Femoral neck fracture-a hollow screw fixation hmanga enkawlna ṭhatna leh ṭhat lohna hriat chian

Femoral neck fracture hi clinical practice-a orthopaedic injury hmuh tam ber zinga mi a ni a, damlo tar tam zawk hi hip fracture 50% aia tam an ni. Statistics atanga a lan dan chuan tun hnaiah femoral neck fracture hi a pung zauh zauh a, mipa aiin hmeichhiaah a tam zawk. Tarte zingah vertigo, dementia, malignancy leh cardiopulmonary disease te leh thalai zingah high-energy injuries te hi femoral neck fracture thlen theihna tur risk factor sang tak an ni.

Tun hnaiah hian internal fixation material tam tak, hollow screw, power hip screw (DHS), sliding hip screw (HSH), proximal femoral dissection plate, reconstruction nail, leh Gamma nail te a lo chhuak ta a ni. Heng internal fixation material zingah hian hollow screw hi hman tam ber a ni. Zirna hrang hrangah chuan surgeon tam zawk chuan nondisplaced fracture enkawlna atan hollow screw an duh zawk tih a tarlang a, surgeon zinga a tam zawk chuan displaced femoral neck fracture atan hollow screw hman an thlang bawk. 3 parallel partially threaded hollow screw fixation hi internal fixation pawm tam zawk a ni.

Femoral neck fracture-a taksa peng hrang hrang (anatomical features) a awm

Tunah chuan femoral head-a vascular structure hi fracture healing leh femoral head necrosis tichhe theitu pawimawh ber a ni tih hi pawm tlangpui a ni. Femoral head thisen supply structures chhiatna hi femoral head ischemic necrosis thlentu pathological factor ber a ni. Femoral neck-a vascular anatomy systematic study-ah chuan epiphyseal vascular network leh inferior supporting zone-a arterial system te hi femoral neck fracture hnua femoral head-a thisen supply vawn rengna atana structure pawimawh tak a ni thei tih hmuhchhuah a ni a, chutiang chuan intraoperative drilling leh implantation chu femoral head central region hnaih thei ang bera siam chuan medically induced injury to ruh chhunga thisen kalna (intraosseous vascular system) a ni.

Figure 1 Femoral head-a thisen supply, anterolateral (a) leh posterior (b) thlir dan. Femoral head-a thisen pek danah danglamna a awm a, mahse lateral leh medial spinofemoral arteries hi deep femoral artery atanga lo chhuak niin damlo 60%-ah chuan a awm a ni.

(1) Femoral head-a thisen kal tam zawk hi lateral rotor femoral artery atanga lo chhuak a ni.

(2) Strap artery thlawptu branch 3 emaw 4 emaw a pe chhuak thin. Heng branch te hi hnunglam leh chunglam hawiin femur synovial neck retroflexed portion zawhin femoral head cartilaginous edge thlengin an kal a ni. Round ligament chhunga thisen kalna kawngte.

(3) Foramen occulta artery atanga lo chhuak. Medial rotor femoral artery-a branch sang chho zel.

(4) Femur trochanter lian zawk a supply a, lateral rotor femoral artery nen arterial ring a siam bawk.

Femoral neck fracture te tan hollow screw hmanga siam a ni

Clinically chuan hollow cancellous bone screw pathum 6.5 mm emaw 7.0 mm emaw 7.3 mm emaw hmangin damlo naupang zawk emaw, kum chanve emaw, kum upa lam emaw, ruh quality tha tak nei tan fixation atan hman theih a ni. Sliding fracture compression awm theihna turin hollow nail 3 te chu parallel taka awm turin guide hman tur a ni. Femoral neck chhungah chuan screw te chu a sir zawng zawngah screw in tur a ni a, screw te chu femoral head chhungah threaded in fracture line atanga thread lo turin fimkhur tur a ni, hei hi inter-end compression hmuh theihna awmchhun a nih avangin. Screw te chu tighten tur a ni a, intraoperative-ah confirm leh tur a ni. Traction bed hman a nih chuan traction chu a relax a ngai a ni. Hollow screw pawh percutaneous-in dah theih a ni bawk. Screw te hi hip joint chhunga a luh loh nan frontal, lateral, leh 45° oblique fluoroscopy tih a ngai a ni.

