Wobu akɔnta be akɔta ƒe gbagbã gblẽa nu le ame tsitsi 500,000 ŋu le United States ƒe sia ƒe. Wokpɔa ŋusẽ gã aɖe ɖe agbenɔnɔ ƒe nyonyome dzi, fifiae nye 3-7% le kɔdzi ƒe ku me eye ƒe ɖeka ƒe ku ƒe agbɔsɔsɔme nye 19.4-58%. Akɔta ƒe gbagbãwo katã ƒe afã lɔƒoe nye ʋukawo dome gbagbã (IT) ƒe gbagbã. Nu eve siwo wotsɔ dea lãme na ame wu siwo wozãna tsɔ daae lae nye cephalomedullary nail (CMN) kple sliding hip screw (SHS).
Togbɔ be mɔ̃ɖaŋununya yi ŋgɔ hã la, ƒu ƒe mamã kple fixation ƒe kpododonuwo abe afɔkpodzi ƒe ta ƒe gege ɖe eme ene gakpɔtɔ dzɔna eye ate ŋu agblẽ nu ŋutɔ. Numekuku siwo wowɔ nyitsɔ laa ɖee fia be woɖe alesi woɖea wo ɖae wòdea 6% le egbegbe nusiwo wotsɔ dea lãme na ame me. Afɔku siwo le fixation failure me dometɔ aɖewoe nye tip-tip distance (TAD) >25 mm, fracture repositioning si mesɔ o, unstall fracture patterns, cephalic spikes si le axadzi alo te le afɔkpodzi ƒe ta ƒe titina, kple cervical stem angle ƒe ememe tɔtrɔ le ememe. Tsitsi kple ƒumeŋuɖui hã do ƒome kple fixation ƒe kpododonu.
dɔnɔwo kple mɔnuwo .
Esia nye numekuku si wowɔ le dɔnɔ siwo wowɔ dɔ na le dɔwɔƒe eve siwo le lãmesẽnyawo gbɔ kpɔkpɔ ƒe ɖoɖo aɖe me le dugã gã aɖe me ŋu le megbe. Wobia nya tso amekola eve (JS kple BC) ƒe nyawo ŋuti nuŋlɔɖiwo ŋu na dɔnɔ siwo katã woxɔ siminti-si ŋu wodo ŋusẽ ɖo be woagbugbɔ ŋku alé ɖe wo ŋu le esi wometsɔ IT ƒe gbagbã zi gbãtɔ tso January 2018 vaseɖe September 2021 me o, le esi dɔwɔƒea ƒe numetoto ƒe dɔdzikpɔha da asi ɖe edzi vɔ megbe. Woɖo kpe siminti ƒe ŋusẽdodo zazã le amekoko si wogbugbɔ wɔ me dzi to elektrɔnik atikewɔwɔ ŋuti nuŋlɔɖi (EMR) me toto le dɔwɔwɔ ŋuti nuŋlɔɖiwo kple fotoɖeɖe le dɔwɔwɔ vɔ megbe me. Míetsɔ dɔnɔ siwo katã ƒe dzesiwo nye cemented strengelsiting le revision fixation me kpe ɖe eŋu le CMN gbãtɔ si do kpo nu alo shs fixation of IT fractures megbe (Nɔnɔmetata 1). Míeɖe dɔnɔ siwo ŋu afɔkpodzi ƒe kɔ alo afɔkpodzi ƒe akpa si le ete ƒe gbagbã le la ɖa, dɔnɔ siwo metrɔ asi le siminti ŋusẽdodo ŋu o, kple dɔnɔ siwo wowɔ ƒunukpeƒetetedɔ na le ɣeyiɣi si me wowɔ dɔ na wo le gɔmedzedzea me.
Figure 1. Nyɔnu aɖe si xɔ ƒe 76 la ƒo afɔkpodzi ɖe vidzidɔa me hena afɔkpodzi ƒe gbagbã le eƒe akɔta (A), eye eƒe akɔta le veve sem atraɖii le ɣleti 2 megbe le nusi wotsɔ de eme (B) ta.
Amekokomɔnu .
