Amekoko ƒe atikewɔwɔ na humeral stem fractures kple mɔ̃ɖaŋununya ƒe teƒewo

Ele be woalé kpekpeme ƒe mɔxexe ɖe enu le dɔwɔwɔ vɔ megbe ɖe asi si ade kilogram ɖeka vaseɖe esime woakpɔ gbagbãdɔ ƒe dɔyɔyɔ vevie (zi geɖe la, ɣleti etɔ̃).Humeral stem fractures (HSF) bɔ ŋutɔ, eye wònyea 1% va ɖo 5% le gbagbãwo katã me. Ƒe sia ƒe ƒe dɔlélea nye 13 va ɖo 20 le ame 100,000 ɖesiaɖe me eye wokpɔe be edzina ɖe edzi ne ame tsi.HSF ƒe ƒexɔxɔ ƒe mama le mɔ eve nu, eye eƒe kɔkɔƒe gbãtɔ dzɔna le ŋutsu siwo xɔ tso ƒe 21 va ɖo ƒe 30 me le ŋusẽ gã ƒe nuveviwɔame megbe, zi geɖe la, ehea lãmeka falɛfalɛwo ƒe abi siwo do ƒome kplii vɛ. Eƒe kɔkɔƒe evelia dzɔna le nyɔnu siwo xɔ tso ƒe 60 va ɖo ƒe 80 me, eye zi geɖe la, le nuveviwɔame si me ŋusẽ boo mele o megbe.

Amekoko ƒe atikewɔwɔ

一 ƒe nya. Ememe fixation kple incisional repositioning plate

Nusiwo ɖee fia:

• Radial nerve palsy (RNP) le HSF me menye nusi fia be woawɔ dɔ na ame o elabena edo ƒome kple hayahaya le eɖokui si ƒe agbɔsɔsɔ gã aɖe (kpɔ - Kuxiwo/Radial Nerve hã le ete).

• Alo, ʋuka ƒe abi ɖesiaɖe si hiã be woadzrae ɖo alo ato eŋu la nye nusi fia bliboe be woawɔ dɔ na ʋuka si me ʋu si gblẽ la, elabena ne wotsɔe ɖo ʋuka me sesĩe la, ekpɔa ʋukawo ƒe anastomosis ta.

• Le nɔnɔme sia koŋ me la, ememe léle ɖe te kple agbalẽvi wɔa dɔ kabakaba eye kakaɖedzi le eŋu wu IMN elabena wowɔa ʋukawo ɖɔɖɔɖo to mɔnu tẽ dzi (zi geɖe la, wotoa mɔnu si le titina dzi).

• HSF si me proximal alo distal intra-articular extension le nye nɔnɔme bubu si me ORIF si me plates le nye tiatia nyuitɔ.

  
  

Amekoko ƒe nuwɔna: .

• Wozãa mɔnu si wozãna tsã si nye anterolateral mɔnu tsɔ daa gbagbã siwo le akpa etɔ̃lia si te ɖe wo nɔewo ŋu kple/alo titina.

• Ne ehiã la, wokekea mɔnu sia ɖe enu wòɖea akɔta ƒe akpa bliboa ɖe go.

• Gake womekafu mɔnu sia na ƒunukpeƒetetedɔ siwo le didiƒe ʋĩ o.

• Zi geɖe la, woɖea akpa etɔ̃lia si le didiƒe ƒe gbagbãwo fiana to mɔnu si nye triceps split approach dzi.

• Le didiƒe kple titina etɔ̃lia ƒe gbagbãwo gome la, megbe mɔnu si ŋu wotrɔ asi le si ŋu Gerwin et al30 ƒo nu tsoe ate ŋu aɖe akɔta ƒe 76-94% ɖe go (enɔ te ɖe radial nerve release kple septal release dzi).

  
  

Amekokomɔnu: .

• Wotsɔa dɔnɔa dana ɖe ƒutazikpui dzi hena ŋgɔgbekpa dzi mɔnu. Abɔtaɖonu zazã kpena ɖe ame ŋu be akɔta ƒe ke nasɔ ɖe ɖoɖo nu. Le megbedede gome la, axadzinɔnɔe nye teƒe si wodi wu.

• Plɛti ƒe wɔwɔme nyuitɔ nyea gakpo si ƒe didime nye milimeta 4.5 alo esi sɔ kplii eye ele be wòatsyɔ lãkusi 6 ya teti le teƒe si wogbãe le tame kple ete, gake lãkusi 8 ye nyo wu.

