Periprosthetic fracture hi engtin nge enkawl a nih?
Views: 17 Author: Site Editor A chhuah hun: 2022-08-12 A chhuahna: Hmun
Chhan
Hip arthroplasty-ah hian proximal femur-a periprosthetic fractures hi harsatna lian tak a ni. Reported incidence hi a tir lama implantation atanga kum 20 hnuah 3.5% a ni a, joint replacement a awm chuan a pung zel a ni. Intraoperative fractures hi uncemented stems nen a inzawm fo thin. A tam zawk chu, puitling kum upa chak lo, operation hnua secondary-a tlu tawhte zingah fracture a awm thin. Cemented leh uncemented stem hman danah hian international hrang hrangah danglamna awm mahse, cemented stem chi khat chu a dang aiin fracture risk sang zawk nen a inzawm tih finfiahna chiang tak a awm lo. Vancouver classification system for periprosthetic femoral fractures hi surgeon-te chuan an hmang nasa hle a, rintlak a nih thu an hmuchhuak a ni.
He zirchianna hian a tum ber chu Vancouver classification-a cemented leh uncemented stem fracture inzawmna hriat a ni. A tum pahnihna chu fracture chi hnih nei damlote baseline characteristic danglamna zirchian a ni.
Thil hman dan leh hman dan
Dawhthei:
A zawna proximal periprosthetic fracture nei damlo hrang hrang.
Primary hip periprosthetic fracture nei damlote chauh an tel a ni.
Intraoperative fracture, revision hip fracture, leh interprosthetic fracture nei damlote chu an tel lo.
Data record: 1.1.
Electronic documentation leh analysis hmanga digital radiography leh computed tomography hmanga siam a ni.
Baseline details record-ah hian kum, sex, body mass index, leh a tan hmaa mobility tlahniam emaw, caregiver dependence emaw te a tel a ni.
Surgery chungchang details record:
Implantation hmasa ber hun, arthroplasty (osteoarthritis emaw fracture emaw) atana indication, stem chi (cemented emaw uncemented emaw), leh arthroplasty chi (total emaw semiarthroplasty) te pawh a tel a ni.
Imaging record kimchang takah chuan Vancouver classification, varus vertebral position leh Dorr classification te a tel a ni.
Stem geometry (cemented stems tan conical emaw compound emaw, uncemented stems tan straight emaw wedge-shaped emaw) chu radiographic appearance atanga record a ni.
Vancouver classification tihfelna hi surgical patient-te imaging findings leh intraoperative findings hmanga tih a ni.
Statistical analysis chu continuous variables T-test leh Fisher’s exact test for categorical variables hmangin cemented leh uncemented stem group-a damlote baseline characteristic leh Vancouver classification te khaikhin a ni.
Trial zawng zawng hi two-sided a ni a, significance level chu 0.05 a ni. Statistical analysis hi GraphPad Prism version 8.0.0 hmangin an ti a.
Rahchhuah
Damlo awm zat: 1.1.
Hospital database zawhna chhangin damlo 1181 hmuhchhuah an ni.
Non-periprosthetic proximal femur fracture nei mi 978 chu an tel lo.
Damlo dang 203 zingah hian 8 chu intraoperative fractures an nei a, 6 chu revision periprosthetic fractures an nei a, 17 chu hip joint fixation device periprosthetic fractures an nei a, chungte chu paih chhuah belh an ni.
Exclusion hnuah damlo 172 an telh a ni.
Fracture zawng zawng hi a tlak hnua thleng vek a ni. Femoral stem bone cement group-ah hian cement tel lo mi 84-ah ruh tliak a awm
Group-ah hian ruh tliak 88 a awm a ni.
Baseline-a mizia: 1.1.
Group hrang hrangte hi kum, implant hmasak ber hun, femoral neck fracture atana arthroplasty hman tur indication, primary hemiarthroplasty, varus stem placement leh body mass index-ah te danglamna nasa tak a awm a ni.
A bik takin cement group-ah chuan a tam zawk chu hemiarthroplasty an ni.
Group hrang hrangte hi sex, Dorr classification, leh premorbid mobility tlahniam emaw caregiver dependence emaw chungchangah danglamna lian tham a awm lo.
Cemented group-ah chuan stem tam zawk chu tapered niin a bak zawng chu composite design a ni.
Cement nei lo group-ah chuan a zung tam zawk chu a dinglam a ni a, a bak chu wedge ang maia siam a ni.
Vancouver-a category hrang hrangah:
VancouverB2 fracture hi fracture pattern hrang hrang paliah then a ni a, chungte chu a hmaa kan sawi tawh comminuted 'burst', clamshell, leh helical pattern te, leh 'reverse' clamshell pattern hmuhchhuah thar te an ni. Series-a X-ray appearance aiawhtu leh a kaihhnawih graphical depiction chu tarlan a ni (Figure 1).
Burst leh spiral fracture te hi cemented stems nen a inzawm tlat a, flap fracture erawh chu uncemented stems nen a inzawm tlat thung.
