Femur ƒe Intertrochanteric Fractures ƒe Gɔmesese
Afɔkpodzi ƒe gbagbã le lãkusiwo dome (si woyɔna hã be trochanteric fractures) fia gbagbã siwo dzɔna tso akɔta ƒe kɔ ƒe gɔme va ɖo afisi wòle le akɔta suetɔ tame. Nusiwo woɖena fiana dometɔ aɖewoe nye vevesese le teƒea, vuvu, ecchymosis. Dɔnɔwo mete ŋu zɔna o, abɔ si ŋu dɔlélea le la nɔa kpuie, eƒe ʋuʋu, eye wòtrɔna le gota, eye akɔta ƒe ƒunukpeƒea mete ŋu ʋãna o.
Gbagbã siawo nyea 3% - 4% le ŋutilã ƒe gbagbãwo katã me eye 35.7% le akɔta gbagbãwo me. Dɔlélea dzina ɖe edzi ne ame tsi, ebɔ ɖe amesiwo xɔ wu ƒe 70 me wu, eye wòbɔ ɖe nyɔnuwo me wu ŋutsuwo.
Applied Anatomy of the Intertrochanteric Fractures of the Femur
Ward ƒe Dzogoe Etɔ̃lia
Dzogoe etɔ̃ ƒe teƒe si woate ŋu adze afɔku le la dzɔna le titina nuto si me afɔkpodzi ƒe kɔ ƒe ʋukawo tsona le. Le ame tsitsi siwo ŋu ƒumeŋuɖui le gome la, ami koe yɔa teƒe sia fũ.
Afɔkpodzi ƒe Calcar
Ƒu gbadzɛ aɖe si le megbe - titina va ɖo afɔkpodzi ƒe kɔ kple akɔta ƒe ƒoƒoƒe si goglo va ɖo trochanter suetɔ gbɔ. Enye megbe - titina ƒe lãkusi ƒe kekeɖenudɔwɔwɔ le afɔkpodzi ƒe ƒu me yi ƒu si le ƒu me eye wònye teƒe si wotsɔa agba si to vovo na afɔkpodzi si te ɖe eŋu la dea.
Akɔtaƒu ƒe Trabeculae ƒe Dzesidede
Mɔ̃ ƒe ŋusẽ si le afɔkpodzi si te ɖe eŋu ƒe dzesidede:
(1) Dzeside 6; (2) Klass 5 lia; (3) Klass 4 lia; (4) Klass 3 lia; (5) Klass 2 lia; (6) Klass 1 lia
Nuveviwɔame ƒe Mɔnuwo le Afɔkpodzi ƒe Intertrochanteric Fractures me
High - energy Nuveviwɔamewo le Sɔhɛ Dɔnɔwo me
Zi geɖe la, abi siwo ŋu ŋusẽ geɖe le abe anyidzedze tso kɔkɔƒe kple ʋufɔkuwo gbɔe wòtsona be intertrochanteric fractures le sɔhɛ dɔnɔwo me. Nɔnɔme siawo ate ŋu ana woagbã vevie, eye ele be woalé ŋku ɖe dɔnɔwo ŋu nyuie be woaxɔ abi siwo do ƒome kplii hã, siwo dometɔ aɖewoe nye esiwo le ta, akɔta, kple akɔta kple ƒodo ƒe ŋutinuwo ŋu.
Nusiwo Hea Dɔnɔ Tsitsiwo ƒe Anyidzedze vɛ
90% le intertrochanteric fractures le ame tsitsiwo me tso anyidzedze gbɔ. Nusiwo nana ame tsitsiwo dina be yewoadze anyi dometɔ aɖewoe nye ŋku ƒe nukpɔkpɔ nyuie o, lãmekawo ƒe ŋusẽ dzi ɖena kpɔtɔna, ʋu ƒe sisi meli ke o, nuwɔwɔ ƒe ŋutete si dzi ɖena kpɔtɔna, ʋukawo me dɔlélewo, kple ƒu kple ƒunukpeƒedɔlélewo.
