Femoral caj dab pob txha yog ib qho ntawm feem ntau ntsib kev raug mob orthopedic hauv kev kho mob, feem ntau ntawm cov neeg mob laus suav nrog ntau dua 50% ntawm pob txha pob txha. Raws li kev txheeb cais, qhov tshwm sim ntawm femoral caj dab tawg tau maj mam nce hauv xyoo tas los no, nrog rau cov poj niam ntau dua li cov txiv neej. Vertigo, dementia, malignancy thiab cardiopulmonary kab mob nyob rau hauv cov neeg laus thiab high-zog raug mob nyob rau hauv cov tub ntxhais hluas yog cov muaj feem xyuam rau lub caj dab femoral fractures.
Nyob rau hauv xyoo tas los no, ntau yam khoom siv kho vaj tse xws li hollow screws, lub hwj chim hip screws (DHS), zawv zawg hip screws (HSH), proximal femoral dissection phaj, reconstruction rau tes, thiab Gamma rau tes tau tshwm sim. Ntawm cov khoom siv kho mob sab hauv, hollow screws yog feem ntau siv. Cov kev tshawb fawb pom tau hais tias feem coob ntawm cov kws phais neeg nyiam hollow screws rau kev kho mob ntawm cov pob txha uas tsis yog qhov chaw, thiab feem ntau ntawm cov kws phais neeg xaiv los siv cov hollow screws rau qhov chaw femoral caj dab tawg. 3 parallel ib nrab threaded hollow ntsia hlau fixation yog qhov ntau tau txais daim ntawv ntawm sab hauv fixation.
Anatomical nta ntawm femoral caj dab tawg
Tam sim no feem ntau lees txais tias cov qauv vascular ntawm lub taub hau femoral yog qhov tseem ceeb tshaj plaws cuam tshuam rau kev kho pob txha thiab femoral taub hau necrosis. Kev puas tsuaj rau cov ntshav cov qauv ntawm lub taub hau femoral yog lub ntsiab pathological ntawm ischemic necrosis ntawm lub taub hau femoral. Ib txoj kev tshawb fawb txog vascular anatomy ntawm lub caj dab femoral pom tias epiphyseal vascular network thiab cov hlab ntsha ntawm qhov chaw txhawb nqa tsis zoo tuaj yeem yog cov qauv tseem ceeb rau kev tswj cov ntshav mus rau lub taub hau femoral tom qab lub caj dab femoral tawg, kom intraoperative drilling thiab implantation kom ze li sai tau rau thaj tsam hauv nruab nrab ntawm kev kho mob tuaj yeem txo qhov kev raug mob ntawm lub taub hau. intraosseous vascular system.
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Daim duab 1 Cov ntshav muab rau lub taub hau femoral, anterolateral (a) thiab posterior (b) views. Muaj kev hloov pauv hauv cov ntshav mus rau lub taub hau femoral, tab sis cov hlab ntsha sab nraud thiab nruab nrab ntawm cov hlab ntsha spinofemoral los ntawm cov hlab ntsha sib sib zog nqus femoral hauv 60% ntawm cov neeg mob.
(1) Feem ntau ntawm cov ntshav muab rau lub taub hau femoral los ntawm lateral rotor femoral artery.
(2) Nws muab tawm 3 lossis 4 ceg uas txhawb nqa cov hlab ntsha. Cov ceg no taug kev tom qab thiab nce mus raws li qhov retroflexed feem ntawm lub caj dab synovial ntawm lub femur mus rau sab ntug cartilaginous ntawm lub taub hau femoral. Cov hlab ntsha nyob rau hauv lub round ligament.
(3) Tau txais los ntawm foramen occulta artery. Ascending ceg ntawm medial rotor femoral artery.
(4) Muab qhov loj dua trochanter ntawm femur thiab tsim ib lub nplhaib arterial nrog rau sab rotor femoral artery.
