I-proximal humerus fractures yenye yezona zinto zixhaphakileyo kwi-trauma orthopedics, kwaye ininzi ye-humerus fractures i-low-energy osteoporotic fractures kubantu abadala.
Nangona uninzi lwe-humerus fractures esondele kakhulu inokunyangwa ngokucokisekileyo, i-10-15% yeefractures isafuna unyango lotyando, olubandakanya ukulungiswa kwepleyiti yokunciphisa i-incision, ukunciphisa ukuvala i-intramedullary nail fixation yangaphakathi, kunye nokutshintshwa ngokubambisana.
Isigqibo sonyango kufuneka sisekelwe kwisimo somzimba wesigulane, imbono yakhe, ukulindela kwengqondo, kunye nohlobo lokuphuka.
Ukusetha kwakhona kunye nokulungiswa kweefractures ezingxamisekileyo
【Ingcebiso】I-proximal humeral enkulu tuberosity (i-NEER uhlobo lwe-2 i-fracture ye-partial fracture) idibaniswe nokuchithwa kwegxalaba, ukuhlolwa kwe-CT kwangaphambili, ngaphandle kokwaphuka kwentamo yotyando, ukubekwa ngokutsha kunye nokuqhawula ngegxalaba elibuhlungu phantsi kwe-anesthesia engxamisekileyo (izinga leengcaphephe zokuncoma; i-620% yencomo: 100%).
2. Ukulawulwa kweentlungu ezibukhali kwangaphambili
【Ingcebiso】Izigulane ezine-proximal humerus fracture zikhetha i-analgesia yangaphambi kokusebenza kunye ne-acetaminophen yomlomo okanye i-NSAID, kunye ne-opioids yomlomo inokongezwa ukuba umphumo awulungile (izinga leengcali zokuncoma: 100%; izinga lokuncoma elinamandla: 73.8%).
3. Imfundo yobuvangeli basemazweni yangaphambi kotyando
[Isincomo] Imfundo yaphambi kotyando kufuneka iqhutywe ngendlela eyahluka-hlukeneyo nangeendlela ezininzi. (Ireyithi yokuncoma ingcali: 100%; ireyithi yengcebiso eqinile: 83.8%)
4. Uvavanyo lwesondlo lwangaphambi kokuhlinzwa kunye nonyango oluxhasayo
【Ingcebiso】Ukugqiba uvavanyo lwesondlo kwizigulana zingaphelanga iyure ezingama-24 zokwamkelwa nokubonelela ngongenelelo lwesondlo kwizigulana ezisengozini yesondlo. (Ireyithi yokuncoma ingcali: 98.5%; ireyithi yengcebiso eqinile: 55.9%)
5. Ukuhlolwa kwe-glucose ye-perioperative kunye nokulawulwa kwisigulane seswekile
【Ingcebiso】Injongo ekhuthazwayo yokulawula i-glycemic yezigulane ezininzi zesifo seswekile ezenza utyando olukhethiweyo yi-7.8 ukuya kwi-10.0 mmol / L.
6. Ukulawulwa kokuvuvukala kwezicubu ezithambileyo kwixesha le-perioperative
【Ingcebiso】Izigulana ezenza utyando olukhethiweyo lweproximal humerus fracture, iindlela ezininzi zomzimba zinikezelwa ukunciphisa ukudumba ngexesha leperioperative. (Ireyithi yokuncoma ingcali: 98.5%; ireyithi yengcebiso eqinile: 80.9%)
7. Ulawulo lokutya kwangaphambili
【Ingcebiso】 Izigulane ezinotyando olukhethiweyo zingatya iziphuzo ezicacileyo 2 h ngaphambi kotyando kunye nokutya okunesitatshi okanye iimveliso zobisi 6 h ngaphambi kokuhlinzwa. (Ireyithi yokuncoma ingcali: 100%; ireyithi yengcebiso eqinile: 76.5%)
8. Ulawulo lwecatheter yomchamo wePerioperative
【Ingcebiso】Utyando lwe-perioperative umchamo alukhuthazwa kuqhaqho lwe-humerus ekufutshane (Ireyithi yengcebiso yengcaphephe: 100%; Izindululo ezinamandla: 78.6%)
9. Ukusetyenziswa kwe-prophylactic ye-perioperative antimicrobial drugs
【Ingcebiso】 Kwizigulane ezine-proximal humerus fractures ezifuna i-endoprosthesis okanye i-joint replacement, ukusetyenziswa kwe-prophylactic ye-cephalosporins yesizukulwana sokuqala kunye nesesibini kuyacetyiswa kuthintelo losulelo kwixesha le-perioperative. (Izinga leengcebiso zengcali: 97.1%; ireyithi yokuncoma eqinile: 73.5%)
10. Ukhetho lwe-anesthesia
【Ingcebiso】 I-Anesthesia iyacetyiswa ukuba yamkele indlela ye-anesthesia yendawo ye-block compound, khetha iziyobisi ukuze ugweme ukunyusa ukungasebenzi kwenkqubo ye-systemic yezigulane ezikhulileyo, kwaye ubeke ingqalelo ekomelezeni ukubeka iliso (izinga lengcebiso yeengcali: 100%; izinga lokuncoma elinamandla: 71.4%).
