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Ubushakashatsi ku mikorere y’uburoso bwa arthroscopic bwariyongereye mu myaka makumyabiri ishize, kandi sisitemu zo kogosha arthroscopic zabaye igikoresho gikoreshwa cyane mu gukata amagufwa. Ariko, inzembe nyinshi muri rusange ntiziba zityaye bihagije, zoroshye kwambara, n'ibindi. Intego y'iyi nkuru ni ukureba imiterere y'icyuma gishya gifite impande ebyiri z'uburoso bwa arthroscopic bwa BJKMC (Bojin◊ Kinetic Medical). Itanga incamake y'imiterere y'igicuruzwa n'uburyo bwo kwemeza. Urwo rwobo rwa arthroscopic rwa BJKMC rufite imiterere y'umuyoboro, ugizwe n'agasanduku k'inyuma k'icyuma kitagira umugese n'umuyoboro w'imbere uzunguruka. Igishishwa cy'inyuma n'igishishwa cy'imbere bifite aho bikura no gukata bikwiranye, kandi hari utudomo ku mpande z'imbere n'inyuma. Kugira ngo habeho imiterere, rwagereranyijwe n'agasanduku ka Dyonics◊ Incisor◊ Plus. Isura, ubukana bw'igikoresho, ubukana bw'umuyoboro w'icyuma, ubunini bw'urukuta rw'igikoresho, imiterere y'amenyo, inguni, imiterere rusange, ingano z'ingenzi, nibindi byagenzuwe kandi bigereranywa. Ubuso bw'akazi n'agace gakomeye kandi gato. Kubwibyo, ibicuruzwa bya BJKMC bishobora gukora neza mu kubaga.
Ingingo mu mubiri w'umuntu ni ubwoko bw'isano ritaziguye hagati y'amagufwa. Ni imiterere igoye kandi ihamye igira uruhare runini mu buzima bwacu bwa buri munsi. Indwara zimwe na zimwe zihindura imitwaro mu ngingo, bigatuma imikorere yazo igabanuka ndetse no kubura imikorere yazo1. Kubaga amagufwa gakondo biragoye kuvura neza iyo umuntu arwaye cyane, kandi igihe cyo gukira nyuma yo kuvurwa ni kirekire. Kubaga amagufwa mu buryo bwa arthroscopic ni uburyo bugabanya ubukana busaba gucibwa gato gusa, butera ibikomere bike n'inkovu, bukira vuba, kandi bukagira ingorane nke. Hamwe n'iterambere ry'ibikoresho by'ubuvuzi, uburyo bwo kubaga bugabanya ubukana bwagiye buhinduka uburyo busanzwe bwo gusuzuma no kuvura amagufwa. Nyuma gato y'aho babaze ivi rya mbere rya arthroscopic, byemejwe ku mugaragaro nk'uburyo bwo kubaga na Kenji Takagi na Masaki Watanabe mu Buyapani2,3. Arthroscopy na endoprosthetics ni bimwe mu byateye imbere by'ingenzi mu buvuzi bw'amagufwa4. Muri iki gihe, kubaga arthroscopic hakoreshejwe uburyo buciriritse bukoreshwa mu kuvura indwara zitandukanye n'imvune, harimo uburwayi bwa osteoarthritis, imvune zo mu bwoko bwa meniscal, imvune zo mu mitsi yo mu mutwe imbere n'inyuma, synovitis, imvune zo mu mutwe, patellar subluxation, cartilage n'ibisebe byo mu mubiri birebire.
Ubusanzwe kubagwa hakoreshejwe uburyo bwa arthroscopic byariyongereye mu myaka makumyabiri ishize, kandi uburyo bwo kogosha arthroscopic bwabaye igikoresho gikoreshwa cyane mu gukata amagufwa. Muri iki gihe, abaganga bafite amahitamo atandukanye aboneka ku baganga, harimo kubaka imitsi yo mu bwoko bwa cruciate ligament, gusana meniscus, grafting osteochondral, arthroscopy yo mu kibuno, na arthroscopy yo mu ngingo, bitewe n'ibyo umuganga akunda1. Uko uburyo bwo kubaga arthroscopic bwaguka bukagera ku ngingo nyinshi, abaganga bashobora gusuzuma ingingo za synovial no kubaga abarwayi mu buryo butari bwiyumvirwe mbere. Muri icyo gihe, hari ibindi bikoresho byakozwe. Akenshi bigizwe n'icyuma gipima, agakoresho ko mu ntoki gafite moteri ikomeye n'igikoresho cyo gukata. Igikoresho cyo gukata amagufwa gifasha gukurura no gusohora amagufwa icyarimwe kandi mu buryo buhoraho6.
