Proximal humerus fractures ndeimwe yeanowanzo fractures mu trauma orthopedics, uye yakawanda proximal humerus fractures yakaderera-energy osteoporotic fractures kune vakwegura.
Kunyangwe iyo yakawanda yeproximal humerus fractures inogona kurapwa nekuchengetedza, 10-15% yekutyoka ichiri kuda kurapwa kwekuvhiya, iyo inosanganisira incisional yekudzikisa ndiro kugadzirisa, kuvharwa kuderedzwa kwemukati medullary chipikiri kugadzirisa, uye kubatana kutsiva.
Sarudzo yekurapa inoda kuenderana nemamiriro emuviri wemurwere, maonero ake, tarisiro yepfungwa, uye rudzi rwekutyoka.
Kugadzirisa zvakare uye kugadzirisa kwekuputsika kwekukurumidzira
【Kurudziro】Pane proximal humeral yakakura tuberosity (NEER mhando 2 chikamu fracture) yakatyoka yakasanganiswa nekutsemuka kwepfudzi, preoperative CT bvunzo, kunze kwekutyoka munharaunda yekuvhiya yemutsipa, repositioning uye braking nekushungurudza pfudzi brace pasi pekurumidzira anesthesia (yenyanzvi yekurudziro chiyero: 7 kurudziro: 620%).
2. Preoperative acute pain control
【Kurudziro】Varwere vane proximal humerus fracture vanofarira preoperative analgesia nemuromo acetaminophen kana NSAIDs, uye opioid yemumuromo inogona kuwedzerwa kana mhedzisiro yacho isiri yakanaka (yero yekurudziro yenyanzvi: 100%; chiyero chakasimba chekurudziro: 73.8%).
3. Dzidzo yemamishinari isati yaitwa
[Kurudziro] Dzidzo yepreoperative inofanira kuitwa nenzira yakasiyana uye yakawanda-modal. (Kurudziro yenyanzvi: 100%; chiyero chakasimba chekukurudzira: 83.8%)
4. Preoperative nutritional assessment uye kutsigira kurapwa
【Kurudziro】Kupedzisa kuongororwa kwehutano hwevarwere mukati memaawa makumi maviri nemana ekubvumidzwa uye nekupa rubatsiro rwekudya kune varwere vane njodzi yekudya. (Kurudziro yenyanzvi: 98.5%; chiyero chakasimba chekurudziro: 55.9%)
5. Perioperative glucose assessment uye mutemo mune chirwere cheshuga
【Kurudziro】 Iyo inokurudzirwa glycemic control tande kune vazhinji vane chirwere cheshuga vari kuvhiyiwa yakasarudzika ndeye 7.8 kusvika 10.0 mmol/L.
6. Kutungamirirwa kwezvinyoro zvinyoro zvinyoro munguva yeperioperative
【Kurudziro】Kuvarwere vari kuvhiyiwa yakasarudzika yeproximal humerus kutyoka, nzira dzakawanda dzemuviri dzinopihwa kuderedza kuzvimba panguva yekuvhiya. (Kurudziro yenyanzvi: 98.5%; chiyero chakasimba chekukurudzira: 80.9%)
7. Preoperative dietary management
【Kurudziro】 Varwere vane kuvhiyiwa kwakasarudzika vanogona kudya zvinwiwa zvakajeka 2h vasati vavhiyiwa uye chikafu chine starchy kana zvigadzirwa zvemukaka 6 h vasati vavhiyiwa. (Kurudziro yenyanzvi: 100%; chiyero chakasimba chekukurudzira: 76.5%)
8. Perioperative weti catheter manejimendi
【Kurudziro】 Routine perioperative weti catheterization haikurudzirwe kune proximal humerus kutyoka kuvhiyiwa (Kurudziro yenyanzvi: 100%; Kurudziro yakasimba: 78.6%)
9. Prophylactic kushandiswa kweperioperative antimicrobial drugs
【Kurudziro】Kuvarwere vane proximal humerus fractures inoda endoprosthesis kana kutsiva majoini, kushandiswa kweprophylactic kwechizvarwa chekutanga uye chechipiri cephalosporins kunokurudzirwa kudzivirira kutapukira munguva yeperioperative. (Kurudziro yenyanzvi: 97.1%; chiyero chakasimba chekukurudzira: 73.5%)
10. Kusarudzwa kweanesthesia
【Kurudziro】Anesthesia inokurudzirwa kutora nzira yeregional block compound general anesthesia, sarudza madhiragi kuti urege kuwedzera kusashanda kwenhengo yemuviri yevarwere vakura, uye teerera kusimbisa kutarisa (yenyanzvi yekurudziro: 100%; chiyero chakasimba chekurudziro: 71.4%).
11. Intraoperative blood pressure contro
[Kurudziro] Kuderedza kuderera kweropa kunofanirwa kucherechedzwa kuti kuderedze kurasikirwa kweropa kwemukati-kati kune proximal humeral fractures, asi varwere vakwegura vane comorbidities dzakawanda vanofanira kuchenjerera kuchengetedza hemodynamic kugadzikana kuti vadzivise kusakwana kweperfusion yezvinyama uye nhengo (nyanzvi yekurudziro rate: 100%; chiyero chakasimba chekurudziro: 61.9%).
12. Intraoperative volume management
[Kurudziro] Itai chinangwa chekugadzirisa mvura, uye mishonga yevasoactive inogona kupiwa prophylactically panguva yeanesthesia yekudzivirira mvura yakawanda (yenyanzvi yekukurudzira chiyero: 100%; chiyero chakasimba chekukurudzira: 69.1%).