Le dɔnɔ siwo xɔa CMN ƒe fixation gbãtɔ gome la, míewɔ ta ƒe ɖa ɖɔliɖɔli si ŋu wotrɔ asi le kple ƒu siminti ƒe ŋusẽdodo. Le gɔmedzedzea me la, woɖea 5-cm ƒe akpa aɖe ɖe trochanter gãtɔ ƒe akpa si te ɖe eŋu dzi, wotsɔa mɔfianu aɖe dea lãkusia ƒe akpa si te ɖe eŋu la me, eye woɖea ƒuwo katã ɖa le ɖaa ƒe akpa si te ɖe wo ŋu la ŋu to reamer si le ʋuʋu ɖi zazã me. Eyome wozã dzogoe ade ƒe ʋuƒo tsɔ ɖe asi le gavi si wotsɔ blaa nu ŋu le CMN la tame (Nɔnɔmetata 2).
![Set screw .]()
Figure 2, intraoperative fluoroscopy si ɖe hexagonal screwdriver si le ƒoƒom ɖe eme eye wòɖea asi le set screw si wotsɔ ati wɔe va yi ŋu.
Emegbe woɖea 1-2 cm transverse incision to iliotibial fascia (ITB) fascia dzi. Wotsɔa mɔfianu si wotsɔ ka trɔe ɖe megbe la ɖea ta ƒe ɖa gbãtɔa ɖa (Nɔnɔmetata 3). Le afɔkpodzi ƒe ta ƒe ʋuʋu gome la, wozãa mɔfianu si me do le si me ʋuƒo si le didiƒe ʋĩ le be woatsɔ axe mɔ ɖe siminti ƒe sisi ɖe ƒunukpeƒea me nu (Nɔnɔmetata 3A). Etɔxɛe la, wodo matriki la zi gbãtɔ le esi woɖe cannula etɔ̃awo ƒe akpa eve siwo le gota la ɖa vɔ megbe eye emegbe wotsɔ wo de teƒe si woɖe do le la to gota gome eve siwo le gota la gbugbɔgade eme.
![Intramedullary Nail .]()
Nɔnɔmetata 3, dɔnɔ bubu ƒe nɔnɔmetata si le ŋgɔgbe (A) kple axadzi (b) siwo ɖe afɔkpodzi ƒe ta si ŋu ƒu ƒe gbagbã ƒe lãkusi le fia.
Eyome, wohea abɔ kple afɔ ƒe akpa si nye akpa aɖe la eye wogbugbɔa eƒe akpa si wogbã la ɖoa teƒe si nye exostosis si sɔ gbɔ wu hena asitɔtrɔ le eŋu. Le malunion alo fibrous heage gome la, wowɔa percutaneous osteotomy to 1/4' bone gouge si me anterolateral mɔnu le zazã me.Esia ƒã hafi wòhiã, gake ewɔa dɔ ŋutɔ ne ehiã be woawɔ vidzidɔ ƒe stem angle si nyo wu (taɖodzinu >130°).
Emegbe wotsɔa gavi alo aŋɔ yeye si le abe ʋuƒo ene la dea ƒugɔmeƒu si le afɔkpodzi ƒe ta me le afɔkpodzi ƒe kɔ ƒe axadzi, eye wòkpɔa egbɔ be yekpɔ nyuie be yemage ɖe ta la me o (Nɔnɔmetata 4). Woɖoe koŋ ƒo asa na gavi la be wòaƒo asa na ɖaƒoƒo si nɔ anyi va yi, gake wogafiaa asi wò be wòawu enu ɖe afɔkpodzi ƒe ta ƒe titina. (Nɔnɔmetata 5) .
![Intramedullary Nail .]()
Nɔnɔmetata 4, ŋgɔgbekpa (a) kple axadzi (b) dɔnɔ bubu ƒe nɔnɔmetata siwo ɖe alesi wotsɔa aŋea dea taɖa yeyea ƒe mɔ dzi la me.
