Mu myaka mike ishize, umubare w’abavunika imitsi yo mu gice cya hafi (PHFs) wiyongereyeho ibirenga 28%, kandi umubare w’ababaga wiyongeraho ibirenga 10% mu barwayi bafite imyaka 65 no hejuru. Birumvikana ko kugabanuka k’ubucucike bw’amagufwa no kwiyongera kw’umubare w’abagwa ari byo bintu bikomeye bishobora guteza akaga mu bantu bageze mu za bukuru. Nubwo hari uburyo butandukanye bwo kubaga buhari bwo gucunga PHF zitameze neza cyangwa zidakora neza, nta gitekerezo kiboneka ku buryo bwiza bwo kubaga ku bageze mu za bukuru. Iterambere ry’ibice byo guhagarara kw’inguni ryatanze uburyo bwo kuvura PHF, ariko igipimo cyo kubabara kinini kigera kuri 40% kigomba kwitabwaho. Ibikunze kuvugwa cyane ni ugusenyuka kw’umutwe w’umutsi no gucika kw’imitsi yo mu gice cya kabiri cy’amagufwa.
Kugabanya imvune mu mubiri, gusubizaho umwanya wo kuvura, no gufata neza vis mu nsi y'umubiri bishobora kugabanya ingorane nk'izo. Gufata vis mu nsi y'umubiri akenshi biragoye kugeraho bitewe n'uko vis mu nsi y'umubiri igenda igabanuka bitewe n'uko vis mu mubiri igenda ihinduka. Kugira ngo iki kibazo gikemuke, gukomeza imiterere y'amagufwa n'vis mu magufwa, hakoreshejwe sima y'amagufwa ya polymethylmethacrylate (PMMA) hafi y'umutwe w'vis, ni uburyo bushya bwo kunoza imbaraga zo gufata vis mu mubiri.
Ubushakashatsi buriho bugamije gusuzuma no gusesengura ibyavuye mu bushakashatsi bwa radiyo bwa PHFs bwavuwe hakoreshejwe angled stabilization plates hamwe n’inyongera y’inyongera ku barwayi barengeje imyaka 60.
Ⅰ.Ibikoresho n'Uburyo
Abarwayi 49 bose hamwe bakorewe imashini zifunga inguni zihamye ndetse bongera sima bakoresheje vis za PHF, naho abarwayi 24 bashyizwe mu bushakashatsi hashingiwe ku bipimo byo gushyiramo no gusiba.
PHF zose uko ari 24 zashyizwe mu byiciro hakoreshejwe uburyo bwa HGLS bwashyizweho na Sukthankar na Hertel hakoreshejwe CT scan mbere yo kubagwa. Hasuzumwe uburyo bwa radiograph mbere yo kubagwa ndetse na radiograph nyuma yo kubagwa. Hasuzumwe uburyo buhagije bwo kugabanya imvune mu mubiri bwagezweho iyo ubwinshi bw'imitsi y'umutwe w'umugongo bwagabanutse kandi bugagaragaza ko hari icyuho kiri munsi ya mm 5 cyangwa kwimuka. Ubusembwa bwo kongera guhindurwa bwasobanuwe nk'aho umutwe w'umugongo uhagaze ugereranyije n'umugongo w'umugongo uri munsi ya 125° naho ubusembwa bwa valgus bwasobanuwe nk'uburenze 145°.
Kwinjira kw'ibanze kw'imitsi byasobanuwe nk'umutwe w'umutsi winjira mu mupaka wa cortex y'umutwe w'umugongo. Kwimuka kw'ivunika rya kabiri byasobanuwe nk'ukwimuka kw'uburemere bwagabanutseho burenga mm 5 cyangwa impinduka ya dogere zirenga 15 mu nguni y'agace k'umutwe kuri radiyo ikurikira ugereranije na radiyo yo mu gihe cyo kubagwa.