• Ne ehiã la, wokafui be woatsɔ kakɛ sue kple gã aƒo ƒu, abe ʋuƒo etɔ̃lia kpui aɖe si le abe ʋuƒo ene be woagbugbɔ aɖo teƒe bubu (transverse fracture alo butterfly fragment), si emegbe wotsɔa gbadzɛ gbadza si ƒe didime nye milimeta 4.5 kpena ɖe eŋu hena gbagbãƒea léle ɖe te mlɔeba.

• Le didiƒe etɔ̃lia ƒe gbagbã gome la, wokafui be woatsɔ megbe axadzi sɔti si wowɔ do ŋgɔ ƒe agbalẽvi (3.5/4.5) awɔe be woaɖe mɔ na epiphyseal fixation sesẽ.

  
  

Wogale nya hem le gavi siwo wotsɔ xea mɔe zazã le HSF me ŋu

• Ne wotsɔ gaƒoɖokui siwo wotsɔ blaa nu sɔ kple esiwo mexea nu o na ƒu gbagbã siwo wogbã kple ƒu ƒe nyonyome nyui la, viɖe aɖeke mele biomechanical me le torsion, bending alo axial stiffness me na xɔ eveawo siaa o.

• Le go bubu me la, ne wodze ŋgɔ ƒu ƒe nyonyome madeamedzi la, agbalẽvi siwo wotsɔ xea mɔe zazã ate ŋu aɖe vi.

• Le biomechanical numekuku aɖe si Gardner et al. koŋ na ƒumeŋuɖui ƒe gbagbã ƒe kpɔɖeŋuwo la, xɔtunu 34 siwo mexe mɔ o la meli ke kura o wu xɔtunu siwo wotu alo esiwo wotsɔ tsaka.

Minimally invasive plate splicing nye amekoko ƒe tiatia si dze abe enaa dzidzedzekpɔkpɔ geɖe eye kuxiwo ƒe agbɔsɔsɔ si mebɔ o ene. Gake le numekuku aɖe si wowɔ le megbe si me dɔnɔ 76 kpɔ gome le me la, van de Wall et al. ɖee fia be akɔta ƒe ke ƒe gbagbã ƒe liƒo blibo ɖeɖe dzaa ɖea ɣeyiɣi si wotsɔ daa dɔ le fotoɖeɖe me dzi kpɔtɔna ŋutɔ ne wotsɔe sɔ kple alesi wòli ke vie.

Dɔwɔwɔ vɔ megbe dzikpɔkpɔ: .

• Zi geɖe la, wokpɔa nusi li ke tsɔ léa nu ɖe ​​te to agbalẽvi zazã me. Eyata woɖea mɔ na dɔnɔa be wòawɔ dɔ siwo me wowɔa dɔ le kple esiwo ŋu wokpena ɖo le dɔwɔwɔ me evɔ abɔta alo abɔta ƒe ʋuʋu ƒe didime aɖeke meɖoa seɖoƒe nɛ o.

• Woate ŋu azã aŋea ŋkeke geɖe hena vevesese dzi ɖuɖu.

• Ele be woalé kpekpeme ƒe mɔxexe ɖe enu le dɔwɔwɔ vɔ megbe ɖe asi wòade kilogram ɖeka vaseɖe esime woakpɔ dɔyɔyɔ ɖedzesi aɖe le ƒu gbagbã ŋu (zi geɖe la, ɣleti etɔ̃).

• Woɖea mɔ na dɔnɔ siwo metsi o be woatsɔ kpekpeme le afisi woɖe mɔ na wo le (le kpɔɖeŋu me, ebia atizɔtiwo hafi woate ŋu azɔ), gake le dɔnɔ tsitsiwo gome la, ele be woaƒo nu tso esia ŋu le nɔnɔme ɖesiaɖe me.

Nusiwo do tso eme siwo ŋu woka nya ta le

• Dɔyɔyɔ ƒe agbɔsɔsɔme le plating megbe tso 87% va ɖo 96%, eye dɔyɔɣi le mama dedie nu nye kwasiɖa 12.

• Kuxiwo ƒe agbɔsɔsɔme tso 5% va ɖo 25%, eye kuxi siwo menye tẽ o abe dɔlékuiwo, ƒumeŋuɖui, kple dɔmawɔmawɔ nyuie ene ye bɔ ​​wu.

• RNP si wokpɔ tso atikewɔwɔ me nye afɔku na humeral stem mɔnu akpa gãtɔ. Streufert et al50 to HSF ƒe nɔnɔme 261 siwo wotsɔ ORIF da dɔe me eye wokpɔe be RNP si wokpɔ tso atikewɔwɔ me la dzɔ le 7.1% me le anterolateral mɔnuwo me, 11.7% le triceps mɔnu siwo woɖe ɖe vovo me, kple 17.9% le triceps mɔnu siwo wodzra ɖo me.

