Pehea e mālama ʻia ai ka haʻihaʻi periprosthetic?

Ke kumu

ʻO nā haʻihaʻi periprosthetic o ka femur proximal kahi pilikia koʻikoʻi i ka hip arthroplasty. ʻO ka maʻi i hōʻike ʻia he 3.5% 20 mau makahiki ma hope o ka hoʻokomo mua ʻana a hoʻonui ʻia me ka ulu ʻana o nā pani pani. Hoʻopili pinepine ʻia nā haʻihaʻi intraoperative me nā kumu i hoʻopaʻa ʻole ʻia. ʻO ka mea maʻamau, loaʻa nā haʻihaʻi i nā poʻe ʻelemakule nāwaliwali i hāʻule i ke kula kiʻekiʻe i ka ʻoki ʻana. ʻOiai aia nā ʻokoʻa o ke ao holoʻokoʻa i ka hoʻohana ʻana i nā kumu lāʻau i hoʻopaʻa ʻia a i ʻole ʻia, ʻaʻohe mea hōʻike maopopo e pili ana kekahi ʻano o ka lāʻau i hoʻopaʻa ʻia me kahi ʻoi aʻe o ka haki ʻana ma mua o kekahi. ʻO ka ʻōnaehana hoʻohālikelike ʻo Vancouver no nā haʻihaʻi femoral periprosthetic ua hoʻohana nui ʻia e nā kauka lapaʻau a ua hōʻike ʻia he hilinaʻi.

ʻO ka pahuhopu nui o kēia noiʻi ʻana, ʻo ia ka hoʻoholo ʻana i ka pilina ma waena o ka hoʻokaʻawale ʻana o Vancouver i nā ʻōpala i hoʻopaʻa ʻia a i ʻole ʻia. ʻO ka pahuhopu ʻelua, ʻo ia ka noiʻi ʻana i nā ʻokoʻa o nā hiʻohiʻona baseline o nā maʻi me nā ʻano haʻihaʻi ʻelua.

Nā mea a me nā ʻano hana

mea maʻi:

1. He pūʻulu o nā mea maʻi me nā haʻihaʻi periprosthetic proximal.

2. ʻO nā poʻe maʻi wale nō me nā haʻihaʻi mua o ka hip periprosthetic i hoʻokomo ʻia.

3. ʻO nā maʻi me nā haʻihaʻi intraoperative, hoʻoponopono hou i ka ʻūhā, a me nā haʻihaʻi interprosthetic i kāpae ʻia.

   
   

ʻIkepili moʻolelo:

1. ʻO ka lekiō kikohoʻe a me ka helu helu helu ma muli o ka palapala uila a me ka nānā ʻana.

2. ʻO nā kikoʻī kumu i hoʻopaʻa ʻia e pili ana i ka makahiki, ke kāne, ka helu ʻana o ke kino, a me ka emi ʻana o ka neʻe ʻana ma mua o ka hoʻomaka ʻana a i ʻole ka hilinaʻi o ka mea mālama.

3. 
   

Hoʻopaʻa moʻolelo kikoʻī o ke kaʻina:

1. ʻO ka manawa o ka hoʻokomo mua ʻana, ka hōʻailona no ka hoʻoheheʻe ʻana (osteoarthritis a i ʻole ka haki ʻana), ke ʻano o ke kumu (cemented a uncemented), a me ke ʻano o ka arthroplasty (total or semiarthroplasty).

2. ʻO nā moʻolelo kiʻi kikoʻī e pili ana i ka hoʻohālikelike ʻana ʻo Vancouver, kūlana varus vertebral, a me ka hoʻohālikelike ʻana o Dorr.

3. Ua hoʻopaʻa ʻia ke ʻano geometry kumu (conical a i ʻole ka hui no nā kumu i hoʻopaʻa ʻia, pololei a i ʻole ke ʻano wili no nā kumu i hoʻopaʻa ʻole ʻia) ma muli o ke ʻano radiographic.

4. Hoʻoholo ʻia ka hoʻohālikelike ʻana o Vancouver ma luna o nā ʻike kiʻi a me nā ʻike intraoperative i nā maʻi maʻi.

5. Ua hana ʻia nā ʻikepili helu me ka hoʻohana ʻana i nā hoʻololi mau T-test a me ka hoʻāʻo pololei a Fisher no nā ʻano hoʻohālikelike e hoʻohālikelike i nā hiʻohiʻona baseline a me ka hoʻokaʻawale ʻana o Vancouver o nā maʻi i nā pūʻulu kumu i hoʻopaʻa ʻia a i hoʻopaʻa ʻole ʻia.

6. ʻO nā hoʻokolohua āpau he ʻelua ʻaoʻao me kahi pae koʻikoʻi o 0.05. Hana ʻia ka ʻikepili helu me ka hoʻohana ʻana iā GraphPad Prism version 8.0.0.

