Ndi njira ziti zomwe zimagwiritsidwa ntchito pokonza ma intertrochanteric fractures?

Intertrochanteric fracture ya femur, yomwe imadziwikanso kuti intertrochanteric fracture, ndi extra-articular capsule fracture. Mawonetseredwe akuluakulu a intertrochanteric fracture ndi ululu waukulu wa m'deralo ndi kutupa, ecchymosis yochuluka, kulephera kwa wodwalayo kuyima kapena kuyenda, kufupikitsa kwakukulu, mkati ndi kunja kusinthasintha kwa chiwalo chokhudzidwa, ndi kuchepetsa kayendetsedwe kake ka chiuno cha chiuno kumbali iliyonse.

Epidemiology

1. Ambiri a iwo ndi okhudzana ndi matenda osteoporosis, makamaka okalamba, amayi ambiri kuposa amuna.

2. Zochitikazo zikukhudzana ndi mtundu, jenda ndi dera.

3. kuvulala kofala kwa okalamba, zaka zapakati pa intertrochanteric fracture ya femur ndi zaka 75.2. Panalibe kusiyana kwakukulu mu zaka za intertrochanteric fracture pakati pa amuna ndi akazi.

4. Chifukwa cha kutuluka kwa magazi olemera mu trochanter, fracture kawirikawiri sichichiritsa, koma n'zosavuta kuchitika kutembenuka kwa ntchafu, ndipo pali zovuta zambiri zomwe zimayambitsidwa ndi kupuma kwa nthawi yaitali kwa odwala okalamba, ndipo chiwerengero cha imfa ndi imfa ndi 15% -20%, choncho amatchedwa kuthyoka kotsiriza kwa okalamba.

Njira yovulaza

1. Achinyamata ambiri amakhala ovulala kwambiri, ayenera kumvetsera ubongo, chifuwa, pamimba ndi mbali zina za kuvulala; anthu okalamba nthawi zambiri ukalamba ntchito ya miyendo mgwirizano kuyankha agility kuchepa ndi kugwa chifukwa.

2. Chiwawa chachindunji: kukhudza mwachindunji dera lalikulu la trochanter. Ngati thupi likugwa pansi ndi mphamvu yofananira nayo pamene ikugwa.

3. Chiwawa chosalunjika: thupi limapotozedwa panthawi ya kugwa, ndipo chiuno chimayang'aniridwa ndi kupsinjika kwa inversion ndi kutsogolo kutsogolo panthawi yomweyo.

4. Pathological fracture, imodzi mwazotupa zofala za mafupa.

5. Intertrochanteric fracture imapangidwa makamaka ndi nkhanza zosalunjika.

chipatala mawonetseredwe

1. Chiwonetsero choyambirira ndi chofanana ndi cha kuphulika kwa khosi lachikazi, ndi ululu wa m'deralo, kutupa ndi kuchepa kwa ntchito ya gawo lokhudzidwa.

2. Chifukwa ndi fracture ya capsule yowonjezera-articular, palibe choletsa cha capsule olowa, kotero kupunduka kwafupikitsa kasinthasintha wakunja (madigiri 90) a m'munsi ndi ovuta kwambiri.

3. Axial percussion ululu.

4. Local hematoma ndi yoopsa kwambiri, ndipo pakhoza kukhala mikwingwirima yambiri ya subcutaneous.

5. Odwala okalamba, amakhala okalamba kuposa odwala khosi lachikazi, ndipo chiwerengero chachikulu cha odwala adwala kale.

Matenda

Mbiri ya kuvulala koonekeratu, kupweteka kwa mwendo wokhudzidwa, ndi kuchepetsa kuyenda. Kufupikitsa ndi kupunduka kwakunja kwa mwendo wapansi kumawonekera mpaka 90 °. Kuyeza kwa X-ray kumafunika nthawi zambiri kuti adziwe matendawo ndipo kulemba kumatengera ma radiographs. Zizindikiro za intertrochanteric fracture zimakhala zofanana ndi za kuphulika kwa khosi lachikazi, koma chotsiriziracho ndi chochepa kwambiri kuposa choyambirira chokhudza ululu wa m'deralo, kutupa, kutayika kwa ntchito, ndi kufupikitsa gawo lomwe lakhudzidwa, ndipo chiwalo chomwe chimakhudzidwa makamaka chimakhala ndi chiuno chochepa kwambiri ndi kupindika kwa mawondo ndi kupunduka kwa kunja, kawirikawiri pakati pa 45 ° -60 °.

