Gukosora imbere hamwe namasahani
Guhuza imigeri hamwe namasahani hamwe ninshuro ni uburyo busanzwe bwo kubaga muri iki gihe.Gufunga isahani yimbere byakoreshejwe cyane muguhuza imigeri.Kugeza ubu, isahani yo guhuza isahani irimo ahanini isahani yimbere hamwe nisahani yinyuma.
Ifoto iri hejuru irerekana firime X-ray mbere na nyuma yo kubagwa kubagwa ihahamuka osteoarthritis hamwe na plaque yimbere ifunga imbere imbere gukosora imigeri hamwe
1. Uburyo bwimbere
Uburyo bwimbere ni ugukora imbere ya longitudinal incision hagati yibirenge bifatanye, gukata ibice kumurongo, hanyuma ukinjira kumwanya wa tendon;gabanya capsule ihuriweho, shyira ahagaragara tibiotalar, ukureho karitsiye hamwe namagufa ya subchondral, hanyuma ushire isahani yimbere imbere yimbere yamaguru.
2. Uburyo bwo kuruhande
Uburyo bwuruhande ni ugukata osteotomy nka cm 10 hejuru yisonga rya fibula no gukuraho igishyitsi burundu.Amagufwa ya kanseri yakuweho kugirango akorwe amagufwa.Ubuso bwa osteotomy bwa fusion burarangiye kandi burakaraba, kandi isahani ishyirwa hanze yumugongo.
Akarusho nuko imbaraga zo gukosora ziri hejuru kandi gukosora birakomeye.Irashobora gukoreshwa mugusana no kwiyubaka kwa varus ikomeye cyangwa valgus deformité yibirenge hamwe nudusimba twinshi twamagufwa nyuma yo koza.Isahani yububiko bwa anatomique ifasha kugarura anatomiya isanzwe yingingo.Aho biherereye.
Ingaruka ni uko periosteum nyinshi hamwe nuduce tworoshye mu gice cyo kubaga bigomba kwamburwa, kandi isahani yicyuma ikabyimbye, bikaba byoroshye kurakaza imitsi ikikije.Isahani yicyuma ishyizwe imbere biroroshye gukoraho munsi yuruhu, kandi harikibazo runaka.
intramedullary imisumari
Mu myaka yashize, ikoreshwa rya retrograde intramedullary yimisumari yo mu bwoko bwa arthrodesis mu kuvura indwara ya rubagimpande yanyuma yagiye ikoreshwa mubuvuzi.
Kugeza ubu, tekinike yo gutera imisumari ikoreshwa cyane cyane hagati yimbere yo hagati yibice cyangwa imigozi ya anteroinferior kuruhande rwa fibula kugirango isukure neza cyangwa igufwa.Umusumari winjizwemo winjizwa muri calcaneus kugeza muri tibial medullary cavity, ifasha mugukosora ubumuga kandi igatera guhuza amagufwa.
Amaguru osteoarthritis ahujwe na subtalar arthritis.Filime ya anteroposterior na X-ray yerekana mbere yerekanaga kwangirika gukabije kwa tibiotalar hamwe na subtalar, gusenyuka igice cya talus, hamwe na osteophyte yibumbiye hamwe (kuva kuri 2)
Impande zinyuranye za fusion screw zo gufunga inguni yo gufunga hindfoot fusion intramedullary imisumari ni ugukosora indege nyinshi, zishobora gukosora ingingo yihariye igomba guhuzwa, kandi impera ya kure ni umwobo ufunze, ushobora kurwanya neza gukata, kuzunguruka, no gukuramo. , kugabanya ibyago byo gukuramo screw.
Ihuriro rya tibiotalar hamwe na subtalar ryashyizwe ahagaragara kandi ritunganywa hifashishijwe uburyo bwo guhinduranya impande zombi, kandi uburebure bwikibiriti ku bwinjiriro bw’imisumari y’imisemburo yari cm 3
Imisumari yimbere ikoreshwa nkigikorwa cyo gukosora hagati, kandi imihangayiko yayo iratatanye, ishobora kwirinda ingaruka zo gukingira kandi ihuye cyane namahame ya biomehanike.
Filime ya Anteroposterior na X-ray nyuma yukwezi 1 nyuma yo gukora yerekanaga ko umurongo wamaguru winyuma wari mwiza kandi imisumari yimbere yashyizweho neza.
Gukoresha retrograde imisumari ya retrograde muguhuza imigeri birashobora kugabanya kwangirika kwinyama zoroshye, kugabanya uruhu rwa necrosis yuruhu, kwandura nizindi ngorane, kandi birashobora gutanga igisubizo gihamye kidafite plaque yinyongera itunganijwe nyuma yo kubagwa.