Bitewe n'ubugoranye bwo kubaga arthroscopic, hakenerwa ibikoresho byinshi. Ibikoresho by'ingenzi bikoreshwa mu kubaga arthroscopic birimo arthroscopes, imikasi yo gupima, ibipfunsi, forceps, ibyuma bya arthroscopic, amenyo ya meniscus n'urwembe, ibikoresho byo kubaga hakoreshejwe amashanyarazi, lasers, ibikoresho bya radio frequency n'ibindi bikoresho 7.
Urwembe ni igikoresho cy'ingenzi mu kubaga. Hari amahame abiri y'ingenzi yo kubaga arthroscopic. Iya mbere ni ugukuraho ibisigazwa bya cartilage yangiritse, harimo n'imibiri idakora neza na cartilage igenda irembera, binyuze mu gukurura no gusukura ingingo n'umunyu mwinshi kugira ngo ukureho ibisebe biri hagati y'imitsi n'ibindi bikoresho bitera ububabare. Ikindi ni ugukuraho cartilage ya articular yatandukanyijwe n'igufwa rya subchondral no gusana ikibazo cya cartilage yashaje. Meniscus yacitse irakurwamo hanyuma meniscus yashaje kandi yavunitse igakora. Urwembe rukoreshwa kandi mu gukuraho bimwe cyangwa byose ku mitsi ya synovial itera ububabare, nka hyperplasia no gukomera1.
Inyinshi mu nsinga zitagira amenyo menshi zitera amenyo zifite igice cyo gukata gifite akantu ko hanze gafite ububobere n'umuyoboro w'imbere udafite ububobere. Ni gake cyane zigira amenyo 8 afite ububobere ku nkombe zo gukata. Impande zitandukanye z'amaboko zitanga imbaraga zitandukanye zo gukata ku bwogo. Amenyo asanzwe yo gukata amenyo ari mu byiciro bitatu (Ishusho ya 1): (a) imiyoboro yo imbere n'inyuma yoroshye; (b) imiyoboro yo hanze yoroshye n'imiyoboro yo imbere ifite ububobere; (c) ifite ububobere (ishobora kuba icyuma cyo gukata amenyo)) imiyoboro y'imbere n'inyuma. 9. Ubukana bwazo ku ngingo zoroshye buriyongera. Imbaraga z'ikirenga n'ubushobozi bwo gukata bw'umukero w'ingano imwe ni byiza kuruta icyuma 10 gifunganye.
Ariko, hari ibibazo byinshi ku bikoresho byo kogosha bya arthroscopic bihari ubu. Icya mbere, icyuma ntabwo gityaye bihagije, kandi biroroshye kuziba iyo ukata ingingo zoroshye. Icya kabiri, icyuma cyo kogosha gishobora gukata ingingo zoroshye za synovial gusa—umuganga agomba gukoresha agakoresho ko kogosha igufwa. Kubwibyo, ibyuma bigomba guhindurwa kenshi mu gihe cyo gukora, ibyo byongera igihe cyo gukora. Kwangirika kw'ibice no kwangirika kw'icyuma nabyo ni ibibazo bikunze kubaho. Gutunganya neza no kugenzura neza byagize igipimo kimwe cy'isuzuma.
Ikibazo cya mbere ni uko icyuma cyo kogosha kidakora neza bihagije bitewe n'icyuho kinini kiri hagati y'icyuma cyo imbere n'icyo hanze. Umuti w'ikibazo cya kabiri ushobora kuba wongera inguni y'icyuma cyo kogosha no kongera imbaraga z'ibikoresho by'ubwubatsi.
