Iwe unoziva nhoroondo yemukati intramoutulary?

Kuuya kwechipikiri cheIntramedudullary kwakamukira kurapwa kwemapfupa akareba pfupa. Kunyangwe hunyanzvi hwaivapo kwemazana emakore, hazvina kuzadzisa chimiro chazvino kusvikira hafu yechipiri yezana ramakore rechi20.

Nzira yekubudirira yakanga isiri nyore nguva dzose, senzira iyo nzira yakasangana nekusagadzikana uye kurangwa nevadzidzi vazhinji muhafu yekutanga yezana ramakore rechi20. Nhasi, kuburikidza nekugadzira metallurgy, yekuvhiya nzira uye hunyanzvi hwekuvhiya, intramuterllary zvipuka zvave kuita mwero wekutarisira mapfupa mapfupa emapfupa akareba.

Kufambira mberi mumunhu ebiomechancal ruzivo kwakaita kuti kusikwa kweiyi manhambwa anogoneka. Mhedzisiro yemazuva ano intramudeny

Ongororo yenhoroondo yakaitwa muchinyorwa ichi inovavarira kupfupisa dzidziso yekushanduka-shanduka kwechipikiri chekutanga, uye isa nzvimbo yemusoro wenguva yemukati mune yemazuva ano orthopedics uye traumatology (semuenzaniso, Mufananidzo 1).

Kuberekwa kweiyo intramedudullary mbichana

VaIjipita vekare vakatanga kushandisa mudziyo wekunze wakafanana nepikiri. Complex yekuvhiya kwekuvhiya kwekunyepedzera kwaisakwanisa kuve kwakaitwa makore mazhinji apfuura.

Chokwadi, ndechipi chokwadi, ndechekuti vaIjipita vekare vaiva nehunyanzvi hukuru hwekusamwisa kubva pakutenda kwavo mukumuka kwemuviri mune mushure mekutevera.

Izvi ndizvo zvakaitika kune amai vanonzi ushanduro muTummenmentu vakawanikwa muTummy's tomb, uko mbambo yakarongedzwa yakaiswa pakati pe femur neTibia kuti ibvise ibvi rakabatanidzwa (seye mumufananidzo 2).

Vanochera matongo vanoratidza kuti amai vari mukati meSarcophagus yakanga isiri mushandirwi

Makore 2000 gare gare, Bernardino de Sahagun, muAnthropologist paHernando Cortedition, yakashuma yekushandiswa kwekutanga kwemukati memurwere wekugara muMexico.

Muna 1524, akapupurira chiremba weAzTec Bone (anonzi 'Tezalo ' Tezalo ') Ita kuti osteotomy uchishandisa banga rechinwiwa uye isa tsvimbo yemukati kuti udzikise kupwanya. Nekuda kwekushaikwa kwehunyanzvi hwekuvhiya kwakaringana uye antisepics, maitiro aya aive aine huwandu hwakanyanya hwekutevedzera uye huwandu hwakanyanya hwekufa.

1800s: Kutanga Matanho

Pasi pemvura-1800s, magazini ekurapa ekutanga akataura nezve intramellary mbichana. DieFenbach, Langebeck, Bararama uye vamwe vanachiremba vanotaura chiGerman vakataurwa kuti vakashandisa zvipikiri zvenyanga dzenyanga dzenyanga dzenyanga dzenyanga dzenyanga dzechibereko mumarara emapfupa akareba kubata pfupa.

Zvichakadaro, Nicholas Snnn of Chicago, muongorori uye anovhiringidza mauto euto, akaitisa mafungu ane mitsetse intramuterllary. Aizozoshandisa iyo gomba rakarongedzwa rakatsemurwa rakagadzirwa neBovine pfupa uye isa iyo muMidlla kuti ibate 'pseudrrrosis ' pseudarrosis 'Pseudrrosis ' mushure mekupwanya.

Muna 1886, Heinrich Bircher weSwitzerland akarondedzerwa pakusangana kwekuvhiya kuiswa zvipikiri zvenyanga muMidy

Makore mashoma gare gare, Themistous Gluck kuGermany akagadzira chivimbo chekutanga chenzvimbo negomba pakupera kwembambo, nokudaro kuunza pfungwa yekukanganisa kekutanga.

Munguva imwe chete iyoyo, Julius NicolelaySen kubva kuNorway ndiye akatanga kunyora nezve biomechancal nheyo dzemukati memuromo weproximal fralures. Akasimbisa kukosha kwekuwedzera kureba kwechipikiri chemukati wekuti awane mukana wakakura wekuita biomechancal uye kupa dziviriro kweinenge pfupa rese.

