Nigute kuvunika periprosthetic bivurwa?

Intego

Ivunika rya periprosthetic ya femur yegeranye nikibazo gikomeye muri hip arthroplasty. Indwara ivugwa ni 3.5% nyuma yimyaka 20 nyuma yo guterwa bwa mbere kandi ikiyongera hamwe nabasimburana hamwe. Imvune zidakorana akenshi zifitanye isano nigiti kidahiye. Mubisanzwe, kuvunika kugaragara kubantu bakuze bafite intege nke baguye kumwanya wa kabiri kubagwa. Nubwo hari itandukaniro mpuzamahanga mugukoresha ibiti bya sima na sima, nta kimenyetso cyerekana ko ubwoko bumwe bwuruti rwa sima bufitanye isano ningaruka zo kuvunika kurenza ubundi. Sisitemu yo gutondekanya Vancouver yo kuvunika periprosthetic femorale yemewe cyane nabaganga babaga kandi byagaragaye ko ari iyo kwizerwa.

Intego yibanze yubu bushakashatsi kwari ukumenya isano iri hagati ya Vancouver ishyirwa mu byiciro bya sima na sima. Intego ya kabiri yari ugukora ubushakashatsi ku itandukaniro ryimiterere yibiranga abarwayi bafite ubwoko bubiri bwavunitse.

Ibikoresho nuburyo

Umurwayi:

1. Urukurikirane rw'abarwayi bafite imvune ikurikiranye ya periprosthetic.

2. Gusa abarwayi bafite imvune yibanze ya hip periprosthetic.

3. Abarwayi bafite imvune zidasanzwe, kuvunika ikibuno cyo gusubiramo, hamwe no kuvunika gusobanura.

   
   

Ibyanditswe:

1. Imibare ya digitale hamwe na tomografi yabazwe ishingiye kubikoresho bya elegitoroniki no gusesengura.

2. Ibisobanuro by'ibanze byanditswemo harimo imyaka, igitsina, indangagaciro z'umubiri, hamwe no kugabanuka kugenda mbere yo gutangira cyangwa kwishingikiriza ku barezi.

3. 
   

Ibisobanuro birambuye byo kubaga:

1. Igihe cyo guterwa bwa mbere, kwerekana arthroplastique (osteoarthritis cyangwa kuvunika), ubwoko bwuruti (sima cyangwa sementedment), nubwoko bwa arthroplastique (yose cyangwa semarthroplastique) yarimo.

2. Ibisobanuro birambuye byerekana amashusho harimo ibyiciro bya Vancouver, imyanya ya verus vertebral, hamwe na Dorr.

3. Ikibaho cya geometrie (conical cyangwa compound for ciment ciment, igororotse cyangwa igiti kimeze nkibiti bitavanze) byanditswe hashingiwe kumiterere ya radiografiya.

4. Kumenyekanisha ibyiciro bya Vancouver byari bishingiye kubushakashatsi bwakozwe hamwe nubushakashatsi bwakozwe mubarwayi babaga.

5. Isesengura mibare ryakozwe hifashishijwe impinduka zihoraho T-test hamwe na Fisher ikizamini nyacyo kubihinduka bitandukanye kugirango ugereranye ibiranga ibyingenzi hamwe na Vancouver itondekanya abarwayi mumatsinda ya sima na sima.

6. Ibigeragezo byose byari impande zombi hamwe nurwego rwingenzi rwa 0.05. Isesengura mibare ryakozwe hifashishijwe GraphPad Prism verisiyo 8.0.0.

   
   

Ibisubizo

Umubare w'abarwayi:

1. Abarwayi 1181 bamenyekanye babaza ububiko bwibitaro.

2. Abarwayi 978 bafite imvune zidafite uburinganire bwa periprosthetike.

3. Mu barwayi 203 basigaye, 8 bafite imvune zo mu nda, 6 bafite ibice byavuguruwe bya periprosthetic, naho 17 bafite ibice byavunitse bya periprosthetike y’igikoresho cyo gukosora ikibuno, nacyo kikaba kitarimo.

