Ndeipi yeanotevera maitiro anoshandiswa kugadzirisa intertrochanteric fractures?

Intertrochanteric fracture ye femur, inozivikanwawo se intertrochanteric fracture, ndeye-extra-articular capsule fracture. Zviratidzo zvikuru zvekuputsika kwe intertrochanteric marwadzo makuru emunharaunda uye kuzvimba, ecchymosis yakawanda, kusakwanisa kwemurwere kumira kana kufamba, kupfupisa kunokosha, mukati nekunze kutenderera kushanduka kwenhengo yakakanganiswa, uye kuderedzwa kwekufamba uye kusinganzwisisiki kwekubatana kwehudyu mune chero nzira.

Epidemiology

1. Vazhinji vavo vane hukama neosteoporosis, kazhinji kune vakwegura, vakadzi vakawanda kupfuura varume.

2. Chiitiko chacho chine chokuita nedzinza, murume kana mukadzi uye nharaunda.

3. kukuvadzwa kunowanzoitika kune vakwegura, nguva yepakati ye intertrochanteric fracture ye femur ndeye 75.2 makore. Ikoko kwakanga kusina misiyano yakakosha muzera re intertrochanteric fracture pakati pevarume nevakadzi.

4. Pamusana peropa rakapfuma rinoyerera mu trochanter, kuputsika hakuwanzoporese, asi zviri nyore kuitika muhudyu inversion, uye kune mamwe matambudziko anokonzerwa nekugara kwenguva refu kwemubhedha muvarwere vakwegura, uye chirwere uye kufa kwehuwandu ndeye 15% -20%, saka inonzi kuparara kwekupedzisira kune vakwegura.

Nzira yekukuvara

1. Vechidiki vakura vanowanzokuvadzwa kwepamusoro-simba, vanofanira kubhadhara uropi, chifuva, dumbu uye zvimwe zvikamu zvekukuvara; vanhu vakura vanonyanya kuchembera basa remakumbo nemakumbo kuwirirana mhinduro agility kuderera uye kudonha kunokonzerwa.

2. Mhirizhonga yakananga: kukanganisa kwakananga pane yakakura trochanter nzvimbo. Kana muviri ukawira pasi ne lateral force pakudonha.

3. Mhirizhonga isina kunanga: muviri unomonyoroka panguva yekudonha, uye chiuno chinoiswa pasi pekunetseka kweinversion uye mberi angle panguva imwe chete.

4. Pathological fracture, imwe yeanowanzo mapfupa emapfupa.

5. Intertrochanteric fracture inonyanya kuumbwa nechisimba chisina kunanga.

Clinical zviratidzo

1. Mharidzo inokosha yakafanana neyekuputsika kwemutsipa wemukadzi, nemarwadzo emunharaunda, kuzvimba uye kupera kwekushanda kwegumbo rakakanganiswa.

2. Nemhaka yokuti i-extra-articular capsule fracture, hapana kurambidzwa kwejojo ​​capsule, saka kukanganisa kwekupfupika kwekutenderera kwekunze (90 degrees) kwechikamu chezasi kunonyanya kuipa.

3. Axial percussion kurwadziwa.

4. Local hematoma inenge yakanyanyisa, uye panogona kunge kune yakawanda yakawanda subcutaneous bruising.

5. Muvarwere vakwegura, vanowanzova vakwegura kupfuura varwere vemitsipa yevakadzi, uye chikamu chikuru chevarwere vane chirwere chekare.

Kuongororwa

Nhoroondo yekutambudzika kuri pachena, kurwadziwa mumakumbo akabatwa, uye kuderedzwa kwekufamba. Kupfupisa uye kuremara kwekunze kwekutenderera kwechikamu chezasi kunoonekwa kusvika ku90 °. Kuongororwa kweX-ray kunowanzo kudiwa kuti uone kuongororwa uye kutaipa kunoenderana neradiographs. Zviratidzo zve intertrochanteric fracture zvakafanana neyekuputsika kwemutsipa wevakadzi, asi iyo yekupedzisira haina kunyanya kuoma kupfuura yekare maererano nemarwadzo emunharaunda, kuzvimba, kurasikirwa kwebasa, uye kupfupika kwechikamu chakakanganiswa, uye nhengo yakakanganiswa kazhinji ine hudyu yakapfava uye kuputika kwemabvi uye kuremara kwekutenderera kwekunze, kazhinji pakati pe45 ° -60 °.