Reverse clamshell pattern hi stem pahnihah hian a awm ve ve a.
Vancouver classification subtype-te, a chunga kan sawi tawh B2 fracture chi pali te pawh telna, stem geometry nena inzawmna hian fracture chi hrang hranga trend tlangpui a tarlang a ni.
Sawiho
Tun thleng hian hei hi cemented leh uncemented stem periprosthetic fractures leh Vancouver classification inzawmna direct-a tehkhin nan zirchianna lian ber a ni:
Vancouver type A, B, C fracture-a cemented leh uncemented stems inzawmnaah danglamna lian tham a awm lo. VancouverB2 fracture awm zat chu group pahnihah hian a inang vek a, hei hian group pahniha periprosthetic fracture-a stem stable leh unstable awm zat a inang tih a tilang.
Chumi danglamna chu Fenelon et al. periprosthetic fractures te chu cemented leh uncemented stems hmanga enfiah a ni. Vancouver B2 leh B3-a ruh tliak vei hi a tam zawk tih a chiang hle.
Phillips leh a thawhpuiten an sawi. conical cement stem segment leh cement jacket zawh zawnga 'crack' 'burst' pattern comminuted sang tak sawi rawh, 'axe head' ang chi. He fracture hi he zirchiannaah hian cemented stems nen a inzawm tlat tih hmuhchhuah a ni.
Heng ruh tliak te hi comminuted nature sang tak a nih avangin ruh deactivation chungchangah ngaihtuahna a siam a, heng ruh tliak te hi uluk taka cement lakchhuah a ngai fo a, distal bearing stem hmanga bypass a ngai fo bawk.
Capello leh a thawhpuiten an sawi. chuan uncemented stems nena inzawm 'flip-flop' fracture a sawi a, thil hmuhchhuahte hian he thil hmuhchhuah hi a tilang chiang hle. Fracture hi greater trochanter medial base atanga lo chhuak a ni a, medial cortex thlengin a inzar pharh a, lateral cortex, lesser trochanter atanga distal chu a humhim a ni. Talar region lian leh stem subsidence hi stem instability radiographic signs a ni. Tun hmaa zirchianna hrang hrangah chuan he fracture hi uncemented stems nen hian anatomical leh wedge-shaped designs nen inzawmna lian tak a awm tih hmuhchhuah a ni a, he zirchianna hian he inzawmna hi a thlawp a ni.
Grammatopolous et al te chuan cemented stems nei periprosthetic fracture-a helical fracture pattern hrang hrang an sawi a, a tlangpuiin isolated wedge fragments leh severe comminution nena inzawm a ni. He series-ah hian cemented stem-a helical fracture awm zat hi nasa takin a pung a, hei hian tubular cemented stem chhehvela fracture awmte chu natural bone ang chiaha a darh duhna a lantir thei a ni.
Periprosthetic fracture tam tak radiographic analysis-ah chuan research team chuan a hmaa literature-a tarlan loh fracture pattern an hmu a. Fracture hi medial calcar atanga lateral cortex kal tlang atanga lo chhuak a ni a, medial cortex chu a awm reng a ni. Hetiang fracture hi 'reverse' clamshell fracture an ti a, hei hi zirchianna chuan Vancouver B2 fracture tlanglawn takah a ngai a ni.
He hming hi chhan pahnih avanga thlan a ni a: pakhatnaah chuan 'flip' mirror image a ni a, pahnihnaah chuan reverse oblique proximal femoral fracture angin a che a, chutiang bawkin abductor-in supralateral displacement a nei a, proximal fragment chu a hruai chhuak a ni. Chutiang bawka fracture chu cemented leh uncemented stems-ah pawh a awm bawk (Figure 2).
He zirchianna hian enkawlna result chhui chian tum ni lo mah se, he zirchiannaah hian reverse flip-flop fracture te hi a tlangpuiin distal load-bearing stem arthroplasty leh proximal fracture fragment te chu cerclage wire emaw plate emaw hmanga fixation hmanga siamthat a ni tlangpui.
Hetiang approach hmanga enkawl damlo entir nan tarlan a ni a, damna hlawhtlinna a lantir a ni (Figure 3).
Figure 2 Flip-top-a ruh tliak dan (reverse) a awm.
Figure 3 Retrograde flap fracture te tan arthroplasty leh cerclage wire fixation te.
Tawpna
Vancouver classification system ang chuan periprosthetic fracture chi hrang hrangah hian cemented leh uncemented prosthesis-ah hian periprosthetic fracture a awm dan a inang vek a ni. Chuvangin, fracture hnua stem nghet leh nghet lo awm zat chu group pahnihah hian a inang vek a ni. VancouverB2 fracture pattern hrang hrang pali, inverted flip-flop pattern hmuhchhuah thar te pawh hriatchhuah hian surgeon-te chu stem instability hriatchhuahna kawngah a pui dawn a ni. He zirchianna atanga thil hmuhchhuah te hi clinical significance hriat chian nan fracture type leh treatment strategy inzawmna zirchian nan nakin lawka zirchianna neih a ngai a ni.
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