Aivawo wekutanga kuraira pfungwa yeProximal uye distal chipikiri / pfupa rekuvhiringidza kugadzirwa static kuvhara. Anotariswa nevamwe vadzidzi saBaba venyamende venyama.

Pakazosvika pakati pegumi nemasere, mapiyona akadai saGnaz Firipi muVienna naJosephlist muGlasgow vaive vaisa hwaro hwekuvhiya. Uku kwaive kwekutanga kwekubudirira kwekuita nekuti kwakabvumira kukura kwehunyanzvi hutsva hwekuvhiya mumamiriro ezvinhu ezvigadzirwa.

1900s: Kushanduka

Muna 1912, chiremba weBritish Ernest Hay Greves ndiye wekuvhiya kwekuvhiya kuti ashandise tsvimbo yesimbi sedombo rakasimba semusoro wenyika

Akawana ruzivo rwake mukati meHondo Yenyika I paakabata varwere aine hutachiona hwePseudarrosis avo vaisazeza kugurisa mitezo yavo. Haana chete Akarondedzera iyo yekutanga intramedy

Akaedza zvipuka zvakagadzirwa neAluminium, magnesium uye simbi uye akaziva kukosha kwe biomechanics mukupora kupora. Kunyangwe zvakadaro, kusuwa kweErnest 'maitiro akatambura nemwero mukuru weutachiona uye saka haana kufarirwa nevararidzi panguva yake.

Muna 1931, Smith-Petersen, muAmerican Orthopedic Surgeon, akaunza simbi yemapapiro matatu yemapapiro ekurapa kweiyo intra-articular caporale mutsipa. Akagadzira nzira yakavhurika iyo yakawedzera chechitatu yeiyo Iliaac Crest, yakapinda munda wekushanda mumucheto wetsiva wetsiva, wobva washandisa mrokita kuti utarise simbi yemukati (Mufananidzo wechikadzi (Mufananidzo 4).

Nekuda kwekubudirira kweiyo Smith-Petersen Sven Johansson akagadzira chikwikama cheHollow intramoutularary muna 1932; Kungwarira kwake kwehungwaru kwakashandisa tsono yechibvundi iyo inobvumidzwa inodzorwa radiologically yakatungamirirwa kuiswa kweiyo intramealry chipikiri. Iyo core technical zvikamu zvaakashandisa achiri kushandiswa nhasi.

Kuenda padanho rimwe, Rush uye hama yake yakaunza iyo pfungwa yeiyo elastic intramedullary mbambo muna 1937.

Ivo vaishandisa elastic, pre-bent stainless simbi yemukati

Mupfungwa yavo, nzvimbo yakasimba yeTishu yeTissue inoita seboka rehondo rinonetsa rinopesana nekunetseka rakagadzirwa neyekutanga-bent elastic mbambo. Kuvaka kwavo kwaive kushoma neiyo elastic zvivakwa zveStanless simbi, iyo yakashanduka kutanga kubva kuElastic deformation kupurasitiki deform. Iyo yekupedzisira inogona kutungamira kune yechipiri kudzingwa uye kuremara kurapa.

Mukuwedzera, zvipikiri zvemukati zvinowanzotanga kubuda pamusuwo kana kupinza zvinokonzerwa nemapfupa emapfupa, kana kunyange kuisa mukati mejoini. Zvakangodaro, The Viennesye Scholar Endner akaramba achishandisa iyi nzira yeiyo Ender Chikoro cheKugadziriswa kweKugadziriswa uye ichiri kushandiswa nhasi kugadziriswa kwePediatric Fractures.

Bone Marrow Nail

Muna 1939, kuvhiya kweGerman Gerthard Küntscher, mubairo weGerbine, akagadzira chiremera chesimbi chakamanikidzwa chechipikiri chekurapa kwekurapa kwesimba rechikadzi.

Künterch uye vamwe vakafuridzirwa neSmith-Petersen Stainless Steel screws vaishandiswa kuita zvechikadzi mutsipa uye vaitenda kuti nheyo dzakafanana dzaigona kushandiswa kumanje. Namambo wekutenderera pavakatanga kutanga V-rakaumbwa muCross-Chikamu uye 7-10 mm mune diameter.

Mushure meCaraveriki nezvidzidzo zvemhuka, akataura zvipikiri zvemukati uye maitiro ekuvhiya ari mumusangano wekuvhiya muBerlin

Hippocrates (460-7-17 BC), chiremba wechiGiriki wekare zvaakawanzotaurwa nezvaBaba vemu mushonga, amboti, 'Anoda kuvhiyiwa anofanira kuenda kuhondo. Izvi ndizvo zvakaitikawo kuKüntscher.

