Mu ntangiriro ya za 90, intiti z’amahanga zafashe iyambere mu gukoresha inanga za suture mu gusana inyubako nka rotate cuff munsi ya arthroscopie. Igitekerezo cyaturutse ku ihame ryo gushyigikira "ikintu cyo kurohama" mu majyepfo ya Texas, muri Amerika, ni ukuvuga mu gukurura insinga z'ibyuma byo mu kuzimu ku mpande ya 45 ° ziroha hasi, inyubako yo munsi y'ubutaka iba ishingiye ku “kintu kurohama” ku rundi ruhande rw'icyuma.
Ubuvuzi bwa siporo bwaturutse ku ihungabana ry’amagufwa. Nibyingenzi nubuvuzi byinshi bitandukanye byubuvuzi na siporo. Intego ni ukugera kubikorwa byinshi byo gusana hamwe nihahamuka rito, harimo gukomeretsa kwa menisque, gukomeretsa ligamente ikomeye, rotator cuff amarira, guhungabana ibitugu, guhungabana kwa SLAP, nibindi byose biri murwego rwo kuvura imiti ya siporo.
Anchor nigikoresho cyubuvuzi gikunze gukoreshwa mubuvuzi bwa siporo no kubaga amagufwa. Ikoreshwa cyane mugukosora ingirangingo zoroshye (nka tendons, ligaments, nibindi) kumagufwa kugirango ateze imbere gukira no gukira. Ubusanzwe inanga zikozwe mubikoresho biocompatible kugirango umutekano n'umutekano bihamye mumubiri.
Ukurikije ibyiciro byo gutondekanya ibyuma, hari ibyiciro bibiri byingenzi: ibyuma bidashobora kwangirika hamwe na biodegradable.
Ibikoresho by'ingenzi bya ankore idashobora kwangirika ni titanium, nikel-titanium alloy, ibyuma bitagira umwanda, titanium na aside poly-L-lactique; ibyinshi mu byuma bya suture bikoreshwa mubikorwa byubuvuzi bikozwe mubikoresho byibyuma, bifite ibyiza byo gufata imbaraga nziza, kuyitera byoroshye no gusuzuma X-ray byoroshye.
Ibikoresho byingenzi byangiza ibinyabuzima ni acide poly-D-lactique, aside poly-L-lactique, acide polyglycolike, nibindi. Birashobora kandi gukoreshwa kubana.
Ibikoresho by'ingenzi
1. Ibyuma byuma
• Ibikoresho: Ahanini ibikoresho byuma nka titanium.
• Ibiranga: Birakomeye kandi biramba, birashobora gutanga ingaruka zihamye zo gukosora. Ariko, amashusho yerekana amashusho arashobora kubaho kandi harikibazo cyo kugwa.
2. Inanga zidasanzwe
• Ibikoresho: ibikoresho bikurura nka aside polylactique (PLLA).
• Ibiranga: Buhoro buhoro mu mubiri, nta kubagwa kwa kabiri bisabwa kugirango bikurweho. Ariko, igipimo cyo gutesha agaciro gishobora kuba kidahindagurika, kandi imbaraga zo gukosora zishobora kugabanuka mugihe.
3. Polyetheretherketone (PEEK) inanga
• Ibikoresho: polymers ikora cyane nka polyetheretherketone.
• Ibiranga: Itanga imbaraga zo mumisumari yumubiri hamwe nubukanishi, mugihe ufite biocompatibilité nziza ningaruka nziza zo gufata amashusho.
4. Inanga zose
• Ibigize: Ahanini bigizwe na inserter, inanga na suture.
• Ibiranga: Ntoya cyane mubunini, yoroshye muburyo, ikwiranye nigihe aho amagufwa kavukire yatakaye cyangwa ikibanza cyatewe ni gito.
Ukurikije ibishushanyo mbonera biranga inanga, birashobora kugabanywamo ibyiciro bibiri: inanga zifunze kandi zidafite ipfundo (nka suture yuzuye):
1. Inanga zifunze
Inanga zometseho ni ubwoko bwa ankeri gakondo, burangwa nigice cya suture ihujwe umurizo wa ankeri. Muganga akeneye kunyuza suture akoresheje urushinge rworoshye akoresheje urushinge hanyuma agahambira ipfundo kugirango akosore imyenda yoroshye kuri ankeri, ni ukuvuga hejuru yamagufwa.
• Ibikoresho: Inanga zometse mubusanzwe zikozwe mubikoresho bidashobora gukururwa (nka titanium alloy) cyangwa ibikoresho byinjira (nka acide polylactique).
• Uburyo bwibikorwa: Inanga yashizwe mumagufwa binyuze mumigozi cyangwa amababa yo kwaguka, mugihe suture ikoreshwa muguhuza ingirangingo zoroshye na ankeri, kandi ingaruka zifatika zifatika nyuma yo guhambira ipfundo.
• Ibyiza n'ibibi: Ibyiza byo gufunga inanga ni uko ingaruka zo gukosora zizewe kandi zikwiriye gukomeretsa inyama zitandukanye. Nyamara, inzira yo gupfundika irashobora kongera ubunini nigihe cyo gukora, kandi kuba ipfundo rishobora gutuma abantu bahangayikishwa cyane, bikongera ibyago byo kumeneka cyangwa kudoda.
2. Inanga idafunze
Inkingi idafite ubudodo, cyane cyane suture yuzuye, ni ubwoko bushya bwa ankeri bwakozwe mumyaka yashize. Ikiranga ni uko inanga yose igizwe na suture, kandi gukosora ingirabuzimafatizo byoroshye birashobora kugerwaho nta guhambira ipfundo.
