Kubaga ubuvuzi bwavunitse bwimitsi ningingo za tekiniki
Reba: 18 Umwanditsi: Muhinduzi wurubuga Gutangaza Igihe: 2022-10-14 Inkomoko: Urubuga
Kugabanya ibiro nyuma yo kubagwa bigomba gukomeza kurenza kilo imwe kugeza igihe gukira kuvunika gukomeye kugerwaho (ubusanzwe amezi atatu) .Ivunika ryumubiri rusange (HSF) risanzwe risanzwe, bingana na 1% kugeza 5% byavunitse. Indwara ya buri mwaka ni 13 kugeza kuri 20 ku bantu 100.000 kandi byagaragaye ko yiyongera uko imyaka igenda ishira.HSF ifite igabanywa ryimyaka ya bimodal, aho impinga ya mbere igaragara ku bagabo bari hagati y’imyaka 21 na 30 nyuma y’ihungabana ry’ingufu nyinshi, ubusanzwe bikaviramo kuvunika gukabije no gukomeretsa imyenda yoroheje. Impinga ya kabiri iboneka ku bagore bari hagati yimyaka 60 na 80, mubisanzwe bikurikira ihahamuka ridafite ingufu.
Kuvura
一. Gukosora imbere hamwe nisahani isubirwamo
Ibimenyetso ：
Indwara ya radial nervice (RNP) muri HSF ntabwo yerekana kubagwa kuko ifitanye isano nigipimo kinini cyo gukira kwizana (reba kandi - Ingorane / Imyakura ya Radial hepfo).
Ubundi, igikomere cyose cyamaraso gisaba gusanwa cyangwa kurengana nikimenyetso simusiga cyo kuvura kubaga kuvunika, kuko gukosorwa gukomeye birinda anastomose yimitsi.
Muri iki kibazo cyihariye, gukosora imbere hamwe nisahani birihuta kandi byizewe kuruta IMN kuko gusana imitsi bikorwa binyuze muburyo butaziguye (mubisanzwe inzira yo hagati).
HSF hamwe niyaguka ryimbere cyangwa intera intera-articular niyindi mimerere aho ORIF ifite amasahani aribwo buryo bwiza.
Kubaga ：
Ivunika riri hafi ya / cyangwa hagati ya gatatu rivurwa hakoreshejwe uburyo bwa kera butandukanye.
Iyo bikenewe, ubu buryo bwaguwe kure kugirango bugaragaze igituba cyose.
Nyamara, ubu buryo ntabwo busabwa kuvunika intera-arctular.
Ibice bya gatatu bya kure mubisanzwe bigaragazwa nuburyo butandukanijwe.
Kuvunika kure no hagati ya gatatu, uburyo bwahinduwe bwasobanuwe na Gerwin et al30 burashobora kwerekana 76-94% yigitereko (bitewe no kurekura imitsi ya radial no kurekura septal).
Ubuhanga bwo kubaga ：
Umurwayi ashyirwa mu ntebe yinyanja kugirango yegere impande zombi. Gukoresha amaboko y'intoki bifasha kugumya guhuza uruti. Kubyerekanwe inyuma, umwanya wuruhande niwo mwanya watoranijwe.
Kubaka isahani nziza igizwe na plaque ya mm 4,5 cyangwa ibisa nayo kandi igomba gutwikira byibura cortices 6 hejuru no munsi yikibanza cyavunitse, ariko cortices 8 zirahitamo.
Mugihe bikenewe, hasabwa guhuza isahani ntoya nini nini cyane, nkibisahani bigufi bya gatatu byigitereko kugirango bikomeze guhindurwa (kuvunika transvers cyangwa agace kinyugunyugu), hanyuma byongerwaho icyapa kigufi cya mm 4,5 kugirango gikosorwe bwa nyuma.
Kubice bya gatatu byavunitse, inkingi yinyuma yinkingi yabugenewe (3.5 / 4.5) irasabwa kwemerera epiphyseal ikomeye.
