Wobu akɔnta be akɔta ƒe gbagbã dzea ame tsitsi 500,000 dzi le United States ƒe sia ƒe. Wokpɔa ŋusẽ gã aɖe ɖe agbenɔnɔ ƒe nyonyome dzi, fifia wole 3-7% le kɔdzi ƒe ku me eye ƒe ɖeka ƒe ku ƒe agbɔsɔsɔme nye 19.4-58%. Akɔta ƒe gbagbãwo katã ƒe afã lɔƒo nye intertrochanteric (IT) ƒe gbagbã. Nu eve siwo wozãna wu tsɔ daa IT ƒe gbagbãƒewoe nye taɖui si woyɔna be cephalomedullary nail (CMN) kple sliding hip screw (SHS).
Togbɔ be wowɔ ŋgɔyiyi le mɔ̃ɖaŋununya me hã la, ƒu ƒe dɔmawɔmawɔ nyuie kple ƒu ƒe kpododonu abe afɔkpodzi ƒe ta ƒe gege ɖe lãme ene gakpɔtɔ dzɔna eye ate ŋu agblẽ nu le ame ŋu ŋutɔ. Numekuku siwo wowɔ nyitsɔ laa ɖee fia be lãɖeɖe ƒe agbɔsɔsɔme si ade 6% kple egbegbe nusiwo wotsɔ dea lãme na ame. Afɔku siwo ate ŋu ana fixation nado kpo nu dometɔ aɖewoe nye tip-tip distance (TAD) >25 mm, gbagbãƒea ƒe teƒe bubu si mesɔ o, gbagbã ƒe nɔnɔme siwo meli ke o, ta ƒe ʋuʋudedi siwo le afɔkpodzi ƒe ta ƒe axadzi alo titina te, kple vidzidɔa ƒe ke ƒe dzogoe ƒe tɔtrɔ ememetɔ. Tsitsi kple ƒumeŋuɖui hã do ƒome kple fixation ƒe kpododonu.
Dɔnɔwo Kple Mɔnuwo
Esia nye numekuku si wowɔ le dɔnɔ siwo woda dɔ na le dɔwɔƒe eve siwo le lãmesẽnyawo gbɔ kpɔkpɔ ƒe ɖoɖo aɖe me le dugã gã aɖe me ŋu. Wobia amekola eve (JS kple BC) ƒe nyawo ŋuti nuŋlɔɖiwo na dɔnɔ siwo katã wotsɔ siminti do ŋusẽ ɖɔɖɔɖo ƒe ɖɔɖɔɖo le esi wodo kpo nu le IT ƒe gbagbãƒewo ɖɔɖɔɖo gbãtɔ me tso January 2018 va ɖo September 2021 me, le esi dɔwɔƒea ƒe ŋkuléleɖenuŋu ƒe habɔbɔa da asi ɖe edzi vɔ megbe. Wotsɔ elektrɔnik atikewɔwɔ ŋuti nuŋlɔɖiwo (EMR) to dɔwɔwɔ ŋuti nuŋlɔɖiwo kple dɔwɔwɔ vɔ megbe ƒe fotoɖeɖewo me ɖo kpe siminti ƒe ŋusẽdodo zazã le amekoko si me wogbugbɔ léa ŋku ɖo me dzi. Míetsɔ dɔnɔ siwo katã si ŋusẽdodo si wotsɔ siminti wɔ ƒe dzesiwo le revision fixation me de eme le CMN alo SHS fixation gbãtɔ si do kpo IT ƒe gbagbãwo megbe (Nɔnɔmetata 1). Míeɖe dɔnɔ siwo ƒe akɔta ƒe kɔ alo subtrochanteric fracture, dɔnɔ siwo womewɔ revision fixation kple cement reinforcement o, kple dɔnɔ siwo wowɔ arthroplasty le ɣeyiɣi si me wowɔ dɔ na wo gbugbɔgawɔ zi gbãtɔ la ɖa.
