Dysplasia yiterambere ryikibuno (DDH) nindwara idasanzwe yiterambere itera imikorere mibi yibibuno bitewe na dysplasia ivuka ya acetabulum, ubumuga bwa femorale bwa femorale, amasezerano yimitsi yoroheje, hamwe nimpinduka za biomehanike. Indwara ya hip arthroplastique (THA) nimwe muburyo bwingenzi bwo kuvura DDH, ishobora kugabanya impagarara zingingo zoroshye, kugarura ikigo kizunguruka no gutuza kw'ibibuno, no kunoza ubumuga bw'ingingo zo hepfo. Ugereranije n'ubwoko bwa Crowe Ⅰ ~ Ⅲ abarwayi ba DDH, diameter ya anteroposterior ya acetabulum ni ntoya kandi idakabije, kandi itandukaniro ry'imfuruka ya anteversion ni nini; umutwe wa femorale dysplasia ndetse irazimira, inguni ya anteversion femorale nini, trochanter nini ni inyuma, na diameter ya anteroposterior ya femur iruta diameter ibumoso n'iburyo [1-2]; Ugereranije na femur isanzwe, ibipimo byimbere byahindutse cyane, cyane cyane umwobo wa medullary hafi y'urwego ruto rwa trocanter; kwimura ikibuno igihe kirekire byatumye habaho gukomera kwingirangingo zoroshye zaho, bikaviramo ingorane zo kugabanya ikibuno [4]. Kubwibyo, ishyirwaho ryimiterere ihamye yibibuno hamwe no kugarura amagufwa byabaye imwe mubibazo byo kubaga.
1. Kuki dukeneye kubagwa?
Impamvu y'ibanze yo kwisubiramo nyuma ya THA yambere mubwoko bwa Crowe Ⅳ DDH ni ukurekura aseptike ya prothèse. Byongeye kandi, kwandura periprosthetic, kuvunika periprosthetic, osteolysis, gutakaza amagufwa no kuvunika kwa prothèse no guhungabana nabyo ni ibintu bisanzwe bitera kwisubiramo.。
2Gutondekanya inenge
Uruhande rwa acetabular na femorale yubwoko bwa Crowe patients Abarwayi ba DDH bakunze guherekezwa nurwego runaka rwubumuga bwamagufwa mugihe cyo gusubiramo, kandi ubwinshi bwamagufwa yamagufa hamwe nubusembwa bwumugore wa acetabular na proximal femur birashobora gupimwa na X-ray na CT mbere yisubiramo. Kugeza ubu, amahame y’amagufwa asanzwe akoreshwa mu byiciro bya Paprosky.
2.1Icyiciro cya Paprosky
Gutondekanya inenge yamagufa ntibishobora kwerekana gusa urugero rwo gutakaza amagufwa gusa, ahubwo binagaragaza ituze rya prothèse ya acetabula yatewe [5-6], kugirango uhitemo prothèse ikwiye ya acetabula hamwe nibigize.Icyiciro cya Paprosky gishingiye kumashusho yerekana amashusho kugirango asesengure icyerekezo nintera yo kwimura igikombe cya acetabula mubice bitandukanye byubwoko bwa acetabular. . yo gutakaza amagufwa ya buri mwaka, hagati yibibuno byikibuno bizamuka cyane (> cm 3) Kwiyubaka kwa Acetabular no kugarura ikigo cyo kuzunguruka bigira ingaruka kuburyo butaziguye kunanirwa cyangwa kunanirwa kubagwa gusubiramo. Reba Ishusho 1.
2.2Icyiciro cya Paprosky cyuruhande rwumugore
Ibyiciro bya Paprosky byuruhande rwigitsina gore bishingiye ku ntera yubusembwa bwamagufwa muri isthmus yegeranye kandi ya kure ya femur, harimo aho inenge yamagufwa, urugero rwamagufwa asigara yegeranye, uburebure bwa isthmus hamwe namagufwa yayo asigaranye, kandi igabanijwemo ubwoko butatu. Ubwoko Ⅰ na Ⅱ: ubworoherane buringaniye kandi bworoshye bikabije. igufwa ryigitsina gore guma guma neza, ukurikije niba uburebure bwamagufwa asigaye kuri isthus ya femur agera kuri cm 4 [9].
