Ɔkwan bɛn so na wɔde aduru a ɛma obi ho yɛ no yaw di dwuma?

Botaeɛ

Proximal femur no periprosthetic fractures yɛ ɔhaw kɛse wɔ hip arthroplasty mu. Nea wɔbɔ ho amanneɛ no yɛ 3.5% wɔ mfe 20 akyi wɔ mfiase a wɔde hyɛɛ mu no akyi na ɛkɔ soro bere a wɔde nkwaa a wɔde si ananmu no ba no. Mpɛn pii no, oprehyɛn a wɔyɛ wɔ oprehyɛn no mu no ne ntini a wɔmfa nsiyɛ nka ho no wɔ abusuabɔ. Mpɛn pii no, mpanyimfo a wɔn mfe akɔ anim a wɔn mfe akɔ anim a wɔatɔ fam wɔ oprehyɛn mu no mu paapae. Ɛwom sɛ nsonsonoe wɔ amanaman ntam wɔ ntini a wɔde simenti ayɛ ne nea wɔmfa nhyɛ mu a wɔde di dwuma no mu de, nanso adanse biara nni hɔ a emu da hɔ a ɛkyerɛ sɛ dua biako a wɔde simenti ayɛ no ne asiane a ɛkɔ soro sen foforo no wɔ abusuabɔ. Vancouver nhyehyɛe a wɔde kyekyɛ nipadua no mu ma asen mu akisikuru no ayɛ nea nnuruyɛfo a wɔyɛ oprehyɛn no agye atom kɛse na wɔada no adi sɛ wotumi de ho to so.

Nhwehwɛmu yi botae titiriw ne sɛ ɛbɛkyerɛ abusuabɔ a ɛda Vancouver nkyekyem a ɛfa stem a wɔde simenti ayɛ ne nea wɔmfa nsiyɛ nka ho no ntam. Botae a ɛto so abien ne sɛ wɔbɛhwehwɛ nsonsonoe a ɛwɔ ayarefo a wɔn mu apaapae abien no mfiase su mu.

Nneɛma ne akwan a wɔfa so yɛ adwuma .

Ɔyarefoɔ:

1. Ayarefo a wɔtoatoaa so a na proximal periprosthetic fractures a ɛtoatoa so.

2. Ayarefo a wɔn asen mu ntini a ɛma wɔn ho yɛ wɔn yaw titiriw no nkutoo na wɔde wɔn kaa ho.

3. Wɔamfa ayarefo a wɔn mu apaapae wɔ oprehyɛn no mu, wɔn asen mu a wɔsan bubui, ne wɔn ho a wɔde yɛ wɔn ho a wɔde hyɛ wɔn ho no anhyɛ mu.

   
   

Data kyerɛwtohɔ:

1. Digital Radiography ne Computed Tomography a egyina ɛlɛtrɔnik nkrataa ne nhwehwɛmu so.

2. Nsɛm a wɔde gyinaa so a wɔkyerɛw too hɔ no bi ne mfe a obi adi, ɔbarima ne ɔbea nna, nipadua mu duru, ne sɛnea ɛkɔ so no so tew ansa na efi ase anaasɛ ɔhwɛfo a ɔde ne ho to so.

3. 
   

Oprehyɛn ho nsɛm a wɔakyerɛw ato hɔ:

1. Bere a wɔde hyɛ nipadua no mu nea edi kan, a ɛkyerɛ sɛ obi ho yɛ no hyew (osteoarthritis anaa fracture), dua no su (a wɔde ahyɛ mu anaasɛ wɔmfa nsia so), ne arthroplasty type (total or semiroprosty) kaa ho.

2. Mfoniniyɛ ho kyerɛwtohɔ a ɛkɔ akyiri no bi ne Vancouver nkyekyem, Varus vertebral gyinabea, ne DORR nkyekyem.

3. Wɔgyinaa radiographic a ɛda adi so yɛɛ dua geometry (conical anaa compound a wɔde yɛ cemented stems, straight or wedge-shaped for uncemented stems) no ho kyerɛwtohɔ.

4. Wɔde Vancouver nkyekyem no ho gyinaesi gyinaa nea wohui ne nea wohui wɔ oprehyɛn no mu wɔ ayarefo a wɔyɛɛ wɔn oprehyɛn no so.