11. I-intraoperative blood pressure contro
[Isincomo] Ukunciphisa okuphakathi koxinzelelo lwegazi kufuneka kuhlawulwe ingqalelo ekunciphiseni ukulahleka kwegazi kwi-intraoperative kwi-proximal humeral fractures, kodwa izigulane ezisebekhulile ezine-comorbidities ezininzi kufuneka zithathele ingqalelo ekugcineni uzinzo lwe-hemodynamic ukuphepha ukuchithwa ngokwaneleyo kwezicubu kunye nezitho (izinga lokunconywa kweengcali: 100%; izinga lokuncoma elinamandla: 61.9%).
12. Ukulawulwa komthamo we-Intraoperative
[Isincomo] Ukuphumeza isicwangciso solawulo lwe-fluid ejoliswe kwiinjongo, kunye neziyobisi ze-vasoactive zinganikwa i-prophylactically ngexesha le-anesthesia jikelele ukukhusela ukugqithiswa kwamanzi (izinga lokuncoma ingcali: 100%; izinga lokuncoma elinamandla: 69.1%).
13. Ulawulo lwegazi lwangaphakathi
[Iingcebiso] I-Intraoperative controlled hypotension ayikhuthazwa kwi-proximal humeral fractures, ngakumbi kwizigulane ezisele zikhulile, kunye notofelo-gazi lwe-intraoperative kunye ne-tranexamic acid inokusetyenziswa. Itshekhi ye-Intraoperative ye-HGB <80g / L incoma ukutshintshwa kwegazi le-allogeneic (izinga lokunconywa kweengcali: 100%; izinga lokuncoma elinamandla: 73.8%).
14. Ukuthintelwa kwe-hypothermia ye-intraoperative
[Iingcebiso] Izigulane ezine-proximal humeral fractures kufuneka zomeleze ukubeka iliso kwiqondo lokushisa kwi-intraoperative kwaye zithathe amanyathelo ahlukeneyo okugcina iqondo lokushisa eliphambili ngaphezu kwe-36 ° C (izinga leengcali zokuncoma: 100%; izinga lokuncoma elinamandla: 76.2%).
15. Ukukhetha indlela yotyando
(1) Ukuqhekeka kwinqanaba le-humer ekufutshane
[Isincomo] I-Neer's staging iyacetyiswa kwi-proximal humerus fracture staging (izinga lengcebiso yeengcali: 100%; ireyithi yengcebiso eyomeleleyo: 83.3%).
(2) Indlela yotyando
Isicwangciso sotyando kufuneka sikhethwe ngokusekelwe kwi-morphology ye-fracture, umgangatho wamathambo, isimo somzimba kunye nengqondo yesigulane kunye nezinye izinto ezifanelekileyo.
[Isincomo] Isixhobo sokulungiswa kwangaphakathi sinokukhethwa ngokohlobo lokuphuka kunye nobuninzi bamathambo, njengeplate okanye i-intramedullary nail; kwizigulane ezisebekhulile ezine-osteoporosis ezinzima ukusetha kwakhona okanye ukulungisa, i-4-part fracture (kunye ne-fracture dislocation), i-3-part fracture kunye ne-osteoporosis enzima, i-fracture eqhekezayo kunye ne-anatomical neck fracture, i-artificial joint joint replacement ikhethiwe, kunye nokutshintshwa kwegxala elibuyisela umva kuyacetyiswa ukuba kudityaniswe ne-rotator 1 incoma ukulimala kwe-rotat0: i-rotator cuff incoma ukulimala. 71.4%).