4. Abarwayi 172 bose hamwe barimo nyuma yo guhezwa.

5. Ivunika ryose ryabaye nyuma yo kugwa. Umugore wigiti cyamagufa ya sima yamenetse mubice 84 nta sima

6. Muri iryo tsinda habaye ibice 88.

   
   

Ibiranga Ibanze:

1. Hariho itandukaniro rikomeye hagati yitsinda mumyaka, igihe cyo guterwa bwa mbere, ibimenyetso byerekana arthroplasti yo kuvunika ijosi ryigitsina gore, hemiarthroplasti yibanze, varus stem stem, hamwe nuburinganire bwumubiri.

2. By'umwihariko, mu itsinda rya sima, benshi bari hemiarthroplasti.

3. Nta tandukanyirizo ryibanze ryari hagati yitsinda ryerekeranye nigitsina, Dorr ishyirwa mu byiciro, no kugabanuka kwimuka cyangwa kwishingira abarezi.

4. Mu itsinda rya sima, ibiti byinshi byafashwe amajwi naho ibindi byari ibishushanyo mbonera.

5. Mu itsinda ridahwitse, ibiti byinshi byari bigororotse naho ibindi byari bimeze nk'umugozi.

   
   

Ibyiciro bya Vancouver:

1. Ivunika rya VancouverB2 ryashyizwe mubice bine bitandukanye byavunitse: byavuzwe mbere byavuzwe 'guturika ', clamshell, hamwe nuburyo bwo guhindagurika, hamwe nuburyo bushya bwa 'revers '. Kugaragaza X-ray igaragara yuruhererekane hamwe nishusho ishushanyije irerekanwa (Ishusho 1).

2. Kumeneka guturika no kuzunguruka byari bifitanye isano cyane nigiti cya sima, mugihe kuvunika kwa flap byari bifitanye isano cyane nigiti kitavanze.

3. Igishushanyo mbonera cya clashell cyabaye kimwe muribiti byombi.

4. Ihuriro ryubwoko butandukanye bwa Vancouver, harimo ubwoko bune bwa B2 bwavunitse bwasobanuwe haruguru, hamwe na geometrie yibiti byerekana icyerekezo rusange muburyo bwo kuvunika.

Muganire

Kugeza magingo aya, ubu ni bwo bushakashatsi bunini bwo kugereranya mu buryo butaziguye isano iri hagati y’imvune ya sima na sima idasembuye hamwe n’imiterere ya Vancouver:

• Nta tandukaniro rikomeye ryagaragaye mu isano riri hagati y’ibiti bya sima na sima mu bwoko bwa Vancouver bwavunitse A, B, cyangwa C. Ikibazo cyo kuvunika kwa VancouverB2 cyari kimwe muri ayo matsinda yombi, byerekana ko ari kimwe mu biti bitajegajega kandi bidahungabana mu kuvunika kwa periprosthetic mu matsinda yombi.

• Ibinyuranye, Fenelon n'abandi. yasesenguye kuvunika periprosthetic hamwe na sima kandi idafite ibiti. Biragaragara ko umubare w'abarwayi bafite imvune muri Vancouver B2 na B3 ari mwinshi cyane.

• Abafilipi n'abandi. sobanura cyane 'guturika ' ishusho yibice bya sima ya sima na 'gucamo ' kuruhande rwikoti rya sima, bisa na 'umutwe wintorezo '. Uku kuvunika wasangaga bifitanye isano cyane nigiti cya sima muri ubu bushakashatsi.

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• Imiterere miremire yiyi mvune itera impungenge zijyanye no guhagarika amagufwa, kandi ibyo bivunika akenshi bisaba gukuraho neza sima no kuzenguruka hamwe nigiti cyitaruye.