Type

Iyo AO naEvans-Jensen fractures ndiwo maviri anowanzo shandiswa marudzi ekutyoka, uye pane maviri aya, AO rudzi rwekutsemuka ndiyo yakajairika.

Evans-Jensen achitaipa

Nyora I: Yakareruka intertrochanteric fracture ine mutsara wekutsemuka unotsvedza kubva kumusoro kusvika kune yakaderera, pasina kutama uye kugadzikana.

Type II: Displacement yakasanganiswa nediki rotor avulsion fracture, asi femoral spur haina kusimba (iyo femoral spur ndiro gobvu rebhonzo rinowanikwa mukati mukati mehuro yemukadzi uye mubatanidzwa wemuviri weiyo diki rotor.

Rudzi rwechitatu: Yakasanganiswa yakakura trochanteric fracture nekuputsika kuunganidza kwechikadzi spur, nekutama, kazhinji ne posterior inter-rotor fracture.

Rudzi rwechipiri IV: 3-part fracture yakasanganiswa ne comminuted fracture ye trochanter shoma, iyo inogona kupa nekuputika kwekuputika kwemutsipa wemukadzi uye coronal pamusoro peiyo trochanter yakakura.

Rudzi V: posterior lateral uye medial isina kutsigirwa kuputsika (kusanganiswa kwemhando III uye IV).

Rudzi R: anterior intertrochanteric fracture ne oblique fracture line kubva kumusoro kwepakati kusvika kune yakaderera lateral, iyo inogona kubatanidzwa nediki rotor fracture uye kuparadzwa kwechikadzi chechikadzi.

AO kutaipa

A1.1 Mutsetse wekuputsika unopfuura nemutsetse we-inter-rotor

A1.2 Kutsemuka ichipfuura nepakati peiyo trochanter yakakura

A1.3 Kutsemuka kuchipfuura pazasi peiyo trochanter diki

A2.1 Kutyoka ne 1 comminuted bone fragment

A2.2 Kutyoka neakawanda comminuted mapfupa zvimedu

A2.3 Kutsemuka kunowedzera kupfuura 1 cm pazasi peiyo trochanter diki

A3.1 Nyore oblique chimiro

A3.2 Rakareruka rakachinjika chimiro

A3.3 Kuzvipira

Mishonga

Kugadzikana kwekugadziriswa kwemukati kwekuputsika kunowanzoenderana nezvinhu zvishanu: hutano hwepfupa, rudzi rwekuputsika, kuderedzwa, kusarudzwa kwekugadzirisa mukati, uye nzvimbo yekugadziriswa kwemukati maererano nefupa. Kutyoka repositioning kwakakosha pakudzikama mushure mekugadzirisa kwemukati uye kunofanira kuvavarira kuwana chero anatomic reposition kana yakagadzikana isiri-anatomic reposition. Muchidimbu, chinangwa chekugadzirisa zvakare ndechekuwana kugadzikana kwekuputsika. Nzira yekugadzirisa inogona kuvharwa kana incisional. Pasinei nekuoma kwemhando yekuputsika, kuderedzwa kwekuvhara kunofanira kuedzwa kutanga.

• Simba Hip Dowel (DHS)

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Mabhenefiti makuru eDHS Power Hip Screws.

• Iyo screw ine simba rekugadzirisa mukati memusoro wevakadzi, kunyange munyaya ye osteoporosis.

• Iyo nzira yekubhururuka musleeve inodzivirira kupinda kwechipikiri mumusoro wemukadzi kana acetabulum uye kutapurirana kwakananga kwesimba rinokwevera kune bhonzo.

• Iyo simba reku gliding mechanism inochengeta kutyoka kuri panzvimbo uye kunoderedza kusiri mubatanidzwa.

• Iyo ine mbiri mbiri yekumanikidza uye kubhururuka, ine simba uye static compression maitiro.

  
  

• Simba Hip Dowel (DCS)

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  DCS uye 95 madhigirii ekucheka mahwendefa e-anticrotal fractures:

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Mabhenefiti makuru eDCS simba condylar screw ndeaya.

• Inogona kusarudza nenzira kwayo nzvimbo yekupinda ye screw zvinoenderana nemamiriro chaiwo ekutyoka, uye kushanda kuri nyore.

