Amakuru - Uburyo bwo Gushyiraho Imbere Ingano y'Inkono y'Umugore

Hari ubwoko bubiri bw'uburyo bwo kubaga, vis za plate na intramedullary pins, ubwa mbere burimo vis za plate general na vis za AO system compression plate, naho ubwa kabiri burimo vid za closed and open retrograde cyangwa retrograde pins. Amahitamo ashingiye ku hantu runaka n'ubwoko bw'aho imvune yavunitse.
Gufata pin mu miringoti bifite ibyiza byo kubona ibintu bike, kudakuramo neza, kudahindagurika, kudakenera gufunga inyuma, nibindi. Bikwiriye 1/3 cyo hagati, 1/3 cyo hejuru cy'inyuma, imvune nyinshi, kuvunika kwa pathological. Ku mvune yo hasi ya 1/3, bitewe n'aho pin nini iherereye n'amagufwa menshi afunguye, biragoye kugenzura uko pin mu miringoti izenguruka, kandi gufunga ntabwo ari ingenzi, nubwo bishobora gukomezwa n'amaskuru, ariko birakwiriye cyane vis z'icyuma.

I Gufunga imbere mu buryo bworoshye kugira ngo havunike umusumari w'imbere hakoreshejwe inzara zo mu nda
(1) Gukata: Gukata igice cyo ku ruhande cyangwa inyuma cy’inyuma cy’ijosi gikorerwa hagati aho cyavunitse, gifite uburebure bwa cm 10-12, kigaca uruhu n’agace kagari k’ijosi maze kikagaragaza imitsi yo ku ruhande rw’ijosi.
Gukata ku ruhande bikorerwa ku murongo uri hagati ya trochanter nini n'umugongo wo ku ruhande rw'inyuma rw'ikibuno, kandi gukata ku ruhu kw'inyuma y'ikibuno cyo ku ruhande biba bimwe cyangwa nyuma gato, itandukaniro rikomeye ni uko gukata ku ruhande kugabanya imitsi ya vastus lateralis, mu gihe gukata ku ruhande rw'inyuma ku ruhande kunyura mu gice cy'inyuma cy'imitsi ya vastus lateralis binyuze mu mugongo wa vastus lateralis. (Ishusho 3.5.5.2-1, 3.5.5.2-2).

Ku rundi ruhande, gukata imbere y'inyuma bikorerwa mu murongo uva ku mugongo wa iliac uruta iyindi kugeza ku nkengero z'inyuma za patella, kandi binyuzwa mu mitsi yo mu ruhande rw'inyuma n'imitsi yo mu bwoko bwa rectus femoris, bishobora kwangiza imitsi yo mu ruhande rw'inyuma n'amashami y'imitsi yo mu ruhande rw'inyuma n'amashami y'imitsi yo mu ruhande rw'inyuma n'amashami y'imitsi yo mu ruhande rw'inyuma rw'inyuma rw'inyuma rw'inyuma rw'inyuma, bityo ntibikunze gukoreshwa cyangwa ntibikoreshwa na rimwe (Ishusho ya 3.5.5.2-3).