Urwembe rushya rwa BJKMC rukozwe mu buryo bwa arthroscopic rufite icyuma gifite impande ebyiri rushobora gukemura ibibazo byo guca impande zidasobanutse, kuziba byoroshye no kwangirika kw'ibikoresho vuba. Kugira ngo harebwe niba igishushanyo gishya cya BJKMC gifite akamaro, cyagereranyijwe n'icya Dyonics, Incisor◊ Plus Blade.
Urwembe rushya rwa arthroscopic rufite imiterere y'umuyoboro ujya mu muyoboro, harimo agakoresho k'inyuma k'icyuma kitagira umugese n'umuyoboro w'imbere uzunguruka ufite aho gukurura no gukata bihuye ku gakoresho k'inyuma n'umuyoboro w'imbere. Uduce tw'imbere n'inyuma turatoborwa. Mu gihe cyo gukora, sisitemu y'amashanyarazi ituma umuyoboro w'imbere uzenguruka, maze umuyoboro w'inyuma uruma amenyo, bigakorana n'aho gukata. Inyama ziciwe zirangiye n'imibiri irekuye bikurwa mu ngingo binyuze mu muyoboro w'imbere udafite umugese. Kugira ngo kunoze imikorere yo gukata no kunoza imikorere, hatoranijwe imiterere y'amenyo afite amenyo. Gusudira hakoreshejwe laser bikoreshwa mu bice bivanze. Imiterere y'umutwe usanzwe wo kogosha amenyo abiri igaragazwa ku Ishusho ya 2.
Mu miterere rusange, umurambararo w'inyuma w'inyuma y'icyuma cyo kogosha cya arthroscopic uba muto gato ugereranije n'inyuma. Urwembe ntirugomba gushyirwa mu mwanya w'ingingo, kuko impande zombi n'inkombe z'idirishya ryo gukata birasukurwa kandi byangiza ubuso bw'inyuma. Byongeye kandi, ubugari bw'idirishya ryo kogosha bugomba kuba bunini bihagije. Uko idirishya rirushaho kuba rinini, ni ko icyuma cyo kogosha gikata neza kandi kikanyunyuza, kandi ni ko kirinda kuziba kw'idirishya.
Ganira ku ngaruka z'imiterere y'amenyo ku ngufu zo gukata. Icyitegererezo cya 3D cy'ubwoya cyakozwe hakoreshejwe porogaramu ya SolidWorks (SolidWorks 2016, SolidWorks Corp., Massachusetts, USA). Ibishushanyo by'inyuma bifite imiterere y'amenyo itandukanye byinjijwe muri gahunda y'ibintu bingana (ANSYS Workbench 16.0, ANSYS Inc., USA) kugira ngo bikoreshwe mu gupima no gusesengura imihangayiko. Imiterere ya mekanike (uburyo bwo guhindagurika n'igipimo cya Poisson) by'ibikoresho iragaragazwa mu mbonerahamwe. 1. Ubucucike bw'ubwoya bwakoreshejwe ku ngirabuzimafatizo zoroshye bwari 0.05 mm, kandi twanogeje amaso 11 ya planer ahuye n'ingingo zoroshye (Ishusho ya 3a). Icyitegererezo cyose gifite utudomo 40.522 n'utudomo 45.449. Mu miterere y'imiterere y'umupaka, dushyira ku ruhande rwose dogere 6 z'ubwisanzure buhabwa impande 4 z'ingingo zoroshye kandi icyuma cyogosha kizunguruka 20° hirya no hino ku murongo wa x (Ishusho ya 3b).
Isesengura ryakozwe ku buryo butatu bwo gukata (Ishusho ya 4) ryagaragaje ko aho gukata cyane bibaho iyo habayeho impinduka mu buryo butunguranye, bihuye n'imiterere y'imikorere. Urwo rusasu ni igikoresho gikoreshwa mu gukata inshuro imwe4 kandi nta ngaruka nyinshi zo gucika kw'icyuma mu gihe cyo gukoresha rimwe. Kubwibyo, twibanda cyane ku bushobozi bwarwo bwo gukata. Umuvuduko ntarengwa ukoreshwa ku ngingo zoroshye ushobora kugaragaza iki kimenyetso. Mu mikorere imwe, iyo umuvuduko ntarengwa ukoreshwa ari munini, mbere na mbere harebwa ko imiterere yarwo yo gukata ari yo myiza kurusha izindi. Ku bijyanye n'umuvuduko ntarengwa w'ingingo zoroshye, urwasu rwa 60° rwatanze umuvuduko ntarengwa wo gukata ingingo zoroshye (39.213 MPa).
