Tsanangudzo yeIntertrochanteric Fractures yeFemur
Intertrochanteric fractures of the femur (inozivikanwawo se trochanteric fractures) inoreva kuputsika kunoitika kubva pasi pemutsipa wemukadzi kusvika pamwero wepamusoro pe trochanter shoma. Zviratidzo zvinosanganisira marwadzo emunharaunda, kuzvimba, ecchymosis. Varwere havakwanisi kufamba, nekupfupisa, kuderedzwa, uye kutenderera kwekunze kwechikamu chakakanganiswa, uye zvishoma zvishoma zvekufamba kwekubatana kwehudyu.
Kutyoka uku kunoita 3% - 4% yezvose zvakaputsika mumuviri uye 35.7% yehudyu kuputsika. Chiitiko chacho chinowedzera nezera, chichinyanya kuwanda muvanhu vanopfuura makore makumi manomwe, uye chinowanikwa muvakadzi kupfuura varume.
Yakashandiswa Anatomy yeIntertrochanteric Fractures yeFemur
Triangle yeWard
Nzvimbo ine triangular panjodzi inoumbwa munzvimbo yepakati iyo iyo femoral neck trabeculae cross. Muvanhu vakwegura vane osteoporosis, nzvimbo iyi inongozara nemafuta.
Femoral Calcar
A dense bone plate inowanikwa kumashure - yepakati kusvika panosangana mutsipa wemukadzi uye shaft yakadzika kune diki trochanter. Iyo yekuwedzera kweiyo posterior - medial cortex yefemoral shaft mune inokanzura bhonzo uye ndiyo poindi yekushandisa eccentric mutoro pane proximal femur.
Kukwidziridzwa kweHip Bone Trabeculae
Kudhirowa kwesimba remagetsi reiyo proximal femur:
(1) Giredhi 6; (2) Giredhi 5; (3) Giredhi 4; (4) Giredhi 3; (5) Giredhi 2; (6) Giredhi 1
Kukuvadza Maitiro eIntertrochanteric Fractures yeFemur
High - Simba Kukuvara muVarwere Vechidiki
Intertrochanteric fractures muvarwere vechidiki inowanzokonzerwa nekukuvara kwepamusoro-simba sekudonha kubva pakakwirira uye tsaona dzemotokari. Mamiriro ezvinhu aya anogona kukonzera kuputsika kwakanyanya, uye varwere vanofanirwa kutariswa zvakanyanya nezvekukuvara kwakabatana, kusanganisira izvo kumusoro, musana, uye thoracic uye nhengo dzedumbu.
Zvinokonzera Kudonha muVarwere Vakwegura
90% ye intertrochanteric fractures kune vakwegura inokonzerwa nekudonha. Zvinokonzera kuti vakwegura vade kudonha zvinosanganisira kusaona zvakanaka, kuderera kwetsandanyama, kusagadzikana kweBP, kuderera kwemaitiro ekuita, zvirwere zvevascular, uye zvirwere zvemabhonzo nemajoini.
Kana kuwa kunoguma nekuputsika kunotsanangurwa nezvinhu zvishanu zvinotevera: kuoma kwe osteoporosis, kutungamira kwekudonha, kunyanya kana hip kana nzvimbo iri pedyo nehudyu ichirova pasi, kusakwana kwezvidziviriro zvekudzivirira kuderedza simba rekudonha, kusakwanisa kwehudyu zvinyoro zvinyoro kutora simba rakakwana, uye simba risina kukwana rehudyu.
Mhando dzeMhirizhonga uye Nzira dzekuita
Mhirizhonga Yakananga: Kukuvara kwepamusoro-simba kunobata zvakananga pahudyu, senge tsaona dzemotokari kana kudonha uko hudyu inobatwa zvakananga, zvichikonzera kuputsika.
Mhirizhonga Isina Kunanga: Kudhonzwa kwemuviri kunoisa hudyu kune varus uye kumberi kushushikana kwekushushikana. Neine trochanter diki se fulcrum, inodzvanywa zvine simba, uye panogona kunge paine kudhonza kweiliopsoas tsandanyama, kuumba shavishavi-yakaumbwa pfupa fragment. Iyo trochanter yakakura inogonawo kugadzira chidimbu chepfupa chakaparadzaniswa nekuda kwekudhonza kwakasimba kwegluteus medius muscle.
Clinical Classification yeIntertrochanteric Fractures yeFemur
Evans Classification
Iyo inonyanya kushandiswa mumakiriniki maitiro. Evans akakamura intertrochanteric fractures mumhando mbiri:
Type I: Trans - trochanteric fractures Zvinoenderana nekugadzikana pamberi uye mushure mekudzikisa, iyo inokamurwazve kuita 4 subtypes:
Ⅰa: Zviviri - chikamu chakatyoka pasina kutamiswa.
Ⅰb: Zviviri - chikamu chakatyoka nekutamiswa, iyo medial cortex haina kusimba, uye kutyoka kwakagadzikana mushure mekuderedzwa.
Ⅰc: Iyo diki trochanter ndeyemahara, ine fracture displacement uye varus deformity; kana kuti trochanter yakakura ipfupa rakaparadzana.
Ⅰd: Kuwedzera kune intertrochanteric fracture, ese makuru uye madiki trochanters anove akaparadzana mapfupa zvidimbu, ane varus deformity.
