Kuthekani ukuba ukulungiswa kwangaphakathi kwe-inter rotator fracture kuyasilela?

Ukuqhekeka kwe-Hip kuqikelelwa ukuba kuchaphazela abantu abadala abangama-500,000 eUnited States ngonyaka. Zinempembelelo enkulu kumgangatho wobomi, ngoku zibalelwa kwi-3-7% yokusweleka esibhedlele kunye nezinga lokufa konyaka omnye we-19.4-58%. Ngokumalunga nesiqingatha sazo zonke i-hip fractures zi-intertrochanteric (IT) fractures. Ukufakelwa kwezinto ezimbini eziqhelekileyo ezisetyenziselwa ukuphatha i-IT fractures yi-cephalomedullary nail (CMN) kunye ne-sliding hip screw (SHS).

Nangona ukuqhubela phambili kwethekhnoloji, ukuyeka kwamathambo kunye nokungaphumeleli kokulungiswa okufana nokungena kwentloko ye-femal kusenzeka kwaye kunokutshabalalisa. Uphononongo lwakutsha nje luye lwanika ingxelo yereyithi yokurhoxa ukuya kuthi ga kwi-6% kunye nokufakelwa kwanamhlanje. Imingcipheko yokungaphumeleli kokulungiswa ibandakanya umgama we-tip-tip (TAD)> 25 mm, ukungonelanga ukuchithwa kwe-fracture, iipateni zokuqhekeka ezingazinzanga, i-cephalic spikes ebekwe kwicala okanye ngaphantsi kweziko lentloko ye-femoral, kunye nokujikeleza kwangaphakathi kwe-angle ye-stem yomlomo wesibeleko. Ukuguga kunye ne-osteoporosis nazo zihambelana nokungaphumeleli kokulungiswa.

Izigulane kunye neendlela

Olu ibiluvavanyo lokujongwa kwezigulane ezinyangwayo kumaziko amabini abekwe ngaphakathi kwenkqubo yokhathalelo lwempilo kummandla omkhulu wesixeko. Iilogi zecala labagqirha ababini (i-JS kunye ne-BC) babuzwa kuzo zonke izigulane ezifumene ukulungiswa kokuhlaziywa kwe-samente emva kokungaphumeleli kokulungiswa kokuqala kwe-IT fractures ukususela ngoJanuwari 2018 ukuya kuSeptemba 2021, emva kokuvunyelwa yibhodi yokuhlaziya iziko. Ukusetyenziswa kokuqiniswa kwesamente ngexesha lotyando oluhlaziyiweyo kwaqinisekiswa yingxelo yonyango ye-elektroniki (EMR) yokuhlaziywa kweerekhodi zokusebenza kunye ne-radiographs emva kokusebenza. Sifake zonke izigulane ezineempawu zokuqiniswa kwesamente ekulungiseni ukuhlaziywa emva kokungaphumeleli kwe-CMN yokuqala okanye ukulungiswa kwe-SHS ye-IT fractures (Umfanekiso 1). Asibandakanyi izigulane ezinentamo ye-femoral okanye i-subtrochanteric fractures, izigulane ezingazange zihlaziywe ukulungiswa ngokuqiniswa kwe-samente, kunye nezigulane eziye zafumana i-arthroplasty ngexesha lotyando lokuqala lokuhlaziya.

Umzobo 1. Ibhinqa elineminyaka engama-76 ubudala lafumana i-intramedullary nailing for intertrochanteric fracture of the femur (A), kunye neentlungu eziqhubekayo ze-hip kwiinyanga ze-2 kamva ngenxa yokufakwa kwe-implant incision (B).

Ubuchule botyando

Kwizigulane ezifumana ukulungiswa kokuqala kunye ne-CMN, senze ukutshintshwa kwentloko yesikhonkwane kunye nokuqiniswa kwesamente yethambo. Ekuqaleni, i-5-cm incision yenziwa kwicala elisondeleyo le-trochanter enkulu, ucingo lwesikhokelo lwafakwa kwicala elisondeleyo lesikhonkwane, kwaye yonke ithambo yasuswa kwicala elisondeleyo lesikhonkwane usebenzisa i-reamer evulekile. Emva koko, i-screwdriver ye-hexagonal yayisetyenziselwa ukukhulula i-screw fixation phezulu kwe-CMN (Umfanekiso 2).

