Unyango lonyango lweendlela ze-humeral stem kunye namanqaku obuchwephesha

Isithintelo sesimo se-Postoperaperative kufuneka sigcinwe kwikhilogrem enye de kufike ukuphiliswa komtshato okuqhelekileyo kufezekisiwe (ngokufuthi iinyanga ezintathu) ziqhelekile, zinika ingxelo malunga ne-5% yazo zonke iipesenti. Izehlo zonyaka i-13 ukuya kwi-20 nge-100,000 yabantu kwaye ifunyenwe ukuba inyuswe ngeminyaka.hsf inee-bimas ezivela kumadoda aphakathi kweminyaka engama-21 ukuya kwengama-30 ubudala ikhokelela ekuthambekeni kwamandla ama-21 ukuya kwi-quission ehambelana nokonzakala kwezicubu ezithambileyo. I-piki yesibini yenzeka kwabasetyhini phakathi kweminyaka engama-60 nama-80 ubudala, ihlala ilandela umothuko olusezantsi.

Unyango lonyango

一. Ukulungiswa kwangaphakathi kunye neplate yokuphinda kwenziwe

Isalathiso:

• I-nerve ye-nerve ye-radial (i-RNP) kwi-HSF ayilophawu lotyando kuba lunxulunyaniswa nomgangatho ophezulu wokubuyela kwimeko yesiqhelo (jonga kwakhona-iingxaki / i-nerve yethambo okanye i-nerve ye-nerve ingezantsi).

• Ngenye indlela, nakuphi na ukwenzakala kwe-vascular ifuna ukulungisa okanye i -dpass lubonisa olupheleleyo lonyango lwe-subical of shrijity, njengoko ukulungiswa okukhoyo kukhusela i-vastomosis.

• Kule meko, ukulungiswa kwangaphakathi kunye neplate kuyakhawuleza kwaye kuthengiswe ngakumbi kune-IMN kuba ukulungiswa kwe-vascular kwenziwa ngendlela ethe ngqo (ihlala ikwindlela yeMedial).

• I-HSF nge-proximal okanye i-disral ye-distal ye-Intra yenye imeko apho i-orif ineepleyiti yindlela engcono.

  
  

Ukuvezwa kwetyala:

• I-quartsures ekwi-proximal kunye / okanye isithathu sesithathu iphathwa kusetyenziswa indlela ye-anteric anterolates.

• Xa kufuneka, le ndlela idluliselwe ngaphambili ukubhengeza yonke i-humerus.

• Nangona kunjalo, le ndlela ayikhuthazwanga iqhekeza le-disracular.

• Ukuqhekeka kwe-distal okwesithathu kudla ngokuchazwa yindlela yeTrices.

• Kwi-distal kunye nenqanaba lesithathu lesithathu, indlela yokuguqula iguqulwe kwangaphambili echazwe ngu-Gerwin et Al30 inokubhengeza i-76-94% ye-humersus (ngokuxhomekeke kukhutshwa kwi-humerve kunye nokukhutshwa kwe-rabial nestrove).

  
  

Iindlela zoqhawulo:

• Isigulana sibekwe kwisikhundla esihlala kwisitulo sendlela yokuphambuka. Ukusetyenziswa kwengalo yengalo kuyanceda ukugcina ulungelelwaniso lwe-fitural. Ukuvezwa kwasemva, indawo ye-STATRAL sisikhundla esikhethiweyo.

• Iplate efanelekileyo yokwakhiwa iqulathe iplate ye-4.5 mm ye-4,5 mm okanye ilingana kwaye kufuneka igubungele ubuncinci i-6 Comaceces ngaphezulu nangaphantsi kwendawo yokuqhekeka, kodwa i-8 Comaces ikhethiwe.

• Xa kufuneka, indibaniselwano yeplate encinci kwaye i-pite enkulu enesiqwengana, enje ngepleyiti yesithathu ye-tubular ukuba igcinwe (iqhekeza eliguqukayo), isiqwenga sebhabhathane), esongezwa iplate ecekeceke.

• Ngomsebenzi wesithathu wesithathu, indawo yangasemva iplate eguquliweyo (3.5 / 4.5) iyacetyiswa ukuvumela ukulungiswa kwe-epiphyselel eyomeleleyo.

