Nk'igikoresho cyo gufunga imbere mu mubiri, icyuma gifunga umubiri cyagiye kigira uruhare runini mu kuvura imvune. Mu myaka ya vuba aha, igitekerezo cyo gukora osteosynthesis igabanya ubukana bw'ingingo cyarumvikanaga cyane kandi gishyirwa mu bikorwa, buhoro buhoro kiva ku buryo bwa kera bwo gushyira imbere imikorere y'imashini ya fixator imbere mu mubiri kijya ku gushyira imbere imikorere y'ibinyabuzima, bitareba gusa ku kurinda amaraso yo mu magufwa n'ingingo zoroshye, ahubwo binateza imbere uburyo bwo kubaga no gukora fixator imbere mu mubiri.Isahani yo gufunga(LCP) ni sisitemu nshya yo gushyiraho plaque, yakozwe hashingiwe ku gice cyo gukanda (DCP) n'igice cyo gukanda (LC-DCP) gifite ubushobozi bwo gukora plaque (PC-Fix) hamwe n'akamaro k'urwego rw'ingufu (LISS) na sisitemu yo gukangura plaque (LISS) ifite ubushobozi bwo gukora plaque. Iyi sisitemu yatangiye gukoreshwa mu buvuzi muri Gicurasi 2000, yari imaze kugira ingaruka nziza mu buvuzi, kandi raporo nyinshi zayitanzeho isuzuma rikomeye. Nubwo hari ibyiza byinshi mu gushyiraho fracture, ikeneye ikoranabuhanga n'uburambe bwinshi. Iyo idakoreshejwe neza, ishobora kutagira icyo igeraho, kandi igatera ingaruka zidasubirwaho.
1. Amahame y'ibinyabuzima, imiterere n'ibyiza bya LCP
Ubudahangarwa bw'icyuma gisanzwe bushingiye ku kugorana hagati y'icyuma n'igufwa. Udupira tugomba gukomezwa. Iyo utupira tumaze kurekura, kugorana hagati y'icyuma n'igufwa bizagabanuka, kandi kugorana nabyo bizagabanuka, bigatuma icyuma gifata imbere kinanirwa.LCPni icyuma gishya gishyigikira imbere mu mubiri woroshye, gitegurwa binyuze mu guhuza icyuma gisanzwe cyo gukanda n'igishyigikira. Ihame ryacyo ryo gukoma ntirishingira ku gukururana hagati y'icyuma n'igufwa, ahubwo rishingiye ku guhagarara kw'inguni hagati y'icyuma n'inguni zifunga ndetse n'imbaraga zo gufata hagati y'inguni n'igufwa, kugira ngo habeho guhagarara kw'inguni. Inyungu itaziguye iri mu kugabanya ukwivanga kw'amaraso atangwa n'inguni. Guhagarara kw'inguni hagati y'icyuma n'inguni byazamuye cyane imbaraga zo gufata inguni, bityo imbaraga zo gufata igufwa ry'icyuma zikaba nyinshi cyane, ibyo bikaba bikoreshwa ku magufwa atandukanye. [4-7]
Ikintu cyihariye mu miterere ya LCP ni "umwobo uhuza", uhuza imyobo ikoresha imbaraga (DCU) n'imyobo ifite imigozi. DCU ishobora gukora compression y'umurongo ikoresheje vis isanzwe, cyangwa imvune zakuweho zishobora gukandamizwa no gukosorwa binyuze kuri vis ya lag; umwobo ufite imigozi ufite imigozi, ishobora gufunga vis na nut latch, ikamurika torque hagati ya vis na plate, kandi stress ya longitude ishobora kwimurirwa ku ruhande rwa fracture. Byongeye kandi, groove yo gukata ni igishushanyo kiri munsi y'isahani, bigabanya agace gahuza igufwa.