Umzobo 2, i-intraoperative fluoroscopy ebonisa i-screwdriver ene-hexagonal idibanisa kwaye ikhulula isikrufu seseti ebesibethelelwe ngaphambili.

I-1-2 cm ye-transverse incision yenziwa phantsi nge-fascia iliotibial (ITB) fascia. Isikhonkwane sentloko sangaphambili sisuswa ngesikhokelo esinentambo ejikelezayo (Umfanekiso 3). Kwimeko ye-femoral head perforation, isikhokelo esingenanto kunye ne-screw yokutshixa i-distal isetyenziselwa ukuthintela ukuvuza kwesamente kwi-joint (Figure 3A). Ngokukodwa, i-matrix yaqala ukutofwa emva kokususwa kwemigangatho emibini yangaphandle ye-cannula kathathu kwaye emva koko yafakwa kwindawo enemingxuma ngokuphinda ifake iileya ezimbini zangaphandle.

Umzobo we-3, i-Intraoperative anteroposterior (A) kunye ne-lateral (B) imifanekiso yesinye isigulane esibonisa intloko ye-femal kunye ne-interstitial bone defect graft.

Okulandelayo, ilungu liyatsalwa kwaye emva koko ukwaphuka kubekwe kwindawo engaphezulu ye-exostosis yokulungiswa kwakhona. Kwiimeko zokuphulukiswa kwe-malunion okanye i-fibrous, i-osteotomy ye-percutaneous yenziwa ngokusebenzisa i-1 / 4 'i-bone gouge kunye nendlela ye-anterolateral. Oku kunqabile ukuba kufuneke, kodwa kusebenza kakhulu xa kufuneka ukuvelisa i-angle ye-stem ephuculweyo yomlomo wesibeleko (ithagethi> 130 °).

I-screw entsha okanye i-spiral blade ifakwe kwithambo le-subchondral kwintloko ye-femoral ecaleni kwe-axis yentamo ye-femoral, uqinisekise ukuba uqaphele ukuba ungangeni entloko (Umfanekiso 4). I-screw ibekwe ngenjongo yokuphepha i-nail tract yangaphambili, kodwa isakhomba ekupheleni kumbindi wentloko ye-femoral. (Umfanekiso 5)

Umzobo we-4, i-Anteroposterior (A) kunye ne-lateral (B) imifanekiso yesinye isigulane esibonisa ukufakwa kwenaliti ye-kerfing ecaleni kwendlela yesikhonkwane sentloko entsha.

Umzobo 5, i-intraoperative fluoroscopy ebonisa ukufakwa kweblade entsha ye-cephalomedullary ecaleni kwendlela yocingo yesikhokelo, eyathi emva koko yaqiniswa sisikrufu esiseti.

Ekugqibeleni, intloko ye-femal igcwele i-samente yethambo usebenzisa i-injection bone system sement system (Umfanekiso 6). Ukunyamekela kuthathwa ukuphepha ukukhutshwa kwi-joint ngokusebenzisa i-radiographs yexesha langempela kunye nokulungelelanisa ubunzulu kunye nokuqhelaniswa kwe-cement cannula.

Umzobo we-6, Umfanekiso obonisa ukwanda kwesamente ekuqaleni (A), ukuzaliswa ngokuthe ngcembe (B) de i-femoral head defect izaliswe (C).

Kwizigulane ezifumana ukulungiswa kokuqala kwe-SHS, sisusa i-SHS kwaye sibeke i-CMN ende. emva kokwenza i-5-cm incision ephakathi ngaphantsi kwe-trochanter enkulu kunye nokuchonga i-ITB, i-incision ichithwa phantsi kwi-plate lateral. Zonke izikrufu zepleyiti ziyasuswa kusetyenziswa isikrudrayiva esifanelekileyo sesandla kwaye ipleyiti esecaleni iyasuswa. Izikrufu zoxinzelelo ziye zisuswe ngesikhokelo sokubuyela umva njengoko kuchaziwe ngaphambili ukubeka indawo yokwaphuka kwiqondo elikhulu le-valgus. I-5-cm incision yenziwa kwincam yetrochanter enkulu njengoko kuchaziwe ngaphambili. Intambo yesikhokelo ifakwe kwisiphelo esiphezulu se-trochanter enkulu kwaye iqhubele phambili kwi-femoral stem. I-reamer evulekileyo yaziswa ecaleni kwendlela ye-guidewire. I-guide ye-ball-tipped guidewire iye ifakwe kumbindi we-distal femur ngaphantsi kwinqanaba le-patella. Okulandelayo, ukuhlaziya kwakhona okuqhubekayo kwade kwavakala ukungcangcazela kumqolo. Zonke izigulane zethu zifumene isikhonkwane eside se-CMN kunye ne-TFN-ADVANCED (TFNa) iproximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA).

