Uburyo bwo kubaga bwa suprapatellar ni uburyo bwahinduwe bwo kubaga inzara zo mu gice cya tibial intramedullary mu ivi rigufi. Hari ibyiza byinshi, ariko hari n'ibibi, byo gukora inzara zo mu gice cya tibial intramedullary ukoresheje uburyo bwo kuvura inzara zo mu gice cya hallux valgus. Abaganga bamwe bamenyereye gukoresha SPN mu kuvura imvune zose zo mu gice cya tibial uretse imvune zo mu gice cya 1/3 cya tibial.
Ibimenyetso bya SPN ni ibi bikurikira:
1. Gucikamo ibice cyangwa ibice by'igihimba cy'umugongo. 2;
2. kuvunika kw'inyuma y'igituza;
3. kuvunika kw'ikibuno cyangwa ivi hamwe n'aho umuntu ashobora kugorama (urugero: kwangirika kw'ingingo y'ikibuno cyangwa kwivanga, indwara yo kurwara osteoarthritis y'ivi) cyangwa kudashobora gukoza ivi cyangwa ikibuno (urugero: kuvunika kw'inyuma kw'ikibuno, kuvunika kw'inyuma y'ikibuno);
4. kuvunika kw'inyuma y'ikibuno hamwe n'imvune y'uruhu ku mutsi wo mu gice cy'imbere cy'ikibuno;
5. kuvunika kw'igituza ku murwayi ufite igituza kirekire cyane (igice cy'imbere cya gituza akenshi biragoye kubona iyo ukoresheje fluoroscopy iyo uburebure bwa gituza burenze uburebure bwa tripod fluoroscopy ishobora kunyuramo).
Akamaro k'uburyo bwo kuvura inzara zo mu ivi zikoresha uburyo bwa "semi-extended ivi position" mu kuvura indwara zo mu ivi zo mu gice cya "mid-tibial diaphysis" n'izo mu gice cya "distal tibial fractures" ni uko byoroshye kuzihindura no kuzikoresha mu buryo bworoshye. Ubu buryo butuma habaho ubufasha bwiza ku burebure bwose bwa tibi no kugabanya imvune yo mu gice cya "sagittal" bitabaye ngombwa ko ikoreshwa mu kuzikoresha (Ishusho ya 1, 2). Ibi bikuraho ko hakenewe umufasha wabihuguriwe wo gufasha mu buryo bwo kuzikoresha mu ivi.
Ishusho ya 1: Uburyo busanzwe bwo gukoresha tekiniki y'inzara zo mu nda mu buryo bwa infrapatellar: ivi riri mu mwanya woroshye kuri tripod ikoreshwa mu gupima imiterere y'umubiri. Ariko, iyi myanya ishobora kongera imiterere idahwitse y'aho imvune iherereye kandi igasaba ubundi buryo bwo kugabanya imvune kugira ngo imvune igabanuke.
Ishusho ya 2: Mu buryo bunyuranye, aho ivi rihagaze ku gice cyo hejuru cy’urukiramende rw’ifuro byoroshya uburyo bwo guhuza imvune no kuyihindura.
Ubuhanga bwo Kubaga
Ameza / Aho umurwayi ahagaze Umurwayi aryamye aryamye ku gitanda cya fluoroscopic. Hashobora gukorwa gukurura imitsi yo hasi, ariko si ngombwa. Ameza y'imitsi akwiriye cyane imitsi ya suprapatellar approach tibial intramedullary, ariko si ngombwa. Ariko, ibitanda byinshi byo gushyiramo imvune cyangwa ibitanda bya fluoroscopic ntibisabwa kuko bidakwiriye imitsi ya suprapatellar approach tibial intramedullary.
