Ni inter rotator fracture kɔnɔna sirili ma ɲɛ do?

A jateminɛna ko kɔkili kari bɛ baliku 500 000 de minɛ Ameriki jamana na san o san. U bɛ nɔba bila ɲɛnamaya kɛcogo ɲuman na, sisan u bɛ kɛ 3-7% ye dɔgɔtɔrɔso kɔnɔ mɔgɔ sataw la ani san kelen saya hakɛ ye 19,4-58% ye. Kɔnɔbara karilenw bɛɛ tilancɛ ɲɔgɔn ye kɔkolo karilenw ye minnu bɛ wele ko intertrochanteric (IT). Fɛn fila minnu bɛ kɛ ka IT karilenw furakɛ, olu ye ɲɛgɛnɛsiralabanaw (CMN) ani sɔgɔsɔgɔninjɛ sɔgɔsɔgɔninjɛ (SHS) ye.

Hali ni ɲɛtaa kɛra fɛɛrɛ kuraw la, kolo tigɛcogo ni a jɔli dɛsɛ i n’a fɔ senkɔni kunkolo doncogo bɛ kɛ hali bi, wa a bɛ se ka kɛ tiɲɛni ye. Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko rezesiyɔn hakɛ bɛ se 6% ma ni bi fɛnw doncogo ye. Farati minnu bɛ fixation dɛsɛ la, olu ye tip-tip distance (TAD) >25 mm ye, kari yɔrɔ caman tɛ se ka sigi yɔrɔ wɛrɛ la, karicogo basigilen tɛ, kunsɛmɛnasumaya minnu bɛ sɔrɔ senkɔni kun kɛrɛ fɛ walima a cɛmancɛ jukɔrɔ, ani kɔnɔbara basigilen yɔrɔ kɔnɔna jiginni. Kɔrɔya ni koloci fana bɛ tali kɛ fiɲɛ bilali dɛsɛ la.

Banabagatɔw ni u kɛcogo

Nin kɛra kɔfɛ sɛgɛsɛgɛli ye banabagatɔw kan minnu furakɛra baarada fila la minnu bɛ kɛnɛyako siratigɛ la duguba dɔ kɔnɔ. Operelikɛla fila (JS ni BC) ka ko sɛbɛnw ɲininkali kɛra banabagatɔ bɛɛ la minnu ye seginkanni fiɲɛbɔli sɔrɔ ni siman barikama ye, IT karilenw labɛnni fɔlɔ dɛsɛlen kɔfɛ k’a ta san 2018 zanwuyekalo la ka se san 2021 sɛtanburukalo ma, o kɔfɛ, sigida lajɛjɛkulu ka sɔnni kɔfɛ. Siman barikalan baara kɛli opereli seginnkanni senfɛ, o tiɲɛna ni furakɛli sɛbɛnw lajɛli ye ɛntɛrinɛti kan (EMR) opereli sɛbɛnw ni opereli kɔfɛ arajolamaw. An ye banabagatɔ bɛɛ sen don minnu ka fanga bonya taamasiɲɛw bɛ siman na seginnkanni sirili la, IT karilenw CMN walima SHS fiɲɛbɔ fɔlɔ dɛsɛlen kɔfɛ (Jaa 1). An ye banabagatɔ minnu senkɔniw kɔ walima u senkɔniw karilen don, banabagatɔ minnu ma segin-ka-bɔnye kɛ ni siman barika bonya ye, ani banabagatɔ minnu ye joli-sira-funu kɛ segin-ka-bɔnye opereli fɔlɔ waati la, an ye olu bɔ kɛnɛ kan.

Jaa 1. Muso san 76 dɔ ye sɔgɔsɔgɔninjɛ kɛ a senkɔni kɔnɔ ka a sababu kɛ a senkɔni karilen don senkɔniw ni ɲɔgɔn cɛ (A), ni kɔdimi basigilen ye kalo 2 o kɔfɛ ka a sababu kɛ a senkɔni tigɛcogo ye (B).

Opereli kɛcogo minnu bɛ kɛ

Banabagatɔ minnu ye CMN sirili fɔlɔ kɛ, an ye kunkolo wulu caman cili caman kɛ ani ka kolo siman barika bonya. A daminɛ na, santimɛtɛrɛ 5 tigɛra kɛra wuluwuluba kɛrɛfɛla la, ka ɲɛminɛlan dɔ bila wuluwulu kɛrɛfɛla la, ka kolo bɛɛ bɔ wuluwulu kɛrɛfɛla la ni reamer da wulilen ye. O kɔfɛ, fɛnɲɛnamafagalan dɔ kɛra ka CMN sanfɛ sirilan lajɔ (Jaa 2).