Hollow screws rau femoral caj dab tawg
Clinically, peb hollow cancellous pob txha screws ntawm 6.5 hli los yog 7.0 hli los yog 7.3 hli yuav siv tau rau fixation nyob rau hauv cov neeg mob hluas los yog nyob rau hauv nruab nrab-hnub nyoog los yog laus cov neeg mob uas muaj pob txha zoo. Daim ntawv qhia yuav tsum tau siv los ua kom cov 3 hollow ntsia hlau sib npaug kom tso cai rau zawv zawg pob txha compression. Nyob rau hauv lub caj dab femoral, cov ntsia hlau yuav tsum tau muab ntsia rau hauv cov npoo, saib xyuas tias cov ntsia hlau yog threaded rau hauv lub taub hau femoral thiab tsis hla txoj kab tawg, vim qhov no yog tib txoj hauv kev kom tau txais kev sib tw kawg. Cov screws yuav tsum tau nruj nreem thiab rov ua kom paub tseeb tias intraoperatively. Yog tias siv lub txaj traction, lub traction yuav tsum tau so. Hollow screws tuaj yeem muab tso rau percutaneously. Frontal, lateral, thiab 45 ° oblique fluoroscopy yuav tsum tau ua kom ntseeg tau tias cov ntsia hlau tsis nkag mus rau hauv lub duav sib koom.
1 、 Cov txheej txheem kev phais tshwj xeeb.
Siv qhov 'inverted daim duab peb sab' ntsia thawv qhov chaw, uas yog feem ntau siv nyob rau hauv kev kho mob xyaum, ua piv txwv.
ib. Ua ntej ntawm tag nrho cov, nyob rau hauv fluoroscopy, siv X-ray nyob rau hauv ob lub dav hlau ntawm fluoroscopy los txiav txim qhov layout ntawm qis thiab nruab nrab phau ntawv pins.
b. Kev txiav ntawm daim tawv nqaij yog ua kom ntev li 2-3 cm.
c. Lub fascial txheej yog sib cais raws qhov incision thiab Cobb separator yog siv los cais cov longitudinal fibers nyob rau sab femoral leeg.
d. Muab lub koob qhia rau hauv ib txoj haujlwm uas ob lub dav hlau zoo meej.
e. Ib qho kev taw qhia tus pin tau muab tso rau ntawm qhov anterior nam ntawm lub caj dab femoral nrog tus pab los txiav txim siab lub kaum sab xis ntawm sab xub ntiag.
f. Tom qab txhim kho tus thawj coj tus pin, posterosuperior thiab anterosuperior phau ntawv qhia pins raug txheeb xyuas siv cov lus qhia sib npaug kom tau txais kev txhawb nqa tom qab thiab sab hauv cortical hauv lub caj dab femoral.
g. Qhov no yog ua los ntawm inserting ib tug qhia pin saum lub trochanter tsawg dua nyob rau hauv lub distal femoral caj dab cortex ntawm lub femoral qaum; tom ntej no ob phau ntawv qhia pins yog muab tso rau hauv ib qho kev sib piv, kom deb li deb tau thiab 5 hli los ntawm lub anterior thiab posterior cortex; qhov tob ntawm kev nkag ntawm cov lus qhia tus pin yog tom qab ntawd kho kom ncav cuag 5 mm hauv qab pob txha mos; Thaum kawg, lub qhov yog reamed, ntsuas, thiab ib tug pressurized hollow ntsia hlau yog screwed rau hauv.
h. Nco ntsoov tsis txhob nkag mus rau hauv rab koob hauv qab qhov tsawg dua trochanter thiab taug kev ze ntawm femoral qaum.
i. Xyuas kom tseeb tias lub threaded qhia tus pin yog positioned nyob rau hauv lub sib koom tes.
j. Tsis txhob tso cai rau tus pin phau ntawv nkag mus rau qhov chaw ntawm qhov chaw.
k. Txiav txim siab qhov tsim nyog ntsia hlau ntev los ntawm kev ntsuas cov lus qhia tus pin ntev thiab tom qab ntawd tshem tawm 5 hli.
l. Feem ntau nws tus kheej tapping, nws tus kheej-drilling screws yog siv, tab sis qee zaum ua ntej drilling ntawm lub lateral cortex yog xav tau nyob rau hauv cov neeg mob uas muaj siab ntseeg nrog cov pob txha tuab.
m. Yog tias qhov chaw tso cai, siv lub spacer.
n. Lub 4th ntsia hlau (pob zeb diamond teeb tsa) yuav tsim nyog rau cov neeg ntseeg siab uas muaj kev puas tsuaj loj ntawm lub ntsej muag tom qab ntawm tes.
