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Chiwopsezo cha opaleshoni ya arthroscopic chawonjezeka m'zaka makumi awiri zapitazi, ndipo makina ometa arthroscopic akhala chida chogwiritsidwa ntchito kwambiri cha mafupa.Komabe, malezala ambiri sakhala akuthwa mokwanira, osavuta kuvala, ndi zina zotero.Cholinga cha nkhaniyi ndikufufuza momwe malezala atsopano a BJKMC (Bojin◊ Kinetic Medical) alili arthroscopic.Amapereka chithunzithunzi cha kapangidwe kazinthu ndi njira yotsimikizira.Lumo la BJKMC arthroscopic lili ndi kapangidwe ka chubu mu chubu, chopangidwa ndi manja osapanga chitsulo chosapanga dzimbiri komanso chubu chamkati chozungulira.Chigoba chakunja ndi chipolopolo chamkati chimakhala ndi madoko oyamwa ndi odulira, ndipo pali zipolopolo zamkati ndi zakunja.Kuti mutsimikizire kapangidwe kake, kanafaniziridwa ndi choyikapo Dyonics◊ Incisor◊ Plus.Mawonekedwe, kuuma kwa zida, kuuma kwa chubu chachitsulo, makulidwe a khoma la chida, mbiri ya mano, ngodya, kapangidwe kake, miyeso yovuta, ndi zina zinafufuzidwa ndikufaniziridwa.malo ogwirira ntchito komanso nsonga yolimba komanso yocheperako.Choncho, mankhwala a BJKMC amatha kugwira ntchito moyenera pa opaleshoni.
Kulumikizana m'thupi la munthu ndi njira yolumikizira mafupa.Iwo ndi dongosolo lovuta komanso lokhazikika lomwe limagwira ntchito yofunika kwambiri pamoyo wathu watsiku ndi tsiku.Matenda ena amasintha kagawidwe ka katundu mu olowa, zomwe zimapangitsa kuchepa kwa magwiridwe antchito ndi kutayika kwa ntchito1.Opaleshoni yachikhalidwe ya mafupa ndizovuta kuchiza molondola pang'ono, ndipo nthawi yochira pambuyo pa chithandizo ndi yaitali.Opaleshoni ya Arthroscopic ndi njira yochepetsera pang'ono yomwe imangofunika kudulidwa pang'ono, imayambitsa kupwetekedwa mtima pang'ono ndi zipsera, imakhala ndi nthawi yochira msanga, ndi zovuta zochepa.Ndi chitukuko cha zipangizo zachipatala, njira zochepetsera zochepetsera pang'onopang'ono zakhala njira yachizoloŵezi yowunikira mafupa ndi chithandizo chamankhwala.Atangochita opaleshoni yoyamba ya mawondo a arthroscopic, adavomerezedwa mwalamulo ngati njira ya opaleshoni ya Kenji Takagi ndi Masaki Watanabe ku Japan2,3.Arthroscopy ndi endoprosthetics ndi ziwiri mwazofunikira kwambiri mu orthopedics4.Masiku ano, opaleshoni yochepa kwambiri ya arthroscopic imagwiritsidwa ntchito pochiza matenda osiyanasiyana ndi kuvulala, kuphatikizapo osteoarthritis, kuvulala kwa meniscal, kuvulala kwapambuyo ndi kumbuyo, synovitis, intra-articular fractures, patellar subluxation, cartilage ndi zotupa za thupi.
