Proximal humerus fractures ndi imodzi mwazowonongeka kwambiri m'mafupa ovulala, ndipo ma fractures ambiri omwe amapezeka pafupi ndi osteoporotic fractures otsika mphamvu okalamba.
Ngakhale kuti ming'alu yambiri ya proximal humerus imatha kuthandizidwa mosamala, 10-15% ya fractures imafunikirabe chithandizo cha opaleshoni, chomwe chimaphatikizapo kukonza mbale zochepetsera, kuchepetsa kutsekedwa kwa intramedullary misomali mkati, ndi kulowetsa m'malo.
Chisankho cha chithandizo chiyenera kutengera momwe wodwalayo alili, malingaliro ake, ziyembekezo zamaganizo, ndi mtundu wa fracture.
Kukhazikitsanso ndi kukonza zosweka mwadzidzidzi
【Malangizo】Pa ma proximal humeral more tuberosity (mtundu wa NEER 2 wothyoka pang'ono) wothyoka kuphatikiza ndi kusuntha kwa mapewa, kuyezetsa koyambirira kwa CT, kupatula zothyoka m'dera la khosi la opaleshoni, kuyikanso ndi braking ndi brace yopweteketsa paphewa pansi pa opaleshoni yadzidzidzi (chiyerekezo cha akatswiri; 620%).
2. Preoperative kupweteka kwapang'onopang'ono
【Malingaliro】Odwala omwe ali ndi proximal humerus fracture amakonda analgesia isanayambike ndi oral acetaminophen kapena NSAIDs, ndipo ma opioid amkamwa amatha kuwonjezedwa ngati zotsatira zake sizili bwino (chiwongola dzanja cha akatswiri: 100%; chiwongola dzanja champhamvu: 73.8%).
3. Maphunziro aumishonale asanayambe kugwira ntchito
[Maganizo] Maphunziro asanayambe udokotala ayenera kuchitidwa mosiyanasiyana komanso mosiyanasiyana. (Chiwongola dzanja cha akatswiri: 100%; chiwongola dzanja champhamvu: 83.8%)
4. Kuunika kwa zakudya zopatsa thanzi kusanachitike komanso chithandizo chothandizira
【Malangizo】Kumaliza kuyezetsa zakudya za odwala pasanathe maola 24 atalandilidwa ndikupereka chithandizo chamankhwala kwa odwala omwe ali pachiwopsezo cha zakudya. (Chiwongola dzanja cha akatswiri: 98.5%; chiwongola dzanja champhamvu: 55.9%)
5. Kuwunika kwa shuga wa perioperative ndi kuwongolera kwa wodwala matenda ashuga
【Malangizo】Cholinga chowongolera glycemic kwa odwala ambiri omwe ali ndi matenda ashuga omwe akuchitidwa opaleshoni yosankha ndi 7.8 mpaka 10.0 mmol/L.
6. Kusamalira kutupa kwa minofu yofewa mu nthawi ya perioperative
【Malangizo】Kwa odwala omwe akuchitidwa opaleshoni yosankha chifukwa cha kupasuka kwa proximal humerus, njira zingapo zolimbitsa thupi zimaperekedwa kuti muchepetse kutupa panthawi ya opaleshoni. (Chiwongola dzanja cha akatswiri: 98.5%; chiwongola dzanja champhamvu: 80.9%)
7. Preoperative dietary management
【Malangizo】 Odwala omwe ali ndi opaleshoni yosankha amatha kudya zakumwa zomveka 2 h asanachite opaleshoni ndi zakudya zowuma kapena mkaka 6 maola asanachite opaleshoni. (Chiwongola dzanja cha akatswiri: 100%; chiwongola dzanja champhamvu: 76.5%)
8. Perioperative mkodzo catheter kasamalidwe
【Malingaliro】Kuphatikizika kwa mkodzo kwapang'onopang'ono sikuvomerezeka pakuchita opaleshoni yapakatikati (Mlingo wa akatswiri: 100%; Mulingo wamphamvu: 78.6%)
9. Prophylactic kugwiritsa ntchito mankhwala oletsa tizilombo toyambitsa matenda
【Malingaliro】Kwa odwala omwe ali ndi ma proximal humerus fractures omwe amafunikira endoprosthesis kapena olowa m'malo, kugwiritsa ntchito prophylactic ya cephalosporins a m'badwo woyamba ndi wachiwiri kumalimbikitsidwa popewa matenda panthawi ya opaleshoni. (Chiwongola dzanja cha akatswiri: 97.1%; chiwongola dzanja champhamvu: 73.5%)
10. Kusankha opaleshoni
【Malangizo】 Anesthesia tikulimbikitsidwa kutengera njira ya dera chipika pawiri opaleshoni ambiri, kusankha mankhwala kupewa kukulitsa zokhudza zonse chiwalo kukanika okalamba, ndi kulabadira kulimbikitsa kuwunika (akatswiri umboni mlingo: 100%; amphamvu umboni mlingo: 71,4%).
