Ko periprosthetic fracture inorapwa sei?

Chinangwa

Periprosthetic fractures ye proximal femur idambudziko rakakura muhudyu arthroplasty. Chiitiko chakashumwa ndeye 3.5% makore makumi maviri mushure mekutanga kudyarwa uye inowedzera nehuwandu hwekutsiviwa kwemajoini. Intraoperative fractures inowanzobatanidzwa nemashizha asina kuiswa. Zvizhinji zvinowanzoitika, kuputsika kunoitika kune vakura vasina simba vakawira pasi pechipiri pakuvhiyiwa. Kunyange zvazvo kune misiyano yenyika yose mukushandiswa kwemasimende uye isina kusimbiswa, hapana humbowo hwakajeka hwokuti rumwe rudzi rwesimende tsvina inobatanidzwa nepamusoro pekuputsika kwengozi kupfuura imwe. Iyo Vancouver classification system ye periprosthetic femoral fractures yakagamuchirwa zvakanyanya nevanovhiya uye yakaratidza kuve yakavimbika.

Chinangwa chikuru chechidzidzo ichi chaive chekuona hukama pakati peVancouver kupatsanurwa kwemasimende uye asina kuisirwa dzinde kuputsika. Chinangwa chechipiri chaiva chekuongorora kusiyana kwemaitiro ekutanga evarwere vane marudzi maviri ekuputsika.

Zvishandiso uye Nzira

Murwere:

1. Mutsara wevarwere vane akatevedzana proximal periprosthetic fractures.

2. Varwere chete vane primary hip periprosthetic fractures vakabatanidzwa.

3. Varwere vane intraoperative fractures, revision hip fractures, uye interprosthetic fractures hazvina kubatanidzwa.

   
   

Data rekodhi:

1. Digital radiography uye computed tomography inobva pamagetsi zvinyorwa uye kuongorora.

2. Baseline tsananguro dzakarekodwa dzinosanganisira zera, bonde, body mass index, uye kuderera kwekufamba kusati kwatanga kana kutsamira muchengeti.

3. 
   

Zvekuvhiya zvinorekodha:

1. Nguva yekutanga kuiswa, chiratidzo che arthroplasty (osteoarthritis kana kuputsika), rudzi rwezinde (samende kana isina kusimbiswa), uye rudzi rwe arthroplasty (yakazara kana semiarthroplasty) yakabatanidzwa.

2. Detailed imaging marekodhi aisanganisira Vancouver classification, varus vertebral chinzvimbo, uye Dorr classification.

3. Stem geometry (conical kana mukomboni wemasimende akaiswa simende, akatwasuka kana kuti wedge-akaita seasina kuisirwa hunde) yakanyorwa zvichibva pakuonekwa kweradiographic.

4. Kutsunga kweiyo Vancouver classification yaive yakavakirwa pakufungidzira zvakawanikwa uye intraoperative zvakawanikwa muvarwere vekuvhiya.

5. Ongororo yenhamba yakaitwa pachishandiswa zvinoramba zvichiitika T-test uye Fisher's chaiyo bvunzo yecategorical variables kuenzanisa yekutanga maitiro uye Vancouver classification yevarwere mumapoka akasimwa uye asina kuisirwa stem.

6. Yese miedzo yaive nemativi maviri ane kukosha kwe0.05. Kuongorora kwenhamba kwakaitwa pachishandiswa GraphPad Prism vhezheni 8.0.0.

   
   

Results

Nhamba yevarwere:

1. Huwandu hwevarwere zana nemakumi masere nerimwe vakaonekwa nekubvunza dhatabhesi rechipatara.

2. 978 varwere vane-non-periprosthetic proximal femur fractures havana kubatanidzwa.

3. Pakati pevarwere ve203 vakasara, 8 yakanga ine intraoperative fractures, 6 yakanga ine revision periprosthetic fractures, uye 17 yakanga ine periprosthetic fractures yehup joint fixation device, iyo yakaramba isingabatanidzwi.

4. Huwandu hwevarwere ve172 hwakaverengerwa mushure mekubviswa.

5. Kutyoka kwese kwakaitika mushure mekudonha. Femoral stem bone sement group inoputsika mu84 kesi pasina simende

6. Pakanga pane 88 kuputsika muboka.

   
   

Baseline Hunhu:

1. Pakanga paine misiyano yakakura pakati pemapoka muzera, nguva yekutanga kuiswa, zviratidzo zve arthroplasty yekutyoka kwemutsipa wevakadzi, primary hemiarthroplasty, varus stem placement, uye body mass index.

2. Kunyanya, muboka resimende, vazhinji vaiva hemiarthroplasty.

3. Pakanga pasina misiyano yakakosha pakati pemapoka ane chekuita nebonde, Dorr kupatsanura, uye kuderera kwe premorbid kufamba kana kutarisira muchengeti.

4. Muboka rakasimirirwa, madzinde mazhinji akaiswa tape uye mamwe aive akaumbwa.

5. Muboka risina kusimirirwa, madzinde mazhinji akanga akati twasu uye mamwe acho akanga akaita seweji.

   
   

Zvikamu zveVancouver:

1. Kutyoka kweVancouverB2 kwakakamurwa kuita mana akatyoka mapatani: izvo zvakambotsanangurwa comminuted 'burst', clamshell, uye helical mapatani, uye ichangoonekwa 'reverse' clamshell pateni. Mumiriri weX-ray kutaridzika kweakateedzana uye inoenderana graphical ratidziro inoratidzwa (Mufananidzo 1).

2. Kuputika uye spiral fractures yakabatanidzwa zvakanyanya nemasimende stems, nepo kuputika kwekuputika kwakanyatsobatanidzwa nemakumbo asina kuiswa.

