Byagenda bite niba gukosora imbere kuvunika inter rotator byananiranye?

Bavuga ko kuvunika ikibuno bigira ingaruka ku bantu bakuru 500.000 muri Amerika buri mwaka. Bafite ingaruka zikomeye ku mibereho y’ubuzima, kuri ubu bangana na 3-7% by’impfu ziri mu bitaro ndetse n’umwaka umwe bapfa bangana na 19.4-58%. Hafi ya kimwe cya kabiri cyavunitse ikibuno ni intertrochanteric (IT) ivunika. Ibintu bibiri bikunze gukoreshwa byifashishwa mu kuvura imvune za IT ni umusumari wa cephalomedullary (CMN) hamwe na hip screw yo kunyerera (SHS).

Nubwo iterambere ryiterambere ryikoranabuhanga, guhagarika amagufwa no kunanirwa gukosorwa nko kwinjira mumutwe wumugore biracyagaragara kandi birashobora kwangiza. Ubushakashatsi buherutse gukorwa bwerekanye ibipimo byo kwanga kugera kuri 6% hamwe nogutera kijyambere. Impamvu zishobora gutera kunanirwa gukosora zirimo intera-tip intera (TAD)> mm 25, gusubiramo kuvunika bidahagije, uburyo bwo kuvunika budahungabana, imitoma ya cephalic iherereye kuruhande cyangwa munsi yumutwe wumutwe wigitsina gore, no kuzenguruka imbere kuruhande rwinkondo y'umura. Gusaza na osteoporose nabyo bifitanye isano no kunanirwa gukosorwa.

Abarwayi nuburyo bwiza

Ubu ni ubushakashatsi bwihuse ku barwayi bavuwe mu bigo bibiri biherereye muri gahunda y’ubuzima mu gace kanini. Ibibazo by'imanza z'abaganga babiri (JS na BC) byabajijwe abarwayi bose bakiriye sima ishimangirwa na verisiyo nyuma yo kunanirwa gukosorwa bwa mbere kuvunika IT kuva muri Mutarama 2018 kugeza muri Nzeri 2021, nyuma yo kwemezwa n'akanama gashinzwe gusuzuma. Gukoresha imbaraga za sima mugihe cyo kubaga ubugororangingo byemejwe nubuvuzi bwa elegitoronike (EMR) bwo gusuzuma inyandiko zakozwe na radiyo nyuma yo kubagwa. Twashyizemo abarwayi bose bafite ibimenyetso byerekana imbaraga za sima mugukosora nyuma yo kunanirwa kwa mbere kwa CMN cyangwa SHS gukosora ibice bya IT (Ishusho 1). Twakuyemo abarwayi bafite ijosi ryigitsina gore cyangwa imvune za subtrochanteric, abarwayi batigeze bakosorwa hamwe nogukomeza sima, nabarwayi babazwe arthroplastique mugihe cyo kubagwa bwa mbere.

Igicapo 1. Umugore w'imyaka 76 yatewe imisumari idasanzwe kugirango avunagurwe hagati y’igitsina gore (A), akomeza kubabara ikibuno nyuma y'amezi 2 bitewe no guterwa (B).

Ubuhanga bwo kubaga

Ku barwayi bahabwa gukosorwa bwa mbere na CMN, twakoze imitwe yahinduwe yo gusimbuza imisumari hamwe no gushimangira amagufwa ya sima. Ku ikubitiro, intambwe ya cm 5 yakozwe ku mpande zegeranye za trocanter nini, umugozi uyobora washyizwe mu mpande zegeranye z'umusumari, kandi amagufwa yose yakuwe ku mpande zegeranye z'umusumari akoresheje reamer ifunguye. Ibikurikira, icyuma cya mpande esheshatu cyakoreshejwe mu guhanagura umugozi wo gukosora hejuru ya CMN (Ishusho 2).

Igishushanyo cya 2, fluoroscopy intraoperative yerekana icyuma cyerekana impande esheshatu zikurura kandi zirekura umugozi washyizweho imisumari.

