Proximal humerus fractures yɛ mpaapaemu a ɛtaa ba wɔ trauma orthopedics mu no mu biako, na proximal humerus fractures dodow no ara yɛ nnompe mu akisikuru a ahoɔden kakraa bi na ɛwom wɔ nkwakoraa ne mmerewa mu.
Ɛwom sɛ wobetumi ayɛ proximal humerus akisikuru dodow no ara wɔ ɔkwan a ɛnyɛ nea wɔahyɛ da ayɛ so de, nanso 10-15% da so ara hia oprehyɛn ayaresa, a nea ɛka ho ne incisional reduction plate fixation, closed reduction intramedullary nail internal fixation, ne nkwaa a wɔde besi ananmu.
Ɛsɛ sɛ wogyina ɔyarefo no nipadua mu tebea, n’ankasa nsusuwii, adwene mu akwanhwɛ, ne sɛnea abubu no so na esi ayaresa ho gyinae.
Reseting ne fixation a egye ntɛmpɛ abubu
【Kamfoni】Ma proximal humeral kɛse tuberosity (NEER type 2 fã bi abubu) abubuw a wɔaka abom ne mmati dislocation, preoperative CT nhwehwɛmu, gye sɛ abubuw wɔ oprehyɛn kɔn mpɔtam, repositioning ne breki ne traumatic mmati brace wɔ ntɛm anesthesia (abenfo nyansahyɛ dodow: 100% 76.2%) na ɛwɔ hɔ.
2. Ɛyaw a emu yɛ den a wɔde siw ano ansa na wɔayɛ oprehyɛn
【Kamfoni】Ayarefo a wɔwɔ proximal humerus fracture no pɛ sɛ wɔde acetaminophen anaa NSAIDs a wɔnom di ɛyaw ano ansa na wɔayɛ oprehyɛn, na sɛ nkɛntɛnso no nyɛ papa a, wobetumi de opioids a wɔnom aka ho (abenfo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den: 73.8%).
3. Asɛmpatrɛwfo nhomasua ansa na wɔayɛ oprehyɛn
[Nkamfo] Ɛsɛ sɛ wɔyɛ nkyerɛkyerɛ ansa na wɔayɛ oprehyɛn wɔ akwan horow so na wɔfa akwan horow pii so. (Animdefo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den dodow: 83.8%)
4. Aduandi ho nhwehwɛmu a wɔyɛ ansa na wɔayɛ oprehyɛn ne ayaresa a ɛboa
【Kamfoni】Sɛ wobewie aduannuru ho nhwehwɛmu wɔ ayarefo mu wɔ 24 h akyi a wɔde wɔn akɔ ayaresabea na wɔde aduannuru ho nhyehyɛe ama ayarefo a wɔwɔ aduannuru ho asiane mu. (Animdefo nyansahyɛ dodow: 98.5%; nyansahyɛ a emu yɛ den dodow: 55.9%)
5. Glucose nhwehwɛmu ne nhyehyɛe a wɔyɛ wɔ oprehyɛn bere mu wɔ ɔyarefo a ɔwɔ asikreyare mu
【Kamfoni】Gycemic control botae a wɔkamfo kyerɛ ma asikreyare ayarefo dodow no ara a wɔreyɛ wɔn oprehyɛn a wɔpaw no ne 7.8 kosi 10.0 mmol/L.
6. Ntini a ɛyɛ mmerɛw a ɛho ahonhon wɔ oprehyɛn bere no mu a wɔhwɛ so
【Kamfoni】Wɔ ayarefo a wɔreyɛ wɔn oprehyɛn a wɔpaw ma proximal humerus fracture no, wɔde nipadua mu akwan horow pii ma de tew ɔfe so wɔ bere a wɔreyɛ oprehyɛn no mu. (Animdefo nyansahyɛ dodow: 98.5%; nyansahyɛ a emu yɛ den dodow: 80.9%)
7. Aduan a wɔde di dwuma ansa na wɔayɛ oprehyɛn
【Recommendation】 Ayarefo a wɔyɛ wɔn oprehyɛn a wɔpaw no betumi adi anonne a emu da hɔ 2 h ansa na wɔayɛ oprehyɛn ne nnuan a starchy anaa nufusu mu nneɛma 6 h ansa na wɔayɛ oprehyɛn. (Animdefo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den dodow: 76.5%)
8. Urinary catheter a wɔde di dwuma bere a wɔyɛ oprehyɛn no
【Kamfoni】Wɔnkamfo perioperative urinary catheterization a wɔyɛ no daa mma proximal humerus fracture oprehyɛn (Abenfo nyansahyɛ dodow: 100%; Strong recommendation rate: 78.6%)
9. Nnuru a wɔde kum mmoawa a wɔde di dwuma bere a wɔyɛ oprehyɛn no de siw ano
【Kamfoni】Wɔ ayarefo a wɔwɔ proximal humerus fractures a ɛhwehwɛ sɛ wɔde endoprosthesis anaa nkwaa si ananmu no, wɔkamfo kyerɛ sɛ wɔmfa awo ntoatoaso a edi kan ne nea ɛto so abien cephalosporins nni dwuma de siw ɔyare mmoawa ano wɔ oprehyɛn bere no mu. (Animdefo nyansahyɛ dodow: 97.1%; nyansahyɛ a emu yɛ den dodow: 73.5%)
10. Aduru a wɔde kum nipadua no a wɔpaw
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11. Mogya mmoroso a wɔde di dwuma wɔ oprehyɛn mu
[Nkamfo] Ɛsɛ sɛ wɔhwɛ mogya mmoroso a ɛso tew a ɛkɔ fam so na ama mogya a wɔhwere wɔ oprehyɛn no mu no so atew wɔ proximal humeral fractures ho, nanso ɛsɛ sɛ ayarefo a wɔn mfe akɔ anim a wɔwɔ comorbidities pii no hwɛ yiye sɛ wɔbɛkɔ so akura hemodynamic stability mu na wɔakwati sɛ wɔmfa nsu a ɛfata nkɔ ntini ne akwaa mu (abenfo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den dodow: 61.9%).
