Inyangwa njani i-periprosthetic fracture?

Injongo

I-Periprosthetic fractures ye-proximal femur yingxaki enkulu kwi-hip arthroplasty. Isiganeko esixeliweyo yi-3.5% iminyaka engama-20 emva kokufakelwa kokuqala kunye nokunyuka kunye neziganeko zokutshintshwa ngokubambisana. Ukuqhekeka kwe-intraoperative kudla ngokudibaniswa neziqu ezingafakwanga. Ngokuqhelekileyo, iifracture zenzeka kubantu abadala ababuthathaka abaye bawela kwisigxina sotyando. Nangona kukho ukungafani kwamazwe ngamazwe ekusetyenzisweni kwe-cemented stems, akukho bungqina obucacileyo bokuthi uhlobo oluthile lwe-cemented stem ludibene nomngcipheko ophezulu wokuphuka kunomnye. Inkqubo yokuhlelwa kweVancouver ye-periprosthetic femoral fractures iye yamkelwa ngokubanzi ngoogqirha kwaye ibonakaliswe ukuba inokuthenjwa.

Injongo ephambili yolu phononongo yayikukumisela ubudlelwane phakathi kokuhlelwa kweVancouver yeefractures ze-cemented ne-stem fractures. Injongo yesibini yayikukuphanda ukungafani kwiimpawu ezisisiseko zezigulane ezineentlobo ezimbini zokuphuka.

Impahla nenkqubo

Isigulana:

1. Uluhlu lwezigulane ezine-periprosthetic fractures ezilandelelanayo.

2. Kuphela izigulane ezine-primary hip periprosthetic fractures zifakiwe.

3. Izigulane ezine-intraoperative fractures, ukuhlaziywa kwe-hip fractures, kunye ne-interprosthetic fractures zazingabandakanywa.

   
   

Irekhodi yedatha:

1. I-radiography yedijithali kunye ne-computed tomography esekelwe kumaxwebhu e-elektroniki kunye nohlalutyo.

2. Iinkcukacha ezisisiseko ezirekhodiweyo zibandakanya ubudala, isondo, isalathisi sobunzima bomzimba, kunye nokunciphisa ukuhamba ngaphambi kokuqala okanye ukuxhomekeka komnakekeli.

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Iinkcukacha zotyando zirekhoda:

1. Ixesha lokuqala lokufakelwa, isibonakaliso se-arthroplasty (i-osteoarthritis okanye i-fracture), uhlobo lwesiqu (i-cemented okanye i-uncemented), kunye nohlobo lwe-arthroplasty (i-total okanye i-semiarthroplasty) ifakiwe.

2. Iirekhodi zemifanekiso eneenkcukacha zibandakanya ukuhlelwa kweVancouver, indawo ye-varus vertebral, kunye nokuhlelwa kweDorr.

3. I-Stem geometry (i-conical okanye i-compound ye-cemented stems, i-straight okanye i-wedge-shaped for stems incemented stems) yabhalwa ngokusekelwe kwimbonakalo ye-radiographic.

4. Ukumiselwa kokuhlelwa kweVancouver kwakusekelwe kwiziphumo zemifanekiso kunye neziphumo ze-intraoperative kwizigulane zotyando.

5. Uhlalutyo lweenkcukacha-manani lwenziwa ngokusetyenziswa kweenguqu eziqhubekayo ze-T-test kunye novavanyo oluchanekileyo lwe-Fisher kwiintlobo ezahlukeneyo zokuthelekisa iimpawu zesiseko kunye nokuhlelwa kweVancouver yezigulane kumaqela e-cemented stem.

6. Zonke izilingo zazinamacala amabini kunye nenqanaba lokubaluleka kwe-0.05. Uhlalutyo lwamanani lwenziwa kusetyenziswa i-GraphPad Prism version 8.0.0.

   
   

Iziphumo

Inani lezigulana:

1. Izigulane ezili-1181 ziye zachongwa ngokubuza kuluhlu lwezibhedlele.

2. Izigulane ze-978 ezine-non-periprosthetic proximal femur fractures zazingabandakanywa.

3. Phakathi kwezigulane ze-203 ezisele, i-8 yayine-intraoperative fractures, i-6 yayinokuhlaziywa kwe-periprosthetic fractures, kwaye i-17 yayine-periprosthetic fractures yesixhobo sokulungiswa kwe-hip joint, engazange ifakwe ngaphandle.