  
  

Ukusetyenziswa kwezikrelemnqa kwi-HSF kuhlala kuyimpikiswano

• Xa uthelekisa iipleyiti zokutshixa kunye neepleyiti ezingafudukiyo ze-quinter enomgangatho ofanelekileyo wethambo, akukho ncedo lwe-biomechachachachacal kwitorion, ukugoba okanye ukuqina kwe-axilial kuzo zombini izinto.

• Kwelinye icala, xa ujongene nomgangatho wethambo elihlwempuzekileyo, ukusetyenziswa kweepleyiti zokutshixa kunokuba yingenelo.

• Kwisifundo sebhayoloji eqhutywa nguGarnener et al. Ngokukodwa iimodeli ze-osteoporotic ze-Osteoporotic, iindawo ezingama-34 ezingathandekiyo zazizinzile kakhulu kunokukhangelo okanye izinto ze-hybrid.

Ukuhlaselwa kwepleyiti engahlaseliyo yindlela yokuhlinzwa ebonakalayo ekunikezeleni inqanaba eliphezulu lempumelelo kunye nenqanaba eliphantsi lokwenza umsebenzi. Nangona kunjalo, kwisifundo sokubuyela umva esibandakanya abaguli abangama-76, iVan Dall Wall et al. ibonakalise ukuba uzinzo ngokupheleleyo lweziqu ze-humeral scoures zedwa ezikhulu kakhulu ixesha lokuphilisa elithelekiswa nokuzinza kwesihlobo.

Ulawulo lwePosi:

• Ngokwesiqhelo, ukulungiswa kwezinto kufumaneka ngokusetyenziswa kweplate. Ngenxa yoko, isigulana sivunyelwe ukuba senze imisebenzi esebenzayo nesebenzayo engasebenziyo ngaphandle kokulinganiselwa ngoluhlu lwegxalaba okanye i-elbow.

• Isithole sinokusetyenziselwa iintsuku ezininzi zolawulo lweentlungu.

• Isithintelo sesimo se-Postoperapeative kufuneka sigcinwe kwikhilogrem enye de kufezekiswe ukuphiliswa kokuqhekezwa kwefuko (ngokufuthi iinyanga ezintathu).

• Izigulana ezisezantsi zivunyelwe ukuba zithwale ubunzima apho uvunyelwe (umz.

Iziphumo ezixeliweyo

• IIREKHOLA ZOKUHLAZIYWA KWEXESHA LOKUHLAZIYA KWI-87% ukuya kwi-96%, ixesha lokuphilisa ixesha lokuphilisa iiveki ezili-12.

• Uluhlu lweeRhafu Uluhlu ukusuka kwi-5% ukuya kwi-25%, kunye neengxaki eziqhelekileyo ezifana nosulelo, i-osteonecrosis, kunye ne -mgloon.

• I-RNP ethathiweyo ye-RNP ngumngcipheko weendlela ezininzi ze-fitural. I-Alfufert et al50 iphonononge iimeko ezingama-261 ze-HSF inyangwe nge-orif kwaye ifumene ukuba i-RNP ethathiweyo nge-7,1% yeendlela ze-anterolates, kunye ne-17.9% ye-triceps egciniweyo.

• Ke ngoko, kubalulekile ukuba ichonge kwaye ikhusele i-nerve ye-radial kuyo yonke into evulekileyo.

  
  

二. I-Intramellary Nail

Isalathiso:

• Ithiyori, i-IMN inokubonelela ngezibonelelo ze-biomechachacal kunye ne-subxical ephezulu yokubekwa

• Ukusuka kwindawo ye-biomechachachacal

• Ngesi sizathu, i-implant iphantsi komhlaba iphantsi komhlaba kwaye ivumela ukwabelana ngomthwalo obungcono. Izalathiso zoqhaqho kwi-Intramellary izantya ziyafana nokubekwa.

• Nangona kunjalo, njengoko kuchaziwe ngaphambili, ezinye zeqhekeza zilungele ukubekwa kukubetheka.

• Iimpawu eziqhekezayo kunye neepateni ezifunyenweyo ukuba ziphezulu kakhulu kwi-IMn yi-pathologic kunye nefrading quations, izilonda zesahlulo, kunye namanzi e-osteoporothoc.

• I-ract ephakathi phakathi kwesithathu iguqukayo ikwabalulekile kwi-IMN.

• Ukongeza, isikhonkwane singafakwa ngokudityaniswa okuncinci, esinciphisa ukuqhekeza izicubu ezithambileyo xa kuthelekiswa nendlela yokubeka.

• Oku kuyinyani ikakhulu kwi-quations yeSithathu se-humerus.

