Ƙarƙashin wuyan mata na mata yana daya daga cikin raunin da aka fi fuskanta a cikin aikin asibiti, tare da yawancin tsofaffi marasa lafiya suna lissafin fiye da 50% na raunin hip. Bisa kididdigar da aka yi, yawan raunin wuyan mata na mata ya karu a hankali a cikin 'yan shekarun nan, tare da karuwa a cikin mata fiye da maza. Vertigo, dementia, rashin lafiya da cututtukan zuciya a cikin tsofaffi da kuma raunin da ya faru a cikin matasa sune manyan abubuwan haɗari ga ƙwayar wuyan mata.
A cikin 'yan shekarun nan, yawancin kayan gyara na ciki irin su screws, screws power hips (DHS), sliding hip screws (HSH), faranti na tarwatsewar mata na kusa, kusoshi na sake ginawa, da ƙusoshin Gamma sun bayyana. Daga cikin waɗannan kayan gyara na ciki, screws ne mafi yawan amfani da su. Nazarin ya nuna cewa yawancin likitocin fiɗa sun fi son screws don magance karayar da ba a raba su ba, kuma yawancin likitocin sun zaɓi yin amfani da ƙuƙumma don karyewar wuyan mata. 3 daidaitaccen ɓangaren zaren gyare-gyaren madaidaicin dunƙule shi ne mafi karɓar nau'i na gyaran ciki.
Siffofin halittar jiki na karyewar wuyan mata
Yanzu an yarda da cewa tsarin jijiyoyin bugun jini na shugaban femoral shine mafi mahimmancin abin da ya shafi warkar da karaya da ciwon kai na femoral necrosis. Lalacewa ga tsarin samar da jini na shugaban femoral shine babban abin da ke haifar da cututtukan cututtukan ischemic necrosis na shugaban mata. Wani bincike na yau da kullun na jijiyoyin bugun jini na wuyan femoral ya gano cewa hanyar sadarwa ta epiphyseal da tsarin jijiyoyin jijiya na yanki mai tallafi na baya na iya zama mahimman tsari don kiyaye samar da jini ga shugaban femoral bayan raunin wuyan femoral, don haka hakowa na ciki da dasawa kamar yadda zai yiwu zuwa tsakiyar yankin na femoral shugaban na iya haifar da rauni ta hanyar lafiya yadda ya kamata. tsarin.
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Hoto 1 Samar da jini ga kan femoral, hangen nesa (a) da na baya (b). Akwai bambance-bambance a cikin samar da jini ga shugaban femoral, amma na gefe da na tsakiya na spinofemoral arteries sun samo asali ne daga zurfin jijiya na mata a cikin 60% na marasa lafiya.
(1) Mafi yawan jinin da ake bayarwa ga kan femoral yana fitowa ne daga jijiyar rotor femoral artery.
(2) Yana ba da rassa 3 ko 4 waɗanda ke tallafawa jijiya madauri. Waɗannan rassan suna tafiya a baya da sama tare da retroflexed part na synovial wuyan femur zuwa cartilaginous gefen femoral kan femoral. Tasoshin da ke cikin zagaye ligament.
(3) An samo shi daga jijiyar occulta. Hawan reshe na tsaka-tsaki na rotor femoral artery.
(4) Yana ba da mafi girma trochanter na femur kuma ya samar da zoben jijiya tare da jijiya mai juyi na femoral na gefe.
Screws don karyewar wuyan mata
A asibiti, ana iya amfani da 6.5mm ko 7.0 mm ko 7.3 mm Sukurorin ƙashi don gyarawa a cikin ƙananan marasa lafiya ko a matsakaita ko tsofaffi marasa lafiya tare da ingancin ƙashi. Ya kamata a yi amfani da jagora don kiyaye ƙusoshin ƙusoshi 3 daidai gwargwado don ba da damar matse karaya. A cikin wuyan femoral, ya kamata a dunƙule sukurori tare da gefuna, kula da cewa screws suna zare a cikin kan femoral kuma ba a fadin layin karaya ba, saboda wannan ita ce hanya daya tilo don samun matsawa tsakanin ƙarshen. Yakamata a kunkuntar da sukurori kuma a maimaita akai-akai a ciki. Idan an yi amfani da gadon jujjuyawar, dole ne a sassauta motsin. Hakanan za'a iya sanya sukurori mara kyau a lokaci guda. Dole ne a yi fluoroscopy na gaba, na gefe, da 45° na madaidaici don tabbatar da cewa skru ba su shiga cikin haɗin gwiwa na hip.