Gukoresha imigozi yo gufunga muri HSF bikomeje kutavugwaho rumwe
Iyo ugereranije amasahani yo gufunga hamwe namasahani adafunze kumeneka yagabanijwe hamwe nubwiza bwamagufwa meza, nta nyungu ya biomehanike ifite muri torsion, kunama cyangwa gukomera kwa axial kubintu byombi.
Ku rundi ruhande, iyo uhuye nubuziranenge bwamagufwa, gukoresha amasahani yo gufunga birashobora kuba byiza.
Mu bushakashatsi bwibinyabuzima bwakozwe na Gardner n'abandi. byumwihariko kubintu byavunitse osteoporotic, ibyubatswe 34 bidafunze byari bike cyane ugereranije no gufunga cyangwa kuvanga.
Gutera isahani ntoya ni uburyo bwo kubaga bigaragara ko butanga intsinzi yo hejuru hamwe nigipimo gito. Ariko, mubushakashatsi bwisubireho burimo abarwayi 76, van de Wall n'abandi. Yerekanye ko ituze ryuzuye ryimyanya ndangagitsina yonyine igabanya cyane igihe cyo gukiza radiyo ugereranije no guhagarara neza.
Ubuyobozi bwa nyuma yibikorwa ：
Mubisanzwe, gukosora bihamye kuboneka hamwe no gukoresha isahani. Rero, umurwayi yemerewe gukora ibikorwa bifatika kandi bifashwa bitagabanijwe nurwego rwo kugenda rwigitugu cyangwa inkokora.
Sling irashobora gukoreshwa muminsi myinshi mugucunga ububabare.
Kugabanya ibiro nyuma yo kubagwa bigomba gukomeza kurenza kilo imwe kugeza igihe gukira kuvunika gukomeye kugerwaho (mubisanzwe amezi atatu).
Abarwayi bakiri bato bemerewe kwikorera ibiro aho byemewe (urugero, bisaba inkoni kugenda), ariko kubarwayi bakuze ibi bigomba kuganirwaho buri kibazo.
Ibisubizo byatangajwe
Igipimo cyo gukira nyuma yo gupakira cyari hagati ya 87% na 96%, hamwe nigihe cyo gukira cyibyumweru 12.
Igipimo cyingutu kiri hagati ya 5% na 25%, hamwe nibibazo bidasanzwe bidafite akamaro nko kwandura, osteonecrosis, na malunion.
Ubuvuzi bukomoka kuri RNP ningaruka kubintu byinshi byumuntu. Streufert et al50 yasuzumye ibibazo 261 bya HSF yavuwe na ORIF isanga RNP ikomoka ku buvuzi yabaye muri 7.1% yuburyo butandukanye, 11.7% yuburyo butandukanye, na 17.9% byuburyo bwa triceps bwabitswe.
Kubwibyo, ni ngombwa kumenya no kurinda imitsi ya radiyo mu bice byose byafunguye.
二. Umusumari
Ibimenyetso ：
Mubyukuri, IMN irashobora gutanga inyungu za biomechanical na chirurgie zirenze isahani
Uhereye ku binyabuzima, igikoresho cyimbere cyimbere gihujwe na axe ya mashini ya stem ya humeral.
Kubwiyi mpamvu, iyatewe ikorerwa imbaraga zo kugonda hasi kandi ikemerera kugabana imitwaro myiza. Ibimenyetso byo kubaga imisumari yimbere ni kimwe no gufata amasahani.
Ariko, nkuko byavuzwe haruguru, kuvunika bimwe bikwiranye no gusya kuruta imisumari.
Ibiranga kuvunika hamwe nuburyo byagaragaye ko buruta IMN ni ibice bya patologique kandi byegereje, ibikomere byigice, hamwe no kuvunika osteoporotic.
Ivunika ryoroshye hagati ya gatatu ya transvers nayo ni ibimenyetso byiza kuri IMN.