Gupfundikira ikibuno cya kabiri bifasha kugumana impera yo hasi mu mwanya wayo wo kuzunguruka inyuma. Hanyuma hakoreshwa ifuro ridafite umwanda kugira ngo hazamurwe urwego rwafashwe hejuru y'uruhande rwo ku ruhande kugira ngo hakorwe fluoroscopy nyuma y'aho amaguru anyura, kandi imiterere y'ikibuno n'ivi bifasha mu kuyobora inzara n'imitsi yo mu nda. Inguni nziza yo gupfundikira ivi iracyavugwaho rumwe, aho Beltran n'abandi bavuga ko gupfundikira ivi kuri 10° naho Kubiak avuga ko gupfundikira ivi kuri 30°. Abahanga benshi bemeranya ko inguni zo gupfundikira ivi muri izi ntera zemewe.
Ariko, Eastman n'abandi basanze uko inguni yo gupfuka ivi yagendaga yiyongera buhoro buhoro kuva kuri 10° kugeza kuri 50°, ingaruka z'ikibuno cy'ivi ku kwinjira kw'igikoresho mu ruhu zaragabanutse. Kubwibyo, inguni yo gupfuka ivi cyane izafasha mu guhitamo aho inzara zinjira neza mu ruhu no gukosora ubumuga bw'ivi mu gice cya sagittal.
Fluoroscopy
Imashini yo mu bwoko bwa C-arm igomba gushyirwa ku ruhande rw’ameza uvuye ku rugingo rwangiritse, kandi niba umuganga ahagaze ku ruhande rw’ivi ryangiritse, imashini yo mu bwoko bwa C-arm igomba kuba ku mutwe w’imashini yo mu bwoko bwa C-arm kandi hafi. Ibi bituma umuganga n’inzobere mu by’imirasire babona byoroshye imashini yo mu bwoko bwa C-arm, keretse iyo hagomba gushyirwaho umunyururu ufatanye. Nubwo atari itegeko, abanditsi basaba ko ukuboko kwa C kwimurirwa ku ruhande rumwe n’umuganga ku rundi ruhande iyo hagomba gutwarwa vis yo mu bwoko bwa medial interlocking. Ubundi buryo, imashini yo mu bwoko bwa C-arm igomba gushyirwa ku ruhande rwangiritse mu gihe umuganga akora igikorwa ku ruhande rw’uruhande (Ishusho ya 3). Ubu buryo ni bwo bukoreshwa cyane n’abanditsi kuko bwirinda ko umuganga ava ku ruhande rw’uruhande rw’uruhande akajya ku ruhande rw’uruhande iyo atwaye umunyururu ufatanye.
Ishusho ya 3: Umuganga ubaga ahagaze ku ruhande rw’igituza cyafashwe kugira ngo igitambaro cyo hagati gishobore gutwarwa byoroshye. Ikimenyetso kiri imbere y’umuganga ubaga, ku mutwe w’ukuboko kwa C.
Uburyo bwose bwo kureba imbere n'inyuma y'umubiri buboneka hatabayeho kwimura urugingo rwangiritse. Ibi birinda kwimura aho rwavunitse mbere yuko imvune ikomera burundu. Byongeye kandi, amashusho y'uburebure bwose bwa tibia ashobora kuboneka hatabayeho kugonda C-ukuboko hakoreshejwe uburyo bwavuzwe haruguru.
Gukata uruhu Gukata uruhu mu buryo buciriritse no mu buryo burambuye birakwiye. Uburyo bwo gukata inzara bukoreshwa mu gukata inzara mu buryo burambuye bushingiye ku gukoresha icyuma cya cm 3 mu gukata inzara. Inyinshi muri izi nganda zibagwa ni iz'uburebure, ariko zishobora no kuba zihinduranya, nk'uko Dr. Morandi yabisabye, kandi uburyo bwo gukata uruhu bukoreshwa na Dr. Tornetta n'abandi bugaragazwa ku barwayi bafite uburyo bwo gukata inzara mu buryo burambuye, bafite uburyo bwo gukata inzara mu buryo burambuye cyangwa burambuye. Ishusho ya 4 igaragaza uburyo butandukanye bwo gukata inzara.
