Femoral neck fracture ndeimwe yezvinowanzosangana nekukuvadzwa kwemapfupa mumakiriniki, uye vazhinji vevarwere vakwegura vanoverengera kupfuura 50% yehudyu fractures. Maererano nenhamba, chiitiko chekuputsika kwemutsipa wevakadzi chakawedzera zvishoma nezvishoma mumakore achangopfuura, nehuwandu hwehuwandu hwevakadzi kupfuura varume. Vertigo, dementia, hutsinye uye chirwere chemwoyo mune vakwegura uye kukuvara kwepamusoro-simba kune vechidiki ndezvipi zvinokonzera kukanganisa kwemutsipa wemukadzi.
Mumakore achangopfuura, zvinhu zvakawanda zvekugadzirisa zvemukati senge hollow screws, power hip screws (DHS), sliding hip screws (HSH), proximal femoral dissection plates, zvipikiri zvekuvaka patsva, uye Gamma misumari zvakabuda. Pakati pezvinhu izvi zvemukati zvekugadzirisa, hollow screws ndiyo inonyanya kushandiswa. Zvidzidzo zvakaratidza kuti ruzhinji rwevavhiyi vanosarudza maburi screws ekurapa mavhu asina kutsemuka, uye chikamu chakakosha chevavhiyi vanosarudza kushandisa hollow screws kune vakadzika mutsipa mutsipa. 3 parallel partially threaded hollow screw fixation ndiyo inonyanya kugamuchirwa chimiro chemukati kugadzirisa.
Anatomical features of femoral neck fractures
Iko zvino inowanzogamuchirwa kuti chimiro chevascular chemusoro wechikadzi ndicho chinonyanya kukosha chinokanganisa kuporesa kuputsika uye femoral head necrosis. Kukuvadza kweropa rekupa zvimiro zvemusoro wechikadzi ndicho chikuru pathological factor ye ischemic necrosis yemusoro wechikadzi. Kuongorora kwakarongeka kwevascular anatomy yemutsipa wechikadzi yakawana kuti epiphyseal vascular network uye arterial system yepasi pasi inotsigira nzvimbo inogona kuva zvivako zvakakosha zvekuchengetedza ropa kumusoro wemukadzi mushure mekuputsika kwemutsipa wemukadzi, kuitira kuti intraoperative drilling uye kuisirwa padhuze nepaunogona napo kusvika kunharaunda yepakati yehutano hunogona kuderedza mukana wekukuvara kwehutano. intraosseous vascular system.
![微信图片_20221205172646]()
Mufananidzo 1 Ropa rekupa kune musoro wemukadzi, anterolateral (a) uye shure (b) maonero. Pane kuchinja kweropa kune musoro wechikadzi, asi lateral uye medial spinofemoral arteries inobva kumvura yakadzika yevakadzi mu60% yevarwere.
(1) Kuwanda kweropa kumusoro wemukadzi kunobva kune lateral rotor femoral artery.
(2) Inoburitsa matavi matatu kana mana anotsigira tsinga yetambo. Aya matavi anofamba mberi uye kumusoro pamwe nechikamu che retroflexed che synovial neck ye femur kusvika kumucheto we cartilaginous wemusoro wevakadzi. Midziyo iri mukati memutsara wakatenderera.
(3) Inotorwa kubva kune foramen occulta artery. Kukwira kwebazi remukati rotor femoral artery.
(4) Inopa iyo yakakura trochanter yefemur uye inoumba arterial ring ine lateral rotor femoral artery.
Hollow screws yekutyoka kwemutsipa wemukadzi
Kliniki, matatu maburi ekudzima pfupa screws e6.5 mm kana 7.0 mm kana 7.3 mm anogona kushandiswa kugadzirisa muvarwere vadiki kana muzera repakati kana vakuru varwere vane bhonzo rakanaka. Gwaro rinofanirwa kuiswa kuchengetedza zvipikiri zvitatu zvisina mhango zvakapindirana kuti zvibvumire kutsvedza kwekutyoka. Mukati memutsipa wechikadzi, ma screws anofanirwa kukwizwa mukati memipendero, achichenjerera kuti ma screws akaiswa mumusoro wemukadzi uye kwete kuyambuka mutsara wekutyoka, sezvo iyi ndiyo chete nzira yekuwana inter-end compression. Iyo screws inofanira kusimbiswa uye yakadzokororwa yakasimbiswa intraoperatively. Kana mubhedha wekukweva ukashandiswa, kukweva kunofanirwa kuve kwakasununguka. Hollow screws inogonawo kuiswa percutaneously. Frontal, lateral, uye 45 ° oblique fluoroscopy inofanirwa kuitwa kuti ive nechokwadi chekuti screws haipindi muhudyu joint.
1、Matanho ekuvhiya chaiwo ekuvhiya.
