Kodi fracture ya periprosthetic imachiritsidwa bwanji?

Cholinga

Kuphulika kwa periprosthetic kwa proximal femur ndi vuto lalikulu mu hip arthroplasty. Zomwe zanenedwazo ndi 3.5% zaka 20 pambuyo pa kubzalidwa koyambirira ndipo zimawonjezeka ndi zochitika zolowa m'malo. Kuthyoka kwa intraoperative nthawi zambiri kumalumikizidwa ndi tsinde zosakhazikika. Nthawi zambiri, ma fractures amapezeka mwa okalamba ofooka omwe adagwa pambuyo pa opaleshoni. Ngakhale kuti pali kusiyana kwapadziko lonse pakugwiritsa ntchito tsinde lopangidwa ndi simenti ndi losasunthika, palibe umboni woonekeratu wakuti mtundu umodzi wa tsinde la simenti umagwirizanitsidwa ndi chiopsezo chachikulu cha kupasuka kuposa china. Dongosolo la Vancouver classification la periprosthetic femoral fractures lavomerezedwa kwambiri ndi madokotala ochita opaleshoni ndipo lasonyezedwa kuti ndi lodalirika.

Cholinga chachikulu cha kafukufukuyu chinali kudziwa mgwirizano pakati pa gulu la Vancouver la fractures za simenti ndi zopanda tsinde. Cholinga chachiwiri chinali kufufuza kusiyana kwa makhalidwe oyambirira a odwala omwe ali ndi mitundu iwiri ya fracture.

Zida ndi njira

Wodwala:

1. Mndandanda wa odwala omwe ali ndi fractures zotsatizana za proximal periprosthetic.

2. Odwala okhawo omwe ali ndi fractures ya hip periprosthetic anaphatikizidwa.

3. Odwala omwe anali ndi fractures ya intraoperative, kukonzanso kuphulika kwa m'chiuno, ndi kuphulika kwa interprosthetic sikunaphatikizidwe.

   
   

Zolemba za data:

1. Digital radiography ndi computed tomography yochokera pa zolemba zamagetsi ndi kusanthula.

2. Mfundo zoyambira zomwe zalembedwa zikuphatikiza zaka, kugonana, kuchuluka kwa thupi, komanso kuchepa kwa kuyenda musanayambe kapena kudalira wosamalira.

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Tsatanetsatane wa opaleshoni:

1. Nthawi yoyamba kuikidwa, chizindikiro cha arthroplasty (osteoarthritis kapena fracture), mtundu wa tsinde (simenti kapena wosakanizidwa), ndi mtundu wa arthroplasty (total kapena semiarthroplasty) zinaphatikizidwa.

2. Zolemba zatsatanetsatane zazithunzi zinaphatikizapo gulu la Vancouver, varus vertebral position, ndi Dorr classification.

3. Stem geometry (conical kapena pawiri kwa tsinde zomangika, zowongoka kapena zowoneka ngati mphero kwa tsinde zopanda simenti) zidalembedwa potengera mawonekedwe a radiographic.

4. Kutsimikiza kwa gulu la Vancouver kunatengera zomwe zapezedwa pazithunzi komanso zomwe zapezeka mwa odwala opaleshoni.

5. Kusanthula kwachiwerengero kunachitika pogwiritsa ntchito zosinthika mosalekeza T-mayeso ndi mayeso enieni a Fisher pazosintha zamagulu kuti afananize mikhalidwe yoyambira ndi gulu la Vancouver la odwala omwe ali m'magulu a simenti ndi osakhazikika.

6. Mayesero onse anali a mbali ziwiri ndi mulingo wofunikira wa 0.05. Kusanthula kwachiwerengero kunachitika pogwiritsa ntchito mtundu wa GraphPad Prism 8.0.0.