1、Surgical operation hman dan bik.

Clinical practice-a hman tlanglawn tak 'inverted triangle' nail placement hi entirnan han la ila.

ani. A hmasa berah chuan fluoroscopy hnuaiah hian fluoroscopy plane pahnih-a X-ray hmangin lower leh middle guide pin layout hriat theih a ni.

b. Skin incision siam a ni a, chu chu proximally cm 2-3 vel a sei a ni.

c. Fascial layer chu incision zawh zawngin a inthen a, Cobb separator hmangin lateral femoral muscle zawh zawnga longitudinal fibers te chu then hran a ni.

d. Guide needle chu plane pahnih a ṭha famkimna hmunah dah rawh.

e. Guide pin pakhat chu femoral neck hmalam hawi zawngin assistant nen dahin hmalam tilt angle hriat theih a ni.

f. Guide pin hmasa ber fixation hnuah posterosuperior leh anterosuperior guide pin te chu parallel guide hmangin hriatchhuah a ni a, chu chuan femoral neck chhungah posterior leh anterior cortical support a hmu thei a ni.

g. Hei hi lesser trochanter chungah guide pin dahin distal femoral neck cortex-ah femoral spine kaltlangin tih a ni a; a hnuaia guide pin pahnih chu parallel fashion-in proximally-ah dah a ni a, a sang thei ang bera leh anterior leh posterior cortex atanga mm 5-a hlaah dah a ni a; chutah chuan guide pin luh thuk zawng chu cartilage hnuai lam 5 mm thleng turin an siamrem a; a tâwpah chuan, chu khur chu ream-in, an teh a, pressurized hollow screw chu screw-in an dah a ni.

h. Lesser trochanter hnuaia needle chhungah lut lo la, femoral spine zawhin proximally-in kal rawh.

Ka. Threaded guide pin chu joint hnuaiah dah ngei ngei tur a ni.

j. Guide pin chu articular surface chhungah luh tir suh.

k. Guide pin sei zawng teh a, chutah chuan 5 mm la chhuakin screw sei tur dik tak chu teh rawh.

l. A tlangpuiin self-tapping, self-drilling screw hman a ni a, mahse a chang chuan ruh thuk tak nei damlo rinawmte tan chuan lateral cortex pre-drilling a ngai thin.

m. Hmun a awm chuan spacer hman theih a ni.

n. Kut hnunglam a comminuted fracture na tak nei loyalist tan chuan 4th screw (diamond arrangement) a ngai thei.

Tunah chuan femoral neck fracture atana hollow screw hman hi a awm fo tawh nachungin, surgically placed hollow screws zat leh configuration chungchangah ngaihdan inang lo tak tak a la awm a, a tlangpuiin operator duh dan azirin damlo ruh density, screw chakna, leh enkawlna hlawhtlinna te pawh hian nghawng a nei bawk.

1、Screw hollow awm zat.

• Femoral neck fracture hi a tlangpuiin hollow screw 2-4 hmanga fix thin a ni.

• A tam zawkah chuan screw 3 hman a ni a, a chhan chu anterior stress nasa tak a tuar thei a, stability a tipung thei a, fracture end displacement a ti tlem thei bawk.

• Pauwells angle >50° nei femoral neck fracture tan chuan screw 2 hman a remchang zawk.

• Posterior femoral neck-a comminuted fracture na tak nei damlote tan chuan hollow screw 4 hman an rawt a ni.

• Mahse, hmanlai chu fixation atan hollow screw 3 hman a la ni tho.

2、Hollow screw siam dan tur.

• Femoral neck fracture internal fixation atan hollow screw 3 hman a nih chuan 'sliding compression' theory zawm tur niin an ngai tlangpui a, chutiang chuan screw 3 implanted te chu orthogonal view-ah parallel an ni a, lateral view-ah triangular configuration an nei ang.