Indlela yokutya:

• Isimo esifanelekileyo soguliso sale nkqubo sikwisitulo sentsholongwane. Ukusetyenziswa kwengalo i-brace iluncedo kakhulu ekugcineni ulungelelwaniso lweshaft kunye nokwenza izikrelem ezifunukayo.

• Inqaku lokungena lixhomekeke kuyilo lwezipikili, kodwa ihlala ibekwe kwi-cuberosity enkulu kunye nomphezulu we-rouricular yentloko ye-figural kufuneka ingene.

• Kule nkqubo, kuyacetyiswa ukuba wenze indlela yecandelo lezahlulo ukuze ube nomfanekiso-ngqondweni we-supraspinatus tendon.

• Ngapha koko, xa ungena kwintloko ye-humeral embindini we-supraspinatus, umntu uza kuzifumana embindini wentloko kwindiza ye-sagittal.

• Kubalulekile ukusebenzisa i-keratomile phantsi kwe-fluoroscopcopy yokuqinisekisa ukuba indawo yokungena kwindawo eyamkelekileyo kuzo zombini iinqwelomoya kunye ne-comines.

• Emva kwale, icingo yesikhokelo kufuneka liqhubekekile ngaphambi kokuvula i-supraspinatus tendon ixesha elide phantsi kombono othe ngqo phantsi.

• Inyathelo elilandelayo liqulathe ukuvula i-Canal ngaphezulu kwenaliti yeKirschner, iqinisekisa ukuba i-phract ihambelana netreyini kunye / okanye ubuqhetseba bangaphandle, kwaye emva koko uqhubele phambili isikhokelo kwi-intimel.

• Ukuphinda kufunyanwe kufunyenwe ukuba luncedo kwizigulana ezincinci kwaye akusoloko kuyimfuneko kwizigulana ezindala.

• Ukubekwa kwe-distal bolt, i-AP ekutshintshelweni kuphephe kwaye kufuna indlela encinci ye-2-3 ye-CM yokunciphisa umngcipheko wokulimala kwe-myve.

• Okokugqibela, i-Imn ehambelana nayo iphezulu kakhulu ukuba iphinde iphinde ibuye imbonakalo yeyona nto ikhutshelwe ngokwasempilweni, ilahleko yolwandiso lwe-elbow, kunye ne-uperapic.

  
  

Uqwalaselo olukhethekileyo kufuneka luhlawulwe kubude bezipikisi eyakhethiweyo, njengezikhonkwane ezinde kakhulu zingakhokelela kwiimpazamo ezimbini zobugcisa:

• Ukuphazamiseka kwindawo yokuqhekeka ngexesha lempembelelo

• kwaye / okanye izipikili ziphuma kwindawo yokucoca

  
  

Kwindawo yesithathu ye-proximal okanye i-quix ye-obliquique ende, ababhali bacebisa indlela encinci yokuvula ukunciphisa iqhekeza elilandelwe ngokulungiswa nge-wire tire ye-wire tire. Ngapha koko, ngenxa yolu qhekeko, umsipha we-Deltoud uzama ukuwahlulahlulahlula-hluhuthiswa kwe-proximal uqhekezo ngelixa i-pectoralsis enkulu ityhutyha i-dispal qungraured typerment ye-osution ye-osution okanye enyusa ukuphiliswa.

Ulawulo lwePosi

• Izigulana ziyakhuthazeka ukuba zenze intshukumo esebenzayo nencedisiweyo yegxalaba kunye ne-elbow njengoko inyamezele.

• Izilayidi zinokusetyenziselwa iintsuku ezimbalwa zolawulo lweentlungu.

• Izithintelo zendawo yokuphakamisa umzimba zigcinwa kwikhilogrem enye de kufike ukuphiliswa komduko kuyabonakala (ihlala iinyanga ezintathu).

• Kwiimeko ezininzi, ukuthwala ubunzima kuvunyelwe

  
  

Iziphumo ezifunyenweyo:

• Uncwadi ekusebenziseni izixhobo zokutyunjwa kwamatshini wokulawulwa kwe-HSF ayingqinelani. Kwelinye icala, inqanaba elixeliweyo lethambo liguquguquka kakhulu (phakathi kwe-0% ne-14%), kunye nezehlo eziphezulu kwizipikili. Kwelinye icala, izehlo zeengxaki zegxalaba (kubandakanya iintlungu, ukungcola, ukuphulukana nokuhamba okanye ukulahleka kwentshukumo okanye ukulahleka kwe-6% ukuya kwi-100%) inikwe ingxelo kuncwadi lwangaphambili.