Ishusho ya 4: Ishusho y'uburyo butandukanye bwo kubaga.1- Uburyo bwo gukata imitsi ya Suprapatellar transpatellar; 2- Uburyo bwo gukata imitsi ya Parapatellar; 3- Uburyo bwo gukata imitsi ya parapatellar buciriritse; 4- Uburyo bwo gukata imitsi ya parapatellar burambye; 5- Uburyo bwo gukata imitsi ya parapatellar buherereye ku ruhande. Uburyo bwo gukata imitsi ya parapatellar bushobora kuba binyuze mu ngingo cyangwa hanze ya bursa y'ingingo.
Kwigaragaza cyane
Uburyo bwo gufunga imitsi yo mu bwoko bwa percutaneous suprapatellar bukorwa ahanini binyuze mu gutandukanya tendon ya quadriceps mu buryo burambuye kugeza igihe icyuho gishobora kwakira inzira y'ibikoresho nka inzara zo mu bwoko bwa intramedullary. Uburyo bwo gufunga imitsi ya parapatellar, bunyura iruhande rw'imitsi ya quadriceps, bushobora kandi kugaragazwa mu buryo bwo gufunga imitsi yo mu bwoko bwa tibial intramedullary. Urushinge rwa trocar rudafite ishingiro na cannula binyuzwa mu ngingo ya patellofemoral witonze, uburyo buyobora cyane cyane aho inzara zo mu bwoko bwa tibial intramedullary zinjira binyuze muri trocar yo mu bwoko bwa femoral. Iyo trocar imaze gushyirwa neza, igomba gushyirwa mu mwanya wayo kugira ngo wirinde kwangirika kwa cartilage y'ivi.
Uburyo bwo gukata bunini bwa transligamentous bushobora gukoreshwa hamwe n'uburyo bwo gukata uruhu bwa hyperextension parapatellar, haba hakoreshejwe uburyo bwo hagati cyangwa ubw'inyuma. Nubwo bamwe mu baganga babaga badakomeza gukata bursa neza mu gihe cyo kubaga, Kubiak n'abandi bemera ko bursa igomba kubikwa neza kandi ingingo zidafite aho zihuriye n'ingingo zigomba kugaragara neza. Mu buryo bw'imitekerereze, ibi bitanga uburinzi bwiza ku ngingo y'ivi kandi bikarinda kwangirika nko kwandura ivi.
Uburyo bwavuzwe haruguru burimo kandi gukuraho hemi-dislocation ya patella, bigabanya umuvuduko wo gukora ku buso bw'ingingo ku rugero runaka. Iyo bigoye gukora isuzuma ry'ingingo za patellofemoral ukoresheje umwobo muto w'ingingo n'igikoresho cyo kwagura ivi gito cyane, abanditsi basaba ko patella ishobora gukurwaho gato binyuze mu gutandukanya imitsi. Ku rundi ruhande, gukata hagati mu buryo bw'ivi birinda kwangirika kw'imitsi ishyigikira, ariko biragoye gusana neza imvune zo mu ivi.
Aho urushinge rwa SPN rwinjirira ni kimwe n'aho infrapatellar approach ikoreshwa. Fluoroscopy y'imbere n'iy'inyuma mu gihe cyo gushyira urushinge ikora neza. Umuganga w'inzobere agomba kugenzura ko urushinge ruyobora rudasunikwa inyuma cyane mu gice cy'imbere cya tibia. Iyo rusunzwe inyuma cyane, rugomba gusubizwa inyuma hifashishijwe umusumari ufunga munsi ya fluoroscopy y'inyuma y'ivi. Byongeye kandi, Eastman n'abandi bemera ko gucukura agapira k'ivi mu mwanya ugororotse bifasha mu kongera gukomereka mu mwanya udasanzwe.
