Wehewehe 'ana o nā ha'iha'i waena o ka femur
ʻO nā haʻihaʻi intertrochanteric o ka femur (ʻike pū ʻia ʻo trochanteric fractures) e pili ana i nā haʻihaʻi e puka mai ana mai ke kumu o ka ʻāʻī femoral a i ka pae ma luna o ka trochanter liʻiliʻi. ʻO nā hōʻike e pili ana i ka ʻeha kūloko, ka pehu, ecchymosis. ʻAʻole hiki i nā maʻi ke hele, me ka pōkole, ka hoʻohui ʻana, a me ka hoʻololi ʻana i waho o ka lālā i hoʻopilikia ʻia, a me ka palena o ka neʻe ʻana o ka hui pūhaka.
ʻO kēia mau haʻihaʻi he 3% - 4% o nā haʻihaʻi āpau i loko o ke kino a me 35.7% o nā haʻi ʻūhā. Piʻi ka maʻi i ka makahiki, ʻoi aku ka nui o ka poʻe ma mua o 70 mau makahiki, a ʻoi aku ka maʻamau i nā wahine ma mua o nā kāne.
Hoʻohana ʻia Anatomy o nā ʻAha Intertrochanteric o ka Femur
Ka Triangle o Ward
Hoʻokumu ʻia kahi ʻāpana palupalu triangular ma ke kikowaena kahi e kū ai ka ʻāʻī femoral trabeculae. I ka poʻe ʻelemakule me ka osteoporosis, piha wale kēia wahi i ka momona.
Femoral Calcar
He pā iwi mānoanoa ma hope - ma waena o ka hui ʻana o ka ʻāʻī femoral a me ke kumu hohonu i ka trochanter liʻiliʻi. He hoʻonui ia o ka hope - medial cortex o ka femoral shaft i loko o ka iwi cancellous a ʻo ia ke kiko o ka hoʻohana ʻana i ka ukana eccentric ma ka femur proximal.
Ka helu ʻana o ka iwi ʻūhā Trabeculae
Ka helu ʻana i ka ikaika mechanical o ka femur proximal:
(1) Papa 6; (2) Papa 5; (3) Papa 4; (4) Papa 3; (5) Papa 2; (6) Papa 1
Mechanisms Poha o Intertrochanteric Fractures o ka Femur
Nā ʻeha kiʻekiʻe - ikehu i nā maʻi ʻōpio
ʻO nā haʻihaʻi Intertrochanteric i nā poʻe maʻi ʻōpio ke kumu maʻamau e nā ʻeha kiʻekiʻe - e like me ka hāʻule ʻana mai kahi kiʻekiʻe a me nā ulia kaʻa. Hiki i kēia mau kūlana ke alakaʻi i nā haʻihaʻi koʻikoʻi, a pono e nānā pono ʻia nā poʻe maʻi no nā ʻeha e pili ana, me nā mea i ke poʻo, spine, a me nā ʻōpū a me nā ʻōpū.
Nā kumu o ka hāʻule ʻana o nā maʻi ʻelemakule
ʻO 90% o nā haʻihaʻi intertrochanteric i ka poʻe ʻelemakule ma muli o ka hāʻule. ʻO nā kumu e hāʻule ai ka poʻe ʻelemakule, ʻo ia ka ʻike maka ʻole, ka emi ʻana o ka ikaika o ka ʻiʻo, ke koko paʻa ʻole, ka emi ʻana o ka hiki ke hoʻokō, nā maʻi vascular, a me nā maʻi iwi a me nā hui.
ʻO ka hāʻule ʻana o ka haʻihaʻi e hoʻoholo ʻia e nā kumu ʻelima: ka paʻakikī o ka osteoporosis, ke kuhikuhi o ka hāʻule ʻana, ʻoi aku ka nui o ka wā e paʻi ai ka ʻūhā a i ʻole kahi kokoke i ka ʻūhā i ka lepo, ka lawa ʻole o nā reflexes pale e hōʻemi i ka ikehu o ka hāʻule ʻana, ka hiki ʻole o nā ʻiʻo palupalu o ka ʻūhā e komo i ka ikehu, a me ka ikaika ʻole o nā iwi ʻūhā.
Nā ʻano hana ʻino a me nā ʻano hana
Hoʻomāinoino pololei: ʻO nā ʻeha kiʻekiʻe - hana pololei ma ka ʻūhā, e like me nā ulia kaʻa a hāʻule paha kahi i hoʻopili pololei ʻia ai ka ʻūhā, e alakaʻi ana i nā haʻihaʻi.
