Amekoko ƒe atikewɔwɔ na humeral stem fractures kple mɔ̃ɖaŋununya ƒe teƒewo .

Ele be woalé kpekpeme ƒe mɔxexe ɖe dɔwɔwɔ vɔ megbe nu ɖe ​​kilogram ɖeka ƒe agbɔsɔsɔ si sɔ gbɔ wu dzi vaseɖe esime woakpɔ gbagbãƒe ƒe dɔyɔyɔ ɖedzesi aɖe (zi geɖe la, ɣleti etɔ̃).Humeral stem fractures (HSF) bɔ ŋutɔ, si ade 1% va ɖo 5% le fractures katã me. Ƒe sia ƒe ƒe dzɔdzɔ 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 eve le esi, eye eƒe kɔkɔƒe gbãtɔ dzɔna le ŋutsu siwo xɔ tso ƒe 21 va ɖo ƒe 30 le ŋusẽ gã ƒe nuveviwɔame megbe, si wɔnɛ be zi geɖe la, wowɔa comminud fractures kple abi siwo do ƒome kplii. Taƒoƒo evelia dzɔna ɖe nyɔnu siwo xɔ tso ƒe 60 va ɖo ƒe 80 dzi, eye zi geɖe la, wowɔa nuvevi ame le ŋusẽ si me ŋusẽ mele o megbe.

Amekoko ƒe atikewɔwɔ .

一. Ememe fixation kple incisional repositioning plate .

Nusiwo fia:

• Radial nerve palsy (RNP) le HSF me menye dzesi na amekoko o elabena edo ƒome kple hayahaya ƒe agbɔsɔsɔ gã aɖe (kpɔ - kuxiwo/radial nerve le ete).

• Alo, ʋuka me nuveviwɔame ɖesiaɖe si hiã be woadzrae ɖo alo ato mɔ si to eŋu la nye nusi woatsɔ awɔ dɔ na amekoko na gbagbãƒea, elabena fixation sesẽ kpɔa ʋukawo ƒe anastomosis ta.

• Le nɔnɔme sia koŋ me la, ememe fixation kple plate le kabakaba eye kakaɖedzi le eŋu wu IMN elabena wowɔa ʋukawo ɖɔɖɔɖo to mɔnu tẽ dzi (zi geɖe la, titina mɔnu).

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

  
  

Amekoko ƒe Nuɖeɖefia:

• Wozãa anterolateral mɔnu si wozãna tsã la tsɔ wɔa dɔ na gbagbã siwo le proximal kple/alo titina etɔ̃lia me.

• Ne ehiã la, wokekea mɔnu sia ɖe enu le didiƒe be wòaɖe humerus bliboa ɖe go.

• Gake womeɖo aɖaŋu be woawɔ mɔnu sia na ƒunukpeƒewo ƒe akpa si le didiƒe o.

• Zi geɖe la, wotsɔa triceps split mɔnu aɖe ɖea akpa etɔ̃lia si le didiƒe ƒe gbagbãwo ɖe go.

• Le didiƒe kple titina etɔ̃lia ƒe gbagbã, megbe mɔnu si ŋu wotrɔ asi le si ŋu Gerwin kple ehatiwo ƒo nu tsoe la ate ŋu aɖe 76-94% le humerus la me (le radial nerve ƒe dodo kple septal release nu).

  
  

Amekokomɔnu:

• Wotsɔa dɔnɔa dana ɖe ƒutazikpui ƒe nɔnɔme me hena anterolateral mɔnu la. Abɔtaɖonu zazã kpena ɖe ame ŋu be akɔta ƒe ke ƒe sɔsɔme nanɔ anyi. Le megbe gome la, axadzinɔnɔmee nye teƒe si wodi wu.

• Optimal plate construction nye 4.5 mm gakpo gbadzɛ alo esi sɔ kplii eye ele be wòatsyɔ cortices 6 ya teti dzi le fracture teƒea tame kple ete, gake 8 cortices ye wodi wu.