   
   

Zotsatira

Chiwerengero cha odwala:

1. Odwala okwana 1181 adadziwika pofunsa zomwe zidasungidwa m'chipatala.

2. Odwala a 978 omwe anali ndi fractures yosagwirizana ndi periprosthetic proximal femur sanaphatikizidwe.

3. Pakati pa odwala 203 otsalawo, 8 anali ndi ma fractures a intraoperative, 6 anali ndi ma fractures osinthika a periprosthetic, ndipo 17 anali ndi periprosthetic fractures ya chipangizo chogwirizanitsa chiuno, chomwe chinachotsedwanso.

4. Odwala okwana 172 adaphatikizidwa atachotsedwa.

5. Zosweka zonse zidachitika pambuyo pa kugwa. Femoral tsinde fupa simenti gulu fractures mu milandu 84 popanda simenti

6. Panali 88 zosweka mu gulu.

   
   

Makhalidwe Oyambira:

1. Panali kusiyana kwakukulu pakati pa magulu a msinkhu, nthawi yoyambira kuikidwa, zizindikiro za arthroplasty chifukwa cha kuphulika kwa khosi lachikazi, primary hemiarthroplasty, varus stem placement, ndi body mass index.

2. Makamaka, mu gulu la simenti, ambiri anali hemiarthroplasty.

3. Panalibe kusiyana kwakukulu pakati pa magulu okhudzana ndi kugonana, kugawidwa kwa Dorr, ndi kuchepa kwa kuyenda kwa premorbid kapena kudalira wosamalira.

4. M'gulu la simenti, tsinde zambiri zidadulidwa ndipo zina zonse zidapangidwa.

5. M’gulu losamangidwa, tsinde zambiri zinali zowongoka ndipo zina zonse zinali zooneka ngati mphero.

   
   

Magulu a Vancouver:

1. Kuphulika kwa VancouverB2 kumagawika m'magulu anayi osiyana: ofotokozedwa kale 'kuphulika', ma clamshell, ndi ma helical, ndi 'reverse' clamshell pattern. Mawonekedwe oyimira a X-ray pamndandandawu ndi chithunzi chofananira akuwonetsedwa (Chithunzi 1).

2. Kuphulika kwapang'onopang'ono ndi kuphulika kunali kogwirizana kwambiri ndi tsinde la simenti, pamene fractures ya flap inali yogwirizana kwambiri ndi tsinde zopanda uncemented.

3. Njira yosinthira ya clamshell idachitikanso chimodzimodzi muzitsulo zonse ziwiri.

4. Mgwirizano wamagulu amtundu wa Vancouver, kuphatikiza mitundu inayi yosweka ya B2 yomwe yafotokozedwa pamwambapa, yokhala ndi tsinde ya geometry imawonetsa momwe zimakhalira mitundu yosweka.

Kambiranani

Mpaka pano, iyi ndiye kafukufuku wamkulu kwambiri wofanizira mwachindunji ubale pakati pa fractures za simenti ndi zosakhazikika za periprosthetic ndi gulu la Vancouver:

• Panalibe kusiyana kwakukulu pamalumikizidwe pakati pa tsinde zomangidwa ndi simenti ndi zopanda simenti mu Vancouver mtundu wa A, B, kapena C fractures. Zochitika za VancouverB2 fractures zinali zofanana m'magulu onse awiri, zomwe zikuwonetsa zochitika zomwe zimakhala zokhazikika komanso zosasunthika m'magulu a periprosthetic fractures.

• Mosiyana, Fenelon et al. kusanthula fractures periprosthetic ndi simenti zimayambira ndi uncemented. Zikuwonekeratu kuti chiwerengero cha odwala omwe ali ndi fractures ku Vancouver B2 ndi B3 ndipamwamba kwambiri.

• Phillips ndi al. fotokozani 'zophulika' zamagulu a tsinde la simenti ndi 'kung'amba' pa jekete la simenti, mofanana ndi 'mutu wa nkhwangwa'. Kuphulika kumeneku kunapezeka kuti kumagwirizana kwambiri ndi zitsime za simenti mu phunziroli.