• Chutiang chuan parallel hollow screw pathumte hian mechanical support tha tak a pe thei a, sliding track a siam thei a, chutiang chuan fracture block chu hip muscles contraction hnuaiah femoral neck axis-ah a slide thei a, fracture tawp lamah pressure a siam thei a, fracture healing a tichak bawk.

• Mahse, hollow screw 3 te hi orthotriangular emaw inverted triangular configuration-a dah a nih leh nih loh chu sawisel a hlawh hle.

  
  

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Femoral neck fracture te tan hollow screw fixation technique lama hmasawnna

Yuenyongviwat leh a thawhpuiten an sawi. internal fixation hmanga femoral neck fracture enkawlna atana hollow screw dahna tur adjustable parallel drilling guide thar an design a, he guide thar hian operation hun leh intraoperative fluoroscopic views chu traditional method nena khaikhin chuan a tihtlem thei tih an hmuchhuak a, chu chuan surgical result lungawithlak tak a hmu thei a ni.

Filipov leh a thawhpuiten an sawi. biplane double-supported screw fixation (BDSF) an design a, chutah chuan hollow screw pathum luhna hmun chu proximal femoral stem-a cortical area thick-ah a awm a, screw pathumte chu femoral head periphery-ah inang tlang taka offset a ni a, chu chuan plane pahnih a siam a ni. Hetiang approach hian double cortical support a phalsak a, chu chuan movement laiin fixation strength tling tak a pe a ni.



Cadaveric specimen hmanga biomechanical experiment an neihah chuan BDSF fixation method hian traditional inverted triangle fixation method aiin fixation tha zawk a pe a ni. Cadaveric specimen hmanga biomechanical experiment result atanga a lan dan chuan calcium phosphate cement reinforced hollow screw fixation hian femoral neck fracture hollow screw fixation stability nasa takin a ti tha a, femoral neck compression resistance a ti sang a, torsional stiffness a ti tha bawk a, hei hi clinical value nasa tak a ni.



Femoral neck fracture avanga hollow nail fixation hnua femoral head necrosis awm theihna a tam avangin, femoral head necrosis ang chi complication tihziaawmna turin hollow nail internal fixation pui turin method dang hman chhunzawm zel a ni. Femoral neck fracture hnua femoral head necrosis awm chhan bulpui ber chu femoral head-a thisen kalna hloh vang a ni a, chuvangin enkawlna ngaih pawimawh ber chu thisen kal dan tihchangtlun dan tur a ni. Thisen hmanga pek chhuah periosteum graft chu femoral head necrotic area-a dah luh leh germinating layer-in residual cavity pawn lam a luah khat chuan grafted periosteum chu osteoblast-ah a inthliarna bakah vascular sprouts te siam thar lehna a ti awlsam ang a, hei hian osteogenic leh revascularizing effect a nei vek a ni.

Khaihtawi

Femoral neck fracture atana hollow screw fixation hi fixation method tha tak a ni a, hei hian operation awlsam tak, operation hun rei lo, trauma tlem, fixation rintlak leh operation hnua dam chakna tha tak a nei a ni. Mahse, femoral neck fracture-a anatomical characteristics avang hian femoral neck fracture-a internal fixation hmangin femoral head ischemic necrosis leh non-union of the fracture-a harsatna awmte chu a la pumpelh kim thei lo. Chuvangin, he fixation method hman dan tur hi hman hmain chiang zawka hriat a ngai a, damlo tar, femoral neck fractures nasa taka displaced leh general status tha lo, activity hmasa lama mamawh te chuan a theih ang anga femoral neck fractures atan internal fixation hman loh tur a ni. Damlo prognosis tichhe thei risk factors, ruh tliak chi, ruh density leh damlo hnathawh dan te pawh ngaihtuah tel a ngai a, chu chuan hun rei tak chhunga operation hnua harsatna awm thei te tihziaawm a, chutiang chuan femoral neck fracture enkawlna result a tichangtlung thei a ni.

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