Unoziva here nhoroondo ye intramedullary nailing?

Kuuya kwe intramedullary nail kwakashandura kurapwa kwemafupa marefu akatyoka. Kunyangwe hunyanzvi hwacho hwaivepo kwemazana emakore, hahuna kuwana chimiro chayo chazvino kusvika muhafu yechipiri yezana ramakore rechi20.

Nzira yekubudirira yakanga isiri nyore nguva dzose, sezvo nzira yacho yakasangana nekusava nechokwadi uye kurambwa nenyanzvi dzakawanda muhafu yekutanga yezana remakore rechi20. Nhasi, kuburikidza nekuvandudzwa kwesimbi, maitiro ekuvhiya uye hunyanzvi hwefluoroscopic, intramedullary nailing yave chiyero chekutarisira kwekutsemuka kwepfupa refu.

Kufambira mberi muruzivo rwevanhu biomechanical kwakaita kuti kusikwa kweiyi dhizaini yemazuva ano kugoneke. Mazuvano intramedullary nailing inoratidzwa nekuderera kwehutachiwana hwehutachiona, kushoma mavanga, kugadzikana kwakanaka kwekutyoka, uye kufamba kwemurwere nekukurumidza.

Ongororo yezvakaitika kare yakaitwa munyaya ino ine chinangwa chekupfupisa kushanduka kwembambo ye intramedullary, kusimbisa zviitiko zvayo zvinokosha, kuratidza nguva yemhepo yekushandiswa kwekutanga uye kushanduka kwechipikiri che intramedullary, uye kuunza nzvimbo ye intramedullary mbambo mune zvemazuva ano orthopedics uye traumatology (semuenzaniso, Mufananidzo 1).

Kuberekwa kwe intramedullary nail

MaEgipita ekare akatanga kushandisa intramedullary mudziyo wakafanana nembambo. Complex yekuvhiya kutyoka kutarisirwa kwaisaita kunge kwavepo makore mazhinji apfuura.

Chine chokwadi, zvisinei, ndechekuti vaEgipita vekare vaive nehunyanzvi hwekuomesa zvitunha hwaibva mukutenda kwavo mukumuka kwemuviri muhupenyu hwapashure perufu.

Izvi ndizvo zvakaitika naamai vanonzi Usermontu vakawanikwa muguva raTutankhamun, apo mbambo yakarukwa yakaiswa pakati pefemu netibia kuti igadzikane ibvi (semufananidzo 2).

Vanochera matongo vanofungidzira kuti mummy mukati me sarcophagus akanga asiri Usermontu pachake, asi mumwe munhu akatsiviwa nemakororo ekare mumakuva muna 600 B CE .

Makore 2000 gare gare, Bernardino de Sahagun, anthropologist paHernando Cortes expedition, akashuma kushandiswa kwekutanga kwe intramedullary nailing mumurwere mupenyu muMexico.

Muna 1524, akaona chiremba weAztec bone (anonzi 'Tezalo') achiita osteotomy achishandisa banga re obsidian uye oisa tsvimbo yeresin mumedullary cavity kuti agadzikane kuputsika. Nekuda kwekushaikwa kwehunyanzvi hwekuvhiya hwakakwana uye mishonga inouraya hutachiona, maitiro aya aive nehuwandu hwekunetsekana uye huwandu hwekufa kwakanyanya.

1800s: Matanho ekutanga

Pakati pemakore ekuma1800, magazini ekutanga ezvokurapa akashuma nezve intramedullary nailing. Diefenbach, Langenbeck, Bardenheuer uye vamwe vanachiremba vanotaura chiGermany vanonzi vakashandisa zvipikiri zvenyanga dzenzou mumwongo wemapfupa akareba kuti vabate kuparara kwemapfupa.

Zvichakadaro, Nicholas Senn wekuChicago, muongorori uye anovhiya muchiuto anovhiya, akaita ongororo ne intramedullary fixation. Aizoshandisa buri rakapinza rakagadzirwa nebovine bhonzo oriisa mu medulla kurapa 'pseudarthrosis' mushure mekutyoka.