Byongeye kandi, umusumari urashobora kwinjizwamo ukoresheje agace gato, kugabanya kugabanya imyenda yoroheje ugereranije nubuhanga bwo gufata.
Ibi ni ukuri cyane kuvunika igice cya gatatu cyo hagati yigitereko.
Ubuhanga bwo kubaga ：
Umwanya mwiza wumurwayi kuriyi nzira ni ku ntebe yinyanja. Gukoresha amaboko yintoki ningirakamaro cyane mugukomeza guhuza ibiti kimwe no gukora imigozi ya kure yubusa.
Ingingo yo kwinjirira iterwa nigishushanyo cyumusumari, ariko mubisanzwe iba ihuriro ryigituntu kinini hamwe nubuso bwumutwe bwumutwe wa humeral, bivuze ko imitsi ya rotate cuff imitsi igomba kwinjira.
Kuri ubu buryo, birasabwa gukora uburyo bwo kugabana deltoid kugirango ubone amashusho ya supraspinatus.
Mubyukuri, iyo winjiye mumutwe wa humeral hagati ya supraspinatus tendon, umuntu azisanga hagati mumutwe hagati yindege ya sagittal.
Ni ngombwa gukoresha keratomile munsi ya fluoroscopi kugirango umenye neza ko aho winjirira uri mumwanya wemewe haba mu ndege ya sagittal na coronale.
Nyuma yibi, umurongo wuyobora ugomba gutera imbere mbere yo gufungura supraspinatus tendon igihe kirekire muburyo bwo kureba neza.
Intambwe ikurikiraho igizwe no gufungura umuyoboro hejuru y'urushinge rwa Kirschner, ukemeza ko kuvunika guhuzwa no gukwega hamwe na / cyangwa gukoresha manipuline yo hanze, hanyuma ugateza imbere ubuyobozi mu muyoboro winjiye munsi ukageza ku nkokora.
Reaming byagaragaye ko ari byiza kubarwayi bakiri bato kandi ntabwo buri gihe ari ngombwa kubarwayi bakuze.
Kugirango ushire kure, gufunga AP ni byiza kandi bisaba uburyo buto bwa cm 2-3 kugirango ugabanye ibyago byo gukomeretsa imitsi ya myocutaneous.
Hanyuma, kugereranya IMN iruta retrograde IMN kubera ingorane zihariye zanyuma zirimo kuvunika kwa supracondylar kuvurwa, gutakaza kwaguka kwinkokora, hamwe na osiferi ya heterotopique.
Hagomba kwitabwaho cyane cyane uburebure bwumusumari watoranijwe, kuko imisumari ndende cyane ishobora gukurura amakosa abiri ya tekiniki ：
Kubwa hafi ya gatatu ya helix cyangwa kuvunika birebire, abanditsi barasaba ko hajyaho miniature ifunguye kugirango igabanye kuvunika ikurikirwa no gukosorwa ninsinga ya karuvati. Mubyukuri, kubwubu bwoko bwavunitse, imitsi ya deltoid ikunda gushimuta agace kavunitse mugihe mugihe pectoralis major ikurura igice cyacitse cyavunitse hagati, ibyo bikaba byongera ibyago byo kudahuza osseous cyangwa gutinda gukira.
Ubuyobozi nyuma yubuvuzi
Abarwayi barashishikarizwa gukora ibikorwa kandi bifashwa ningendo zintugu ninkokora nkuko byihanganirwa.
Imishumi irashobora gukoreshwa muminsi mike muguhashya ububabare.
Ibipimo byo guterura nyuma yibikorwa bikomeza kurenza ikiro kimwe kugeza gukira kuvunika kugaragara (mubisanzwe amezi atatu).