Muri make, ifite ibyiza byinshi ugereranyije n'amasahani asanzwe: ① ikomeza inguni: inguni iri hagati y'amasahani y'inzara irahamye kandi ihamye, ikaba ingirakamaro ku magufwa atandukanye; ② igabanya ibyago byo kugabanuka: nta mpamvu yo gukora neza mbere yo kunama ku masahani, bigabanya ibyago byo kugabanuka mu cyiciro cya mbere no kugabanuka mu cyiciro cya kabiri; [8] ③ irinda amaraso: ubuso buke hagati y'icyuma n'igufwa bigabanya kugabanuka kw'amasahani ku maraso ya periosteum, bihuye neza n'amahame yo kugabanya cyane; ④ ifite imiterere myiza yo gufata: ikoreshwa cyane cyane ku igufwa rya osteoporosis, igabanya ibyago byo kurekura no gusohoka kw'amagufwa; ⑤ yemerera imyitozo ngororamubiri hakiri kare; ⑥ ifite uburyo bwinshi bwo kuyikoresha: ubwoko bw'amasahani n'uburebure biratunganye, ishusho y'umubiri ni nziza, ishobora gutuma ibice bitandukanye bikomera kandi ubwoko butandukanye bw'amasahani buvunika.
2. Ibimenyetso bya LCP
LCP ishobora gukoreshwa nk'icyuma gikoreshwa mu gukanda cyangwa nk'icyuma gifasha imbere mu mubiri. Umuganga ubaga ashobora kandi kubihuza byombi, kugira ngo yongere ibimenyetso byabyo kandi ashyire mu byiciro bitandukanye by'imvune.
2.1 Gucikagurika byoroshye kwa Diaphysis cyangwa Metaphysis: niba kwangirika kw'ingingo zoroshye kudakabije kandi igufwa rifite ubuziranenge bwiza, gucikagurika byoroshye cyangwa gucikagurika gugufi kw'amagufwa maremare birakenewe kugira ngo hacibwe kandi bigabanuke neza, kandi uruhande rw'ivunitse rusaba gukanda cyane, bityo LCP ishobora gukoreshwa nk'isahani yo gukandagira n'isahani cyangwa isahani yo kugabanya.
2.2 Ivunika rya Diaphysis cyangwa Metaphyseal: LCP ishobora gukoreshwa nk'ikiraro, gikoresha uburyo bwo kugabanya butari bwo no gukora osteosynthesis y'ikiraro. Ntisaba kugabanya imiterere y'umubiri, ahubwo igarura uburebure bw'ingingo, kuzenguruka n'umurongo w'imbaraga z'umurongo. Ivunika rya radius na ulna ni ikintu kidasanzwe, kuko imikorere yo kuzunguruka kw'amaboko ishingiye ahanini ku miterere isanzwe ya radius na ulna, isa n'ivunika ry'imbere mu gice cy'umubiri. Byongeye kandi, kugabanya imiterere y'umubiri bigomba gukorwa, kandi bigomba gushyirwaho neza hamwe n'ibice.
2.3 Gucikamo ibice hagati y’ingingo n’ibikomere: Mu gucikamo ibice hagati y’ingingo, ntitugomba gusa gukora igabanya ry’imiterere y’umubiri kugira ngo tugarure uburyohe bw’ubuso bw’ingingo, ahubwo tugomba no gukanda amagufwa kugira ngo tugere ku buryo buhamye kandi dukomeze gukira kw’amagufwa, kandi bigatuma imyitozo ngororamubiri itangira. Niba imvune z’ingingo zigira ingaruka ku magufwa, LCP ishobora gukosoraingingohagati y’aho ingingo z’umubiri zigabanuka n’aho ibice by’umubiri biherereye. Kandi nta mpamvu yo gushushanya icyuma mu gihe cyo kubaga, ibyo bikaba byaragabanyije igihe cyo kubaga.
2.4 Ihuriro ry'abakozi ryatinze cyangwa ridafitanye isano.
2.5 Osteotomy ifunze cyangwa ifunguye.
2.6 Ntabwo bikurikizwa ku guhuzagucura imisumari imbere mu ndakuvunika, kandi LCP ni ubundi buryo bwiza cyane. Urugero, LCP ntikoreshwa mu kuvura imvune z'abana cyangwa abangavu, abantu bafite utwobo tw'ibinure duto cyane cyangwa tunini cyane cyangwa dufite imiterere mibi.
2.7 Abarwayi ba Osteoporosis: kubera ko cortex y'amagufwa ari nto cyane, biragoye ko plate isanzwe ibona uburinzi bwizewe, ibyo byongereye ingorabahizi zo kubagwa, kandi bigatuma habaho gutsindwa bitewe no koroha no gusohoka kw'ifatizo nyuma yo kubagwa. Udupira two gufunga twa LCP n'icyuma gifunga plate birema inkingi ihamye, kandi inzara z'icyuma zirahuzwa. Byongeye kandi, umurambararo wa mandrel wa screw yo gufunga ni munini, byongera imbaraga zo gufata amagufwa. Kubwibyo, gucika kw'udupira two gufunga biragabanuka cyane. Imyitozo ngororamubiri ikorwa hakiri kare yemerewe nyuma yo kubagwa. Osteoporosis ni ikimenyetso gikomeye cya LCP, kandi raporo nyinshi zayihaye agaciro gakomeye.