Mtundu

The AO ndi Evans-Jensen fractures ndi mitundu iwiri yomwe imagwiritsidwa ntchito kwambiri, ndipo mwa awiriwa, mtundu wa AO fracture ndi wofala kwambiri.

Evans-Jensen akulemba

Lembani I: Kuthyoka kosavuta kwa intertrochanteric ndi mzere wosweka wotsetsereka kuchokera pamwamba mpaka pansi, popanda kusamuka ndi kukhazikika.

Mtundu Wachiwiri: Kusamuka pamodzi ndi kuphulika kwakung'ono kwa rotor avulsion fracture, koma femoral spur imakhala yolimba (femoral spur ndi mbale yochuluka ya fupa yomwe ili mkati mwa khosi lachikazi ndi thupi la rotor yaying'ono.

Mtundu Wachitatu: Kuphatikizika kwakukulu kwa trochanteric fracture ndi fracture kudzikundikira kwa femoral spur, ndi kusamuka, nthawi zambiri ndi posterior inter-rotor fracture.

Mtundu wa IV: 3-part fracture pamodzi ndi comminuted fracture ya trochanter yaying'ono, yomwe ingapereke ndi kupasuka kwa khosi lachikazi ndi coronal pamwamba pa trochanter yaikulu.

Mtundu V: kusweka kwapambuyo kwapambuyo komanso kwapakatikati (kuphatikiza mitundu ya III ndi IV).

Mtundu R: kuphulika kwapakati pa intertrochanteric ndi mzere wa oblique fracture kuchokera kumtunda wapamwamba kupita kumalo otsika, omwe angagwirizane ndi kuphulika kwa rotor ndi kuwonongeka kwa msana wa chikazi.

AO kulemba

A1.1 Mzere wosweka umadutsa pakati pa rotor

A1.2 Kusweka kumadutsa mu trochanter yayikulu

A1.3 Kuphulika kumadutsa pansi pa trochanter yocheperako

A2.1 Kuthyoka ndi 1 comminuted fupa fragment

A2.2 Kuthyoka ndi tiziduswa ta mafupa angapo

A2.3 Fracture yopitilira 1 cm pansi pa trochanter yaying'ono

A3.1 mawonekedwe osavuta oblique

A3.2 Mawonekedwe ophatikizika osavuta

A3.3 Kukhazikika

Chithandizo

Kukhazikika kwa kukhazikika kwa mkati mwa fractures nthawi zambiri kumadalira zinthu zisanu: ubwino wa fupa, mtundu wa fracture, kuchepetsa, kusankha kwa mkati mwa mkati, ndi malo opangira mkati molingana ndi fupa. Kuyikanso ng'anjo ndikofunikira kuti pakhale bata pambuyo pakukhazikika kwamkati ndipo kuyenera kukhala ndi cholinga chokwaniritsa mawonekedwe a anatomiki kapena kukhazikika kosagwirizana ndi anatomiki. Mwachidule, cholinga cha repositioning ndi kupeza fracture bata. Njira yobwezeretsanso ikhoza kutsekedwa kapena incisional. Mosasamala kanthu za zovuta za mtundu wa fracture, kuchepetsa kutsekedwa kuyenera kuyesedwa poyamba.

• Mphamvu ya Hip Dowel (DHS)

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Ubwino waukulu wa DHS Power Hip Screws.

• Chophimbacho chimakhala ndi mphamvu yokhazikika mkati mwa mutu wa chikazi, ngakhale pakakhala matenda a osteoporosis.

• Njira yothamangitsira m'manja imalepheretsa kulowa kwa msomali kumutu wa chikazi kapena acetabulum ndikutumiza mwachindunji mphamvu yokoka ku fupa.

• Dongosolo loyendetsa magetsi limapangitsa kuti fracture ikhalepo ndipo imachepetsa kusagwirizana.

• Lili ndi ntchito ziwiri zoponderezana ndi kutsetsereka, zomwe zimakhala ndi mphamvu komanso zokhazikika.

  
  

• Mphamvu ya Hip Dowel (DCS)

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  DCS ndi mbale zodulira 95 degree za anticrotal fractures:

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Ubwino waukulu wa DCS power condylar screw ndi.