12. Oprehyɛn mu nne dodow a wɔhwɛ so
[Nkamfo] Fa nsuo a wɔde di dwuma ho nhyehyɛeɛ a egyina botaeɛ so di dwuma, na wɔbɛtumi de nnuru a ɛma mogya tu no ama wɔ ɔkwan a wɔfa so siw ano wɔ berɛ a wɔde aduru a wɔde kum nipadua no nyinaa bɛsiw nsuo a ɛboro soɔ ano (abenfoɔ nyansahyɛ dodoɔ: 100%; nyansahyɛ dodoɔ a emu yɛ den: 69.1%).
13. Mogya a wɔde di dwuma wɔ oprehyɛn mu
[Nkamfo] Wɔnkamfo mogya mmoroso a wɔhwɛ so wɔ oprehyɛn mu mma proximal humeral fractures, titiriw wɔ ayarefo a wɔn mfe akɔ anim mu, na wobetumi de mogya a wɔde ma wɔ oprehyɛn mu ne tranexamic acid ahyɛ mu. HGB <80g/L a wɔhwɛ wɔ oprehyɛn mu no kamfo kyerɛ sɛ wɔmfa mogya a ɛyɛ allogeneic mma (abenfo kamfo kyerɛ: 100%; nyansahyɛ a emu yɛ den: 73.8%).
14. Oprehyɛn mu ɔhyew a ɛba fam a wosiw ano
[Nkamfo] Ɛsɛ sɛ ayarefo a wɔwɔ proximal humeral fractures no hyɛ oprehyɛn no mu ɔhyew a wɔhwɛ so no mu den na wɔyɛ nneɛma ahorow a ɛbɛma core temperature akɔ so atra 36°C (abenfo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den: 76.2%).
15. Oprehyɛn kwan a wɔpaw
(1) Akisikuru a ɛkɔ so wɔ proximal humerus no mu
[Nkamfo] Wɔkamfo Neer staging kyerɛ ma proximal humerus fracture staging (abenfo nyansahyɛ dodow: 100%; nyansahyɛ a emu yɛ den dodow: 83.3%).
(2) Ɔkwan a wɔfa so yɛ oprehyɛn
Ɛsɛ sɛ wogyina sɛnea nnompe a abubu no te, nnompe no su, ɔyarefo no nipadua ne adwene mu tebea ne nneɛma afoforo a ɛfa ho so paw oprehyɛn nhyehyɛe no.
[Nkamfo] Wobetumi apaw ade a wɔde besi mu no sɛnea nnompe no abubu ne sɛnea nnompe no mu yɛ den te, te sɛ mprɛte anaa nnadewa a ɛwɔ medullary mu; wɔ ayarefo a wɔn mfe akɔ anim a wɔwɔ nnompe mu yare a ɛyɛ den sɛ wɔbɛsan de asi hɔ anaasɛ wobesiesie, afã 4 a abubu (ne abubuw a ɛpaapae), afã 3 a abubu a nnompe mu yare a emu yɛ den, mpaapaemu a apaapae ne nipadua mu kɔn a abubu, wɔpaw mmati nkwaa a wɔde nsa ayɛ, na wɔkamfo kyerɛ sɛ wɔmfa mmati nkwaa a wɔde si akyi sɛ wɔde ka rotator cuff opira ho a (abenfo kamfo kyerɛ:: 100% (Nkamfo a emu yɛ den: 71.4%).
![Humerus a ɛbɛn hɔ a ɛpaapae]()
Mfonini 1 Ɔbea bi a wadi mfe 65 a proximal humeral adductor insertion no mu abubu afã 4 na allograft fibular implant plate fixation a wɔatwa no na wɔasan de asi hɔ.