• Eyata ele vevie ŋutɔ be woade dzesi lãmeka si woyɔna be radial nerve ahakpɔ eta le lãɖeɖe siwo katã woʋu me.

  
  

二 ƒe nya. Nail si le lãkusi me

Nusiwo ɖee fia:

• Le nukpɔsusu nu la, IMN ate ŋu ana biomechanical kple amekoko ƒe viɖe siwo de ŋgɔ wu plating

• Le biomechanical nukpɔsusu nu la, mɔ̃a ƒe intramedullary positioning sɔ kple mechanical axis si le humeral stem la me.

• Le susu sia ta la, wotsɔa ŋusẽ si bɔbɔ ɖe anyi wu dea nusi wotsɔ dea eme la me eye wònaa woate ŋu ama agbawo nyuie wu. Amekoko ƒe dzesi siwo fia be woaƒo ati ɖe lãkusi me la sɔ kple esiwo woatsɔ aƒoe.

• Gake abe alesi míegblɔe va yi ene la, gbagbãƒe aɖewo sɔ nyuie wu be woatsɔ ablae wu atitsotso.

• Ƒu ƒe gbagbã ƒe nɔnɔmewo kple eƒe nɔnɔme siwo wokpɔ be enyo wu IMN enye dɔléle kple ƒu gbagbã siwo gbɔna, abi siwo le akpa vovovowo me, kple ƒu ƒe gbagbã.

• Mid-third transverse fractures bɔbɔewo hã nye dzesi nyuiwo na IMN.

• Tsɔ kpe ɖe eŋu la, woate ŋu ade ɖaa to lãɖeɖe sue aɖe me, si ɖea lãkusi falɛfalɛwo ƒe ʋuʋu dzi kpɔtɔna ne wotsɔe sɔ kple alesi wotsɔa ɖaa ƒoa ɖae.

• Esia nye nyateƒe vevietɔ le akɔta ƒe akpa etɔ̃lia ƒe titina ƒe gbagbã gome.

Amekokomɔnu: .

• Dɔnɔ ƒe nɔƒe nyuitɔ kekeake na dɔdamɔnu siae nye be wòanɔ ƒutazikpui dzi. Abɔta ƒe akɔtaɖonu zazã ɖea vi ŋutɔ le asiléƒe ƒe ɖoɖowɔwɔ me léle ɖe asi kpakple distal freehand locking screws wɔwɔ me.

• Afisi wòage ɖo la nɔ te ɖe alesi wowɔ ɖaa dzi ya, gake zi geɖe la, enɔa afisi lãkusi si lolo wu kple akɔta ƒe ta ƒe ƒunukpeƒe ƒe gogloƒe, si fia be ele be woage ɖe rotator cuff ƒe lãmekawo me.

• Le dɔ sia wɔwɔ me la, wokafui be woawɔ deltoid division mɔnu atsɔ akpɔ supraspinatus tendon la le susu me.

• Le nyateƒe me la, ne ame ge ɖe akɔta ƒe ta me le supraspinatus ƒe lãkusi titina la, akpɔ eɖokui le ta titina le sagittal plane me.

• Ele vevie be woazã keratomile le fluoroscopy te be woakpɔ egbɔ be afisi woage ɖo la le nɔnɔme si dzi woda asi ɖo me le sagittal kple coronal yameʋuwo siaa me.

• Le esia megbe la, ele be woado mɔfianu ka la ɖe ŋgɔ wu hafi aʋu supraspinatus ƒe lãkusia le didime nu le nukpɔkpɔ tẽ me.

• Afɔɖeɖe si kplɔe ɖoe nye be woaʋu tɔdzisasrãa ɖe Kirschner ƒe aŋea dzi, akpɔ egbɔ be gbagbãƒea sɔ kple hehe kple/alo gotagome asitɔtrɔ, eye emegbe woado mɔfianu si le tɔdzisasrã si le lãkusia me la ɖe ŋgɔ vaseɖe abɔta.

• Wokpɔe be reaming ɖea vi na dɔnɔ siwo metsi o eye mehiã ɣesiaɣi le dɔnɔ tsitsiwo gome o.

• Le distal bolt ɖoɖo gome la, AP locking le dedie wu eye ebia be woawɔ mɔnu sue aɖe si didi sentimeta 2-3 be woaɖe afɔku si le myocutaneous nerve ƒe abixɔxɔ me dzi akpɔtɔ.