Uburebure bwa cm 1-2 hanyuma bukozwe muri fassiya ya iliotibial (ITB). Umusumari wumutwe wumwimerere ukurwaho hamwe nu murongo uyobora umurongo (Ishusho 3). Ku bijyanye no gutobora umutwe w'igitsina gore, hifashishijwe imiyoboro idafite icyerekezo gifunga intera ikoreshwa mu rwego rwo kwirinda ko sima yinjira mu gihimba (Ishusho 3A). By'umwihariko, matrix yabanje guterwa inshinge nyuma yo gukuraho ibice bibiri byo hanze bya cannula eshatu hanyuma bigashyirwa ahantu hacuramye hongera gushiramo ibice bibiri byo hanze.

Igishushanyo cya 3, Intraoperative anteroposterior (A) hamwe na (B) amashusho yundi murwayi werekana umutwe wigitsina gore ufite amagufwa yinenge.

Ibikurikira, urugingo rurakwega hanyuma kuvunika bigasubizwa mubindi byinshi bya exostose kugirango bikosorwe. Mugihe cyo gukira kwa malunion cyangwa fibrous, osteotomy ya percutaneous osteotomy ikorwa hakoreshejwe 1/4 'amagufwa ya gouge hamwe nuburyo budahwitse. Ibi ntibikenewe cyane, ariko bigira akamaro cyane mugihe bikenewe kugirango habeho inguni yinkondo y'umura (intego> 130 °).

Umuyoboro mushya cyangwa uruziga rushyirwa mu igufwa rya subchondral mu mutwe wigitsina gore ukurikira umurongo w ijosi ryigitsina gore, ukareba neza ko wirinda kutinjira mumutwe (Ishusho 4). Imashini ishyirwa nkana kwirinda inzira yimisumari yabanjirije, ariko iracyerekana kurangirira hagati yumutwe wigitsina gore. (Isanamu 5)

Igishushanyo 4, Anteroposterior (A) hamwe na B (B) amashusho yundi murwayi yerekana kwinjiza urushinge rwa kerfing kumuhanda wumusumari mushya.

Igicapo 5, fluoroscopy intraoperative yerekana kwinjiza icyuma gishya cya cephalomedullary kumuhanda wicyerekezo, cyaje gukomezwa nicyuma cyashyizweho.

Hanyuma, umutwe wigitsina gore wuzuyemo sima yamagufa ukoresheje sisitemu ya sima yatewe inshinge (Ishusho 6). Hafashwe ingamba zo kwirinda gusohoka mu gihimba ukoresheje amaradiyo nyayo kandi ugahindura ubujyakuzimu hamwe nicyerekezo cya sima ya sima.

Igishushanyo cya 6, Ishusho yerekana sima yiyongera muburyo bwambere (A), kuzura buhoro buhoro (B) kugeza inenge yumutwe wumugore wuzuye (C).

Ku barwayi bahabwa gukosorwa kwambere kwa SHS, dukuraho SHS tugashyira CMN ndende. nyuma yo gukora santimetero 5 hagati hagati ya trocanter nini no kumenya ITB, gutemagurwa kumanuka kugeza ku isahani yegeranye. Amasahani yose yisahani yakuweho ukoresheje icyuma gikwiye cyamaboko hanyuma isahani yinyuma noneho ikurwaho. Imiyoboro ya tension noneho ikurwaho hamwe nu murongo uyobora umurongo nkuko byasobanuwe mbere kugirango uhindure kuvunika kurwego runini rwa valgus. Igice cya cm 5 noneho gikozwe kumutwe wa trochanter nini nkuko byasobanuwe mbere. Umugozi uyobora winjizwa kumpera yegereye ya trocanter nini kandi igatera imbere muruti rwumugore. Gufungura reamer yatangijwe munzira yubuyobozi. Umupira muremure uyobora umurongo noneho uhindurwamo hagati hagati yigitereko cya kure munsi yurwego rwa patella. Ibikurikira, reaming igenda ikorwa kugeza igihe umutingito wunvikana mumugongo. Abarwayi bacu bose bakiriye umusumari muremure wa CMN hamwe na TFN-ADVANCED (TFNa) yegeranye na femorale femorale yimisumari (DePuy-Synthes, Raynham, MA).

