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Kuwanda kwekuvhiyiwa kwe arthroscopic kwakawedzera mumakore makumi maviri apfuura, uye masisitimu ekugera arthroscopic ave chishandiso chinoshandiswa zvakanyanya chemapfupa. Zvisinei, mareza mazhinji haawanzo kupinza zvakakwana, ari nyore kupfeka, nezvimwewo. Chinangwa chechinyorwa chino ndechekuongorora hunhu hwechimiro chebanga idzva rine serrated double serrated reBJKMC (Bojin◊ Kinetic Medical) arthroscopic razor. Inopa tarisiro yekugadzirwa kwechigadzirwa uye maitiro ekusimbisa. BJKMC arthroscopic razor ine dhizaini ye tube-in-tube, ine sleeve yekunze yesimbi isina ngura uye tube yemukati ine hole inotenderera. Goko rekunze negoko remukati zvine mapombi ekukweva uye ekucheka anoenderana, uye kune maburi pagoko remukati nerekunze. Kuti zvienderane nedhizaini, yakaenzaniswa neDyonics◊ Incisor◊ Plus insert. Chitarisiko, kuomarara kwechishandiso, kuomarara kwechubhu yesimbi, ukobvu hwemadziro echishandiso, chimiro chezino, kona, chimiro chose, zviyero zvakakosha, nezvimwewo zvakaongororwa uye zvakaenzaniswa. nzvimbo yekushanda uye muromo wakaoma uye wakatetepa. Nokudaro, zvigadzirwa zveBJKMC zvinogona kushanda zvinogutsa mukuvhiya.
Joini riri mumuviri wemunhu imhando yekubatana kusina kunanga pakati pemapfupa. Iwo maumbirwo akaomarara uye akagadzikana anoita basa rakakosha muhupenyu hwedu hwezuva nezuva. Zvimwe zvirwere zvinoshandura kugoverwa kwemutoro mujoini, zvichikonzera kushomeka kwekushanda uye kurasikirwa nekushanda1. Kuvhiyiwa kwemapfupa kwechinyakare kwakaoma kurapa nemazvo kusingapindi zvakanyanya, uye nguva yekupora mushure mekurapwa yakareba. Kuvhiyiwa kweArthroscopy inzira isingapindi zvakanyanya inoda kuchekwa kudiki, inokonzera kukuvara kushoma uye mavanga, ine nguva yekupora nekukurumidza, uye matambudziko mashoma. Nekugadzirwa kwemidziyo yekurapa, nzira dzekuvhiya dzisingapindi zvakanyanya dzave nzira yakajairika yekuongorora nekurapa mapfupa. Nguva pfupi mushure mekuvhiyiwa kwekutanga kwebvi rearthroscopic, yakagamuchirwa zviri pamutemo senzira yekuvhiya naKenji Takagi naMasaki Watanabe muJapan2,3. Arthroscopy ne endoprosthetics ndedzimwe dzekufambira mberi kwakakosha mukurapa mapfupa4. Nhasi uno, kuvhiyiwa kwe arthroscopic kunoshandiswa kurapa zvirwere zvakasiyana-siyana, kusanganisira osteoarthritis, kukuvara kwemeniscal, kukuvara kwe anterior ne posterior cruciate ligament, synovitis, intra-articular fractures, patellar subluxation, cartilage uye loose body loses.
Kuwanda kwekuvhiyiwa kwe arthroscopic kwakawedzera mumakore makumi maviri apfuura, uye masisitimu ekugera arthroscopic ave chishandiso chinoshandiswa zvakanyanya chemapfupa. Parizvino, vanachiremba vane nzira dzakasiyana siyana dziripo kune vanachiremba, kusanganisira kuvakazve cruciate ligament, kugadzirisa meniscus, osteochondral grafting, hip arthroscopy, uye facet joint arthroscopy, zvichienderana nezvinodiwa nemuvhiyi1. Sezvo nzira dzekuvhiya dze arthroscopic dzichiwedzera kusvika kumajoini akawanda, vanachiremba vanogona kuongorora majoini e synovial uye kurapa varwere nenzira dzaisambofungidzirwa. Panguva imwe chete, zvimwe zvishandiso zvakagadzirwa. Zvinowanzova neyuniti yekudzora, ruoko rune mota ine simba uye chishandiso chekucheka. Chishandiso chekupatsanura chinobvumira kusveta nekuburitsa tsvina panguva imwe chete uye nguva dzose6.