Nenye be anyidzedze na wògbã la, nu atɔ̃ siawoe wotsɔ dea dzesii: alesi ƒumeŋuɖui sesẽe, afisi wòdze anyi ɖo, vevietɔ ne akɔta alo teƒe aɖe si te ɖe akɔta ŋu va dze anyigba, ametakpɔnu siwo mesɔ gbɔ be woaɖe ŋusẽ si le anyidzedzea me dzi akpɔtɔ o, akɔta ƒe lãkusi falɛfalɛwo ƒe ŋutete be woaxɔ ŋusẽ si sɔ, kple akɔta ƒe ƒuwo ƒe ŋusẽ si mesɔ gbɔ o.
Ŋutasẽnuwɔwɔ Ƒomeviwo Kple Mɔnu Siwo Wotsɔ Wɔ Nui
Ŋutasẽnuwɔwɔ Tsã: Abi siwo ŋu ŋusẽ le ŋutɔ wɔa dɔ ɖe akɔta tẽ, abe ʋufɔkuwo alo anyidzedze le afisiwo akɔta dze le tẽ ene, si wɔnɛ be wògbãna.
Ŋutasẽnuwɔwɔ si metso tẽ o: Ŋutilã ƒe ʋuʋu nana akɔta nɔa varus kple ŋgɔgbe ƒe dzogoe ƒe nuteɖeamedzi me. Esi trochanter suetɔ nye fulcrum ta la, womiãnɛ sesĩe, eye iliopsoas lãmeka ƒe heheŋusẽ hã ate ŋu anɔ anyi, si awɔ ƒu kakɛ si le abe kpakpaluʋui ene. Trochanter gãtɔ ate ŋu awɔ ƒu kakɛ si ma ɖe vovo hã le gluteus medius lãmeka ƒe hehe sesẽ ta.
Dɔdaƒe ƒe Ƒomedodo le Afɔkpodzi ƒe Intertrochanteric Fractures ŋu
Evans ƒe hatsotsowo me toto
Wozãnɛ wu le atikewɔnyawo me. Evans ma intertrochanteric fractures ɖe ƒomevi eve me:
Ƒomevi I:Trans - trochanteric fractures Le alesi wòli ke do ŋgɔ na edziɖeɖe kple emegbe nu la, wogamae ɖe hatsotso sue 4 me:
Ia: Eve - akpa ƒe gbagbã si me ʋuʋu manɔmee.
Ib: Akpa eve ƒe gbagbã kple ʋuʋu, titina lãkusia me gblẽ vie, eye gbagbãƒea li ke le edziɖeɖe vɔ megbe.
Ic: Trochanter suetɔ la mevo o, eye eƒe gbagbã ƒe ʋuʋu kple varus ƒe nɔnɔme gblẽ; alo trochanter gãtɔ nye ƒu kakɛ aɖe si to vovo.
Id: Tsɔ kpe ɖe ƒu ƒe gbagbã ŋu la, ƒu ƒe akpa gãtɔ kple suetɔ siaa zua ƒu kakɛ vovovowo, eye varus ƒe nɔnɔme gblẽna.
Le wo dome la, ƒomevi Ia kple 1b nye ƒomevi siwo li ke, eye susɔeawo nye ƒomevi siwo meli ke o.
Ƒomevi II:Reverse - oblique intertrochanteric fractures
Ƒomevi II nye reverse - trochanteric fracture, eye gbagbã ƒe fli la kekena ɖe enu le ŋgɔgbe tso trochanter gãtɔ te va ɖoa trochanter suetɔ ƒe akpa si le etame.
AO ƒe hatsotsowo me toto
Ƒomevi A1: Akpa eve ƒe gbagbã bɔbɔewo to trochanter me, eye wotsɔa titinaƒu ƒe lãkusi kple axadziƒu ƒe akpa si me gblẽ o kpena ɖe eŋu nyuie.
Le intertrochanteric fli la dzi.
To trochanter gãtɔ dzi.