• Ne ehiã la, wokafua kakɛ sue aɖe kple kakɛ gã aɖe ƒe ƒuƒoƒo, abe ʋuƒo kpui etɔ̃lia ƒe agba si me woatsɔe aɖo teƒe si wogbugbɔ ɖo ɖe teƒe bubu (tomeƒuƒu alo kpakpaluʋui kakɛ ene), si wotsɔa agba 4.5 ƒe agba 4.5 kpena ɖe eŋu emegbe hena gbagbãƒe mamlɛtɔ.

• Le didiƒe etɔ̃lia ƒe gbagbãƒewo gome la, wokafui be woawɔ megbe sɔti si wowɔ do ŋgɔ (3.5/4.5) be woaɖe mɔ ɖe epiphyseal fixation sesẽ ŋu.

  
  

Wogaʋlia nya le gavi siwo wotsɔna xea mɔ̃e zazã le HSF me ŋu .

• Ne wotsɔ ʋuƒo siwo wotsɔ xea mɔ na nu kple agba siwo menye ʋuʋu o sɔ kple wo nɔewo hena ƒu ƒe gbagbã siwo wotsɔ ƒu gbe kple ƒu ƒe nyonyome nyuie la, biomechanical viɖe aɖeke mele torsion, bending alo axial stiffness me na structures eveawo siaa o.

• Le go bubu me la, ne ƒu ƒe nyonyome mede ame dzi o la, woate ŋu azã agba siwo wotsɔna ƒoa nui la ate ŋu aɖe vi.

• Le biomechanical numekuku aɖe si Gardner et al. Le ƒumeŋuɖui ƒe gbagbã ƒe kpɔɖeŋuwo koŋ gome la, xɔ 34 siwo mexena o la me li ke kura wu xɔtunu siwo wotu alo esiwo wotsɔ tsaka o.

Subɔsubɔdɔ ƒe mɔnu si dze abe ɖe wòle be woawɔ dɔ le ame ŋu ene si dze abe ɖe wònaa dzidzedzekpɔkpɔ ƒe agbɔsɔsɔme si sɔ gbɔ kple kuxi siwo mebɔ o ƒe agbɔsɔsɔ si mede o ene. Gake le numekuku aɖe si wowɔ le megbe me si me dɔnɔ 76 nɔ la, Van de Wall et al. ɖee fia be humeral stem fractures ɖeɖe dzaa ƒe liƒo blibo nana ɣeyiɣi si wotsɔ daa gbe le radiographic me nɔa kpuie ŋutɔ ne wotsɔe sɔ kple liƒo si sɔ.

Dɔwɔwɔ vɔ megbe dzikpɔkpɔ:

• Zi geɖe la, wokpɔa fixation si li ke ne wozã agba. Eyata woɖea mɔ na dɔnɔa be wòawɔ dɔ siwo me wowɔa dɔ le vevie eye wowɔa dɔ le dɔ dzi evɔ abɔta alo abɔta ƒe ʋuʋu ƒe didime mede se ɖe enu o.

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

• Ele be woalé kpekpeme ƒe mɔxexe ɖe dɔwɔwɔ vɔ megbe ɖe asi le kilogram ɖeka ƒe agbɔsɔsɔ si sɔ gbɔ wu me vaseɖe esime woakpɔ gbagbãƒe ƒe dɔyɔyɔ ɖedzesi aɖe (zi geɖe la, ɣleti etɔ̃).

• Woɖea mɔ na dɔnɔ siwo metsi o be woatsɔ woƒe kpekpeme ɖe asi le afisi woɖe mɔ ɖo (le kpɔɖeŋu me, ebia tso atizɔtiwo si be woazɔ), gake le dɔnɔ tsitsiwo gome la, ele be woaƒo nu tso esia ŋu le nɔnɔme ɖesiaɖe me.

Wogblɔ nusiwo do tso eme .

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

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

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

• Eyata ele vevie ŋutɔ be woade dzesi radial nerve ahakpɔ eta le ʋuʋudedi siwo katã le ʋuʋu ɖi me.

  
  

二. Intramedullary Nail .

Nusiwo 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 la sɔ kple mɔ̃ɖaŋununya ƒe axis si le humeral stem.

• Le susu sia ta la, wotsɔa nusiwo wotsɔ dea lãme na ame la dea bending forces si bɔbɔ ɖe anyi wu me eye wòɖea mɔ be woama agbawo nyuie wu. Amekoko ƒe dzesi siwo woatsɔ awɔ lãkusi me ƒoƒoe la sɔ kple esi wotsɔ ƒoa nui.