ʻO ka hoʻomāinoino ʻole: ʻO ke kino o ke kino e hoʻopiʻi i ka ʻūhā i ka varus a me ke koʻikoʻi angulation i mua. Me ka trochanter liʻiliʻi ma ke ʻano he fulcrum, ua paʻa ikaika ia, a aia paha ka hopena huki o ka ʻiʻo iliopsoas, e hana ana i ʻāpana iwi ʻano pepeke. Hiki i ka trochanter nui ke hana i ʻāpana iwi i hoʻokaʻawale ʻia ma muli o ka huki ikaika ʻana o ka ʻiʻo gluteus medius.
ʻO ka hoʻokaʻawale ʻana i nā ʻāpana Intertrochanteric o ka Femur
Hoʻokaʻawale Evans
ʻO ka mea maʻamau i hoʻohana ʻia i ka hana lapaʻau. Ua hoʻokaʻawale ʻo Evans i nā ʻāpana intertrochanteric i ʻelua ʻano:
Type I: Trans - trochanteric fractures E like me ke kūpaʻa ma mua a ma hope o ka hōʻemi ʻana, ua māhele hou ʻia i 4 mau ʻano:
Ⅰa: ʻElua ʻāpana haʻi me ka hoʻoneʻe ʻole.
Ⅰb: ʻElua ʻāpana haʻi me ka neʻe ʻana, paʻa mau ka cortex medial, a paʻa ka haʻi ma hope o ka hōʻemi ʻana.
Ⅰc: ʻAʻole manuahi ka trochanter liʻiliʻi, me ka hoʻoneʻe ʻana i ka haʻihaʻi a me ka ʻino o ka varus; a ʻo ka trochanter nui he ʻāpana iwi ʻokoʻa.
Ⅰd: Ma waho aʻe o ka haʻihaʻi intertrochanteric, lilo nā trochanter nui a me ka liʻiliʻi i mau ʻāpana iwi ʻokoʻa, me ke ʻano o ka varus.
Ma waena o lākou, ʻo nā ʻano Ⅰa a me Ⅰb nā ʻano paʻa, a ʻo ke koena he mau ʻano paʻa ʻole.
ʻAno II: Hoʻohuli - nā haʻihaʻi oblique intertrochanteric
ʻO ke ʻano II he haʻi hope - trochanteric fracture, me ka laina o ka haʻihaʻi e hoʻonui obliquely mai lalo o ka trochanter nui a i ka ʻaoʻao o luna o ka trochanter liʻiliʻi.
Hoʻokaʻawale AO
ʻAno A1: ʻO nā haʻihaʻi ʻelua ʻāpana ma o ka trochanter, me ke kākoʻo maikaʻi ʻana o ka iwi iwi waena a me ka cortex iwi ʻaoʻao paʻa.
Ma ka laina intertrochanteric.
Ma o ka trochanter nui.
Ma o ka liʻiliʻi trochanter.
ʻAno A2: Nā haʻihaʻi i hoʻopili ʻia ma o ka trochanter, me nā haʻi o ka cortex medial ma nā mokulele ʻelua, akā paʻa mau ka cortex iwi ʻaoʻao.
Me hoʻokahi ʻāpana haʻi waena.
Me kekahi mau ʻāpana haʻi waena.
ʻOi aku ma mua o 1 knm ma lalo o ka trochanter liʻiliʻi.
ʻAno A3: Huli - nā haʻihaʻi intertrochanteric, me nā haʻihaʻi o ka cortex ʻaoʻao pū kekahi.
Oblique.
Kūʻē.
Hoʻoholo ʻia.
ʻO ka maʻamau, manaʻo ʻia nā ʻano A1.1 a i A2.1 i paʻa, a ʻo nā ʻano A2.2 a i A3.3 i manaʻo ʻia ʻaʻole paʻa.
Ka Lapaau o na Ha'i Intertrochanteric o ka Femur
ʻO ke kumu nui o ka lapaʻau ʻana, ʻo ia ka hoʻopaʻa paʻa ʻana o ka haʻihaʻi intertrochanteric ma hope o ka emi ʻana. ʻO ka paʻa o ka hoʻopaʻa ʻana e pili ana i kēia mau kumu: ka maikaʻi o ka iwi, ke ʻano haʻihaʻi, ka hoʻoemi, ka hoʻolālā ʻana o ka mea hoʻoponopono kūloko, a me ke kūlana hoʻonohonoho o ka mea hoʻoponopono kūloko.
I nā makahiki i hala iho nei, ua hoʻomohala mau ʻia nā mea hoʻoponopono kūloko no ka mālama ʻana i nā haʻihaʻi intertrochanteric. Ma waena o lākou, hoʻohana maʻamau ka hoʻoponopono intramedullary, e like me PFNA a me INTERTAN, e like me ka mea hoʻoponopono kūloko maʻamau.