To trochanter suetɔ dzi.
Ƒomevi A2: Ƒu ƒe gbagbã siwo to trochanter dzi, eye titinaƒu ƒe gbagbã le yameʋu eve me, gake axadziƒu ƒe lãkusi ya gakpɔtɔ le nenema.
Kple titina ƒe gbagbã ƒe kakɛ ɖeka.
Le titina ƒe gbagbã ƒe kakɛ geɖe me.
Ekeke wu sentimeta 1 le trochanter suetɔ te.
Ƒomevi A3: Trɔ megbe - intertrochanteric fractures, kple lateral cortex ƒe gbagbã hã.
Oblique ƒe nɔnɔme.
Tsitretsitsi.
Wotsɔe na.
Zi geɖe la, wobua ƒomevi A1.1 vaseɖe A2.1 be woli ke, eye wobua ƒomevi A2.2 vaseɖe A3.3 be womeli ke o.
Amekoko ƒe Atikewɔwɔ na Afɔkpodzi ƒe Ʋukawo Dome Gãwo
Taɖodzinu vevitɔ si le amekoko ƒe atikewɔwɔ ŋue nye be woaɖo akɔta ƒe gbagbãƒea sesĩe le edziɖeɖe vɔ megbe. Alesi nusi wotsɔ blaa ƒua ƒe sesẽme nɔa te ɖe nusiwo gbɔna dzi: ƒu ƒe nyonyome, ƒu ƒe gbagbã ƒomevi, edziɖeɖe, alesi wowɔ nusi wotsɔ blaa ememenuwoe, kple afisi woatsɔ nusi wotsɔ blaa ememetɔa aɖoe.
Le ƒe ʋɛ siwo va yi me la, wotoa nusiwo wotsɔ léa ememenuwo ɖe te hena atikewɔwɔ na ʋukawo dome gbagbãwo vɛ ɣesiaɣi hewɔa wo yeyee. Le wo dome la, wozãa intramedullary fixation, abe PFNA kple INTERTAN ene, zi geɖe abe ememe fixation device si wozãna ɖaa ene.
PFNA na Afɔkpodzi ƒe Intertrochanteric Fractures ƒe Atikewɔwɔ
Wozãa PFNA na ƒumeŋuɖui ƒe ƒu ƒe gbagbã siwo meli ke o abe Evans Ic, Id, kple Type II ene. Eƒe dɔwɔwɔ nyo wu, eƒe ŋutete nyui si tsi tre ɖe tɔtrɔ ŋu, dɔwɔwɔ ƒe ɣeyiɣi kpui, ʋu si mebɔ o, kuxi ʋɛ aɖewo, eye kakaɖedzi si li be proximal locking nail cut - out, si ɖe atikewɔwɔ ƒe viɖe siwo dze ƒã fia.
Wofia PFNA na ƒumeŋuɖui ƒe ƒu ƒe gbagbã siwo meli ke o (abe Evans ƒomevi Ic, Id, kple II ene). Eɖea dɔwɔwɔ nyuie wu fiana kple ŋutete nyui aɖe si tsi tre ɖe tɔtrɔ ŋu, dɔwɔwɔ ƒe ɣeyiɣi kpui aɖe, ʋu ƒe gege dzi ɖeɖe kpɔtɔ, kple kuxi ʋɛ aɖewo. Nuɖoanyia ƒe helical blade ƒe wɔwɔme ƒoa ƒua nu ƒu nyuie, si naa ŋusẽ sesẽ si léa ƒua ɖe asi eye wòɖea afɔku si le be woatsoe le afɔkpodzi ƒe ta ŋu dzi kpɔtɔna ŋutɔ, si naa atikewɔwɔ me viɖe vovovowo.