Mu bihe byinshi, biremereye gutwara ibiro biremewe
Ibisubizo byatangajwe ：
Ubuvanganzo bwo gukoresha ibikoresho byo gufunga imisumari yo kuyobora HSF ntabwo bihuye. Ku ruhande rumwe, igipimo cyavuzwe cyo kudahuza amagufwa kirahinduka cyane (hagati ya 0% na 14%), hamwe n’ibibazo byinshi mu bisekuru byakera by’imisumari. Ku rundi ruhande, byagaragaye ko ibibazo bituruka ku bitugu (harimo kubabara, kubangamira, gutakaza imbaraga cyangwa imbaraga) (kuva kuri 6% kugeza 100%) byavuzwe mu bitabo byabanjirije iki.
Bimwe mubibazo bishobora gusobanurwa nihungabana rya subacromial kubera imikorere idakira ya tendon idatewe no gutera imisumari, ingirangingo zinkovu na / cyangwa igikomere cya rotate cuff muri kariya gace gakomeye ka isovascularity.
Abanditsi benshi basobanuye uburyo butandukanye bwo kwirinda kariya karere ka hypovasculaire no gusana imitsi muburyo bwubwenge, bwerekanye ibipimo biri hasi yimikorere mibi yigitugu.
Kuvura konservateur ya HSF byatanze umusaruro ushimishije hamwe nigipimo kinini cyo gukira byibuze 80% byabarwayi. Kubera iyo mpamvu, iracyari uburyo bwo guhitamo HSF nyinshi. Niba guhuza bitemewe, kubagwa bigomba gutekerezwa. Ibi ni ukuri cyane cyane kubarwayi barengeje imyaka 55 y'amavuko bagaragaza kuvunika kwa gatatu kwa hafi (igipimo cyo gukira cyo hasi). Kubijyanye no kuvura kubaga, ubuvanganzo ntibugaragaza itandukaniro rinini riri hagati yisahani na IMN mubijyanye nigipimo cyo gukira cyangwa ingorane zifata imitsi ya radial, ariko ingorane zintugu (kubangamira no kugabanya umuvuduko wimikorere) birashoboka cyane na IMN. Kubwibyo, cuff igomba gucungwa neza haba aho yinjira no mugihe cyo gufunga.
Bitewe no kwizera ko umuntu wese kuri iyi si akwiye serivisi nziza yubuzima. CZMEDITECH CZMEDITECH
Twatangiye urugendo rudasanzwe hamwe na orthopedic yatewe hashize imyaka 13. Mubikorwa, umurongo wibyakozwe wahinduwe muburyo bwo gushiramo umugongo , ihahamuka , cranial-maxillofacial , prothèse , ibikoresho by'ingufu, abatunganya hanze , arthroscopy ubuvuzi bw'amatungo , hamwe na ibikoresho
Ibikoresho byacu byose bibisi biva mubitanga ubuziranenge mu gihugu no hanze yacyo. Ku bijyanye n'ubuziranenge, ntituzigera dusigarana ikiguzi mu nshingano zacu kugirango dukomeze gutera intambwe, bityo dushiraho laboratoire yacu bwite kugirango tumenye neza ibikoresho fatizo. Imashini zacu zose zitumizwa mu mahanga zitumizwa muri Amerika, Ubudage, Ubuyapani hamwe n’ibirango byo hejuru mu Gihugu kugirango tumenye neza ibicuruzwa byose twakoze.
Umwanya munini nimbaraga zishorwa mubushakashatsi kunoza no kuzamura ibicuruzwa byanyuma. Dufite itsinda ryubushakashatsi bwumwuga, itsinda ryababyaye hamwe nitsinda rya QC kugirango tumenye neza ubuziranenge hamwe nitsinda ryacu ryo kugurisha kugirango dukemure ibibazo byose kandi dutange serivisi nziza nyuma yo kugurisha.
Dushishikariye kwizera kwacu, dukomeje guhatira imipaka yubumenyi-bwo gutanga ibisubizo byujuje ubuziranenge, udushya twibisubizo kubakiriya bacu bose kwisi yose kandi dushyira imbaraga zidatezuka kubuzima bwabantu.