5. Wɔde nsakraeɛ a ɛkɔ so t-sɔhwɛ ne Fisher sɔhwɛ a ɛyɛ pɛpɛɛpɛ a wɔde yɛɛ categorical variables no yɛɛ akontabuo nhwehwɛmu de totoo mfitiaseɛ su ne Vancouver nkyekyɛmu a ɛfa ayarefoɔ ho wɔ stem akuo a wɔde cemented ne uncemented ayɛ no mu.

6. Nsɔhwɛ ahorow no nyinaa yɛ afã abien a ɛho hia 0.05. Wɔde GraphPad Prism version 8.0.0 na ɛyɛɛ akontaabu nhwehwɛmu.

   
   

Nsunsuansoɔ

Ayarefo dodow:

1. Wɔnam ayaresabea no ho nsɛm a wobisae so huu ayarefo a wɔn dodow yɛ 1181.

2. Wɔamfa ayarefo 978 a na wɔn akyi berɛmo mu ayɛ wɔn yaw a ɛnyɛ akisikuru no anhyɛ mu.

3. Wɔ ayarefo 203 a wɔaka no mu no, na 8 wɔ oprehyɛn no mu akisikuru, 6 wɔ revision periprosthetic fractures, na 17 nyaa periprosthetic fractures a ɛwɔ hip joint fixation device no mu, a wɔansan anhyɛ mu.

4. Wɔde ayarefo a wɔn dodow yɛ 172 kaa ho bere a wɔayi wɔn afi mu akyi.

5. Mmubui nyinaa sii wɔ asehwe akyi. Femoral stem bone cement kuw no mu paapae wɔ nsɛm 84 mu a enni cement .

6. Ná akisikuru 88 na ɛwɔ kuw no mu.

   
   

Nneɛma a wɔde gyina so: .

1. Nsonsonoe kɛse wɔ akuw a wɔadi mfe, bere a wɔde hyɛ nipadua mu kan, nsɛnkyerɛnne a ɛkyerɛ sɛ arthroplasty wɔ asen mu kɔn mu a ɛpaapae, hemiarthroplasty titiriw, varus stem placement, ne nipadua mu duru a wɔde hyɛ nipadua mu no ntam.

2. Titiriw no, wɔ semɛnte kuw no mu no, na dodow no ara yɛ hemiarthroplasty.

3. Nsonsonoe titiriw biara amma akuw ahorow no mu wɔ ɔbarima ne ɔbea nna, DORR nkyekyɛmu, ne sɛnea na wɔn ho a wɔde wɔn ho to so ansa na wɔanyɛ wɔn ho anaasɛ ɔhwɛfo a wɔde wɔn ho to wɔn so no so atew ho.

4. Wɔ cemented kuw no mu no, na ntini dodow no ara yɛ teateaa na nea aka no yɛ composite designs.

5. Wɔ kuw a wɔmfa nsiyɛ nka ho no mu no, na ntini dodow no ara yɛ tẽẽ na nea aka no yɛ nea ɛte sɛ wedge.

   
   

Vancouver no mu nsɛm:

1. Vancouverb2 abubuo no, wɔakyekyɛ mu ayɛ no abubuo nhyehyɛeɛ anan a ɛsono emu biara: comminited 'burst', clamshell, ne helical patterns a wɔadi kan akyerɛkyerɛ mu, ne 'reverse' clamshell nsusuiɛ foforɔ a wɔahu no foforɔ. Wɔakyerɛ x-ray a ɛda adi wɔ x-ray a ɛwɔ ntoatoaso no mu ne mfonini mfonini a ɛne no hyia (Mfonini 1).

2. Ná ntini a ɛpae ne nea ɛyɛ nkuruwankuruwa no ne ntini a wɔde simenti ayɛ no wɔ abusuabɔ kɛse, bere a na flap a ɛpaapae no ne ntini a enni abon no wɔ abusuabɔ kɛse.

