Ukuhlelwa, ukuxilongwa kweKlinikhi kunye noNyango lwe-Intertrochanteric Fractures ye-Femur

Unxantathu weWadi

Ummandla osengozini ye-triangular yenziwa kwindawo ephakathi apho i-femoral neck trabeculae cross. Kubantu abadala abane-osteoporosis, le ndawo izaliswe ngamafutha kuphela.

I-Femoral Calcar

Ipleyiti yethambo eshinyeneyo ebekwe ngasemva - ephakathi ukuya ekudibaneni kwentamo ye-femoral kunye ne-shaft enzulu kwi-trochanter encinci. Kukwandiswa kwe-posterior - medial cortex ye-femoral shaft kwithambo lokukhansela kwaye yindawo yokusetyenziswa komthwalo we-eccentric kwi-proximal femur.

Ukuhlelwa kwe-Hip Bone Trabeculae

 Ukuhlelwa kwamandla omatshini we-proximal femur:
(1) iBakala 6; (2) iBanga lesi-5; (3) iBanga lesi-4; (4) iBanga lesi-3; (5) iBanga lesi-2; (6) iBanga loku-1

Ukwenzakala kwamandla aphezulu kwizigulane eziselula

I-Intertrochanteric fractures kwizigulane ezincinci zidla ngokubangelwa kukulimala okuphezulu-enemandla okufana nokuwa ukusuka kwindawo ephakamileyo kunye neengozi zemoto. Ezi meko zinokukhokelela ekuqhekekeni okukhulu, kwaye izigulane kufuneka zibekwe esweni ngokulimala okuhambelanayo, kubandakanywa nentloko, umqolo, kunye ne-thoracic kunye nezitho zesisu.

Izinto zokuwa kwiZigulana eziDala

I-90% ye-intertrochanteric fractures kubantu abadala ibangelwa ukuwa. Izinto ezifak’ isandla ekutyekeni kwabantu abadala ziquka ukungaboni kakuhle, ukuncipha kokuqina kwezihlunu, uxinzelelo lwegazi olungazinzanga, ukungakwazi ukuphendula, izifo zemithambo, izifo zamathambo namalungu.
   Ingaba ukuwa kuphumela ekuqhekekeni kunqunywe ngezi zinto zintlanu zilandelayo: ubunzima be-osteoporosis, isalathiso sokuwa, ngakumbi xa i-hip okanye indawo ekufutshane ne-hip ibetha emhlabeni, ukungonelanga kwee-reflexes zokukhusela ukunciphisa amandla okuwa, ukungakwazi kwe-hip izicubu ezithambileyo ukufunxa amandla aneleyo, kunye nokungonelanga kwamathambo e-hip.

Iindidi zoBundlobongela kunye neeNdlela zokuSebenza

1. Ubundlobongela obuNgqongileyo: Ukulimala okuphezulu kwamandla kusebenze ngokuthe ngqo kwi-hip, njengeengozi zendlela okanye ukuwa apho i-hip ichaphazeleka ngokuthe ngqo, ekhokelela ekuqhekekeni.

2. Ubundlobongela obungathanga ngqo: Ukuxhatshazwa komzimba kuxhomekeke kwi-hip kwi-varus kunye noxinzelelo lwangaphambili lwe-angulation. Nge-trochanter encinci njenge-fulcrum, ixinzelelwe ngamandla, kwaye kunokubakho umphumo wokutsalwa kwe-iliopsoas muscle, eyenza i-butterfly-shaped bone fragment. I-trochanter enkulu inokwenza iqhekeza lethambo elihlukeneyo ngenxa yokutsalwa okunamandla kwe-gluteus medius muscle.

Evans Classification

 Eyona isetyenziswa ngokuqhelekileyo kwiklinikhi. U-Evans wahlulahlula i-intertrochanteric fractures kwiintlobo ezimbini:

1. Uhlobo I: Trans - trochanteric fractures    Ngokozinzo ngaphambi nangemva kokunciphisa, iphinde yahlulwe ibe yi-4 subtypes:

• Ⅰa: Iinxalenye ezimbini zokwaphuka ngaphandle kokufuduswa.

