Dab tsi ntawm cov txheej txheem hauv qab no yog siv los kho cov pob txha intertrochanteric?

Intertrochanteric fracture ntawm lub femur, tseem hu ua intertrochanteric fracture, yog ib qho ntxiv-articular capsule fracture. Lub ntsiab tshwm sim ntawm intertrochanteric pob txha yog qhov mob loj hauv zos thiab o, qhov dav ecchymosis, tsis muaj peev xwm ntawm tus neeg mob sawv los yog taug kev, luv luv, sab hauv thiab sab nraud tig deformity ntawm tus ceg ceg, thiab kev txwv tsis pub txav mus los ntawm lub duav sib koom ua ke hauv txhua qhov kev taw qhia.

Kab mob sib kis

1. Feem ntau ntawm lawv muaj feem cuam tshuam nrog kev mob pob txha, feem ntau tshwm sim hauv cov neeg laus, cov poj niam ntau dua li cov txiv neej.

2. Qhov tshwm sim muaj feem xyuam rau haiv neeg, poj niam txiv neej thiab cheeb tsam.

3. Kev raug mob tshwm sim hauv cov neeg laus, qhov nruab nrab hnub nyoog ntawm intertrochanteric fracture ntawm femur yog 75.2 xyoo. Tsis muaj qhov sib txawv tseem ceeb hauv lub hnub nyoog ntawm intertrochanteric tawg ntawm txiv neej thiab poj niam.

4. Vim cov ntshav nplua nuj nyob hauv trochanter, pob txha pob txha tsis tshua zoo, tab sis nws yog ib qho yooj yim uas yuav tshwm sim hip inversion, thiab muaj ntau yam teeb meem tshwm sim los ntawm kev pw tsaug zog ntev rau cov neeg laus, thiab qhov mob thiab kev tuag ntawm cov neeg laus yog 15% -20%, yog li nws yog hu ua qhov kawg tawg ntawm cov neeg laus.

Mechanism ntawm kev raug mob

1. Cov tub ntxhais hluas feem ntau raug mob hnyav, yuav tsum tau saib xyuas lub hlwb, hauv siab, plab thiab lwm qhov ntawm qhov raug mob; cov neeg laus feem ntau yog cov laus muaj nuj nqi ntawm cov ceg ceg kev sib koom tes teb agility poob thiab poob los ntawm.

2. Kev nruj nruj: cuam tshuam ncaj qha rau thaj tsam trochanter ntau dua. Yog hais tias lub cev ntog rau hauv av nrog lateral quab yuam thaum ntog.

3. Indirect kev nruj kev tsiv: lub cev yog twisted thaum lub caij nplooj zeeg, thiab lub duav yog raug rau cov kev ntxhov siab ntawm inversion thiab rau pem hauv ntej lub kaum sab xis tib lub sij hawm.

4. Pathological fracture, ib qho ntawm cov pob txha pob txha.

5. Intertrochanteric puas feem ntau yog tsim los ntawm kev ua phem tsis ncaj.

Clinical manifestations

1. Qhov kev nthuav qhia yooj yim yog tib yam li ntawm femoral caj dab tawg, nrog rau qhov mob hauv zos, o thiab kev ua haujlwm tsis zoo ntawm cov ceg ceg.

2. Vim hais tias nws yog ib qho ntxiv-articular capsule fracture, tsis muaj kev txwv ntawm kev sib koom tes capsule, yog li qhov deformity ntawm shortened sab nraud rotation (90 degrees) ntawm lub qis qis yog hnyav dua.

3. Axial percussion mob.

4. Cov hematoma hauv zos yog qhov hnyav heev, thiab tej zaum yuav muaj ntau qhov nqaij tawv subcutaneous.

5. Hauv cov neeg mob laus, lawv zoo li laus dua cov neeg mob caj dab femoral, thiab feem ntau ntawm cov neeg mob tau mob stroke yav dhau los.

Kev kuaj mob

Keeb kwm ntawm kev raug mob pom tseeb, qhov mob ntawm cov ceg ceg, thiab kev txwv ntawm kev txav mus los. Shortening thiab sab nraud rotation deformity ntawm lub ceg qis yog pom tseeb txog li 90 °. Kev kuaj X-ray feem ntau yuav tsum tau tsim kom muaj kev kuaj mob thiab ntaus ntawv raws li cov duab hluav taws xob. Cov tsos mob ntawm cov pob txha intertrochanteric zoo ib yam li cov pob txha femoral caj dab, tab sis tom kawg yog tsawg dua qhov qub ntawm qhov mob hauv zos, o, ua haujlwm tsis zoo, thiab txo qis ntawm cov ceg ceg, thiab cov ceg uas cuam tshuam feem ntau muaj me ntsis hip flexion thiab lub hauv caug flexion thiab sab nraud rotation deformity, feem ntau ntawm 60 ° - 45 °.