Jaa 2, opereli kɔnɔ fluoroscopie min bɛ fɛnɲɛnamafagalan dɔ jira min bɛ kɛ ni kuru wɔɔrɔ ye, o bɛ kuru sigilen dɔ minɛ ani k’a lajɔ.

O kɔfɛ, santimɛtɛrɛ 1-2 tigɛli bɛ kɛ ka jigin ka tɛmɛ sɔgɔsɔgɔninjɛ fascia (ITB) fascia fɛ. Kungolo kungolo fɔlɔ bɛ bɔ ni ɲɛjiralan ye min bɛ kɛ ni kɔsegin ye (Jaa 3). Ni senkɔni kunkolo sɔgɔra, ɲɛjiralan dingɛlen dɔ bɛ kɛ ni a datugulan ye min bɛ yɔrɔjan walasa ka siman bɔli bali ka don joli la (Jaa 3A). Kɛrɛnkɛrɛnnenya la, matirili pikiri kɛra fɔlɔ kansɛri saba kɛnɛma fila bɔlen kɔfɛ, ka sɔrɔ ka a bila yɔrɔ la min kɔnɔna bɛ dawolo la ni kɛnɛma fila donli ye kokura.

Jaa 3, Banabagatɔ wɛrɛ ka ja minnu bɛ kɛ opereli kɔnɔ ɲɛfɛla kɔfɛ (A) ani kɛrɛfɛ (B) minnu bɛ senkɔni kunkolo jira ni kolotuguda cɛmancɛ la.

O kɔfɛ, bolokɔni bɛ sama ka sɔrɔ ka karilen bila yɔrɔ wɛrɛ la ka kɛ exostose caman ye walasa ka segin-ka-bɔnye siri. Ni kolosinsinnan ma ɲɛ walima ni fiɲɛ bɛ kɛnɛya, koloci bɛ kɛ farikolo la ni kolotuguda 1/4' ye ni ɲɛda ɲɛfɛla fɛɛrɛ ye. O man teli ka kɛ wajibi ye, nka a bɛ nɔ bɔ kosɛbɛ ni a mago bɛ a la walasa ka kɔnɔbara basigilen kɛ ka ɲɛ (laɲini >130°).

O kɔfɛ, kuru kura walima jiribolo kura bɛ don senkɔni kolo la senkɔni kunkolo la senkɔni kɔkolo fan fɛ, aw bɛ aw janto aw yɛrɛ la walasa a kana don kunkolo la (Jaa 4). Kuru in bɛ bila ni laɲini ye ka a yɛrɛ tanga wuluwulu tɛmɛnen ma, nka a bɛ a jira hali bi a laban na senkɔni kun cɛmancɛ la. (Jaa 5nan)

Jaa 4, Banabagatɔ wɛrɛ ka ɲɛfɛla kɔfɛ (A) ni kɔfɛla (B) ja minnu bɛ kerfing pikirijikɛlan doncogo jira kunkolo nɛgɛ kura sira kan.

Jaa 5, opereli kɔnɔ fluoroscopie min bɛ kunsɛmɛnasumaya sira kura doncogo jira ɲɛjiralan sira kan, o kɔfɛ, a sirilen don ni kuru sigilen ye.

A laban na, senkɔni kunkolo bɛ fa kolo siman na ni kolo siman pikiri kɛli ye (Jaa 6). Aw bɛ aw janto a la walasa a kana don joli la ni aw bɛ baara kɛ ni waati yɛrɛyɛrɛ ye ani ka siman kanɛli jugumanba ni a ɲɛsincogo ladilan.

Jaa 6, Ja minnu b’a jira ko siman bɛ caya a daminɛ na (A), a bɛ fa dɔɔni dɔɔni (B) fo ka se senkɔni kunkolo nafama fa (C).