Uburyo bwo kogosha no gukwirakwiza imbaraga mu mubiri iyo amenyo y'amenyo afite imiterere itandukanye aciwemo ibice byoroshye: (a) amenyo afite imiterere ya 50°, (b) amenyo afite imiterere ya 60°, (c) amenyo afite imiterere ya 70°.
Kugira ngo hamenyekane imiterere y'icyuma gishya cya BJKMC, cyagereranyijwe n'icyuma kingana na Dyonics◊ Incisor◊ Plus (Ishusho ya 5) gifite imikorere imwe. Ubwoko butatu bumwe bwa buri gicuruzwa bwakoreshejwe mu igerageza ryose. Imashini zose zogosha zakoreshejwe ni nshya kandi ntizangiritse.
Ibintu bigira ingaruka ku mikorere y'amenyo birimo ubukana n'ubugari bw'icyuma, ubukana bw'icyuma, hamwe n'imiterere n'inguni y'amenyo. Kugira ngo upime imiterere n'inguni z'amenyo, hatoranijwe icyuma gipima imiterere gifite ubushobozi bwa mm 0.001 (Starrett 400 series, Fig. 6). Mu igerageza, imitwe yo kogosha yashyizwe ku ntebe yo gukoreramo. Pima imiterere y'amenyo n'inguni ugereranije n'imirongo iri ku gishushanyo hanyuma ukoreshe mikorometero nk'itandukaniro riri hagati y'imirongo ibiri kugira ngo umenye igipimo. Ingano nyayo y'imiterere y'amenyo iboneka ukoresheje uburyo bwo kuyagabanya ukoresheje uburyo bwo kuyakuza. Kugira ngo upime inguni y'amenyo, shyira ingingo zihamye ku mpande zombi z'inguni yapimwe n'aho umurongo uhurira ku gishushanyo cyakuweho hanyuma ukoreshe utudomo tw'inguni turi ku mbonerahamwe kugira ngo ufate imiterere.
Mu gusubiramo iri gerageza, ingano z'ingenzi z'uburebure bw'imikorere (imiyoboro y'imbere n'iy'inyuma), umurambararo w'inyuma n'inyuma, uburebure n'ubugari bw'idirishya, n'uburebure bw'amenyo byarapimwe.
Genzura ubukana bw'ubuso ukoresheje pinutener. Umutwe w'igikoresho wimuwe hejuru y'icyitegererezo, ugororotse ugana aho impeke zatunganyijwe ziherereye. Ubukana busanzwe bwa Ra buboneka buturutse ku gikoresho. Ku ishusho ya 7 herekana igikoresho gifite urushinge (Mitutoyo SJ-310).
Ubukana bw'inkoni zo mu bwoko bwa razor bupimwa hakurikijwe ikizamini cya Vickers cy’ubukana ISO 6507-1:20055. Inda y’inyuma ya diyama ishyirwa hejuru y’icyitegererezo mu gihe runaka munsi y’imbaraga runaka zo gupima. Hanyuma uburebure bw’inyuma bw’inda y’inyuma bwapimwe nyuma yo gukuraho inda y’inyuma. Ubukana bwa Vickers bungana n’igipimo cy’imbaraga z’igerageza n’ubuso bw’ishusho.
Ubugari bw'urukuta rw'umutwe wo kogosha bupimwa hakoreshejwe gushyiramo umutwe w'umupira w'ibumba ufite ubuziranenge bwa mm 0.01 n'urugero rwo gupima ruri hagati ya mm 0-200. Ubugari bw'urukuta busobanurwa nk'itandukaniro riri hagati y'umurambararo w'inyuma n'uw'imbere w'igikoresho. Uburyo bwo kugerageza gupima ubugari bugaragazwa ku Ishusho ya 8.
