Kedu ihe ma ọ bụrụ na nhazi nke ime nke mgbaji inter rotator ada ada?

A na-eche na mgbaji ụkwụ hip ga-emetụta ndị okenye 500,000 na United States kwa afọ. Ha nwere mmetụta dị egwu na ndụ ndụ, ugbu a na-aza 3-7% nke ọnwụ n'ụlọ ọgwụ yana ọnụ ọgụgụ ọnwụ nke otu afọ nke 19.4-58%. Ihe dị ka ọkara nke mgbaji hip niile bụ mgbaji intertrochanteric (IT). Ihe ntinye abụọ a na-ejikarị na-emeso mgbaji IT bụ ntu cephalomedullary (CMN) na screw screw (SHS).

N'agbanyeghị ọganihu na nkà na ụzụ, nkwụsị ọkpụkpụ na nkwụsị nkwụsị dị ka ntinye nke isi femoral ka na-eme ma nwee ike na-agbawa obi. Nnyocha e mere n'oge na-adịbeghị anya akọpụtala ọnụego ntọhapụ ruru 6% na ntinye nke ọgbara ọhụrụ. Ihe ndị dị ize ndụ maka ọdịda nrụzi gụnyere n'ọnụ ọnụ ọnụ (TAD)> 25 mm, nkwụsịtụ na-adịghị mma, usoro mgbaji na-adịghị akwụsi ike, spikes cephalic dị n'akụkụ ma ọ bụ n'okpuru etiti isi femoral, na ntụgharị ime n'akụkụ akụkụ cervical. A na-ejikọtakwa ịka nká na ọkpụkpụ ọkpụkpụ na nkwụsị nhazi.

Ndị ọrịa na ụzọ

Nke a bụ nyocha azụ azụ nke ndị ọrịa na-agwọ na ụlọ ọrụ abụọ dị n'ime usoro nlekọta ahụike na nnukwu obodo mepere emepe. Ajụrụ ajụjụ ikpe nke ndị dọkịta na-awa abụọ (JS na BC) maka ndị ọrịa niile natara nrụzi nrụzigharị ciment-ike ka emechara nrụzi mbụ nke mgbaji IT site na Jenụwarị 2018 ruo Septemba 2021, mgbe ndị ụlọ ọrụ nyochachara nkwado. Nlebanya ndekọ ahụike eletrọnịkị (EMR) nke ndekọ arụrụ arụ na redio ịwachara ahụ kwadoro iji ciment n'oge ịwa ahụ. Anyị gụnyere ndị ọrịa niile nwere akara mgbake simenti na ndozigharị mgbe CMN mbụ dara ada ma ọ bụ ndozi SHS nke mgbaji IT (Nyocha 1). Anyị na-ewepụ ndị ọrịa nwere olu femoral ma ọ bụ mgbaji subtrochanteric, ndị ọrịa na-enwetaghị mmezigharị ya na nkwado ciment, na ndị ọrịa na-arụ ọrụ arthroplasty n'oge mbụ ịwa ahụ.

Ọnụ ọgụgụ 1. Otu nwanyị dị afọ 76 na-agbanye nkuchi intramedullary maka mgbawa intertrochanteric nke femur (A), na-enwe mgbu mgbu na-adịgide adịgide 2 ọnwa mgbe e mesịrị n'ihi ntinye ntinye (B).

Usoro ịwa ahụ

Maka ndị ọrịa na-anata nhazi mbụ na CMN, anyị mere ngbanwe ntu isi na nkwado ciment ọkpụkpụ. Na mbụ, a na-eme mbepụ 5-cm n'akụkụ dị nso nke nnukwu trochanter, a na-etinye waya nduzi n'ime akụkụ nso nke ntu ahụ, a na-ewepụkwa ọkpụkpụ niile n'akụkụ akụkụ nke ntu ahụ site na iji reamer na-emeghe. Na-esote, a na-eji screwdriver hexagonal na-atọpụ ihe nkedo nke dị n'elu CMN (Figure 2).

