Byagenda bite se niba gukosora imbere kuvunyuka hagati yananiwe?

Kuvuka ibibi bivugwa ko bigira ingaruka ku bantu bakuru 500.000 muri Amerika buri mwaka. Bafite ingaruka zikomeye ku mibereho, ubu ibaruramira 3-7% by'abapfaga mu bitaro ndetse n'igipimo cy'imyaka imwe y'abahiga 19.4-58%. Hafi ya kimwe cya kabiri cyibice byose ni uguhuza (ni) kuvunika. Ibice bibiri bikunze gufatwa no kuvunika ni imisumari ya cephalomedillarlary (cmn) hamwe na scare screw (shs).

Nubwo iterambere mu ikoranabuhanga ryateye imbere mu ikoranabuhanga, gutakaza amagufwa no kunanirwa gukosora nko kwinjira mu mutwe wa femorale biracyari bibi. Ubushakashatsi buherutse gukorwa bwatangaje ibipimo bigera kuri 6% hamwe no ku mutima. Ibintu byatewe no kunanirwa gukosorwa birimo intera iringaniye (tad)> 25 kuvunika bidahagije, ibishishwa bidahagije, bitandukanya na cipée. Gusaza na osteoporose nabyo bifitanye isano no kunanirwa gukosorwa.

Abarwayi nuburyo bwiza

Ibi byari ubushakashatsi busubirwamo kubarwayi buvurwa mubigo bibiri biri muri sisitemu yubuzima mukarere ka metero nini. Urubanza rw'ibiti by'abaganga babiri (JS na BC barababazwaga n'abarwayi bose basubijweho nyuma yo kunanirwa kwa mbere kuva mu ntara 2018 kugeza muri Nzeri 20. Gukoresha imikoreshereze ya sima mu gihe cyo kubaga kwaguka byemejwe n'ubuvuzi bwa elegitoronike (EMR) gusubiramo inyandiko za serivisi na radiyo nyuma yo gusubika. Twashyizemo abarwayi bose bafite ibimenyetso byerekana guharanira gukosorwa nyuma yo gukosorwa nyuma ya CMN ya mbere cyangwa SHS ikosora ivunika (Ishusho 1). Twasibye abarwayi bafite ijosi ry'ijosi cyangwa subtrochanterIc, abarwayi batigeze basohora imirongo ya sima, ndetse n'abarwayi bakorewe murthroplast igihe cyo kubaga kwambere.

Igishushanyo 1. Umugore wimyaka 76 yagizwe intera imisumari ya serivise ya femur (a), hamwe nububabare bukomeje, hamwe nububabare bwa kip nyuma y'amezi 2 kubera (B).

Ubuhanga bwo kubaga

Ku barwayi bahabwa gukosorwa kwa mbere na CMN, twakoze imisumari yo gusimbuza imisumari yahinduwe hamwe no gushimangira amagufwa. Ku ikubitiro, hashyizweho cm 5 ku ruhande rwa rezo nini, insinga ziyobora zashyizwe kuruhande rwimisumari, n'amagufwa yose yakuweho kuruhande rwa reamer akoresheje reamer. Ibikurikira, scuwdriver ya hexagonal yakoreshejwe mugusohora ibicuruzwa hejuru ya CMN (Ishusho 2).

Igishushanyo 2, Flueroscous yerekana scufténg ya Hexagonal yishora kandi ikureho imisumari mbere.

Guhagarika CM 1-2 hanyuma bikozwe muri Fascia ya ILITOBIIL (ITB) Fascia. Umusumari wambere wakuweho hamwe nubuyobozi buyobora (Ishusho 3). Kubijyanye no gutembera mu mutwe, ubuyobozi bwuzuyemo imitekerereze ya kure ikoreshwa hagamijwe gukumira imirongo ya shitingi (Igishushanyo 3a). By'umwihariko, Matrix yatewe habaye bwa mbere kuvanamo ibice bibiri by'imirwano ya gatatu hanyuma igashyira mu gace gatuje mukabona ibice bibiri byo hanze.

Igishushanyo cya 3, AnteropoSpion Imbere (ATTraoporive (a) hamwe nandi (B) amashusho yundi murwayi yerekana umutwe wintwari ufite imiyoboro y'amagufwa yamakuba

Ibikurikira, ibirimiho birakorwa hanyuma kuvunika bisubirwamo muri byinshi bya ExoStosis yo gusubiramo. Mugihe cyo gukiza masa cyangwa fibrous gukira, osteotomy ya percutaneous ikorwa ukoresheje 1/4 'igufwa rya gene hamwe nigikorwa cya intete. Ibi birakenewe cyane mugihe bikenewe kugirango umusaruro wijimye (intego> 130).

Umuyoboro mushya cyangwa urusaku ruhita rushyirwa mumagufwa yamagambo mumutwe wimbuto kumurongo wijosi, menya neza ko utitondeka kutinjira mumutwe (Ishusho 4). Umugozi ushyirwa mu gaciro nkana agace kabanjirije imisumari, ariko ndacyagaragaza kurangira hagati yumutwe wumunya femoral. (Ishusho 5)

Igishushanyo cya 4, Anteroposterior (ATHEROPEDIRI (amashusho ya (B) yumuti wumurwayi yerekana kwinjiza urushinge rwa Kerfing kuruhande rwumutwe mushya.