Imiterere y'icyuma cya BJKMC yagereranyijwe n'iy'icyuma cya Dyonics◊ gifite imiterere imwe. Amakuru y'imikorere ya buri gice cy'igicuruzwa arapimwa kandi akagereranywa. Hashingiwe ku makuru y'ingano, ubushobozi bwo gukata bw'ibicuruzwa byombi burateganywa. Ibicuruzwa byombi bifite imiterere myiza y'imiterere, isesengura rigereranya uburyo amashanyarazi atwara impande zose rirakenewe.
Dukurikije igerageza ry’inguni, ibisubizo bigaragazwa mu mbonerahamwe ya 2 n’imbonerahamwe ya 3. Impuzandengo n’itandukaniro ry’amakuru y’inguni y’imiterere y’ibicuruzwa byombi ntabwo byari bitandukanye mu mibare.
Igereranya ry'ibipimo bimwe na bimwe by'ingenzi by'ibicuruzwa byombi rigaragazwa ku Ishusho ya 9. Ku bijyanye n'ubugari n'uburebure bw'umuyoboro w'imbere n'uw'inyuma, amadirishya y'umuyoboro w'imbere n'uw'inyuma ya Dyonics◊ ni maremare kandi yagutse gato ugereranyije n'aya BJKMC. Ibi bivuze ko Dyonics◊ ishobora kugira umwanya munini wo gukata kandi umuyoboro w'amazi ntushobora kuziba. Ibi bicuruzwa byombi ntabwo bitandukanye mu buryo burambuye.
Ibice by'icyuma cya BJKMC bihuzwa no gusudira hakoreshejwe laser. Kubwibyo, nta gitutu cyo hanze kiba kuri solder. Igice kigomba gusudira ntigihura n'ubushyuhe cyangwa impinduka mu bushyuhe. Igice cyo gusudira ni gito, kwinjira ni kinini, imbaraga za mekanike z'igice cyo gusudira ni nyinshi, gutigita ni gukomeye, ubudahangarwa bw'ingaruka ni bwinshi. Ibice byasutswe na laser byizewe cyane mu guteranya14,15.
Ubugari bw'ubuso ni igipimo cy'imiterere y'ubuso. Ibice by'ubuso bipimwe bifite frequency nyinshi n'ibice bigufi, bigena imikoranire hagati y'ikintu n'ibidukikije, birasuzumwa. Agakoresho k'inyuma k'icyuma cy'imbere n'ubugari bw'imbere bw'umuyoboro w'imbere ni byo bikoreshwa cyane mu icyuma cyogosha. Kugabanya ubugari bw'ubuso bwombi bishobora kugabanya kwangirika kw'icyuma no kunoza imikorere yacyo.
Ubukana bw'ubuso bw'igishishwa cy'inyuma, kimwe n'ubuso bw'imbere n'inyuma bw'icyuma cy'imbere cy'imiyoboro ibiri y'icyuma, byabonetse mu buryo bw'igerageza. Impuzandengo yabyo igaragara ku Ishusho ya 10. Ubukana bw'imbere bw'icyuma cy'inyuma n'ubukana bw'inyuma bw'icyuma cy'imbere ni byo bikoreshwa cyane. Ubukana bw'ubuso bw'imbere bw'icyuma cy'inyuma n'ubukana bw'inyuma bw'icyuma cy'imbere cya BJKMC buri hasi ugereranije n'ibicuruzwa bisa bya Dyonics◊ (ibisobanuro bimwe). Ibi bivuze ko ibicuruzwa bya BJKMC bishobora kugira umusaruro ushimishije mu bijyanye n'imikorere yo gukata.