2.8 Gucika kw'inyuma y'impyiko: Gucika kw'impyiko y ...
3. Uburyo bwo kubaga bujyanye no gukoresha LCP
3.1 Ikoranabuhanga rya gakondo ryo Gukanda: nubwo igitekerezo cya AO internal fixator cyahindutse kandi amaraso akingira amagufwa n'ingingo zoroshye ntazirengagizwa bitewe no gushimangira cyane uburyo imikorere ihamye, uruhande rw'amagufwa ruracyasaba gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda; ② nk'isahani yo kurinda, LCP ikoresha vis za lag kugira ngo ikandagire imvune ndende; ③ binyuze mu gukoresha ihame rya tension band, vis zishyirwa ku ruhande rw'amagufwa, zigomba gushyirwaho munsi y'agahinda, kandi amagufwa ya cortical ashobora gukanda; ④ nk'isahani yo ku ruhande, LCP ikoreshwa hamwe na vis za lag kugira ngo habeho gukanda kugira ngo habeho gukanda kugira ngo habeho gukanda.
3.2 Ikoranabuhanga ryo Gufata Ikiraro: Ubwa mbere, koresha uburyo bwo kugabanya butaziguye kugira ngo wongere usubize aho imvune yavunitse, unyuze mu bice byavunitse unyuze mu kiraro hanyuma ukosore impande zombi zavunitse. Kugabanya ingirabuzimafatizo ntabwo ari ngombwa, ahubwo bisaba gusa kugarura uburebure bwa diaphysis, kuzenguruka no ku murongo w'imbaraga. Hagati aho, gushyira amagufwa mu gitereko bishobora gukorwa kugira ngo hakorwe ishingwa rya callus no guteza imbere gukira kwa mvune. Ariko, gufata ikiraro bishobora kugera ku ituze, ariko gukira kwa mvune bigerwaho binyuze mu mvune ebyiri ku bushake bwa kabiri, bityo bikoreshwa gusa ku mvune zavunitse.
3.3 Ikoranabuhanga rya Osteosynthesis y'udusate tw'amaraso (MIPO) mu buryo budakabije: Kuva mu myaka ya 1970, umuryango wa AO washyize imbere amahame yo kuvura imvune: kugabanya imiterere y'umubiri, gukora imyitozo ngororamubiri imbere, kurinda amaraso no gukora imyitozo ngororamubiri mu buryo butababaza. Ayo mahame yamenyekanye cyane ku isi, kandi ingaruka z'ubuvuzi ni nziza kurusha uburyo bwo kuvura bwabanje. Ariko, kugira ngo haboneke uburyo bwo kugabanya imiterere y'umubiri no gukora imyitozo ngororamubiri imbere, akenshi bisaba gukata cyane, bigatuma amaraso agabanuka, amaraso agabanuka ndetse n'ibyago byo kwandura byiyongera. Mu myaka ya vuba aha, intiti zo mu gihugu no mu mahanga zibanda cyane ku ikoranabuhanga ridakabije, zirinda amaraso atangwa n'ingingo zoroshye n'amagufwa mu gihe cyo guteza imbere uburyo bwo gukora imyitozo ngororamubiri imbere, zidakuraho periosteum n'ingingo zoroshye ku mpande z'imvune, zidahatira kugabanya ibice by'imvune. Kubwibyo, irinda ibidukikije by'ibinyabuzima byo kuvunika, ari byo gukora imyitozo ngororamubiri yo koroshya imvune (BO). Mu myaka ya 1990, Krettek yatanze igitekerezo cy'ikoranabuhanga rya MIPO, rikaba ari intambwe nshya yo gukora imyitozo ngororamubiri mu myaka ya vuba aha. Igamije kurinda amaraso aturuka ku magufwa n'ingingo zoroshye ku buryo nta kwangirika gukabije ku rugero runini. Uburyo ni ukubaka umuyoboro w'uburinzi bw'umubiri unyuze mu kantu gato, gushyiraho ibyuma, no gukoresha uburyo bwo kugabanya imvune no gufata imbere. Inguni iri hagati y'ibyuma bya LCP irahamye. Nubwo ibyuma bitabasha gukora neza imiterere y'umubiri, kugabanya imvune birashobora gukomeza, bityo ibyiza by'ikoranabuhanga rya MIPO biragaragara cyane, kandi ni uburyo bwiza bwo gushyiramo ikoranabuhanga rya MIPO.