Munguva yeNazi, Küntscher aive akamiswa muchipatara pane chiFinnish kumberi. Ikoko, akakwanisa kushandisa varwere nevasungwa vehondo munzvimbo iyi. Akaunza pfupa remuchafumasi nemusoro uchishandisa nzira yakavharwa uye yakavhurika yekuvhiya, zvichiteerana.

Mukutaura kwakavharwa, akapfuura zvipikiri zvemukati mugwara rakapindurana kuburikidza neTruchanter yakakura uye akaiisa pane tafura yekudzokorora inoshanda neslat. Iyo bracture inoenderana uye chipikiri chakaiswa mune maviri ndege uchishandisa musoro wefluoroscopy. Muchiitiko chakavhurika, chipikiri chakavhurika chinoiswa kuburikidza nekuvhiringidzika muMidlla kuburikidza neCrawTope mutsara.küntscher

Maitiro aKüntscher akawana kuzivikanwa kwenyika dzese mushure mekudzorerwa kwevasungwa vehondo.

Nenzira iyi mairavira eAmerica neBritish akatanga kuzivikanwa nechipikiri chinomarara akagadziriswa naKüntscher uye akaziva zvakanakira mwaka wayo akajeka munguva ino yekukanganisa kurapwa.

Mukati menguva pfupi, varandakadzi vanowedzera kupota nyika vakatanga kutora nzira yake, uye zvipikiri zveKüntercher Varwere vangadai vasina kukodzera mukukandwa kwemwedzi mwedzi vanogona kuve mbozha mune yemazuva.

Parizvino, chiremba anovhiya weGerman anoonekwa sekiyi yekuvandudza mikimazuva emukati, uye ane nzvimbo inokosha munhoroondo yekuvhiyiwa.

Kuwedzera Intramedullary Chikamambo

Muna 1942, Fisher et al. Kutanga kurondedzera kushandiswa kweiyo mongororo-inowedzera kugedaira yekukwevera nzvimbo yekuwisira pasi pakati pechipikiri chemukati uye kuti uvandudze kugadzikana kwekufungidzira.

Zvakangodaro, Künter akaunza kudzora-kutungamirwa kwekutungamirwa nhasi uye anotsigira kudzora pamusoro pehurefu hwese hwenyika mwero wepfuma kuti afambise kuiswa kweiyo yakakura diameter

Pakutanga, kuraswa kwekutenderera kwakagadzirirwa kuwedzera zvakanyanya nharaunda yePfupa kusangana neiyo intramedulary chipikiri chekugadziriswa kwekupwanya uye nekukurumidza murwere wekufamba kwemurwere.

Sezvinotsanangurwa na smith et al, yega yega 1 mm yekuwedzera kwekuwedzera inowedzera iyo nzvimbo yekuonana na38%. Izvi zvinobvumira kushandiswa kweakakura uye stiffer intrameduutllary zvipikiri, kuvandudza kugadzikana kwakazara kweiyo inopwanya kugadziriswa chimiro.

Nekudaro, kunyangwe iyo Küntser Intrameduutery Chemukati neyechinjiki Intramedullary Reaming Drill

1960s: Zera rima

Muma1960s, intramuterudenllary mbichana yakangoerekana yaonekwa mukufarira ndiro uye screw inokatyamadza kugadzirisa.

Kunyangwe nzira yaKüntscher inoshanda zvakanaka, varapi vepopota pasi rose vakavaramba nekuda kwemhedzisiro yemarasha.

Uyezve, vamwe vanachiremba vakatanga kusiya nzira dzekurara, dzakadai semusoro wefluoroscopy, nekuti vanachiremba vakanyadziswa nemhedzisiro inokanganiswa nemaronda. Iko kuvandudzwa kwemukati memukati kwakambomira ipapo, kunyangwe paine kuwirirana kwakawanda kweInternational yekushandisa mapuranga emukati magadzirirwo emukati.

Küntscher, chiremba wechiremba weGerman, akaziva zvakanakira kutaurirana uye akatanga kupindurwa-kwakakwenenzverwa kwakakwenenzverwa kwepamhondi Achilles chitsitsinho chechisimba chechipikiri cheiyo nguva yaisatadza kudzikamisa zvakapetwa kaviri kuti masaga emhando huru ndiyo mhinduro yedambudziko iri raive kushandiswa kwekuvhara.

Mhinduro yedambudziko iri yaive yekudzikamisa chipikiri cheIntramedudullary neClrew inovhara.