Umwaka umwe nyuma yo gukora, firime nziza kandi yinyuma yerekana X-ray yerekana kwerekana guhuza amagufwa ya tibiotalar hamwe na subtalar, kandi guhuza ibirenge byinyuma byari byiza.
Umurwayi arashobora kuva muburiri akabyara ibiro hakiri kare, ibyo bigatuma umurwayi yihanganira ubuzima bwe.Ariko, kubera ko ingingo ya subtalar igomba gukosorwa icyarimwe, ntabwo byemewe kubarwayi bafite ingingo nziza ya subtalar.Kubungabunga ingingo ya subtalar nuburyo bwingenzi bwo kwishyura imikorere yumutwe wamaguru kubarwayi bafite uruvangitirane.
screw imbere
Percutaneous screw imbere gukosora nuburyo busanzwe bwo gukosora muri arthrodesis.Ifite ibyiza byo kubaga byoroheje nko kubagwa bito no gutakaza amaraso make, kandi birashobora kugabanya kwangirika kwinyama zoroshye.
Filime ya Anteroposterior na X-ray yerekana imigeri ihagaze mbere yo kubaga yerekanaga osteoarthritis ikomeye yibirenge byiburyo ifite ubumuga bwa varus, kandi inguni iri hagati yubuso bwa tibiotalar yapimwe ko ari 19 ° varus
Ubushakashatsi bwerekanye ko gukosora byoroshye hamwe na 2 kugeza kuri 4 bya lag bishobora kugerwaho gukosorwa no kwikuramo neza, kandi imikorere iroroshye kandi igiciro kirahendutse.Nibihitamo byambere byintiti nyinshi kurubu.Byongeye kandi, isuku ntoya yibirenge byogusukura birashobora gukorwa munsi ya arthroscopie, kandi imigozi irashobora kwinjizwamo muburyo butandukanye.Ihahamuka ryo kubaga ni rito kandi ingaruka zo gukiza zirashimishije.
Munsi ya arthroscopie, ahantu hanini hafite inenge ya karitsiye igaragara;munsi ya arthroscopy, igikoresho cya microfracture yerekanwe ikoreshwa mugutunganya ubuso bwa arctular
Bamwe mu banditsi bemeza ko gukosora imigozi 3 bishobora kugabanya ibyago byo kwandura nyuma yo kubagwa, kandi kwiyongera kw'igipimo cyo guhuza bishobora kuba bifitanye isano no gukomera gukomeye kwa 3.
Gukurikirana firime X-ray nyuma yibyumweru 15 nyuma yo kubagwa yerekanye bony fusion.Amanota ya AOFAS yari amanota 47 mbere yo gukora na amanota 74 nyuma yumwaka ukora.
Niba imiyoboro itatu ikoreshwa mugukosora, ikigereranyo cyo gukosora ni uko ibice bibiri byambere byinjijwe uhereye kumpande ya anteromedial na anterolateral ya tibia, ukanyura hejuru yubuso ugana kumubiri wa talar, hanyuma umugozi wa gatatu winjizwa uhereye inyuma. uruhande rwa tibia kuruhande rwo hagati rwa talus.
Uburyo bwo gukosora hanze
Gukosora hanze byari ibikoresho byambere byakoreshwaga muri arthrodezi yamaguru kandi byahindutse kuva 1950 kugeza ubu Ilizarov, Hoffman, Hybrid na Taylor ikibanza (TSF).
Gukomeretsa kumugongo hamwe no kwandura imyaka 3, arthrodesis yamaguru nyuma y'amezi 6 nyuma yo kurwanya indwara
Kubibazo bimwe na bimwe bigoye kurwara arthrite yanduye inshuro nyinshi, kubisubiramo inshuro nyinshi, uruhu rwaho ruteye neza hamwe nuduce tworoshye twa tissue, imiterere yinkovu, inenge zamagufa, osteoporose hamwe nindwara zanduye zaho, Ilizarov impeta yo hanze ikoreshwa cyane mubuvuzi kugirango ihuze ingingo.
Impeta imeze nk'impeta yo hanze ikosorwa ku ndege ya coronale n'indege ya sagittal, kandi irashobora gutanga ingaruka zifatika zo gukosora.Muburyo bwambere bwo kwikorera imitwaro, bizotsa igitutu kumeneka, biteze imbere gushiraho, kandi bizamura umuvuduko.Ku barwayi bafite ubumuga bukabije, uwakosoye hanze arashobora gukosora buhoro buhoro ubumuga.Birumvikana ko gukosora imigeri yo hanze bizagira ibibazo nko kutorohereza abarwayi kwambara ndetse ningaruka zo kwandura inshinge.
Twandikire:
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Email:liuyaoyao@medtechcah.com
Igihe cyo kohereza: Nyakanga-08-2023