4. Impamvu n'ingamba zo kurwanya itsindwa ry'ubusabe bwa LCP
4.1 Kunanirwa kwa fixator y'imbere
Inyongera zose zishobora kurekura, kwimura, kuvunika n'izindi ngaruka zo kwangirika, ibyuma bifunga na LCP ntabwo ari ibidasanzwe. Nk'uko raporo zibigaragaza, kunanirwa kwa fixator y'imbere ntabwo biterwa ahanini n'icyuma ubwacyo, ahubwo biterwa n'uko amahame shingiro yo kuvura kuvunika atubahirijwe bitewe no kudasobanukirwa neza no kumenya neza fixation ya LCP.
4.1.1. Amasahani yatoranijwe ni magufi cyane. Uburebure bw'isahani n'imigozi ni ibintu by'ingenzi bigira ingaruka ku kudahinduka kw'imigozi. Mbere yuko ikoranabuhanga rya IMIPO ritangira, amasahani magufi ashobora kugabanya uburebure bw'imigozi n'itandukaniro ry'imigozi yoroshye. Amasahani magufi cyane agabanya imbaraga z'imigozi n'imbaraga zo guhindukira ku miterere rusange, bigatuma umugozi w'imbere unanirwa. Hamwe n'iterambere ry'ikoranabuhanga ryo kugabanya ibintu mu buryo butaziguye n'ikoranabuhanga ritabangamira cyane, amasahani maremare ntabwo yongera uburebure bw'imigozi yoroshye. Abaganga bagomba guhitamo uburebure bw'isahani hakurikijwe biomekanike yo gufunga imigozi. Ku mvune zoroshye, igipimo cy'uburebure bwiza bw'isahani n'uburebure bw'agace kose k'imigozi kigomba kuba kiri hejuru y'inshuro 8-10, mu gihe ku mvune yacitse, iki gipimo kigomba kuba kiri hejuru y'inshuro 2-3. [13, 15] Amasahani afite uburebure buhagije azagabanya umutwaro w'isahani, agabanya umutwaro w'imigozi, bityo agabanye ibyago byo gucika kw'umugozi w'imbere. Dukurikije ibyavuye mu isesengura rya LCP finite element, iyo icyuho kiri hagati y’impande zombi z’aho zacitse ari 1mm, uruhande rw’aho zacitse rusiga umwobo umwe w’aho zacitse, stress kuri plate compression plate igabanya 10%, naho stress kuri vis igabanya 63%; iyo uruhande rw’aho zacitse rusiga utwobo tubiri, stress kuri plate compression plate igabanya 45%, naho stress kuri vis igabanya 78%. Kubera iyo mpamvu, kugira ngo hirindwe stress nyinshi, ku mvune zoroshye, hagomba gusigara utwobo 1-2 twegereye impande zombi, mu gihe ku mvune zacitse, hasabwa gukoresha vis eshatu kuri buri ruhande rw’aho zacitse kandi vis ebyiri zegereye aho zacitse.
4.1.2 Icyuho kiri hagati y’ibipande n’ubuso bw’amagufwa kiba kinini cyane. Iyo LCP ikoresheje ikoranabuhanga ryo gufata ibiraro, ibipande ntibisabwa kugera kuri periosteum kugira ngo birinde amaraso yo mu gace kavunitse. Biri mu cyiciro cyo gufata ibipande, bigatera imbaraga za kabiri zo gukura kwa callus. Mu kwiga uburyo umubiri uhagaze, Ahmad M, Nanda R [16] n'abandi basanze iyo icyuho kiri hagati ya LCP n’ubuso bw’amagufwa kirenze 5mm, imbaraga za axial na torsion z’ibipande zigabanuka cyane; iyo icyuho kiri munsi ya 2mm, nta kugabanuka gukomeye kugaragara. Kubwibyo, icyuho cyasabwe kuba munsi ya 2mm.