4. Iyonke izigulane ze-172 zabandakanywa emva kokukhutshwa.

5. Zonke iifracture zenzeke emva kokuwa. I-Femoral stem bone ye-cement group fractures kwiimeko ze-84 ngaphandle kwesamente

6. Kwakukho iifractures ezingama-88 kwiqela.

   
   

Iimpawu ezisisiseko:

1. Kwakukho umahluko omkhulu phakathi kwamaqela aneminyaka yobudala, ixesha lokufakelwa okokuqala, izibonakaliso ze-arthroplasty yokwaphuka kwentamo ye-femal, i-hemiarthroplasty yokuqala, i-varus stem placement, kunye ne-index mass body.

2. Ngokukodwa, kwiqela lesamente, uninzi lwaluyi-hemiarthroplasty.

3. Kwakungekho mahluko ubalulekileyo phakathi kwamaqela ngokubhekiselele kwisondo, ukuhlelwa kweDorr, kunye nokunciphisa ukuhamba kwangaphambili okanye ukuxhomekeka komnakekeli.

4. Kwiqela lesamente, izikhondo ezininzi zazicolile kwaye ezinye zaziyidizayini edibeneyo.

5. Kwiqela elingamiselwanga, izikhondo ezininzi zazithe tye kwaye ezinye zazimile okwe-wedge.

   
   

Iindidi zeVancouver:

1. VancouverB2 fractures zihlelwa ngokweepateni ezine ezahlukeneyo zokuphuka: ezichazwe ngaphambili comminuted 'burst', i-clamshell, kunye neepateni ze-helical, kunye ne-'reverse' pattern ye-clamshell esanda kubonwa. Ummeli we-X-ray wembonakalo yochungechunge kunye nokuboniswa kwegraphical ehambelanayo kubonisiwe (Umfanekiso 1).

2. Ukuqhuma kunye nokuqhekeka kwe-spiral kwakunxulunyaniswa kakhulu neziqu ze-cemented, kanti i-flap fractures yayinxulunyaniswa kakhulu neziqu ezingafakwanga.

3. Ipateni ye-reverse clamshell yenzeka ngokufanayo kuzo zombini izikhondo.

4. Umbutho we-Vancouver classification subtypes, kubandakanywa neentlobo ezine ze-B2 zokuphuka ezichazwe ngasentla, kunye nejometri ye-stem ibonisa indlela eqhelekileyo kwiintlobo zokuphuka.

Xoxa

Ukuza kuthi ga ngoku, esi sesona sifundo sikhulu sokuthelekisa ngokuthe ngqo ubudlelwane phakathi kwe-cemented stem periprosthetic fractures kunye nokuhlelwa kweVancouver:

• Kwakungekho nantlukwano ebalulekileyo ekulungelelaniseni phakathi kweziqu zesamente kunye nezingafakwanga kwiVancouver uhlobo lwe-A, B, okanye C fractures. Isiganeko se-VancouverB2 fractures sasifana kumaqela omabini, ebonisa iziganeko ezifanayo zeziqu ezizinzileyo nezingazinzanga kwiifractures ze-periprosthetic kumaqela omabini.

• Ngokwahlukileyo, uFenelon et al. ihlalutye i-periprosthetic fractures ene-cemented neziqu ezingafakwanga. Kucacile ukuba inani lezigulane ezineefractures kwiVancouver B2 kunye ne-B3 ziphezulu kakhulu.

• Phillips kunye nabanye. chaza ipateni 'yokugqabhuka' eyenzelwe kakhulu yamacandelo esiqu sesamente kunye 'noqhekeko' ecaleni kwebhatyi yesamente, efana 'nentloko yezembe'. Oku kwaphulwa kwafunyaniswa ukuba kunxulumene kakhulu neziqu zesamente kolu phando.

