Bwanji ngati kukonza kwamkati kwa inter rotator fracture kulephera?

Kuthyoka kwa m'chiuno akuti kumakhudza akuluakulu a 500,000 ku United States chaka chilichonse. Amakhudzidwa kwambiri ndi moyo wabwino, pakali pano akuwerengera 3-7% ya anthu omwe amamwalira m'chipatala komanso chiwerengero cha imfa cha chaka chimodzi cha 19.4-58%. Pafupifupi theka la ntchafu zonse zosweka ndi intertrochanteric (IT) fractures. Ma implants awiri omwe amagwiritsidwa ntchito pochiza fractures ya IT ndi cephalomedullary nail (CMN) ndi sliding hip screw (SHS).

Ngakhale kupita patsogolo kwa teknoloji, kutha kwa mafupa ndi kulephera kukonza monga kulowa kwa mutu wa chikazi kumachitikabe ndipo zingakhale zowononga. Kafukufuku waposachedwa wanena kuti kuchuluka kwa resection mpaka 6% ndi implants zamakono. Zowopsa zomwe zimalepheretsa kukonza zikuphatikizapo nsonga-nsonga mtunda (TAD)> 25 mm, kusakwanira kwa fracture repositioning, kusakhazikika kwa fracture, ma cephalic spikes omwe ali pambali kapena pansi pa pakati pa mutu wa chikazi, ndi kuzungulira kwa mkati kwa mbali ya khomo lachiberekero. Kukalamba ndi kufooka kwa mafupa kumalumikizidwanso ndi kulephera kukonza.

Odwala ndi Njira

Uku kunali kufufuza kobwerezabwereza kwa odwala omwe amathandizidwa m'mabungwe awiri omwe ali mkati mwa dongosolo lachipatala mumzinda waukulu. Zolemba za maopaleshoni awiri (JS ndi BC) adafunsidwa kwa odwala onse omwe adalandira simenti yokonzedwanso pambuyo polephera kukonza koyambirira kwa ma fractures a IT kuyambira Januware 2018 mpaka Seputembara 2021, atavomerezedwa ndi bungwe loyang'anira mabungwe. Kugwiritsiridwa ntchito kwa kulimbikitsa simenti panthawi ya opaleshoni yokonzanso kunatsimikiziridwa ndi mbiri yachipatala yamagetsi (EMR) yowunikira zolemba zogwirira ntchito ndi ma radiographs a postoperative. Tinaphatikizapo odwala onse omwe ali ndi zizindikiro zolimbitsa simenti pakukonzanso kukonzanso pambuyo polephera CMN kapena SHS fixation ya IT fractures (Chithunzi 1). Sitinaphatikizepo odwala omwe ali ndi khosi lachikazi kapena fractures ya subtrochanteric, odwala omwe sanakonzedwenso kukonzanso ndi kulimbitsa simenti, ndi odwala omwe anachitidwa opaleshoni ya arthroplasty panthawi ya opaleshoni yoyamba yokonzanso.

Chithunzi 1. Mayi wina wazaka za 76 adagwidwa ndi intramedullary kukhomerera kwa intertrochanteric fracture ya femur (A), ndi kupweteka kosalekeza kwa m'chiuno miyezi 2 pambuyo pake chifukwa cha kudulidwa kwa implant (B).

Njira za opaleshoni

Kwa odwala omwe amalandila kukonza koyambirira ndi CMN, tidapanga kusintha kwa msomali wamutu ndikulimbitsa simenti ya mafupa. Poyambirira, 5-cm incision inapangidwa kumbali yozungulira ya trochanter yaikulu, waya wotsogolera anayikidwa pambali ya msomali, ndipo fupa lonse linachotsedwa kumbali yozungulira ya msomali pogwiritsa ntchito remer yotseguka. Kenako, screwdriver ya hexagonal idagwiritsidwa ntchito kumasula zomangira zokhazikika pamwamba pa CMN (Chithunzi 2).

Chithunzi 2, intraoperative fluoroscopy yowonetsa screwdriver ya hexagonal ikugwira ndikumasula sikona yokhomeredwapo kale.