• Capello n'abandi. yasobanuye kuvunika 'flip-flop ' bifitanye isano nigiti kidahiye, kandi ibyagaragaye birerekana ubu bushakashatsi. Ivunika rituruka kumurongo wo hagati wa trocanter nini, rigera kuri cortex yo hagati, kandi rikabika cortex kuruhande, kure ya trocanter nto. Kwiyongera kwakarere ka talar no kugabanuka kwuruti ni ibimenyetso bya radiografiya byerekana ihungabana ryuruti. Ubushakashatsi bwibanze bwerekanye ishyirahamwe rikomeye ryuvunika hamwe nigiti kidahwitse hamwe nuburyo bwa anatomique na wedge, kandi ubu bushakashatsi bushyigikira iri shyirahamwe.

• Ikibonezamvugo n'ibindi bisobanura urukurikirane rw'imvune zavunitse mu kuvunika kwa periprosthetike hamwe n'ibiti bya sima, ubusanzwe bifitanye isano n'ibice byitaruye kandi bikabije. Umubare wavunitse uhindagurika mu giti cya sima wariyongereye cyane muri uru ruhererekane, rushobora kwerekana uburyo bwo kuvunika kuzengurutse uruti rwa sima ya sima ikwirakwizwa mu buryo busa n’amagufwa karemano.

• Mu isesengura rya radiografiya ku mubare munini wavunitse wa periprosthetike, itsinda ry’ubushakashatsi ryabonye uburyo bwo kuvunika butigeze busobanurwa mu bitabo. Ivunika rituruka kuri calcar yo hagati inyura muri cortex kuruhande, hasigara cortex yo hagati. Ubu bwoko bwo kuvunika bwitwa 'reverse ' kuvunika clamshell, ubushakashatsi bwafataga kuvunika kwa Vancouver B2.

• Iri zina ryatoranijwe kubwimpamvu ebyiri: icya mbere, ni ishusho yindorerwamo ya 'flip ', naho icya kabiri, yitwara nkigice cya oblique cyegeranye cyavunitse femorale femorale, hamwe no kwimura ibintu bisa nkibintu byimuka byashimuswe bikurura igice cyegeranye. Ivunika nkiryo ryabaye hamwe nigiti cya sima kandi kidatunganijwe (Ishusho 2).

• Nubwo intego yubu bushakashatsi itari iyo gukora iperereza ku byavuye mu buvuzi, muri ubu bushakashatsi, kuvunika kwa flip-flop ubusanzwe byavuguruwe hamwe na arthroplastique y’uruti rurerure ruremereye no gukosora ibice byavunitse byegeranye hamwe n’insinga za cerclage.

• Urugero rwumurwayi wavuwe nubu buryo arerekanwa, yerekana ibyagezweho byo gukira (Ishusho 3).

Igishushanyo 2 Hindura uburyo bwo kuvunika hejuru.

Igishushanyo cya 3 Arthroplasti na cerclage wire ikosora kugirango retrograde ivunike.

Umwanzuro

Dukurikije gahunda yo gushyira mu byiciro bya Vancouver, ubwoko bwavunitse bwa periprosthetic bufite ikibazo kimwe cyo kuvunika periprosthetic muri sima na sima idasembuye. Kubwibyo, ikibazo cyibiti bitajegajega kandi bitajegajega nyuma yo kuvunika byari bingana mumatsinda yombi. Kumenya uburyo bune butandukanye bwavunitse bwa VancouverB2, harimo nuburyo bushya bwahinduwe bwa flip-flop, bizafasha kubaga kumenya ihungabana rikomeye. Inyigisho z'ejo hazaza zirakenewe kugira ngo hakorwe ubushakashatsi ku isano riri hagati yubwoko bwavunitse ningamba zo kuvura kugirango hamenyekane akamaro kivuriro ryibyavuye muri ubu bushakashatsi.

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

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