3. Iyo reverse clamshell pateni yakaitika zvakafanana mumatande ese ari maviri.

4. Iko kushamwaridzana kweVancouver classification subtypes, kusanganisira ina B2 mhando dzekutsemuka dzakatsanangurwa pamusoro, ine stem geometry inoratidza maitiro akajairwa mumhando dzekutsemuka.

Kurukurai

Parizvino, ichi ndicho chidzidzo chikuru chekuenzanisa zvakananga hukama pakati pesimende uye isina kuisirwa stem periprosthetic fractures uye Vancouver classification:

• Pakanga pasina mutsauko wakakura mukuwirirana pakati pemasimende ane simende uye asina kuisirwa muVancouver mhando A, B, kana C mafractures. Chiitiko cheVancouverB2 fractures chakanga chakafanana mumapoka ose maviri, zvichiratidza chiitiko chakafanana chekugadzikana uye kusagadzikana kwezvidzitiro mu periprosthetic fractures mumapoka ose maviri.

• Kusiyana neizvi, Fenelon et al. yakaongororwa periprosthetic fractures ine simende uye isina kusimbiswa madzinde. Zviri pachena kuti nhamba yevarwere vane kuputsika muVancouver B2 uye B3 yakanyanya kukwirira.

• Phillips nevamwe. tsanangura 'yakaputika' patani yezvimedu zvesimende uye 'kutsemuka' pamwe nebhachi resimende, zvakafanana 'musoro wedemo'. Kutyoka uku kwakawanikwa kuve kwakabatana zvakanyanya nesamende madzinde muchidzidzo ichi.

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• Iyo yakakwira comminuted yemhando yekuputsika iyi inomutsa kunetsekana nezve pfupa deactivation, uye kuputsika uku kunowanzoda kungwarira kubviswa kwe simenti uye nekupfuura ne distal bearing stem.

• Capello et al. yakatsanangura 'flip-flop' kutsemuka kwakabatana nemadzinde asina kuisirwa, uye zvakawanikwa zvinoratidza kuwanikwa uku. Kutyoka kunobva kunheyo yepakati peiyo trochanter yakakura, inosvika kune yepakati cortex, uye inochengetedza iyo lateral cortex, distal kusvika kudiki trochanter. Kuwedzera kwenzvimbo yeTalar uye kudzikira kwehunde zviratidzo zveradiographic zvekusagadzikana kwe stem. Zvidzidzo zvakapfuura zvakaratidza kubatana kwakakosha kwekutyoka uku nemadzinde asina kuisirwa ane anatomical uye akaumbwa-akaumbwa madhizaini, uye chidzidzo ichi chinotsigira kubatana uku.

• Grammatopolous et al vanotsanangura nhevedzano yehelical fracture mapatani mu periprosthetic fractures ine simende madzinde, anowanzo sangana neakasarudzika wedge zvimedu uye zvakanyanya comminution. Nhamba yehelical fractures mu cemented stem yakawedzera zvakanyanya munyaya iyi, iyo inogona kuratidza maitiro ekuputsika kwakapoteredza tubular cemented stem kuti iparadzire nenzira yakafanana nefupa rechisikigo.

• Mukuongororwa kweradiographic yenhamba huru yeperiprosthetic fractures, boka rekutsvagisa rakaona maitiro ekutyoka asina kumbotsanangurwa mumabhuku. Kutyoka kwacho kunobva kune medial calcar ichipfuura nepakati cortex, ichisiya iyo medial cortex yakasimba. Rudzi rwekutyoka urwu rwunodaidzwa kuti 'reverse' clamshell fracture, iyo chidzidzo chakaona seyakajairwa Vancouver B2 kutyoka.

• Iri zita rakasarudzwa nekuda kwezvikonzero zviviri: chekutanga, igirazi mufananidzo we 'flip', uye chechipiri, rinoita senge reverse oblique proximal femoral kutyoka, ine yakafanana supralateral displacement yeabductor achidhonza chidimbu chepamusoro. Kuputsika kwakafanana kwakaitika nemasimende uye asina kusimbiswa stems (Mufananidzo 2).

• Kunyange zvazvo chinangwa chechidzidzo ichi chakanga chisiri chekuongorora migumisiro yekurapa, muchidzidzo ichi, reverse flip-flop fractures yaiwanzogadziridzwa ne arthroplasty ye distal load-bearing stem uye kugadziriswa kwezvimedu zvekuputsika kwepamusoro newaya dze cerclage kana mahwendefa.

• Muenzaniso wemurwere akabatwa nenzira iyi inoratidzwa, kuratidza kubudirira kwekuporesa (Mufananidzo 3).

Mufananidzo 2 Reverse flip-top fracture pattern.

Mufananidzo 3 Arthroplasty uye cerclage wire fixation ye retrograde flap fractures.

Mhedziso

Maererano neVancouver classification system, periprosthetic fracture marudzi ane chiitiko chakafanana chekuputsika kweperiprosthetic mune simende uye isina kusimbiswa prostheses. Nokudaro, chiitiko chekugadzikana uye kusagadzikana matanda mushure mekuputsika kwakaenzana mumapoka maviri. Kuziva mana akasarudzika eVancouverB2 mapatani ekutyoka, kusanganisira ichangobva kucherechedzwa inverted flip-flop pateni, zvichabatsira vanachiremba vanovhiya kuona kusagadzikana kwedzinde. Zvidzidzo zvenguva yemberi zvinodikanwa kuongorora hukama pakati pemhando yekutyoka uye nzira yekurapa kuti uone kukosha kwekiriniki kwezvakawanikwa muchidzidzo ichi.

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