Uburyo bwo kuvura imvune zo mu gice cya kure cy'umugongo

Umusaruro w'ubuvuzi uterwa no guhindura imiterere y'umubiri w'ingingo yavunitse, gufata neza ingingo yavunitse, kubungabunga uburyo umubiri woroshye utwikiriye neza ndetse no gukora imyitozo ngororamubiri hakiri kare.

Imiterere y'umubiri

Itsindauruhu rwo mu kirengeigabanyijemo inkingi yo hagati n'inkingi yo ku ruhande (Ishusho ya 1).

Ishusho ya 1 Ipfundo rya kure rigizwe n'inkingi yo hagati n'iy'inyuma

Igice cyo hagati kirimo igice cyo hagati cya epiphysis ya humeral, epicondyle yo hagati ya humerus n'igice cyo hagati cya humeral condyle harimo na humeral glide.

Inkingi yo ku ruhande igizwe n'igice cyo ku ruhande cya epiphysis y'umugongo, epicondyle yo hanze ya humerus n'inyuma ya humerus harimo n'ikibyimba cya humeral.

Hagati y'inkingi ebyiri zo ku ruhande hari fossa y'imbere ya coronoid n'inyuma ya humeral fossa.

Uburyo bw'imvune

Gucika kw'inyuma y'umugongo (supracondylar humerus) akenshi biterwa no kugwa uturutse ahantu hirengeye.

Abarwayi bakiri bato bafite imvune zo mu gice cy’imbere cy’ingingo akenshi ziterwa n’imvune zikoresha imbaraga nyinshi, ariko abarwayi bakuze bashobora kugira imvune zo mu gice cy’imbere cy’ingingo zikomoka ku mvune zikoresha imbaraga nke zikomoka ku ndwara ya osteoporosis.

Kwandika

(a) Hari imvune zo mu gice cyo hejuru cy'umugongo, imvune zo mu gice cyo hagati cy'umugongo n'imvune zo mu gice cyo hagati cy'umugongo.

(b)Imvune zo mu gice cya Supracondylar cy'umugongo: aho imvune iherereye hejuru y'umugongo w'igisiga.

(c) Kwangirika kwa condylar ya Humeral: aho yavunitse haba mu gice cy'umukungugu.

(d) kuvunika kwa humerus hagati y'imitsi: aho humerus yavunitse ni hagati y'imitsi ibiri ya kure y'imitsi.

Ishusho ya 2 AO yandika

Ubwoko bwa AO humeral fracture (Ishusho ya 2)

Ubwoko bwa A: kuvunika kw'ingingo zidasanzwe.

Ubwoko bwa B: kuvunika ku gice cy'imbere cy'ingingo (kuvunika kw'inkingi imwe).

Ubwoko bwa C: gutandukana burundu kw'ubuso bw'ingingo ya humerus iri kure n'igitereko cya humerus (gucikamo kabiri).

Buri bwoko bugabanyijemo ubwoko butatu hakurikijwe urwego rw'ihungabana ry'ihungabana, (ubwoko 1 ~ 3 bufite urwego rw'ihungabana ryiyongera muri urwo rutonde).

Ishusho ya 3 Riseborough-Radin yandika

Uburyo bwa Riseborough-Radin bwo gushushanya imvune hagati y'imitsi yo mu bwoko bwa humerus (ubwoko bwose burimo igice cya supracondylar cya humerus)

Ubwoko bwa I: kuvunika nta kwimuka hagati y'ikibyimba cya humeral na talus.

Ubwoko bwa II: kuvunika kwa humerus hagati y'imitsi hamwe no kwimura uburemere bw'imitsi ya condyle nta guhindagurika kw'ishusho.

Ubwoko bwa III: kuvunika kwa humerus hagati y'inyuma hamwe no kwimura igice cy'inyuma cy'inyuma hamwe n'ubumuga bwo kuzenguruka.

Ubwoko bwa IV: kuvunika gukomeye kw'ubuso bw'ingingo bwa condyle imwe cyangwa zombi (Ishusho ya 3).

Ishusho ya 4 Ubwoko bwa I bwa humeral tuberosity fracture

Ishusho ya 5 Uburyo bwo kuvunika kw'ibibyimba bya Humeral

Gucika kw'ikibyimba cy'umugongo: gukomeretsa igice cy'umugongo cya kure

Ubwoko bwa I: kuvunika kw'ikibyimba cyose cya humeral harimo n'inkombe z'uruhande rwa talus ya humeral (vunika rya Hahn-Steinthal) (Ishusho ya 4).

Ubwoko bwa II: kuvunika kwa subchondral kw'agatsima k'ingingo k'ikibembe cya humeral (Kocher-Lorenz fracture).