Muna 1886, Heinrich Bircher wekuSwitzerland akatsanangura pamusangano wekuvhiya kuiswa kwezvipikiri zvenzou mu medulla kuitira kurapwa kwakanyanya kwekuputsika kwakaoma (Mufananidzo 3).

Makore mashoma gare gare, Themistocles Gluck muGermany akagadzira mbambo yekutanga yenzou intramedullary ine buri pamagumo embambo, nokudaro achiunza pfungwa yekuvharira kekutanga.

Munguva imwecheteyo, Julius Nicolaysen wekuNorway ndiye akatanga kunyora nezve biomechanical nheyo dze intramedullary nailing ye proximal femoral fractures. Akasimbisa kukosha kwekuwedzera urefu hwembambo ye intramedullary kuti iwane hukuru hwebiomechanical uye kupa kudzivirirwa kweinenge pfupa rose.

Akanga ariwo wekutanga kupa pfungwa yeproximal uye distal mbambo / bone interlocking kugadzira static kukiya. Anoonekwa nedzimwe nyanzvi sababa ve intramedullary nailing.

Pakazosvika pakati pema1800, mapiyona akadai saIgnaz Philipp Semmelweis kuVienna naJosephLister kuGlasgow vakanga vavaka hwaro hwekuvhiya mbereko. Uku kwaive budiriro huru nekuti yakabvumira kuvandudzwa kwemaitiro matsva ekuvhiya pasi pemamiriro eeseptic.

1900s: Evolution

Muna 1912, chiremba wekuvhiya wekuBritain Ernest Hay Groves ndiye aive chiremba wekutanga kushandisa simbi yakasimba sembambo yemukati medullary uye aive piyona weiyo retrograde intramedullary chipikiri.

Akawana ruzivo rwake munguva yeHondo Yenyika I apo akarapa varwere vane utachiona hwepseudarthrosis vakanga vasingadi kudimbura makumbo nemaoko. Haana kungotsanangura nzira yekutanga ye intramedullary nailing yakabvumira osseointegration kuburikidza nekushungurudzika kuduku, asi aivewo neunyanzvi hwekushandisa intramedullary misumari uye zvipikiri zviduku kugadzirisa kuputsika.

Akaedza ma implants akagadzirwa nealuminium, magnesium nesimbi uye akaziva kukosha kwebiomechanics mukurapa kwekutyoka. Kunyangwe zvakadaro, maitiro aErnest Hay Groves akatambura nehuwandu hwehutachiona uye saka akange asina kufarirwa zvakanyanya nevenguva yake.

Muna 1931, Smith-Petersen, chiremba wekuAmerica wemapfupa, akaunza siruu yesimbi ine mapapiro matatu yekurapa intra-articular capsule femoral neck fractures. Akagadzira nzira yakazaruka yakapinza anterior chetatu cheiriac crest, yakapinda mumunda wekushanda ichitevedza kumucheto kweanterior fascial tensor, ndokuisazve pakatyoka uye akashandisa impactor kutyaira simbi isina tsvina mumusoro wechikadzi (Mufananidzo 4).

Nekuda kwekubudirira kwekutongwa kweSmith-Petersen, vanachiremba vazhinji vakatanga kuedza nesimbi inodyarwa yekutyoka. Sven Johansson akagadzira hollow intramedullary chipikiri muna 1932; hungwaru hwake hutsva hwakashandisa tsono yekerfing yaibvumira kudzorwa neradiologically guided kuiswa kwe intramedullary chipikiri. Zvinhu zvakakosha zvehunyanzvi zvaakashandisa zvichiri kushandiswa nanhasi.

Vachienda nhanho imwe mberi, Rush nemukoma wake vakaunza pfungwa ye elastic intramedullary chipikiri muna 1937.

Vakashandisa elastic, pre-yakabhenda Stainless simbi intramedullary chipikiri uye vakaedza kugadzira intramedullary matatu-point fixation chimiro kurwisa tsika yeaxial displacement yakatenderedza kuputsika.

