Byagenda bite niba gukosora imbere kuvunika inter rotator byananiranye?

Bavuga ko kuvunika ikibuno bigira ingaruka ku bantu bakuru 500.000 muri Amerika buri mwaka. Zifite ingaruka zikomeye ku mibereho y’ubuzima, kuri ubu zingana na 3-7% by’impfu ziri mu bitaro n’impfu z’umwaka umwe zingana 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 ryikoranabuhanga, guhagarika amagufwa no kunanirwa gukosorwa nko kwinjira mumutwe wigitsina gore biracyagaragara kandi birashobora kuba bibi. 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 elegitoroniki (EMR) bwo gusuzuma inyandiko zakozwe na radiyo nyuma yo kubagwa. Twashyizemo abarwayi bose bafite ibimenyetso byerekana imbaraga za sima mugukosora nyuma yo kunanirwa kwambere kwa CMN cyangwa SHS gukosora ibice bya IT (Ishusho 1). Twakuyemo abarwayi bafite ijosi ryigitsina gore cyangwa imvune za subtrochanteric, abarwayi batigeze bakosorwa hamwe no gushimangira sima, nabarwayi babazwe arthroplastique mugihe cyo kubagwa bwa mbere.

Igicapo 1. Umugore w'imyaka 76 yatewe imisumari yimbere kugirango avunagurwe hagati yintangangore (A), ububabare bwikibuno bukomeza amezi 2 nyuma yo 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). Kubijyanye no gutobora umutwe wigitsina gore, ubuyobozi butoboye hamwe na kure Sikulufu ifunga bukoreshwa kugirango hirindwe kumeneka kwa sima mu gihimba (Ishusho 3A). By'umwihariko, matrix yabanje guterwa nyuma yo gukuraho ibice bibiri byo hanze bya kanseri ya gatatu hanyuma igashyirwa ahantu hacuramye hongera gushyirwamo 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 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 magufa ya 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, gucamo ibice kugeza kumasahani yegeranye. Amasahani yose yisahani yakuweho ukoresheje icyuma gikwiye cyamaboko hanyuma isahani yinyuma noneho ikurwaho. Imiyoboro ya tension noneho ikurwaho hamwe nu murongo winyuma 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-ADVAN CE D (TFNa) sisitemu yimisumari ya femorale yimisumari (DePuy- Synthes , Raynham, MA).

Ikiganiro

Tekinike yacu ikoresha amagufa ya sima ishimangira mugihe cyo gusubiramo. Gushimangira amagufwa ya sima kugirango bikosorwe bwa mbere kuvunika kwa osteoporotic proximal femur yamenetse kandi byerekanye ibisubizo byiza bya biomehaniki na clinique. Isuzuma riherutse gukorwa ryerekanye ko gushimangira amagufa ya sima byatumye habaho imitwaro myinshi yo kunanirwa, kugabanuka kwimurwa, hamwe ningorane nke no kongera gukora ugereranije no gukosorwa kudafite ingufu. Ubushakashatsi buteganijwe, butandukanye kandi bwerekanye kandi 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 bwagaragaje ko umubare w'impfu ziri mu bitaro 3-7%, impfu z'umwaka umwe zikagabanuka ziva kuri 19.4% zikagera kuri 58%. By'umwihariko, kuvunika kwa IT byagaragaye ko 27% by'impfu z'umwaka umwe. Urukurikirane rw’amavuriro rwerekanye ko nta rupfu rw’ibitaro hamwe n’umwaka umwe bapfa bangana na 13,6%, ibyo bikaba ari bike ugereranije n’ibitabo. Kuberako kugenda 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, bwizewe, kandi buhendutse kuburyo bwo kwandura imvubura zanduye zanduye zanduye 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. Uburyo 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 umurongo wuzuye wibicuruzwa byatewe no kubaga amagufwa hamwe nibikoresho bijyanye, ibicuruzwa birimo umugongo, imisumari, icyapa cy'ihungabana, Icyuma gifunga, cranial-maxillofacial, prothèse, ibikoresho by'ingufu, External Fixators, arthroscopy, ubuvuzi bwamatungo nibikoresho byabo bifasha.

Twongeyeho, twiyemeje gukomeza guteza imbere ibicuruzwa bishya no kwagura imirongo y’ibicuruzwa, kugira ngo duhuze ibyifuzo by’abaganga n’abarwayi benshi, kandi tunatuma sosiyete yacu irushanwa mu isi yose Ibikoresho byatewe mu magufa n’ibikoresho by’ibikoresho.

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