16. Wɔde kuru no mu nsuo afiri a wɔde si hɔ
[Nkamfo] Nneɛma a ɛkyerɛ sɛ wɔmfa nsuo a wɔde fa nsuo mu nsi hɔ: 1 Oprehyɛn akwan a ɛnyɛ den koraa (MIPPO ne nnadewa a wɔde hyɛ anom); 2 Mogya a ɛba fam. Nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde drainage tube besi: 1 via pectoral deltoid approach, locking plate fixation anaasɛ mmati nkwaa a wɔde besi ananmu; 2 mogya a ɛtɔ kɛse fi kuru no ani (abenfo kamfo kyerɛ: 100%; nyansahyɛ a emu yɛ den: 71.4%).
17. Kuru a wɔde to mu
【Kamfoni】Wɔde oprehyɛn no mu ntwitwiridii no mu denam nhama a ɛnyɛ den a wɔatwa mu, a wɔde ntama a wɔde fa so (abenfo nyansahyɛ dodow: 100%; nyansahyɛ dodow a emu yɛ den: 76.2%) so.
18. Oprehyɛn akyi aduan a wɔde ma obi ho tɔ no
【Kamfoni】Ayarefo betumi anom anonne a dregs-free via ano bere a wɔanyan wɔ oprehyɛn akyi, na wɔasan afi ase adi aduan a ɛfata wɔ 1-2 h akyi sɛ biribiara nni hɔ a ɛyɛ bɔne a.
19. Oprehyɛn akyi gyinabea a wɔpaw ne dwumadi a wɔyɛ no ntɛm
【Recommendation】Ɛho nhia sɛ ayarefo da fam wɔ pillow so wɔ oprehyɛn akyi, wobetumi agye semi-recumbent gyinabea na wobetumi akɔ fam bere a wɔanyan awie no. Ɛsɛ sɛ wɔde breki hyɛ mmati a ɛyɛ hu no mu.
20. Oprehyɛn akyi nnuru a wɔde kum ɛyaw
【Kamfoni】Wɔkamfo kyerɛ sɛ wɔmfa ɛyaw ano aduru a wɔde ma ayarefo a wɔwɔ proximal humeral fractures wɔ oprehyɛn akyi no nni dwuma sɛ wɔmfa regional blockade a wɔde NSAIDs 'akyi doses' a wɔde di dwuma daa aka ho, na sɛ ɛho hia a, wɔde ɛyaw ano aduru pɔmpɛ a wɔde fa ntini mu a wɔde ma wɔn ankasa anaasɛ peripheral nerve block a wɔde ma ɛyaw ano aduru a wɔde ma wɔn ankasa di dwuma (abenfo kamfo kyerɛ dodow: 100%; nyansahyɛ a emu yɛ den dodow: 78.6%) na ɛwɔ hɔ.
21. Oprehyɛn akyi akisikuru ne ɔfe a wosiw ano
[Nkamfo] Ɛsɛ sɛ wɔma ayarefo nyinaa nnuru a wɔde siw akisikuru ano simma 30 ansa na wɔawie oprehyɛn no. (Animdefo nyansahyɛ dodow: 97%; nyansahyɛ a emu yɛ den dodow: 47.8%)
22. Dwumadi mu ahosiesie
【Kamfoni】Ɛsɛ sɛ ayarefo a wɔwɔ proximal humerus fractures a ɛyɛ pintinn na ɛyɛ den no fi ase yɛ apɔw-mu-teɛteɛ a wɔde siesie wɔn ho ntɛm ara sɛnea wobetumi wɔ oprehyɛn akyi. Apɔw-mu-teɛteɛ a wɔde siesie nipadua no boa ma wɔsan de akwaa a ɛwɔ soro no yɛ adwuma yiye (Abenfo nyansahyɛ dodow: 100%; Kamfo a emu yɛ den: 92.9%).
23. Nneɛma a wɔde yi obi fi ayaresabea ne nea wodi akyi
【Nkamfo】Ɛsɛ sɛ wɔde gyinapɛn a mfaso wɔ so a wɔde bɛma wɔayi afi ayaresabea si hɔ, na ɛsɛ sɛ wodi ayarefo akyi daa anyɛ yiye koraa no asram 6 (abenfo nyansahyɛ dodow: 100%; nyansahyɛ dodow a emu yɛ den: 83.3%).
Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!
Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.
Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.
Yɛde nneɛma kɔ wiase nyinaa, enti wubetumi di yɛn ho nkɔmmɔ wɔ email address song@orthopedic-china.com na woanya asɛm bi a wontua hwee, anaa fa nkra mena wɔ WhatsApp so na woanya mmuae ntɛmntɛm +86- 18112515727 .
Sɛ wopɛ sɛ wuhu nsɛm pii a,kliki CZMEDITECH na woahu nsɛm pii.