Mune pfungwa yavo, iyo yakapfava yakapfava nzvimbo inoita senge bhendi rekumanikidza rinopokana netension inogadzirwa ne-pre-bent elastic nail. Kuvakwa kwavo kwaiganhurirwa neiyo elastic properties yesimbi isina tsvina, iyo yakachinja kare kubva kugomarara rekuchinja kuenda kupurasitiki deformation. Iyo yekupedzisira inogona kutungamira kune yechipiri kutamiswa uye kuremara kuporeswa.

Pamusoro pezvo, zvipikiri zve intramedullary zvinowanzobuda pamusuwo kana kupinda mukati mezvivakwa zvemabhonzo, kana kutopinda mukati mejoinhi. Zvakadaro, nyanzvi yeViennese Ender yakaramba ichishandisa nzira iyi sehwaro hweEnder chikoro chekugadzirisa kuputsika uye ichiri kushandiswa nanhasi kugadzirisa kuchinjika kwekutyoka kwevana.

Mwongo mbambo

Muna 1939, chiremba wokuvhiya wekuGermany Gerhard Küntscher, akasarudzwa Mubairo weNobel, akagadzira chipikiri chesimbi isina tsvina chemukati medullary chekurapa kwekutyoka kwedzinde remukadzi.

Küntscher nevamwe vakafemerwa neSmith-Petersen Stainless steel screws anoshandiswa kurapa tyoka mutsipa wemukadzi uye vaidavira kuti misimboti imwe cheteyo yaigona kushandiswa pakutyoka. Iyo intramedullary chipikiri yavakagadzira pakutanga yaive V-yakaita muchinjika-chikamu uye 7-10 mm mudhayamita.

Mushure mezvidzidzo zvecadaveric nemhuka, akapa intramedullary mbambo uye nzira yekuvhiya pamusangano wekuvhiya muBerlin muna 1940. Pakutanga, hutsva hwake hwakasekwa nevaaishanda navo veGermany, kunyange zvazvo nzira yake yakawana mukurumbira mushure meHondo Yenyika II.

Hippocrates (460-370 BC), chiremba wekare wechiGiriki aiwanzotaurwa nezvake sababa vemishonga, akamboti, 'Uyo anoda kuvhiya anofanira kuenda kuhondo'; zvimwe chetezvo ndizvo zvakanga zvakaita Küntscher.

Munguva yevaNazi, Küntscher aigara muchipatara chiri pamberi peFinland. Ikoko, akakwanisa kuvhiya varwere nevasungwa vehondo munharaunda yacho. Akasuma mwongo nailing pfungwa achishandisa yakavharwa uye yakavhurika nzira yekuvhiya, zvichiteerana.

Munzira yakavharwa, akapfuudza chipikiri che intramedullary munzira yekusimudzira kuburikidza netrochanter yakakura ndokuiisa patafura yekudzosa yakashandiswa nechipfuramabwe. Kutyoka kunoiswazve uye chipikiri chinopinzwa mundege mbiri uchishandisa musoro fluoroscopy. Munzira yakazaruka, mbambo ye intramedullary inopindirwa kuburikidza nekuputsika mukati me medulla kuburikidza nekucheka pedyo nemutsara wekuputsika.Küntscher anoshandisa intramedullary nail kurapa femoral stem fractures pamwe netibial uye humeral fractures.

Magadzirirwo akaitwa naKüntscher akasvika pakuzivikanwa pasi rese mushure mekudzoserwa kumusha kwevasungwa vehondo veAllied.

Nenzira iyi vanachiremba vekuAmerica neBritain vakave neruzivo nezve intramedullary chipikiri chakagadzirwa naKüntscher uye vakaziva zvakanakira zvayo zvakajeka munguva ino yekurapa kwekutyoka.

Mukati menguva pfupi, vanachiremba vokuvhiya vakawanda munyika yose vakatanga kushandisa nzira yake, uye chipikiri chaKüntscher che intramedullary chakachinja kurapwa kwokutyoka nokuderedza nguva yokupora kwomurwere nerinenge gore. Varwere vaizofanira kuvharwa mucast kwemwedzi yakawanda zvino vaigona kufamba mumazuva mashoma.

Parizvino, chiremba wekuvhiya weGerman anoonekwa semugadziri akakosha weiyo intramedullary chipikiri, uye ane nzvimbo yakakosha munhoroondo yekuvhiyiwa kwekushungurudzika.