Pakati pavo, mhando Ⅰa uye Ⅰb imhando dzakagadzikana, uye mamwe marudzi asina kugadzikana.
Rudzi rwechipiri: Reverse - oblique intertrochanteric fractures
Rudzi rwechipiri ndeye reverse - trochanteric fracture, ine mutsara wekutsemuka uchitambanukira kubva pasi peiyo trochanter yakakura kusvika kumusoro kweiyo trochanter diki.
AO Classification
Rudzi rweA1: Nyore mbiri - chikamu chinotsemuka kuburikidza ne trochanter, nerutsigiro rwakanaka rwepakati bhonzo cortex uye intact lateral bone cortex.
Pakati pemutsara we intertrochanteric.
Kuburikidza netrochanter yakakura.
Kuburikidza nediki trochanter.
Rudzi rweA2: Yakaputsika yakaputsika kuburikidza ne trochanter, ine fractures yepakati cortex mundege mbiri, asi lateral bone cortex inoramba yakasimba.
Nechikamu chimwe chepakati chekutsemuka.
Nezvimedu zvakati wandei zvekutsemuka.
Kuwedzera kupfuura 1 cm pasi peiyo trochanter shoma.
Nyora A3: Reverse - intertrochanteric fractures, ine fractures ye lateral cortex zvakare.
Oblique.
Transverse.
Comminuted.
Kazhinji, marudzi A1.1 kusvika kuA2.1 anonzi akadzikama, uye marudzi A2.2 kusvika kuA3.3 anonzi haana kugadzikana.
Kuvhiya Kurapa kweIntertrochanteric Fractures yeFemur
Chinangwa chikuru chekurapa kwekuvhiya ndechekuwana kugadzirisa kwakasimba kwe intertrochanteric fracture mushure mekuderedza. Kusimba kwekugadzirisa kunoenderana nezvinhu zvinotevera: hutano hwemapfupa, rudzi rwekuputsika, kuderedzwa, kugadzirwa kwechigadziro chemukati chekugadzirisa, uye nzvimbo yekuisa mukati mekugadzirisa zvinhu.
Mumakore achangopfuura, mukati mekugadzirisa zvinhu zvekurapa intertrochanteric fractures zvakaramba zvichigadzirwa uye zvakagadziridzwa. Pakati pavo, intramedullary fixation, senge PFNA uye INTERTAN, inowanzoshandiswa seyakajairwa yemukati kugadzirisa mudziyo.
PFNA yeKurapa kweIntertrochanteric Fractures yeFemur
PFNA inoshandiswa kune isina kugadzikana osteoporotic intertrochanteric fractures seEvans Ic, Id, uye Type II. Iine mashandiro arinani, yakanaka anti - kutenderera kugona, nguva pfupi yekuvhiya, kurasikirwa kweropa kushoma, matambudziko mashoma, uye mukana wakaderera weproximal kukiya mbambo yekucheka - kunze, ichiratidza zviri pachena kurapwa kwakanaka.
PFNA inoratidzwa kune isina kugadzikana osteoporotic intertrochanteric fractures (yakadai seEvans marudzi Ic, Id, uye II). Inoratidza kushanda kwepamusoro neakanakisa anti-kutenderera zvivakwa, ipfupi operative nguva, kuderedzwa kurasikirwa kweropa, uye mashoma matambudziko. Iyo system's helical blade dhizaini inonyatso kubatanidza bhonzo, ichipa yakasimba kubata simba uye zvakanyanya kuderedza njodzi yekucheka-kunze kubva mumusoro wemukadzi, ichipa akasiyana kurapa kwakanakira.
INTERTAN yekurapwa kweIntertrochanteric Fractures yeFemur
Nekuvandudzwa kwehunyanzvi hwemazuva ano hwekurapa, INTERTAN imhando nyowani ye intramedullary mbambo yakanyatsogadzirirwa kurapwa kwe intertrochanteric fractures yefemur. Muchinjikwa - chikamu chembambo yayo huru ndeye trapezoidal. Kana ikashandiswa pamwe chete neinopindirana mbambo yakasanganiswa, inogona kudzivirira 'Z' mhedzisiro. Kuwedzerwa kwechipikiri chechipiri chinobuda kubva kumusoro wemukadzi kunowedzera anti - rotational effect ye lag screw. Iyi intramedullary mbambo ine huwandu hwakawanda hwekushandisa uye inokodzera varwere vane osteoporosis yakaoma.
Iyo INTERTAN ibhuku re intramedullary mbambo rakagadzirirwa zvakanangana ne intertrochanteric fractures, inoratidza kufambira mberi muhunyanzvi hwemazuva ano hwekurapa. Chipikiri chayo chikuru chinoratidzira trapezoidal cross-section yekusimudzira kugadzikana. Chikamu cheproximal chinoshandisa chivakwa chakabatanidzwa (a lag screw uye compression screw), iyo inodzivirira nemazvo 'Z-effect' (apo siruu imwe inodzokera kunze apo imwe inopinda mumusoro wemukadzi). Iyo yekuwedzera set screw inobvumira iyo lag screw kuti iwedzere kuenderera mukati memusoro wemukadzi, ichiwedzera kugona kwayo kwekudzivirira kutenderera. Iyi mbambo ine huwandu hwakawanda hwezviratidzo uye inonyanya kukodzera varwere vane osteoporosis yakaoma.
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