Dukurikije ikizamini cyo gukomera kw'icyuma, amakuru y'igerageza ry'amatsinda abiri y'ibyuma byogosha agaragara ku Ishusho ya 11. Ibyinshi mu bikoresho byogosha bya arthroscopic bikora mu byuma bitagira umugese bya austenitic bitewe n'imbaraga nyinshi, ubukana n'ubushobozi bwo gupfuka bukenewe ku bikoresho byogosha. Ariko, imitwe yo kogosha ya BJKMC ikorwa mu byuma bitagira umugese bya martensitic 1RK91. Ibyuma bitagira umugese bya martensitic bifite imbaraga n'ubukana bwinshi kurusha ibyuma bitagira umugese bya austenitic 17. Ibintu bya chimique biri mu bicuruzwa bya BJKMC byujuje ibisabwa na S46910 (ASTM-F899 Surgical Instruments) mu gihe cyo gucura. Ibikoresho byageragejwe kugira ngo harebwe uburozi bwa cytotoxic kandi bikoreshwa cyane mu bikoresho by'ubuvuzi.
Bigaragara mu byavuye mu isesengura ry’ibintu bito bito ko uburemere bw’umusuguro w’amenyo bwibanda cyane ku ireme ry’amenyo. IRK91 ni icyuma gikozwe mu cyuma gikonjesha cyane gifite imbaraga nyinshi kandi gikomera neza haba ku bushyuhe bw’icyumba ndetse no ku bushyuhe bwinshi. Imbaraga zo gukonjesha ku bushyuhe bw’icyumba zishobora kugera kuri MPa irenga 2000, kandi agaciro ntarengwa k’umusuguro nk’uko bigaragazwa n’isesengura ry’ibintu bito bito ni MPa 130, ibyo bikaba biri kure cyane y’aho ibikoresho bishobora gukonjesha. Twizera ko ibyago byo kuvunika kw’icyuma ari bike cyane.
Ubunini bw'icyuma bugira ingaruka zitaziguye ku bushobozi bwo gukata bw'icyuma. Uko icyuma gikata buhoro, niko icyuma gikata neza. Igikoresho gishya cya BJKMC kigabanya ubunini bw'urukuta rw'imitambiko ibiri izenguruka, kandi umutwe ufite urukuta rworoshye kurusha urwa Dyonics◊. Imbugita zoroshye zishobora kongera imbaraga zo gukata ku mutwe.
Amakuru ari mu mbonerahamwe ya 4 agaragaza ko ubugari bw'urukuta rw'urwembe rwa BJKMC bupimwe hakoreshejwe uburyo bwo gupima ubugari bw'urukuta bukoreshwa mu gukanda no kuzunguruka ari buto ugereranyije n'ubwa Dyonics◊ bwo buryo bumwe.
Dukurikije ubushakashatsi bugereranya, urwembe rushya rwa BJKMC rukozwe mu buryo bwa arthroscopic nta tandukaniro rigaragara rwagaragaje mu miterere yarwo n’iya Dyonics◊ isa. Ugereranyije n’udupira twa Dyonics◊ Incisor◊ Plus mu bijyanye n’imiterere y’ibikoresho, udupira twa BJKMC dufite ubuso bworoshye bwo gukora n’agace gakomeye kandi gato. Kubwibyo, ibicuruzwa bya BJKMC bishobora gukora neza mu kubaga. Ubu bushakashatsi bwakozwe mu buryo bukurikije icyerekezo kandi imikorere yihariye igomba kugeragezwa mu bushakashatsi bukurikira.
Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B. Isuzuma ku bikoresho byo kubaga byo gukuraho arthroscope mu ivi no gufunga ikibuno cyose. Chen, Z., Wang, C., Jiang, W., Na, T. & Chen, B. Isuzuma ku bikoresho byo kubaga byo gukuraho arthroscope mu ivi no gufunga ikibuno cyose.Chen Z, Wang K, Jiang W, Na T, na Chen B. Isuzuma ry'ibikoresho byo kubaga byo gukuraho uburibwe bw'amavi n'uburibwe bw'ikibuno cyose. 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, na Chen B. Isuzuma ry'ibikoresho byo kubaga byo gukuraho uburibwe bw'ivi mu buryo bw'imitsi no gusimbuza ikibuno cyose.Urugendo rwa Circus. 65, 291–298 (2017).
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Ishuri ry’ibikoresho by’ubuvuzi n’ubuhanga mu biribwa, Kaminuza y’ikoranabuhanga ya Shanghai, No. 516, Yungong Road, Shanghai, Repubulika y’Abaturage b’Ubushinwa, 2000 93