Maonero: 235 Munyori: Saiti Edhita Nguva Yekuburitsa: 2023-06-06 Mabviro: Site
Proximal femoral fractures inoramba iri imwe yekukuvara kwakanyanya uye kwakaoma mukukuvara kwemapfupa, kunyanya pakati pevarwere vakwegura vane osteoporosis. Nekuwedzera kwehupenyu hwehupenyu uye chiitiko chepamusoro chekutyoka kwehudyu pasi rose, yakagadzika masisitimu ekugadzirisa anobvumira kuunganidza kwekutanga uye kuvimbika kwekupwanyika kuporeswa kwave kunonyanya kukosha kuchipatara.
Iyo PFNA chipikiri (Proximal Femoral Nail Antirotation) yakagadzirwa kugadzirisa izvi zvinodiwa. Nekubatanidza intramedullary load-sharing mechanics ine antirotation blade dhizaini, iyo PFNA sisitimu yave mhinduro inogamuchirwa nevakawanda yekusagadzikana proximal femoral fractures.
Ichi chinyorwa chinopa tarisiro yakazara yePFNA mbambo system, kusanganisira zviratidzo zvayo, biomechanical zvakanakira, kuvhiya misimboti, postoperative kupora, uye kufunga nezve njodzi.

Iyo PFNA chipikiri ndeye intramedullary fixation system yakanyatso kugadzirirwa kuputsika kweiyo proximal femur. Kusiyana neyakajairwa extramedullary zvishandiso, PFNA inoshanda padivi pemuchina axis yefemur, ichibvumira yakawedzera physiological mutoro kutamiswa.
Chinhu chinotsanangudza chePFNA system ndeye helical antirotation blade , iyo inobatanidza cancellous bone panguva yekuiswa. Iyi compaction inowedzera kutenga mukati meosteoporotic bone uye inovandudza kuramba kutenderera uye varus kudonha masimba. Nekuda kweizvozvo, PFNA inopa kugadzikana kwakawedzera zvichienzaniswa neyakajairwa lag screw-based masisitimu, kunyanya muvarwere vane hurombo hwemapfupa.

PFNA zvipikiri zvinonyanya kuratidzwa kune mafractures anosanganisira proximal femur, kusanganisira:
Intertrochanteric femoral fractures
Kusagadzikana kana kuderedzwa kwetrochanteric fractures
Subtrochanteric femoral fractures
Reverse obliquity fracture mapatani
Aya marudzi ekutyoka anowanzo kupa biomechanical kusagadzikana, zvichiita kuti intramedullary fixation ive sarudzo inosarudzwa.
Osteoporosis inonyanya kukanganisa screw fixation simba mumusoro wemukadzi. Iyo PFNA antirotation blade inonyanya kubatsira mune idzi kesi, sezvo inomanikidza trabecular bone pane kuribvisa. Iyi dhizaini inoderedza njodzi yekudyara-kuchekwa-kunze uye kurasikirwa kwekugadzirisa, zvichiita kuti PFNA ive sarudzo yakavimbika kune vakura varwere vane osteoporotic hip fractures.
Kubva pane biomechanical maonero, intramedullary zvipikiri zvinopa yepamusoro mitoro-kugovera kana ichienzaniswa neplate-based system. Iyo PFNA chipikiri inobatana padhuze neiyo femoral mechanical axis, ichideredza nguva dzekukotama panzvimbo yekutyoka.
Iyo antirotation blade inosimudzira kutenderera kugadzikana nekuwedzera pamusoro pekubata nekanzura pfupa, iyo inobatsira kuchengetedza kuderedzwa kwekutyoka pasi peaxial uye torsional mitoro panguva yekutanga kurema.
PFNA implantation inoda kuratidzwa kudiki kwekuvhiya zvichienzaniswa nemaitiro akavhurika ekugadzirisa echinyakare. Kuderedza kukanganiswa kwenyama yakapfava kunobatsira kuderedza kurasikirwa kweropa, kuderera kwemarwadzo ekuvhiyiwa, uye kukurumidza kushanda kupora-zvinhu zvinonyanya kukosha muvarwere vegeriatric trauma.