3Kongera kubaka acetabulum
Kubera imiterere yimiterere yubwoko bwa Crowe patients Abarwayi ba DDH hamwe nuruhererekane rwibibazo nyuma yo gusimburwa kwambere, prothèse nyinshi zisubirwamo ntizishobora kugera kumurongo wambere wibihuriweho, amagufwa ahagije cyangwa kunoza imikorere ya morfologiya.
3.1Gukoresha igikombe cyibinyabuzima gihamye
Iyo hari ubwoko bwa Paprosky bwa II cyangwa hejuru yamagufwa yamagufwa muri acetabulum hamwe nibisanzwe bisanzwe biologique hemispherical acetabular igikombe ntigishobora gutanga igisubizo gihamye, prothèse nini ya acetabular igikombe (igikombe cya Jumbo) irashobora gukoreshwa kugirango wongere aho uhurira namagufwa akikije acetabulum kandi wongere aho uhurira, kugirango ugere kumurongo muremure.
3.2Amagufwa
Amagufwa yangiritse ni uburyo bukoreshwa muburyo bwo gusana amagufwa mubuvuzi. Ku barwayi bafite amagufwa mato ya acetabula, kwangirika kw'amagufwa cyangwa prothèse nko gushimangira impeta, guhagarika ibyuma na Cage birashobora gukoreshwa mu kugarura ubwinshi bw'amagufwa, kwinjiza imitsi y'amaraso, gushushanya amagufwa no kunoza igufwa ry'amagufwa ku busembwa bw'amagufwa ya acetabula, kugira ngo ugere ku ntego yo guhagarara neza kwa prostate [10].
3.3Gukoresha ibyuma byongera
Muri icyo gihe, ahantu ho guhurira hagati yumubiri wamagufwa ahabigenewe no guhagarika ibyuma byiyongera, ibyo bikaba bishobora guteza imbere amagufwa.Ibice byicyuma bifite imiterere nubunini butandukanye, kandi birashobora guterwa nigice cyamagufwa yamagufwa kurwego runini cyane muguhitamo icyuma gikwiye.
3.4Gushyira mu kato & ibikombe bitatu-amababa
Hano hari amagufwa make kurukuta rwagati hamwe ninkingi yimbere yubwoko bwa Crowe patients abarwayi ba DDH, kandi abarwayi bamwe bafite inenge nini yamagufwa mugihe cyo kubagwa kwisubiramo, bikaviramo guhagarika acetabula, kandi igikombe cya acetabula ntigishobora gukosorwa neza mugihe cyo gusubiramo, bityo Cage cyangwa igikombe cyamababa atatu ya acetabula irashobora gukoreshwa mugihe cyo kwiyubaka kwa acetabulum muriki gihe.
3.5Ubuhanga bwo gucapa 3D
Ku barwayi bafite Paprosky type inenge yamagufwa, acetabulum ntikomeza kubera gutakaza amagufwa menshi, biganisha ku guhungabana kwa pelvic hamwe ningorabahizi mu gutera prothèse acetabular. Tekinoroji ya 3D yo gucapura irashobora gukoreshwa mugukora icyitegererezo cyibice bitatu byigitereko cyumurwayi, aho uyikoresha ashobora gusobanukirwa byimazeyo inenge zidasanzwe za acetabulum, akumva imiterere ya anatomique yaho ndetse nubunini bwinenge, gahunda nziza mbere yo gukora, hitamo ibice bikwiye kugirango asane inenge, cyangwa akoreshe tekinoroji yo gucapura 3D kugirango ategure neza kugarura ikibuno, kugendagenda no gutuza.
4Kwiyubaka kuruhande rwumugore
4.1Ingorane zo kubaga
。Ubumuga bw'umugore ku barwayi ba DDH bwahindutse hamwe n'urwego rwo gutandukana kw'ibibuno.Muri bo, ubwoko bwa Crowe IV burangwa no gutandukana cyane kw'ibibuno, impinduka zikomeye muri morphologie n'imikorere ya femur yegeranye, hamwe no kuba coxa vara na valgus nyinshi [11-12]. Iyo igice cyigitsina gore cyabarwayi ba DDH kirekuye kandi kijyana no guta no guta amagufwa igice, kuvugurura uruhande rwigitsina gore biragoye.Nkuko kuvanaho insimburangingo, kubungabunga amagufwa yegeranye, kongera kubaka femur yegeranye, guhitamo insimburangingo ikwiye no gutuza byabaye ingorabahizi zo kubaga femorale [13].