• Gake abe alesi míegblɔe va yi ene la, ƒu gbagbã aɖewo sɔ nyuie na plating wu be woatsɔ aƒoe.

• Akpa si wogbã ƒe nɔnɔmewo kple nɔnɔme siwo wokpɔ be wosɔ gbɔ wu IMN lae nye dɔléle kple gbagbãƒe siwo gbɔna, abi siwo le akpa vovovowo me, kple ƒumeŋuɖui ƒe gbagbã.

• Simple mid-third transverse fractures hã nye dzesi nyuiwo na IMN.

• Tsɔ kpe ɖe eŋu la, woate ŋu atsɔ lãgbalẽa ade eme to lãkusi si le sue wu me, si ɖea lãkusi falɛfalɛwo ƒe ʋuʋu dzi kpɔtɔna ne wotsɔe sɔ kple mɔ̃ si wotsɔ blaa nu la.

• Esia nye nyateƒe vevietɔ le Humerus ƒe titina ƒe akpa etɔ̃lia ƒe gbagbãwo gome.

Amekokomɔnu:

• Dɔnɔa ƒe nɔƒe nyuitɔ kekeake si woawɔ dɔ sia le enye ƒutazikpui dzi. Abɔ ƒe akɔtaɖonu zazã ɖea vi ŋutɔ le shaft ƒe ɖoɖowɔwɔ me léle ɖe asi me kpakple distal freehand locking screws wɔwɔ me.

• Teƒe si wòge ɖo la nɔ te ɖe alesi wowɔ ɖa lae dzi nyateƒe, gake zi geɖe la, enɔa tuberosity gãtɔ kple abɔta ƒe ta ƒe go si le eƒe goa ƒe go kemɛ dzi, si fia be ele be woage ɖe rotator cuff lãmekaawo me.

• Le dɔdamɔnu sia gome la, wokafui be woawɔ deltoid mama ƒe mɔnu aɖe atsɔ akpɔ supraspinatus ƒe lãkusi le susu me.

• Le nyateƒe me la, ne woge ɖe akɔta ƒe ta me le supraspinatus ƒe lãkusia titina la, ame akpɔ eɖokui le ta titina le sagittal yameʋua me.

• Ele vevie be woazã keratomile si le fluoroscopy me atsɔ akpɔ egbɔ be teƒe si wogena ɖo la le nɔnɔme si dzi woda asi ɖo me le sagittal kple coronal plane siaa me.

• Le esia megbe la, ele be woado mɔfianu ƒe ka la ɖe ŋgɔ hafi aʋu Supraspinatus ƒe lãkusi si le ɣeyiɣi didi me le nukpɔkpɔ tẽ te.

• Afɔɖeɖe si kplɔe ɖoe nye be woaʋu tɔdzisasrãa ɖe Kirschner ƒe aŋea dzi, akpɔ egbɔ be ƒugɔmea sɔ kple hehe kple/alo gotagome asitɔtrɔ, eye emegbe wòado mɔfiame la ɖe ŋgɔ le ʋuka si le ʋukaa me la me vaseɖe abɔta.

• Wokpɔe be reaming ɖea vi le dɔnɔ siwo metsi o me eye mehiãna ɣesiaɣi le dɔnɔ tsitsiwo me o.

• Le distal bolt ɖoɖo me la, AP ƒe ʋuʋu le dedie wu eye wòbia be woawɔ mɔnu sue aɖe si ƒe didime nye 2-3 cm atsɔ aɖe afɔku si le lãmekawo ƒe abixɔxɔ me dzi akpɔtɔ.

• Mlɔeba la, IMN ƒe sɔsɔ kple wo nɔewo nyo wu IMN si trɔna ɖe megbe le kuxi tɔxɛ siwo le mamlɛtɔa ŋu siwo dometɔ aɖewoe nye supracondylar ƒe gbagbã siwo wowɔ le atikewɔwɔ me, abɔta keke, 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 ƒe vodada eve vɛ:

• Heheɖemegbe le afisi wogbãa gbagbãƒe le le Impact Nail me .