Chiwopsezo cha opaleshoni ya arthroscopic chawonjezeka m'zaka makumi awiri zapitazi, ndipo makina ometa arthroscopic akhala chida chogwiritsidwa ntchito kwambiri cha mafupa.Pakalipano, madokotala ochita opaleshoni ali ndi njira zosiyanasiyana zopangira opaleshoni, kuphatikizapo cruciate ligament reconstruction, meniscus kukonza, osteochondral grafting, hip arthroscopy, ndi facet joint arthroscopy, malingana ndi zokonda za dokotala wa opaleshoni1.Pamene opaleshoni ya arthroscopic ikukulirakulira m'malo olumikizirana mafupa ambiri, madokotala amatha kuyang'ana mafupa a synovial ndikuchiritsa odwala m'njira zomwe sanaganizirepo kale.Panthawi imodzimodziyo, zida zina zinapangidwa.Nthawi zambiri amakhala ndi unit control unit, handpiece yokhala ndi mota yamphamvu komanso chida chodulira.Chida cha dissection chimalola kuyamwa nthawi imodzi komanso mosalekeza ndikuchotsa6.
Chifukwa cha zovuta za opaleshoni ya arthroscopic, zida zambiri zimafunikira.Zida zazikulu zopangira opaleshoni zomwe zimagwiritsidwa ntchito popanga opaleshoni ya arthroscopic ndi monga ma arthroscopes, lumo lofufuza, nkhonya, forceps, mipeni ya arthroscopic, meniscus blade ndi malezala, zida zamagetsi, ma lasers, zida zamawayilesi ndi zida zina 7.
Lumo ndi chida chofunika kwambiri pa opaleshoni.Pali mfundo ziwiri zazikulu za opaleshoni ya arthroscopic.Choyamba ndi kuchotsa zotsalira za chichereŵechereŵe, kuphatikizapo matupi otayirira ndi cartilage yoyandama yoyandama, poyamwa ndi kupukuta olowa ndi mchere wambiri kuti achotse zotupa za intra-articular ndi oyimira pakati.China ndicho kuchotsa chichereŵechereŵe chosiyana ndi fupa la subchondral ndikukonza chilema chowonongeka cha cartilage.Meniscus yong'ambika imadulidwa ndipo meniscus yotha komanso yosweka imapangidwa.Razors amagwiritsidwanso ntchito kuchotsa zina kapena zonse zotupa za synovial, monga hyperplasia ndi thickening1.
Ma scalpels ambiri omwe amawononga pang'ono amakhala ndi gawo lodulira lomwe lili ndi dzenje lakunja lakunja ndi chubu chamkati chamkati.Nthawi zambiri amakhala ndi mano 8 odulira.Malangizo osiyanasiyana a tsamba amapereka milingo yosiyanasiyana yodula mphamvu ku lumo.Mano ochiritsira lumo amagwera m'magulu atatu (Chithunzi 1): (a) machubu osalala amkati ndi akunja;(b) machubu osalala akunja ndi machubu amkati opindika;(c) chopindika (chomwe chingakhale lumo)) machubu amkati ndi akunja.9. Kuthwa kwawo ku minofu yofewa kumawonjezeka.Mphamvu yapamwamba kwambiri komanso kudula bwino kwa macheka amtundu womwewo ndikwabwino kuposa 10 lathyathyathya.
Komabe, pali zovuta zingapo zomwe zilipo pakali pano zometa arthroscopic.Choyamba, tsambalo silikuthwa mokwanira, ndipo ndi losavuta kutsekereza podula minofu yofewa.Chachiwiri, lumo limatha kudula minofu yofewa ya synovial-dokotala ayenera kugwiritsa ntchito burr kuti apukutire fupa.Choncho, masamba amafunika kusinthidwa pafupipafupi pakugwira ntchito, zomwe zimawonjezera nthawi yogwira ntchito.Kuwonongeka kodula ndi kuvala lumo ndizovuta zofala.Kuwongolera kolondola komanso kuwongolera kolondola kunapangadi index imodzi yowunikira.
Vuto loyamba ndilakuti lumo silosalala mokwanira chifukwa cha kusiyana kwakukulu pakati pa masamba amkati ndi akunja.Njira yothetsera vuto lachiwiri ingakhale kuonjezera ngodya ya lumo ndikuwonjezera mphamvu ya zinthu zomanga.