Tora 'inverted triangle' chipikiri chekuisa, icho chinowanzoshandiswa mukudzidzira kwekiriniki, semuenzaniso.
a. Chekutanga pane zvese, pasi pefluoroscopy, shandisa X-ray mundege mbiri dzefluoroscopy kuona marongero epini yezasi neyepakati.
b. Kuchekwa kweganda kunogadzirwa kunosvika 2-3 cm proximally.
c. Iyo fascial layer inopatsanurwa pamwe neiyo incision uye Cobb separator inoshandiswa kupatsanura iyo longitudinal fiber pamwe ne lateral femoral muscle.
d. Isa iyo inotungamira tsono munzvimbo iyo ndege dzese dzakakwana.
e. Pini imwe yegwara yakaiswa parutivi rwemberi kwehuro hwemukadzi nemubatsiri wekuona anterior tilt angle.
f. Mushure mekugadzirisa kwepini yekutanga yepini, iyo posterosuperior uye anterosuperior guide pini inotaridzirwa uchishandisa madhigirii akafanana kuti awane posterior uye anterior cortical support mukati memutsipa wechikadzi.
g. Izvi zvinoitwa nekuisa pini yekutungamira pamusoro peiyo trochanter diki padivi pe distal femoral neck cortex kuburikidza nemusana wechikadzi; mapini maviri anotevera anopinzwa ari proximally nenzira yakafanana, kureba kumusoro sezvinobvira uye 5 mm kubva kune anterior uye posterior cortex; kudzika kwekupinda kwepini yemutungamiri inobva yagadziriswa kuti isvike 5 mm pasi pe cartilage; pekupedzisira, gomba rinodzokororwa, kuyerwa, uye siruu yakadzvanywa inopindirwa mukati.
h. Ita shuwa kuti usapinda tsono pazasi pe trochanter diki uye famba proximally uchitevedza femoral musana.
i. Ita shuwa kuti pini yekutungamira ine threaded yakaiswa pasi pejoinhi.
j. Usabvumira pini yemutungamiri kupinda mukati me articular surface.
k. Sarudza kureba kwakakodzera sikuruwa nekuyera kureba kwepini yekutungamira wozobvisa 5 mm.
l. Kazhinji kuzvirovera, kuzvirovera screws anoshandiswa, asi dzimwe nguva pre-drilling ye lateral cortex inodiwa muvarwere vakavimbika vane gobvu bone.
m. Kana nzvimbo ichibvumira, spacer inogona kushandiswa.
n. A 4th screw (dhaimani kuronga) inogona kudikanwa kune vanovimbika vane zvakanyanya comminuted fractures yeshure kweruoko.
![微信图片_20221205173632]()
Kunyangwe maburi maburi ekutyoka kwemutsipa kwechikadzi anyanya kuwanda, pachine misiyano yemafungiro maererano nehuwandu uye gadziriso yeakavhiyiwa akaiswa hollow screws, kazhinji zvichienderana nezvinodiwa nemushandisi; zvinhu zvakaita sekuwanda kwebhonzo remurwere, kusimba kwescrew, uye kubudirira kwekurapa zvine zvazvinoita.
1、Nhamba yemasiruuru.
Femoral neck fractures inowanzogadziriswa ne 2-4 hollow screws.
Muzviitiko zvakawanda, 3 screws inoshandiswa nokuti inogona kumira yakasimba anterior stresss, kuwedzera kugadzikana, uye kuderedza kutama kwekuguma kwekuputsika.
Pakutyoka kwemutsipa wemukadzi nePauwells angle > 50 °, 2 screws zvinonzwisisika.
Mune varwere vane zvakanyanya comminuted fractures ye posterior femoral neck, 4 hollow screws yakatsigirwa.
Nekudaro, iyo tsika iripo ichiri kushandisa 3 hollow screws yekugadzirisa.
2, Kugadziriswa kwegomba sikuruu.
Kana 3 hollow screws inoshandiswa kugadzirisa mukati mekutyoka kwefemoral neck, zvinotendwa kuti dzidziso ye 'sliding compression' inofanirwa kuteverwa, kuitira kuti 3 screws akadyarwa aenderane kune imwe neimwe mune orthogonal maonero uye ave netriangular configuration mu lateral maonero.
Nenzira iyi, matatu akaenzana maburi screws anogona kupa yakanaka mechanical rutsigiro uye kugadzira sliding track, kuitira kuti chivharo chekutsemuka chikwanise kutsvedza padyo negoro remukadzi axis pasi pekumisikidzwa kwemhasuru dzehudyu, zvichigadzira kumanikidza kumagumo ekutyoka uye kukurudzira kuporeswa kwekutyoka.
Zvakadaro, kuti 3 hollow screws akaiswa mune orthotriangular kana inverted triangular configuration zvave negakava.
Kufambira mberi mune hollow screw fixation tekinoroji yekutyoka kwemutsipa wemukadzi
Yuenyongviwat et al. akagadzira itsva inogadziriswa parallel drilling guide yekuiswa kwehollow screws mukurapa kwechikadzi mutsipa kuputsika nekugadzirisa kwemukati, uye yakaona kuti mutungamiri mutsva uyu unogona kuderedza nguva yekushanda uye nhamba ye intraoperative fluoroscopic maonero kana ichienzaniswa nemaitiro echinyakare, nokudaro kuwana migumisiro inogutsa yekuvhiya.