• Ⅰb: Izahlulo ezimbini zokuqhekeka kunye nokufuduswa, i-medial cortex ayilunganga, kwaye ukwaphuka kuzinzile emva kokuncitshiswa.

• Ⅰc: I-trochanter encinci isimahla, kunye ne-fracture displacement kunye ne-varus deformity; okanye i-trochanter enkulu liqhekeza lethambo elahlukileyo.

• Ⅰd: Ukongeza kwi-intertrochanteric fracture, zombini i-trochanters enkulu kunye nencinci iba ngamaqhekeza amathambo ahlukeneyo, kunye ne-varus deformity.

• Phakathi kwazo, iindidi ze-Ⅰa kunye ne-Ⅰb ziintlobo ezizinzileyo, kwaye ezinye ntlobo ezingazinzanga.

2. Uhlobo lwe-II: I-reverse - i-oblique intertrochanteric fractures
   Uhlobo lwe-II luyi-reverse - i-trochanteric fracture, kunye ne-fracture line ephuma ngokugqithisileyo ukusuka ngaphantsi kwe-trochanter enkulu ukuya kwindawo ephezulu ye-trochanter encinci.

Ukuhlelwa kwe-AO

Uhlobo lwe-A1: I-Simple two-part fractures ngokusebenzisa i-trochanter, kunye nenkxaso efanelekileyo ye-cortex ye-bone medial kunye ne-lateral bone cortex.

1. Ecaleni komgca we-intertrochanteric.

2. Ngokusebenzisa i-trochanter enkulu.

3. Ngokusebenzisa i-trochanter encinci.

Uhlobo lwe-A2: Iifractures ezenziwe nge-trochanter, kunye ne-fractures ye-cortex yangaphakathi kwiindiza ezimbini, kodwa i-lateral bone cortex ihlala ilungile.

1. Ngeqhekeza elinye le-medial fragment.

2. Ngamaqhekeza amaninzi aphakathi.

3. Ukwandisa ngaphezu kwe-1 cm ngaphantsi kwe-trochanter encinci.

Uhlobo lwe-A3:  I-Reverse - i-intertrochanteric fractures, kunye ne-fractures ye-cortex yecala ngokunjalo.

1. Oblique.

2. Ukunqamleza.

3. Uzimisele.

Ngokuqhelekileyo, iindidi ze-A1.1 ukuya ku-A2.1 zibhekwa njengezizinzileyo, kwaye iintlobo ze-A2.2 ukuya ku-A3.3 zibhekwa njengezingazinzanga.

I-PFNA yoNyango lwe-Intertrochanteric Fractures ye-Femur

I-PFNA isetyenziselwa i-osteoporotic intertrochanteric fractures engazinzanga njenge-Evans Ic, i-Id, kunye ne-Type II. Inomsebenzi ongcono, isakhono esihle sokuchasana nokujikeleza, ixesha elifutshane lokusebenza, ukulahleka kwegazi okuncinci, iingxaki ezimbalwa, kunye namathuba aphantsi okusikwa kwe-nail yokutshixa - ngaphandle, ebonisa uncedo olucacileyo lonyango.

I-INTERTAN yoNyango lwe-Intertrochanteric Fractures ye-Femur

Ngokuphuhliswa kobuchwepheshe bezonyango zanamhlanje, i-INTERTAN luhlobo olutsha lwesikhonkwane se-intramedullary eyenzelwe ngokukodwa unyango lwe-intertrochanteric fractures ye-femur. Umnqamlezo-icandelo lesikhonkwane sayo esiphambili sitrapezoidal. Xa isetyenziswe ngokudibanisa ne-proximal interlocking edibeneyo isikhonkwane, inokuthintela umphumo 'Z'. Ukongezwa kwesikhonkwane sesibini esiphuma kwintloko ye-femoral kwandisa i-anti-rotational effect ye-screw lag. Esi sikhonkwane se-intramedullary sinoluhlu olubanzi lwezicelo kwaye lufanelekile kwizigulane ezine-osteoporosis enzima.