Nekuda kwekuoma kwekuvhiyiwa kwe arthroscopic, zvishandiso zvakawanda zvinowanzo dikanwa. Zvishandiso zvikuru zvinoshandiswa mukuvhiyiwa kwe arthroscopic zvinosanganisira arthroscopes, probe scissors, punches, forceps, arthroscopic knives, meniscus blades and razors, electrosurgical instruments, lasers, radio frequency instruments nezvimwe zvishandiso 7.
Chisvo chinoshandiswa zvikuru mukuvhiya. Kune misimboti miviri mikuru yekuvhiya kwe arthroscopic. Chekutanga kubvisa zvasara zve cartilage yakashata, kusanganisira miviri yakasununguka ne cartilage inoyangarara, nekusveta nekusuka joini ne saline yakawanda kubvisa maronda emukati mearticular uye zvinodzivirira kuzvimba. Chimwe ndechekubvisa cartilage yakaparadzaniswa nepfupa re subchondral uye kugadzirisa dambudziko re cartilage yakasakara. Meniscus yakabvaruka inobviswa uye meniscus yakasakara uye yakatyoka inoumbwa. Marezor anoshandiswawo kubvisa zvimwe kana zvese zve synovial tissue zvinozvimba, zvakaita se hyperplasia uye thickening1.
Mazhinji ema scalpel asinganyanyi kupinda mukati ane chikamu chekucheka chine cannula yekunze isina chinhu uye chubhu yemukati isina chinhu. Haawanzove nemazino masere ane mapanga ekucheka. Matipi akasiyana emapanga anopa mazinga akasiyana esimba rekucheka kune reza. Mazino echinyakare e arthroscopic razor anowira muzvikamu zvitatu (Mufananidzo 1): (a) machubhu emukati nekunze akapfava; (b) machubhu ekunze akapfava uye machubhu emukati akapfava; (c) akapfava (angave banga rebanga)) machubhu emukati nekunze. 9. Kupinza kwawo kumatishu akapfava kunowedzera. Simba repamusoro uye kushanda zvakanaka kwesaha rine chimiro chimwe chete kuri nani pane 10 flat bar.
Zvisinei, kune matambudziko akati wandei nemidziyo yekugera ye arthroscopic iripo parizvino. Chekutanga, banga harina kupinza zvakakwana, uye zviri nyore kuvharika kana uchicheka nyama yakapfava. Chechipiri, reza inogona kungocheka nyama yakapfava ye synovial chete—chiremba anofanira kushandisa burr kupukuta pfupa. Saka, mapanga acho anofanira kuchinjwa nguva nenguva panguva yekushanda, izvo zvinowedzera nguva yekushanda. Kukuvara kwekucheka uye kupera kweganda re razor matambudziko akajairika. Kugadzirisa nemazvo uye kutonga kwakarurama kwakagadzira indekisi imwe chete yekuongorora.
Dambudziko rekutanga nderekuti banga rebvudzi harina kutsetseka zvakakwana nekuda kwemukana wakawandisa pakati pebanga remukati nerekunze. Mhinduro yedambudziko rechipiri inogona kuve yekuwedzera kona yebanga rebvudzi uye kuwedzera simba rechinhu chakagadzirwa.
Razor itsva yeBJKMC ine jira remhando yepamusoro ine jira rakapinza kaviri inogona kugadzirisa matambudziko ekucheka mipendero isina kusimba, kuvhara nyore uye kupfeka zvishandiso nekukurumidza. Kuti zviongororwe kushanda kwedhizaini itsva yerazor yeBJKMC, yakaenzaniswa neyaDyonics, iyo Incisor◊ Plus Blade.
Chiredzo chitsva che arthroscopic chine dhizaini yechubhu-iri-mu-chubhu, inosanganisira ruoko rwekunze rwesimbi isina ngura uye chubhu yemukati ine hollow inotenderera ine mapombi ekukweva uye ekucheka anoenderana paruoko rwekunze nechubhu yemukati. Makesi emukati nekunze anochekwa. Munguva yekushanda, sisitimu yemagetsi inoita kuti chubhu yemukati itenderere, uye chubhu yekunze inoruma mazino, ichibatana nekucheka. Kuchekwa kwenyama kwapera uye miviri yakasununguka zvinobviswa kubva pajoini kuburikidza nechubhu yemukati ine hollow. Kuti kucheka kuve kwakanaka uye kushanda zvakanaka, chimiro chemazino akakombama chakasarudzwa. Kushongedza kwelaser kunoshandiswa kune zvikamu zvakasanganiswa. Chimiro chemusoro wekugera mazino maviri wakajairika chinoratidzwa muMufananidzo 2.