• Ibikoresho: Inanga zidoda zisanzwe zikoresha ibikoresho byoroshye kandi bikomeye, nka fibre fibre ultra-high molekile polyethylene (UHMWPE).
• Uburyo bwibikorwa: Inanga zuzuye za suture zirashobora kwinjizwa mubice byamagufwa binyuze mumiterere yihariye ya suture hamwe nuburyo bwo kuyitera, mugihe ukoresheje impagarara za suture kugirango ukosore neza imyenda yoroshye hejuru yamagufwa. Kubera ko bidakenewe guhambira ipfundo, ingorane nigihe cyo gukora biragabanuka, kandi ibyago byo kumeneka no kudoda inanga nabyo biragabanuka.
• Ibyiza n'ibibi: Ibyiza bya suture yuzuye ni uburyo bworoshye bwo kubaga, ingaruka zo gukosora zizewe no kwangirika kwinshi kwinyama zoroshye. Ariko, kubera imiterere yihariye, ifite ibisabwa byinshi muburyo bwo kubaga no guterwa. Byongeye kandi, igiciro cya suture yuzuye irashobora kuba hejuru, ibyo bikaba byongera umutwaro wamafaranga kubarwayi.
Inanga zikoreshwa cyane mubuvuzi butandukanye bwimikino ngororamubiri, nko gusana rotate cuff gusana, gukosora imitsi, kwiyubaka kwa ligament, nibindi bikurikira ni intangiriro yo kubaga uburyo bwo kubaga inanga hakoreshejwe gusana rotate cuff nkurugero:
• Intambwe zo kubaga: Icya mbere, umuganga azasukura kandi ategure aho ibikomere bya rotator; hanyuma, shyira inanga mumwanya ukwiye; hanyuma, koresha suture kugirango ukosore rotate cuff tissue kuri ankor; amaherezo, suture na bande.
• Ingaruka zo kubaga: Binyuze mugukosora inanga, ituze hamwe nimikorere ya rotate cuff tissue irashobora kugarurwa, bigatuma umurwayi akira.
Ibyiza, Ibibi hamwe no Kwirinda Inanga
Ibyiza
• Itanga igisubizo gihamye.
• Birakoreshwa mubikomere bitandukanye byoroshye.
• Inanga zimwe zirashobora gukururwa kandi ntizisaba kubagwa kabiri kugirango ziveho.
Ibibi
• Ibyuma byuma bishobora kubyara ibishusho.
• Igipimo cyo gutesha agaciro inanga zishobora gukururwa zishobora kuba zidahindagurika.
• Hariho ingorane zo gutandukana cyangwa kumeneka.
Imiti yimikino ya siporo irashobora gukoreshwa kubagwa gukurikira:
1.
2. Amarira ya biceps ya kure ararira: Amarira aterwa nurwego rudasanzwe rwimikorere, gukwega, ingaruka, nibindi birashobora kuvurwa ninsinga. Inanga ebyiri zashyinguwe mububumbe bwa radial, hanyuma umugozi wumurizo ushushanywa kuri biceps tendon stump.
3. Inkokora y'inkokora iturika: Gutandukana inyuma yinkokora akenshi biherekejwe no gukomeretsa kwa ulnar ingwate, cyane cyane igikomere cyimbere. Kubikomere byinkokora, intiti nyinshi zikunda kuvura hakiri kare. Uburyo bwa ankor insinga bukoreshwa mugukomera hejuru yamagufwa aho ligamenti ifatanye. Nyuma yo kuva amaraso mashya, inanga irajugunywa hejuru yamagufwa aho ligamenti ifatanye, hanyuma insinga zometse kumpera yumusumari zikoreshwa mugukata igiti cya ligament hanyuma ukagikomera cyangwa gusana ligamente nurushinge.
. Gukoresha uburyo bwa ankor uburyo bufite ibyerekezo byinshi kandi ntibigarukira kubunini bw'igice cyacitse. Ntabwo bisaba fluoroscopy intraoperative kugirango ihindure icyerekezo cya screw. Igikorwa kiroroshye kandi igihe cyo gukora kiragufi.
5.Patellar ihungabana: iterwa na bony anatomical idasanzwe no kubuza ingirabuzimafatizo zidahagije. Intiti nyinshi zishyigikira ubuvuzi bukomeye bwo kubaga hakoreshejwe inanga.
6. Ivunika rya Patellar ritoya: Ikoranabuhanga rya insinga irashobora gukoreshwa mukuvura patellar munsi ya pole. Mugukosora imvune ya patellar ntoya no kuboha no kudoda ligamente ya patellar, ubusugire bwuburyo bwo kwagura ivi burashobora kugarurwa kandi uburebure bwa physiologique bwuburyo bwo kwagura ivi burashobora gukomeza.
.
Kwirinda
• Amagufwa yumurwayi nuburyo imiterere ya anatomique yikibanza cyo kubaga bigomba gusuzumwa neza mbere yo kubagwa.
• Hitamo ubwoko bwa ankeri bukwiye hamwe nibisobanuro kugirango umenye ingaruka zo kubaga.
• Imyitozo ikwiye yo gusubiza mu buzima busanzwe igomba gukorwa nyuma yo kubagwa kugirango iteze imbere gukira no kugarura imikorere.
Muri make, inanga zigira uruhare runini mubuvuzi bwa siporo. Muguhitamo ubwoko bwa ankeri bukwiye nibisobanuro hanyuma ugakurikiza intambwe iboneye yo kubaga no kwirinda, ingaruka zo kubaga zirashobora kwizerwa kandi umurwayi ashobora gukira.
Igihe cyo kohereza: Ukuboza-17-2024