Lumo latsopano la arthroscopic la BJKMC lokhala ndi tsamba lopindika pawiri limatha kuthana ndi zovuta za m'mphepete mwachisawawa, kutsekeka kosavuta komanso kuvala zida mwachangu.Kuti muyese kuthekera kwa mapangidwe atsopano a BJKMC, adafanizidwa ndi mnzake wa Dyonics◊, Incisor◊ Plus Blade.
Lumo latsopano la arthroscopy lili ndi kapangidwe ka chubu mu chubu, kuphatikiza dzanja lakunja lachitsulo chosapanga dzimbiri komanso chubu chamkati chozungulira chozungulira chokhala ndi madoko ofananira ndi odula pamakono akunja ndi chubu lamkati.Zipinda zamkati ndi zakunja ndizokhazikika.Panthawi yogwira ntchito, mphamvu yamagetsi imapangitsa kuti chubu chamkati chizizungulira, ndipo chubu chakunja chimaluma ndi mano, chikugwirizana ndi kudula.Minofu yomaliza yodulidwa ndi matupi omasuka amachotsedwa pamgwirizano kudzera mu chubu chamkati chamkati.Kuti apititse patsogolo ntchito yodula komanso yogwira ntchito, adasankhidwa kupanga mano a concave.Kuwotcherera kwa laser kumagwiritsidwa ntchito pazinthu zophatikizika.Maonekedwe a mutu wometa wometa bwino akuwonetsedwa pa chithunzi 2.
Kapangidwe kambiri, m'mimba mwake wakunja wakumbuyo kwa shaver ya arthroscopic ndi yocheperako kuposa yakumbuyo.Lumo sayenera kukakamizika mu malo olowa, chifukwa nsonga ndi m'mphepete mwa zenera kudula amatsukidwa ndi kuwononga articular pamwamba.Komanso, m'lifupi mwa zenera shaver ayenera kukhala lalikulu mokwanira.Kukula kwazenera, m'pamenenso kumetedwa kwadongosolo kumadula ndikuyamwa, ndipo kumalepheretsa kutseka zenera bwino.
Kambiranani zotsatira za mbiri ya dzino pa mphamvu yodula.Mtundu wa 3D wa lumo unapangidwa pogwiritsa ntchito pulogalamu ya SolidWorks (SolidWorks 2016, SolidWorks Corp., Massachusetts, USA).Mitundu yakunja ya zigoba yokhala ndi mbiri yosiyana ya mano idatumizidwa ku pulogalamu yomaliza (ANSYS Workbench 16.0, ANSYS Inc., USA) kuti ifufuze ndikuwunika kupsinjika.Makina amakina (modulus of elasticity ndi Poisson's ratio) azinthu amaperekedwa mu Table.1. Kuchuluka kwa ma mesh omwe amagwiritsidwa ntchito pazitsulo zofewa kunali 0.05 mm, ndipo tinayenga nkhope za planer 11 pokhudzana ndi zofewa (mkuyu 3a).Mtundu wonsewo uli ndi ma node 40,522 ndi ma meshes 45,449.M'makonzedwe a malire, timakakamiza kwathunthu madigiri a 6 a ufulu woperekedwa ku mbali za 4 za minofu yofewa ndipo lezala imazungulira 20 ° kuzungulira x-axis (mkuyu 3b).
Kusanthula kwa mitundu itatu ya lumo (mkuyu 4) kunawonetsa kuti mfundo ya kupsinjika kwakukulu imachitika pakusintha kwadzidzidzi kwadongosolo, komwe kumagwirizana ndi zida zamakina.Lumo ndi chida chotayirapo4 ndipo pali chiopsezo chochepa cha kusweka kwa tsamba mukangogwiritsa ntchito kamodzi.Choncho, timayang'ana kwambiri luso lake locheka.Kupanikizika kwakukulu kofanana komwe kumachitika pa minofu yofewa kungasonyeze khalidweli.Pansi pazikhalidwe zomwezo zogwirira ntchito, pamene kupanikizika kwakukulu kofanana ndi kwakukulu kwambiri, kumaganiziridwa kuti katundu wake wodula ndi wabwino kwambiri.Pankhani ya kupsinjika kwa minofu yofewa, lumo la 60 ° la dzino limatulutsa kumeta ubweya wofewa kwambiri (39.213 MPa).