Mukugadzirwa kwakajairika, dhayamita yekunze yemucheto wepamberi we arthroscopic shaver idiki zvishoma pane mugumo wepashure. Reza haifanirwe kumanikidzwa kupinda munzvimbo yejoini, nekuti zvese muromo nemupendero wehwindo rekucheka zvinosukwa uye zvinokuvadza pamusoro pe articular. Pamusoro pezvo, upamhi hwehwindo rekucheka hunofanira kunge hwakakura zvakakwana. Kana hwindo rakafara, shaver inocheka nekukweva, uye zviri nani kudzivirira kuvharika kwehwindo.
Kurukurai nezvemhedzisiro yeprofile yemazino pasimba rekucheka. Modhi ye3D yerazor yakagadzirwa uchishandisa software yeSolidWorks (SolidWorks 2016, SolidWorks Corp., Massachusetts, USA). Mamodheru ekunze ane profiles dzakasiyana dzemazino akapinzwa muchirongwa che finite element (ANSYS Workbench 16.0, ANSYS Inc., USA) kuti ashandiswe pameshi uye kuongorora kushushikana. Hunhu hwemechanical (modulus of elasticity uye Poisson's ratio) yezvinhu zvakapihwa muTafura. 1. Huremu hwemeshi hwakashandiswa kumatishu akapfava hwaive 0.05 mm, uye takanatsa 11 planer faces dzakasangana nematishu akapfava (Mufananidzo 3a). Modhi yese ine ma nodes 40,522 uye ma meshes 45,449. Mumamiriro emiganhu, tinodzikamisa zvizere madhigirii matanhatu erusununguko anopiwa kumativi mana ematishu akapfava uye razor blade inotenderedzwa 20° kutenderedza x-axis (Mufananidzo 3b).
Kuongororwa kwemhando nhatu dzerazor (Mufananidzo 4) kwakaratidza kuti poindi yekumanikidzwa kwakanyanya kunoitika kana chimiro chachinja kamwe kamwe, izvo zvinoenderana nehunyanzvi hwemuchina. Razor chishandiso chinoraswa4 uye hapana njodzi yekutyoka kwebanga panguva yekushandiswa kamwe chete. Nokudaro, tinonyanya kutarisa pakugona kwayo kucheka. Kumanikidzwa kwakanyanya kunoshanda panyama yakapfava kunogona kuratidza hunhu uhwu. Pasi pemamiriro akafanana ekushanda, kana kumanikidzwa kwakanyanya kuenzana kuri kukuru, zvinotanga kutariswa kuti hunhu hwayo hwekucheka ndihwo hwakanakisa. Panyaya yekumanikidzwa kwenyama yakapfava, razor ye60° yakaburitsa kumanikidzwa kwakanyanya kwenyama yakapfava (39.213 MPa).
Kupararira kwekugera uye kushushikana kwenyama yakapfava kana razor sheaths ine ma profiles akasiyana emazino ichicheka nyama dzakapfava: (a) profile yemazino 50°, (b) profile yemazino 60°, (c) profile yemazino 70°.
Kuti zvikwanisike kugadzira banga idzva reBJKMC, rakaenzaniswa nebanga rakaenzana reDyonics◊ Incisor◊ Plus (Mufananidzo 5) rine mashandiro akafanana. Mhando nhatu dzakafanana dzechigadzirwa chimwe nechimwe dzakashandiswa mukuyedza kwese. Mareza ese akashandiswa matsva uye haana kukuvara.
Zvinhu zvinokanganisa mashandiro ebvudzi zvinosanganisira kuomarara uye ukobvu hwebanga, kuomarara kwechubhu yesimbi, uye chimiro nekona yezino. Kuti uedze ma contours nemakona emazino, purojekiti ye contour ine resolution ye 0.001 mm yakasarudzwa (Starrett 400 series, Fig. 6). Mukuyedza, misoro yekuveura yakaiswa pabhenji rebasa. Yera chimiro chezino nekona zvichienzaniswa ne crosshairs pachidzitiro che projection uye shandisa micrometer semusiyano uripo pakati pemitsara miviri kuti uone chiyero. Saizi chaiyo yechimiro chezino inowanikwa nekuiparadzanisa nekuwedzera kwechinangwa chakasarudzwa. Kuti uedze kona yezino, enzanisa mapoinzi akasimbiswa kumativi ese ekona yakayerwa ne sub-line intersection pachidzitiro chakachekwa uye shandisa angle cursors patafura kuti utore kuverenga.