![Ukwaphuka kwe-humerus ekufutshane]()
Umzobo 1 Ibhinqa elineminyaka engama-65 ubudala kunye ne-4-part fracture ye-proximal humeral adductor insertion kunye ne-allograft fibular implant plate fixation kunye nokusikwa kunye nokubekwa kwakhona.
16. Ukubekwa ityhubhu yokukhupha inxeba
[Iingcebiso] Iimpawu zokungabeki iityhubhu zokuhambisa amanzi: ① Ubuchule obuncinci bokusebenza (i-MIPPO kunye ne-intramedullary nailing); ② Ukopha kancinci. Iimpawu zokufakwa kwetyhubhu yokuhambisa amanzi: ① ngendlela ye-pectoral deltoid, ukulungiswa kwepleyiti yokutshixa okanye ukutshintshwa kwegxalaba; ② ukopha okubonakalayo kwindawo yesilonda (izinga leengcali zokuncoma: 100%; izinga lokuncoma elinamandla: 71.4%).
17. Ukuvalwa kwenxeba
【Isincomo】I-incision yotyando yavalwa ngokuphazamiseka okulula, i-layer-by-layer sutures (izinga lengcebiso yeengcali: 100%; izinga lokuncoma elinamandla: 76.2%).
18. Ukutya kokubuyisela emva kokusebenza
【Ingcebiso】Izigulana zingaginya iziselo ezingenazinkcenkce ngomlomo xa zivukile emva kotyando, kwaye ziphinde ziqalise ukutya okuqhelekileyo emva kweyure eyi-1-2 ukuba akukho mpendulo igwenxa.
19. Ukukhetha isikhundla emva kokuhlinzwa kunye nomsebenzi wokuqala
【Ingcebiso】Izigulana akufuneki zilale phantsi emqamelweni emva kotyando, zinokwamkela indawo enesiqingatha-recumbent kwaye zinokuhamba emgangathweni emva kokuvuka. Izibambiso zamagxa ezenzakeleyo kufuneka ziqhawulwe.
20. Amanyathelo e-postoperative analgesic
【Ingcebiso】I-analgesia yangemva kokuhlinzwa kwizigulane ezinokwaphuka kwe-humeral ekufutshane kuyacetyiswa ukuba kusetyenziswe ibhloko yengingqi edityaniswe nesiqhelo 'idosi yangasemva' ye-NSAIDs, kwaye ukuba kuyimfuneko, iimpompo ze-analgesia ezizilawula ngokwazo ngomthambo okanye i-peripheral nerve block self-administered self-administered; 78.6%).
21. Uthintelo lwesicaphucaphu kunye nokugabha emva kokuhlinzwa
[Isincomo] Zonke izigulane kufuneka zinikwe amayeza e-prophylactic antiemetic 30 min ngaphambi kokuphela kotyando. (Ireyithi yokuncoma ingcali: 97%; ireyithi yengcebiso eqinile: 47.8%)
22. Ukuvuselelwa okusebenzayo
【Ingcebiso】Izigulana ezineefractures ze-humerus ezizinzileyo nezizinzileyo kufuneka ziqale umthambo wokubuyisela kwisimo sangaphambili kwangoko emva kotyando. Ukuziqhelanisa nokuvuselela kunceda ukubuyisela ngcono umsebenzi womlenze ophezulu (Izinga lokunconywa kweengcali: 100%; Izinga lokuncoma elinamandla: 92.9%).
23. Iikhrayitheriya zokukhutshwa kunye nokulandelwa
【Isincomo】Iikhrayitheriya ezisebenzayo zokukhutshwa kufuneka zisekwe, kwaye izigulane kufuneka zilandelwe rhoqo ubuncinane kwiinyanga ze-6 (izinga leengcali zokuncoma: 100%; izinga lokuncoma elinamandla: 83.3%).
Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?
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