   
   

Nā hualoaʻa

Ka nui o nā maʻi:

1. Ua ʻike ʻia he 1181 mau maʻi ma ka nīnau ʻana i ka ʻikepili o ka haukapila.

2. Ua kāpae ʻia nā maʻi 978 me nā haʻihaʻi femur proximal non-periprosthetic.

3. Ma waena o nā maʻi 203 i koe, ua loaʻa iā 8 nā ʻeha intraoperative, 6 i hōʻano hou ʻia i nā periprosthetic fractures, a ʻo 17 i nā haʻihaʻi periprosthetic o ka mīkini hoʻopaʻa hui pūhaka, a ua kāpae ʻia.

4. He 172 mau maʻi i hoʻokomo ʻia ma hope o ka haʻalele ʻana.

5. Loaʻa nā haʻihaʻi āpau ma hope o ka hāʻule ʻana. He 84 mau hihia me ka ʻole o ka sima

6. He 88 mau haki i loko o ka hui.

   
   

Nā hiʻohiʻona kumu:

1. Nui nā ʻokoʻa ma waena o nā pūʻulu o ka makahiki, ka manawa i ka hoʻokomo mua ʻana, nā hōʻailona no ka arthroplasty no nā haʻihaʻi ʻāʻī o ka ʻāʻī, ka hemiarthroplasty mua, ka hoʻokomo ʻana i ke kumu varus, a me ka helu helu kino.

2. ʻO ka mea nui, i ka hui cement, ʻo ka hapa nui he hemiarthroplasty.

3. ʻAʻohe ʻokoʻa koʻikoʻi ma waena o nā pūʻulu e pili ana i ka wahine, ka hoʻokaʻawale ʻana o Dorr, a me ka emi ʻana o ka mobility premorbid a i ʻole ka hilinaʻi mālama.

4. I loko o ka hui i hoʻopaʻa ʻia, ʻo ka hapa nui o nā kumu i hoʻopaʻa ʻia a ʻo nā mea ʻē aʻe he hoʻolālā hoʻohui.

5. I ka hui i hoʻopaʻa ʻole ʻia, ʻo ka hapa nui o nā kumu lāʻau pololei a ʻo ke koena he ʻano wili.

   
   

Nā ʻāpana o Vancouver:

1. Hoʻokaʻawale ʻia nā haʻihaʻi ʻo VancouverB2 i ʻehā mau hiʻohiʻona haʻihaʻi ʻokoʻa: ʻo ka 'burst' i hōʻike mua ʻia i hōʻike ʻia ma mua o nā ʻano ʻano ʻāpana 'huhū' i hoʻohālikelike ʻia, a me nā ʻano hiʻohiʻona helical i ʻike ʻia. Hōʻike ʻia kahi hiʻohiʻona X-ray o ka moʻo a me nā kiʻi kiʻi like (Figure 1).

2. Hoʻopili nui ʻia nā haʻihaʻi ʻūhā a me nā spiral me nā kumu lāʻau i hoʻopaʻa ʻia, ʻoiai ua pili nui ʻia nā haʻihaʻi flap me nā kumu i hoʻopaʻa ʻole ʻia.

3. Ua like ke ʻano o ka ʻili ʻili hope ma nā kumu ʻelua.

4. ʻO ka hui ʻana o nā subtypes classification Vancouver, me nā ʻano haʻihaʻi ʻehā B2 i hōʻike ʻia ma luna, me ka geometry stem e hōʻike ana i ke ʻano maʻamau o nā ʻano haʻihaʻi.

Kūkākūkā

I kēia lā, ʻo kēia ka haʻawina nui loa e hoʻohālikelike pololei i ka pilina ma waena o nā ʻāpana cemented stem periprosthetic fractures a me ka hoʻohālikelike ʻana o Vancouver:

• ʻAʻohe ʻokoʻa koʻikoʻi o ka hoʻopili ʻana ma waena o nā kumu i hoʻopaʻa ʻia a i hoʻopaʻa ʻole ʻia ma nā ʻano o Vancouver ʻano A, B, a C paha. Ua like ka nui o na ha'iha'i o VancouverB2 ma nā hui 'elua, e hō'ike ana i ka like 'ana o nā kumu pa'a a pa'a 'ole i nā ha'iha'i periprosthetic ma nā hui 'elua.

• Ma keʻano likeʻole, Fenelon et al. kālailai ʻia nā haʻihaʻi periprosthetic me nā kumu lāʻau i hoʻopaʻa ʻia a paʻa ʻole. Ua maopopo ka nui o ka nui o ka poe maʻi me ka hakihaki ma Vancouver B2 a me B3.

• Phillips et al. e wehewehe i ke ʻano o ka 'huhū' o nā ʻāpana kumu sima conical a me ka 'māka' ma ka ʻaʻahu sima, e like me ka 'poʻo koʻi'. Ua ʻike ʻia kēia haʻihaʻi i pili nui ʻia me nā kumu cemented i kēia haʻawina.