INTERTAN na Atikewɔwɔ na Afɔkpodzi ƒe Ʋukawo Dome Gãwo
Esi woto egbegbe atikewɔwɔmɔnu vɛ ta la, INTERTAN nye ɖa yeye aɖe si wozãna le lãkusi me si wowɔ koŋ na akɔta ƒe gbagbã siwo le lãkusiwo dome la dada. Eƒe ɖa vevitɔ ƒe cross - section nye trapezoidal. Ne wozãe kpe ɖe proximal interlocking combined nail ŋu la, ateŋu axe mɔ ɖe 'Z' ƒe ŋusẽkpɔɖeamedzi nu. Ne wotsɔ ɖa evelia si do tso afɔkpodzi ƒe ta la kpe ɖe eŋu la, edzia lag screw ƒe anti - rotational ŋusẽkpɔɖeamedzi ɖe edzi. Woate ŋu azã ɖa sia si le lãkusi me le mɔ vovovowo nu eye wòsɔ na dɔnɔ siwo ŋu ƒumeŋuɖui sesẽ le.
INTERTAN nye ɖa yeye aɖe si le lãkusi me si wowɔ koŋ na lãkusi ƒe gbagbã, si ɖe ŋgɔyiyi siwo wowɔ le egbegbe atikewɔwɔ me fia. Eƒe ɖa vevitɔa ƒe akpa si le abe trapezoidal ene le eŋu be wòali ke nyuie wu. Akpa si te ɖe eŋu la zãa xɔtuɖoɖo si wotsɔ ƒo ƒui (lag screw kple compression screw), si xea mɔ nyuie na 'Z-effect' (afisi screw ɖeka trɔna ɖe megbe esime evelia gena ɖe afɔkpodzi ƒe ta me). Set screw bubu aɖe na lag screw la te ŋu dona ɖe afɔkpodzi ƒe ta me yi ŋgɔe, si wɔnɛ be eƒe ŋutete si tsi tre ɖe tɔtrɔ ŋu dzina ɖe edzi. Dzesi vovovowo le ɖa sia ŋu eye wòsɔ na dɔnɔ siwo ŋu ƒumeŋuɖui sesẽ le koŋ.
CHANGZHOU MEDITECH Mɔ̃ɖaŋununya CO., LTD. bi ɖe ƒumeŋuɖui siwo wɔa dɔ nyuie kple amekoko ƒe atike deŋgɔwo me. Enye mɔ̃ɖaŋudɔwɔƒe deŋgɔ si ƒoa Numekuku kple Dɔwɔnawo, nuwɔwɔ, nudzadzra, kple subɔsubɔdɔwo nu ƒu ɖekae.
Le xexemenunya si nye 'Innovation Driven, Pursuit of Excellence,' dzi wɔwɔ me la, dɔwɔƒea ƒe adzɔnuwo ƒe hatsotso bliboa ku ɖe akɔta, intramedullary nails, locking plates, gotagome fixation, ƒunukpeƒewo, craniomaxillofacial, lãwo ƒe dɔléle, elektrikdɔwɔnuwo, dɔwɔnu veviwo, kple balloons ŋu. Adzɔnu siawo tsi tre ɖi na nuto vevi siwo me mɔ̃ɖaŋununya ƒe nu yeyewo dodo ɖe ŋgɔ le le lãmesẽnyawo gbɔ kpɔkpɔ dɔwɔƒea me, eye woɖoe kplikpaa be yewoana amekoko ƒe tiatia siwo me kɔ eye kakaɖedzi le wo ŋu xexeame katã ƒe atikewɔlawo. Esi dɔwɔƒea le eƒe adzɔnu vovovowo kple mɔ̃ɖaŋununya ƒe ŋutete sesẽwo ta la, edoa atikewɔwɔ ŋuti mɔ̃ɖaŋununya ƒe ŋgɔyiyi kple eƒe asi bɔbɔe ɖe ŋgɔ vevie.
Foto siwo woɖe le wɔnaa me, siwo dometɔ aɖewoe nye kadodo kple amekolawo kple mamalawo, ɖe hadomeɖoɖo ƒe gbɔgbɔ kple ɖokuitsɔtsɔna ɖekae be woana dɔnɔdzikpɔkpɔ nanyo ɖe edzi la fia.
