I.Uburyo bwo kuzuza sima y'amagufwa
Uburyo bwo kuzuza sima y'amagufwa burakwiriye abarwayi bafite inenge ntoya z'amagufwa yo mu bwoko bwa AORI type I kandi badakora cyane.
Ikoranabuhanga ryoroshye rya sima y'amagufwa risaba gusukura neza ikibazo cy'amagufwa, kandi sima y'amagufwa yuzuza ikibazo cy'amagufwa mu gihe cy'ifu, kugira ngo ibashe gushyirwa mu mfuruka z'ikibazo uko bishoboka kose, bityo igere ku buryo ihuza neza n'aho amagufwa aherereye.
Uburyo bwihariye bwoBkimweCigice +SIkoranabuhanga rya crew ni ugusukura neza inenge y'amagufwa, hanyuma ugashyiraho vis ku igufwa ry'umuntu, kandi ukitondera ko umupfundikizo w'amagufwa utarenga ubuso bw'amagufwa nyuma yo kuvurwa; hanyuma ukavange sima y'amagufwa, wuzuze inenge y'amagufwa mu cyiciro cy'ifu, hanyuma upfundike vis. Ritter MA n'abandi bakoresheje ubu buryo bwo kongera kubaka inenge y'amagufwa ya tibial plateau, kandi ubugari bw'iyo vis bwageze kuri mm 9, kandi nta gucika intege kwabayeho nyuma y'imyaka 3. Ikoranabuhanga ryo kuzuza sima y'amagufwa rikuraho amagufwa make, hanyuma rigakoresha uburyo busanzwe bwo kuvugurura vis, bityo bigabanyiriza ikiguzi cyo kuvurwa bitewe no gukoresha vis zivugurura, zifite akamaro kanini.
Uburyo bwihariye bwo gukoresha sima y'amagufwa + screw ni ugusukura neza inenge y'amagufwa, gukosora screw ku igufwa ry'umuntu, no kwitondera ko umupfundikizo w'igufwa utagomba kurenza ubuso bw'amagufwa ku gice cy'ingingo nyuma yo kubagwa; hanyuma uvange sima y'amagufwa, wuzuze inenge y'amagufwa mu cyiciro cy'ifu, hanyuma upfundike screw. Ritter MA n'abandi bakoresheje ubu buryo kugira ngo bongereho ikibazo cy'amagufwa yo mu gice cya tibial, kandi ubugari bw'ikibazo bwageze kuri mm 9, kandi nta kurekura kwabayeho nyuma y'imyaka 3 nyuma yo kubagwa. Ikoranabuhanga ryo kuzuza sima y'amagufwa rikuraho amagufwa make, hanyuma rigakoresha uburyo busanzwe bwo kuvugurura ibyuma, bityo bigabanyiriza ikiguzi cyo kuvura bitewe no gukoresha ibyuma bivugurura ibyuma, bifite akamaro kanini (Ishusho).I-1).
IgishushanyoI-1Gushyira sima mu magufwa no kuyikomeza
II.Uburyo bwo guteranya amagufwa
Gutera amagufwa mu buryo bwo gukanda bishobora gukoreshwa mu gusana inenge z’amagufwa zirimo cyangwa zitarimo izindi mu kubaga ivi. Bikwiriye cyane cyane mu gusana inenge z’amagufwa zo mu bwoko bwa AROI kuva kuri 1 kugeza kuri 3. Mu kubaga ivugururwa, kubera ko ubunini n’ingano y’intege nke z’amagufwa muri rusange biba bikomeye, ingano y’amagufwa ya autologous aboneka ni mato kandi ahanini ni amagufwa afite sclerotic iyo poroteyine na sima by’amagufwa bikuweho mu gihe cyo kubaga kugira ngo hakomeze kubakwa amagufwa. Kubwibyo, amagufwa ya allogeneic akunze gukoreshwa mu gutera amagufwa mu buryo bwo gukanda mu gihe cyo kubaga ivugururwa.
Ibyiza byo guteranya amagufwa mu buryo bukabije ni: kugumana uburemere bw'amagufwa y'igufwa ry'umuntu; gusana inenge nini cyangwa zikomeye z'amagufwa.
Ingaruka mbi z'iri koranabuhanga ni izi: imikorere itwara igihe; ikoranabuhanga ryo gusana rirasaba imbaraga nyinshi (cyane cyane iyo hakoreshejwe utuzu duto tw'ingufu); hari amahirwe yo kwanduzanya indwara.