Ubwoko bwa III: kuvunika kw'ikibyimba cya humeral (Ishusho ya 5).

Kuvura abantu badakoresheje ubuvuzi

Uburyo bwo kuvura ingingo zidakomeretse mu gice cyo hagati cy’ingingo (distal humeral vune) bufite uruhare ruto. Intego yo kuvura ingingo zidakomeretse ni uku: kugenda mu ngingo hakiri kare kugira ngo hirindwe gukomera kw'ingingo; abarwayi bageze mu za bukuru, bakunze kurwara indwara nyinshi, bagomba kuvurwa hakoreshejwe uburyo bworoshye bwo gukata ingingo mu bushyuhe bwa 60° mu gihe cy'ibyumweru 2-3, hanyuma hagakurikiraho gukora ibikorwa byoroheje.

Ubuvuzi bwo kubaga

Intego y'ubuvuzi ni ukugarura imikorere y'ingingo idafite ububabare (30° yo kwagura inkokora, 130° yo guhindukira inkokora, 50° yo kuzenguruka imbere n'inyuma); gufata neza imbere kw'ivunitse bituma imyitozo ngororamubiri y'inkokora itangira nyuma yo gukira kw'ibikomere by'uruhu; gufata amaguru abiri y'inyuma y'umugongo harimo: gufata amaguru abiri y'inyuma n'inyuma y'umugongo, cyangwahagati n'inyumagufunga ibyuma bibiri.

Uburyo bwo kubaga

(a) Umurwayi ashyirwa mu mwanya werekeza hejuru, agatambaro gashyirwa munsi y'urugingo rwafashwe.

kumenya no kurinda imitsi yo hagati n'iyo mu gihe cyo kubagwa.

Inkokora y'inyuma ishobora kongerwaho uburyo bwo kubaga: gukorerwa osteotomy ya ulnar hawk cyangwa gukorerwa triceps retraction kugira ngo hagaragare imvune yimbitse y'ingingo.

Gucukura amenyo ya ulnar hawkeye: uburyo bwo kugaragara neza, cyane cyane ku mvune zacitse ku gice cy'inyuma cy'ingingo. Ariko, imvune idakwirakwira ikunze kubaho aho icukura amenyo. Igipimo cyo kucukura amenyo adakwirakwira cyagabanutse cyane bitewe n'uburyo bwo kuvura amenyo ya ulnar hawk (herringbone osteotomy) no gufunga icyuma gifunga amaguru cyangwa plaque.

Uburyo bwo gukurura ingingo bushobora gukoreshwa ku ngingo zavunitse mu gice cya kure cy’inyuma cy’inyuma, kandi uburyo bwo gukurura ingingo bushobora guca umutwe w’inyuma w’inyuma ukawushyira ahagaragara kuri cm 1.

Byagaragaye ko amasahani abiri ashobora gushyirwa mu buryo bugororotse cyangwa mu buryo buteganye, bitewe n'ubwoko bw'aho amasahani agomba gushyirwa.

Amasasu yo ku buso bw'ingingo agomba kugarurwa ku buso burambuye bw'ingingo hanyuma agashyirwa ku ruti rw'inyuma.

Ishusho ya 6 Gufata imbere mu nkokora nyuma yo kubagwa

Gufata by'agateganyo agace k'ivunika byakozwe hakoreshejwe insinga ya K, hanyuma agace k'imbaraga ka mm 3.5 gashyirwa ku ishusho y'agace hakurikijwe imiterere iri inyuma y'inkingi yo ku ruhande rwa humerus iri kure, naho agace k'isana ka mm 3.5 gashyirwa ku ishusho y'inkingi yo hagati, kugira ngo impande zombi z'agace k'inyuma zihuze n'ubuso bw'amagufwa (agace gashya k'ishusho gashobora koroshya inzira.) (Ishusho ya 6).

Witondere kudashyiraho agace k'agace k'ubuso bw'ingingo gafite imigozi yose hamwe n'igitutu kiva hagati kugeza ku ruhande rw'inyuma.

Ahantu ho kwimuka kw'ibihumbi bya epiphysis-humerus ni ingenzi kugira ngo hirindwe ko aho umuntu yavunitse hatabaho.

Gushyiramo igufwa ryuzuye aho ikibazo cy’amagufwa cyabereye, gukoresha igufwa rya Iliac cancellous grafts kugira ngo kuzuza ikibazo cyo gucika kw’amagufwa: inkingi yo hagati, ubuso bw’ingingo n’inkingi yo ku ruhande, gushyiramo igufwa rya cancellous ku ruhande hamwe n’igufwa rya periosteum ritameze neza n’igufwa rya compression defect kuri epiphysis.