11. Kuchepetsa kuthamanga kwa magazi m'thupi
[Malangizo] Kuchepetsa pang'onopang'ono kwa kuthamanga kwa magazi kuyenera kuchitidwa mosamala kuti muchepetse kutaya kwa magazi kwapang'onopang'ono chifukwa cha fractures ya humeral, koma odwala okalamba omwe ali ndi comorbidities angapo ayenera kusamala kuti apitirizebe kukhazikika kwa hemodynamic kuti apewe kutsekemera kosakwanira kwa minofu ndi ziwalo (chiwongoladzanja cha akatswiri: 100%; mlingo wovomerezeka wamphamvu: 61.9%).
12. Intraoperative volume management
[Malangizo] Gwiritsani ntchito njira yoyendetsera madzimadzi yoyendetsedwa ndi cholinga, ndipo mankhwala a vasoactive angaperekedwe prophylactically panthawi ya anesthesia kuti muteteze kuchulukitsitsa kwamadzimadzi (chiŵerengero cha akatswiri ovomerezeka: 100%; mlingo wovomerezeka wamphamvu: 69.1%).
13. Kusamalira magazi m'mitsempha
[Malangizo] Intraoperative ankalamulira hypotension si bwino kwa proximal humeral fractures, makamaka odwala okalamba, ndi intraoperative magazi ndi tranexamic acid angagwiritsidwe ntchito. Kuwunika kwa intraoperative kwa HGB <80g/L kumalimbikitsa kuikidwa magazi a allogeneic (chiwongola dzanja cha akatswiri: 100%; mlingo wovomerezeka wamphamvu: 73.8%).
14. Kupewa intraoperative hypothermia
[Malangizo] Odwala omwe ali ndi proximal humeral fractures ayenera kulimbikitsa kuyang'anira kutentha kwa intraoperative ndikuchitapo kanthu kuti asunge kutentha kwapakati pamwamba pa 36 ° C (chiwongoladzanja cha akatswiri: 100%; mlingo wovomerezeka wamphamvu: 76.2%).
15. Kusankha njira ya opaleshoni
(1) Kusweka kwa proximal humers
[Maganizo] Mawonekedwe a Neer akulimbikitsidwa kuti pakhale kuphulika kwa humerus (chiwopsezo cha akatswiri: 100%; chiwongola dzanja champhamvu: 83.3%).
(2) Njira ya opaleshoni
Dongosolo la opaleshoni liyenera kusankhidwa potengera fracture morphology, fupa la mafupa, momwe wodwalayo alili pathupi komanso m'maganizo ndi zina zofunika.
[Malangizo] Zomwe zimapangidwira mkati zimatha kusankhidwa molingana ndi mtundu wa fracture ndi kachulukidwe ka mafupa, monga mbale kapena intramedullary msomali; kwa odwala okalamba omwe ali ndi matenda osteoporosis omwe ndi ovuta kukonzanso kapena kukonza, 4-part fracture (ndi fracture dislocation), 3-part fracture ndi osteoporosis yoopsa, kupasuka kwapatukana ndi kupasuka kwa khosi, kusankhidwa kwa mapewa opangira mapewa kumasankhidwa, ndipo kusinthika kwa mapewa kumalimbikitsidwa ngati kuli kophatikizana ndi chiwongolero cha rotator 0 : kuvulaza kwa rotator 0 : kuvulaza kozungulira 0 . 71.4 peresenti.
