Nubuhe buryo bukurikira bukoreshwa mugusana imvune hagati?

Ivunika rya Intertrochanteric ya femur, izwi kandi kuvunika intertrochanteric, ni kuvunika kwa capsule idasanzwe. Ikigaragara cyingenzi cyo kuvunika kwa intertrochanteric nububabare bukomeye bwaho no kubyimba, ecchymose nini, kutabasha umurwayi guhagarara cyangwa kugenda, kugabanuka gukomeye, guhindura imbere kwimbere ninyuma yimiterere yibihimba byanduye, no kugabanuka kwimikorere yibikorwa byikibuno cyerekezo cyerekezo icyo aricyo cyose.

Epidemiologiya

1. Benshi muribo bafitanye isano na osteoporose, cyane cyane mubasaza, abagore benshi kurusha abagabo.

2. Indwara ifitanye isano nubwoko, igitsina nakarere.

3. Gukomeretsa bisanzwe mubasaza, imyaka yo hagati yo kuvunika hagati yimitsi ni imyaka 75.2. Nta tandukaniro rikomeye ryigeze riba mu gihe cyo kuvunika hagati y’abagabo n’abagore.

4. Bitewe n'amaraso menshi atemba muri trochanter, kuvunika gake ntibikiza, ariko biroroshye kubaho guhinduranya ikibuno, kandi hariho izindi ngorane nyinshi ziterwa no kuruhuka igihe kirekire kubarwayi bageze mu zabukuru, kandi indwara nimpfu ni 15% -20%, bityo byitwa kuvunika kwa nyuma mubasaza.

Uburyo bwo gukomeretsa

1. Abakiri bato bakuze cyane ni ibikomere byingufu nyinshi, bagomba kwitondera ubwonko, igituza, inda nibindi bice byimvune; abantu bageze mu zabukuru usanga ahanini basaza imikorere yibihimba guhuza ibisubizo kugabanuka no kugwa biterwa na.

2. Ihohoterwa ritaziguye: ingaruka zitaziguye ahantu hanini cyane. Niba umubiri uguye hasi n'imbaraga zegeranye iyo ziguye.

3. Ihohoterwa ritaziguye: umubiri uhindagurika mugihe cyo kugwa, kandi ikibuno gikorerwa guhangayikishwa no guhindukira no kugana imbere icyarimwe.

4. Kuvunika kwa pathologiya, kimwe mubibyimba bisanzwe byamagufwa.

5. Ivunika hagati yimikorere iterwa ahanini n urugomo rutaziguye.

Kugaragara kwa Clinical

1.Icyerekezo cyibanze ni kimwe no kuvunika ijosi ryigitsina gore, hamwe nububabare bwaho, kubyimba no kugabanya imikorere yingingo zanduye.

2. Kuberako ari ukuvunika kwa capsule idasanzwe, nta mbogamizi ya capsule ihuriweho, bityo rero ubumuga bwo kugabanuka kuzengurutse hanze (dogere 90) zingingo zo hepfo birakomeye.

3. Ububabare bwa Axial percussion.

4. Hematoma yaho irakomeye cyane, kandi hashobora kubaho gukomeretsa cyane munsi yubutaka.

5. Ku barwayi bageze mu zabukuru, usanga bakuze kurusha abarwayi bo mu ijosi, kandi umubare munini w'abarwayi bagize ubwonko bwabanje.

Gusuzuma

Amateka y'ihahamuka rigaragara, ububabare mu gihimba cyanduye, no kugabanya kugenda. Kugabanuka no kuzunguruka hanze byimiterere yibihimba byo hepfo bigaragara kugeza kuri 90 °. Ikizamini cya X-ray gisabwa kenshi kugirango hamenyekane isuzuma kandi kwandika bishingiye kumaradiyo. Ibimenyetso byo kuvunika intertrochanteric bisa nibyavunitse ijosi ryigitsina gore, ariko ibyanyuma ntibikabije kurenza ibya mbere mubijyanye nububabare bwaho, kubyimba, gutakaza imikorere, no kugabanya ingingo zanduye, kandi ingingo yibasiwe ahanini ifite ibibuno byoroheje byoroheje hamwe no guhindagurika kw'ivi hamwe no guhindagurika hanze, mubisanzwe hagati ya 45 ° -60 °.