Nɔnɔmetata 1. Wotsɔ ati ƒo nyɔnu aɖe si xɔ ƒe 76 le eƒe akɔta le eƒe akɔta ƒe gbagbã (A) ta, eye akɔta nɔ veve sem atraɖii le ɣleti 2 megbe le esi wotso akɔta (B) ta.
Amekoko ƒe mɔnuwo
Le dɔnɔ siwo wotsɔ CMN blae zi gbãtɔ gome la, míewɔ ta ƒe ɖa ɖɔliɖɔli si ŋu wotrɔ asi le kple ƒu ƒe siminti ƒe ŋusẽdodo. Le gɔmedzedzea me la, woɖea ƒu si didi sentimeta 5 ɖe ʋuƒo gãtɔ ƒe akpa si te ɖe eŋu, wotsɔa ka si fiaa mɔe dea ɖaa ƒe akpa si te ɖe eŋu la me, eye wotsɔa ʋuƒo si le ʋuʋu ɖi ɖea ƒuwo katã ɖa le ɖaa ƒe akpa si te ɖe eŋu la dzi. Eyome wozã dzogoe ade ƒe ʋuƒo tsɔ ɖe gavi si wotsɔ léa nu ɖe te si le CMN la tame la ɖa (Nɔnɔmetata 2).
![Set screw]()
Nutata 2, intraoperative fluoroscopy si ɖe dzogoe ade ƒe screwdriver si le nu ƒom kple set screw si wotsɔ ati ƒoe va yi eye wòɖe asi le eŋu fia.
Emegbe woɖea sentimeta 1-2 le tsia dzi to iliotibial fascia (ITB) fascia me yia anyime. Wotsɔa mɔfianu si wotsɔ ka ƒo 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 wotsɔa gavi si xea mɔ na nu le didiƒe ʋĩ be woatsɔ axe mɔ na siminti ƒe sisi ɖe ƒunukpeƒea (Nɔnɔmetata 3A). Etɔxɛe la, wodoa matriki la gbã ne woɖe gotagome ƒuƒoƒo eve siwo le ʋuƒo etɔ̃awo me la ɖa vɔ eye emegbe wotsɔe dea teƒe si do le la to gotagome ƒuƒoƒo eveawo gbugbɔgade eme me.
![Nail si le lãkusi me]()
Nɔnɔmetata 3, Dɔnɔ bubu ƒe nɔnɔmetata siwo wowɔ le dɔwɔwɔ na wo me le ŋgɔgbe megbe (A) kple axadzi (B) siwo ɖe afɔkpodzi ƒe ta si ŋu ƒu ƒe gbɔdzɔgbɔdzɔ le domedome la fia.
Eyome, wohea abɔa eye emegbe wogbugbɔa gbagbãƒea ɖona wòzua exostosis geɖe wu hena revision fixation. Le malunion alo fibrous healing gome la, wowɔa ƒumeŋuɖui to ŋutigbalẽ me to 1/4' bone gouge zazã me kple anterolateral approach. Ƒã hafi esia hiã, gake ewɔa dɔ ŋutɔ ne ehiã be woawɔ cervical stem angle si nyo wu (taɖodzinu >130°).
Emegbe wotsɔa gavi yeye alo spiral blade dea subchondral ƒu si le afɔkpodzi ƒe ta me le afɔkpodzi ƒe kɔ ƒe axadzi, eye wokpɔa egbɔ be yekpɔ nyuie be yemage ɖe ta la me o (Nɔnɔmetata 4). Woɖoe koŋ tsɔa gavi la ƒoa asa na ɖa ƒe mɔ si nɔ anyi tsã, gake egafiaa asi eƒe nuwuwu le afɔkpodzi ƒe ta titina. (Nɔnɔmetata 5)
![Nail si le lãkusi me]()
Nɔnɔmetata 4, Dɔnɔ bubu ƒe ŋgɔgbe megbe (A) kple axadzi (B) ƒe nɔnɔmetata siwo ɖe alesi wotsɔ kerfing aŋea de ta ƒe ɖa yeyea ƒe mɔ dzi fia.
