Kutyoka kwehumerus, pfupa rekumusoro kweruoko, kunogona kukanganisa zvakanyanya mabasa emunhu ezuva nezuva uye hupenyu hwehupenyu. Kurapa mafractures aya kunoda kunyatsotariswa kwezvinhu zvakasiyana, kusanganisira rudzi rwekutsemuka, nzvimbo, uye hunhu hwemurwere. Imwe nzira yekuvhiya iyo yakawana mukurumbira mumakore achangopfuura ndeye kushandiswa kwehumerus intramedullary nail. Chinyorwa ichi chinoongorora mabhenefiti, nzira yekuvhiya, njodzi, uye kudzoreredza kwakabatana neiyi nzira yekurapa.
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Nhanganyaya
Kana kuputsika kunoitika muhumerus, kunogona kukonzera kurwadziwa kwakanyanya, kusafamba zvishoma, uye kukanganisa kushanda. Nzira dzechinyakare dzekurapa, dzakadai sekukanda kana plating, dzine zvadzisingakwanisi, uye kutsvaga mhinduro dzinoshanda kwakatungamira mukugadzirwa kwehumerus intramedullary nail.
Chii chinonzi Humerus Intramed ullary Nail?
A humerus intramedullary chipikiri chishandiso chekurapa chakagadzirirwa kudzikamisa uye kukurudzira kuporeswa kweakaputsika muhumeral shaft. Inoumbwa nesimbi yakareba tsvimbo inopinzwa mukati megomba pakati pefupa, ichipa kugadzikana uye kutsigirwa panguva yekurapa. Iyo mbambo inowanzo gadzirwa netitanium kana simbi isina tsvina uye inouya muhukuru hwakasiyana kuti igare akasiyana evarwere anatomies.
Zviratidzo zveHumerus Intramedullary Nail
Humerus intramedullary misumari inowanzoshandiswa pakurapa midshaft uye proximal humeral fractures. Izvo zvinonyanya kushanda kune zvimedu zvinoda kugadziriswa kwakadzikama, zvakadai sekuputsika kwakagadziriswa kana kuputsika kunobatanidzwa nekutama kukuru. Uyezve, nzira iyi yakakodzera kune varwere vane hutano husina kunaka hwemapfupa kana kana chimiro chisina kurema-chinodiwa.
Kuvhiya Technique yeHumerus Intramedullary Nail
Preoperative Planning
Kuvhiyiwa kusati kwaitwa, kunyatsoronga preoperative inokosha. Izvi zvinosanganisira kuongororwa kwakazara kwemaitiro ekutyoka, hutano hwemurwere, uye chero kukuvara kwakabatana. X-rays, CT scans, kana MRI inogona kushandiswa kuwana kunzwisisa kwakajeka kwemaitiro ekuputsika uye kuronga nzira yekuvhiya maererano.
Patient Positioning
Munguva yekuvhiyiwa, murwere anowanzo miswa mune chigaro chemahombekombe kana lateral decubitus chinzvimbo. Sarudzo inoenderana nezvinodiwa nachiremba uye nzvimbo yekuputsika. Kumisikidzwa kwakaringana kunovimbisa kuwana kwakaringana kunzvimbo yakatsemuka uye kunofambisa kuiswa kwembambo.
Incision uye Access
Incision inoitwa pamusoro penzvimbo yekuvhiya kuti uwane bhonzo rakatyoka. Kureba uye nzvimbo yekucheka kunoenderana nerudzi rwekutsemuka uye nzvimbo yaro pamwe nehumerus. Kungwarira kubata matishu akapfava kwakakosha kuderedza kukuvadzwa uye kuderedza njodzi yehutachiona.
Kupinza Kwezvipikiri
Mushure mekugadzira nzvimbo yekupinda, chiremba anovhiya anoisa humerus intramedullary mbambo mumugero wehumeral. Fluoroscopic nhungamiro inoshandiswa kuve nechokwadi chekuiswa uye kurongeka. Chipikiri chinokwidziridzwa mubhonzo, chichigadzirisa chero zvidimbu zvakabviswa, uye kudzoreredza anatomu chaiyo.