Kuwedzera Mbambo yemukati memwongo

Muna 1942, Fisher et al. akatanga akatsanangura kushandiswa kwemarrow-kuwedzera grinding drill kuwedzera nzvimbo yekubatana pakati pe intramedullary nail uye pfupa uye kuvandudza kugadzikana kwekugadzirisa kuputsika.

Zvakadaro, Küntscher yakaunza flexible-guided reming drill iyo ichiri kushandiswa nanhasi uye inotsigira reming pamusoro pehurefu hwose hwemedullary cavity yebhonzo rebhonzo kufambisa kuiswa kwehombe dhayamita intramedullary zvipikiri.

Pakutanga, intramedullary reming yakagadzirirwa kuwedzera zvakanyanya nzvimbo yepfupa yekubatana ne intramedullary mbambo yekugadzirisa kugadzikana kwekuputsika uye kukurumidza kufamba kwevarwere.

Sezvakatsanangurwa naSmith et al, yega yega 1 mm yekuwedzera kwemedullary inowedzera nzvimbo yekusangana ne38%. Izvi zvinobvumira kushandiswa kwezvipikiri zvakakura uye zvakasimba zve intramedullary, zvichisimbisa kugadzikana kwese kwechimiro chekugadzirisa kuputsika.

Zvisineyi, kunyangwe mbambo yeKüntscher intramedullary ine flexible intramedullary reaming drill yakave sarudzo yakakodzera yemukati mekugadzirisa mudziyo weosteotomy, academia yakarasa kufarirwa nayo mukupera kwema1960 ichifarira mahwendefa matsva eArbeitsgemeinschaft für Osteosynthesefragen (A).

1960s: Nguva yeRima

Mumakore ekuma1960, kurovera zvipikiri kwemukati medullary kwakangoerekana kwabviswa nekuda kwekugadziriswa kweplate uye screw fracture.

Kunyange zvazvo nzira yaKüntscher yaishanda zvakanaka, vanachiremba vokuvhiya pasi pose vakairamba nemhaka yemigumisiro yakaipa yapashure pokuvhiyiwa.

Mukuwedzera, vamwe vavhiyi vakatanga kusiya nzira dzokushandisa mwaranzi, dzakadai sefluoroscopy yemusoro, nokuti vanachiremba vokuvhiya vakatanga kusemeswa nemigumisiro yakaipa inobatanidzwa nemwaranzi. Kuvandudzwa kwe intramedullary nailing hakuna kumira ipapo, pasinei nekubvumirana kwenyika dzakawanda kushandiswa kweplate internal fixation systems.

Küntscher, chiremba wekuGermany, akaziva zvakanakira kuvharirana achibva agadzira chipikiri chemukati medullary chakaita sevhavha, chaakatumidza zita rekuti 'chipikiri chekuvharirwa'. Chitsitsinho cheAchilles chekugadzirwa kwembambo ye intramedullary yenguva iyoyo kwaiva kusakwanisa kudzikamisa zvipembenene zvakanyanya kana kuputsika izvo zvakatamiswa mumakona makuru Mhinduro yedambudziko iri yaiva kushandiswa kwe Masiruu ekukiya .

Mhinduro yedambudziko iri yaive yekudzikamisa mbambo ye intramedullary ne Siruu yekukiya .

Neiyi nzira, iyo implant inogona kuramba iri nani kukotama uye torsional masimba uku ichidzivirira kupfupisa nhengo. Kuchishandisa musanganiswa wemazano kubva kuKüntscher, Klaus Klemm, naWolf-Dieter Schellmann, chipikiri chemukati medullary chakagadzirwa kuti chipe kugadzikana kukuru nekumboboora maburi escuru proximal uye distal kune intramedullary chipikiri, iyo yakavharirwa kune screw yakaiswa.

Mumakore mashomanana akatevera, kufambira mberi mukujeka kwechifananidzo chefluoroscopic kwakabvumira kusarudzwa zvakare kwekuvharwa kwekuputsika uye nzira dzokuderedza.