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Txawm hais tias hollow screws rau femoral caj dab tawg yog tam sim no ntau heev, tseem muaj qhov sib txawv ntawm kev xav txog tus naj npawb thiab kev teeb tsa ntawm qhov phais tso hollow screws, feem ntau nyob ntawm tus neeg teb xov tooj nyiam; factors such as the patient's bone density, screw strength, and success of treatment also have an impact.
1 、 Tus naj npawb ntawm hollow screws.
Femoral caj dab pob txha feem ntau yog kho nrog 2-4 hollow screws.
Feem ntau, 3 screws yog siv vim tias lawv tuaj yeem tiv taus qhov kev ntxhov siab sab hauv, ua kom muaj kev ruaj ntseg, thiab txo qhov kev tawg ntawm qhov kawg.
Rau femoral caj dab tawg nrog lub Pauwells lub kaum sab xis> 50 °, 2 screws yog tsim nyog.
Nyob rau hauv cov neeg mob uas mob hnyav comminuted pob txha ntawm lub caj dab posterior femoral, 4 hollow screws tau tawm tswv yim.
Txawm li cas los xij, kev xyaum ua tiav tseem yog siv 3 hollow screws rau fixation.
2, Configuration ntawm hollow ntsia hlau.
Thaum 3 hollow screws siv rau kev kho sab hauv ntawm femoral caj dab tawg, nws feem ntau ntseeg tias txoj kev xav ntawm 'sliding compression' yuav tsum tau ua raws li, yog li ntawd 3 screws implanted yog tib yam rau ib leeg nyob rau hauv lub orthogonal saib thiab muaj ib tug triangular configuration nyob rau hauv lub lateral saib.
Nyob rau hauv txoj kev no, peb qhov sib npaug hollow screws tuaj yeem muab kev txhawb nqa zoo thiab tsim cov zawv zawg, kom cov pob txha tawg tuaj yeem xaub raws femoral caj dab axis nyob rau hauv kev cog lus ntawm cov leeg ntawm lub duav, tsim siab ntawm qhov tawg kawg thiab txhawb kev puas tsuaj.
Txawm li cas los xij, seb 3 hollow screws tau muab tso rau hauv ib qho orthotriangular lossis inverted triangular configuration tau muaj teeb meem.
Advances nyob rau hauv hollow ntsia hlau fixation txheej txheem rau femoral caj dab tawg
Yuenyongviwat et al. tsim ib tug tshiab adjustable thaum uas tig mus drilling phau ntawv qhia rau qhov chaw ntawm hollow screws nyob rau hauv kev kho mob ntawm femoral caj dab fractures los ntawm internal fixation, thiab pom hais tias cov tshiab qhia no yuav txo tau lub sij hawm ua hauj lwm thiab tus naj npawb ntawm intraoperative fluoroscopic views piv nrog rau cov tsoos txoj kev, yog li ua tau raws li qhov kev txiav txim siab.
Filipov et al. tsim ib tug biplane ob-txhawb ntsia hlau fixation (BDSF), nyob rau hauv uas lub nkag point ntawm peb hollow screws nyob rau hauv lub tuab cortical cheeb tsam ntawm lub proximal femoral qia, thiab peb screws yog sib npaug offset rau lub periphery ntawm lub femoral taub hau, yog li tsim ob lub dav hlau. Txoj hauv kev no tso cai rau kev txhawb nqa ob lub cortical, yog li muab lub zog ruaj khov txaus thaum txav mus los.
Biomechanical thwmsim siv cadaveric specimens pom tias BDSF fixation txoj kev muab fixation zoo dua li ib txwm inverted daim duab peb sab fixation txoj kev. Cov txiaj ntsig ntawm kev sim biomechanical siv cadaveric specimens pom tias calcium phosphate cement reinforced hollow screw fixation ho txhim kho qhov ruaj khov ntawm hollow ntsia hlau fixation ntawm femoral caj dab pob txha, txhim kho lub compression tsis kam ntawm lub caj dab femoral, thiab txhim kho torsional txhav, uas yog cov txiaj ntsig zoo heev.