• 
  

• ʻO ke ʻano haʻihaʻi kiʻekiʻe o kēia mau haʻihaʻi e hāpai ana i nā hopohopo e pili ana i ka hoʻopau ʻana i ka iwi, a ʻo kēia mau haʻihaʻi e koi pinepine i ka wehe pono ʻana i ka sima a me ke kaʻe ʻana me kahi kumu lāʻau mamao.

• Capello et al. i wehewehe ʻia he 'flip-flop' haʻihaʻi e pili ana me nā ʻōpala i hoʻopaʻa ʻole ʻia, a ʻo nā ʻike e hōʻike ana i kēia ʻike. Hoʻomaka ka haʻihaʻi mai ke kumu waena o ka trochanter nui, hoʻonui i ka cortex medial, a mālama i ka cortex ʻaoʻao, mamao a hiki i ka trochanter liʻiliʻi. ʻO ka hoʻonui ʻia ʻana o ka ʻāina talar a me ka emi ʻana o ke kumu he mau hōʻailona radiographic o ka paʻa ʻole o ke kumu. Ua hōʻike nā haʻawina mua i kahi hui nui o kēia haʻihaʻi me nā kumu i hoʻopaʻa ʻole ʻia me nā hoʻolālā anatomical a me ke ʻano wedge, a kākoʻo kēia haʻawina i kēia hui.

• Hōʻike ʻo Grammatopolous et al i ke ʻano o nā ʻano haʻihaʻi helical i nā haʻihaʻi periprosthetic me nā kumu cemented, pili maʻamau me nā ʻāpana wedge kaʻawale a me ka hoʻemi nui ʻana. Ua hoʻonui nui ʻia ka helu o nā haʻi helical i loko o ke kumu i hoʻopaʻa ʻia ma kēia moʻo, e hōʻike ana i ka manaʻo o nā haʻihaʻi a puni ke kumu cemented tubular e hoʻolaha ma ke ʻano like me ka iwi maoli.

• I loko o kahi loiloi radiographic o ka nui o nā haʻihaʻi periprosthetic, ua ʻike ka hui noiʻi i kahi ʻano haʻihaʻi i hōʻike ʻole ʻia ma ka palapala. Hoʻokumu ʻia ka haʻihaʻi mai ka calcar medial e hele ana ma ka ʻaoʻao ʻaoʻao, me ka waiho ʻana i ka cortex medial i paʻa. Kapa ʻia kēia ʻano haʻihaʻi ʻo ka 'reverse' clamshell fracture, i manaʻo ʻia e ka haʻi ʻana he haki maʻamau ʻo Vancouver B2.

• Ua koho ʻia kēia inoa no nā kumu ʻelua: ʻo ka mua, he kiʻi aniani ia o ka 'flip', a ʻo ka lua, hana ia e like me ka haʻihaʻi oblique proximal femoral fracture, me kahi hoʻoneʻe supralateral like o ka mea ʻaihue e huki ana i ka ʻāpana proximal. Ua like nā haʻihaʻi like me nā kumu lāʻau i hoʻopaʻa ʻia a paʻa ʻole (Figure 2).

• ʻOiai ʻaʻole ke kumu o kēia noiʻi ʻana no ka noiʻi ʻana i nā hopena lapaʻau, ma kēia haʻawina, ua hoʻoponopono maʻamau ʻia nā haʻihaʻi flip-flop me kahi arthroplasty o ke kumu haʻahaʻa haʻahaʻa mamao a me ka hoʻopaʻa ʻana o nā ʻāpana haʻihaʻi kokoke me nā uwea cerclage a i ʻole nā ​​​​papa.

• Hōʻike ʻia kahi laʻana o ka mea maʻi i mālama ʻia me kēia ala, e hōʻike ana i ka hoʻokō ʻana o ka ho'ōla (Figure 3).

Kiʻi 2 Hoʻohuli i ke ʻano o ka haʻi ʻana i luna.

Kiʻi 3 Arthroplasty a me cerclage uea hoʻopaʻa 'ana no ka retrograde flap fractures.

Ka hopena

Wahi a ka ʻōnaehana hoʻohālikelike ʻo Wanekoua, ua like nā ʻano haʻihaʻi periprosthetic o nā haʻihaʻi periprosthetic i nā prostheses sima a me ka ʻole. No laila, ua like ka nui o nā kumu paʻa a paʻa ʻole ma hope o ka haki ʻana i nā hui ʻelua. ʻO ka ʻike ʻana i ʻehā mau hiʻohiʻona haʻihaʻi ʻo VancouverB2, me ke ʻano hoʻohālike flip-flop hou i ʻike ʻia, e kōkua i nā kauka lapaʻau e ʻike i ka paʻa ʻole o ke kumu. Pono nā haʻawina i ka wā e hiki mai ana e noiʻi i ka pilina ma waena o ke ʻano haʻihaʻi a me ka hoʻolālā lapaʻau e hoʻoholo ai i ke koʻikoʻi o ke kino o nā ʻike o kēia noiʻi.

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