1. Specific tiyata aiki dabaru.
Ɗauki ' triangle mai jujjuyawar ƙusa ', wanda aka fi amfani da shi a aikin asibiti, a matsayin misali.
a. Da farko, a karkashin fluoroscopy, yi amfani da X-ray a cikin jirage biyu na fluoroscopy don tantance shimfidar filaye na ƙasa da na tsakiya.
b. An yi wani yanki na fata wanda ya wuce 2-3 cm kusa.
c. An raba Layer na fascial tare da ƙaddamarwa kuma ana amfani da mai raba Cobb don raba filaye masu tsayi tare da tsokar mace ta gefe.
d. Sanya allurar jagora a wuri inda duka jirage biyu suka dace.
e. An sanya fil ɗin jagora ɗaya tare da gefen gaba na wuyan mata tare da mataimaki don ƙayyade kusurwar karkatar da baya.
f. Bayan gyare-gyaren fil ɗin jagora na farko, ana gano filaye na baya da na gaba da na gaba ta hanyar amfani da jagororin layi daya don samun goyon bayan cortical na baya da na gaba a cikin wuyan mata.
g. Ana yin wannan ta hanyar saka fil ɗin jagora a sama da ƙaramin trochanter tare da ƙwayar wuyan mace mai nisa ta kashin bayan mata; Ana shigar da fil ɗin jagora guda biyu na gaba kusa da juna a cikin layi ɗaya, gwargwadon yiwuwar da 5 mm daga baya da na baya; zurfin shigarwar fil ɗin jagora sannan an daidaita shi don isa 5 mm ƙasa da guringuntsi; A ƙarshe, ana sake gyara ramin, a auna shi, kuma ana murƙushe ƙugiya mai matsewa a ciki.
h. Tabbatar cewa kar a shigar da allura a ƙasa da ƙaramin magudanar ruwa kuma ku yi tafiya kusa da kashin bayan mata.
i. Tabbatar cewa fil ɗin jagorar da aka yi masa zaren yana matsayi a ƙarƙashin haɗin gwiwa.
j. Kada ka ƙyale fil ɗin jagora ya kutsa cikin saman articular.
k. Ƙayyade tsayin dunƙule mai dacewa ta hanyar auna tsawon fil ɗin jagora sannan cire 5 mm.
l. Yawancin lokaci ana yin amfani da kai, ana amfani da sukurori, amma wani lokacin ana buƙatar pre-hako na gefe cortex a cikin marasa lafiya masu aminci masu kauri kashi.
m. Idan sarari ya ba da izini, ana iya amfani da tazarar sarari.
n. Ƙaƙƙarfan dunƙule na 4 (tsarin lu'u-lu'u) na iya zama dole ga masu aminci masu rauni mai tsanani na gefen hannu na baya.
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Kodayake screws don karyewar wuyan mace a yanzu sun zama ruwan dare sosai, har yanzu akwai bambance-bambancen ra'ayi game da lamba da kuma daidaita sukurun da aka sanya su cikin tiyata, yawanci ya danganta da fifikon mai aiki; abubuwa kamar girman kashi na majiyyaci, ƙarfin dunƙulewa, da nasarar jiyya suma suna da tasiri.
1. Adadin sukurori.
Karyawar wuyan mata yawanci ana gyarawa tare da screws 2-4.
A mafi yawan lokuta, ana amfani da sukurori 3 saboda suna iya jure wa matsi mai ƙarfi na gaba, ƙara kwanciyar hankali, da rage ƙaura daga ƙarshen karaya.
Don karyewar wuyan mata tare da kusurwar Pauwells>50°, screws 2 sun fi dacewa.
A cikin marasa lafiya tare da raunin raunin da ya faru na wuyan mata na baya, an ba da shawarar screws 4.
Koyaya, al'adar da ake amfani da ita ita ce a yi amfani da sukurori 3 mara kyau don gyarawa.
2. Kanfigareshan m dunƙule.
Lokacin da aka yi amfani da sukurori 3 mara kyau don gyara cikin ciki na karyewar wuyan mata, galibi an yi imani da cewa ya kamata a bi ka'idar ' matsawa mai zamiya ', ta yadda skru 3 da aka dasa sun yi daidai da juna a cikin ra'ayi na orthogonal kuma suna da tsari na triangular a cikin ra'ayi na gefe.