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• Iyo simba yekumanikidza tension screw iri pakona yekurudyi kune ndiro, iyo inosangana ne biomechanical zvinodiwa zvehudyu. Munguva yekutakura uremu, simba rakashata rinotanga kushandiswa kune ruoko rupfupi rweplate uye rozoparadzirwa kune screw imwe neimwe, kuitira kuti kushushikana kuparadzirwe uye kugadzirisa kunonyanya kusimba.

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• Nhamba yakakura zvishoma yeDCS screws pakuputsika inowedzera kusimba, uye nzvimbo yekuputsika inogona kuvharwa uye kugadziriswa, nokudaro kuderedza kuitika kwemashure ekugadzirisa matambudziko.

Proximal Femoral Locking Intramedullary Nail (PFN)

Zvakanakira zvePFN fixation.

• Diki zvipikiri dhayamita (kazhinji 9mm), inogona kudhiraivha mukati pasina dilation. (yepamusoro kune yakakora caudal kupera kweGamma chipikiri - 17mm)

• Magumo epamusoro ePFN ane camber yakada kusvika 6 madhigirii, achidzikisa kona yevalgus uye kubvisa kudiwa kwekudzoreredza kwakasimba kwemukati panguva yekudhonza.

• Mugumo wepamusoro unobvumira kuiswa kwemakumbo maviri mumusoro wemukadzi, pamwe nekuwedzera kwe-anti-rotation screw uye kaviri mbambo inotakura mumutsipa wechikadzi, iyo inowedzera kuneta kuramba.

• Nharaunda pakati pegomba rekuvhara distal uye kumucheto kwechipikiri chikuru (tapered extension) yakareba, iyo inogona kuderedza kushushikana mupfungwa muhudzi hwemukadzi.

• Zvishoma kukuvadzwa.

Gammar misumari

Zvakanakira zveGammar nail fixation.

• Iyo ishoma invasive intramedullary fixation nzira ine diki incision uye kushoma trauma.

• Iyo Gamma mbambo inobatanidza zvakasimba iyo yepamusoro femur uye femoral mutsipa kuburikidza nekubatanidzwa kwe intramedullary nail uye tension screw, uye intramedullary mbambo inogadziriswa ne distal self-locking nail, iyo inodzivirira kutenderera uye kupfupisa kutama uye inopa kugadzirisa kwakavimbika.

Kunatsiridza kwaGammar - PFNA

Internal fixator kusarudzwa (PFNA).

• Yakanakira yakavakirwa-mukati yekusagadzikana intertrochanteric fractures yefemur.

• Inogadzirisa zvakasimba musoro wemukadzi uye mutsipa uye inodzivirira kutenderera kwekuguma kwekuputsika.

• Inodzivirira matambudziko akadai sekudonha nekuda kwebhonzo resorption mushure mekurasikirwa kwekutsigirwa kwemukati, inversion deformity, uye kucheka kubva mumusoro wemukadzi nekuiswa.

• Inokodzera kunenge kune yese intertrochanteric fractures, kunyanya kune isina kugadzikana fractures (eg anterior intertrochanteric fractures) uye yakasanganiswa osteoporosis.

• Pachine chimwe chiitiko chematambudziko, akadai seye femoral head avulsion, izvo zvinoita kuti zvibvirire kutsiva mamwe magadzirirwo emukati.

Artificial Joint Replacement

Zviratidzo zvekuvhiya kwejoints artificial joint replacement ye intertrochanteric fracture ye femur:

• Age pamusoro pe80 makore.

• Yakagadziriswa uye isina kugadzikana intertrochanteric fracture.

• Bone osteoporosis iri pachena, uye kugadziriswa kwemukati kwakaoma kugadzirisa zvinobudirira.

• Hapana kukosha kwakakosha kwehudyu kana kufamba kwemabvi pamberi pekukuvara.

• Mamiriro emuviri wese anogona kushivirira kurapwa kwekuvhiya.

Varwere vasingakwanisi kurapwa pamubhedha kwenguva yakareba.

Advantages: kutanga post-operative positioning pasi. Dzivisa matambudziko anogara pamubhedha. Wedzera nguva yekupona uye uvandudze hupenyu.

Nzira yeKutenga Orthopedic Implants uye Orthopedic Instruments?

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