4.1.3 Isahani iratandukanye n’umurongo wa diaphysis, kandi imisumari iratandukanye n’iy’umugozi. Iyo LCP ihujwe n’ikoranabuhanga rya MIPO, imisumari isabwa gushyirwamo ibice bigororotse, kandi rimwe na rimwe biragoye kugenzura aho isahani iherereye. Niba umurongo w’igufwa utaringaniye n’umurongo w’umurongo wa plate, isahani iri kure ishobora kuva ku murongo w’igufwa, ibyo bikaba byatera imisumari guhindagurika no kudakomera. [9,15]. Ni byiza gufata incision ikwiye, kandi isuzuma rya X-ray rizakorwa nyuma y’uko aho urutoki ruhagaze neza kandi pin ya Kuntscher ihagaze neza.
4.1.4 Kunanirwa gukurikiza amahame y'ibanze yo kuvura imvune no guhitamo ikoranabuhanga ritari ryo ryo gufata imvune imbere no kuyishyiraho. Ku mvune zo mu gice cy'imbere cy'ingingo, imvune zoroshye zo mu gice cy'imbere cy'ingingo, LCP ishobora gukoreshwa nk'icyuma gikanda kugira ngo itunganye imvune ihamye binyuze mu ikoranabuhanga ryo kuyishyiraho, no guteza imbere gukira kw'ibanze kw'imvune; ku mvune za Metaphyseal cyangwa imvune zaciwe, ikoranabuhanga ryo gufata imvune rigomba gukoreshwa, kwita ku miyoboro y'amaraso yo kurinda amagufwa n'ingingo zoroshye, kwemerera imvune gukomeza guhagarara neza, gutera imbaraga gukura kwa callus kugira ngo ikire binyuze mu gice cya kabiri cy'ingingo. Ibinyuranye n'ibyo, gukoresha ikoranabuhanga ryo gufata imvune mu kuvura imvune zoroshye bishobora gutera imvune zidahamye, bigatuma imvune itinda gukira; [17] gushakisha cyane imvune zaciwe ku mpande zombi bishobora kwangiza uburyo amaraso atangwa n'amagufwa, bigatuma habaho gutinda cyangwa kudahuza.
4.1.5 Hitamo ubwoko bw'imigozi idakwiye. Umwobo uhuza LCP ushobora gushyirwamo imigozi mu bwoko bune bw'imigozi: imigozi isanzwe ya cortical, imigozi isanzwe ya cancellous bone, imigozi yiyicukura/yiyicukura n'imigozi yiyicukura. Imigozi yiyicukura/yiyicukura ikoreshwa nk'imigozi isanzwe kugira ngo ikosore imvune isanzwe ya diaphyseal y'amagufwa. Isonga ryayo ry'inzara rifite imiterere y'icyitegererezo cy'imashini, byoroshye kunyura muri cortex akenshi nta gupima uburebure. Niba umwobo wa diaphyseal pulp ari muto cyane, screw nut ishobora kudakwira neza kuri screw, kandi screw head igakora kuri cortex inyuranye, ibyangiritse kuri cortex ihamye bigira ingaruka ku mbaraga zo gufata hagati ya screws n'amagufwa, kandi screw ziyicukura zigomba gukoreshwa muri iki gihe. Imigozi isanzwe ya unicortical ifite imbaraga zo gufata neza ku magufwa asanzwe, ariko igufwa rya osteoporosis rikunze kugira cortex idakomeye. Kubera ko igihe cyo gukora cy'imigozi kigabanuka, igihe imbaraga zo guhagarara ku kuboko ziragabanuka, ibyo bikaba byoroshye gutuma cortex y'amagufwa icibwa, screw irekura kandi ikavaho. [18] Kubera ko vis za bicortical zongereye uburebure bw'imikorere y'vis, imbaraga zo gufata amagufwa nazo ziryongera. Ikirenze byose, igufwa risanzwe rishobora gukoresha vis za unicortical kugira ngo rikosore, nyamara igufwa rya osteoporosis ni byiza gukoresha vis za bicortical. Byongeye kandi, cortex y'amagufwa ya humerus ni nto cyane, ituma byoroshye gukata, bityo vis za bicortical zirakenewe kugira ngo zikosorerwe mu kuvura imvune za humeral.