13. Intraoperative blood management
[Kurudziro] Intraoperative controlled hypotension haikurudzirwe kune proximal humeral fractures, kunyanya muvarwere vakura, uye intraoperative kuisirwa ropa uye tranexamic acid inogona kuiswa. Intraoperative cheki yeHGB <80g/L inokurudzira kuwedzerwa ropa reallogeneic (nyanzvi yekukurudzira mwero: 100%; chiyero chakasimba chekukurudzira: 73.8%).
14. Kudzivirira intraoperative hypothermia
[Mazano] Varwere vane proximal humeral fractures vanofanira kusimbisa intraoperative tembiricha yekutarisa uye kutora matanho akasiyana-siyana kuchengetedza kupisa kwepakati pamusoro pe36 ° C (yero yekurudziro yenyanzvi: 100%; chiyero chakasimba chekukurudzira: 76.2%).
15. Kusarudzwa kwekuvhiya nzira
(1) Kutsemuka kwechikamu cheproximal humerus
[Kurudziro] Neer's staging inokurudzirwa kune proximal humerus fracture staging (yenyanzvi yekurudziro mwero: 100%; chiyero chakasimba chekurudziro: 83.3%).
(2) Kuvhiya
Urongwa hwekuvhiya hunofanirwa kusarudzwa zvichienderana nekutyoka morphology, kunaka kwebhonzo, chimiro chemurwere uye chepfungwa uye zvimwe zvakakosha.
[Kurudziro] Iyo yemukati inogadzirisa zvinhu inogona kusarudzwa zvinoenderana nerudzi rwekutsemuka uye kusimba kwepfupa, senge ndiro kana intramedullary nail; kune vakwegura varwere vane osteoporosis yakaoma kugadzirisa zvakare kana kugadzirisa, 4-part fracture (uye fracture dislocation), 3-part fracture ine osteoporosis yakaoma, kupatsanurwa kwekuputika uye kuputika kwemutsipa weanatomical, kugadzirwa kwepfudzi kuchinjwa kunosarudzwa, uye reverse joint joint replacement inokurudzirwa kana yakabatanidzwa ne rotaper cuff rate rate: exrotor 1 inokurudzira kukuvara . 71.4%).
![Proximal humerus kuputsika]()
Mufananidzo 1 Mukadzi ane makore makumi matanhatu nemashanu ekuzvarwa ane 4-chikamu chekutsemuka kweproximal humeral adductor kuiswa uye allograft fibular implant plate fixation ine incision uye repositioning.
16. Kuiswa kwemaronda drainage chubhu
[Recommendations] Zviratidzo zvekusaisa machubhu emvura: ① Minimally invasive operation techniques (MIPPO uye intramedullary nailing); ② Kubuda ropa kushoma. Zviratidzo zvekuiswa kwechubhu yemvura: ① kuburikidza nepectoral deltoid nzira, kukiya ndiro yekumisikidza kana pfudzi kutsiva; ② kubuda ropa kwakakosha kubva pachironda chepamusoro (nyanzvi yekurudziro mwero: 100%; chiyero chakasimba chekurudziro: 71.4%).
17. Kuvharwa kwemaronda
【Kurudziro】 Iyo yekuvhiya incision yakavharwa neyakaganhurirwa nyore, layer-by-layer sutures (yero yekurudziro yenyanzvi: 100%; chiyero chakasimba chekurudziro: 76.2%).
18. Postoperative recovery diet
【Kurudziro】 Varwere vanogona kunwa zvinwiwa zvisina madhiri nemuromo kana vamuka mushure mekuvhiyiwa, uye kutangazve kudya kwakajairwa mushure memaawa 1-2 kana pasina kuita kwakashata.
19. Kusarudzwa kwechinzvimbo chemashure uye basa rekutanga
【Kurudziro】Varwere havafanirwe kurara papillow mushure mekuvhiyiwa, vanogona kutora chinzvimbo chehafu-recumbent uye vanogona kufamba pasi mushure mekumuka. Iyo inoshungurudza pfudzi brace inofanira kubhurwa.
20. Postoperative analgesic matanho
【Kurudziro】Postoperative analgesia muvarwere vane proximal humeral fractures inokurudzirwa kushandisa blockade yedunhu yakasanganiswa neyakajairwa 'background doses' yeNSAIDs, uye kana zvichidikanwa, intravenous self-administered analgesia pumps kana peripheral nerve block self-administered analgesia0: chiyero chakasimba cheanalgesia000. 78.6%).
21. Kudzivirirwa kwemashure ekuvhiya uye kurutsa
[Kurudziro] Vese varwere vanofanirwa kupihwa prophylactic antiemetic mishonga 30 min kusati kwapera kuvhiyiwa. (Kurudziro yenyanzvi: 97%; chiyero chakasimba chekukurudzira: 47.8%)
22. Kuvandudza kushanda
【Kurudziro】Varwere vane yakagadziriswa uye yakagadzikana proximal humerus fractures vanofanirwa kutanga maekisesaizi ekudzoreredza nekukurumidza sezvinobvira mushure mekuvhiyiwa. Maekisesaizi ekudzoreredza anobatsira kudzorera zvirinani basa remugumbo wepamusoro (Nyanzvi yekukurudzira mwero: 100%; Kurudziro yakasimba: 92.9%).
23. Maitiro ekubvisa uye kutevera
【Kurudziro】Maitiro anoshanda ekubvisa anofanira kugadzwa, uye varwere vanofanirwa kuteverwa nguva nenguva kweinenge mwedzi 6 (yero yekurudziro yenyanzvi: 100%; chiyero chakasimba chekurudziro: 83.3%).
Nzira yeKutenga Orthopedic Implants uye Orthopedic Instruments?
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