Locking Screws Placement
Kana chipikiri chaiswa zvakanaka, zvikwiriso zvekukiya zvinopinzwa kuchengetedza chipikiri mukati mebhonzo. Aya screws anopa kumwe kugadzikana uye kudzivirira kutenderera kana axial mafambiro ezvimedu zvekutsemuka. Nhamba uye kuiswa kwe screws zvinoenderana nepeteni yekutyoka uye zvaanoda chiremba wekuvhiya.
Kuvharwa Kwemaronda
Mushure mekunge mbambo uye screws zvakachengeteka munzvimbo, incision yakavharwa uchishandisa sutures kana staples. Kuvharwa kwemaronda kwakakosha kukurudzira kupora uye kuderedza njodzi yehutachiona. Nzvimbo yekuvhiya inobva yapfekedzwa, uye bhandiji risina utachiona kana kupfeka rinoiswa.
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Zvakanakira Humerus Intramedullary Nail
Kushandiswa kwehumerus intramedullary nail kunopa zvakati wandei zvakanakira pane echinyakare nzira dzekurapa. Mamwe emabhenefiti akakosha anosanganisira:
Kugadzikana uye kurongeka: Chipikiri chinopa kugadzirisa kwakadzikama, kubvumira kurongeka kwakakodzera kwezvimedu zvekuputsika, izvo zvinokurudzira kupora kwakakwana.
Kukanganiswa kwematishu akapfava zvishoma: Kuenzaniswa nemaitiro ekuputira, intramedullary nailing inosanganisira madiki madiki uye kushomeka kwematishu kukanganisa, kuderedza njodzi yematambudziko.
Kuunganidza kwekutanga: Chipikiri chinopa kugadzikana kwakakwana kubvumira kufamba kwekutanga nekugadzirisa, kukurudzira kukurumidza kupora uye kudzorerwa kwebasa.
Kudzikira kwenjodzi yehutachiona: Iyo yakavharwa nzira ye intramedullary nailing inoderedza njodzi yehutachiona hwenzvimbo yekuvhiya kana ichienzaniswa nekuvhura kuderedza uye nzira dzekugadzirisa dzemukati.
Matambudziko uye Njodzi
Nepo humerus intramedullary nail kuvhiyiwa kazhinji kwakachengeteka uye kunoshanda, pane zvinogona kunetsa uye njodzi dzine chekuita nemaitiro acho. Zvakakosha kuziva zvingangoitika izvi usati warapwa. Mamwe ematambudziko anosanganisira:
Utachiona
Chero nzira yekuvhiya ine njodzi yekutapukirwa. Kunyangwe huwandu hwehutachiona hwakadzikira nehumerus intramedullary nailing, nzira dzakakodzera dzekusabereka uye kuchengetedza kwepashure kwakakosha kudzikisa njodzi iyi. Muchiitiko chehutachiona, kurapwa kwakakodzera kwemishonga inorwisa mabhakitiriya uye zvichida kupindira kwekuvhiya kunogona kudiwa.
Malunion kana Nonunion
Mune zvimwe zviitiko, kuputsika hakugoni kupora zvakanaka, zvichiita kuti malunion (kurongeka kusina kunaka) kana kusava nonunion (kushaya kuporesa). Zvinhu zvakadai sehutano husina kunaka hwemapfupa, kusakwana kwekugadzirisa, kana kufamba kwakanyanyisa kunogona kukonzera matambudziko aya. Kunyatsoongorora, kugara uchitevera kushanya, uye kupindira panguva yakakodzera kunogona kubatsira kugadzirisa nyaya idzi kana dzikamuka.