Andika

Ivunika rya AO na Evans-Jensen nuburyo bubiri bukoreshwa cyane kuvunika, kandi muribi byombi, ubwoko bwavunitse bwa AO nibisanzwe.

Kwandika Evans-Jensen

Ubwoko bwa I: Kuvunika byoroheje intertrochanteric hamwe numurongo wavunitse uva kumurongo uva hejuru ugana hasi, nta kwimurwa no gutuza.

Ubwoko bwa II: Gusimburwa bihujwe no kuvunika kwa rotor ntoya, ariko spur femorale ntigihinduka (spur femorale ni isahani yuzuye amagufwa iherereye imbere mu ijosi ryigitsina gore no guhuza umubiri wa rotor nto.

Ubwoko bwa III: Bivanze no kuvunika gukomeye kwa Trochanteric hamwe no kuvunika kwa spur femorale, hamwe no kwimurwa, akenshi hamwe no kuvunika hagati ya rotor.

Ubwoko bwa IV: kuvunika ibice 3 byahujwe no kuvunika gukabije kwa trochanter ntoya, ishobora kwerekana hamwe no kuvunika kw'ijosi ry'umugore hamwe n'ubuso bwa coronale ya trocanter nini.

Ubwoko V: inyuma yinyuma hamwe no hagati idashyigikiwe kuvunika (guhuza ubwoko bwa III na IV).

Ubwoko R: kuvunika imbere yimbere hamwe numurongo wavunitse uva kumurongo wo hagati ugana kuruhande ruto, bishobora kuba bifitanye isano no kuvunika kwa rotor nto no gusenya urutirigongo rwumugore.

Kwandika AO

A1.1 Umurongo wacitse unyura kumurongo wa rotor

A1.2 Kumeneka kunyura muri trochanter nini

A1.3 Kumeneka kunyura munsi ya trocanter ntoya

A2.1 Kumeneka hamwe nigice 1 cyagabanijwe

A2.2 Kumeneka hamwe nibice byinshi byamagufwa

A2.3 Kumeneka kwagura cm zirenga 1 munsi ya trocanter ntoya

A3.1 Imiterere yoroshye

A3.2 Imiterere yoroshye yo guhinduranya

A3.3

Umuti

Ihinduka ryimiterere yimbere yimvune muri rusange biterwa nibintu bitanu: ubwiza bwamagufwa, ubwoko bwimvune, kugabanuka, guhitamo gukosorwa imbere, hamwe numwanya wimbere imbere bijyanye nigufwa. Gusimburana kuvunika ni ngombwa kugirango habeho gutuza nyuma yo gukosorwa imbere kandi bigomba intego yo kugera kuri anatomic reposition cyangwa ihamye idahwitse. Muri make, intego yo kwimurwa ni ukubona ituze rihamye. Uburyo bwo gusubiramo bushobora gufungwa cyangwa gutemagurwa. Hatitawe kubibazo byubwoko bwavunitse, kugabanya gufunga bigomba kubanza kubanza.

• Imbaraga Hip Dowel (DHS)

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Ibyiza byingenzi bya DHS Imbaraga Zibibuno.

• Imiyoboro ifite ingaruka zikomeye zo gukosora mumutwe wumugore, kabone niyo byaba osteoporose.

• Uburyo bwo kunyerera mu ntoki birinda kwinjirira mu musumari mu mutwe wa femorale cyangwa acetabulum no kwanduza mu buryo butaziguye imbaraga zikomeye ku magufa.

• Uburyo bwo kunyerera imbaraga butuma kuvunika bigabanuka kandi bikagabanya kudahuza.

• Ifite imikorere ibiri yo kwikuramo no kunyerera, hamwe ningaruka zingirakamaro kandi zihamye.

  
  

• Imbaraga Hip Dowel (DCS)

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  DCS na plaque 95 zo gukata kubice bya anticrotal:

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Ibyiza byingenzi bya DCS power condylar screw ni.