Igishushanyo 5, Amara ya Blooroscopy yerekana kwinjiza cladullamedinerlarlarlar nshya kuruhande rwinzira yububiko, bwariyongereyeho imigozi.

Hanyuma, umutwe wintwari wuzuyemo na cement yamagufa ukoresheje sisitemu ya sime ya sima (Ishusho 6). Hafashwe icyemezo kugirango wirinde gukangurwa mu ngingo ukoresheje amarafu nyayo hanyuma ugahindura ubujyakuzimu n'icyerekezo cya sima.

Igishushanyo cya 6, Gutekereza Kwerekana sima Kwiyongera Mubibanje (A), Buzuye buhoro buhoro (B) kugeza igihe inenge yumutwe wuzuye yuzuye (c).

Kubarwayi bahabwa gukosorwa kwabanjirije SHS, dukuraho shs dushyire cmn ndende. Nyuma yo gukora 5-cm cm cm cm mumujyi urutakoro kinini no kumenya ITB, gutemandurwa kugeza ku isahani iri kuruhande. Imiyoboro yose yakozweho ikurwaho hakoreshejwe screwdriver ikwiye hamwe nisahani kuruhande noneho irakurwaho. Imigozi ya terefone noneho ikurwaho nubuyobozi bwuzuye nkuko byasobanuwe kugirango ugaragaze kuvugurura urwego runini rwa Valgusi. Guhagarika 5-cm noneho bikozwe mugihe cyo guswera cyane nkuko byasobanuwe mbere. Insinga yinjijwe kumurongo wihuse cyane yo gufungurwa cyane kandi uteye imbere mutinda wa femoral. Reamer ifunguye itangijwe munzira yayobora. Umupira muremure-utabara umupira wamaguru hanyuma ugana urutwe hagati ya femur ya kure munsi yurwego rwa patella. Ibikurikira, Gusubira inyuma byakozwe kugeza Fremor yumvise mu mugongo. Abarwayi bacu bose bakiriye imisumari ndende ya TFN-Iterambere (TFNA) Intexral Stress Stnter Sisitemu Yimisumari (Depiyo-Synthes, Raynham, May.

Ikiganiro

Tekinike yacu ikoresha imikoreshereze ya magufa mugihe mugihe cyo gusubiramo. Amagufa ya cement gushimangira kugirango akosorwe mbere ya osteoporotique ya osteoporotique ya osteoporotique yibatswe kandi yerekanye ibisubizo byiza bya biomenical na kavukire. Isubiramo riherutse kuvugwa ko gushimangira amagufwa byatewe no kunanirwa kwishyurwa, byagabanijwe kwimura, ndetse n'ibibazo bike ndetse no kugaruka ugereranije no gukosora bidafite ishingiro. Ubushakashatsi buteganijwe, mubyiciro byinshi kandi byatangaje ko nta muhango wogosha cyangwa ibimenyetso by'ibimenyetso byo kwimurwa na CMN mu itsinda rishingiye ku byaro ugereranije n'imanza esheshatu.

Kuvunika ibibuno ni byinshi. Ubushakashatsi buherutse gukorwa bwasobanuye ibipimo 3-7% muri-ibitaro, impfu z'urupfu rumwe bigabanuka kuva 19.4% kugeza 58%. By'umwihariko, kuvunika byerekanwe ku ya 27% by'urupfu mu mwaka umwe. Urukurikirane rwacu rwivuriro rwerekanye ko nta rupfu rw'ibitaro no ku rugero rw'imfungano rw'umwaka umwe 13.6%, rufite hasi ugereranije n'ibitabo. Kuberako uburiri bwambere nyuma yo kubaga bufitanye isano no gupfa hasi, kwagukana hamwe nibisubizo byimikorere murukurikirane rwacu birashobora gusobanura urupfu ruto rugaragara rwagaragaye mubarwayi bacu.

Umwanzuro

Imiterere ya sima isubirwamo ni uburyo bwiza, butekanye, kandi buhendutse bwo kuvunika gutandukanya umurongo wa sertantrochanter kunanirwa kuba abarwayi bo mu bageze mu zabukuru bafite amagufwa ahagije.

Abarwayi bafite ibicuruzwa byananiranye bicuruzwa byatoranijwe byanduye bikurikirwa no gukosorwa no gusubiramo sima ryerekanaga ibyavuye mu mavuriro igihe kirekire ndetse n'ubuzima bwiza. Inzira yakoreshejwe gusa mugihe benshi mubuso bwa acetabular burinzwe kandi umusumari yagumye mu ijosi. Urebye aho ugarukira arthroplas muburwayi bwabakuru ba failend, ubu buryo bwerekana amasezerano neza kandi bigabanya ibishoboka byose mugihe bigabanye igihe kinini mugihe bigabanye igihe cyakazi nikiguzi muri iri tsinda ryabarwayi.

Nigute wagura amagufwa hamwe nibikoresho bya orthopedic?

Kuri Czmeditech , dufite umurongo wuzuye wibicuruzwa byubasaguro orthopperic bitera kandi nibikoresho bihuye, ibicuruzwa birimo 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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