3. Reverse clamshell nhyehyɛe no sii saa ara wɔ ntini abien no nyinaa mu.

4. Vancouver nkyekyɛmu nketewa no fekubɔ, a B2 a ɛpaapae ahorow anan a yɛaka ho asɛm wɔ atifi hɔ no ka ho, ne stem geometry no da su a ɛwɔ abubuw ahorow mu no adi.

Pɛnsɛpɛnsɛ mu

Ɛde besi nnɛ no, eyi ne nhwehwɛmu kɛse a wɔde toto abusuabɔ a ɛda stem periprosthetic fractures ne Vancouver classification ntam no ho tẽẽ:

• Nsonsonoe titiriw biara amma abusuabɔ a ɛda cemented ne uncemented stems ntam wɔ Vancouver Type A, B, anaa C fractures mu. Na Vancouverb2 a ɛpaapaee no yɛ pɛ wɔ akuw abien no nyinaa mu, na ɛkyerɛ sɛ ntini a ɛyɛ den ne nea entumi nnyina no yɛ pɛ wɔ ntini a ɛwɔ akyi no mu wɔ akuw abien no nyinaa mu.

• Nea ɛne eyi bɔ abira no, Fenelon ne afoforo. Nhwehwɛmu a wɔyɛe wɔ periprosthetic fractures a ɛwɔ cemented ne uncemented stems mu. Ɛda adi pefee sɛ ayarefo dodow a wɔn mu apaapae wɔ Vancouver B2 ne B3 no dɔɔso kɛse.

• Phillips ne afoforo. Kyerɛkyerɛ 'burst' nhyehyɛe a ɛyɛ comminet a ɛyɛ den a ɛyɛ conical cement stem afã horow ne 'crack' wɔ cement jacket no ho, a ɛte sɛ 'agyan ti'. Wohui sɛ saa mpaapaemu yi ne cemented stems wɔ abusuabɔ kɛse wɔ nhwehwɛmu yi mu.

• 
  

• Saa mpaapaemu yi su a ɛyɛ comminet no ma nnompe a ɛma ɛyɛ adwuma no ho dadwen sɔre, na mpɛn pii no, saa akisikuru yi hwehwɛ sɛ woyi semɛnte no yiye na wɔde dua a ɛwɔ akyirikyiri twa ho hyia.

• Capello ne afoforo. Ɔkyerɛkyerɛɛ 'flip-flop' a ɛpaapae a ɛbata ntini a wɔmfa nsiyɛ nka ho mu, na nea wɔahu no da nea wɔahu yi adi. Mpaapaemu no fi ase fi mfinimfini fam a ɛwɔ trochanter kɛse no mu, ɛtrɛw kɔ mfinimfini cortex no so, na ɛkora akyi ntini no so, na ɛwɔ akyirikyiri kɔ trochanter ketewa no so. Talar region no a ɛyɛ kɛse ne dua no ase a ɛkɔ fam no yɛ radiographic signs of stem instability. Nhwehwɛmu ahorow a atwam no ada abusuabɔ titiriw bi adi wɔ saa mpaapaemu yi ne ntini a enni abon mu ne nipadua ne wedge-nsusuwii ho nhyehyɛe ahorow ho, na nhwehwɛmu yi foa saa fekubɔ yi so.

• Grammatopolous ne ne mfɛfo kyerɛkyerɛ helical fracture nhyehyɛe ahorow a ɛtoatoa so wɔ periprosthetic fractures a cemented stems wom mu, a mpɛn pii no ɛne wedge asinasin a atew ne ho ne comminution a emu yɛ den wɔ abusuabɔ. Helical fractures dodow a ɛwɔ cemented stem no mu no kɔɔ soro kɛse wɔ saa series yi mu, a ebetumi ada su a ɛwɔ abubuw a atwa cemented stem no ho ahyia no adi sɛ ɛbɛtrɛw wɔ ɔkwan a ɛte sɛ abɔde mu dompe so.

• Wɔ radiographic nhwehwɛmu a wɔyɛe wɔ periprosthetic fractures dodow bi ho no, nhwehwɛmu kuw no huu fracture nhyehyɛe bi a wɔanka ho asɛm kan wɔ nhoma ahorow mu. Mmubui no fi mfinimfini calcar a ɛfa lateral cortex no mu, na ɛma medial cortex no yɛ nea ɛwɔ hɔ. Wɔfrɛ saa mpaapaemu yi sɛ 'reverse' clamshell fracture, a nhwehwɛmu no buu no sɛ ɛyɛ Vancouver B2 a ɛpaapae.