Kuronga kwakaringana preoperative kwakakosha pakubudirira PFNA kugadzirisa. Radiographic assessment, kusanganisira anteroposterior uye lateral maonero ehudyu uye femur, inobatsira kuona kupatsanurwa, kureba kwembambo, blade size, uye yakakwana yekupinda nzvimbo.
Muzviitiko zvakaoma, CT imaging inogona kushandiswa kuongorora fracture morphology uye kutungamira nzira yekuvhiya.

Matanho akakosha emaitiro anowanzo sanganisira:
Murwere akamira patafura yakatsemuka ine kukweva kwakakodzera
Yakavharwa kana zvishoma yakabatsirwa kutyoka kuderedzwa pasi pefluoroscopy
Kugadzwa kweiyo chaiyo chipikiri yekupinda poindi
Intramedullary chipikiri kuisa uye kurongeka
Kuiswa kweanodzivirira blade mumusoro wemukadzi
Distal locking kudzora kutenderera uye kureba
Kunyatsoita blade positioning mukati memusoro wechikadzi kunokosha kuti kuderedze mechanical complications uye kuve nechokwadi chekugadzirisa kwenguva refu kugadzikana.
Chimwe chezvinangwa zvekutanga zvePFNA kugadzirisa ndeyekubvumidza kuunganidza kwekutanga. Zvichienderana nekutsiga kwekutyoka uye mamiriro evarwere, chikamu kana chakazara uremu chinogona kutangwa munguva pfupi mushure mekuvhiyiwa pasi pekutariswa kwekiriniki.
Kuunganidza kwekutanga kunobatsira kuderedza matambudziko akadai seyakadzika vein thrombosis, nyaya dzepulmonary, uye tsandanyama atrophy.
Postoperative rehabilitation inotarisa kudzoreredza hudyu huwandu hwekufamba, simba remhasuru, uye gait kugadzikana. Zvibereko zvekushanda zvinowanzoongororwa pachishandiswa marwadzo ekurwadziwa, kugona kufamba, uye radiographic humbowo hwekutyoka kwekuporesa.
Zvinogona kuitika mukati mekushanda nyaya dzinosanganisira kusakwana kwembambo yekupinda, suboptimal blade chinzvimbo, kana kusakwana kuderedzwa kwekutyoka. Izvi zvinhu zvinogona kuwedzera njodzi yekutadza kugadzirisa uye zvinofanirwa kudzorwa nekuchenjerera kuburikidza nefluoroscopic kutungamira uye chiitiko chekuvhiya.
Kunyange zvazvo PFNA ichibatanidzwa nemigumisiro yakanaka, zvinetso zvakadai sekuchekwa-kwe-blade, kutapukirwa, kunonoka kubatana, kana marwadzo ane chokuita nekudyara anogona kuitika. Hunyanzvi hwekuvhiya nzira, kusarudzwa kwakakodzera kwemurwere, uye kurongeka kwekuchengetedza kwepashure ndizvo zvakakosha mukudzikisa njodzi idzi.
Zvidzidzo zvekiriniki zvakagara zvichiratidza huwandu hwemubatanidzwa uye zvinogutsa mhedzisiro yekushanda nePFNA kugadzirisa mune proximal femoral fractures. Zvichienzaniswa nemidziyo yeextramedullary, PFNA yakaratidza zvakanakira kudzikisa mitengo yekutadza kwemechini, kunyanya mukusagadzikana kwekutyoka mapatani uye osteoporotic bone.
Izvi zvakawanikwa zvinotsigira PFNA semhinduro yakavimbika uye yakagamuchirwa zvakanyanya mune yemazuva ano orthopedic trauma practice.
Mari yese yekurapa kwePFNA inosanganisira kuisirwa kusarudzwa, kuvhiyiwa, kuchipatara, uye kugadzirisa. Nepo intramedullary masisitimu angave ane mitengo yakakwira yekutanga kudyara, kugona kwavo kutsigira kukurumidza kuunganidza uye kuderedza mari ine chekuita nekukanganisika kunogona kupa mabhenefiti ehupfumi kwenguva refu.
