Uburyo bwa SaprapateLer ni uburyo bwo kubaga bwahinduwe kuri tibial intera imisumari mu gice cya kabiri. Hariho ibyiza byinshi, ariko kandi, gukora ibibi, gukora intttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttterollary yo muri Tibia binyuze muburyo bwo gutanga Porogaramu muri Hallux Valtus. Abaganga bamwe bamenyereye gukoresha spN kugirango bavure ibirungo byose usibye kuvunika-bidasanzwe bya proximal 1/3 bya Tibia.
Ibimenyetso byo kuba spine ni:
1. 2;
2. Kuvunika kwa mataphysis;
3. Kuvunika ku kibuno cyangwa ivi hamwe nimbogamizi yabanjirije Flexion (urugero, ibiti bya degeneratique cyangwa ibidukikije, otteocation yo guhindagurika cyangwa ikibuno cya femur yinyuma);
4. Kuvunika tibial bihujwe nibikomere byuruhu kuri Tendon ya Injiji;
5. Kuvunika muri tibial mumurwayi hamwe na tibia ndende (iherezo ryibiti akenshi biragoye kwiyumvisha munsi ya flueroscop mugihe uburebure bwa tibia burenze uburebure bwa tripode irashobora kunyuramo).
Ibyiza bya kimwe cya kabiri cyo hejuru yivi rya tibial Intramedinal Tekinike yo kuvura diaphysis yo hagati ya tibial hamwe na dicral diibiles iri mu buryo bworoshye bwo kwisubiraho no koroshya fluoroscopy. Ubu buryo bwemerera inkunga nziza yuburebure bwuzuye bwa tibia kandi byoroshye kugabanya kuvunika badakeneye gukoreshwa (Ishusho 1, 2). Ibi bikuraho gukenera umufasha watojwe gufasha muri tekinike yo mu misumari.
Igishushanyo 1: Umwanya usanzwe kuri tekinike yo mu misumari yo muri intera yuburyo bwa infrapatellar: ivi iri mumwanya woroshye kuri criomoskode ya flueroscodeskod. Ariko, uyu mwanya urashobora kuzamura guhuza nabi guhagarika guhagarika kandi bisaba uburyo bwo kugabanya amafaranga yo kugabanya kugabanuka.
Igishushanyo 2: Ibinyuranye, imyanya yagutse ivi kuri ram ram ram yorohereza kuvugurura guhagarika imipaka no gukoresha nabi.
Ubuhanga bwo kubaga
Imbonerahamwe / Umwanya Umurwayi aryamye mumwanya wo gutanga suplescopique. Guturika munsi yo gukata, ariko ntibikenewe. Nimboneza yimyanya akwiranye neza na Porogaramu ya Tibial yegera isuku, ariko ntabwo ari ngombwa. Nyamara, gucika intege cyane ibitanda cyangwa ibitanda bya fluoscopique ntibisabwa kuko bidakwiriye gukwirakwiza muri Tibial IntramediLlary Umusumari.
Padding Ikibuno cya IPRIEATERAL ifasha gukurikiza impera yo hepfo mumwanya uzunguruka hanze. Ram ya Sterile Rams noneho ikoreshwa mu kuzamura ingingo yibasiwe hejuru yimpande zamavurungano kuri fluoscopy posterolate, hamwe nubutaka bworoshye hamwe na sine nacyo biyobora PIN na Intramediat gushyira umusumari. Inguni ya Optimol Flexion iracyafite impaka, hamwe na Beltran et al. Gutanga igitekerezo cya 10 ° ivi na kubaak byerekana 30 ° guhindagurika. Intiti nyinshi zemeza ko inguni yo gupfuka ivi muriyi mazi yemewe.
Ariko, Eastman et al. Habonetse ko nkuko inguvu ya piregion yiyongereye buhoro buhoro kuva kuri 10 ° kugeza 50 °, ingaruka za Talog ya femoral kuri percaneous yishoramari yagabanutse. Kubwibyo, inguni nini ipfunduye izafasha muguhitamo umusumari winjira mumwanya winjira no gukosora imyumvire iboneye mu ndege ya Sagittal.