• Ikhoza kusankha molondola malo olowera wononga molingana ndi momwe fracture ilili, ndipo ntchitoyo ndi yabwino.

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• Sirawu yopondereza mphamvu ili pakona yakumanja kwa mbale, yomwe imakwaniritsa zofunikira za biomechanical m'chiuno. Panthawi yolemetsa, mphamvu yoipa imayamba kugwiritsidwa ntchito pa mkono waufupi wa mbaleyo kenako imamwazika ku screw iliyonse, kotero kuti kupsinjika kumabalalika ndipo kukonza kumakhala kolimba kwambiri.

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• Nambala yokulirapo pang'ono ya zomangira za DCS pa fracture imawonjezera kulimba, ndipo malo ophwanyika amatha kutsekedwa ndi kukhazikika, motero kuchepetsa zovuta za postoperative.

Proximal Femoral Locking Intramedullary Nail (PFN)

Ubwino wa PFN fixation.

• Zing'onozing'ono za msomali (nthawi zambiri 9mm), zimatha kulowetsedwa popanda dilation. (kuposa kumapeto kokulirapo kwa msomali wa Gamma - 17mm)

• Mapeto afupipafupi a PFN ali ndi camber pafupifupi 6 madigiri, kuchepetsa ngodya ya valgus ndikuchotsa kufunikira kwa kubweza mwamphamvu mkati panthawi yokoka.

• Kumapeto kwapamwamba kumalola kuyika kwazitsulo ziwiri pamutu wa chikazi, ndi kuwonjezera kwa anti-rotation screw ndi kunyamula misomali iwiri pakhosi lachikazi, zomwe zimawonjezera kutopa.

• Mtunda pakati pa dzenje lotsekera distal ndi kumapeto kwa msomali waukulu (tapered extension) ndi wautali, zomwe zingachepetse kupsinjika kwa tsinde lachikazi.

• Zowopsa zochepa.

Misomali ya Gammar

Ubwino wa Gammar misomali fixation.

• Ndi njira yochepetsera pang'ono ya intramedullary fixation yokhala ndi kadulidwe kakang'ono komanso kuvulala kochepa.

• Msomali wa Gamma umagwirizanitsa mwamphamvu khosi lachikazi ndi khosi lachikazi kupyolera mu kuphatikiza kwa intramedullary msomali ndi tension screw, ndipo msomali wa intramedullary umakhazikitsidwa ndi distal self-lock msomali, womwe umalepheretsa kuzungulira ndi kufupikitsa kusamuka ndikupereka kukhazikika kodalirika.

Kusintha kwa Gammar - PFNA

Kusankhidwa kwa zida zamkati (PFNA).

• Njira yabwino yopangira ma intertrochanteric fractures a femur.

• Zimakonza mwamphamvu mutu wa chikazi ndi khosi ndipo zimalepheretsa kusinthasintha kwa mapeto a fracture.

• Zimalepheretsa zovuta monga kugwa chifukwa cha kuphulika kwa fupa pambuyo pa kutayika kwa chithandizo chapakati, kuwonongeka kwa inversion, ndi kudula mutu wa chikazi ndi choyikapo.

• Oyenera pafupifupi onse intertrochanteric fractures, makamaka osakhazikika fractures (mwachitsanzo anterior intertrochanteric fractures) ndi kuphatikiza osteoporosis.

• Palinso zochitika zina za zovuta, monga kugwedezeka kwa mutu wa chikazi, zomwe zimapangitsa kuti zikhale zosatheka kusintha zina zamkati.

Zopangira Zophatikizana M'malo

Zizindikiro za opaleshoni yopangira olowa m'malo mwa intertrochanteric fracture ya femur:

• Zaka zopitilira 80.

• Kuphwanyidwa kosasunthika komanso kosakhazikika kwa intertrochanteric.

• Matenda a mafupa ndi odziwikiratu, ndipo kukonza mkati kumakhala kovuta kukonza bwino.

• Palibe malire ofunikira a ntchafu kapena mawondo asanayambe kuvulala.

• Thupi lonse likhoza kulekerera chithandizo cha opaleshoni.

Odwala omwe sangathe kuchiritsidwa pabedi kwa nthawi yayitali.

Ubwino: koyambirira pambuyo pa opaleshoni kuyikika pansi. Pewani zovuta zobwera ndi kama. Wonjezerani nthawi yopulumuka ndikuwongolera moyo wabwino.

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.

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