Wibuke ingingo z'ingenzi zo gushimangira.

Gufata igice cy'aho igice cyacitse kiri kure gifite umubare uhagijevisuko bishoboka kose.

gushyiraho ibice byinshi bishoboka byacitsemo ibice hakoreshejwe imisumari inyura hagati igana ku ruhande.

Amasahani y'icyuma agomba gushyirwa ku mpande zo hagati n'izo ku mpande z'umugongo wa kure.

Uburyo bwo kuvura: Total elbow arthroplasty

Ku barwayi bafite imvune zikomeye cyangwa indwara yo kuvunika kw'amagufwa, ubuvuzi bwo kuvura inkokora bushobora gusubiza ingingo z'inkokora zikora neza ndetse n'imikorere y'amaboko nyuma y'abarwayi badasaba byinshi; uburyo bwo kubaga busa na ubuvuzi bwo kuvura inkokora butuma ingingo z'inkokora zihinduka.

(1) gukoresha icyuma kirekire cyo mu bwoko bwa stem kugira ngo hirindwe ko imvune yo hafi y'igitereko yangirika.

(2) Incamake y'ibikorwa byo kubaga.

(a) Ubu buryo bukorwa hakoreshejwe uburyo bwo gukata inkokora inyuma, hamwe n'intambwe zisa n'izikoreshwa mu gukata no gufunga imbere mu nda (ORIF).

Gushyira imbere umutsi wo mu gituza.

koresha impande zombi za triceps kugira ngo ukureho igufwa ryacitsemo ibice (ingingo y'ingenzi: ntugace aho triceps ihagarara aho ulnar hawk iherereye).

Inyamaswa zose zo mu bwoko bwa hawk fossa zishobora gukurwaho no gushyirwaho icyuma gipima, kitazasiga izindi ngingo zikomeye niba hakuweho indi santimetero I kugeza kuri 2.

Guhindura uburyo imitsi ya triceps ikora mu gihe cyo gushyiramo amenyo nyuma yo gukata amenyo ya humeral condyle.

Gukata umutwe w'agace k'imbere k'urugingo kugira ngo byorohereze kubona no gushyiraho igice cy'inyongera cya ulnar (Ishusho ya 7).

Ishusho ya 7 Arthroplasty yo mu gituza

Ubuvuzi nyuma yo kubagwa

Nyuma yo kubagwa, igice cy'inyuma cy'inkokora kigomba gukurwaho igihe igikomere cy'uruhu rw'umurwayi kimaze gukira, kandi hagatangira imyitozo ngororamubiri ikora neza hifashishijwe ubufasha; igice cy'inkokora kigomba gukosorwa igihe gihagije nyuma yo gusimbuza ingingo zose kugira ngo hakorwe neza gukira kw'ibikomere by'uruhu (igice cy'inkokora gishobora gukosorwa mu mwanya ugororotse mu gihe cy'ibyumweru 2 nyuma yo kubagwa kugira ngo bifashe kugira imikorere myiza yo kwagura); igice cy'inkokora gikurwaho ubu gikoreshwa cyane mu buvuzi kugira ngo cyorohereze imyitozo ngororamubiri itandukanye iyo gishobora gukurwaho kenshi kugira ngo kirinde neza urugingo rwangiritse; imyitozo ngororamubiri ikora neza akenshi itangira nyuma y'ibyumweru 6-8 nyuma y'uko igikomere cy'uruhu gikize burundu.

Ubuvuzi nyuma yo kubagwa

Nyuma yo kubagwa, igice cy'inyuma cy'inkokora kigomba gukurwaho igihe igikomere cy'uruhu rw'umurwayi kimaze gukira, kandi hagatangira imyitozo ngororamubiri ikora neza hifashishijwe ubufasha; igice cy'inkokora kigomba gukosorwa igihe gihagije nyuma yo gusimbuza ingingo zose kugira ngo hakorwe neza gukira kw'ibikomere by'uruhu (igice cy'inkokora gishobora gukosorwa mu mwanya ugororotse mu gihe cy'ibyumweru 2 nyuma yo kubagwa kugira ngo bifashe kugira imikorere myiza yo kwagura); igice cy'inkokora gikurwaho ubu gikoreshwa cyane mu buvuzi kugira ngo cyorohereze imyitozo ngororamubiri itandukanye iyo gishobora gukurwaho kenshi kugira ngo kirinde neza urugingo rwangiritse; imyitozo ngororamubiri ikora neza akenshi itangira nyuma y'ibyumweru 6-8 nyuma y'uko igikomere cy'uruhu gikize burundu.