• Wɔpaw saa din yi esiane nneɛma abien nti: nea edi kan no, ɛyɛ 'flip' no ahwehwɛ mfonini, na nea ɛto so abien no, ɛyɛ n’ade te sɛ reverse oblique proximal femoral fracture, a suprarallateral displacement a ɛte saa ara a ɛwɔ abductor no mu a ɛtwe proximal fragment no . Mmubui a ɛte saa ara bae wɔ cemented ne uncemented stems ho (Mfonini 2).

• Ɛwom sɛ na ɛnyɛ nhwehwɛmu yi atirimpɔw ne sɛ wɔbɛhwehwɛ nea efi ayaresa mu ba no mu de, nanso wɔ nhwehwɛmu yi mu no, na wɔtaa yɛ reverse flip-flop fractures no mu nsakrae denam arthroplasty a ɛyɛ stem a ɛwɔ akyirikyiri no so ne fixation a ɛwɔ proximal fracture fragments no mu a wɔde cercage wires anaa mprɛte ayɛ.

• Wɔada ɔyarefo bi a wɔde saa kwan yi ayɛ no nhwɛso adi, a ɛkyerɛ sɛnea ayaresa no atumi ayɛ adwuma (Mfonini 3).

Mfonini 2 Reverse flip-top fracture pattern.

Mfonini 3 arthroplasty ne cerclage wire fixation ma retrograde flap fractures.

Awie

Sɛnea Vancouver nhyehyɛe no kyerɛ no, periprosthetic fracture types no wɔ periprosthetic fractures a ɛwɔ cemented ne uncemented prostheses mu no ara. Enti, na ntini a ɛyɛ den ne nea entumi nnyina wɔ abubu akyi no yɛ pɛ wɔ akuw abien no mu. Sɛ wohu Vancouverb2 a ɛpaapae nhyehyɛe ahorow anan a ɛsono emu biara, a nea wɔayɛ no foforo a wɔadan no akyi a wɔdannan no ka ho a, ɛbɛboa oprehyɛn ho animdefo ahu sɛnea STEM no ntumi nnyina. Nhwehwɛmu a wɔbɛyɛ daakye ho hia na wɔde ahwehwɛ abusuabɔ a ɛda mpaapaemu su ne ayaresa ho nhyehyɛe ntam de ahu nea nhwehwɛmu yi mu nsɛm a wɔahu no kyerɛ wɔ ayaresabea.

Sɛnea wobɛtɔ nnompe mu nneɛma a wɔde hyɛ nipadua mu ne nnompe mu nnwinnade a wɔde yɛ aduan, .

Ma Czmeditech , yɛwɔ aduru a wɔde yɛ nnompe mu oprehyɛn a edi mũ yiye ne nnwinnade a ɛne no hyia, nneɛma a ɛka ho ne . akyi berɛmo a wɔde hyɛ nipadua mu ., nnadewa a wɔde hyɛ nipadua no mu ., Trauma mprɛte ., Mprɛte a wɔde to mu ., atiridiinini-maxillofacial ., Nneɛma a wɔde yɛ nipadua no ., Nnwinnade a ɛma ahoɔden ., abɔnten so fixators ., Arthroscopy ., Mmoa ho ayaresa ne wɔn adwinnade a ɛboa.

Nea ɛka ho no, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma a wɔyɛ mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛasan nso ama yɛn adwumakuw no asi akan kɛse wɔ wiase nyinaa nnompe mu nneɛma a wɔde hyɛ nipadua mu nyinaa mu.

Yɛde kɔ amannɔne wɔ wiase nyinaa, enti wubetumi . Wo ne yɛn nkasa wɔ email address song@orthopedic-china.com ma quote a wontua hwee, anaa fa nkrasɛm bi mena wɔ WhatsApp so ma mmuae ntɛm +86- 18112515727 .

Sɛ wopɛ sɛ wuhu nsɛm pii a, klik . Czmeditech na woahwehwɛ ho nsɛm pii.