Gucika intege kw'inyuma y'inyuma ni imvune zikunze kugaragara mu ndwara ziterwa n'ihungabana rikomeye. Bitewe n'imiterere y'umubiri w'inyuma y'inyuma, umurongo w'ivunika ukunze kuba hafi y'ubuso bw'inyuma bw'inyuma kandi ushobora kugera no mu ngingo, bigatuma bidakwiye gushyirwaho inzara zo mu nda. Kubera iyo mpamvu, igice kinini cy'indwara kiracyashingiye ku gushyirwaho hakoreshejwe uburyo bwa plate na screw. Ariko, imiterere y'ibice by'inyuma by'inyuma y'inyuma itera ibyago byinshi byo guhura n'ingorane nko kunanirwa gushyirwaho kw'inyuma y'inyuma, gucika kw'inyuma y'inyuma, no gukururwa n'impande. Gukoresha ubufasha bw'impande zombi mu gushyiraho impagarike, nubwo ari ingirakamaro, bizana n'imbogamizi zo kwiyongera kw'ihungabana, igihe kirekire cyo kubagwa, ibyago byinshi byo kwandura nyuma yo kubagwa, ndetse n'umutwaro w'amafaranga ku barwayi.
Bitewe n'ibi bitekerezo, kugira ngo habeho uburinganire bukwiye hagati y'ingaruka mbi za biomechanical z'ibice bimwe byo ku ruhande n'ihungabana ryo kubaga rijyanye no gukoresha ibice bibiri byo ku ruhande n'ibyo ku ruhande, intiti z'abanyamahanga zakoresheje uburyo bwo gufata ibice byo ku ruhande hamwe n'inyongera ku ruhande rwo hagati rw'ibice. Ubu buryo bwagaragaje umusaruro mwiza mu buvuzi.
Nyuma yo gusinziriza, umurwayi ashyirwa mu mwanya we wo kuryama.
Intambwe ya 1: Kugabanya kuvunika. Shyira urushinge rwa Kocher rwa 2.0mm mu gice cy'ikirenge, ushyiremo imbaraga kugira ngo usubize uburebure bw'ikirenge, hanyuma ukoreshe agakoresho ko gukosora aho ikirenge cya sagittal giherereye.
Intambwe ya 2: Gushyira icyuma cyo ku ruhande. Nyuma yo kugabanya by'ibanze ukoresheje imbaraga, jya mu ruhande rw'imbere rw'inyuma, hitamo icyuma gifunga uburebure bukwiye kugira ngo ukomeze kugabanya, hanyuma ushyiremo vis ebyiri ku mpera z'aho imvune ivunitse kugira ngo ukomeze kugabanya imvune. Muri iki gihe, ni ngombwa kumenya ko vis ebyiri zo ku ruhande zigomba gushyirwa hafi y'imbere uko bishoboka kose kugira ngo hirindwe ko vis zo ku ruhande zishyirwa.
Intambwe ya 3: Gushyiramo vis zo mu nkingo zo hagati. Nyuma yo gushimangira aho imvune yacitse ukoresheje icyuma cyo ku ruhande, koresha vis yo mu bwoko bwa 2.8mm iyobora vis kugira ngo winjire mu nkingo yo hagati, aho urushinge ruherereye hagati cyangwa inyuma y’agace k’imbere k’inyuma k’inyuma, inyuma no hejuru, rwinjira mu igufwa ritandukanye. Nyuma yo kugabanya fluoroscopy neza, koresha vis yo mu bwoko bwa 5.0mm kugira ngo ukore umwobo hanyuma ushyiremo vis yo mu igufwa ya 7.3mm igabanya vis.
Ishusho igaragaza inzira yo kugabanya no gufunga imvune. Umugore w'imyaka 74 ufite imvune yo mu gice cy'imbere cy'inyuma (AO 33C1). (A, B) Isuzuma rya radiyo mbere yo kubagwa rigaragaza ko imvune yo mu gice cy'imbere cy'inyuma cy'inyuma y ...
Mu gihe cyo kugabanya, ni ngombwa gusuzuma ingingo zikurikira:
(1) Koresha insinga iyobora ifite vis. Gushyiramo vis zo mu nkuta z’imbere ni byinshi cyane, kandi gukoresha insinga iyobora nta vis bishobora gutuma inguni irushaho kuba ndende mu gihe cyo gucukura condyle yo mu nkuta z’imbere, bigatuma igenda inyerera.
(2) Niba vis zo mu gice cyo ku ruhande zifashe neza igice cyo ku ruhande ariko ntizigere ku gice cyo ku ruhande gifata neza igice cyo ku ruhande, hindura icyerekezo cy’igice cyo ku ruhande imbere, ureke vis zinjire mu ruhande rw’imbere rw’igice cyo ku ruhande kugira ngo zigere ku gice cyo ku ruhande gishimishije.
(3) Ku barwayi bafite indwara ya osteoporosis, gushyiramo agakoresho ko kumesa gafite vis yo hagati bishobora kubuza vis gukata mu igufwa.
(4) Utwuma turi ku mpera y'icyapa dushobora kubangamira ishyirwa ry'utuzu duto tw'inkingi. Niba utwuma duto twagaragaye mu gihe cyo gushyiramo utuzu duto tw'inkingi, tekereza gukuramo cyangwa kongera gushyiramo utuzu duto tw'icyapa cyo ku ruhande, uha agaciro ishyirwa ry'utuzu duto tw'inkingi.
Urugero rwa 2. Umurwayi w'umugore, w'imyaka 76, ufite imvune yo mu gice cya kure cy'inyuma cy'umugongo. (A, B) Imirasire ya X mbere yo kubagwa igaragaza kwimuka gukomeye, ubumuga bw'inguni, no kwimuka kw'ivuniko ry'umugongo; (C, D) Imirasire ya X nyuma yo kubagwa mu buryo bwo kureba inyuma n'imbere yerekana kwimuka hakoreshejwe icyuma cyo hanze cy'inyuma gihujwe n'imigozi yo hagati; (E, F) Imirasire ya X nyuma y'amezi 7 nyuma yo kubagwa igaragaza gukira neza kw'imvune nta kimenyetso cy'uko kwimuka kw'imbere kwananiwe.
Urugero rwa 3. Umurwayi w'umugore, w'imyaka 70, ufite imvune ya periprosthetic hafi y'imashini yo mu ivi. (A, B) Imirasire ya X mbere yo kubagwa igaragaza imvune ya periprosthetic hafi y'imashini yo mu ivi nyuma yo gukomeretsa ivi ryose, hamwe n'imvune ya extra-articular hamwe n'imashini ihamye yo mu ivi; (C, D) Imirasire ya X nyuma yo kubagwa igaragaza imvune ikoresheje icyuma cyo hanze gifatanye n'imigozi yo hagati binyuze mu buryo bwa extra-articular; (E, F) Imirasire ya X ikurikiranwa nyuma y'amezi 6 nyuma yo kubagwa igaragaza gukira neza kw'imvune, hamwe n'imashini yo imbere mu ivi.
Igihe cyo kohereza: Mutarama 10-2024