Vim tias muaj qhov ua tau zoo ntawm femoral taub hau necrosis tom qab hollow ntsia thawv kho rau femoral caj dab tawg, lwm txoj kev tau siv tsis tu ncua los pab hollow ntsia thawv sab hauv kho kom txo tau cov teeb meem xws li femoral taub hau necrosis. Lub hauv paus ua rau femoral taub hau necrosis tom qab femoral caj dab tawg yog qhov poob ntawm cov ntshav ntws mus rau lub taub hau femoral, yog li qhov kev kho mob tseem ceeb yog yuav ua li cas txhawm rau txhim kho ntshav txaus. Kev taw qhia ntawm cov ntshav muab periosteum graft rau hauv thaj chaw necrotic ntawm lub taub hau femoral thiab sab nraud txhaws ntawm cov kab noj hniav los ntawm txheej txheej germinating yuav pab txhawb qhov sib txawv ntawm grafted periosteum rau hauv osteoblasts nrog rau kev tsim kho ntawm vascular sprouts, uas muaj ob qho tib si osteogenic thiab regeneration.
Cov ntsiab lus
Hollow ntsia hlau fixation rau femoral caj dab tawg yog ib txoj kev kho zoo heev, uas muaj qhov zoo ntawm kev ua haujlwm yooj yim, lub sijhawm ua haujlwm luv luv, me ntsis kev raug mob, txhim khu kev qha thiab rov qab ua haujlwm sai. Txawm li cas los xij, vim yog cov yam ntxwv ntawm femoral caj dab pob txha, cov teeb meem ntawm ischemic necrosis ntawm lub taub hau femoral thiab tsis sib koom ua ke ntawm cov pob txha tseem tsis tuaj yeem zam tag nrho los ntawm kev kho sab hauv rau femoral caj dab tawg. Yog li, cov lus qhia rau kev siv cov txheej txheem fixation no yuav tsum tau qhia meej ua ntej siv, thiab cov neeg mob laus uas muaj kev cuam tshuam loj heev ntawm lub caj dab femoral thiab cov xwm txheej tsis zoo uas yuav tsum tau ua thaum ntxov yuav tsum zam kom tsis txhob siv kev kho mob sab hauv rau femoral caj dab pob txha kom ntau li ntau tau. Cov kev pheej hmoo cuam tshuam rau tus neeg mob qhov kev mob tshwm sim, xws li hom pob txha, pob txha ntom, thiab tus neeg mob lub luag haujlwm, yuav tsum tau muab coj los txiav txim siab kom txo tau cov teeb meem ntev tom qab phais thiab yog li txhim kho cov txiaj ntsig kev kho mob ntawm femoral caj dab tawg.
Yuav Ua Li Cas Orthopedic Implants thiab Orthopedic Instruments?
Rau CZMEDITECH , peb muaj cov khoom lag luam ua tiav ntawm orthopedic phais implants thiab cov cuab yeej siv, cov khoom suav nrog txha caj qaum, intramedullary rau tes, kev raug mob phaj, xauv phaj, cranial-maxillofacial cov, prosthesis, cov cuab yeej siv zog, sab nraud fixators, arthroscopy, Veterinary saib xyuas thiab lawv cov cuab yeej txhawb nqa.
Tsis tas li ntawd, peb tau cog lus los tsim cov khoom tshiab thiab nthuav dav cov khoom lag luam, txhawm rau ua kom tau raws li kev xav tau ntawm kev phais ntawm ntau tus kws kho mob thiab cov neeg mob, thiab tseem ua rau peb lub tuam txhab muaj kev sib tw ntau dua nyob rau hauv tag nrho lub ntiaj teb orthopedic implants thiab instruments kev lag luam.
Peb xa tawm thoob ntiaj teb, yog li koj tuaj yeem ua tau tiv tauj peb ntawm email chaw nyob song@orthopedic-china.com rau ib qho kev tsocai pub dawb, lossis xa lus ntawm WhatsApp rau cov lus teb ceev +86- 18112515727 .
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