Kubaga kose kwakozwe hakoreshejwe uburyo bwa deltopectoralis major. Kugabanya imvune no gushyira plate mu mwanya byakozwe mu buryo busanzwe. Uburyo bwo kongera sima hakoreshejwe screw-siment bwakoresheje 0.5 ml ya sima mu kongera screw tip.
Guhagarika kugenda nyuma yo kubagwa byakozwe hakoreshejwe uburyo bwo gupfuka amaboko ku rutugu mu gihe cy'ibyumweru 3. Gutangira gukora buhoro buhoro kandi bigafasha mu kugabanya ububabare mu minsi 2 nyuma yo kubagwa kugira ngo habeho uburyo bwose bwo gukora (ROM).
Ⅱ.Ingaruka.
Ibisubizo: Abarwayi 24 bari muri bo, bafite imyaka ibarirwa muri za 77.5 (imyaka 62-96). 21 bari abagore naho batatu bari abagabo. Abavunitse batanu bafite ibice 2, abavunitse 12 bafite ibice 3, n'abavunitse barindwi bafite ibice 4 bavuwe hakoreshejwe ibyuma bifunganye byo guhagarara no kongeramo sima. Batatu muri 24 bavunitse umutwe. Abavunitse 12 muri 24 bavunitse; 15 muri 24 bavunitse; 62.5% by'abarwayi bose nyuma yo kubagwa, 20 muri 21 (95.2%) bari bamaze kuvunika, uretse abarwayi 3 basabye kubagwa hakiri kare.
Umurwayi umwe yagize ikibazo cyo kwimuka vuba (guhindukira inyuma kw'agace k'umutwe wa humeral) nyuma y'ibyumweru 7 nyuma yo kubagwa. Ivugururwa ryakozwe hakoreshejwe uburyo bwo gusimbuza urutugu rw'inyuma amezi 3 nyuma yo kubagwa. Kwinjira kw'urushundura rw'ibanze bitewe n'amazi make ya sima yo mu nda (nta gushonga gukomeye kw'ingingo) byagaragaye ku barwayi 3 (2 muri bo bari baravunitse umutwe wa humeral) mu gihe cyo gukurikirana isuzuma rya radiographic nyuma yo kubagwa. Kwinjira kw'urushundura kwagaragaye mu cyiciro cya C cy'icyuma gikingira inguni ku barwayi 2 no mu gice cya E mu kindi (Ishusho ya 3). 2 muri abo barwayi 3 nyuma yaho barwaye indwara ya avascular necrosis (AVN). Abarwayi bakorewe ubugenzuzi kubera iterambere rya AVN (Imbonerahamwe ya 1, 2).
Ⅲ.Ikiganiro.
Ingorane ikunze kugaragara mu kuvunika kwa humeral proximal (PHFs), usibye gutera kwa avascular necrosis (AVN), ni ukuvamo kwa screw hanyuma igice cy'umutwe wa humeral kikagwa. Ubu bushakashatsi bwagaragaje ko kongera sima na screw byatumye igipimo cy'ubumwe cya 95.2% mu mezi 3, igipimo cya kabiri cyo kwimuka cya 4.2%, igipimo cya AVN cya 16.7%, n'igipimo cyose cyo kuvugurura cya 16.7%. Kongera sima bya screw byatumye igipimo cya kabiri cyo kwimuka cya 4.2% nta kugwa kwa electroduction, ari igipimo gito ugereranyije n'igipimo cya 13.7-16% cyo gushyiraho plate isanzwe ifite angle. Turasaba cyane ko hashyirwa imbaraga kugira ngo hagerwe ku kugabanuka guhagije kwa anatomike, cyane cyane cortex ya humeral medial mu gushyiraho plate ya PHF ifite angle. Nubwo hakoreshwa ubundi buryo bwo kongera screw, hagomba kwitabwaho ibipimo bizwi neza bishobora gutuma habaho gutsindwa.