（2） Kugaragara: Kuramo hanyuma ukure imitsi yo mu ruhande rw'inyuma rw'inyuma hanyuma uyinjize mu gihe cyayo hamwe na biceps femoris, cyangwa ukande kandi utandukanye imitsi yo mu ruhande rw'inyuma rw'inyuma, ariko kuva amaraso ni byinshi. Kata igice cy'imbere kugira ngo ugaragaze impera zo hejuru n'izo hasi zavunitse ku gice cy'inyuma cy'inyuma, kandi ugaragaze urwego rw'inyuma ku buryo rushobora kubonwa no kugarurwa, kandi ukureho uduce tworoshye gake gashoboka.
（3）Gusana aho igitereko cy'imbere giherereye: Kuramo urugingo rwangiritse, shyira impera yavunitse, shyiramo urushinge rwa plum cyangwa urushinge rwa V, hanyuma ugerageze gupima niba ubunini bw'urushinge bukwiye. Niba hari ukugabanuka k'urushinge rwa medullary, umuvuduko w'urushinge rwa medullary ushobora gukoreshwa mu gusana no kwagura neza umwobo, kugira ngo urushinge rutabasha kwinjira no gukurwamo. Kosora impera yavunitse ukoresheje agakoresho ko gufata amagufwa, shyiramo urushinge rwa intramedullary inyuma, winjire mu kibuno uvuye kuri trochanter nini, kandi iyo impera y'urushinge izamuye uruhu, kora akato ka cm 3 aho hantu, hanyuma ukomeze gushyiramo urushinge rwa intramedullary kugeza rugaragaye hanze y'uruhu. Urushinge rwa intramedullary rurakurwa, rujyanwa ahandi, runyuzwa muri foramen uvuye kuri trochanter nini, hanyuma rugashyirwa hafi y'aho igice cyambukiranya. Udushinge twa intramedullary twatunganyijwe neza dufite impera nto zizengurutse zifite utwobo two gukuramo. Icyo gihe nta mpamvu yo gukuramo no guhindura icyerekezo, maze urushinge rugakubitwa hanyuma rugakubitwa rimwe. Ubundi buryo, urushinge rushobora gushyirwaho inyuma hakoreshejwe agapira k'ubuyobozi hanyuma rugashyirwa hanze y'agace kanini ka trochanteric, hanyuma agapira k'imbere mu kibuno gashobora gushyirwa mu kibuno cya medullary.
Gukomeza gusana imvune. Guhuza imiterere y'umubiri bishobora kugerwaho hakoreshejwe uburyo bwo gukurura pin ya proximal intramedullary hamwe no gukurura amagufwa, gukurura, no gupfuka. Gufata amagufwa bikorwa hakoreshejwe agakoresho gafata amagufwa, hanyuma pin ya intramedullary igatembanwa kugira ngo umwobo wo gukuramo pin werekezwe inyuma kugira ngo uhuze n'inyuma y'umugongo w'inyuma. Impera y'urushinge igomba kugera ku gice gikwiye cy'impera y'inyuma y'imvune, ariko ntinyure mu gice cy'urushinge, kandi impera y'urushinge igomba gusigara kuri cm 2 hanze ya trochanter, kugira ngo ibashe gukurwaho nyuma. (Ishusho ya 3.5.5.2-4).

Nyuma yo gukosorwa, gerageza gukora ku buryo urwego rw'umubiri rudakora neza kandi urebe ko nta gukosorwa kwabyo guhindagurika. Niba bibaye ngombwa gusimbuza urushinge rukomeye rwo mu nda, rushobora gukurwaho rugasimburwa. Iyo habayeho gukoroha gato no kudakosorwa, ushobora kongeramo icyuma cyo gukurura kugira ngo gikomeze gukosorwa. (Ishusho ya 3.5.5.2-4).
Amaherezo igikomere cyarahanaguwe gifungwa mu byiciro. Hashyizweho inkweto za plaster zirinda kuzunguruka inyuma.
Imiterere y'imbere ya screw ya II Plate
Gufata imbere hakoreshejwe vis za plaque y'icyuma bishobora gukoreshwa mu bice byose by'umugongo w'inyuma, ariko 1/3 cyo hasi ni cyo gikwiriye cyane kuri ubwo bwoko bw'ugufata bitewe n'aho umwobo munini uherereye. Iplaque rusange y'icyuma cyangwa plaque ya AO yo gukanda irashobora gukoreshwa. Iya nyuma irakomeye kandi ihamye nta gufata inyuma. Ariko, nta n'imwe muri zo ishobora kwirinda uruhare rwo gupfuka imihangayiko no kubahiriza ihame ry'imbaraga zingana, rigomba kunozwa.
Ubu buryo bufite uburyo bwo gukuraho amacandwe menshi, butuma imbere hagaragara neza, bugira ingaruka ku gukira, ndetse bufite n'ibitagenda neza.
Iyo hari ikibazo cyo kutagira aho icyuma gihagarara mu ruhu, imiterere y’aho icyuma gihagarara cyangwa igice kinini cy’aho icyuma kidashobora kunyura n’igice cya gatatu cyo hasi cy’aho icyuma gihagarara birarushaho kwihuta.
(1) Gukata igice cy'imbere cy'umugore cyangwa inyuma y'inyuma.
(2)(2) Uburyo imvune igaragara, kandi bitewe n'imimerere, igomba guhindurwa no gushyirwa imbere hakoreshejwe vis. Isahani igomba gushyirwa ku ruhande rw'inyuma, vis zigomba kunyura mu gice cy'imbere cy'igufwa ku mpande zombi, kandi uburebure bw'isahani bugomba kuba inshuro 4-5 z'umurambararo w'igufwa aho ryavunitse. Uburebure bw'isahani bungana n'inshuro 4 kugeza kuri 8 z'umurambararo w'igufwa ryavunitse. Udupande 6 kugeza kuri 8 tw'imyobo dukunze gukoreshwa mu gice cy'imbere cy'igufwa. Uduce duto tw'amagufwa twavunitse dushobora gukomezwa hakoreshejwe vis z'inyongera, kandi umubare munini w'udupira tw'amagufwa ushobora gushyirwa icyarimwe ku ruhande rw'imbere rw'ivunitse ryavunitse. (Ishusho ya 3.5.5.2-5).