Ibizavurwa bivura biterwa no guhinduranya anatomique yumutwe wavunitse, gukosorwa gukomeye kuvunika, kubungabunga ingirabuzimafatizo nziza no gukora imyitozo hakiri kare.
Anatomy
Uwitekakure ya humerusigabanijwemo inkingi yo hagati hamwe n'inkingi ikurikira (Ishusho 1).
Igishushanyo 1 Indurwe ya kure igizwe ninkingi yo hagati kandi ikurikira
Inkingi yo hagati ikubiyemo igice cyo hagati ya epiphysis ya humeral, epicondyle yo hagati yigitereko hamwe na condyle yo hagati harimo na glide ya humeral.
Inkingi yinyuma igizwe nigice cyuruhande rwa epiphysis ya humeral, epicondyle yo hanze yigitereko hamwe na condyle yo hanze yigitereko harimo na tuberosity.
Hagati yinkingi zombi zegeranye ni imbere ya coronoid fossa na fossa yinyuma.
Uburyo bwo gukomeretsa
Supracondylar kuvunika kw'igituba akenshi biterwa no kugwa ahantu hirengeye.
Abarwayi bakiri bato bafite imvune zo mu nda-bakunze guterwa n’imvune zifite ingufu nyinshi, ariko abarwayi bakuze barashobora kugira imvune zo mu nda ziva mu gukomeretsa ingufu nkeya bitewe na osteoporose.
Kwandika
(a) Hariho kuvunika kwa supracondylar, kuvunika kwa condylar no kuvunika intercondylar.
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(c) Kumeneka humeral condylar: ikibanza cyacitse giherereye muri fossa yinyoni.
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Igishushanyo 2 Kwandika AO
Kwandika kuvunika kwa AO humeral (Ishusho 2)
Ubwoko A: kuvunika bidasanzwe.
Ubwoko B: kuvunika birimo ubuso bwa arctular (kuvunika inkingi imwe).
Ubwoko C: gutandukanya byuzuye hejuru ya arctular yubuso bwa kure nigitereko cya humeral (kuvunika bicolumnar).
Buri bwoko bwongeye kugabanywamo amoko 3 ukurikije urwego rwo gutangira kuvunika, (1 ~ 3 subtypes hamwe no kwiyongera kurwego rwo gutangira muri urwo rutonde).
Igishushanyo3 Kwandika Riseborough-Radin
Riseborough-Radin yandika imvune ya intercondylar ya humerus (ubwoko bwose burimo igice cya supracondylar cya humerus)
Ubwoko I: kuvunika nta kwimura hagati yigituba cya humeral na talus.
Ubwoko bwa II: kuvunika intercondylar ya humerus hamwe no kwimura misa yamenetse ya condyle idafite ubumuga bwo kuzunguruka.
Ubwoko bwa III: kuvunika intercondylar ya humerus hamwe no kwimura igice cyacitse cya condyle hamwe nubumuga bwo kuzunguruka.
Ubwoko bwa IV: kuvunika gukabije gukabije k'ubuso bwa arctular ya kimwe cyangwa byombi (Ishusho 3).
Igishushanyo 4 Ubwoko bwa I humeral tuberosity kuvunika
Igicapo 5 Gutera kuvunika igituntu
Ivunika ryigituba cyimyanya ndangagitsina: gukomeretsa gukata kwimitsi ya kure
Ubwoko bwa I: kuvunika kw'igituba cyose cyimyanya ndangagitsina harimo inkombe ya talus ya humeral (kuvunika Hahn-Steinthal) (Ishusho 4).
Ubwoko bwa II: kuvunika kwa subchondral ya articular artilage ya tuberosity ya humeral (kuvunika Kocher-Lorenz).
Ubwoko bwa III: kuvunika gukabije k'igituntu cyo mu nda (Ishusho 5).