![Nail si le lãkusi me]()
Nɔnɔmetata 5, si nye fluoroscopy si wowɔ le dɔwɔwɔ na ame me si ɖe alesi wotsɔ cephalomedullary blade yeye aɖe de mɔfianu ka ƒe mɔ dzi, si wotsɔ gavi si woɖo ɖi la bla emegbe.
Mlɔeba la, wotsɔa ƒu ƒe siminti yɔa afɔkpodzi ƒe ta me to ƒu ƒe siminti si wodona ɖe lãme na ame zazã me (Nɔnɔmetata 6). Wokpɔa nyuie be woaƒo asa na nusiwo dona ɖe ƒunukpeƒea to ɣeyiɣi ŋutɔŋutɔ me fotoɖeɖe kple asitɔtrɔ le siminti-kaɖia ƒe goglome kple eƒe nɔnɔme ŋu me.
![Nail si le lãkusi me]()
Nɔnɔmetata 6, Nɔnɔmetata siwo ɖe siminti ƒe dzidziɖedzi fia le gɔmedzedzea me (A), vivivi yɔyɔ (B) vaseɖe esime afɔkpodzi ƒe ta ƒe gbagbãƒea yɔ (C).
Le dɔnɔ siwo xɔ SHS ƒe fixation gbãtɔ gome la, míeɖea SHS la ɖa eye míedaa CMN didi aɖe. ne woɖe sentimeta 5 le titina le trochanter gãtɔ te eye wode dzesi ITB vɔ la, woɖea lãɖeɖea vaseɖe axadzi gbadzɛa dzi. Wozãa asi ƒe gavi si sɔ tsɔ ɖea agbalẽvi ƒe gaviwo katã ɖa eye emegbe woɖea axadzi gbadzɛa ɖa. Emegbe wotsɔa ka si wotsɔ trɔa megbe ƒe mɔfianu ɖea tension screws la ɖa abe alesi míegblɔe va yi ene be woagbugbɔ aɖo gbagbãƒea ɖe valgus ƒe seƒe si lolo wu. Emegbe woɖea sentimeta 5 le trochanter gãtɔ ƒe nugbɔ abe alesi míegblɔe va yi ene. Wotsɔa ka si fiaa mɔe dea trochanter gãtɔ ƒe nuwuwu si te ɖe eŋu wu eye wòyia ŋgɔ yia afɔkpodzia ƒe ke me. Wotsɔa reamer si le ʋuʋu ɖi la dea mɔfianu la ƒe mɔ dzi. Emegbe wotsɔa ka didi aɖe si ƒe nugbɔ le bɔl la dea afɔkpodzi si le didiƒe ƒe titina le afɔkpodzia ƒe kɔkɔme te. Eyome wowɔa reaming vivivi vaseɖe esime wose ʋuʋudedi le akɔta. Míaƒe dɔnɔwo katã xɔ CMN ɖa didi aɖe si me TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA) le.
Numedzodzro
Míaƒe mɔnu zãa ƒu ƒe siminti ƒe ŋusẽdodo le revision fixation me. Wosrɔ̃ nu tso ƒu ƒe siminti ƒe ŋusẽdodo hena ƒumeŋuɖui ƒe proximal femur fractures ƒe ɖɔɖɔɖo gbãtɔ ŋu eye wòɖe biomechanical kple dɔdamɔnu nyuiwo fia. Totoɖeme aɖe si wowɔ nyitsɔ laa ka nya ta be ƒu ƒe siminti ƒe ŋusẽdodo na be kpododonu ƒe agbawo dzina ɖe edzi, nusi wotsɔ dea lãme na ame ƒe ʋuʋu dzi ɖe kpɔtɔ, eye kuxiwo kple dɔwɔwɔ ake mesɔ gbɔ o ne wotsɔe sɔ kple esi womedo ŋusẽe o. Numekuku aɖe si wowɔ le vome, si wowɔ le teƒe geɖe siwo wokpɔ mɔ na hã ka nya ta be womegawɔ dɔ na ame ake alo CMN ƒe ʋuʋu ƒe dzesi aɖeke medze le ƒuƒoƒo si me wotsɔ siminti do ŋusẽe me o ne wotsɔe sɔ kple dɔléle ade siwo le ƒuƒoƒo si me womedo ŋusẽe o me o.
