Kwimura inyuma yibibuno biterwa ahanini nubukazi butaziguye nkimpanuka zo mumuhanda.Niba hari kuvunika umutwe wigitsina gore, byitwa kuvunika Pipkin.Ivunika rya Pipkin ntirisanzwe mu mavuriro, kandi indwara zayo zigera kuri 6% yo kwimura ikibuno.Kubera ko kuvunika kwa Pipkin ari kuvunika kwimbere, niba bidakozwe neza, arthrite ihahamuka irashobora kubaho nyuma yo kubagwa, kandi hakaba hashobora kubaho na nérosose yo mumutwe.Muri Werurwe 2016, umwanditsi yavuzemo ikibazo cyo kuvunika ubwoko bwa I Pipkin, anatanga amakuru y’ubuvuzi no kubikurikirana ku buryo bukurikira.
Amakuru yubuvuzi
Uyu murwayi, Lu, umugabo, ufite imyaka 22, yinjiye mu bitaro kubera "kubyimba no kubabara mu kibuno cy'ibumoso byatewe n'impanuka yo mu muhanda, ndetse n'ibikorwa bike mu gihe cy'amasaha 5".Isuzuma ryumubiri: ibimenyetso byingenzi byari bihamye, isuzuma ryumutima ryumutima ryumutima ryari ribi, igihimba cyo hepfo cyibumoso cyari flexion igabanya ubumuga, ikibuno cyibumoso cyabyimbye biragaragara, ubwonko bwibumoso bwo hagati bwagaragaye neza, ububabare bukomeye bwa trocanter percussion hamwe ningingo yo hepfo ububabare bwa percussion ndende bwari bwiza.Igikorwa gikora cyibibuno cyibumoso kigarukira, kandi ububabare bwibikorwa bya pasiporo birakabije.Kugenda kw'iburyo ry'ibumoso ni ibisanzwe, kumva ingingo yo hepfo y’ibumoso ntigabanuka cyane, kandi amaraso ya peripheri ni meza.Isuzuma ry'ubufasha: Filime X-yerekana ingingo ebyiri zifatanije mu kibanza cyiza yerekanaga ko imiterere yamagufwa yumutwe wigitsina gore cyibumoso idahagarara, yimurwa inyuma kandi hejuru, kandi uduce duto twavunitse twagaragaye muri acetabulum.
Kwipimisha
Ibumoso bw'igitsina gore kuvunika hamwe no gutandukanya ikibuno.Nyuma yo kwinjira, kwimura ikibuno cyibumoso byagabanijwe nintoki hanyuma byongera kwimurwa.Nyuma yo kunonosora ibizamini mbere yo gutangira, kuvunika umutwe wigitsina gore cyibumoso no kuvanaho ikibuno byavuwe kugabanuka kumugaragaro no gukosorwa imbere muri anesthesia rusange murwego rushinzwe ubutabazi.
Inzira ya posterolateral yegereye ikibuno cyibumoso cyafashwe, gifite uburebure bwa 12Cm.Mu gihe cyo kubaga, habonetse kuvunika ku mugereka wa ligamentum yo hasi yo hagati ya teres femoris, hamwe no gutandukana kugaragara no kwimura impera yavunitse, kandi ubunini bwa 3.0Cm bwagaragaye mu bice bya acetabulum × 2.5Cm.Amaraso ya 50mL ya periferiya yafashwe kugirango bategure plasma ikungahaye kuri platine (PRP), hanyuma gel PRP ikoreshwa kumeneka.Nyuma yo guhagarika ibice byavunitse, hakoreshejwe imashini eshatu zo muri Finilande INION 40mm zishobora gukururwa (2.7mm z'umurambararo) kugirango zikosore.Byagaragaye ko ubuso bwa arctular yumutwe wigitsina gore bworoheje, kugabanuka byari byiza, kandi gukosora imbere byari bikomeye.Ihuriro ryibibuno risubirwamo, kandi ikibuno gikora ntigishobora guterana no gutandukana.Imirasire ya C-ukuboko yerekanye kugabanuka neza kuvunika umutwe wigitsina gore hamwe nigituba.Nyuma yo koza igikomere, shushanya capsule yinyuma yinyuma, wongere uhagarike imitsi ya rotateur yo hanze, ushushanye fasia lata nuruhu rwumubiri winyuma, hanyuma ugumane umuyoboro wamazi.