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• Ubume obuphezulu bezinto eziqhekekileyo buphakamisa inkxalabo malunga nokuchithwa kwethambo, kwaye ezi ziqhekeza zihlala zifuna ukususwa ngokucophelela kwe-samente kunye nokudlula nge-distal bear stem.

• Capello et al. ichaze 'i-flip-flop' yokwaphuka okunxulunyaniswa nezikhondo ezingafakwanga isamente, kwaye iziphumo zibonisa oku kufunyanisiweyo. I-fracture ivela kwisiseko se-medial ye-trochanter enkulu, idlulela kwi-cortex ye-medial, kwaye igcina i-cortex yecala, i-distal ukuya kwi-trochanter encinci. Ukwandiswa kwendawo ye-talar kunye nokuthotywa kwesiqu zizibonakaliso ze-radiographic zokungazinzi kwesiqu. Izifundo zangaphambili zibonise unxulumano olubalulekileyo lokuqhekeka kunye neziqu ezingafakwanga kunye noyilo lwe-anatomical kunye ne-wedge, kwaye olu phononongo luxhasa lo mbutho.

• I-Grammatopolous et al ichaza uluhlu lweepateni ze-helical fracture kwi-periprosthetic fractures ene-cemented stems, edla ngokuhambelana namaqhekeza e-wedge eyedwa kunye nokuhamba okunzima. Inani le-helical fractures kwi-cemented stem liye lanyuka kakhulu kolu chungechunge, olunokuthi lubonise ukuthambekela kokuqhekeka kwi-tubular cemented stem ukusabalalisa ngendlela efana nethambo lendalo.

• Kuhlalutyo lwe-radiographic yenani elikhulu le-periprosthetic fractures, iqela lophando libone indlela yokuphuka engazange ichazwe ngaphambili kwiincwadi. I-fracture ivela kwi-calcar ephakathi edlula kwi-cortex esecaleni, ishiya i-cortex ephakathi. Olu hlobo lokwaphuka lubizwa ngokuba 'reverse' i-clamshell fracture, apho uphononongo luyithathe njengesiqhelo iVancouver B2 fracture.

• Eli gama likhethwe ngenxa yezizathu ezibini: okokuqala, ngumfanekiso wesibuko 'flip', kwaye okwesibini, liziphatha njenge-reverse oblique proximal fracture ye-femoral, kunye nokufuduka okufanayo kwe-abductor edonsa iqhekeza elisondeleyo . Ukuqhekeka okufanayo kwenzeka kunye neziqu ze-cemented kunye ne-uncemented (Umfanekiso 2).

• Nangona injongo yolu phononongo yayingekokuphanda iziphumo zonyango, kolu phononongo, i-reverse flip-flop fractures yahlaziywa ngokuqhelekileyo kunye ne-arthroplasty ye-distal load-bearing stem kunye nokulungiswa kweengcezu ze-proximal fracture kunye neengcingo ze-cerclage okanye iipleyiti.

• Umzekelo wesigulane esiphathwe ngale ndlela uboniswa, ubonisa ukufezekiswa kokuphilisa (Umfanekiso 3).

Umfanekiso wesi-2 umva ipateni yokwaphuka kweflip-top.

Umzobo 3 I-Arthroplasty kunye ne-cerclage wire fixation ye-retrograde flap fractures.

Ukuqukumbela

Ngokwenkqubo yokuhlelwa kweVancouver, iintlobo ze-periprosthetic fracture zineziganeko ezifanayo zokuphuka kwe-periprosthetic kwi-prostheses ene-cemented kunye ne-uncemented. Ngoko ke, iziganeko zeziqu ezizinzile nezingazinzanga emva kokuphuka zilingana kumaqela amabini. Ukuchonga iipateni ezine ezicacileyo zeVancouverB2 zokuqhekeka, kubandakanywa nephethini esandul 'ukubonwa ye-flip-flop, kuya kunceda oogqirha botyando bachonge ukungazinzi kwesiqu. Izifundo zexesha elizayo ziyafuneka ukuphanda ubudlelwane phakathi kohlobo lokuqhekeka kunye nesicwangciso sonyango ukumisela ukubaluleka kweklinikhi yeziphumo zolu phononongo.

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