune yimitsi isaba endoprosthesis cyangwa gusimburana hamwe, birasabwa gukoresha imiti igabanya ubukana bwa cephalosporine yo mu gisekuru cya mbere n’icya kabiri mu rwego rwo kwirinda indwara mu gihe cyo gutangira. (Igipimo cyifuzo cyinzobere: 97.1%; igipimo gikomeye cyo gusaba: 73.5%)
10. Guhitamo anesteziya
Com Icyifuzo est Anesthesia irasabwa gukoresha uburyo bwo guhagarika akarere ka rusange anesthesia rusange, guhitamo imiti kugirango wirinde kongera imikorere mibi yimikorere yabarwayi bageze mu zabukuru, kandi witondere gushimangira igenzura (igipimo cy’impuguke: 100%; igipimo gikomeye cyo gusaba: 71.4%).
11. Impaka zumuvuduko wamaraso impaka
[Icyifuzo] Kugabanya umuvuduko ukabije wumuvuduko wamaraso bigomba kwitabwaho kugirango ugabanye gutakaza amaraso mungingo ziterwa no kuvunika kwimyanya ndangagitsina, ariko abarwayi bageze mu za bukuru bafite ingaruka nyinshi bagomba kwitondera kubungabunga umutekano wa hemodinamike kugirango birinde guhumeka neza kwingirangingo ningingo (igipimo cy’inzobere: 100%; igipimo gikomeye cyo gusaba: 61.9%).
12. Gucunga amajwi adasanzwe
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13. Gucunga amaraso
[Ibyifuzo] hypotension igenzurwa na operasiyo ntabwo isabwa kuvunika hafi ya humeral, cyane cyane kubarwayi bageze mu zabukuru, kandi guterwa amaraso munda hamwe na aside tranexamic birashobora gukoreshwa. Igenzura rikorwa rya HGB <80g / L risaba guterwa amaraso ya allogeneque (igipimo cy’impuguke: 100%; igipimo gikomeye: 73.8%).
14. Kwirinda hypothermia intraoperative
[Ibyifuzo] Abarwayi bafite imvune ya humeral yegeranye bagomba gushimangira igenzura ryubushyuhe bwimikorere kandi bagafata ingamba zitandukanye kugirango ubushyuhe bwibanze buri hejuru ya 36 ° C (igipimo cyifuzo cyinzobere: 100%; igipimo gikomeye cyo gusaba: 76.2%).
15. Guhitamo uburyo bwo kubaga
(1) Gucika kuvunika kwa nyababyeyi yegeranye
[Icyifuzo] Gutegura Neer birasabwa kubika hafi yo kuvunika kwa humerus (igipimo cyinzobere: 100%; igipimo gikomeye: 83.3%).
(2) Uburyo bwo kubaga
Gahunda yo kubaga igomba guhitamo hashingiwe ku kuvunika kwa morfologiya, ubwiza bwamagufwa, imiterere yumubiri nu mitekerereze ya psychologiya nibindi bintu bifatika.
[Icyifuzo] Ibikoresho byo gutunganya imbere birashobora gutoranywa ukurikije ubwoko bwavunitse hamwe nubucucike bwamagufwa, nka plaque cyangwa imisumari yimbere; kubarwayi bageze mu zabukuru barwaye osteoporose bigoye gusubiramo cyangwa gukosora, kuvunika ibice 4 (no kuvunika kuvunika), kuvunika ibice 3 hamwe na osteoporose ikabije, kuvunika gucikamo ibice no kuvunika ijosi rya anatomique, gutoranya urutugu rwibihimbano hamwe no gusimburanya ibitugu bisabwa niba bihujwe no gukomeretsa kwa rotateur (igipimo cyifuzo cyinzobere: 71.4%).
![Kumeneka hafi ya humerus]()
Igicapo 1 Umugore w'imyaka 65 y'amavuko afite ibice 4 byavunitse byongewemo byongewemo byimyanya ndangagitsina hamwe na allograft fibular yatewe isahani hamwe no kuyisubiramo.
16. Gushyira umuyoboro wamazi
. Amaraso make. Ibimenyetso byo gushyira imiyoboro y'amazi: ① ukoresheje inzira ya deltoid, gutoranya ibyapa cyangwa gusimbuza urutugu; Amaraso ava cyane hejuru y igikomere (igipimo cyifuzo cyinzobere: 100%; igipimo gikomeye cyo gusaba: 71.4%).
17. Gufunga ibikomere
【Icyifuzo inc Igikorwa cyo kubaga cyafunzwe na suture yoroshye ihagaritswe, ibice byateganijwe (igipimo cy’impuguke: 100%; igipimo gikomeye cyo gusaba: 76.2%).
18. Indyo yo gukira nyuma yibikorwa
【Icyifuzo】 Abarwayi barashobora gufata ibinyobwa bidafite dregs bakoresheje umunwa nibamara gukanguka nyuma yo kubagwa, hanyuma bagakomeza indyo isanzwe nyuma ya 1-2 h niba nta reaction mbi.
19. Guhitamo imyanya nyuma yibikorwa nibikorwa hakiri kare
Icyifuzo】 Abarwayi ntibakeneye kuryama hasi ku musego nyuma yo kubagwa, barashobora gufata umwanya wa kabiri kandi bashobora kwimuka hasi nyuma yo kubyuka. Ihahamuka ry'igitugu rigomba gufatwa.
20. Ingamba zo gusesengura nyuma yibikorwa
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21. Kwirinda isesemi nyuma yo kubagwa no kuruka
[Icyifuzo] Abarwayi bose bagomba guhabwa imiti igabanya ubukana 30 min mbere yo kubagwa. (Igipimo cyifuzo cyinzobere: 97%; igipimo gikomeye cyo gusaba: 47.8%)
22. Gusana imikorere
Icyifuzo】 Abarwayi bafite imvune zihamye kandi zihamye zigomba gutangira imyitozo ngororamubiri hakiri kare nyuma yo kubagwa. Imyitozo ngororamubiri ifasha kugarura neza imikorere yingingo yo hejuru (Igipimo cyifuzo cyinzobere: 100%; Igipimo gikomeye cyo gusaba: 92.9%).
23. Gusohora ibipimo no kubikurikirana
Icyifuzo criteria Hagomba gushyirwaho ibipimo ngenderwaho byo gusohora, kandi abarwayi bagomba gukurikiranwa buri gihe byibuze amezi 6 (igipimo cy’impuguke: 100%; igipimo gikomeye cyo gusaba: 83.3%).
Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？
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