Onyonyo 2, fluoroscopy intraoperative na-egosi screwdriver hexagonal na-etinye aka ma na-atọpụ ihe nkedo kpọgidere mbụ.

A na-eme mbepụ ntụgharị 1-2 cm site na iliotibial fascia (ITB) fascia. A na-ewepụ ntu isi mbụ ahụ site na iji ntụzịaka eriri azụ (ọgụgụ 3). N'ihe gbasara perforation isi femoral, a na-eji nduzi oghere nwere ihe mkpuchi mkpuchi anya iji gbochie nkwụsị nke ciment n'ime nkwonkwo (Figure 3A). Kpọmkwem, a na-ebu ụzọ gbanye matriks ahụ ka e wepụsịrị elu abụọ dị n'èzí nke cannula ugboro atọ wee tinye ya n'ime ebe ahụ gbawara agbawa site na ịtinye akwa abụọ dị n'èzí.

Ọnụọgụ 3, Intraoperative anteroposterior (A) na mpụta (B) ihe oyiyi nke onye ọrịa ọzọ na-egosi isi femoral nwere nkwarụ ọkpụkpụ interstitial.

Na-esote, a na-adọkpụ akụkụ ahụ ahụ wee megharịa ọkpụkpụ ahụ n'ime ọtụtụ exostosis maka nhazigharị. N'ihe gbasara ọrịa malunion ma ọ bụ fibrous na-agwọ ọrịa, a na-eme osteotomy percutaneous site na iji 1/4' ọkpụkpụ gouge na ụzọ anterolateral. Nke a adịkarịghị mkpa, ma ọ dị irè mgbe ọ dị mkpa iji mepụta akụkụ cervical ka mma (ebumnuche>130 °).

A na-etinyezi ihe nkedo ọhụrụ ma ọ bụ spiral agụba n'ime ọkpụkpụ subchondral na isi femoral n'akụkụ axis nke olu femoral, na-eme ka ị kpachara anya ka ị ghara ịbanye n'isi (Nyocha 4). A na-etinye ịghasa ụma na-ezere traktị ntu gara aga, mana ka na-atụ aka njedebe na etiti isi femoral. (Foto nke 5)

Ihe osise 4, Anteroposterior (A) na n'akụkụ (B) ihe oyiyi nke onye ọrịa ọzọ na-egosi ntinye nke eriri kerfing n'okporo ụzọ nke ntu isi ọhụrụ.

Onyonyo 5, fluoroscopy intraoperative na-egosi ntinye nke agụba cephalomedullary ọhụrụ n'akụkụ ụzọ waya ntuziaka, bụ nke e mechara sie ike site na ịghasa setịpụ.

N'ikpeazụ, isi femoral jupụtara na ciment ọkpụkpụ site na iji usoro ciment ọkpụkpụ injectable (Nyocha 6). A na-elezi anya iji zere ịpụpụ n'ime nkwonkwo site n'iji redio oge na-emezigharị ihe omimi na nhazi nke cannula ciment.

Ọgụgụ 6, Ihe onyonyo na-egosi mmụba ciment na mbido (A), ndochi nwayọ nwayọ (B) ruo mgbe ntụpọ isi femoral juputara (C).