Kumeta ndi kufalikira kwa kupsinjika kwa minofu yofewa pamene malezala okhala ndi mawonekedwe osiyanasiyana amadula minyewa yofewa: (a) 50 ° mbiri ya dzino, (b) 60° dzino, (c) 70 ° mbiri ya dzino.
Pofuna kutsimikizira mapangidwe a tsamba latsopano la BJKMC, adafanizidwa ndi Dyonics◊ Incisor◊ Plus blade (Mkuyu 5) yomwe ili ndi ntchito yofanana.Mitundu itatu yofanana ya chinthu chilichonse idagwiritsidwa ntchito pazoyeserera zonse.Malumo onse omwe amagwiritsidwa ntchito ndi atsopano komanso osawonongeka.
Zinthu zomwe zimakhudza ntchito ya lumo ndi monga kulimba ndi makulidwe a tsamba, kuuma kwa chubu chachitsulo, ndi mbiri ndi ngodya ya dzino.Kuti muyese ma contours ndi ma angles a mano, pulojekiti yowonongeka yokhala ndi 0.001 mm inasankhidwa (Starrett 400 series, Fig. 6).Poyesera, kumeta mitu inayikidwa pa benchi yogwirira ntchito.Yezerani mbiri ya dzino ndi ngodya yofananira ndi ma crosshairs pazithunzi zowonetsera ndikugwiritsa ntchito micrometer monga kusiyana pakati pa mizere iwiriyi kuti mudziwe muyeso.Kukula kwenikweni kwa mbiri ya dzino kumapezedwa pogawanitsa ndi kukulitsa cholinga chosankhidwa.Kuti muyeze ngodya ya dzino, gwirizanitsani mfundo zokhazikika mbali zonse za ngodya yopimidwa ndi mphambano ya mzere waung'ono pa sikirini yoswedwa ndikugwiritsa ntchito zokhotakhota patebulo kuti muwerenge.
Pobwereza kuyesera kumeneku, miyeso yayikulu ya kutalika kwa ntchito (machubu amkati ndi akunja), ma diameter akunja ndi akunja, kutalika kwazenera ndi m'lifupi, ndi kutalika kwa dzino kunayesedwa.
Yang'anani makulidwe a pamwamba ndi cholozera.Nsonga ya chida imasunthidwa mopingasa pamwamba pa chitsanzo, perpendicular kwa malangizo a tirigu wokonzedwa.Wapakati roughness Ra analandira mwachindunji chida.Pa mkuyu.7 ikuwonetsa chida chokhala ndi singano (Mitutoyo SJ-310).
Kuuma kwa lumo kumayesedwa molingana ndi mayeso a Vickers kuuma kwa ISO 6507-1: 20055.Indenter ya diamondi imakanikizidwa pamwamba pa chitsanzo kwa nthawi yoperekedwa pansi pa mphamvu yoyesera.Kenaka kutalika kwa diagonal kwa indentation kunayesedwa pambuyo pochotsa cholembera.Kuuma kwa Vickers kumafanana ndi chiŵerengero cha mphamvu yoyesera kumtunda wa chithunzicho.
Makulidwe a khoma la mutu wometa amayezedwa ndikuyika mutu wa cylindrical mpira wolondola wa 0.01 mm ndi muyeso wa pafupifupi 0-200 mm.Makulidwe a khoma amatanthauzidwa ngati kusiyana pakati pa ma diameter akunja ndi amkati a chida.Njira yoyesera yoyezera makulidwe ikuwonetsedwa mkuyu 8.