1970s uye 1980s: Rumutsiriro

Mumakore ekuma1970, kufarira pfungwa ye intramedullary nailing yachiremba wekuGermany Küntscher yakanga yakanyanya.

Yakavharwa kudzikisa intramedullary chipikiri kugadzirisa kwekutyoka, nekupindirana kwayo kweanochinjika reming uye kupindirana pfungwa uye kujekeswa kwakawedzera kujeka kwe fluoroscopic matekiniki, yakafambisa kufambira mberi uye kuparadzira iyi yakanakisa nzira yekuvhiya, inoratidzirwa nekushoma nyoro kukuvara kwenyama, kugadzikana kwakanaka, uye nekukurumidza kufamba kwemurwere.

Panguva iyoyo, nyika yezvidzidzo yakatsvairwa munhevedzano yezvitsva zvakafambisa kuvandudzwa kwechizvarwa chechipiri che intramedullary nailing.

Muna 1976, Grosse naKempf vakagadzira mbambo ye intramedullary mbambo yekugadzirisa dambudziko reiyo elastic modulus ye intramedullary chipikiri. Iyo intramedullary mbambo yakanga isina kutsvetwa munharaunda yeproximal uye yaive neburi rezvipikiri kune proximal screw, iyo yakaiswa pa45-degree angle kuti iwedzere kugadzikana kwesimba re intramedullary chipikiri mukati mekugadzirisa chimiro.

Makore mashoma gare gare, AO yakabatana neiyo intramedullary mbambo yekuvandudza zvipikiri nekugadzira zvakafanana mimba intramedullary mbambo (Mufananidzo 5)

Muna 1984, Weinquist et al. yakaronga nzira ine simba, iyo yaive yekusimudzira kupera kwekupwanyika kuporeswa nekushandisa makomba akakura Siruu yekukiya , kubvisa static Masiruu ekukiya , uyezve kugadzirisa Siruu yekukiya maburi kumaburi ezvipikiri mune imwe dhizaini yemazuva ano.

Chinangwa chemaitiro ane simba ndechekusimudzira kuporeswa kwekutyoka uye kudzivirira pfupa kusabatana nekuda kwekunonoka kuita.

Parizvino, intramedullary nailing dynamics yakarasikirwa nevatsigiri vayo senzira yekumira-yega uye ikozvino inoshandiswa chete sechinhu chinodhura-chinogadzirisa pane kutsiva kwakakwana kwegadziriro yekugadzirisa mukati mukurapa kwekuputsika kusina kuporesa.

Muchidzidzo chebiomechanical, Gimeno et al. yakashuma kuti nzvimbo yekuchinja pakati pezvisina-slotted uye slotted zvikamu zve intramedullary mbambo zvakakonzera kushushikana kwepfungwa uye kukundikana kwekuvhiya kwemukati kugadzirisa kugadzirisa.

Kugadzirisa matambudziko aya, Russel naTaylor et al. yakagadzira yekutanga isina-slotted, isina-dilated intramedullary chipikiri muna 1986, ine mhedzisiro inogutsa.

Munguva iyi, dambudziko rekubatanidza zvipikiri zve intramedullary rakaramba richienderera mberi, uye sezvatinoziva nhasi, kupindirana ne screw kuburikidza ne intramedullary chipikiri pre-yakaboorwa gomba kwaiva dhizaini yeKlemm naSchleman kuGermany. Kuiswa kwe screw kwaizotungamirirwa ne freehand fluoroscopy, iyo yaizoisa pachena chiremba wekuvhiya kune yakawanda yemwaranzi.

Nhasi, dambudziko iri rakagadziriswa nedistal yekunongedza sisitimu iyo inosanganisira electromagnetic field tracking tekinoroji, fluoroscopically inotungamirwa freehand tekinoroji, uye chaiyo proximal chipikiri yekuisa gwara.

1990s: Titanium intramedullary chipikiri

Mumakore gumi akatevera, Russel-Taylor intramedullary nail yakave yakakurumbira zvikuru munharaunda yepasi rose yemapfupa. Chiyero chekuchengeta zvishoma nezvishoma chakave intramedullary chipikiri ne static kukiya kwe screws, sezvakaratidzwa nemhedzisiro yeongororo naBrumback et al.