4.1.6 Gukwirakwiza skuru ni binini cyane cyangwa bike cyane. Gushyiraho skuru ni ngombwa kugira ngo hubahirizwe imiterere y’ibinyabutabire byavunitse. Gukwirakwiza skuru binini cyane bizatuma skuru irushaho kuba nyinshi kandi ivunitse imbere; skuru nke cyane kandi imbaraga nke zo gushyiraho skuru nazo zizatuma skuru inanirwa gukora skuru. Iyo ikoranabuhanga rya bridge rikoreshejwe mu gushyiraho skuru, ubucucike bw’skuru busabwa bugomba kuba munsi ya 40% -50% cyangwa munsi yayo. [7,13,15] Kubwibyo, skuru ni ndende, kugira ngo hongerwe uburinganire bw’imashini; hagomba gusigara imyobo 2-3 ku mpande zombi z’ivunitse, kugira ngo skuru irusheho kuba nziza, hirindwe stress nyinshi kandi bigabanye ibyago byo kuvunika imbere [19]. Gautier na Sommer [15] batekereje ko nibura skuru ebyiri zikozwe mu buryo butari bumwe zigomba gushyirwa ku mpande zombi z’ivunitse, umubare wiyongereye wa skuru ntizagabanya igipimo cyo gucika kw’skuru, bityo nibura skuru eshatu zisabwa gushyirwa ku mpande zombi z’ivunitse. Nibura vis 3-4 zirakenewe ku mpande zombi z'umugongo n'ivunika ry'ukuboko, imizigo myinshi yo gutobora igomba kwimurwa.
4.1.7 Ibikoresho byo gufunga byakoreshejwe nabi, bigatuma icyuma gifunga imbere kinanirwa. Sommer C [9] yasuye abarwayi 127 bafite ibibazo 151 byo kuvunika bakoresheje LCP mu gihe cy'umwaka umwe, ibyavuye mu isesengura bigaragaza ko muri vis 700 zo gufunga, ni vis nkeya zifite umurambararo wa 3.5mm gusa zifunguye. Impamvu ni uko habayeho kureka gukoresha vis clocking seeper device. Mu by'ukuri, vis clocking na plate ntabwo ari standy rwose, ahubwo bigaragaza inguni ya dogere 50. Iyi miterere igamije kugabanya stress ya vis clocking. Guhagarika gukoresha vis clocking device bishobora guhindura inzira y'inzara bityo bigatera kwangirika k'imbaraga zo gufunga. Kääb [20] yari yakoze ubushakashatsi bw'igerageza, yasanze inguni iri hagati ya vis na slate za LCP ari nini cyane, bityo imbaraga zo gufata vis zigabanuka cyane.
4.1.8 Gushyira ibiro by'amaguru mu mwanya wabyo hakiri kare cyane. Raporo nyinshi nziza zituma abaganga benshi bemera cyane imbaraga z'amapine n'amasurufu yo gufunga ndetse no kudahindagurika kw'amasurufu, bibeshya ko imbaraga z'amapine yo gufunga zishobora kwihanganira uburemere bwuzuye, bigatuma amapine cyangwa amasurufu avunika. Mu gukoresha amasurufu yo gufunga amasurufu, LCP irahamye, kandi isabwa gukora callus kugira ngo ikire neza binyuze mu guhagarara kwa kabiri. Iyo abarwayi bahagurutse mu buriri kare cyane kandi bakaremerera ibiro byinshi, amapine n'amasurufu bizavunika cyangwa bivanwemo. Gushyira amasurufu yo gufunga amasurufu bituma umuntu akora hakiri kare, ariko gufunga buhoro buhoro bizakorwa nyuma y'ibyumweru bitandatu, kandi amashusho ya x-ray agaragaza ko uruhande rw'amasurufu rugaragaza ikibazo gikomeye. [9]
4.2 Ibikomere by'imitsi n'imitsi:
Ikoranabuhanga rya MIPO risaba ko umuntu ashyiramo vis/ ... Byongeye kandi, mu gihe ucukura vis zikora ku giti cyawe, koresha amazi kugira ngo ugabanye umusaruro w'ubushyuhe kandi ugabanye umuvuduko w'ubushyuhe.