• kple/alo ɖaƒoƒo siwo do ɖe anyigba ƒe akpa si le anyigba te la .

  
  

Le proximal third helix alo long oblique fractures gome la, agbalẽa ŋlɔlawo ɖo aɖaŋu be woawɔ mɔnu sue aɖe si le ʋuʋu ɖi be woaɖe gbagbãƒea dzi akpɔtɔ eye woatsɔ ring tie wire akplɔe ɖo. Le nyateƒe me la, na fracture subtype sia la, deltoid muscle la dina be yealé proximal fracture fragment la ɖa esime pectoralis major hea distal fracture fragment la le titina, si dzia afɔku si nye osseous no union alo delayed heage ɖe edzi.

Dɔwɔwɔ vɔ megbe dzikpɔkpɔ .

• Wodea dzi ƒo na dɔnɔwo be woawɔ abɔta kple abɔta ƒe ʋuʋu siwo le dɔ dzi eye wole dɔ dzi vevie la abe alesi woɖe mɔ ɖe wo ŋu ene.

• Woate ŋu azã slings hena ŋkeke ʋɛ aɖewo hena vevesese dzi ɖuɖu.

• Woléa mɔxexe ɖe kpekpeme kɔkɔ ƒe mɔxexe ɖe dɔwɔwɔ vɔ megbe nu ɖe ​​kilogram ɖeka ƒe agbɔsɔsɔ si sɔ gbɔ wu dzi vaseɖe esime fracture gbedada dzena (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 ɖaƒoƒo siwo wotsɔna xea mɔ na HSF zazã ŋu la mewɔ ɖeka o. Le go ɖeka me la, ƒu ƒe ƒuƒoƒo si ŋu woka nya ta le ƒe agbɔsɔsɔme si ŋu woka nya ta le la trɔna ŋutɔ (le 0% kple 14%), si ƒe dzidziɖedzi sɔ gbɔ wu le ɖa ƒe dzidzime tsitsiwo me. Le go bubu me la, wogblɔ abɔta ƒe kuxiwo (siwo dome vevesese, ʋuʋu, ʋuʋu alo ŋusẽ ƒe bu) ƒe dzɔdzɔ le (si tso 6% va ɖo 100%) le agbalẽ siwo do ŋgɔ me.

• Woate ŋu aɖe kuxia ƒe akpa aɖe me to subacromial trauma me le lãkusi ƒe dɔmawɔmawɔ nyuie si nɔa anyi didi si tsoa ɖa siwo do ɖe gota, abi ƒe lãkusi kple/alo rotator cuff injury le isovoscularity ƒe akpa vevi sia me gbɔ.

• Agbalẽŋlɔla geɖe ƒo nu tso mɔnu vovovo siwo dzi woato aƒo asa na ʋu ƒe sisi ƒe nuto sia ŋu eye woaɖɔ lãkusia ɖo le mɔ si me aɖaŋu le nu, si ɖee fia be abɔta ƒe dɔmawɔmawɔ nyuie ƒe agbɔsɔsɔ dzi ɖe kpɔtɔ.

  
  

HSF ƒe atikewɔwɔ si me womezãa atikewo le o na dɔwɔwɔ me tsonu nyuiwo kple dɔyɔyɔ ƒe agbɔsɔsɔ gbogbo aɖe le dɔnɔ 80% ya teti me. Le susu sia ta la, egakpɔtɔ nye atike si HSF akpa gãtɔ tia. Ne womelɔ̃ ɖe ɖoɖo si wowɔ ɖe ɖoɖo nu ŋu o la, ele be woabu amekoko ŋu. Esia nye nyateƒe vevietɔ na dɔnɔ siwo xɔ wu ƒe 55 siwo tsɔ wo ɖokui ɖe go kple akpa etɔ̃lia si te ɖe wo nɔewo ŋu si nye oblique fracture (si le sue wu le dɔyɔyɔ me). Le amekoko ƒe atikewɔwɔ gome la, agbalẽawo meɖe vovototo gã aɖeke fia le agbalẽviwo kple IMN dome le dɔyɔyɔ ƒe agbɔsɔsɔ alo lãmeka ƒe kuxi siwo le radial me gome o, gake abɔta ƒe kuxiwo (dzimakpɔmakpɔ kple ʋuʋu ƒe didime si dzi ɖe kpɔtɔ) le IMN ŋu wu. Eyata ele be woakpɔ cuff la dzi nyuie ŋutɔ le afisi woage ɖo kple le nutsotso me siaa.