Filipov et al. akagadzira biplane inotsigirwa kaviri screw fixation (BDSF), umo panopindwa napo twunhatu mhango screws inowanikwa munzvimbo gobvu yecortical yeproximal femoral hunde, uye matatu screws akaenzana kureba kune periphery yefemoral head, nokudaro kugadzira ndege mbiri. Iyi nzira inobvumira kutsigirwa kwekortical kaviri, nokudaro kupa simba rakakwana rekugadzirisa panguva yekufamba.
Kuedza kweBiomechanical uchishandisa cadaveric specimens yakaratidza kuti BDSF kugadzirisa nzira inopa kugadzirisa kuri nani pane yechinyakare inverted triangle fixation nzira. Mhedzisiro yekuongorora kwebiomechanical uchishandisa cadaveric specimens yakaratidza kuti calcium phosphate simende yakasimbisa hollow screw fixation yakavandudza zvakanyanya kugadzikana kwehollow screw fixation yekutyoka kwemutsipa wemukadzi, yakasimbisa kuramba kwemutsipa wemukadzi, uye yakavandudza kuomarara kwemuviri, uko kune kukosha kukuru kwekiriniki.
Nekuda kwepamusoro mukana weiyo femoral head necrosis mushure mekugadzika mbambo yekutyoka kwechikadzi mutsipa wakatyoka, dzimwe nzira dzave dzichiramba dzichishandiswa kubatsira hollow chipikiri kugadzika kwemukati kuderedza zvinonetsa senge femoral head necrosis. Mhedzisiro yemusoro wevakadzi necrosis mushure mekuputsika kwemutsipa wemukadzi ndiko kurasikirwa kwekuyerera kweropa kune musoro wemukadzi, saka chinangwa chekurapa ndechekuvandudza kuyerera kweropa. Kuiswa kweropa-inopihwa periosteum graft munzvimbo yenecrotic yemusoro wemukadzi uye kuzadza kwekunze kwegomba rakasara neyakamera inomera zvichabatsira kusiyanisa kweiyo periosteum yakabatanidzwa muosteoblasts pamwe nekuvandudzwa kwevascular sprouts, iyo ine zvese osteogenic uye revascular effects.
Summary
Hollow screw fixation ye femoral mutsipa kuputsika inzira inoshanda kwazvo yekugadzirisa, ine zvakanakira kushanda kuri nyore, nguva pfupi yekushanda, kushungurudza kudiki, kugadzirisa kwakavimbika uye nekukurumidza postoperative kupora. Zvisinei, nekuda kwemaitiro eanatomical ekuputsika kwemutsipa wevakadzi, zvinetso zve ischemic necrosis yemusoro wevakadzi uye kusabatanidzwa kwekuputsika hakugoni kudziviswa zvachose nekugadzirisa kwemukati kwekuputsika kwemutsipa wevakadzi. Nokudaro, zviratidzo zvekushandiswa kweiyi nzira yekugadzirisa zvinoda kujekeswa zvisati zvashandiswa, uye varwere vakwegura vane zvakanyanya vakadzingwa mutsipa wemutsipa fractures uye urombo huzhinji hunoita hunoda basa rekutanga vanofanira kudzivisa kushandisa kugadziriswa kwemukati kwekuputsika kwemutsipa wevakadzi zvakanyanya sezvinobvira. Izvo zvinokonzerwa nehutachiona hunokanganisa kufungidzira kwemurwere, zvakadai semhando yekuputsika, kuputika kwepfupa, uye mamiriro ekushanda kwemurwere, inofanirawo kutorwa mukufungisisa kuderedza dambudziko renguva refu mushure mekuvhiyiwa uye nokudaro kuvandudza mugumisiro wekurapa kwekuputsika kwemutsipa wevakadzi.
Nzira yeKutenga Orthopedic Implants uye Orthopedic Instruments?
For CZMEDITECH , isu tine yakazara yakazara chigadzirwa mutsara we orthopedic oparesheni yekuvhiya uye inowirirana zviridzwa, zvigadzirwa zvinosanganisira ma implants emusana, intramedullary misumari, trauma plate, kukiya ndiro, cranial-maxillofacial, prosthesis, zvishandiso zvemagetsi, vagadziri vekunze, arthroscopy, veterinary care uye yavo inotsigira chiridzwa seti.
Pamusoro pezvo, takazvipira kuenderera mberi nekugadzira zvigadzirwa zvitsva uye kuwedzera mitsara yechigadzirwa, kuitira kuti tisangane nekuvhiyiwa kwevamwe vanachiremba nevarwere, uye zvakare kuita kuti kambani yedu iwedzere kukwikwidza muindasitiri yepasi rose yemapfupa emapfupa uye zviridzwa.
Isu tinotumira kunze kwenyika pasi rose, saka iwe unogona taura nesu pa email kero song@orthopedic-china.com yemahara quote, kana kutumira meseji paWhatsApp kuti upindure nekukurumidza +86- 18112515727 .
Kana uchida kuziva rumwe ruzivo, tinya CZMEDITECH kuti uwane mamwe mashoko.