Muchidzidzo ichi chinotarisirwa, zvigumisiro zvakashuma kuti kuvhara kwakabudisa zvibereko zvakanaka muzviitiko zvakawanda uye kwakanga kusina kubatanidzwa nekusabatanidzwa kwekuputsika.

Kufambira mberi kwesimbi kwakakonzera kubuda kwetitanium intramedullary mbambo, iyo inoshandiswa zvakanyanya muindasitiri yebiomedical nekuda kwesimba rayo, kunaka kwekusagadzikana uye biocompatibility.

Iyo Alta intramedullary nailing system ndiyo yekutanga kuwanikwa titanium intramedullary chipikiri, uye yakagamuchirwa zvikuru nevezvechiremba nekuda kweiyo mechanical properties yetitanium, inova simbi yakasimba asi isina kusimba kupfuura simbi isina tsvina.

Zvisinei, zvinyorwa zvemazuva ano hazvina chokwadi kana titanium iri chinhu chakakodzera chekugadzirisa mukati kupfuura simbi isina tsvina, kunyanya nekuda kwekuwedzera kwemari inobatanidza nekushandiswa kwetitanium.

Nekudaro, zvimwe zvakanakira titanium, senge elastic modulus padyo necortical bone uye magineti resonance imaging inoenderana, inoita kuti ive sarudzo inoyevedza.

Uye zvakare, titanium isarudzo inoyevedza kana diki dhayamita intramedullary zvipikiri zvinodiwa.

Current Trends

Mushure mekubudirira uye kutadza kwemakumi emakore apfuura, vanachiremba vemapfupa vane ruzivo rwakawanda ne intramedullary nailing.

Intramedullary nail fixation ye femoral, tibial uye humeral fractures yava chiyero chekutarisira kune dzakawanda dzakavharwa kuputsika uye dzimwe dzakavhurika dzakavhurika. Mitsva yekunangisa uye yekumisikidza masisitimu yaita kuti nzira yacho ive nyore uye igone kudhindwa kune kunyange vasina ruzivo rwekuvhiya.

Zvichangoburwa maitiro anoratidza kuti titanium nesimbi isina simbi zvine yakakwira modulus yekunyungudika uye izvo zvinosimbisa zvinodzikamisa zvinoshungurudza zvinoshungurudza zvinodiwa pakupora kwemapfupa. Nyowani biomaterials senge magnesium alloys, chimiro chendangariro alloys uye resorbable zvinhu zviri kuedzwa muacademia.

Intramedullary zvipikiri zvakagadzirwa neinoenderera kabhoni fiber-yakasimbiswa mapolymers ane yakagadziridzwa elastic modulus uye kukuru kuneta simba zviripo parizvino. Magnesium alloys ane modulus ye elasticity yakafanana neye cortical bone uye ine biodegradable.

Zvidzidzo zvenguva pfupi yapfuura naLi et al. vakaratidza zvakakosha mukurapa osteoporotic fractures mumhando dzemhuka dzinonzi kusanganiswa kwe magnesium uye zoledronate coating yekugadzirisa kuputsika, maitiro anogona kuva kurapa kwe osteoporotic fractures mune ramangwana.

Mhedziso

Kwemakore, nekuvandudzwa kwakakosha mukugadzirwa kwezvipikiri zvemukati medullary, hunyanzvi hwesimbi, uye nzira dzekuvhiya, intramedullary nailing yakave yazvino chiyero chekutarisira kweakawanda marefu ekutyoka kwemapfupa uye inoshanda, zvishoma invasive, uye kudzokorora maitiro.

Nekudaro, nekuda kweakawanda intramedullary chipikiri magadzirirwo, yakawanda ruzivo rwuri kushaikwa maererano nemhedzisiro yavo yekuvhiya. Imwe tsvagiridzo inodiwa kuti uone iyo yakakwana intramedullary chipikiri mhando saizi, hunhu uye radius ye curvature.

Isu tinofanotaura kuti hutsva mumunda webiomaterials huchaunza kubuda kweiyo intramedullary zvipikiri dhizaini.

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