Hom

AO thiab Evans-Jensen fractures yog ob hom pob txha siv ntau tshaj plaws, thiab ntawm ob qho no, hom pob txha AO yog qhov ntau tshaj.

Evans-Jensen ntaus ntawv

Hom I: Ib qho yooj yim intertrochanteric pob txha tawg nrog ib txoj kab tawg ntawm txoj kab nqes los ntawm qhov zoo tshaj mus rau qhov tsis zoo, tsis muaj kev hloov pauv thiab ruaj khov.

Hom II: Kev tshem tawm ua ke nrog me me rotor avulsion tawg, tab sis lub femoral spur yog zoo lawm (femoral spur yog ib tug tuab pob txha phaj nyob rau hauv tob hauv lub femoral caj dab thiab lub cev hlws ris ntawm lub me rotor.

Hom III: Ua ke ntau dua trochanteric pob txha pob txha nrog pob txha pob txha pob txha ntawm femoral spur, nrog kev hloov pauv, feem ntau nrog cov pob txha hauv nruab nrab ntawm lub rotor.

Hom IV: 3-txoj kev puas tsuaj ua ke nrog kev sib tsoo ntawm qhov tsawg dua trochanter, uas tuaj yeem tshwm sim nrog pob txha tawg ntawm lub caj dab femoral thiab coronal nto ntawm qhov loj dua trochanter.

Hom V: posterior lateral and medial unsupported fracture (combination of type III and IV).

Hom R: anterior intertrochanteric fracture nrog oblique fracture kab los ntawm superior medial mus rau inferior lateral, uas tej zaum yuav txuam nrog ib tug me me rotor puas thiab kev puas tsuaj ntawm femoral qaum.

AO typing

A1.1 Cov kab tawg hla dhau los ntawm txoj kab nruab nrab ntawm rotor

A1.2 Fracture dhau los ntawm ntau dua trochanter

A1.3 Fracture dhau hauv qab qhov tsawg dua trochanter

A2.1 Fracture nrog 1 comminuted pob txha tawg

A2.2 Fracture nrog ntau cov pob txha comminuted

A2.3 Fracture ncua ntau tshaj 1 cm hauv qab qhov tsawg dua trochanter

A3.1 Cov duab oblique yooj yim

A3.2 Yooj yim transverse duab

A3.3 Cov lus qhia

Kev kho mob

Kev ruaj ntseg ntawm kev txhim kho sab hauv ntawm cov pob txha yog feem ntau nyob ntawm tsib yam: qhov zoo ntawm cov pob txha, hom pob txha, qhov txo qis, kev xaiv ntawm kev kho sab hauv, thiab txoj hauj lwm ntawm kev txhim kho sab hauv ntawm cov pob txha. Fracture repositioning yog ib qho tseem ceeb rau kev ruaj ntseg tom qab kev txhim kho sab hauv thiab yuav tsum tau ua kom tiav ib qho kev hloov pauv ntawm lub cev los yog qhov chaw tsis muaj qhov tsis zoo ntawm lub cev. Nyob rau hauv cov ntsiab lus, lub hom phiaj ntawm repositioning yog kom tau pob txha stability. Txoj kev ntawm repositioning yuav raug kaw los yog incisional. Txawm hais tias qhov nyuaj ntawm hom kev puas tsuaj, kaw yuav tsum tau sim ua ntej.

• Lub Hwj Chim Dowel (DHS)

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Cov txiaj ntsig tseem ceeb ntawm DHS Lub Hwj Hwj Hwj Hwj Hlwb.

• Cov ntsia hlau muaj zog fixation nyob rau hauv lub taub hau femoral, txawm nyob rau hauv cov ntaub ntawv ntawm osteoporosis.

• Lub gliding mechanism nyob rau hauv lub tes tsho tiv thaiv kev nkag mus ntawm tus ntsia thawv kawg rau hauv lub taub hau femoral los yog acetabulum thiab ncaj qha kis ntawm lub ntiajteb txawj nqus tsis zoo rau cov pob txha.

• Lub zog gliding mechanism ua kom qhov tawg ntawm qhov chaw thiab txo qis kev sib koom ua ke.

• Nws muaj ob txoj haujlwm ntawm compression thiab gliding, nrog rau cov nyhuv dynamic thiab zoo li qub compression.

  
  

• Lub Hwj Chim Dowel (DCS)

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  DCS thiab 95 degree txiav daim hlau rau anticrotal pob txha:

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Qhov zoo ntawm DCS lub zog condylar ntsia hlau yog.

• Nws tuaj yeem xaiv qhov nkag nkag ntawm cov ntsia hlau raws li qhov xwm txheej tshwj xeeb ntawm kev tawg, thiab kev ua haujlwm yooj yim.