4.3 Kwandura aho umuntu abagwa no guhura n'agapira k'inkari:
LCP ni sisitemu yo gufunga imbere yakozwe hifashishijwe uburyo bwo guteza imbere igitekerezo cyo kugabanya ibyangiritse, kugabanya ubwandu, kudahuza n'izindi ngorane. Mu kubaga, tugomba kwita cyane ku kurinda ingingo zoroshye, cyane cyane ibice by'umubiri byoroshye. Ugereranyije na DCP, LCP ifite ubugari bunini n'ubugari bwinshi. Mu gukoresha ikoranabuhanga rya MIPO mu gushyiramo ingingo cyangwa imitsi, bishobora gutera kwangirika kw'ingingo zoroshye cyangwa kwangirika kw'imitsi bigatuma habaho kwandura kw'ibikomere. Phinit P [23] yavuze ko sisitemu ya LISS yavumbuye 37 byavunitse tibia hafi, kandi umubare w'ubwandu bwo mu gice cy'imbere nyuma yo kubagwa wari ugeze kuri 22%. Namazi H [24] yavuze ko LCP yavumbuye 34 byavunitse tibia ku bice 34 byavunitse tibia, kandi umubare w'ubwandu bwo mu gice cy'imbere nyuma yo kubagwa wari ugeze kuri 23.5%. Kubwibyo, mbere yo kubagwa, amahirwe n'umuganga wo gufunga imbere bigomba gusuzumwa cyane hakurikijwe ibyangiritse by'ingingo zoroshye n'uburyo imvune zavunitse.
4.4 Indwara y'amara iterwa n'imitsi yoroshye:
Phinit P [23] yavuze ko sisitemu ya LISS yavumbuye abantu 37 bavunitse tibia hafi y’aho bavunitse, abantu 4 bavunitse ingingo zoroshye nyuma yo kubagwa (ububabare bw’igice cyo hasi cy’umubiri gishobora gupimwa no hafi y’igice), aho ibice 3 biri kuri mm 5 uvuye ku buso bw’amagufwa naho igice 1 kiri kuri mm 10 uvuye ku buso bw’amagufwa. Hasenboehler.E [17] n’abandi bavuze ko LCP yavumbuye abantu 32 bavunitse tibia hafi y’aho bavunitse, harimo n’abantu 29 bavunitse mikorobe. Impamvu ni uko ingano y’igice ari kinini cyane cyangwa ibipande bishyirwa nabi kandi igice cyoroshye kikaba gito kuri malleolus yo hagati, bityo abarwayi bazumva batameze neza iyo abarwayi bambaye inkweto ndende kandi bakanda uruhu. Inkuru nziza ni uko igice gishya cya metaphyseal cyakozwe na Synthes ari gito kandi gifata ku buso bw’amagufwa gifite impande zoroshye, ibyo bikaba byarakemuye iki kibazo neza.
4.5 Ingorane mu gukuraho vis zo gufunga:
Ibikoresho bya LCP bifite titaniyumu ikomeye cyane, bihura neza n'umubiri w'umuntu, byoroshye gupakira na callus. Mu kubikuraho, kubanza gukuraho callus bitera ingorane nyinshi. Indi mpamvu yo kubikuraho ni ugufunga cyane vis zo gufunga cyangwa kwangirika kw'intete, akenshi biterwa no gusimbuza icyuma cyo kureba vis cyo gufunga cyasizwe n'igikoresho cyo kwirebera. Kubwibyo, igikoresho cyo kureba kigomba gukoreshwa mu gufata vis zo gufunga, kugira ngo vis zo gufunga zifatanye neza n'imigozi y'icyuma. [9] Hakenewe icyuma cyihariye gikoreshwa mu gufunga vis, kugira ngo hagenzurwe ubunini bw'imbaraga.
Ikirenze byose, nk'icyitegererezo cy'iterambere rigezweho rya AO, LCP yatanze uburyo bushya bwo kuvura imvune zigezweho. Ihujwe n'ikoranabuhanga rya MIPO, LCP ihuza amaraso ku mpande zombi, ifasha imvune gukira, igabanya ibyago byo kwandura no kongera kuvunika, ikomeza guhagarara neza, bityo ifite amahirwe menshi yo kuyikoresha mu kuvura imvune. Kuva ikoreshwa, LCP yabonye ibisubizo byiza by'igihe gito, ariko hari n'ibibazo bimwe na bimwe bigaragara. Kubaga bisaba igenamigambi rirambuye mbere yo kubagwa no kugira uburambe bwinshi mu buvuzi, ihitamo ibikoresho byo kuvura imbere n'ikoranabuhanga rikwiye hashingiwe ku miterere y'imvune runaka, ikurikiza amahame shingiro yo kuvura imvune, ikoresha ibikoresho byo kuvura imvune mu buryo bukwiye kandi busanzwe, kugira ngo hirindwe ingorane no kubona ingaruka nziza zo kuvura.
Igihe cyo kohereza: Kamena-02-2022