Ingxoxo

Ubuchule bethu busebenzisa ukuqiniswa kwesamente yethambo ngexesha lokulungiswa kwakhona. Ukuqiniswa kwesamente yethambo ukulungiselela ukulungiswa kokuqala kwe-osteoporotic proximal femur fractures ifundwe kwaye ibonise iziphumo ezilungileyo ze-biomechanical kunye nekliniki. Uphononongo lwakutsha nje luxele ukuba ukuqiniswa kwe-samente yethambo kubangele imithwalo ephezulu yokungaphumeleli, ukunciphisa ukufuduswa kokufakelwa, kunye neengxaki ezimbalwa kunye nokusebenza kwakhona xa kuthelekiswa nokulungiswa okungaqiniswanga. Uphononongo olungenamkhethe, olunamaziko amaninzi luphinde lwabika ukuba akukho phinda-phinda usebenziswe okanye iimpawu ezibonisa ukufuduswa kwe-CMN kwiqela eliqiniswe ngesamente xa kuthelekiswa namatyala amathandathu kwiqela elingaqiniswanga.

Ukufa kwe-hip fracture kuphezulu. Uphononongo lwakutsha nje luchaze i-3-7% yezinga lokufa kwabantu esibhedlele, kunye nokufa konyaka omnye kwehla ukusuka kwi-19.4% ukuya kwi-58%. Ngokukodwa, i-IT fractures ibonakaliswe kwi-akhawunti ye-27% yokufa ngonyaka omnye. Uluhlu lwethu lwezonyango alubonisanga ukusweleka esibhedlele kunye nezinga lokufa konyaka omnye we-13.6%, eliphantsi kakhulu xa kuthelekiswa noncwadi. Ngenxa yokuba ukuhamba kwebhedi kwangethuba emva kotyando kunxulunyaniswa nokusweleka okuphantsi, ukuhamba kakuhle kunye neziphumo ezisebenzayo kuthotho lwethu kunokuchaza ukusweleka okuphantsi okubonwa kwizigulana zethu.

Ukuqukumbela

Ukulungiswa kwe-cement-reinforced revision fixation yindlela esebenzayo, ekhuselekileyo, kunye neendleko ezifanelekileyo zokungaphumeleli kokulungiswa kwe-intertrochanteric fracture engasulelwanga kwizigulane ezisebekhulile ezineethambo ezaneleyo ze-acetabular.

Izigulane ezinokulungiswa okungaphumeleliyo kweefractures eziphambili ze-intertrochanteric ezilandelwa ukulungiswa ngokutsha kunye nonyango oluqiniswe ngesamente lubonise iziphumo ezilungileyo zexesha elide zeklinikhi kunye nomgangatho wobomi. Inkqubo yayisetyenziswe kuphela kwiimeko apho uninzi lwe-acetabular articular surface lugcinwe kwaye intloko yesikhonkwane yahlala iqulethwe kwintamo ye-femoral. Ukuqwalasela imida yokuhlaziywa kwe-arthroplasty kwizigulane ezikhulileyo ezibuthathaka, le nkqubo ibonisa isithembiso ngokukhuselekileyo nangempumelelo ekunciphiseni iingxaki ezinzulu ngelixa kunciphisa ixesha lokusebenza kunye neendleko kweli qela lezigulane.

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

Kuba I-CZMEDITECH , sinomgca wemveliso ogqityiweyo kakhulu wokufakelwa kotyando lwe-orthopedic kunye nezixhobo ezihambelanayo, iimveliso ezibandakanya ukufakelwa komqolo, iinzipho ze-intramedullary, ipleyiti yokwenzakala, ipleyiti yokutshixa, i-cranial-maxillofacial, iprosthesis, izixhobo zamandla, izilungisi zangaphandle, arthroscopy, ukhathalelo lwezilwanyana kunye neeseti zezixhobo ezixhasayo.

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