Mu myaka mike ishize ishize, ikibazo cyo kuvunika hafi y’imyanya ndangagitsina (PHFs) cyiyongereyeho hejuru ya 28%, naho umubare wo kubaga wiyongereyeho 10% ku barwayi bafite imyaka 65 nayirenga. Ikigaragara ni uko kugabanuka kw'amagufwa no kwiyongera kw'igabanuka ari byo bintu nyamukuru bishobora guteza abantu bageze mu za bukuru. Nubwo uburyo butandukanye bwo kubaga buhari bwo gucunga PHF yimuwe cyangwa idahindagurika, nta bwumvikane ku buryo bwiza bwo kubaga abageze mu zabukuru. Iterambere rya plaque stabilisateur ryatanze uburyo bwo kuvura uburyo bwo kubaga ubuvuzi bwa PHF, ariko hagomba gutekerezwa igipimo kinini cy’ingutu kigera kuri 40%. Bikunze kuvugwa cyane ni gusenyuka gusenyuka hamwe na dislodgement ya screw na necrosis avascular (AVN) yumutwe wa humeral.
Kugabanuka kwa anatomike kuvunika, kugarura umwanya wumuntu, hamwe no gukosora neza munsi ya screw birashobora kugabanya ibibazo nkibi. Gukosora imigozi akenshi biragoye kubigeraho bitewe nubwiza bwamagufwa yangiritse yimitsi ya hafi iterwa na osteoporose. Kugira ngo iki kibazo gikemuke, gushimangira amagufwa ya screw hamwe nubuziranenge bwamagufwa ukoresheje polymethylmethacrylate (PMMA) sima yamagufa hafi yisonga rya screw nuburyo bushya bwo kunoza imbaraga zo gukosora kwatewe.
Ubu bushakashatsi bugamije gusuzuma no gusesengura ibisubizo bya radiografiya ya PHF ivurwa hamwe na plaque stabilisation hamwe no kongera imiyoboro ya screw ku barwayi barengeje imyaka 60.
Ⅰ.Ibikoresho nuburyo
Abarwayi 49 bose batewe isahani ihamye kandi bongerewe sima hiyongereyeho imigozi ya PHF, kandi abarwayi 24 bashyizwe mu bushakashatsi hashingiwe ku ngingo zishyirwa mu bikorwa.
PHFs zose uko ari 24 zashyizwe mubikorwa hakoreshejwe sisitemu ya HGLS yashyizwe ahagaragara na Sukthankar na Hertel ukoresheje CT scan mbere yo gutangira. Harasuzumwe amaradiyo mbere yo gutangira kimwe na nyuma yibikorwa bisanzwe. Kugabanya anatomic ihagije yo kuvunika byafatwaga nkigerwaho mugihe igituntu cyumutwe wigitereko cyongeye kugabanuka kandi kigaragaza munsi ya mm 5 zicyuho cyangwa kwimuka. Ubumuga bwo kwiyongera bwasobanuwe nkuguhindura umutwe wa humeral ugereranije nigitereko cya humeral kiri munsi ya 125 ° naho ubumuga bwa valgus bwasobanuwe hejuru ya 145 °.
Kwinjira kwa primaire byasobanuwe nkinama ya screw yinjira kumupaka wa medullary cortex yumutwe wa humeral. Icyiciro cya kabiri cyo kuvunika cyasobanuwe nko kwimura igituntu cyagabanutse hejuru ya mm 5 na / cyangwa guhindura hejuru ya 15 ° mu mpande zegeranye z’igice cy’umutwe kuri radiyo ikurikiranwa ugereranije na radiografi idakorana.
Kubaga byose byakozwe hakoreshejwe uburyo bwa deltopectoralis. Kugabanya kuvunika no gushyira isahani byakozwe muburyo busanzwe. Tekinike yo kongera imiyoboro ya sima yakoresheje ml 0,5 ya sima kugirango yongere.
Immobilisation yakozwe nyuma yibikorwa mumaboko yabigenewe ku rutugu ibyumweru 3. Kera kare kandi ifasha kugenda neza hamwe no guhindura ububabare yatangijwe iminsi 2 nyuma yo kubagwa kugirango igere kumurongo wuzuye (ROM).
Ⅱ.Ingaruka.
Ibisubizo: Harimo abarwayi makumyabiri na bane, bafite hagati yimyaka 77.5 (intera, imyaka 62-96). 21 ni ab'igitsina gore na batatu bari abagabo. Ibice bitanu 2 byavunitse, 12 byavunitse 3 3, hamwe n’ibice birindwi 4 bigize ibice 4 byavuwe hakoreshejwe kubagwa hakoreshejwe ibyapa bifatika kandi byongera umugozi wa sima. Bitatu muri 24 byavunitse byari kuvunika umutwe. Kugabanya Anatomic byagezweho muri 12 kuri 24 barwayi; kugabanya burundu cortex yo hagati byagezweho mubarwayi 15 kuri 24 (62.5%). Nyuma y'amezi 3 nyuma yo kubagwa, 20 ku barwayi 21 (95.2%) bari baragize ubumwe bwavunitse, usibye abarwayi 3 basabye kubagwa hakiri kare.