Kuvura bidakorewe
Uburyo budasanzwe bwo kuvura kuvunika kure ya humeral bifite uruhare ruto.Intego yo kuvura idakorwa ni: kugenda hakiri kare kugirango wirinde gukomera;abarwayi bageze mu zabukuru, cyane cyane barwaye indwara nyinshi zivanze, bagomba kuvurwa hakoreshejwe uburyo bworoshye bwo gutandukanya ingingo yinkokora muri 60 ° ya flexion kumayinga 2-3, hanyuma hagakurikiraho ibikorwa byoroheje.
Kuvura
Intego yo kuvura ni ukugarura ububabare butagira ububabare bwimikorere yingingo (30 ° yo kwagura inkokora, 130 ° yo guhindagurika kwinkokora, 50 ° yo kuzunguruka imbere ninyuma);gukomera imbere kandi gukomeye imbere kuvunika bituma itangira imyitozo yinkokora ikora nyuma yo gukira igikomere cyuruhu;ibyapa bibiri byo gukosora byimyanya ndangagitsina birimo: hagati na inyuma yinyuma ya plaque ikosora, cyangwahagati no kuruhandeibyapa bibiri.
Uburyo bwo kubaga
(a) Umurwayi ashyirwa mumwanya wo hejuru ugana umurongo ushyizwe munsi yingingo zanduye.
kumenya no kurinda imitsi ya median na radial idakorana.
Inkokora yinyuma irashobora kwagurwa kubagwa: ulnar hawk osteotomy cyangwa triceps retraction kugirango igaragaze kuvunika cyane.
ulnar hawkeye osteotomy: guhura bihagije, cyane cyane kumeneka yagabanutse hejuru yubuso.Ariko, kuvunika kutari ubumwe bikunze kugaragara kurubuga rwa osteotomy.Igipimo cyo kuvunika kutari ubumwe cyaragabanutse cyane hamwe na ulnar hawk osteotomy (herringbone osteotomy) hamwe na transtension band wire cyangwa plaque.
Kwikuramo kwa Triceps birashobora gukoreshwa kumenwa ya kure ya humeral trifold yamenetse hamwe no guhurira hamwe, kandi kwaguka kwerekanwa rya humeral birashobora guca no kwerekana ulnar hawk kuri cm 1.
Byagaragaye ko amasahani abiri ashobora gushyirwaho mu buryo butandukanye cyangwa mu buryo bubangikanye, bitewe n'ubwoko bwavunitse aho amasahani agomba gushyirwa.
Kuvunika hejuru yubuso bigomba gusubizwa hejuru yubuso kandi bigashyirwa kumurongo wa humeral.
Igicapo 6 Nyuma yimikorere yimbere yimbere yo kuvunika inkokora
Gukosora by'agateganyo agace kavunitse byakozwe hakoreshejwe insinga ya K, nyuma ya plaque ya mm 3,5 yo gukata amashanyarazi yagabanijwe kumiterere yisahani ukurikije imiterere iri inyuma yinkingi yinyuma ya humerus ya kure, kandi plaque yo kwiyubaka ya mm 3,5 yari gutondekanya kumiterere yinkingi yo hagati, kugirango impande zombi zisahani zihure hejuru yamagufwa (icyapa gishya cyerekana imbere gishobora koroshya inzira.) (Ishusho 6).
Witondere kudakosora agace kavunitse kavunitse hamwe nuduce twose twa cortical cortical screw hamwe numuvuduko uva hagati ugana kuruhande.
epiphysis-humerus urubuga rwimuka igihumbi ningirakamaro kugirango twirinde kudahuza kuvunika.
gutanga amagufwa yuzuza ahabigenewe inenge yamagufa, ushyire mubikorwa bya iliac cancellous amagufwa kugirango wuzuze inenge yamenetse: inkingi yo hagati, hejuru ya arctular hamwe ninkingi yuruhande, guhuza amagufwa ya kanseri kuruhande hamwe na periosteum idahwitse hamwe nubusembwa bwamagufwa kuri epiphysis.