Nenzira iyi, iyo Mplant inogona kuramba zvirinani mabhendi uye torsonional mauto uchidzivirira kupfupika. Uchishandisa musanganiswa wezano kubva kuKüntscher, Klaus Klemm, uye mikwenzi yekuchera Schelllmann

Kwemakore mashoma anotevera, kufambira mberi muFluoroscopic mufananidzo clarity inobvumidzwa kuti isarudzo yekuvhiringidza kuvharwa uye nzira dzekuderedza.

1970s uye 1980s: Rumutsiriro

Mumakore ekuma1970, kufarira mufundisi wepamoyo weGergyuron Küntscher aive akanyanya.

Kuvharwa kuderedzwa Intramedullary zvipikiri zvechipfuva, pamwe nekupindirana kwekuchinja kwehunyanzvi uye kuisanzverwa kwehunyanzvi hwekuvhiya uku, kugadzikana kwemukati, uye kugadzikana kwakanaka, uye kusunganidzwa kwekukurumidza.

Panguva iyoyo, nyika yevadzidzi yakatsvairwa mune dzidzo dzevanotevedzana dzakatyaira kukura kwechizvarwa chechipiri chechigaro chemukati.

Muna 1976, grosse uye kempf yakagadzira chikamu chakareruka chakapindirwa nechisimba kugadzirisa dambudziko reiyo elastic modulus yeiyo intramedulaly mbambo. Mberi intramudent

Makore mashoma gare gare, Ao akabatana nemaitiro emukati mekusimudzira chipinganidzo nekukudziridza zvakafanana pamisoro intramoutulary (Mufananidzo 5)

Muna 1984, weinquist et al. Takurudzira nzira ine simba, iyo yaive yekuwedzera kupora kupora nekushandisa zvakakura zvekuvhiya maburi, kubvisa zvigunwe zvekuvhara masaga ekuvhara, uye nekukasira mbichana maburi kuOIL Tail mahombodo mune mamwe madimikira emazuva ano.

Chinangwa cheiyo dynamic nzira ndeyekukurudzira kupora kupora uye kudzivirira kupopota nonunion nekuda kwekunonoka chiitiko.

Parizvino, Intramutery Nailing Dynamics yakarasikirwa nevanotsigira senzira yekumira-ndega nzira chete semhinduro inowedzera pane yekutsiva yemukati yekugadzirisa mamiriro ekugadzirisa kwemukati mukurapa kwekupora.

Mune biomekantical kudzidza, Gimeno et al. Yakashuma kuti nzvimbo inoshandurwa pakati peiyo isina-yakagadziriswa uye yakagadziriswa zvikamu zvemukati mernarrellary yakakonzera kushushikana kwekushushikana uye kukuvadzwa kwekusimbisa kwekugadziriswa kwemukati.

Kugadzirisa matambudziko aya, russel ne taylor et al. Yakagadzirwa yekutanga isina-slotted, isina-diled intramedullary mbambo muna 1986, ine mhinduro dzinogutsa.

Pakati peino nguva, dambudziko rekuvhiringidza zvipikiri zvakaramba zvichienderera mberi nekufambira mberi, uye sezvatinoziva nhasi, kubatanidza nehombodo yechidimbu chepamberi pakatarisana neklem uye schlemani. Iko kuisirwa kwechikepe kungatungamirirwa neye fluors fluoroscopy, iyo yaizonurura chiremba anovhiya kune radiation yakawanda.

Nhasi, dambudziko iri rakagadziriswa nehurongwa hwekutarisira hwemagetsi hunosanganisira Electroter

1990s: titanium intramedullary zvipikiri

Kwemakore anotevera, iyo Russel-Taylor Intrameduutery Chikombiyasi ichi yakakurumbira kwazvo munharaunda yepasi rose yeOrthopedic. Mwero wekutarisira zvishoma nezvishoma wakave wakavhiringidzwa nekuvhiya nekuvhiringidza kwezvibodzwa, sezvakaratidzwa nemhedzisiro yekudzidza ne brumback et al.

Mukudzidza uku kwekudzidza, mhedzisiro yacho yakashuma kuti kuvhara kwakaburitsa mibairo yakanaka uye hakuna kubatana nekwaanosanganisa.

Kufambira mberi muSimbi kwakatungamira mukubuda kweTitanium Intrameduutery zvipikiri, izvo zvinoshandiswa zvakanyanya muindasitiri yebhaya nekuda kwesimba ravo, rakanyanyisa kupokana uye kusiyana.