Maka ndị ọrịa na-anata nhazi mbụ nke SHS, anyị na-ewepụ SHS ma tinye ogologo CMN. Mgbe emechara mbepụ 5-cm n'etiti etiti n'okpuru nnukwu trochanter ma chọpụta ITB, mbepụ ahụ na-agbadata ruo efere mpụta. A na-ewepụ skru efere niile site na iji screwdriver aka dabara adaba wee wepụ efere dị n'akụkụ. A na-ewepụkwa skru nke esemokwu ahụ site na iji ntuziaka ntụgharị azụ dịka akọwara na mbụ iji megharịa mgbaji ahụ ruo ogo valgus ka ukwuu. A na-eme mbepụ 5-cm n'ọnụ ọnụ nke nnukwu trochanter dị ka akọwara na mbụ. A na-etinye waya nduzi na njedebe kacha nso nke trochanter ka ukwuu wee banye n'ime osisi femoral. A na-ewebata reamer na-emeghe n'okporo ụzọ nduzi. A na-etinyezi eriri ndu ogologo bọọlụ nwere ogologo n'ime etiti femur distal n'okpuru ọkwa patella. Na-esote, a na-emegharị ihe na-aga n'ihu ruo mgbe a na-ama jijiji na ọkpụkpụ azụ. Ndị ọrịa anyị niile nwetara ntu ogologo CMN nwere TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA).

Mkparịta ụka

Usoro anyị na-eji nkwado ciment ọkpụkpụ n'oge ndozigharị. Mkwado simenti ọkpụkpụ maka nhazi mbụ nke osteoporotic proximal femur fractures ka a mụọla ma gosipụta ezigbo ihe biomechanical na ụlọ ọgwụ. Nnyocha e mere n'oge na-adịbeghị anya kọrọ na nkwado simenti ọkpụkpụ rụpụtara nnukwu ọdịda dị elu, mbelata nchụpụ ihe ọkụkụ, na obere nsogbu na arụgharị ọrụ ma e jiri ya tụnyere nhazi enweghị ike. Nnyocha a na-atụ anya n'ọtụtụ ebe na-enweghị usoro akọpụtakwaghị ọrụ ọ bụla ma ọ bụ ihe mgbaàmà nke nchụpụ CMN n'ime otu sirimenti kwadoro ma e jiri ya tụnyere ikpe isii n'ime otu enweghị ike.

Ọnwụ mgbawa hip dị elu. Nnyocha e mere n'oge na-adịbeghị anya kọwara ọnụ ọgụgụ ndị nwụrụ n'ụlọ ọgwụ 3-7%, yana ọnwụ otu afọ na-agbada site na 19.4% ruo 58%. Karịsịa, egosiri mgbawa IT na-akpata 27% nke ọnwụ n'otu afọ. Usoro ụlọ ọgwụ anyị egosighi ọnwụ n'ụlọ ọgwụ yana ọnụ ọgụgụ ọnwụ nke otu afọ nke 13.6%, nke dị ntakịrị ma e jiri ya tụnyere akwụkwọ. N'ihi na mmegharị akwa n'oge mgbe ịwachara ahụ na-ejikọta ya na ọnwụ dị ala, ezigbo ambulation na nsonaazụ arụ ọrụ na usoro anyị nwere ike ịkọwa ọnwụ dị ntakịrị nke a na-ahụ na ndị ọrịa anyị.

Mmechi

Ndozi ngbanwe nke ciment na-eme ka ọ dịkwuo mma bụ ụzọ dị irè, nchekwa, na ọnụ ahịa dị irè maka nkwụsị nke mgbagwoju anya intertrochanteric na-adịghị emerụ ahụ na ndị ọrịa agadi nwere oke ọkpụkpụ acetabular.

Ndị na-arịa ọrịa na-emezigharị nke ọma nke isi mgbaji intertrochanteric na-esote nhazigharị ngbanwe na ọgwụgwọ ciment na-arụsi ọrụ ike egosipụtawo ihe dị mma na-adị ogologo oge na ọgwụgwọ ndụ. A na-eji usoro ahụ eme ihe naanị n'ọnọdụ ebe a na-echekwa ihe ka ukwuu n'elu ala articular acetabular na ntu isi ka dị n'ime olu femoral. N'iburu n'uche na njedebe nke arthroplasty revision na ndị ọrịa agadi na-esighị ike, usoro a na-egosi nkwa na n'enweghị nsogbu na ibelata nsogbu siri ike ma na-ebelata oge ọrụ na ọnụ ahịa n'ime ìgwè ndị ọrịa a.

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