Ibuka ingingo z'ingenzi zo gukosora.
Gukosora ibice byavunitse bya kure hamwe na byinshiimigozibishoboka.
gukosora ibice byinshi byacitsemo ibice bishoboka hamwe ninsinga zambukiranya hagati kugeza kuruhande.
Isahani yicyuma igomba gushyirwa kumpande hagati no kuruhande rwa humerus ya kure.
Uburyo bwo kuvura: Inkokora zose
Ku barwayi bafite imvune zikomeye cyangwa osteoporose, arthroplasti yinkokora yose irashobora kugarura inkokora hamwe no gukora amaboko nyuma yabarwayi badakenewe cyane;tekinike yo kubaga isa na arthroplasti yuzuye kugirango ihindagurika ryangirika ryinkokora.
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(2) Incamake y'ibikorwa byo kubaga.
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Imbere yumutima wa ulnar.
kwinjira unyuze kumpande zombi za triceps kugirango ukureho igufwa ryacitsemo ibice (ingingo yingenzi: ntugabanye guhagarara kwa triceps kurubuga rwa ulnar hawk).
Indurwe ya kure yose harimo na fossa ya hawk irashobora gukurwaho hamwe na prothèse igashyirwaho, itazasiga urukurikirane rukomeye niba hiyongereyeho cm 1 kugeza kuri cm 2
Guhindura imitekerereze yimbere yimitsi ya triceps mugihe gikwiranye na prothèse ya humeral nyuma yo gukuramo condyle.
Gucukumbura hejuru yisonga ya ulnar eminence kugirango yemererwe kubona neza no kwishyiriraho ibice bya prothèse ya ulnar (Ishusho 7).
Igicapo 7 Inkokora
Kuvura nyuma yo kubagwa
Gutandukana nyuma yibice byinyuma yinyuma yinkokora bigomba kuvaho igihe igikomere cyuruhu rwumurwayi kimaze gukira, kandi hagomba gutangira imyitozo ngororamubiri ikora ifashijwe;ingingo y'inkokora igomba gukosorwa igihe kinini gihagije nyuma yo gusimburana hamwe kugirango iteze igikomere cyuruhu (ingingo yinkokora irashobora gukosorwa mumwanya ugororotse mugihe cibyumweru 2 nyuma yo kubagwa kugirango ifashe kubona imikorere myiza yo kwagura);kuvanaho ibintu byakuweho ubu bikoreshwa mubuvuzi kugirango byorohereze imyitozo yimyitozo mugihe ishobora gukurwaho kenshi kugirango irinde neza ingingo zanduye;imyitozo ngororamubiri ikora itangira ibyumweru 6-8 nyuma yuko igikomere cyuruhu kimaze gukira.
Kuvura nyuma yo kubagwa
Gutandukana nyuma yibice byinyuma yinyuma yinkokora bigomba kuvaho igihe igikomere cyuruhu rwumurwayi kimaze gukira, kandi hagomba gutangira imyitozo ngororamubiri ikora ifashijwe;ingingo y'inkokora igomba gukosorwa igihe kinini gihagije nyuma yo gusimburana hamwe kugirango iteze igikomere cyuruhu (ingingo yinkokora irashobora gukosorwa mumwanya ugororotse mugihe cibyumweru 2 nyuma yo kubagwa kugirango ifashe kubona imikorere myiza yo kwagura);kuvanaho ibintu byakuweho ubu bikoreshwa mubuvuzi kugirango byorohereze imyitozo yimyitozo mugihe ishobora gukurwaho kenshi kugirango irinde neza ingingo zanduye;imyitozo ngororamubiri ikora itangira ibyumweru 6-8 nyuma yuko igikomere cyuruhu kimaze gukira.
Igihe cyo kohereza: Ukuboza-03-2022