Muganire
Kuvunika kw'ipine ni kuvunika imbere.Kuvura konservateur akenshi biragoye kugera kugabanuka ryiza, kandi biragoye gukomeza kugabanuka.Byongeye kandi, ibice bisigaye byamagufwa yubusa mu ngingo byongera imyambarire yimbere, byoroshye gutera arthrite ihahamuka.Byongeye kandi, kuvanaho ikibuno hamwe no kuvunika umutwe wigitsina gore bikunda kwandura umutwe wa femorale kubera ibikomere byamaraso yumutwe wumugore.Igipimo cy'umutwe wa femorale kiri hejuru cyane ku rubyiruko rukuze nyuma yo kuvunika umutwe w'igitsina gore, bityo ubushakashatsi bwinshi buvuga ko kubagwa byihutirwa bigomba gukorwa mu masaha 12.Umurwayi yavuwe no kugabanya intoki nyuma yo kwinjira.Nyuma yo kugabanuka neza, firime X-ray yerekanaga ko umurwayi yongeye kwimurwa.Byatekerezwaga ko guhagarika kuvunika mu cyuho cya arctular byagira ingaruka zikomeye kumutekano wo kugabanuka.Kugabanya kumugaragaro no gukosora imbere byakozwe mugihe cyihutirwa nyuma yo kwinjira kugirango bigabanye umuvuduko wumutwe wigitsina gore no kugabanya amahirwe yo kwandura umutwe wa femorale.Guhitamo uburyo bwo kubaga nabyo ni ngombwa kugirango intsinzi igerweho.Abanditsi bemeza ko uburyo bwo kubaga bugomba gutoranywa hakurikijwe icyerekezo cyo gutandukanya umutwe w’umugore, guhura no kubaga, gutondekanya kuvunika n’ibindi bintu.Uyu murwayi ni dislocation yinyuma yibibuno bifatanije no kuvunika umutwe wo hagati no munsi yumugore.Nubwo inzira yimbere ishobora kuba yoroshye muguhishurirwa kuvunika, inzira yinyuma yarangije guhitamo kubera ko kuvunika kuvunika umutwe wigitsina gore ari gutandukana inyuma.Ku mbaraga zikomeye, capsule yinyuma yinyuma yangiritse, kandi amaraso yinyuma yumutwe wumugore wangiritse.Uburyo bwa posterolateral burashobora kurinda capsule yimbere idakomeretse, Niba uburyo bwimbere bwongeye gukoreshwa, capsule yimbere izacibwa, bizasenya amaraso asigaye yumutwe wigitsina gore.
Umurwayi yashizwemo imigozi 3 ishobora gukururwa, ishobora icyarimwe icyarimwe uruhare rwo gukosora compression no kurwanya kuzunguruka kumeneka, kandi bigatera gukira neza kuvunika.
PRP ikubiyemo ibintu byinshi byikura, nkibintu bikura bikomoka kuri platine (PDGF) hamwe nimpinduka zo gukura - β （TGF－ β） factor Imikurire yimitsi iva mu mitsi (VEGF), ibintu bikura nka insuline (IGF), ibintu bikura epidermal (EGF), nibindi Mu myaka yashize, intiti zimwe zemeje ko PRP ifite ubushobozi busobanutse bwo gutera amagufwa.Ku barwayi bafite imvune yumutwe wigitsina gore, amahirwe yo kurwara umutwe wa femorale nyuma yo kubagwa ni menshi.Gukoresha PRP kumpera yamenetse byitezwe ko bizamura kuvunika hakiri kare kandi wirinde ko habaho na nérosose yumutwe wumugore.Uyu murwayi ntabwo yagize umutwe wa femorale femorale mugihe cyumwaka 1 nyuma yo kubagwa, kandi yakize neza nyuma yo kubagwa, bisaba ko byakurikiranwa.
[Ibiri muri iyi ngingo byororoka kandi bigasangirwa.Ntabwo dushinzwe ibitekerezo byiyi ngingo.Nyamuneka sobanukirwa.]
Igihe cyo kohereza: Werurwe-17-2023