Sarudzo dzekurapa dzinofanirwa kuenzanisa kushanda kwekiriniki, zvinhu zvevarwere, uye mapuroteni emasangano.
Iyo PFNA mbambo inomiririra yakanyatsogadziriswa orthopedic mhinduro yekurapwa kweproximal femoral fractures. Iyo intramedullary dhizaini, antirotation blade tekinoroji, uye kukodzera kweosteoporotic bone inoita kuti inyatso shanda mukugadzirisa kusagadzikana kwehudyu kuputsika.
Kana ikashandiswa neakakodzera nzira yekuvhiya uye kusarudzwa kwevarwere, PFNA inogadzirisa inotsigira yakagadzikana kuporeswa kwekutyoka, kudzoreredza kwekutanga, uye nekuvandudza mashandiro emhedzisiro-zvinangwa zvakakosha mukutarisira kwezvino orthopedic trauma care.
PFNA mbambo inoshandiswa kugadzirisa mukati me proximal femoral fractures, kunyanya intertrochanteric uye kusagadzikana kwehudyu fractures. Yakagadzirirwa kupa yakagadzikana intramedullary fixation ichibvumira kutanga kwemurwere kuunganidza.
PFNA inowanzoratidzwa kune intertrochanteric fractures, kusagadzikana kwetrochanteric fractures, subtrochanteric fractures, uye reverse obliquity fracture maitiro, kunyanya kune vakwegura kana osteoporotic varwere.
Iyo PFNA antirotation blade inobata pfupa rinokanzura panguva yekuisa, kuvandudza kutenga kwekudyara uye kuderedza njodzi yekucheka-kunze. Izvi zvinoita kuti zvive zvakanyanya kushanda kune varwere vane hutano husina kunaka hwemapfupa.
Kusiyana neakasimba hip screw (DHS) masisitimu, PFNA inopa intramedullary mutoro-kugovera kugadzirisa. Yayo yepakati kurongeka uye antirotation blade inopa yakagadziridzwa biomechanical kugadzikana, kunyanya kune isina kugadzikana yekutyoka mapatani.
Ehe. Kuisirwa kwePFNA kunoitwa kuburikidza nemaitiro mashoma ekupinda neadiki madiki, kuderedzwa kukuvara kwenyama yakapfava, uye kazhinji kudzikisa kurasikirwa kweropa zvichienzaniswa nemaitiro akavhurika ekugadzirisa.
Huremu-inotakura maprotocol zvinoenderana nekutsiga kwekutyoka uye mamiriro emurwere. Muzviitiko zvakawanda, chikamu kana kudzora uremu huremu hunogona kutanga nekukurumidza, pasi pekutungamirwa nachiremba anorapa uye rehabilitation timu.
Matambudziko anogona kuitika anosanganisira kucheka-kubuda kweblade, kuisirwa zvisina kunaka, kutapukirwa, kunonoka kubatana, kana marwadzo ane chekuita nekudyara. Njodzi zhinji dzinogona kudzikiswa nehunyanzvi hwekuvhiya hwakakodzera uye kusarudzwa kwemurwere.
Radiographic fracture kuporeswa inowanzoitika mukati memwedzi yakati wandei, zvichienderana nerudzi rwekutyoka, kunaka kwebhonzo, uye hutano hwemurwere. Kushanda kupora kunogona kufambira mberi nekugadzirisa kwakakodzera.
Ehe. PFNA inogonawo kushandiswa kune vadiki varwere vane kusagadzikana proximal femoral fractures inokonzerwa ne-high-energy trauma, chero kuderedzwa kweanatomical uye kugadzirisa kwakagadzikana kunowanikwa.
Kudyara kusarudzwa kunobva pane preoperative imaging, fracture pattern, femoral anatomy, uye intraoperative fluoroscopic assessment kuti ive nechokwadi chekugadzirisa uye biomechanical kugadzikana.
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