Iyo Alta Intramealy Nailing System ndiyo yaive yekutanga kuwanikwa Titaniuterulary chipikiri, uye yakagamuchirwa zvikuru nenharaunda yezvekurapa nekuda kweiyo titanium, iyo yakasimba asi isina kusimba simbi pane simbi isina tsvina.

Nekudaro, mabhuku azvino haana chokwadi chekuti titanium zvinhu zvakaringana zvekugadziriswa kwemukati pane simbi isina simba, kunyanya nekuda kwemitengo yakawedzera inosanganiswa nekushandiswa kweTitanium.

Nekudaro, zvimwe zvakanakira zveTitanium, zvakadai se elastic modulus padhuze nepfupa rekoramu uye nemagineti rekufungidzira kufungidzira, ita sarudzo inokwezva.

Uye zvakare, Titanium inzira inokwezva kwazvo kana diki diki yedhiramu intramuterllary zvipikiri zvinodikanwa.

Zviitiko zvazvino

Mushure mekubudirira uye kutadza kwemakumi emakore, vanachiremba veongororo vane ruzivo rwakawanda nekuziva zviri mumisangano.

Intramellary zvipikiri zvechikadzi zvechikadzi, tibiel uye humieral fractures yave mwero wekutarisira kune dzakanyanya kuvharwa zvikamu uye zvimwe zvikanganiso zvakavhurika. Zvitsva zvinongedzo uye kumisikidza masisitimu akagadzira maitiro akapfava uye kubereka kune kunyangwe vanachiremba vasingavhiyiwa.

Mafungiro achangobva kuitika anoratidza kuti Titanium uye simbi yesimbi ine simbi yakanyanya kuderera kweElasticity uye kuti kushushikana kwakavanzika kushushikana kunotsamwisa kunodiwa pakuporesa pfupa. New Biomaterials yakadai seMagnesium Alloys, Shape Memory Alloys uye Zvinhu Zvinogadzirisa Zviripano zviri kuedzwa muAcademia.

Intramellary zvipikiri zvakagadzirwa nehuremu carbon fiber-yakasimbiswa polymers ine yakagadziridzwa elastic modulus uye simba rakakura rinopera simba parizvino riri kuwanikwa. Magnesium Alloys vane modulus yeiyo elasticity yakafanana neiyo yekora pfupa uye iri biodegradable.

Munguva pfupi yapfuura zvidzidzo ne li et al. Vakaratidzira zvakanakira kurapa mafungidziro emhuka mumhando yemhuka zvinoratidzwa kusvika pakubatanidzwa kweMagnesium uye Modelity iyo inogona kurapwa kuti iparareji yemangwana mune ramangwana.

Mhedziso

Kwemakore, nekuvandudzwa kwakakosha mumamiriro ezvinhu epanyama, uye maitiro ekuvhiya, mumamiriro ezvinhu ekuvhiya akagadzira maratidziro okutarisira mazhinji emapfupa mazhinji uye anoshanda, uye nenzira yekubereka.

Nekudaro, nekuda kwekutenderera kwakawanda kwepamhepo madhiri, ruzivo rwakawanda rwunoshaya maererano nezvinobuda. Kuwedzeredzwa kwakawanda kunodiwa kuti uone yakakwana intramedullary zvipikiri zvemuviri saizi, hunhu uye radius ye curvature.

Isu tinofungidzira kuti gadziriro iri mumunda we biomaterials ichasvina kubuda kweiyo itsva intramedullary zvipikiri zvechipikiri.

Matenga sei kuti utenge orthopedic mispende uye zviridzwa zveOrthopedic?

Nekuti Czmeditech , isu tine mutsara wakakwana wechigadzirwa weOrthopedic kuvhiya kusurukirwa uye zviridzwa zvinoenderana, zvigadzirwa zvinosanganisira Spine Implants, intramedullary zvipikiri, Traumal Plate, Locking Plate, cranial-maxillofacial, prostisesa, Zvishandiso zvine simba, vekunze taxators, arthroscopy, kutarisirwa kwevaterinary uye yavo inotsigira chiridzwa.

Mukuwedzera, isu takazvipira kuramba tichikudziridza zvigadzirwa zvitsva uye tichiwedzera mitsara yechigadzirwa, kuti tisangane nezvinodiwa zvevamwe vanachiremba nevarwere, uyezve vanokwanisawo kukwikwidza vese muzvinyorwa zvepasirese uye zviridzwa.

Isu tinotengesa pasi rese, saka unogona Taura neTemail Kero Rwiyo@orthopepepedic-cho.com quote yemahara, kana kutumira meseji pane whatsapp yekukurumidza kupindura +86 - 18112515727.

Kana u Czmeditech kuti uwane zvimwe zvakawanda.