Kudulira kozungulira kwa 1-2 masentimita kumapangidwa pansi kudzera mu iliotibial fascia (ITB) fascia. Msomali wamutu woyambirira umachotsedwa ndi kalozera wobwerera kumbuyo (Chithunzi 3). Pankhani ya kuphulika kwa mutu wa chikazi, kalozera wopanda kanthu wokhala ndi zotsekera za distal amagwiritsidwa ntchito pofuna kupewa kutayikira kwa simenti mu olowa (Chithunzi 3A). Mwachindunji, matrix adayamba kubayidwa atachotsa zigawo ziwiri zakunja za cannula katatu kenako ndikuyika m'malo opindika polowetsanso zigawo ziwiri zakunja.

Chithunzi 3, Intraoperative anteroposterior (A) ndi lateral (B) zithunzi za wodwala wina yemwe akuwonetsa mutu wachikazi wokhala ndi vuto la mafupa a interstitial.

Kenako, mwendo umagwedezeka ndiyeno fractureyo imayikidwanso mu exostosis kuti ikonzedwenso. Pazochitika za malunion kapena machiritso a fibrous, osteotomy ya percutaneous ikugwiritsidwa ntchito pogwiritsa ntchito 1/4 'gouge ya fupa ndi njira ya anterolateral. Izi sizili zofunikira kawirikawiri, koma zimakhala zogwira mtima kwambiri pakufunika kuti pakhale njira yabwino ya khomo lachiberekero (chandamale> 130 °).

Chophimba chatsopano kapena tsamba lozungulira limayikidwa mu fupa la subchondral pamutu wa chikazi pamphepete mwa khosi lachikazi, kuonetsetsa kuti musalowe m'mutu (Chithunzi 4). Zomangirazo zimayikidwa mwadala kupewa misomali yam'mbuyo, komabe zikulozera kumapeto pakati pa mutu wa chikazi. (Chithunzi 5)

Chithunzi 4, Anteroposterior (A) ndi lateral (B) zithunzi za wodwala wina akuwonetsa kuyika kwa singano ya kerfing panjira ya msomali watsopano.

Chithunzi 5, intraoperative fluoroscopy yosonyeza kuyika kwa tsamba latsopano la cephalomedullary m'mphepete mwa njira yawaya yowongolera, yomwe pambuyo pake idalimbitsidwa ndi wononga.

Pomaliza, mutu wa chikazi umadzazidwa ndi simenti ya mafupa pogwiritsa ntchito jekeseni ya simenti ya mafupa (Chithunzi 6). Chisamaliro chimatengedwa kuti tipewe kutuluka mumgwirizano pogwiritsa ntchito ma radiographs enieni ndikusintha kuya ndi kulunjika kwa cannula ya simenti.

Chithunzi 6, Kujambula kusonyeza kuwonjezeka kwa simenti poyamba (A), kudzaza pang'onopang'ono (B) mpaka chilema cha mutu wa chikazi chidzadzazidwa (C).

Kwa odwala omwe amalandira kukonza koyambirira kwa SHS, timachotsa SHS ndikuyika CMN yayitali. mutatha kupanga 5-cm incision chapakati pansi pa trochanter yaikulu ndikuzindikiritsa ITB, chodulidwacho chimadulidwa mpaka ku mbale ya lateral. Zomangira zonse za mbale zimachotsedwa pogwiritsa ntchito screwdriver yoyenera ndipo mbale yakumbuyo imachotsedwa. Zomangirazo zimachotsedwa ndi kalozera wa ulusi wobwerera m'mbuyo monga momwe tafotokozera kale kuti akhazikitsenso chophwanyikacho kuti chikhale chokulirapo cha valgus. Kudulira kwa 5-cm kumapangidwa kumapeto kwa trochanter yayikulu monga tafotokozera kale. Waya wolondolera umayikidwa kumapeto kwenikweni kwa trochanter yayikulu ndikupitilira mutsinde lachikazi. Chotsegula chotsegula chimayambitsidwa panjira ya guidewire. Waya wautali wokhala ndi nsonga ya mpira umalumikizidwa pakati pa femur ya distal pansi pa mulingo wa patella. Kenako, kubwerezanso pang'onopang'ono kunkachitika mpaka kunjenjemera kumamveka msana. Odwala athu onse adalandira msomali wautali wa CMN ndi TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA).