4.2Kwirinda gukora
Hashobora kubaho osteosclerose muri femur yegeranye no mu mwobo muto wa medullary wo mu bwoko bwa Crowe patients abarwayi ba DDH mugihe cyo kubagwa. Iyo ukuyemo prothèse ya biologiya femorale, tissue ya sklerotic yamagufa na fibrous tissue ipfunyitse muri femur yegeranye bigomba gukurwaho uko bishoboka kwose, kandi prothèse igomba guhishurwa byimazeyo kandi intera yamagufa-prothèse igomba gutandukana kugirango igabanye igufwa rya iatrogène.Kwirinda ko habaho gutobora kwa cortique no kuvunika kwa progaramu ya progaramu ya prétèse [14-15]. yinenge yamagufwa ya femorale yegeranye, gushushanya, gutoranya no gutunganya prothèse yatewe, hamwe no gusuzuma ubwiza bwibigega bisigaye.
4.3Nigute ushobora guhitamo uruti rukwiye?
Prothèse modular modular ikunze gukoreshwa mugikorwa cyo kubaga abarwayi ba Crowe Ⅳ DDH. Prothèse ya segmental modular irashobora guhuza neza ibikenewe byigitsina gore cyumurwayi, uruti rwigitsina gore rwa kure rushobora kugera kumihindagurikire y’imihindagurikire y’ikirere, kandi cuff yegeranye irashobora gukumira neza osteolysis nyuma yo kubagwa ndetse no gukosorwa bikabije. kwiyubaka no kubungabunga ituze rya prothèse nkintego yibanze.
5Nigute ushobora guhitamo umurongo?
Kugeza ubu, prothèse ikunze gukoreshwa mu kubaga harimo ibyuma-ibyuma, ibyuma-polyethylene, interineti ceramic-polyethylene hamwe na ceramic-ceramic interface [7,11] .Ibikoresho bya polietilen nubwoko nyamukuru bwo guhitamo muri iki gihe. Kugeza ubu, umurongo wa polyethylene uhuza cyane wasimbuye buhoro buhoro umurongo wa polyethylene usanzwe, ufite imbaraga zo kurwanya kwambara cyane, kugabanya osteolysis no kwambara hagati ya prostate nyuma yo kubagwa, kandi bikaba bifasha gukomeza guhanura igihe kirekire [16] .Abarwayi benshi bafite ubwoko bwa Crowe Ⅳ DDH bari bato mugihe bakoraga ibikorwa bya buri munsi bya THA, kandi bari bafite ibikorwa byinshi bya buri munsi. Urebye inenge yamagufa yatewe no kwambara mugihe cyo gusubiramo hamwe ningorabahizi yo gusubiramo, umurongo wa ceramic ugomba gutoranywa uko bishoboka kwose mugihe cyambere THA cyangwa gusubiramo. Niba bidashoboka guhitamo bitewe nubunini buke, umurongo wa polyethylene uhujwe cyane urashobora gutoranywa [17] .O nko kongera igihe cyakazi cya prothèse no kugabanya umubare wibikorwa byo gusubiramo.
6Umwanzuro
。Kurekura Aseptic ya prothèse niyo mpamvu itera gusubiramo nyuma ya THA yambere kubwoko bwa Crowe Ⅳ DDH. Gusubiramo inshuro nyinshi ingingo, inenge yamagufa, kwandura, kudahurira kurubuga rwa osteotomy, no kuvunika kwa prothèse bishobora no gutuma habaho kubagwa kwisubiramo.Ikibuno cyo kwiyubaka hamwe no gutera prothèse femorale nizo ngorane nyamukuru zokubaga ubugororangingo kubarwayi nkabo, bakeneye isuzumabumenyi ryuzuye kandi ryuzuye mbere yo kubagwa. kubaga abarwayi ba Crowe ubwoko bwa IV DDH. Nubwo ikoranabuhanga rya Cage, ibice bya modular hamwe na prothèse yihariye byagaragaye ko bifite umusaruro mwiza hakiri kare nigihe giciriritse muriki cyiciro, igipimo cyigihe kirekire cyo kubaho kiracyakenewe kurushaho gusobanurwa.Nubwo iterambere rihoraho ryubuhanga bwubwenge bwubwenge mubuvuzi, ibice bya prothèse yihariye nabyo bizatanga amahitamo menshi yo kuvugurura abarwayi nkabo.
Reba
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Igihe cyo kohereza: Apr-16-2024