I.Tekinike yo kuzuza amagufwa ya sima
Uburyo bwo kuzuza amagufwa ya sima burakwiriye kubarwayi bafite AORI ntoya yo mu bwoko bwa I bafite amagufwa nibikorwa bidakora cyane.
Tekinoroji yoroshye ya sima ya sima isaba ubuhanga bwogusukura neza inenge yamagufwa, kandi sima yamagufa yuzuza inenge yamagufwa mugihe cyumukate, kugirango ishobore kwinjizwa mu cyuho kiri mu mfuruka yinenge uko bishoboka kwose, bityo bigerweho neza cyane hamwe nu magufwa yakiriye.
Uburyo bwihariye bwaBimweCement +Stekinoroji y'abakozi ni ugusukura neza inenge yamagufwa, hanyuma ugakosora umugozi kumagufwa yakiriye, kandi witondere kutareka capa ya screw irenga igufwa ryamagufwa ya platifomu nyuma ya osteotomy; hanyuma uvange sima yamagufa, wuzuze inenge yamagufa murwego rwumukate, hanyuma uzenguruke umugozi. Ritter MA n'abandi. yakoresheje ubu buryo kugirango yongere yubake inenge yamagufwa ya tibial plateau, kandi ubunini bwinenge bwageze kuri 9mm, kandi ntihabayeho kugabanuka nyuma yimyaka 3 nyuma yo kubagwa. Ubuhanga bwo kuzuza amagufwa ya sima bukuraho amagufwa make, hanyuma bukoresha ivugurura rya prothèse isanzwe, bityo bikagabanya amafaranga yo kwivuza bitewe no gukoresha prothèse ivugurura, ifite agaciro kanini.
Uburyo bwihariye bwa sima ya sima + tekinoroji ni ugusukura neza inenge yamagufwa, gutunganya umugozi kumagufwa yakiriye, kandi ukitondera ko capage ya screw itagomba kurenza igufwa ryamagufwa ya platifomu nyuma ya osteotomy; hanyuma uvange sima yamagufa, wuzuze inenge yamagufa murwego rwumukate, hanyuma uzenguruke umugozi. Ritter MA n'abandi. yakoresheje ubu buryo kugirango yongere yubake inenge ya tibial plateau amagufwa, kandi ubunini bwinenge bwageze kuri 9mm, kandi ntihabayeho kugabanuka nyuma yimyaka 3 nyuma yo kubagwa. Tekinoroji yuzuza amagufwa ya sima ikuraho amagufwa make, hanyuma ikoresha prothèse isanzwe, bityo bikagabanya ikiguzi cyo kuvura bitewe no gukoresha prothèse ivugurura, ifite agaciro keza (IshushoI-1).
IgishushanyoI-1Amagufa ya sima yuzuza no gushimangira imigozi
II.Uburyo bwo guhuza amagufwa
Gufata amagufwa yogusenyera birashobora gukoreshwa mugusana inenge zuzuye cyangwa zidashyizwemo mugikorwa cyo kubaga ivi. Irakwiriye cyane cyane kongera kubaka inenge ya AROI I kugeza III. Mu kubaga ubugororangingo, kubera ko ingano n’urwego rw’inenge zamagufwa muri rusange bikabije, ubwinshi bwamagufwa ya autologique yabonetse ni mato kandi ahanini amagufwa ya sclerotique iyo prothèse na sima yamagufwa byavanyweho mugihe cyo kubagwa kugirango bibungabunge amagufwa. Kubwibyo, granular allogeneic amagufwa akoreshwa mugukomeretsa amagufwa mugihe cyo kubagwa.
Ibyiza byo kwikuramo amagufwa ni: kugumana amagufwa yamagufwa yakiriye; gusana inenge nini yoroshye cyangwa igoye.
Ibibi by'ikoranabuhanga ni: imikorere itwara igihe; tekinoroji yo kwiyubaka irasaba (cyane cyane iyo ukoresheje akazu ka MESH); hari amahirwe yo kwandura indwara.
Kwiyoroshya byoroshye amagufwa:Kwiyoroshya byoroheje amagufwa akoreshwa kenshi muburyo bwuzuye amagufwa. Itandukaniro riri hagati yo guhunika amagufwa no guhuza amagufwa yubatswe ni uko ibikoresho byo mu magufa ya granular yakozwe no guhunika amagufwa bishobora kwihuta kandi byuzuye.
Agasanduku k'icyuma gashya + guhunika amagufwa:Ubusembwa bwamagufwa adakubiyemo ubusanzwe busaba kwiyubaka ukoresheje kashe ya mesh kugirango ushiremo amagufwa ya kanseri. Kwubaka femur mubisanzwe biragoye kuruta kwiyubaka tibia. X-imirasire yerekana ko guhuza amagufwa no gushushanya amagufwa yibikoresho byangiritse birangira buhoro buhoro (IshushoII-1-1, IshushoII-1-2).
IgishushanyoII-1-1Mesh cage imbere yo kwikuramo amagufwa kugirango asane inenge ya tibial. Imikoranire; B Nyuma yo gukorerwa X-ray
Igishushanyoe II-1-2Gusana inenge ya femorale na tibia amagufwa hamwe na titanium mesh imbere yo kwikuramo amagufwa. Imikoranire; B Nyuma yo gukorerwa X-ray
Mugihe cyo gusubiramo ivi arthroplasti, amagufwa ya allogeneic yubatswe ahanini akoreshwa mukubaka inenge ya AORI ya II cyangwa III. Usibye kuba afite ubuhanga buhebuje bwo kubaga n'uburambe bukomeye mu gusimbuza amavi bigoye, umuganga agomba no gukora gahunda yitonze kandi irambuye mbere yo gutangira. Amagufwa yubatswe arashobora gukoreshwa mugukosora inenge yamagufwa no kongera amagufwa.