Umurwayi umwe yagize ibyimurwa hakiri kare (kuzenguruka inyuma yumutwe wa humeral) nyuma yibyumweru 7 nyuma yo kubagwa. Isubiramo ryakozwe hamwe na arthroplasti yigitugu yose nyuma y'amezi 3 nyuma yo kubagwa. Imiyoboro y'ibanze yinjiye kubera sima ntoya yo mu nda (idafite isuri rikomeye ry'urugingo) byagaragaye ku barwayi 3 (2 muri bo bavunitse umutwe) mu gihe cyo gukurikirana radiyo nyuma yo gukorerwa. Kwinjira mu miyoboro byagaragaye mu cyiciro cya C cya plaque itajegajega ku barwayi 2 no mu cyiciro cya E mu kindi (Ishusho 3). 2 muri aba barwayi 3 bakurikiranye indwara ya nérosose avascular (AVN). Abarwayi babazwe ubugororangingo kubera iterambere rya AVN (Imbonerahamwe 1, 2).
Ⅲ.Ikiganiro.
Ingorane zikunze kugaragara mu kuvunika kwimyanya ndangagitsina (PHFs), usibye iterambere rya nérosose avascular (AVN), ni dislodgement hamwe no gusenyuka nyuma yo gusenyuka k'umutwe wa humeral. Ubu bushakashatsi bwerekanye ko kongera sima-screw byatumye igipimo cy’ubumwe kingana na 95.2% mu mezi 3, icyiciro cya kabiri cyo kwimurwa cya 4.2%, AVN cya 16.7%, n’ivugurura rusange rya 16.7%. Kwiyongera kwa sima kwamashanyarazi byatumye igipimo cya kabiri cyo kwimurwa cya 4.2% nta gusenyuka kwangiritse, kikaba ari igipimo cyo hasi ugereranije na 13.7-16% hamwe nibisanzwe byerekana ibyapa. Turasaba cyane ko hashyirwaho ingufu kugirango hagabanuke anatomic ihagije, cyane cyane ya cortex yo hagati yo hagati ya plaque ya plaque ya PHFs. Nubwo inyongera ya screw tip yongerewe ikoreshwa, bizwi neza ko bishobora gutsindwa.
Igipimo rusange cyo gusubiramo kingana na 16.7% ukoresheje ubwiyongere bwa screw tip muri ubu bushakashatsi buri murwego rwo hasi rwibipimo byisubiramo mbere byashyizwe ahagaragara ku byapa gakondo bihindura inguni muri PHF, byagaragaje ibipimo byo kuvugurura mubantu bageze mu zabukuru kuva kuri 13% kugeza 28%. Nta gutegereza. Ibyifuzo, byateganijwe, bigenzurwa na multicenter ubushakashatsi bwakozwe na Hengg nabandi. ntiyerekanye inyungu zo kongera sima screw. Mu barwayi 65 bose barangije umwaka 1 bakurikirana, kunanirwa kwa mashini byagaragaye ku barwayi 9 na 3 mu itsinda ryiyongera. AVN yagaragaye ku barwayi 2 (10.3%) no mu barwayi 2 (5,6%) mu itsinda ridatera imbere. Muri rusange, nta tandukaniro ryibanze ryabayeho mugihe habaye ibintu bibi nibisubizo byubuvuzi hagati yaya matsinda yombi. Nubwo ubu bushakashatsi bwibanze ku mavuriro na radiologiya, ntabwo basuzumye amaradiyo ku buryo burambuye nkubu bushakashatsi. Muri rusange, ibibazo byagaragaye kuri radiologiya bisa nibiri muri ubu bushakashatsi. Nta na hamwe muri ubwo bushakashatsi bwigeze buvuga ko sima yamenetse, usibye ubushakashatsi bwakozwe na Hengg n'abandi, babonye iki kibazo kibi ku murwayi umwe. Muri ubu bushakashatsi, ubushakashatsi bwibanze bwagaragaye inshuro ebyiri kurwego rwa C na rimwe kurwego rwa E, nyuma ya sima yimbere-arctular yamenetse nta sano ifitanye isano nubuvuzi. Ibikoresho bitandukanye byatewe inshinge za fluoroscopique mbere yo kongera sima kuri buri cyuma. Nyamara, ibitekerezo bitandukanye bya radiografiya kumyanya yintoki bigomba gukorwa kandi bigasuzumwa neza kugirango hirindwe ikintu cyambere cyinjira mbere yo gusaba sima. Byongeye kandi, gushimangira sima gushimangira imigozi kurwego C (iboneza rya screw itandukanye) bigomba kwirindwa kubera ibyago byinshi byo kwinjira mumashanyarazi nyamukuru no kumeneka kwa sima. Kwiyongera kwa sima ya sima ntabwo byemewe kubarwayi bafite imvune zo mumutwe kubera ubushobozi bwinshi bwo kumeneka kwimbere munda bigaragara muri ubu buryo bwo kuvunika (bigaragara ku barwayi 2).
VI. Umwanzuro.
Mu kuvura PHF hamwe nisahani ihagaze neza ukoresheje sima ya PMMA, kongera sima ya sima ya sima ni tekinike yizewe yo kubaga yongerera imbaraga igenamigambi ryatewe kumagufwa, bikaviramo umuvuduko muke wa 4.2% kubarwayi ba osteoporotique. Ugereranije nubuvanganzo buriho, ubwiyongere bwa necrosis avasulaire (AVN) bwagaragaye cyane cyane muburyo bwo kuvunika gukabije kandi bigomba kwitabwaho. Mbere yo gusaba sima, isima iyo ari yo yose yamenetse igomba gukurwaho neza nubuyobozi buciriritse. Bitewe n’ibyago byinshi byo gutembera kwa sima imbere mu kuvunika umutwe wa humeral, ntabwo dusaba ko inama ya sima yaguka muri uku kuvunika.
Igihe cyo kohereza: Kanama-06-2024