Ikiganiro

Tekinike yacu ikoresha amagufa ya sima ishimangira mugihe cyo gukosora. Gushimangira amagufa ya sima kugirango bikosorwe bwa mbere kuvunika kwa osteoporotic proximal femur yavunitse kandi byerekanye ibisubizo byiza bya biomehaniki na clinique. Isuzuma riherutse gukorwa ryerekanye ko gushimangira amagufa ya sima byatumye imitwaro myinshi yananirana, igabanuka ryimurwa, hamwe ningorane nke no kongera gukora ugereranije no gukosorwa bidashyizweho ingufu. Ubushakashatsi bwakozwe ku bushake, butandukanye kandi bwerekanye ko nta kongera gukora cyangwa ibimenyetso byerekana ko CMN yimuwe mu itsinda ryashimangiwe na sima ugereranije n’imanza esheshatu ziri mu itsinda ridafite ingufu.

Impfu zavunitse mu kibuno ni nyinshi. Ubushakashatsi buherutse gukorwa bwerekanye ko 3-7% by’impfu ziri mu bitaro, aho impfu z'umwaka umwe zagabanutse ziva kuri 19.4% zikagera kuri 58%. By'umwihariko, kuvunika IT byagaragaye ko 27% by'impfu z'umwaka umwe. Urukurikirane rw’amavuriro rwerekanye ko nta rupfu rw’ibitaro ndetse n’umwaka umwe bapfa bangana na 13,6%, ibyo bikaba ari bike ugereranije n’ibitabo. Kubera ko kuryama hakiri kare nyuma yo kubagwa bifitanye isano nimpfu nke, kwifata neza hamwe nigisubizo cyimikorere murirukurikirane rwacu bishobora gusobanura impfu nke ugereranije n’abarwayi bacu.

Umwanzuro

Isima-yongerewe imbaraga yo gusubiramo ni uburyo bwiza, butekanye, kandi buhendutse kubwo kunanirwa kuvunika kutanduye kwandura abarwayi bageze mu zabukuru bafite amagufwa ahagije ya acetabula.

Abarwayi bafite ikibazo cyo kunanirwa kuvunika kwa intertrochanteric primaire hakurikiraho gukosorwa no kuvura sima bongerewe imbaraga bagaragaje umusaruro mwiza wigihe kirekire cyamavuriro nubuzima bwiza. Ubwo buryo bwakoreshwaga gusa mugihe igice kinini cyubuso bwa acetabula cyarinzwe kandi umusumari wumutwe ugakomeza kuba mwijosi ryumugore. Urebye aho imipaka igarukira ku barwayi bageze mu za bukuru bafite intege nke, ubu buryo bwerekana amasezerano mu buryo bworoshye kandi bugabanya ingaruka zikomeye mu gihe cyo kugabanya igihe cyo gukora ndetse n’igiciro muri iri tsinda ry’abarwayi.

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

Kuri CZMEDITECH , dufite ibicuruzwa byuzuye byumurongo wo kubaga amagufwa hamwe nibikoresho bijyanye, ibicuruzwa birimo umugongo, imisumari, icyapa cy'ihungabana, icyapa, cranial-maxillofacial, prothèse, ibikoresho by'ingufu, abatunganya hanze, arthroscopy, ubuvuzi bwamatungo nibikoresho byabo bifasha.

Twongeyeho, twiyemeje gukomeza guteza imbere ibicuruzwa bishya no kwagura imirongo y’ibicuruzwa, kugira ngo duhuze ibyifuzo byo kubaga abaganga n’abarwayi benshi, kandi tunatuma uruganda rwacu rirushanwa cyane mu nganda zose z’imyororokere n’ibikoresho by’inganda.

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