Flueroscopy
Imashini ya C-ARM igomba gushyirwa kuruhande rwimeza kuva mu gihimba cyanduye, kandi niba umuganga ubaga ahagaze kuruhande rwivi, hagomba kuba umuganga uhagaze kuruhande rwivi, rigomba kuba kumutwe wimashini ya C. Ibi bituma umuganga ubaga na radiologue yitegereza byoroshye monitor, usibye iyo isumari yo guhuza cyane igomba kwinjizwamo. Nubwo atari itegeko, abanditsi basaba ko c-Ukuboko kwimurwa kuruhande rumwe nuwagabatse kuruhande rwibinyuranye mugihe imitekerereze yo hagati igomba gutwarwa. Ubundi, imashini ya C-ARM igomba gushyirwa kuruhande rwibasiwe mugihe umuganga ubaga akora uburyo bwo kunyuramo (Ishusho 3). Ubu ni bwo buryo bukoreshwa cyane n'abanditsi kuko birinda gukenera kubaga kuva kuruhande rwumucyo kugeza kuruhande rwibirukana.
Igishushanyo cya 3: Umuganga ubaga ahagarara kuruhande rwa Tibia yagize kugirango imitekerereze yo hagati ihagarike ihagarikwa rishobora gutwarwa byoroshye. Iyerekanwa riherereye mu bubaga, ku mutwe w'ukuboko kwa C-C-ART.
Ibitekerezo byose bya anteroposition hamwe na likile-kuruhande bya Fluoscopic byabonetse utimuye ingingo yibasiwe. Ibi birinda kwimura urubuga rwavuzagurwa mbere yuko kuvunika byakosowe rwose. Byongeye kandi, amashusho yuburebure bwuzuye bwa Tibia arashobora kuboneka atagongana na C-ukuboko muburyo bwasobanuwe haruguru.
Gukuramo uruhu byombi bigarukira kandi byagutse neza ibirimo birakwiriye. Icyegera kuri Percapatellar cyerekana ko umusumari wimisumari ashingiye ku gukoresha cm 3 yo gutema imisumari yo gutwara umusumari. Byinshi muribi bikorwa byo kubaga ni bimaze igihe kirekire, ariko birashobora kandi guhindura, nkuko byasabwe na Dr. Morandi, hamwe nibitekerezo byakoreshejwe na Dr. Tornetta hamwe na Pater Patellar subluation, hamwe nuburyo bwa parapatellar yiganje cyangwa bwuzuye. Igishushanyo cya 4 cyerekana ibibandiro bitandukanye.
Igishushanyo cya 4: Ishusho yerekana uburyo butandukanye bwo gukandaga.1- Suprapatellar Transpatellar uburyo bwo kwacu transpatellar. 2- Uburyo bwa Lidepatellar bwonyine; 3- Hagati ntarengwa yerekana parapatellar Lidepade Melide; 4- Hagati ya parapatellar yonyine ya parapatellar. 5- Inzira ya Paruwaza ya Licapatellar. Iterambere ryimbitse ryinzira ya parapatellar rirashobora kuba rihuriweho hamwe cyangwa hanze ya bursa.
Kugaragaza cyane
Uburyo bwa Percapatellar bukorwa cyane cyane bitandukanya quadrices tedon kugeza icyuho gishobora kwakira ibice byibikoresho nkibikoresho byo mu ntambara. Uburyo bwo kwa parapatellar, bunyura iruhande rwimitsi ya quadriceps, irashobora kandi kwerekanwa kuri tekinike yigituba. Urushinge rwa Trocar na Cannula rwanyuze mu myanya ihuriweho ni patelloferal, uburyo bwarimo buyobora cyane cyane kwinjira muri Tibial Intramedilary Umusaruro wa Tramedul ukoresheje igikombe cya femoramedi. Ikamyo imaze guhagarara neza, igomba kuba ifite umutekano muhantu kugirango yirinde kwangirika kumagare artice yo mu ivi.
Uburyo bunini bwo gutunganya ibicuruzwa burashobora gukoreshwa muburyo bwa HyperengexTell PayLellar Gukuramo uruhu, hamwe nuburyo bwo hagati cyangwa kuruhande. Nubwo abaganga bamwe badashobora kubungabunga bursa bidahwitse, kubiak et al. Emera ko Bursa agomba kubikwa inzego zidasanzwe kandi zidasanzwe-zidasanzwe zigomba kugaragara bihagije. Ubuntu, ibi bitanga uburinzi buhebuje bwo gupima no kwirinda kwangirika nkandura amavi.
Ubumwe bwasobanuwe haruguru burimo Hemi-Kwirinda Patella, bigabanya igitutu cyibitumanaho ku bwinshi. Iyo bigoye gukora isuzuma rya patellofemoral rifite ihuriro rito hamwe nigikoresho cyo kwagura ivi, abanditsi basaba ko patella ishobora kuba igice cyashishikarizwa no gutandukana. Ku rundi ruhande, imitekerereze yo mu rwego rwo guhinduranya, yirinda kwangiriza amategeko ashyigikira, ariko biragoye gusana ivi.