Zokambirana

Njira yathu imagwiritsa ntchito kulimbikitsa simenti ya mafupa panthawi yokonzanso. Kulimbitsa simenti ya mafupa pokonzekera koyambirira kwa osteoporotic proximal femur fractures adaphunziridwa ndipo awonetsa zotsatira zabwino za biomechanical ndi zachipatala. Ndemanga yaposachedwa inanena kuti kulimbikitsana kwa simenti ya mafupa kumapangitsa kulemedwa kwakukulu, kuchepetsa kusuntha kwa implant, ndi zovuta zochepa komanso kuyambiranso poyerekeza ndi kusakhazikika kosakhazikika. Kafukufuku wopangidwa mwachisawawa, wamitundu yambiri adawonetsanso kuti palibe kuyambiranso kapena zizindikiro za kusamuka kwa CMN m'gulu lolimbikitsidwa ndi simenti poyerekeza ndi milandu isanu ndi umodzi pagulu losalimbikitsidwa.

Imfa zothyoka m'chiuno ndizochuluka. Kafukufuku waposachedwa afotokoza za 3-7% ya kufa m'chipatala, pomwe kufa kwa chaka chimodzi kutsika kuchokera 19.4% mpaka 58%. Makamaka, kuwonongeka kwa IT kwawonetsedwa kuti ndi 27% yaimfa pa chaka chimodzi. Mndandanda wathu wachipatala sunawonetsere imfa ya m'chipatala komanso chiwerengero cha imfa cha chaka chimodzi cha 13.6%, chomwe ndi chochepa kwambiri poyerekeza ndi mabuku. Chifukwa chakuti kuyenda kwa bedi koyambirira pambuyo pa opaleshoni kumagwirizanitsidwa ndi imfa yochepa, kuthamangitsidwa bwino ndi zotsatira zogwira ntchito pamndandanda wathu zingafotokozere kuchepa kwa imfa zomwe zimawonedwa mwa odwala athu.

Mapeto

Kukonzekera kokonzanso simenti ndi njira yothandiza, yotetezeka, komanso yotsika mtengo kwa osagwirizana ndi intertrochanteric fracture fixation kulephera kwa odwala okalamba omwe ali ndi mafupa okwanira a acetabular.

Odwala omwe ali ndi vuto lolephera kukonza ma intertrochanteric fractures omwe amatsatiridwa ndi kukonzanso kukonzanso ndi chithandizo cha simenti awonetsa zotsatira zabwino zachipatala komanso moyo wabwino. Njirayi inkagwiritsidwa ntchito pokhapokha pamene ambiri a acetabular articular pamwamba adasungidwa ndipo msomali wamutu umakhalabe mkati mwa khosi lachikazi. Poganizira zoperewera za kukonzanso arthroplasty kwa odwala okalamba ofooka, njirayi imasonyeza kulonjeza mwachitetezo komanso moyenera kuchepetsa mavuto aakulu pamene kuchepetsa nthawi yogwiritsira ntchito ndi mtengo mu gulu ili la odwala.

Kodi Mungagule Bwanji Ma Implant a Orthopedic ndi Orthopedic Zida?

Za CZMEDITECH , tili ndi mzere wathunthu wa mankhwala opangira opaleshoni ya mafupa ndi zida zofanana, zomwe zimaphatikizapo implants za msana, misomali ya intramedullary, trauma plate, mbale yotsekera, cranial-maxillofacial, prosthesis, zida zamagetsi, okonza kunja, arthroscopy, chisamaliro cha ziweto ndi zida zawo zothandizira.

Kuphatikiza apo, tadzipereka kupitiliza kupanga zinthu zatsopano ndikukulitsa mizere yazogulitsa, kuti tikwaniritse zosowa za maopaleshoni a madokotala ndi odwala ambiri, ndikupangitsanso kampani yathu kukhala yopikisana pamakampani onse apadziko lonse oyika mafupa ndi zida zamagetsi.

Timatumiza kunja padziko lonse lapansi, kuti mutha tilankhule nafe imelo adilesi song@orthopedic-china.com pa mtengo waulere, kapena tumizani uthenga pa WhatsApp kuti muyankhe mwachangu +86- 18112515727 .

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