Mapangidwe a lumo la BJKMC adafanizidwa ndi lumo la Dyonics◊ lamtundu womwewo.Zomwe zimachitika pagawo lililonse lazinthu zimayesedwa ndikufanizidwa.Kutengera ndi dimensional deta, kudula kuthekera kwa mankhwala onsewa ndi zodziwikiratu.Zogulitsa zonsezi zili ndi mawonekedwe abwino kwambiri, kuwunika kofananira kwamagetsi amagetsi kuchokera kumbali zonse kumafunikirabe.
Malinga ndi kuyesa kwa ngodya, zotsatira zikuwonetsedwa mu Table 2 ndi Table 3. Kutanthawuza ndi kupotoza koyenera kwa deta ya angle angle yazinthu ziwirizo sizinali zosiyana.
Kuyerekeza kwa magawo ena ofunikira azinthu ziwirizi kukuwonetsedwa mu Chithunzi 9. Pankhani ya mkati ndi kunja kwa chubu m'lifupi ndi kutalika, Dyonics◊ mawindo amkati ndi akunja a chubu ndi otalikirapo pang'ono komanso ochulukirapo kuposa a BJKMC.Izi zikutanthauza kuti Dyonics◊ ikhoza kukhala ndi malo ambiri odula ndipo chubu sichingatseke.Zogulitsa ziwirizi sizinali zosiyana powerengera pazinthu zina.
Zigawo za lumo la BJKMC zimalumikizidwa ndi kuwotcherera kwa laser.Choncho, palibe kukakamiza kunja pa weld.Gawo loti liwotchedwe silimakhudzidwa ndi kupsinjika kwa kutentha kapena kusintha kwa kutentha.Mbali yowotcherera ndi yopapatiza, kulowa kwake kuli kwakukulu, mphamvu yamakina ya gawo lowotcherera ndilapamwamba, kugwedezeka kumakhala kolimba, kukana kwamphamvu kumakhala kwakukulu.Zigawo za laser-welded ndizodalirika kwambiri mu msonkhano14,15.
Kukhwinyata pamwamba ndi muyeso wa kapangidwe ka pamwamba.Zigawo zamtundu wapamwamba kwambiri komanso zazifupi zamtundu woyezera, zomwe zimatsimikizira kuyanjana pakati pa chinthucho ndi chilengedwe chake, zimaganiziridwa.Manja akunja a mpeni wamkati ndi mkati mwa chubu chamkati ndizomwe zimagwirira ntchito za lumo.Kuchepetsa kukhwimitsa zinthu ziwirizi kumatha kuchepetsa kuvala kwa lumo ndikuwongolera magwiridwe antchito ake.
Kukula kwapamwamba kwa chipolopolo chakunja, komanso mkati ndi kunja kwa tsamba lamkati la machubu awiri achitsulo, adapezedwa moyesera.Miyezo yawo yapakati ikuwonetsedwa mu Chithunzi 10. M'kati mwa sheath yakunja ndi kunja kwa mpeni wamkati ndizo zikuluzikulu zogwirira ntchito.Kuvuta kwa mkati mwa scabbard ndi kunja kwa mpeni wamkati wa BJKMC ndi wotsika kuposa mankhwala ofanana a Dyonics◊ (matchulidwe omwewo).Izi zikutanthauza kuti malonda a BJKMC akhoza kukhala ndi zotsatira zokhutiritsa potsata ntchito yodula.
Malingana ndi kuyesa kwa kuuma kwa tsamba, deta yoyesera ya magulu awiri a lumo ikuwonetsedwa mu Chithunzi 11. Zambiri zazitsulo za arthroscopic zimapangidwa ndi chitsulo chosapanga dzimbiri cha austenitic chifukwa cha mphamvu zambiri, kulimba ndi ductility zomwe zimafunikira pazitsulo.Komabe, mitu yometa ya BJKMC imapangidwa kuchokera ku chitsulo chosapanga dzimbiri cha 1RK91 martensitic.Zitsulo zosapanga dzimbiri za martensitic zili ndi mphamvu komanso kulimba kwambiri kuposa zitsulo zosapanga dzimbiri za austenitic17.Zomwe zimapangidwa ndi mankhwala a BJKMC zimakwaniritsa zofunikira za S46910 (ASTM-F899 Surgical Instruments) panthawi yopanga.Zomwe zayesedwa za cytotoxicity ndipo zimagwiritsidwa ntchito kwambiri pazida zamankhwala.