Ta wannan hanya, nau'i-nau'i guda uku na layi daya na iya ba da goyon baya na injiniya mai kyau da kuma samar da waƙa mai zamiya, don haka toshe fashe zai iya zamewa tare da wuyan wuyansa na mata a ƙarƙashin ƙaddamar da tsokoki na hip, haifar da matsa lamba a ƙarshen karaya da kuma inganta waraka.
Koyaya, ko an shimfiɗa sukullun 3 mara kyau a cikin tsari na kothotriangular ko jujjuyawar alwatika ya kasance mai kawo rigima.
Ci gaba a cikin dabarar gyara madaidaicin dunƙule don karyewar wuyan mata
Yuenyongviwat et al. ya tsara wani sabon daidaitacce daidaitaccen jagorar hakowa don sanya screws mara kyau a cikin maganin raunin wuyan mata ta hanyar gyarawa na ciki, kuma ya gano cewa wannan sabon jagorar zai iya rage lokacin aiki da adadin ra'ayoyin intraoperative fluoroscopic idan aka kwatanta da hanyar gargajiya, don haka samun sakamako mai gamsarwa.
Filipov et al. An tsara wani biplane mai goyon bayan dunƙule guda biyu (BDSF), wanda wurin shigarwa na screws uku masu zurfi yana cikin kauri na cortical yanki na kusancin femoral, kuma sukurori uku suna daidaitawa daidai gwargwado na kan femoral, don haka samar da jirage biyu. Wannan hanya tana ba da damar tallafin cortical sau biyu, don haka samar da isasshen ƙarfin gyarawa yayin motsi.
Gwaje-gwajen halittun halittu ta amfani da samfurori na cadaveric sun nuna cewa hanyar daidaitawa ta BDSF tana ba da ingantaccen gyara fiye da hanyar gyara alwatika na gargajiya. Sakamakon gwaje-gwajen gwaje-gwajen kwayoyin halitta ta amfani da samfurori na cadaveric sun nuna cewa ciminti na calcium phosphate ya ƙarfafa ƙullun gyare-gyaren gyare-gyare mai mahimmanci ya inganta kwanciyar hankali na gyare-gyaren gyare-gyare na ƙananan wuyan mata, ya inganta juriya na matsawa na wuyan femoral, da kuma inganta ƙwanƙwasawa, wanda yake da babban darajar asibiti.
Saboda babban yiwuwar necrosis na mata na mata bayan gyaran ƙusa mai zurfi don karyewar wuyan mata, an ci gaba da amfani da wasu hanyoyin don taimakawa ƙusa cikin ƙusa mai zurfi don rage rikice-rikice kamar necrosis na femoral. Tushen tushen necrosis na mata bayan raunin wuyan mata shine asarar jini zuwa kan femoral, don haka mayar da hankali ga jiyya shine yadda za a inganta jini. Gabatarwar da aka ba da jini a cikin yanki na necrotic na shugaban femoral da kuma cikawar waje na raƙuman rami ta hanyar germinating Layer zai sauƙaƙe bambance-bambancen periosteum a cikin osteoblasts da kuma sake farfadowa na sprouts na jijiyoyin jini, wanda ke da tasirin osteogenic da revascularizing.
Takaitawa
Ƙaƙwalwar ƙuƙwalwar ƙuƙwalwar ƙuƙwalwa don ƙwayar wuyan mata na mata shine hanya mai mahimmanci mai mahimmanci, wanda ke da fa'idodin aiki mai sauƙi, ɗan gajeren lokacin aiki, ƙananan rauni, gyare-gyaren abin dogara da sauri bayan dawowa. Duk da haka, saboda halayen halayen halayen ƙwayar wuyan mata na femoral, matsalolin ischemic necrosis na shugaban mata da kuma rashin haɗin gwiwa ba za a iya kauce masa gaba daya ta hanyar gyaran ciki na ciki don raunin wuyan mata ba. Sabili da haka, alamun yin amfani da wannan hanyar gyarawa ya kamata a bayyana kafin amfani da su, kuma tsofaffi marasa lafiya tare da mummunan rauni na wuyan wuyan mata na mata da rashin matsayi na gaba ɗaya da ake buƙatar aiki na farko ya kamata su guje wa yin amfani da gyaran ciki na ciki don raunin wuyan mata kamar yadda zai yiwu. Hakanan ya kamata a yi la'akari da abubuwan da ke haifar da haɗari da ke shafar tsinkayen mai haƙuri, irin su nau'in raunin da ya faru, ƙananan kashi, da matsayi na aikin mai haƙuri, don rage yawan rikice-rikice na dogon lokaci kuma don haka inganta sakamakon maganin raunin wuyan mata.
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