Ku ɖe CzmediTech .

Xɔse si nye be ame sia ame si le ɣletinyigba sia dzi dze na lãmesẽnyawo gbɔ kpɔkpɔ nyuie wu la ʋãnɛ. CzmediTech  wɔa dɔ veviedodotɔe be yeakpe ɖe ame bubuwo ŋu woanɔ agbe vɔvɔ̃manɔmee. Míedaa akpe na mía ɖokui ne dɔnɔ siwo kpɔ viɖe geɖe eye woƒe agbe nyo wu le míaƒe atikewo ta eye míaƒe afɔtoƒewo keke ta ɖo dukɔ siwo wu 70 bubuwo, afisi dɔnɔwo, ɖɔktawo kple woƒe zɔhɛwo siaa ɖoa ŋu ɖo  CzmediTech . be yewoayi ŋgɔ. Ƒumeŋuɖui ɖesiaɖe si míewɔna la ɖoa dzidzenu kɔkɔtɔ kekeake gbɔ.

Míedze mɔzɔzɔ tɔxɛa gɔme kple ƒumeŋuɖui ƒe 13 enye sia. Le esia wɔwɔ me la, woto mɔ̃ si wotsɔ wɔa nuawoe la me ɖe mɔ vovovowo nu be woatsɔe ade asi na . Akɔta ., vevesesegã, Tagbɔ-maxillofacial ., Ametia ƒe akpa aɖe ., Ŋusẽdɔwɔnuwo, . External fixators ., Arthroscopy  kple . lãwo ƒe dɔlélewo gbɔ kpɔkpɔ , kpe ɖe . Dɔwɔnu siwo  wozãna le amekokomɔnu siwo do ƒome kplii me.

Míaƒe nu xoxowo katã tso dɔwɔƒe deŋgɔwo le aƒeme kple duta. Ne míeƒo nu tso nyonyo ŋu la, míeɖea asi le gazazãwo ŋu gbeɖe le míaƒe dɔdasi me be míanɔ afɔɖeɖe ɖeka me o, si to esia me míeɖo mía ŋutɔwo ƒe dodokpɔwɔƒe be míakpɔ egbɔ be nu xoxoawo ƒe nyonyome. Wotsɔa míaƒe mɔ̃ siwo katã wotsɔ wɔa nu la tso USA, Germany, Japan kple adzɔnu deŋgɔwo le dukɔa me be woakpɔ egbɔ be nu ɖesiaɖe si míewɔ la de pɛpɛpɛ.

Wodea ga ɣeyiɣi kple agbagbadzedze geɖe me le numekuku wɔwɔ tso ŋgɔyiyiwo ŋu kple nu mamlɛtɔ si woawɔ la dzi ɖeɖe kpɔtɔ me. Míewɔa numekuku ƒuƒoƒo, nuwɔwɔ ƒe ƒuƒoƒo kple QC ƒuƒoƒo be míakpɔ egbɔ be nyonyome nyuitɔ kekeake kple míaƒe nudzralawo ƒe ƒuƒoƒoa ƒe kpekpeɖeŋu be woakpɔ kuxiwo katã gbɔ eye míana dɔ nyuitɔ kekeake si woawɔ le edzadzra megbe.

Esi míetsɔ dzo ɖe míaƒe xɔse ŋu ta la, míele míaƒe sidzedze ƒe seɖoƒewo tum ɖo ɣesiaɣi be míana míaƒe asisiwo katã ƒe adzɔnuwo gbɔ kpɔnu deŋgɔwo, nu yeyewo dodo ɖe ŋgɔ ƒe adzɔnuwo ƒe kuxiwo gbɔ kpɔnu le xexeame katã eye míele agbagba dzem be míaɖe asi le amegbetɔ ƒe lãmesẽ ŋu madzudzɔmadzudzɔe.