![Intramedullary Nail .]()
Nɔnɔmetata 5, fluoroscopy si wowɔna le dɔwɔwɔ me si fia cephalomedullary blade yeye aɖe dede mɔfiaka ƒe mɔ dzi, si wotsɔ gavi si woɖo ɖe ɖoɖo nu gasẽ ɖe edzi emegbe.
Mlɔeba la, ƒu siminti yɔ afɔkpodzi ƒe ta la fũ to ƒumeŋuɖunu si woate ŋu ado ɖe eme zazã me (Nɔnɔmetata 6). Wokpɔa egbɔ be womegaɖea nu me le ƒunukpeƒea o to fotoɖeɖe le ɣeyiɣi ŋutɔŋutɔ me zazã me eye woatrɔ asi le siminti-tsilénua ƒe goglome kple eƒe nɔnɔme ŋu.
![Intramedullary Nail .]()
Figure 6, Imaging si fia siminti dzina ɖe edzi le gɔmedzedzea me (A), vivivi la, wotsɔa nuawo yɔa wo me vivivi (B) vaseɖe esime woƒe afɔkpodzi ƒe ta ƒe gbagbãƒe (C) la yɔ fũ.
Le dɔnɔ siwo xɔa SHS ƒe gɔmedzedze la, míeɖea SHS la ɖa eye míetsɔa CMN didi aɖe dana ɖe eme. Ne woɖe 5-cm ƒe lãɖeɖe ɖe titina le trochanter gãtɔ te eye wode dzesi ITB la, woɖea lãkusia vaseɖe axadzi plate la dzi. Wozãa asi ƒe ʋuƒo si sɔ tsɔ ɖea plate screws katã ɖa eye emegbe woɖea axadzi plate la ɖa. Emegbe wotsɔa ka ƒe mɔfianu si wotsɔ trɔa asi le eŋu la ɖea teteɖeanyi ƒe ʋuƒoawo ɖa abe alesi woɖɔe va yi ene be woatrɔ asi le gbagbãƒea ŋu wòalolo wu. Emegbe woɖea 5-cm ƒe akpa aɖe ɖe trochanter gãtɔ ƒe nugbɔ abe alesi wogblɔe va yi ene. Wotsɔa mɔfianu aɖe dea trochanter gãtɔ ƒe nugbɔ si te ɖe eŋu wu me eye wodona ɖe ŋgɔ yia afɔkpodzi ƒe ke me. Wotoa reamer si le ʋuʋu ɖi la vɛ le mɔ si dzi wofiaa nu le la dzi. Emegbe wotsɔa mɔfianu didi aɖe si ƒe nugbɔ le abe bɔl ene la ƒoa ka ɖe akɔta ƒe akpa si le didiƒe ʋĩ la titina le akɔta ƒe kɔkɔme te. Eyome wowɔa reaming vivivi vaseɖe esime wosea ʋuʋu le megbeƒu me. Míaƒe dɔnɔwo katã xɔ CMN ƒe ɖa legbe si me TFN-advanced (TFNA) proximal femoral intramedullary nailing system (Depuy-Synthes, Raynham, MA) le.
Numedzodzro
Míaƒe aɖaŋu zãa ƒu siminti ƒe ŋusẽdodo le revision fixation me. Wosrɔ̃ nu tso ƒu ƒe siminti ƒe ŋusẽdodo ŋu hena ƒumeŋuɖui ƒe ŋgɔgbekpa ƒe akɔtaƒu ƒe gbagbã zi gbãtɔ eye wòɖe biomechanical kple dɔdamɔnu me tsonu nyuiwo fia. Toto aɖe si wowɔ nyitsɔ laa ka nya ta be ƒu siminti ƒe ŋusẽdodo na agba siwo do kpo nu la lolo wu, woƒe lãme ƒe ʋuʋu dzi ɖe kpɔtɔ, eye kuxi kple dɔwɔwɔ na wo le ʋɛ wu ne wotsɔe sɔ kple nusiwo ŋu womedo ŋusẽe o. Numekuku si wowɔ le ɖoɖo nu, si wowɔ le teƒe geɖe hã gblɔ be womegawɔ dɔ aɖeke ɖe CMN ƒe ʋuʋu le ƒuƒoƒo si me siminti le me o alo eƒe dzesiwo ƒe dzɔdzɔ aɖeke mele eme o ne wotsɔe sɔ kple ame ade siwo le ƒuƒoƒo si me womedo ŋusẽe o me.