Ibikoresho byo kugabanya
Ibikoresho ngiro byo kugabanya birimo imbaraga zo kugabanya ingingo zifite ingano zitandukanye, ibikoresho byo guterura imyenge, ibikoresho byo gufata inyuma, n'ibikoresho byo gufata imbere mu gufata ibice bito byavunitse hakoreshejwe icyuma kimwe cyo mu mutwe. Imisumari yo kuziba ishobora kandi gukoreshwa mu gikorwa cyo kugabanya cyavuzwe haruguru. Inyundo zo kugabanya zikoreshwa mu gukosora inguni ya sagittal n'ubumuga bwo kwimuka bunyura mu nzira.
Ibimera
Abakora ibikoresho byinshi byo gufunga imbere mu magufwa bashyizeho uburyo bwo gukoresha ibyuma kugira ngo biyobore uburyo inzara zo mu magufwa zishyirwa mu magufwa. Harimo ukuboko kwagutse, icyuma gipima uburebure bw'udupira, n'icyuma gipima uburebure bw'udupira. Ni ngombwa cyane ko udupira twa trocar n'udupira tw ...
Udukingirizo two Gufunga
Umuganga w’inzobere agomba kugenzura ko hashyizweho umubare uhagije w’amakuru yo gufunga kugira ngo akomeze kugabanuka ku buryo bushimishije. Gufata ibice bito byavunitse (by’imbere cyangwa ibya kure) bikorwa hakoreshejwe amakuru atatu cyangwa arenga yo gufunga hagati y’ibice byavunitse byegeranye, cyangwa hakoreshejwe amakuru y’inguni zihamye gusa. Uburyo bwo gukoresha inzara za tibial intramedullary bumeze nk’uburyo bwo gukoresha infrapatellar mu bijyanye n’uburyo bwo gukoresha amakuru. Amakuru yo gufunga akoreshwa neza cyane hifashishijwe fluoroscopy.
Gufunga igikomere
Gukuramo agapfundikizo gakwiye k'inyuma mu gihe cyo kwaguka bikuraho ibice by'amagufwa biri hanze. Ibikomere byose bigomba kuvomerwa neza, cyane cyane aho babagiye ivi. Imitsi y'amagufwa cyangwa ligament hamwe n'umushongi aho byacitse birafungwa, hagakurikiraho gufunga dermis n'uruhu.
Gukuraho urwagashya rwo mu nda
Niba umusumari wo mu gice cya tibial unyuze mu buryo bwa suprapatellar ushobora gukurwaho hakoreshejwe ubundi buryo bwo kubaga biracyari impaka. Uburyo bukunze gukoreshwa cyane ni uburyo bwa transarticular suprapatellar bwo gukuraho inzara zo mu gice cya tibial. Ubu buryo bugaragaza umusumari unyuze mu gice cya tibial intramedullary ukoresheje imashini itobora ya mm 5.5. Igikoresho cyo gukuraho inzara gica mu gice cya tibial, ariko ubu buryo bushobora kugorana. Uburyo bwa parapatellar na infrapatellar ni ubundi buryo bwo gukuraho inzara zo mu gice cya tibial.
Ingaruka Ingaruka zo kubaga hakoreshejwe uburyo bwa suprapatellar bwo gukoresha uburyo bwo kubaga inzara za tibial intramedullary ni imvune ku ndwara ya patella na femoral talus cartilage, imvune ku zindi ngingo za intra-articular, kwandura ingingo, n'imyanda ya intra-articular. Ariko, nta raporo z'ubuvuzi zijyanye n'ibyo. Abarwayi ba chondromalacia bazahura n'imvune nyinshi ku ndwara ya cartilage. Kwangirika kw'indwara ku ngingo za patellar na femoral articular ni ikibazo gikomeye ku baganga bakoresha ubu buryo bwo kubaga, cyane cyane uburyo bwa trans-articular.
Kugeza ubu, nta bimenyetso bifatika bigaragaza ibyiza n'ibibi by'uburyo bwo kuvura inzara bwo mu gice cya tibial intramedullary.
Igihe cyo kohereza: Ukwakira-23-2023