Nekudzokorora kuyedza uku, zviyero zvikuru zvehurefu hwekushanda (machubhu emukati nekunze), dhayamita dzekunze dzepamberi nedzekumashure, kureba nehupamhi hwehwindo, uye kukwirira kwezino zvakayerwa.
Tarisa kushata kwepamusoro nechinhu chinopinza. Musoro wechishandiso unofambiswa wakatwasuka pamusoro pemuenzaniso, wakatwasuka kuenda kudivi retsanga yakagayiwa. Avhareji yekushata kweRa inowanikwa zvakananga kubva pachishandiso. Pamufananidzo 7 panoratidza chishandiso chine tsono (Mitutoyo SJ-310).
Kuomarara kwemashizha erazor kunoyerwa zvichienderana neVickers hardness test ISO 6507-1:20055. Dhaimani indenter inodzvanywa pamusoro pemuenzaniso kwenguva yakatarwa pasi pesimba rekuyedza. Zvadaro kureba kwe diagonal kwe indentation kunoyerwa mushure mekubviswa kwe indenter. Kuomarara kweVickers kunoenderana nechiyero chesimba rekuyedza nenzvimbo yepamusoro yechiratidzo.
Ukobvu hwemadziro emusoro wekugera hunoyerwa nekuisa musoro webhora wakaita sedenderedzwa une hunyoro hwe 0.01 mm uye chiyero chekuyera chingangoita 0-200 mm. Ukobvu hwemadziro hunotsanangurwa semusiyano uripo pakati pedhayamita yekunze neyemukati yechishandiso. Maitiro ekuyedza ekuyera ukobvu anoratidzwa muMufananidzo 8.
Kushanda kwechimiro cheBJKMC razor kwakaenzaniswa nekweDyonics◊ razor ine chimiro chimwe chete. Data rekushanda kwechikamu chimwe nechimwe chechigadzirwa rinoyerwa uye rinoenzaniswa. Zvichibva padata rehukuru, kugona kwekucheka kwezvigadzirwa zvese zviri zviviri kunogoneka. Zvigadzirwa zvese zviri zviviri zvine hunhu hwakanaka hwechimiro, ongororo yekuenzanisa yekufambisa magetsi kubva kumativi ese ichiri kudiwa.
Zvichienderana nekuyedza kwekona, mhedzisiro yacho inoratidzwa muTafura 2 neTafura 3. Kutsauka pakati nepakati uye kwakajairika kwedata rekona yeprofile yezvigadzirwa zviviri izvi kwakanga kusina kusiyana kwehuwandu.
Kuenzanisa kwezvimwe zvinhu zvakakosha zvezvigadzirwa zviviri kunoratidzwa muMufananidzo 9. Panyaya yehupamhi nehurefu hwechubhu yemukati neyekunze, mahwindo echubhu yemukati neyekunze eDyonics◊ akareba uye akafara zvishoma kupfuura eBJKMC. Izvi zvinoreva kuti Dyonics◊ inogona kuva nenzvimbo yakakura yekucheka uye chubhu yacho hainyanyi kuvharika. Zvigadzirwa zviviri izvi hazvina kusiyana muzvikamu mune zvimwe zvinhu.
Zvikamu zveBJKMC razor zvakabatana ne laser welding. Saka, hapana kumanikidzwa kwekunze pa weld. Chikamu chinofanira kusungirirwa hachipinzwe mukupisa kana kushanduka kwekupisa. Chikamu chekusungirirwa chakamanikana, kupinda kwacho kwakakura, simba remuchina we welding rakakwira, kudedera kwakasimba, kuramba kukanganiswa kwakakwira. Zvikamu zvakasungirirwa ne laser zvinovimbika zvikuru pakuungana14,15.
Kukombama kwepazasi ndiko kuyera magadzirirwo epazasi. Zvikamu zvemafrequency akakwira uye mapfupi-mafungu epazasi zvakayerwa, izvo zvinosarudza kudyidzana pakati pechinhu nenzvimbo yacho, zvinofungwa. Bazi rekunze rebanga remukati nepazasi pechubhu yemukati ndizvo zvinonyanya kushanda pareza. Kuderedza kukombama kwenzvimbo mbiri idzi kunogona kuderedza kupfeka kwereza uye kuvandudza mashandiro ayo.