Ibyiza by'ikoranabuhanga birimo: Irashobora gukorwa mu bunini no mu buryo ubwo aribwo bwose kugira ngo ihuze n'inenge z'amagufwa atandukanye ya geometrike; ifite ingaruka nziza zunganira kuri prothèse yo gusubiramo; hamwe nigihe kirekire cyibinyabuzima bishobora kugerwaho hagati yamagufwa ya allogeneic namagufwa yakira.
Ibibi birimo: igihe kinini cyo gukora mugihe ukata amagufwa ya allogeneque; amasoko make yamagufwa ya allogeneic; ibyago byo kudahuza hamwe no gutinda ubumwe bitewe nimpamvu nka resorption yamagufa no kuvunika umunaniro mbere yuko gahunda yo guhuza amagufwa irangira; ibibazo byo kwinjiza no kwanduza ibikoresho byatewe; ubushobozi bwo kwandura indwara; no kudahagarara kwambere kwamagufwa ya allogeneic. Amagufwa ya Allogeneic yubatswe asarurwa kuva femur ya kure, tibia yegeranye, cyangwa umutwe wumugore. Niba ibikoresho byo guterwa ari binini, revascularization yuzuye ntabwo ibaho. Umutwe wa Allogeneic femorale urashobora gukoreshwa mugusana femorale condyle na tibial plateau yamagufwa yamagufwa, cyane cyane mugukosora inenge nini yo mu bwoko bwa cavity yo mu bwoko bwa cavity, kandi igashyirwaho nogukanda nyuma yo gutema no gushiraho. Ibisubizo byambere byubuvuzi byo gukoresha amagufwa ya allogeneic kugirango asane inenge yamagufa yerekanaga umuvuduko mwinshi wo gukiza amagufwa yatewe (IshushoII-1-3, IshushoII-1-4).
IgishushanyoII-1-3Gusana inenge yamagufwa yumugore hamwe na allogeneic femorale imitwe yumutwe
IgishushanyoII-1-4Gusana inenge yamagufwa ya tibial hamwe na allogeneic femorale umutwe wamagufwa
III.Ikoranabuhanga ryuzuza ibyuma
Ikoranabuhanga rya modular Ikoranabuhanga rya modular risobanura ko ibyuma byuzuza ibyuma bishobora guteranyirizwa hamwe na prothèse hamwe nigiti cyimbere. Abuzuza barimo moderi zitandukanye kugirango borohereze kwiyubaka inenge zamagufa yubunini butandukanye.
Ibyuma Prosthetic Kanama：Icyuma cyerekana icyuma gikwiranye cyane cyane na AORI ubwoko bwa II butagira amagufwa afite ubugari bugera kuri cm 2.Gukoresha ibyuma kugirango usane inenge yamagufwa biroroshye, byoroshye, kandi bifite ingaruka zamavuriro.
Icyogajuru gishobora kuba cyoroshye cyangwa gikomeye, kandi imiterere yabyo irimo imigozi cyangwa uduce. Icyogajuru gishobora guhuzwa na prothèse ihuriweho n'imigozi cyangwa igashyirwaho na sima yamagufa. Bamwe mu bahanga bemeza ko gutunganya amagufwa ya sima bishobora kwirinda kwambara hagati y’ibyuma kandi bagasaba ko amagufa yatunganywa. Intiti zimwe nazo zishyigikira uburyo bwo gukoresha sima yamagufa mbere hanyuma igashimangirwa ninshuro hagati ya spacer na protezi. Ubusembwa bwumugore bukunze kugaragara mubice byinyuma no kure ya condyle femorale, kubwibyo icyuma cyicyuma gishyirwa mubice byinyuma kandi byitaruye bya femorale. Kubireba amagufwa ya tibial, udusimba cyangwa uduce birashobora gutoranywa kugirango twiyubake kugirango duhuze nuburyo butandukanye. Ubuvanganzo buvuga ko ibiciro byiza kandi byiza biri hejuru ya 84% kugeza 98%.
Inzitizi zimeze nk'imigozi zikoreshwa mugihe inenge yamagufwa iba imeze nkumugozi, ishobora kubika amagufwa menshi yakira. Ubu buryo busaba osteotomy neza kugirango ubuso bwa osteotomy buhuze na blok. Usibye guhangayika, hariho imbaraga zo gukata hagati yimikoranire. Kubwibyo, inguni ya wedge ntigomba kurenga 15 °. Ugereranije nuduce tumeze nk'umugozi, ibyuma bya silindrike bifite ibyuma byo kongera ubwinshi bwa osteotomy, ariko kubaga biroroshye kandi byoroshye, kandi ingaruka za mashini ziri hafi yubusanzwe (III-1-1A, B).
IgishushanyoIII-1-1Icyogajuru cyuma: Umwanya umeze nk'umugozi wo gusana inenge ya tibial; B inkingi imeze nkibikoresho byo gusana inenge
Kuberako icyogajuru cyakozwe muburyo butandukanye no mubunini, bikoreshwa cyane mubutagira amagufwa adafite inenge hamwe nudusimba twamagufwa yuburyo butandukanye, kandi bitanga uburyo bwiza bwambere bwo gutekinika. Nyamara, ubushakashatsi bwigihe kirekire bwerekanye ko icyogajuru cyananirana kubera gukingira stress. Ugereranije nubukorikori bwamagufwa, niba icyogajuru cyananiranye kandi kigomba gusubirwamo, bizatera inenge nini.
Igihe cyo kohereza: Ukwakira-28-2024