Igipimo rusange cyo kuvugurura cya 16.7% hakoreshejwe kongera insinga z'imigozi muri ubu bushakashatsi kiri mu cyiciro cyo hasi cy’igipimo cyasohotse mbere cyo kuvugurura ibyuma bisanzwe byo kubungabunga inguni muri PHF, byagaragaje igipimo cyo kuvugurura mu bantu bageze mu zabukuru kiri hagati ya 13% na 28%. Nta gutegereza. Inyigo y’ubushakashatsi yakozwe na Hengg et al., yakozwe mu buryo bwa "randomized", yagenzuwe n’ibigo byinshi, ntiyagaragaje akamaro ko kongera insinga z’imigozi za sima. Mu barwayi 65 bakurikiranye umwaka umwe, habayeho ikibazo cy’imashini mu barwayi 9 na 3 mu itsinda ryo kongera insinga. AVN yagaragaye mu barwayi 2 (10.3%) no mu barwayi 2 (5.6%) mu itsinda ritarakosowe. Muri rusange, nta tandukaniro rinini ryagaragaye mu kubaho kw’ingaruka mbi n’ingaruka z’ubuvuzi hagati y’amatsinda yombi. Nubwo ubu bushakashatsi bwibanze ku bisubizo by’ubuvuzi n’ibyavuye mu miyoboro y’amashanyarazi, ntabwo bwasuzumye radiyo mu buryo burambuye nk’ubu bushakashatsi. Muri rusange, ingorane zabonetse hakoreshejwe radiyo zari zisa n’izo muri ubu bushakashatsi. Nta na kimwe muri ubu bushakashatsi cyagaragaje ko sima yavuye mu gice cy’imbere cy’umutwe, uretse ubushakashatsi bwakozwe na Hengg et al., babonye iki kibazo kibi ku murwayi umwe. Muri ubu bushakashatsi, kwinjira mu gice cy’imbere cy’umutwe byagaragaye kabiri ku rwego rwa C n’ikindi ku rwego rwa E, hanyuma hakaza kuvamo sima mu gice cy’imbere cy’umutwe nta kibazo na kimwe gihari. Ibikoresho byo gutandukanya byatewe hifashishijwe fluoroscopic mbere yo kongera sima kuri buri skuru. Ariko, hagomba gukorwa amashusho atandukanye ya radiographic ahantu hatandukanye mu maboko no gusuzumwa neza kugira ngo hamenyekane ko nta skuru y’imbere y’umutwe yavuyemo mbere yo gukoresha sima. Byongeye kandi, kongera sima mu gice cy’imbere cy’umutwe (skuru y’imbere y’umutwe) bigomba kwirindwa kubera ibyago byinshi byo kwinjira mu gice cy’imbere cy’umutwe no kuvamo kwa sima nyuma yaho. Kongeramo skuru y’umutwe wa sima ntibyemewe ku barwayi bafite imvune zo mu mutwe bitewe n’ubushobozi bwinshi bwo kuvamo mu gice cy’imbere cy’umutwe byagaragaye muri ubu buryo bwo kuvunika (byagaragaye ku barwayi 2).
VI. Umwanzuro.
Mu kuvura PHF hakoreshejwe ibyuma bifite inguni bihamye hakoreshejwe sima ya PMMA, kongera vis ya sima ni uburyo bwizewe bwo kubaga butuma icyuma gifata igufwa, bigatuma igipimo cyo kwimuka cya kabiri cya 4.2% ku barwayi bafite osteoporosis gigabanuka. Ugereranyije n'inyandiko zisanzweho, kwiyongera kwa AVN (avascular necrosis) byagaragaye cyane cyane mu miterere ikomeye y'amagufwa kandi ibi bigomba kwitabwaho. Mbere yo gukoresha sima, kuva kwa sima mu gice cy'imbere cy'ingingo bigomba kwitonderwa hatangwa uburyo bwo kugabanya imiterere y'ingingo. Kubera ibyago byinshi byo kuva kwa sima mu gice cy'imbere cy'ingingo mu kuvunika umutwe, ntabwo twasaba kongera vis ya sima mu gice cy'imbere cy'ingingo muri uku kuvunika.
Igihe cyo kohereza: Kanama-06-2024