Kutadza Kudyara
Kashoma, iyo implant inoshandiswa kune intramedullary nailing inogona kutadza. Izvi zvinogona kuitika nekuda kwekuputsika kwekudyara, kusunungura, kana kutama. Kusarudzwa kwakakodzera kwekudyara, nzira yekuvhiya, uye kutarisirwa mushure mekuvhiyiwa zvinogona kuderedza njodzi yekutadza kuisirwa.
Nerve Injury
Panguva yekuvhiyiwa, pane ngozi shoma yekukuvara kwetsinga, iyo inogona kutungamirira kumanzwiro kana kukanganisa kwemotokari. Vanachiremba vanotora matanho ekuzvidzivirira kuti vadzivise kukuvara kwetsinga, sekunyatso patsanura uye ruzivo rwakafanira rwemuviri. Chero zviratidzo zvine chekuita netsinga zvinofanirwa kuudzwa nekukurumidza kuchikwata chekurapa kuti chiongororwe uye kutungamira.
Kudzorera uye Kudzorera
Mushure mekuvhiyiwa kwehumerus intramedullary chipikiri, chirongwa chakazara chekudzorera chakakosha kuti uwane kupora. Iyo chaiyo chirongwa chekudzorera chinogona kusiyana zvichienderana nekutyoka kuomarara uye nemurwere zvinhu. Kuunganidza kwekutanga, zvinyoro-nyoro-ye-kufamba maekisesaizi, uye kusimbisa maekisesaizi zvinounzwa zvishoma nezvishoma kudzoreredza basa uye kunatsiridza simba remhasuru. Physical therapy sessions, inotungamirirwa nenyanzvi yekurapa, inoita basa rakakosha mukupora.
Nyaya Dzidzo uye Nhau Dzakabudirira
Varwere vazhinji vakawana mhedzisiro yakanaka nekuvhiya kwehumerus intramedullary nail. Imwe nyaya yekuongorora yaisanganisira munhu ane makore makumi mana nemashanu ekuzvarwa ane akadzingwa humeral shaft fracture. Mushure mekuvhiyiwa nechipikiri che intramedullary, murwere akawana kurongeka kwakanakisa kwekutyoka, akawanazve mafambiro akazara, uye akadzokera kudanho ravo rekukuvara kwekutanga mukati memwedzi mitanhatu.
Kuenzanisa Nedzimwe Kurapa Sarudzo
Paunenge uchifunga nezve nzira dzekurapa dzehumeral fractures, zvakakosha kuenzanisa mabhenefiti uye miganhu yeimwe neimwe nzira. Nepo kushandiswa kwehumerus intramedullary chipikiri kuchipa akawanda mabhenefiti, sekugadzikana, kukurumidza kuunganidza, uye kushoma nyoro kukanganiswa kwetishu, inogona kunge isingakodzeri kuputsika kwese kana murwere. Dzimwe nzira, senge plating kana yekunze kugadzirisa, inogona kufarirwa mune zvimwe zviitiko. Kubvunzana nenyanzvi yemapfupa kuchabatsira kuona nzira yakakodzera yekurapa zvichienderana nemamiriro emunhu.
Mhedziso
Mukupedzisa, kushandiswa kwehumerus intramedullary nail kwakabuda seyakanaka uye yakavimbika yekurapa sarudzo yehumeral fractures. Iyi nzira yekuvhiya inopa kugadzirisa kwakagadzikana, inosimudzira kukurumidza kuunganidza, uye inopa zvakati wandei zvakanakira pamusoro pechinyakare nzira. Nepo kune njodzi dzinogona kuitika uye matambudziko anoenderana nemaitirwo acho, kuronga kwakaringana kuvhiya, hunyanzvi hwekuita, uye kutarisirwa kwepashure kunogona kubatsira kuderedza kunetseka uku. Nekudzoreredzwa kwakakodzera uye kutarisisa kwepedyo, varwere vanogona kuwana kupora kwakabudirira uye kuwanazve kugona kwavo kushanda.