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• Lub zog compression nro ntsia hlau yog nyob rau ntawm lub kaum sab xis ntawm lub phaj, uas ua tau raws li cov txheej txheem biomechanical ntawm lub duav. Thaum lub sij hawm hnyav-kev coj tus kheej, lub zog tsis zoo yog thawj zaug rau ntawm caj npab luv ntawm lub phaj thiab tom qab ntawd tawg mus rau txhua tus ntsia hlau, yog li ntawd qhov kev ntxhov siab tau tawg thiab qhov kho tau zoo heev.

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• Qhov loj me me ntawm DCS screws ntawm qhov tawg ua rau muaj kev ruaj khov, thiab qhov chaw tawg tuaj yeem txuas thiab kho, yog li txo qhov tshwm sim ntawm kev mob tom qab phais.

Proximal Femoral Locking Intramedullary Nail (PFN)

Qhov zoo ntawm PFN fixation.

• Cov ntsia hlau me me (feem ntau yog 9 hli), tuaj yeem tsav hauv yam tsis muaj dilation. (superior rau lub thicker caudal kawg ntawm Gamma ntsia thawv - 17mm)

• Qhov kawg ntawm PFN muaj kwv yees li ntawm 6 degrees, txo lub kaum sab xis ntawm valgus thiab tshem tawm qhov xav tau kom muaj zog sab hauv retraction thaum lub sij hawm traction.

• Sab saum toj kawg tso cai rau kev tso ntawm ob lub taub hau rau hauv lub taub hau femoral, nrog rau qhov sib ntxiv ntawm cov ntsia hlau los tiv thaiv kev sib hloov thiab ob chav ntsia hlau bearing hauv lub caj dab femoral, uas ua rau kom qaug zog.

• Qhov kev ncua deb ntawm qhov distal locking qhov thiab qhov kawg ntawm qhov kawg ntawm tus ntsia hlau loj (tapered extension) ntev dua, uas tuaj yeem txo qhov kev ntxhov siab hauv cov qia femoral.

• Kev raug mob tsawg dua.

Gamma rau tes

Qhov zoo ntawm Gamma ntsia thawv fixation.

• Nws yog ib qho me me invasive intramedullary fixation txoj kev nrog me me incision thiab tsawg heev raug mob.

• Gamma ntsia thawv ruaj khov sib sau ua ke ntawm lub caj dab sab sauv thiab lub caj dab femoral los ntawm kev sib xyaw ntawm cov ntsia hlau intramedullary thiab nro ntsia hlau, thiab cov ntsia hlau intramedullary yog kho los ntawm tus ntsia thawv distal nws tus kheej, uas tiv thaiv kev sib hloov thiab kev hloov pauv sai thiab muab kev txhim kho txhim khu kev qha.

Kev txhim kho Gamar - PFNA

Internal fixator xaiv (PFNA).

• Ib qho zoo tagnrho built-in rau tsis ruaj khov intertrochanteric pob txha ntawm lub femur.

• Nws ruaj khov kho lub taub hau thiab caj dab femoral thiab tiv thaiv kev sib hloov ntawm qhov kawg ntawm pob txha.

• Tiv thaiv cov teeb meem xws li kev sib tsoo vim cov pob txha resorption tom qab poob kev txhawb nqa medial, inversion deformity, thiab txiav tawm ntawm lub taub hau femoral nrog cov ntxig.

• Haum rau yuav luag tag nrho cov pob txha intertrochanteric, tshwj xeeb tshaj yog rau cov pob txha tsis ruaj khov (xws li anterior intertrochanteric fractures) thiab ua ke nrog cov pob txha pob txha.

• Tseem muaj qee qhov xwm txheej ntawm cov teeb meem, xws li femoral taub hau avulsion, uas ua rau nws tsis tuaj yeem hloov lwm yam kev kho sab hauv.

Artificial Joint Hloov

Cov lus qhia rau kev sib koom ua ke hloov kev phais rau intertrochanteric pob txha ntawm lub femur:

• Hnub nyoog tshaj 80 xyoo.

• Comminuted thiab unstable intertrochanteric puas.

• Pob txha pob txha yog qhov pom tseeb, thiab kev kho sab hauv yog qhov nyuaj los kho kom zoo.

• Tsis muaj kev txwv tseem ceeb ntawm lub duav lossis lub hauv caug txav ua ntej raug mob.

• Tag nrho lub cev mob tuaj yeem zam kev kho mob phais.

Cov neeg mob uas tsis tuaj yeem kho tau hauv txaj ntev.

Qhov zoo: thaum ntxov post-operative positioning rau hauv av. Tsis txhob muaj teeb meem pw hauv txaj. Nthuav lub sijhawm muaj sia nyob thiab txhim kho lub neej zoo.

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 .

Yog xav paub ntxiv, nyem CZMEDITECH kom paub meej ntxiv.