Akɔta ƒe gbagbã ƒe ku le kɔkɔm. Numekuku siwo wowɔ nyitsɔ laa ƒo nu tso 3-7% ƒe ku ƒe agbɔsɔsɔ ŋu, eye ƒe ɖeka ƒe ku dzi ɖe kpɔtɔ tso 19.4% va ɖo 58%. Vevietɔ la, woɖee fia be egbãa ame ƒe ku ƒe 27% le ƒe ɖeka me. Míaƒe dɔdaƒe siwo kplɔ wo nɔewo ɖo ɖee fia be womeku le kɔdzi o eye ƒe ɖeka ƒe ku ƒe agbɔsɔsɔme nye 13.6%, si le sue ŋutɔ ne wotsɔe sɔ kple agbalẽwo. Esi wònye be abati ƒe ʋuʋu kaba le amekoko megbe do ƒome kple amewo ƒe ku si bɔbɔ ɖe anyi ta la, ʋuʋu nyuie kple dɔwɔwɔ me tsonu siwo le míaƒe tsiatretsitsi me ate ŋu aɖe ku si le míaƒe dɔnɔwo me si mede tututu o la me.
Nyanuwuwuw
Siminti-do ŋusẽ revision fixation nye mɔnu nyui aɖe, dedie, eye mexɔa ga geɖe o na non-infected intertrochanteric fracture fixation failure le dɔnɔ tsitsi siwo si acetabular bone stock sɔ gbɔ ɖo.
Dɔnɔ siwo ƒe ʋufɔtiwo dome gbagbã gbãtɔ siwo me mekɔ o siwo do kpo nu eye emegbe wotsɔ wo ɖo wo nɔewo ŋu eye wotsɔ siminti do ŋusẽe la ɖe dɔdamɔnu kple agbenɔnɔ ƒe nyonyome me tsonu nyui aɖe fia. Wozãa dɔa le nɔnɔme siwo me wodzraa acetabular articular surface ƒe akpa gãtɔ ɖo eye ta ƒe ɖa nɔa afɔkpodzi ƒe kɔ me ko. Ne míebu seɖoƒe siwo le ƒunukpeƒetetedɔ si wogbugbɔ wɔ ŋu le dɔnɔ tsitsi siwo ƒe lãme gblẽ wu me ŋu la, dɔdamɔnu sia ɖe ŋugbedodo fia le kuxi sesẽwo dzi ɖeɖe kpɔtɔ dedie kple nyuie me esime wòɖe dɔwɔwɔ ƒe ɣeyiɣi kple gazazã dzi kpɔtɔ le dɔnɔwo ƒe ƒuƒoƒo sia me.
Ale Si Nàƒle Ƒumeŋutinunya Kple Ƒumeŋuɖuiwo ƒe Dɔwɔnuwo)
na . czmediTech , míekpɔa atike ƒomevi aɖe si de blibo ŋutɔ le ƒumeŋutinunya ƒe dɔwɔwɔ na ame ƒe ŋutilã kple dɔwɔnu siwo sɔ kplii me, atikeawo dometɔ aɖewoe nye . Akɔta ƒe nusiwo wotsɔ dea akɔtae ., Intramedullary ƒe ɖawo ., nuveviwɔame ƒe agbalẽvi ., Locking Plate ., Tagbɔ-maxillofacial ., Ametia ƒe akpa aɖe ., Ŋusẽ Dɔwɔnuwo ., External fixators ., Arthroscopy ., Lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe dɔwɔnu siwo kpena ɖe wo ŋu.
Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi anɔ atike yeyewo tum ɖo eye míakeke atikewo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho le xexeame katã ƒe ƒumeŋutinunya kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.
Míeɖoa wo ɖe xexeame katã, ale be nàte ŋu awɔ . Ka ɖe mía dzi le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .
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