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• Mkhalidwe wapamwamba wa fractures uwu umabweretsa nkhawa zokhudzana ndi kutsekedwa kwa mafupa, ndipo fractures izi nthawi zambiri zimafuna kuchotsa mosamala simenti ndikudutsa ndi tsinde lokhala ndi distal.

• Capello et al. adafotokoza za kuthyoka kwa 'flip-flop' komwe kumalumikizidwa ndi tsinde zopanda simenti, ndipo zomwe zapeza zikuwonetsa izi. Kuphulika kumachokera kumtunda wapakati wa trochanter wamkulu, kumapita ku medial cortex, ndikusunga lateral cortex, distal kwa trochanter yaying'ono. Kukula kwa dera la talar ndi kutsika kwa tsinde ndi zizindikiro za radiographic za kusakhazikika kwa tsinde. Kafukufuku wam'mbuyomu awonetsa kuyanjana kwakukulu kwa kusweka uku ndi matsinde osamangika okhala ndi mapangidwe owoneka ngati nthiti, ndipo kafukufukuyu amathandizira mgwirizanowu.

• Grammatopolous et al amafotokoza mndandanda wa ma fractures a helical mu fractures ya periprosthetic yokhala ndi tsinde za simenti, zomwe nthawi zambiri zimagwirizanitsidwa ndi tizidutswa tating'ono tating'onoting'ono komanso comminution yovuta. Chiwerengero cha ma helical fractures mu tsinde la simenti chinawonjezeka kwambiri mndandandawu, zomwe zingasonyeze chizolowezi cha fractures kuzungulira tsinde la simenti la tubular kuti lifalikire mofanana ndi fupa lachilengedwe.

• Pakuwunika kwa radiographic kwa kuchuluka kwa fractures ya periprosthetic, gulu lofufuza lidawona njira yosweka yomwe sinafotokozedwe kale m'mabuku. Kuphulikaku kumachokera ku calcar yapakati yomwe imadutsa mu lateral cortex, ndikusiya cortex yapakati. Kuthyoka kwamtunduwu kumatchedwa 'reverse' clamshell fracture, yomwe kafukufukuyu adawona ngati kusweka kwa Vancouver B2 wamba.

• Dzinali lidasankhidwa pazifukwa ziwiri: choyamba, ndi chithunzi chagalasi cha 'flip', ndipo chachiwiri, chimakhala ngati kusweka kwa chikazi, ndikusuntha kofananako kwa wolanda akukoka chidutswa chapakati . Kusweka kofananako kunachitika ndi tsinde za simenti komanso zopanda simenti (Chithunzi 2).

• Ngakhale kuti cholinga cha phunziroli sichinali kufufuza zotsatira za chithandizo, mu phunziroli, kuphulika kwa flip-flop kunkasinthidwa kawirikawiri ndi arthroplasty ya distal katundu wonyamula tsinde ndi kukonza zidutswa za fracture zowonongeka ndi mawaya a cerclage kapena mbale.

• Chitsanzo cha wodwala wothandizidwa ndi njirayi chikuwonetsedwa, kusonyeza kupindula kwa machiritso (Chithunzi 3).

Chithunzi 2 Njira yophwanyika m'mbuyo.

Chithunzi 3 Arthroplasty ndi cerclage wire fixation for retrograde flap fractures.

Mapeto

Malinga ndi Vancouver classification system, mitundu ya periprosthetic fracture imakhala ndi zochitika zofanana za periprosthetic fractures mu ma prostheses omangidwa ndi simenti. Choncho, zochitika zokhazikika komanso zosasunthika zimayambira pambuyo pa fracture zinali zofanana m'magulu awiriwa. Kuzindikira mitundu inayi yosweka ya VancouverB2, kuphatikiza mawonekedwe opindika kumene, zithandizira maopaleshoni kuzindikira kusakhazikika kwa tsinde. Maphunziro amtsogolo akufunika kuti afufuze mgwirizano pakati pa mtundu wa fracture ndi njira ya chithandizo kuti mudziwe tanthauzo lachipatala la zomwe zapeza pa phunziroli.

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