PFNA no ka lapaʻau ʻana i nā haʻihaʻi Intertrochanteric o ka Femur
Hoʻohana ʻia ka PFNA no nā haʻihaʻi intertrochanteric osteoporotic paʻa ʻole e like me Evans Ic, Id, a me Type II. Loaʻa ka maikaʻi o ka hana, maikaʻi anti - rotational hiki, pōkole hana manawa, emi koko poho, emi complications, a me ka haʻahaʻa probability o proximal laka kui kui - i waho, e hoike maopopo lapaʻau pono.
Hōʻike ʻia ka PFNA no nā haʻihaʻi intertrochanteric osteoporotic paʻa ʻole (e like me nā ʻano Evans Ic, Id, a me II). Hōʻike ʻo ia i ka hana ʻoi aku ka maikaʻi me nā waiwai anti-rotation maikaʻi loa, ʻoi aku ka pōkole o ka manawa hana, hoʻemi i ke kahe koko, a me nā pilikia liʻiliʻi. Hoʻopaʻa pono ka ʻōnaehana helical blade i ka iwi, hāʻawi i ka mana paʻa ikaika a hōʻemi nui i ka hopena o ke ʻoki ʻia mai ke poʻo femoral, e hāʻawi ana i nā pono therapeutic ʻokoʻa.
INTERTAN no ka lapaʻau ʻana i nā haʻihaʻi Intertrochanteric o ka Femur
Me ka hoʻomohala ʻana o ka ʻenehana lapaʻau hou, ʻo INTERTAN kahi ʻano hou o ke kui intramedullary i hoʻolālā ʻia no ka mālama ʻana i nā haʻihaʻi intertrochanteric o ka femur. ʻO ka ʻāpana keʻa o kāna kui nui he trapezoidal. Ke hoʻohana ʻia i ka hui pū ʻana me ka nail hoʻopili pili kokoke, hiki iā ia ke pale i ka hopena 'Z'. ʻO ka hoʻohui ʻana o kahi kui lua e puka mai ana mai ke poʻo femoral e hoʻonui i ka hopena anti - rotational o ka lag screw. ʻO kēia kui intramedullary he ʻano nui o nā noi a kūpono i nā poʻe maʻi me ka osteoporosis koʻikoʻi.
ʻO ka INTERTAN kahi kui intramedullary hou i hoʻolālā ʻia no nā haʻihaʻi intertrochanteric, e hōʻike ana i nā holomua i ka ʻenehana lapaʻau hou. Hōʻike kona kui nui i kahi ʻāpana trapezoidal no ka hoʻonui ʻana i ka paʻa. Hoʻohana ka ʻāpana proximal i kahi hana hoʻopili i hoʻohui ʻia (kahi wili lag a me kahi wili kaomi), e pale pono i ka 'Z-effect' (kahi e hoʻi hope ai kekahi wili a komo kekahi i ke poʻo femoral). Hiki i ka wili hoʻonohonoho ʻē aʻe ke hana hou aku i loko o ke poʻo femoral, e hoʻonui ana i kona hiki ke anti-rotation. He laulā nā hōʻailona o kēia kui a kūpono loa i nā poʻe maʻi me ka osteoporosis koʻikoʻi.
CHANGZHOU MEDITECH TECHNOLOGY CO., LTD. loea i nā implants orthopedic kiʻekiʻe a me nā hoʻonā ʻokiʻoki kiʻekiʻe. He ʻoihana ʻenehana kiʻekiʻe e hoʻohui ana i ka R&D, ka hana, ke kūʻai aku, a me ka lawelawe.
ʻO ka pili ʻana i ka manaʻo o 'Innovation Driven, Pursuit of Excellence,' ʻo ka waihona huahana piha o ka hui e uhi ana i ka spine, nā kui intramedullary, nā papa laka, ka hoʻopaʻa ʻana i waho, nā hono, craniomaxillofacial, holoholona, nā mea hana mana, nā mea kani, a me nā baluna. Ke hōʻike nei kēia mau laina huahana i nā wahi koʻikoʻi no ka ʻenehana ʻenehana i loko o ka ʻoihana mālama ola, i hoʻolako ʻia i ka hāʻawi ʻana i nā koho ʻoki āpau a hilinaʻi no nā kauka lapaʻau honua. Me kona ʻano huahana like ʻole a me nā mana ʻenehana paʻa, hoʻolaha ikaika ka ʻoihana i ka holomua a me ka hiki ʻana o ka ʻenehana lapaʻau.
ʻO nā kiʻi i paʻi ʻia i ka wā o ka hanana, me ka launa pū ʻana me nā kauka lapaʻau a me nā mea hoʻolaha, hōʻike i ka ʻuhane o ka pilina a me ka hoʻopaʻa like ʻana i ka hoʻomaikaʻi ʻana i ka mālama maʻi.