Zitha kuwoneka kuchokera ku zotsatira za kusanthula kwazinthu zomaliza kuti kupsinjika kwa lumo kumakhazikika kwambiri pamano.IRK91 ndi chitsulo chosapanga dzimbiri champhamvu champhamvu cha supermartensitic cholimba kwambiri komanso cholimba champhamvu pazipinda zonse komanso kutentha kokwera.Mphamvu yamphamvu pa kutentha kwapakati imatha kufika ku 2000 MPa, ndipo kupanikizika kwakukulu kolingana ndi kusanthula kwazinthu kumafika pafupifupi 130 MPa, yomwe ili kutali ndi malire a zinthuzo.Timakhulupirira kuti chiopsezo cha kusweka kwa tsamba ndi chochepa kwambiri.
Kuchuluka kwa tsamba kumakhudza mwachindunji luso lodula la lumo.Kuchepa kwa makulidwe a khoma, kumapangitsanso ntchito yodula bwino.Lumo latsopano la BJKMC limachepetsa makulidwe a khoma la mipiringidzo iwiri yozungulira, ndipo mutu uli ndi khoma locheperako kuposa la Dyonics◊.Mipeni yopyapyala imatha kuwonjezera mphamvu yodulira nsonga.
Zomwe zili mu Table 4 zikuwonetsa kuti makulidwe a khoma la lumo la BJKMC loyezedwa ndi njira yoyezera makulidwe a khoma lozungulira ndi locheperapo kuposa la Dyonics◊ lumo lofanana.
Malinga ndi kuyesa koyerekeza, lumo latsopano la BJKMC la arthroscopy silinawonetse kusiyana koonekeratu kwa mapangidwe a Dyonics◊ ofanana.Poyerekeza ndi Dyonics◊ Incisor◊ Plus zoyikapo potengera zinthu zakuthupi, BJKMC zoyikamo zapawiri zimakhala ndi malo ogwirira ntchito komanso nsonga yolimba komanso yocheperako.Choncho, mankhwala a BJKMC amatha kugwira ntchito moyenera pa opaleshoni.Kafukufukuyu adapangidwa mwachiyembekezo ndipo magwiridwe antchito amayenera kuyesedwa pazoyeserera zotsatila.
Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B. Ndemanga pa zida zopangira opaleshoni za kuwonongeka kwa mawondo arthroscopic ndi arthroplasty yonse ya chiuno. Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B. Ndemanga pa zida zopangira opaleshoni za kuwonongeka kwa mawondo arthroscopic ndi arthroplasty yonse ya chiuno.Chen Z, Wang K, Jiang W, Na T, ndi Chen B. Ndemanga ya zida zopangira opaleshoni za arthroscopic knee debridement and total hip arthroplasty. Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B. 膝关节镜清创术和全髋关节置换术手术器械综述. Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B.Chen Z, Wang K, Jiang W, Na T, ndi Chen B. Ndemanga ya zida zopangira opaleshoni zowononga mawondo a arthroscopic ndi kubwezeretsa chiuno chonse.Ulendo wa Circus.65, 291-298 (2017).
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Kafukufukuyu sanalandire ndalama zenizeni kuchokera ku mabungwe aliwonse opereka ndalama m'magulu aboma, amalonda, kapena osachita phindu.
School of Medical Devices and Food Engineering, Shanghai University of Technology, No. 516, Yungong Road, Shanghai, People's Republic of China, 2000 93