• Mlɔeba la, IMN si sɔ kple wo nɔewo nyo wu IMN si trɔna yi megbe le esi mamlɛtɔa ƒe kuxi tɔxɛ siwo dometɔ aɖewoe nye supracondylar fractures si atikewɔwɔ hena vɛ, abɔta ƒe kekeme ƒe bu, kple heterotopic ossification ta.

  
  

Ele be woalé ŋku ɖe ɖa si wotia ƒe didime ŋu etɔxɛe, elabena ɖa siwo didi akpa ate ŋu ahe mɔ̃ɖaŋununya me vodada eve vɛ:

• Susuhenuwo le afisi wògbã le le esime woƒo ɖa

• kple/alo ɖa siwo do ɖe gota ɖe subacromial space me

  
  

Le proximal third helix alo long oblique fractures gome la, agbalẽa ŋlɔlawo kafu mɔnu sue aɖe si le ʋuʋu ɖi be woatsɔ aɖe gbagbãƒea dzi akpɔtɔ eye woatsɔ ring tie wire ablae. Le nyateƒe me la, le ƒu ƒe gbagbã ƒe hatsotso sue sia gome la, deltoid lãmeka la dina be yealé ƒu ƒe gbagbã ƒe akpa si te ɖe eŋu la dzoe esime pectoralis major ya hea ƒu ƒe gbagbã ƒe akpa si le didiƒe la yia titina, si wɔnɛ be ƒu ƒe ƒuƒu ƒe kadodo alo dɔyɔyɔ tsi megbe ƒe afɔkua dzina ɖe edzi.

Dɔwɔwɔ vɔ megbe ƒe dɔdzikpɔkpɔ

• Wodea dzi ƒo na dɔnɔwo be woawɔ abɔta kple abɔta ƒe ʋuʋu le dɔwɔwɔ me kple esi ŋu wokpena ɖo le dɔwɔwɔ me abe alesi woɖe mɔ ɖe eŋu ene.

• Woate ŋu azã aŋenuwo ŋkeke ʋɛ aɖewo atsɔ aɖu vevesese dzi.

• Woléa mɔxexe ɖe kpekpeme kɔkɔ nu le dɔwɔwɔ vɔ megbe me ɖe asi be wòade kilogram ɖeka vaseɖe esime wòadze ƒã be eƒe gbagbã ƒe dɔyɔyɔ (zi geɖe la, ɣleti etɔ̃).

• Zi geɖe la, woɖea mɔ ɖe kpekpeme tsɔtsɔ ŋu

  
  

Nusiwo ŋu woke ɖo siwo ŋu woka nya ta le:

• Agbalẽ siwo ku ɖe mɔ̃ siwo wotsɔ xea ɖae zazã hena HSF dzikpɔkpɔ ŋu la mewɔ ɖeka o. Le go ɖeka me la, ƒu ƒe nonunion ƒe agbɔsɔsɔ si ŋu woka nya ta le la trɔna ŋutɔ (le 0% va ɖo 14%), eye wòbɔna wu le ɖa ƒe dzidzime tsitsiwo me. Le go bubu me la, wogblɔ abɔta ƒe kuxiwo ƒe dzɔdzɔ (siwo dometɔ aɖewoe nye vevesese, ƒoƒo, ʋuʋu alo ŋusẽ ƒe bu) (si tso 6% va ɖo 100%) le agbalẽ siwo do ŋgɔ me.

• Woateŋu aɖe kuxia ƒe akpa aɖe me to subacromial trauma si tso tendon ƒe dɔmawɔmawɔ nyuie si nɔa anyi didi si tso ɖa siwo do ɖe gota, abi ƒe lãkusi kple/alo rotator cuff ƒe abixɔxɔ le isovascularity ƒe akpa vevi sia gbɔ.

• Agbalẽŋlɔla geɖe ƒo nu tso mɔnu vovovo siwo dzi woato aƒo asa na ʋuka siwo me ʋu sina tona ƒe nuto sia eye woadzra lãkusia ɖo le aɖaŋudzedze me, si ɖee fia be abɔta ƒe dɔmawɔmawɔ nyuie ƒe agbɔsɔsɔ si le ʋɛ wu.