Banabagatɔ minnu bɛ SHS fiɲɛbɔ fɔlɔ sɔrɔ, an bɛ SHS bɔ ka CMN jan dɔ bila a la. santimɛtɛrɛ 5 tigɛlen kɔfɛ cɛmancɛ la trochanter belebele jukɔrɔ ani ka ITB dɔn, tigɛ bɛ tigɛ ka jigin fo ka se kɛrɛfɛla plati ma. Plati kuru bɛɛ bɛ bɔ ni bololabɔlan bɛnnen ye, o kɔfɛ, kɛrɛfɛla bɛ bɔ. O kɔfɛ, tension screws bɛ bɔ ni reverse thread guide ye i n’a fɔ a ɲɛfɔra cogo min ka tɛmɛ walasa ka kariyɔrɔ in bila yɔrɔ wɛrɛ la ka se valgus hakɛ ma min ka bon. O kɔfɛ, santimɛtɛrɛ 5 tigɛ bɛ kɛ sɔgɔsɔgɔninjɛ belebeleba kun na i n’a fɔ a ɲɛfɔra cogo min ka tɛmɛ. Ɲɛjiralan dɔ bɛ don senkɔni belebeleba laban na min ka surun kosɛbɛ, ka taa ɲɛfɛ ka don senkɔni jiribolo la. Reamer da wulilen dɔ bɛ don ɲɛminɛlan sira fɛ. O kɔfɛ, bololabaarakɛlan jan dɔ bɛ siri senkɔni yɔrɔjan cɛmancɛ la, senkɔni senkɔni hakɛ jukɔrɔ. O kɔfɛ, reaming (reaming) kɛra ka taa a fɛ fo ka se yɛrɛyɛrɛli ma kɔkolo la. An ka banabagatɔ bɛɛ ye CMN nɛgɛ jan dɔ sɔrɔ ni TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA) ye.

Jɛkafɔ

An ka fɛɛrɛ bɛ baara kɛ ni kolo siman barika bonya ye seginnkanni sirili waati. Kolo siman barika bonya walasa ka kolotugudaw karilenw siri fɔlɔ, o sɛgɛsɛgɛra, wa a ye ɲɛtaa ɲuman jira biyomekaniki ni kɛnɛyako la. Kɔsa in na, seginnkanni dɔ y’a jira ko kolo siman barika bonya kɛra sababu ye ka dɛsɛ doni caya, ka dɔ bɔ fɛn dontaw jiginni na, ani ka gɛlɛyaw ni opereli seginni dɔgɔya ni i ye a suma ni a sirili ye min ma barika bonya. Sɛgɛsɛgɛli min kɛra ni mɔgɔw ye, min kɛra santiri caman na, o fana y’a jira ko opereli seginni walima CMN jiginni taamasiɲɛw si ma kɛ siman fangatigi kulu la ni i ye a suma ni ko wɔɔrɔ ye kulu min barika ma bonya.

Kɔnɔnatumu karilen saya ka ca. Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko mɔgɔ minnu bɛ sa dɔgɔtɔrɔso la, olu hakɛ bɛ 3-7% bɔ, ni san kelen mɔgɔfaga bɛ dɔgɔya ka bɔ 19,4% na ka se 58% ma. Kɛrɛnkɛrɛnnenya la, a jirala ko IT karilenw bɛ kɛ sababu ye ka mɔgɔ 27% sɔrɔ san kelen kɔnɔ. An ka kɛnɛyaso lajɛw y’a jira ko mɔgɔ si ma sa dɔgɔtɔrɔso la ani san kelen saya hakɛ ye 13,6% ye, o hakɛ ka dɔgɔn kosɛbɛ ni i y’a suma ni sɛbɛnw ye. Ikomi dilan teliya opereli kɔfɛ, o bɛ tali kɛ saya dɔgɔyali la, taama ɲuman ni baarakɛcogo ɲuman minnu bɛ sɔrɔ an ka seriyali kɔnɔ, olu bɛ se ka saya dɔgɔyali ɲɛfɔ min kɔlɔsira an ka banabagatɔw la.

Kuncɛli

Siman-reinforced revision fixation ye fɛɛrɛ ɲuman ye, min tɛ mɔgɔ tɔɔrɔ, wa a musaka ka dɔgɔn, ka ɲɛsin intertrochanteric fracture fixation dɛsɛli ma min tɛ banakisɛ sɔrɔ banabagatɔ kɔrɔbaw la, ni acetabular bone stock bɛ u la.

Banabagatɔ minnu ka sɔgɔsɔgɔninjɛ fɔlɔw sirili ma ɲɛ, ka sɔrɔ ka segin-ka-bɔnye kɛ ani ka furakɛli barikama kɛ ni siman ye, olu ye kɛnɛyako ni ɲɛnamaya kɛcogo ɲuman sɔrɔ kuntaalajan na. O kɛcogo tun bɛ kɛ dɔrɔn ni acetabular articular surface fanba maralen don ani kunkolo nɛgɛ tora senkɔni kɔ kɔnɔ. Ni an y’a jateminɛ ko joli segin-segincogo dan ye banabagatɔ kɔrɔba barikamaw ye, nin wale in bɛ layidu jira ka gɛlɛya juguw dɔgɔya cogo la min tɛ mɔgɔ tɔɔrɔ ani cogo ɲuman na ka sɔrɔ ka opereli waati ni musaka dɔgɔya nin banabagatɔ kulu in na.

Cogo min na i bɛ se ka kolotugudaw ni kolotugudaw sancogo?

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