Guteranya amagufwa mu buryo bworoshye:Guteranya amagufwa mu buryo bworoshye akenshi bikoreshwa ku busembwa bw’amagufwa burimo ibice. Itandukaniro riri hagati yo guteranya amagufwa mu buryo bworoshye no guteranya amagufwa mu buryo bw’imiterere ni uko ibikoresho byo guteranya amagufwa mu buryo bworoshye byakozwe no guteranya amagufwa mu buryo bworoshye bishobora kuvugururwa vuba kandi burundu.
Akazu k'icyuma gafite imisumari + gutera amagufwa mu buryo bwo gukanda:Ubusembwa bw'amagufwa butarimo ubusanzwe busaba kongera kubaka hakoreshejwe utuzu tw'icyuma kugira ngo bashyiremo igufwa ridafite ingirabuzimafatizo. Gusana igufwa ry'umugongo mu buryo busanzwe biragoye kurusha kongera kubaka igufwa ry'umugongo mu gice cy'imbere cy'igufwa. Imirasire ya X-ray igaragaza ko guhuza amagufwa no kurema igufwa ry'ibikoresho byo mu igufwa bigenda birangira buhoro buhoro (IshushoII-1-1, IgishushanyoII-1-2).
IgishushanyoII-1-1Gushyira amagufwa mu kazu k'umuyoboro w'amazi mu gisenge kugira ngo hakorwe ikibazo cy'amagufwa yo mu gituza. Intraoperative; B Nyuma yo kubagwa X-ray
Igishushanyoe II-1-2Gusana ibibazo by'amagufwa yo mu kibuno n'ay'ikibuno hakoreshejwe uburyo bwa titanium mesh internal compression igufwa. Intraoperative; B Nyuma yo kubagwa X-ray
Mu gihe cyo gusubiramo uburyo bwo kuvura indwara y'ivi, igufwa ry’imiterere ya allogeneic rikoreshwa cyane cyane mu kongera kubaga inenge z’amagufwa ya AORI yo mu bwoko bwa II cyangwa III. Uretse kuba afite ubuhanga buhanitse mu kubaga n’uburambe buhambaye mu gusimbuza ivi mu buryo bugoye, umuganga ubaga agomba no gukora gahunda zirambuye kandi zitonze mbere yo kubagwa. Guteranya amagufwa mu miterere y’imiterere y’umubiri bishobora gukoreshwa mu gusana inenge z’amagufwa yo mu gice cy’imbere cy’umubiri no kongera uburemere bw’amagufwa.
Ibyiza by'iri koranabuhanga birimo: Rishobora gukorwa mu bunini n'imiterere iyo ari yo yose kugira ngo rihuze n'ubumuga bw'amagufwa y'imiterere itandukanye ya geometrike; rigira ingaruka nziza ku nganda zivugurura; kandi guhuza ibinyabuzima igihe kirekire bishobora kugerwaho hagati y'igufwa rya allogeneic n'igufwa ry'umuturage.
Ibibi birimo: kumara igihe kinini umuntu akoresha igufwa rya allogeneic; amasoko make y'igufwa rya allogeneic; ibyago byo kudahuza no gutinda guhuza bitewe n'ibintu nko kuzura kw'igufwa no kuvunika umunaniro mbere yuko inzira yo guhuza igufwa irangira; ibibazo byo kwinjiza no kwandura ibikoresho byatewe; ubushobozi bwo kwandura indwara; no kudakomera neza kw'igufwa rya allogeneic. Igufwa ry'imiterere ya allogeneic rikurwa mu gice cyo hagati cy'igufwa, igice cyo hagati cy'igufwa, cyangwa igice cyo hagati cy'igufwa. Niba ibikoresho byo gutera igufwa ari binini, ntabwo bikunze kubaho kuvugurura imitsi y'amaraso. Imitwe ya allogeneic femoral ishobora gukoreshwa mu gusana ubusembwa bw'igufwa rya femoral na tibial plateau, ahanini mu gusana ubusembwa bunini bw'igufwa, kandi bigakosorwa no gushyiramo icyuma nyuma yo gukata no gushushanya. Ibisubizo bya mbere by'ubuvuzi byo gukoresha igufwa ry'imiterere ya allogeneic mu gusana ubusembwa bw'igufwa byagaragaje ko igufwa ryatewe rifite umuvuduko mwinshi wo gukira (Ishusho).II-1-3, IgishushanyoII-1-4).