  
  

HSF ƒe atikewɔwɔ si me woɖea mɔ ɖe nu ŋu le na dɔwɔwɔ me tsonu nyuiwo kple dɔyɔyɔ ƒe agbɔsɔsɔ gã le dɔnɔ 80% ya teti me. Le susu sia ta la, egakpɔtɔ nye atike si HSF akpa gãtɔ tia. Ne womate ŋu alɔ̃ ɖe alesi woawɔe wòasɔ ɖe ɖoɖo nu dzi o la, ele be woabu amekoko ŋu. Esia nye nyateƒe vevietɔ le dɔnɔ siwo xɔ wu ƒe 55 siwo va kple proximal third oblique fracture (dɔyɔyɔ ƒe agbɔsɔsɔ si bɔbɔ ɖe anyi wu) gome. Ku ɖe amekoko ƒe atikewɔwɔ ŋu la, agbalẽawo meɖe vovototo gã aɖeke fia le agbalẽviwo kple IMN dome le dɔyɔyɔ ƒe agbɔsɔsɔ alo lãmeka siwo le ʋuʋu ɖi ƒe kuxiwo gome o, gake abɔta ƒe kuxiwo (impingement kple ʋuʋu ƒe didime dzi ɖeɖe kpɔtɔ) ate ŋu adzɔ wu le IMN gome. Eyata ele be woakpɔ asibidea dzi nyuie ŋutɔ le afisi wòge ɖo kple le etutuɣi siaa.

Ku ɖe CzmediTech .

Xɔse si nye be ame sia ame si le ɣletinyigba sia dzi dze na lãmesẽnyawo gbɔ kpɔkpɔ nyuie wue ʋãe. CZMEDITECH  wɔa dɔ vevie be yeakpe ɖe ame bubuwo ŋu woanɔ agbe vɔvɔ̃manɔmee. Enye dada na mí ne dɔnɔ siwo kpɔ viɖe geɖe eye woƒe agbenɔnɔ nyo wu le míaƒe adzɔnuwo kple míaƒe afɔtoƒewo ta keke ta ɖo dukɔ siwo wu 70 bubuwo me, afisi dɔnɔwo, ɖɔktawo kple hadɔwɔlawo siaa ɖoa ŋu ɖo  CzmediTech . be woayi ŋgɔ le. Ƒumeŋuɖui ɖesiaɖe si míewɔ la ɖoa nyonyome ƒe dzidzenu kɔkɔtɔ kekeake gbɔ.

Míedze mɔzɔzɔ tɔxɛa gɔme kple ƒumeŋuɖui ƒe 13 enye sia. Le esia wɔwɔ me la, wotrɔ asi le ewɔwɔ ƒe mɔnu vovovowo ŋu wòzu nusiwo wotsɔ dea ame me na... akɔtaƒu, vevesesegã, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, . gotagome fixators, ƒunukpeƒetetedɔ  kple lãmesẽnyawo gbɔ kpɔkpɔ , kpe ɖe dɔwɔnu  siwo wozãna le amekokomɔnu siwo do ƒome kplii me.

Míaƒe nu xoxowo katã tso nudzrala deŋgɔwo gbɔ le dukɔa me kple duta. Ne míeƒo nu tso nyonyome ŋu la, míeɖea gazazãwo dzi kpɔtɔna gbeɖe le míaƒe dɔdasi si nye be míanɔ ŋgɔ afɔɖeɖe ɖeka me o, si to esia me ɖoa mía ŋutɔwo ƒe dodokpɔwɔƒe be míakpɔ egbɔ be nusiwo wotsɔ wɔe ƒe nyonyome. Míaƒe mɔ̃ siwo katã míewɔna la nye esiwo wotsɔ tso USA, Germany, Japan kple adzɔha kɔkɔtɔwo le Domestic be míakpɔ egbɔ be nu ɖesiaɖe si míewɔ la de pɛpɛpɛ.

Wozãa ɣeyiɣi kple agbagbadzedze geɖe tsɔ wɔa numekuku le ŋgɔyiyi siwo wowɔ ŋu eye wotsɔa nu mamlɛtɔ si woatsɔ awɔe la ɖoa ʋua dzi. Míekpɔ dɔnyala numekuku ƒuƒoƒo, nuwɔwɔ ƒe ƒuƒoƒo kple QC ƒuƒoƒo be woakpɔ egbɔ be nyonyome nyuitɔ kekeake kple míaƒe nudzralawo ƒe ƒuƒoƒo ƒe kpekpeɖeŋu be woakpɔ kuxiwo katã gbɔ eye míana subɔsubɔdɔ nyuitɔ kekeake le nudzadzra megbe.

Esi míetsɔ dzo ɖe míaƒe xɔse ŋu ta la, míele míaƒe sidzedze ƒe seɖoƒewo tum ɖo ɣesiaɣi be míana adzɔnuwo ƒe kuxiwo gbɔ kpɔnu deŋgɔ, siwo me nu yeyewo le la míaƒe asisiwo katã le xexeame godoo eye míedzea agbagba madzudzɔmadzudzɔe ɖe amegbetɔwo ƒe lãmesẽ ta.