• Irashobora guhitamo neza aho yinjirira ya screw ukurikije ibihe byihariye byo kuvunika, kandi imikorere iroroshye.

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• Imbaraga zo guhonyora imbaraga ziri kumurongo ugana ku isahani, yujuje ibisabwa bya biomehanike yibibuno. Mugihe cyo kwikorera ibiro, imbaraga mbi zabanje gukoreshwa kubiganza bigufi byisahani hanyuma bigakwirakwizwa kuri buri cyuma, kugirango imihangayiko itatanye kandi gukosorwa birakomeye bidasanzwe.

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• Umubare munini cyane wibikoresho bya DCS kumeneka byongera gukomera, kandi agace kavunitse karashobora kuba ikiraro kandi kigakosorwa, bityo bikagabanya ibibazo byikibazo nyuma yibikorwa.

Gufunga Abagore Bose Bafunze Imisumari (PFN)

Ibyiza byo gukosora PFN.

• Diameter ntoya (mubisanzwe 9mm), irashobora gutwarwa nta kwaguka. .

• Impera yegeranye ya PFN ifite kamera igera kuri dogere 6, igabanya inguni ya valgus kandi ikuraho ibikenewe gusubira inyuma imbere mugihe gikurura.

• Impera yo hejuru yemerera gushyira imigozi ibiri mumutwe wigitsina gore, hiyongereyeho umugozi urwanya kuzunguruka hamwe n’imisumari ibiri ifite ijosi ryigitsina gore, ibyo bikaba byongera umunaniro ukabije.

• Intera iri hagati yumwobo wafunguye nu musozo wa kure wumusumari wingenzi (kwaguka kashe) ni ndende, ishobora kugabanya imihangayiko yibiti byumugore.

• Ugereranije nihahamuka.

Imisumari

Ibyiza bya Gammar imisumari.

• Nuburyo bworoshye bwo gutera intramedullary uburyo bwo gukosora hamwe no gukomeretsa gato hamwe nihahamuka rito.

• Umusumari wa Gamma uhuza byimazeyo femur yo hejuru hamwe nijosi ryigitsina gore binyuze muguhuza umusumari wimbere hamwe nu mugozi wa tension, kandi umusumari winjiye ushyirwaho numusumari wa kure wo kwifungisha, birinda kuzunguruka no kugabanya kwimuka kandi bitanga gukosorwa kwizewe.

Gammar gutera imbere - PFNA

Guhitamo gukosora imbere (PFNA).

• Icyiza cyubatswe kubwimvururu zidahindagurika zavunitse.

• Ikosora neza umutwe n ijosi ryigitsina gore kandi ikarinda kuzunguruka kumpera.

• Irinda ingorane nko gusenyuka bitewe no gusubirana amagufwa nyuma yo gutakaza inkunga yo hagati, guhindagurika kwa inversion, no guca umutwe wumugore hamwe no gushiramo.

• Birakwiriye kuvunika hafi ya intertrochanteric, cyane cyane kuvunika kudahindagurika (urugero kuvunika imbere imbere) hamwe na osteoporose.

• Haracyariho ibibazo bimwe na bimwe byingorabahizi, nka avulion yumutwe wigitsina gore, bigatuma bidashoboka gusimbuza ibindi byakosowe imbere.

Gusimburana hamwe

Ibimenyetso byo kubaga ibihimbano byo gusimburanya kuvunika hagati ya femur:

• Imyaka iri hejuru yimyaka 80.

• Kuvunika no kudahindagurika kuvunika intertrochanteric.

• Amagufwa osteoporose aragaragara, kandi gukosora imbere biragoye kubikemura neza.

• Nta mbogamizi igaragara yo kugenda ikibuno cyangwa ivi mbere yimvune.

• Imiterere yumubiri yose irashobora kwihanganira ubuvuzi bwo kubaga.

Abarwayi badashobora kuvurwa muburiri igihe kinini.

Ibyiza: imyanya ya nyuma ya operasiyo hasi. Irinde ingorane ziterwa n'uburiri. Ongera igihe cyo kubaho no kuzamura imibereho.

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

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