• Inxalenye yengxaki inokuchazwa yi-sumacramial typerma ye-themfonial thesfnetion ebangelwa zizikhonkwane ezingqubana, i-tissue ye-tissue kunye / okanye ukwenzakala kwe-Cuff ye-Cuff kule ndawo ibalulekileyo ye-isovasity.

• Ababhali abaninzi bachaze iindlela ezahlukeneyo zokuphepha le ngcaciso i-hypovascular kwaye balungise i-tendon ngendlela enobulumko, ebonise amaxabiso asezantsi egxalaba.

  
  

Unyango lolondolozo lwe-HSF lubonelele ngeziphumo ezilungileyo ezisebenzayo kunye nenqanaba eliphezulu lokuphilisa ubuncinci ngama-80% abaguli. Ngesi sizathu, kuhlala kunyango lokukhetha kwi-HSF eninzi ye-HSF. Ukuba ulungelelwaniso aluphelelwa, utyando kufuneka luqwalaselwe. Oku kuyinyani kwizigulana ngaphezulu kweminyaka engama-55 yobudala eboniswa nge-proxiiquiquy yesithathu ye-obliquiquiquy (inqanaba lokuphilisa eliphantsi). Ngokuphathelele unyango lonyuko, uncwadi alubonisi naluphi na umahluko obonakalayo phakathi kweepleyiti kunye ne-IMN malunga namazinga okuphilisa okanye iingxaki ze-radial nerve, kodwa ukuncitshiswa kwe-motions) kunokwenzeka nge-IMN. Ke ngoko, i-Cuff kufuneka ilawulwe ngononophelo zombini kwinqanaba lokungena nasemva kokuvalwa.

Malunga Czmedch

Iqhutywa lukholo ukuba wonke umntu ophakathi kwale planethi ufanele inkonzo engcono yokhathalelo lwempilo. I-Czemedtite  sebenza isebenza kakhulu ukunceda abanye baphile ngokungoyiki. Siyazingca xa abaguli abancedala kwaye benobomi obungcono ngenxa yeemveliso zethu kunye neenyawo zethu zandise amazwe angaphezu kwama-70 ngaphezulu, apho abaguli, ogqirha, oogqirha banxamnye nabo baxhomekeke  Czmedch phambili. Yonke i-orphent ye-Orthoperic yenziwe ngu-US ihlangabezana nemigangatho ephezulu yomgangatho.

Siqale uhambo olungathethekiyo kunye ne-Orthopedent ye-Orthopents kwiminyaka eli-13 eyadlulayo. Kwinkqubo, umgca wemveliso uye wahlukile kwi-uffers i-spine, uxinzelelo, I-cranial-maxillofacial, I-Prosthesis, Izixhobo zamandla, Abalungisi bangaphandle, I-Arthroscopy  kunye ukhathalelo lwezilwanyana , kunye ne izixhobo  ezisetyenzisiweyo kwiinkqubo zotyando ezinxulumene noko.

Zonke izinto zethu eziluhlaza zivela kubathengisi abaphezulu basekhaya nakwelinye ilizwe. Xa kufikwa kumgangatho, asinakuze siyibize iindleko kwinjongo yethu yokuhlala ukuze sihlale sinyathelo ngaphambili, nto leyo esimisele ilebhu yovavanyo. Onke oomatshini bethu bemveliso bangeniswa e-USA, iJamani, iJapan kunye neempawu eziphezulu zasekhaya ukuqinisekisa ukuchaneka kwayo yonke imveliso esenziwe ngayo.

Ixesha elininzi kunye nomzamo utyalomali ekuphangaphuleni ukuphuculwa kunye nokuphakamisa imveliso yokugqibela. Sineqela lophando lobuchule, iqela lemveliso kunye neqela le-QC ukuqinisekisa olona phawu lubalaseleyo kunye neqela lethu lokuthengisa ukusombulula bonke ubunzima kwaye linike ezona nkonzo zibalaseleyo zentengiso.

Umnqweno wokholo lwethu, sihlala sityhalela imida yethu yazi-Indlela yokubonelela ngezisombululo eziphezulu eziphezulu, eziNgeniso zazo kubo bonke abathengi bethu kwihlabathi liphela kwaye zenza iinzame ezingabuyisayo impilo yabantu.