Uruhushya rwinjira rwinjira ni kimwe nikintu cya infrapatellar. Imbere hamwe na Liproscopy mugihe cyo kwinjiza inshinge cyemeza ko ingingo yo kwinjiza inshinge ari yo. Umuganga ubaga agomba kwemeza ko urufatiro ruyobora rudatwarwa kure cyane muri tibia proxima. Niba bitwarwa cyane cyane, bigomba gusubirwamo hamwe nubufasha bwo guhagarika imisumari munsi yinyuma ya coronal fluoscopy. Byongeye, EASTMAN ET. Emera ko gushimisha PIN yinjira mumwanya wanduye ivi ryanduye ipfunditi mugukavuka mu buryo bwo guhagarika inzira ya Hyperengeje.
Ibikoresho byo kugabanya
Ibikoresho bifatika byo kugabanuka birimo imbaraga zigabanya ingingo zitandukanye, kuzamura femoral, ibikoresho byo gukosora hanze, hamwe nibikoresho byimbere byo gukosora ibice bito hamwe nisahani imwe ya cottique. Guhagarika imisumari birashobora kandi gukoreshwa mubikorwa byavuzwe haruguru. Kugabanya inyundo bikoreshwa mugukosora sagittal kurangiza no guhindura kwikuramo.
Gutera
Abakora ibicuruzwa byinshi byo mu gihugu bya orthopedicique byateye imbere uburyo bwo gukoresha ibicuruzwa kugirango bayobore gushyira mu gaciro imisumari y'inzitizi. Harimo ukuboko kwagutse, igikoresho cyayobowe na GIPE-GOUTUremewe, hamwe na gitero. Ni ngombwa cyane ko trokar hamwe na trocar quarcar birekurire intera imisumari yo mu misumari. Umuganga ubaga agomba gushimangira umwanya wa onnula kugirango uruniko ruhuze hamwe ninzego za patelloferara cyangwa peteroli kubera hafi cyane kubikoresho byo gutwara bitabaho.
Gufunga imigozi
Umuganga ubaga agomba kwemeza ko umubare uhagije wo gufunga winjijwe kugirango ukomeze kugabanuka. Gukosora ibice bito (proximal cyangwa kure) bigerwaho nimigozi 3 cyangwa myinshi yo gufunga hagati yamavuta yegeranye, cyangwa hamwe nimigozi-inguni yonyine. Uburyo bwo gukwirakwiza muri Porogaramu ya Tibial Intramediallary tekinike isa niyerono ya infrapatellar mubijyanye na tekinike yo gutwara. Gufunga imigozi biratwarwa neza munsi ya flueroscopi.
Gufunga ibikomere
Kunywa hamwe na ciser yo hanze mugihe cyonyine ikuraho ibice byamagufwa kubuntu. Ibikomere byose bigomba kumvikana neza, cyane cyane urubuga rwo kubaga ivi. Quadrices Tendon cyangwa urwego rwiziritse hamwe na suture kurubuga rwamavurungano noneho bifunze, hakurikiraho gufunga dermis nuruhu.
Gukuraho IntramediLary Umusumari
Niba intera ya tibiemedillary yatwarwa nuburyo bwo gukwirakwiza burashobora gukurwaho binyuze muburyo butandukanye bwo kubaga budakomeza kuvugurura. Uburyo bukunze kugaragara ni uburyo bwo kwerekana gahunda ya tracapatellar yo gukuraho imisumari. Ubu buhanga bwerekana umusumari mugucukura ukoresheje umuyoboro wimisumari yimisumari ukoresheje imyitozo ya Mm 5.5. Igikoresho cyo gukuraho imisumari noneho kiyobowe numuyoboro, ariko iyi mico irashobora kugorana. Inzira ya parapatellar na infrapatellar nuburyo bundi buryo bwo gukuraho imisumari.
Ingaruka ziterwa no kubaga uburyo bwo kwerekana gahunda yo gutangaza imisumari ya Tibiemedlary ni Gukomeretsa kwa Catal na Piomor, Gukomeretsa Ubuvuzi kurindi, Inzitizi zifatika, hamwe no kwandura ibintu. Ariko, hariho kubura raporo zubwishingizi. Abarwayi bafite Chondromalania bazarushaho gukunda ibikomere bya karitsiye. Kwangiza ubuvuzi kuri patellar nuduce twibinyabuzima bihangayikishijwe cyane nabaganga bakoresheje ubu buryo bwo kubaga, cyane cyane inzira nyabaranga.
Kugeza ubu, nta bimenyetso by'imibare ishingiye ku bijyanye n'imibare n'ibibi by'ibice bya kabiri byagutse intera imisumari.
Igihe cyohereza: Ukwakira-23-2023