IgishushanyoII-1-3Gusana ikibazo cy'amagufwa yo mu kibuno hakoreshejwe uburyo bwa allogeneic femoral structure head graft
IgishushanyoII-1-4Gusana ikibazo cy'amagufwa yo mu gice cy'amagufwa hakoreshejwe uburyo bwa allogeneic femoral head graft
III.Ikoranabuhanga ryo kuzuza ibyuma
Ikoranabuhanga rya Modular Ikoranabuhanga rya Modular risobanura ko ibikoresho by'icyuma bishobora guteranywa hakoreshejwe poroteyine n'imiti yo mu nda. Ibi bikoresho birimo imiterere itandukanye kugira ngo byoroshye kongera gusana ubumuga bw'amagufwa y'ingano zitandukanye.
Ibyuma Inyongeramusaruro Inyongera:Imashini igabanya ubukana bw'icyuma ikoreshwa mu gupima ubugari bwa AORI yo mu bwoko bwa II ifite ubugari bwa cm 2.Gukoresha ibice by'icyuma mu gusana inenge z'amagufwa biroroshye, biroroshye, kandi bifite ingaruka nziza ku buvuzi.
Uduce tw'ibyuma dushobora kuba dufite imyenge cyangwa bikomeye, kandi imiterere yatwo irimo uduce duto cyangwa uduce duto. Uduce tw'ibyuma dushobora guhuzwa n'uduce duto tw'inyongera dukoresheje vis cyangwa tugashyirwaho na sima y'amagufwa. Hari abahanga bemeza ko gufunga sima y'amagufwa bishobora kwirinda kwangirika hagati y'ibyuma kandi bagasaba ko gufunga sima y'amagufwa. Hari abahanga kandi bashyigikira uburyo bwo gukoresha sima y'amagufwa mbere na mbere hanyuma bagashimangira ukoresheje vis hagati y'uduce duto n'uduce duto. Ubusembwa bw'abagore bukunze kubaho mu bice by'inyuma n'inyuma bya femoral condyle, bityo uduce duto tw'ibyuma dushyirwa mu bice by'inyuma n'inyuma bya femoral condyle. Ku busembwa bw'amagufwa ya tibial, uduce duto cyangwa uduce duto dushobora gutoranywa kugira ngo twongere duhuze n'imiterere itandukanye y'ubusembwa. Inyandiko zivuga ko igipimo cyiza kandi cyiza kiri hagati ya 84% na 98%.
Uduce dusa n'uduce dukoreshwa iyo ikibazo cy'igufwa gifite ishusho nk'iy'agace, gishobora kubungabunga amagufwa menshi. Ubu buryo busaba osteotomy ihamye kugira ngo ubuso bw'utuce duhuze n'agace. Uretse gukanda cyane, hariho n'imbaraga zo gukata hagati y'aho uhurira. Kubwibyo, inguni y'agace ntigomba kurenza 15°. Ugereranyije n'uduce dusa n'uduce, uduce tw'icyuma dufite uburebure bwo kongera ingano ya osteotomy, ariko kubaga byoroshye kandi byoroshye, kandi ingaruka zabyo ni hafi y'ibisanzwe (III-1-1A, B).
IgishushanyoIII-1-1Uduce duto tw'icyuma: Uduce duto dufite ishusho y'umugozi two gusana inenge y'umugongo; Uduce duto dufite ishusho y'inkingi ya B two gusana inenge y'umugongo
Kubera ko ibyuma bitandukanya ibice bikozwe mu buryo butandukanye n'ingano zitandukanye, bikoreshwa cyane mu busembwa bw'amagufwa butarimo ibice n'ubusembwa bw'amagufwa bw'imiterere itandukanye, kandi bitanga ubushobozi bwo kubikora neza mbere. Ariko, ubushakashatsi bw'igihe kirekire bwagaragaje ko ibyuma bigabanya ibice bigabanya ibice bitagira ubushobozi bwo gukingira stress. Ugereranyije n'ibice bigabanya amagufwa, niba ibyuma bigabanya ibice bitagira ubushobozi bwo gukosora, bizatera ubusembwa bw'amagufwa bunini.
Igihe cyo kohereza: Ukwakira-28-2024