![Proximal humer fracture]()
Chithunzi 1 Mkazi wazaka 65 wokhala ndi mbali 4 zosweka za proximal humeral adductor insert ndi allograft fibular implant plate fixation with incision and repositioning.
16. Kuyika kwa chubu chotayira mabala
[Maganizo] Zizindikiro za kusayika machubu otayira ngalande: ① Njira zowononga pang'ono (MIPPO ndi intramedullary nailing); ② Kutaya magazi pang'ono. Zizindikiro za kuyika kwa chubu cha ngalande: ① kudzera pa pectoral deltoid njira, Locking plate kukonza kapena kulowetsa mapewa; ② kutulutsa magazi kwakukulu kuchokera pachilonda (chiwopsezo cha akatswiri: 100%; chiwongola dzanja champhamvu: 71.4%).
17. Kutsekeka kwa mabala
【Malangizo】Opanga opaleshoniyo adatsekedwa ndi ma sutures osavuta, osanjikiza-ndi-wosanjikiza (chiwongola dzanja cha akatswiri: 100%; chiwongola dzanja champhamvu: 76.2%).
18. Chakudya chobwezeretsa pambuyo pa opaleshoni
【Malingaliro】Odwala amatha kumwa zakumwa zopanda zingwe pakamwa akadzuka pambuyo pa opaleshoni, ndikuyambanso zakudya zanthawi zonse pakatha maola 1-2 ngati palibe vuto.
19. Kusankhidwa kwa postoperative ndi ntchito yoyambirira
【Malangizo】Odwala safunika kugona motsamira pamtsamiro atachitidwa opaleshoni, amatha kukhala ndi malo ozungulira ndipo amatha kusuntha pansi akadzuka. Chomangira chovulala pamapewa chiyenera kuthyoledwa.
20. Miyezo ya postoperative analgesic
【Malangizo】Postoperative analgesia kwa odwala omwe ali ndi vuto lopunduka akulimbikitsidwa kuti agwiritse ntchito kutsekeka kwa chigawo pamodzi ndi 'mlingo wakumbuyo' wa NSAIDs, ndipo ngati kuli kotheka, mapampu odzipangira okha m'mitsempha kapena zotumphukira za mitsempha zotumphukira zodziyimira pawokha (expergesit 10% amavomereza; 78.6 peresenti.
21. Kupewa nseru ndi kusanza pambuyo pa opaleshoni
[Malangizo] Odwala onse ayenera kupatsidwa prophylactic antiemetic mankhwala 30 min asanathe opaleshoni. (Chiwongola dzanja cha akatswiri: 97%; chiwongola dzanja champhamvu: 47.8%)
22. Kukonzanso ntchito
【Malingaliro】Odwala omwe ali ndi vuto lokhazikika komanso lokhazikika la proximal humerus fractures ayenera kuyamba masewera olimbitsa thupi mwamsanga atatha opaleshoni. Zochita zolimbitsa thupi zimathandiza kubwezeretsa bwino ntchito ya chiwalo chapamwamba (Mlingo wovomerezeka wa akatswiri: 100%; Mlingo wamphamvu wovomerezeka: 92.9%).
23. Njira zochotsera ndi kutsata
【Malangizo】Njira zoyenera zotulutsira ziyenera kukhazikitsidwa, ndipo odwala ayenera kutsatiridwa pafupipafupi kwa miyezi yosachepera 6 (chiwongola dzanja cha akatswiri: 100%; chiwongola dzanja champhamvu: 83.3%).
Kodi Mungagule Bwanji Ma Implant a Orthopedic ndi Orthopedic Zida?
Za CZMEDITECH , tili ndi mzere wathunthu wazopanga za opareshoni ya mafupa ndi zida zofananira, zopangidwa kuphatikiza implants za msana, misomali ya intramedullary, trauma plate, Locking plate, cranial-maxillofacial, prosthesis, zida zamagetsi, External Fixators, arthroscopy, chisamaliro cha ziweto ndi zida zawo zothandizira.
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