Ame siwo kuna le akɔta ƒe gbagbã ta sɔ gbɔ ŋutɔ. Numekuku siwo wowɔ nyitsɔ laa ɖee fia be 3-7% ƒe ku le kɔdzi, eye ƒe ɖeka ƒe ku dzi ɖe kpɔtɔ tso 19.4% va ɖo 58%. Vevietɔ la, wokpɔe be IT ƒe gbagbãwoe nyea ku ƒe 27% le ƒe ɖeka me. Míaƒe dɔdamɔnu siwo kplɔ wo nɔewo ɖo meɖee fia be ame aɖeke meku 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 aba dzi ʋuʋu kaba le amekoko megbe do ƒome kple ku dzi ɖeɖe kpɔtɔ ta la, azɔlizɔzɔ nyuie kple dɔwɔwɔ me tsonu siwo le míaƒe nudzɔdzɔ siwo kplɔ wo nɔewo ɖo me ate ŋu aɖe ku si mede ŋgɔ boo o si wokpɔ le míaƒe dɔnɔwo me la me.
Nyanuwuwuw
Cement-reinforced revision fixation nye mɔnu nyui aɖe, si le dedie, eye wòxɔa ga geɖe na intertrochanteric fracture fixation fixation si me dɔlékui mele o ƒe kpododonu le dɔnɔ tsitsi siwo si acetabular bone stock sɔ gbɔ ɖo me.
Dɔnɔ siwo ƒe ahɔhɔ̃mekawo dome gbagbã gbãtɔwo ƒe tsɔtsɔ do kpo nu eye wotsɔ asitɔtrɔ le wo ŋu kple atikewɔwɔ si me wotsɔ siminti do ŋusẽe kplɔe ɖo la ɖe dɔdamɔnu kple agbenɔnɔ ƒe nyonyome me tsonu nyuiwo fia. Le nɔnɔme siwo me wokpɔ acetabular articular surface ƒe akpa gãtɔ ta eye ta ƒe ɖa gakpɔtɔ le afɔkpodzi ƒe kɔ me koe wozã mɔnu sia. Ne míebu seɖoƒe siwo le ƒunukpeƒetetedɔ si wogbugbɔ trɔna ŋu le dɔnɔ tsitsi siwo gbɔdzɔ wu ŋu la, dɔdamɔnu sia ɖe ŋugbedodo fia le kuxi sesẽwo dzi ɖeɖe kpɔtɔ dedie eye wòwɔa dɔ nyuie esime wòɖea dɔwɔwɔ ƒe ɣeyiɣi kple gazazã dzi kpɔtɔna le dɔnɔwo ƒe ƒuƒoƒo sia me.
Ale Si Nàƒle Ƒumeŋuɖuiwo Kple Ƒumeŋuɖui Dɔwɔnuwo?
Elabena CZMEDITECH , míekpɔa adzɔnuwo ƒe hatsotso si de blibo ŋutɔ si nye ƒumeŋuɖui ƒe amekoko ƒe nusiwo wotsɔ dea ame me kple dɔwɔnu siwo sɔ kplii, nusiwo dometɔ aɖewoe nye akɔta ƒe akpa siwo wotsɔ dea ame me, ɖa siwo le lãkusi me, trauma plate, ʋuƒo si wotsɔ xea mɔ na nu, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, gotagome fixators, ƒunukpeƒetetedɔ (arthroscopy)., lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe kpeɖeŋutɔ dɔwɔnuwo.
Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi anɔ atike yeyewo wɔm eye míakeke adzɔnuwo ƒe hatsotsowo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho geɖe wu le xexeame katã ƒe ƒumeŋuɖui kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.
Míeɖoa nu ɖe xexeame katã, eyata àte ŋui te ɖe mía ŋu le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .
Ne èdi be yeanya nyatakaka bubuwo la,zi edzi CZMEDITECH be nàkpɔ nyatakaka bubuwo.