Kuomarara kweganda rekunze, pamwe chete nepamusoro pemukati nekunze kwebanga remukati remachubhu maviri esimbi, zvakawanikwa nekuyedza. Avhareji yehunhu hwavo inoratidzwa muMufananidzo 10. Pamusoro pemukati medanda rekunze nepamusoro pebanga remukati ndidzo nzvimbo huru dzinoshanda. Kuomarara kwemukati medanda remukati nepamusoro pebanga remukati reBJKMC kwakaderera pane zvigadzirwa zvakafanana zveDyonics◊ (zvakatsanangurwa zvakafanana). Izvi zvinoreva kuti zvigadzirwa zveBJKMC zvinogona kuva nemigumisiro inogutsa maererano nekushanda kwekucheka.
Zvichienderana nebvunzo rekuoma kwemapanga, data rekuyedza remapoka maviri emapanga erazor rinoratidzwa muMufananidzo 11. Mazhinji marezor earthroscopic anogadzirwa nesimbi isina tsvina yeaustenitic nekuda kwekusimba kwakanyanya, kuomarara uye ductility inodiwa pamapanga erazor. Zvisinei, misoro yekugera yeBJKMC inogadzirwa nesimbi isina tsvina ye1RK91 martensitic. Matayiro eMartensitic ane simba rakawanda uye kusimba kupfuura simbi dzisina tsvina dzeaustenitic17. Zvinhu zvemakemikari zviri muzvigadzirwa zveBJKMC zvinosangana nezvinodiwa zveS46910 (ASTM-F899 Surgical Instruments) panguva yekugadzira. Chinhu ichi chakaedzwa kuti chionekwe sechechirwere checytotoxicity uye chinoshandiswa zvakanyanya mumidziyo yekurapa.
Zvinogona kuonekwa kubva mumhedzisiro yekuongorora kwe finite element kuti huwandu hwekushushikana kwerazor hunonyanya kutarisisa paprofile yezino. IRK91 isimbi isina tsvina yakasimba ine simba guru uye yakasimba pakusimba kwekubata patembiricha yemukamuri uye patembiricha yakakwira. Simba rekusimba patembiricha yemukamuri rinogona kusvika kupfuura 2000 MPa, uye kukosha kwakanyanya kwekushushikana zvichienderana nekuongorora kwe finite element i130 MPa, iri kure nemuganhu wekutyoka kwechinhu chacho. Tinotenda kuti njodzi yekutyoka kwebanga idiki kwazvo.
Ukobvu hwebanga hunokanganisa zvakananga kugona kwekucheka kwereza. Kana ukobvu hwemadziro hukaita hutete, zvinoita kuti kucheka kuve nani. Reza itsva yeBJKMC inoderedza ukobvu hwemadziro embariro mbiri dzinotenderera dzakatarisana, uye musoro une madziro akatetepa kupfuura mamwe eDyonics◊. Mapanga akatetepa anogona kuwedzera simba rekucheka kwemuromo.
Data riri muTafura 4 rinoratidza kuti ukobvu hwemadziro eBJKMC razor hwakayerwa nenzira yekuyera ukobvu hwemadziro hwekudzvanywa-kutenderera hwakaderera pane hweDyonics◊ razor ine zvirevo zvakafanana.
Zvichienderana nekuyedza kwekuenzanisa, razor itsva yeBJKMC arthroscopic haina kuratidza musiyano uri pachena wekugadzira kubva kune yakafanana neDyonics◊ modhi. Zvichienzaniswa neDyonics◊ Incisor◊ Plus inserts maererano nehunhu hwezvinhu, BJKMC double nooth inserts ine nzvimbo inoshanda yakapfava uye muromo wakaoma uye wakatetepa. Saka, zvigadzirwa zveBJKMC zvinogona kushanda zvinogutsa mukuvhiya. Chidzidzo ichi chakagadzirwa nenzira yekufambira mberi uye mashandiro chaiwo anofanira kuyedzwa mukuyedza kunotevera.
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Chidzidzo ichi hachina kuwana mari chaiyo kubva kumasangano anobatsira mune zveveruzhinji, zvemabhizinesi, kana masangano asiri epurofiti.
Chikoro cheMidziyo Yekurapa neUinjiniya hweChikafu, Shanghai University of Technology, Nhamba 516, Yungong Road, Shanghai, People's Republic of China, 2000 93