Zeziphi kwezi zindlela zilandelayo ezisetyenziselwa ukulungisa iifractures ze-intertrochanteric?

I-Intertrochanteric fracture ye-femur, eyaziwa ngokuba yi-intertrochanteric fracture, i-extra-articular capsule fracture. Ukubonakaliswa okuphambili kwe-intertrochanteric fracture yintlungu ebalulekileyo yendawo kunye nokuvuvukala, i-ecchymosis ebanzi, ukungakwazi kwesigulane ukuma okanye ukuhamba, ukunciphisa okubalulekileyo, ukukhubazeka kwangaphakathi nangaphandle kokujikeleza kwelungu elichaphazelekayo, kunye nokunciphisa ukunyakaza okusebenzayo kunye nokunyanzeliswa kokubambisana kwe-hip kuyo nayiphi na indlela.

I-Epidemiology

1. Uninzi lwazo lunxulumene ne-osteoporosis, ngokuqhelekileyo kubantu abadala, abafazi abaninzi kunamadoda.

2. Isiganeko sinxulumene nobuhlanga, isini kunye nommandla.

3. ukulimala okuqhelekileyo kubantu abadala, iminyaka yobudala be-intertrochanteric fracture ye-femur yi-75.2 iminyaka. Kwakungekho mmahluko obalulekileyo kwiminyaka yobudala be-intertrochanteric fracture phakathi kwamadoda nabasetyhini.

4. Ngenxa yokutyeba kwegazi kwi-trochanter, i-fracture ayifane iphilise, kodwa kulula ukwenzeka inversion ye-hip, kwaye kukho iingxaki ezibangelwa ukuphumla kwexesha elide lokulala kwizigulane ezikhulileyo, kwaye izinga lokufa kunye nokufa liyi-15% -20%, ngoko kubizwa ngokuba yi-fracture yokugqibela kubantu abadala.

Indlela yokwenzakala

1. Abantu abadala abancinci banokulimala okukhulu kwamandla, kufuneka banikele ingqalelo kwingqondo, isifuba, isisu kunye nezinye iindawo zokulimala; abantu abadala ikakhulu ukwaluphala umsebenzi amalungu ulungelelwaniso impendulo agility ukwehla kunye nokuwa okubangelwa.

2. Ubundlobongela obuthe ngqo: impembelelo ngqo kwindawo enkulu yetrochanter. Ukuba umzimba uwela emhlabeni ngamandla asecaleni xa uwa.

3. Ubundlobongela obungathanga ngqo: umzimba uguqulwe ngexesha lokuwa, kwaye i-hip iphantsi koxinzelelo lwe-inversion kunye ne-angle yangaphambili ngexesha elifanayo.

4. I-Pathological fracture, enye yamathambo aqhelekileyo amathambo.

5. I-intertrochanteric fracture yenziwa ikakhulu bubundlobongela obungathanga ngqo.

Ukubonakaliswa kweklinikhi

1. Inkcazo eyisiseko iyafana neyokuphulwa kwentamo ye-femal, kunye nentlungu yendawo, ukuvuvukala kunye nokunciphisa ukusebenza kwelungu elichaphazelekayo.

2. Ngenxa yokuba i-capsule i-extra-articular fracture, akukho mqathango we-capsule edibeneyo, ngoko ke ukukhubazeka kokujikeleza kwangaphandle okufutshane (i-90 degrees) yomlenze ongezantsi kubi kakhulu.

3. Iintlungu ze-axial percussion.

4. I-hematoma yendawo inzima kakhulu, kwaye kunokubakho i-subcutaneous bruising ebanzi.

5. Kwizigulane ezisebekhulile, zivame ukuba zikhulile kunezigulane zentamo ye-femoral, kwaye inxalenye ebalulekileyo yezigulane ziye zafumana i-stroke yangaphambili.

Uxilongo

Imbali yokwenzakala okucacileyo, intlungu kwilungu elichaphazelekayo, kunye nokunciphisa ukuhamba. Ukunciphisa kunye nokukhubazeka kokujikeleza kwangaphandle kwelungu elisezantsi libonakala ukuya kwi-90 °. Uvavanyo lwe-X-reyi lusoloko lufuneka ukuseka uxilongo kwaye ukuchwetheza kusekelwe kwiiradiographs. Iimpawu ze-intertrochanteric fracture zifana nezo ze-femoral neck fracture, kodwa okokugqibela kuncinci kunokokuqala ngokubhekiselele kwintlungu yendawo, ukuvuvukala, ukulahlekelwa ngumsebenzi, kunye nokunciphisa umlenze ochaphazelekayo, kunye nomlenze ochaphazelekayo ubukhulu becala unobuncinci be-hip kunye nokuguqulwa kwamadolo kunye nokukhubazeka kokujikeleza kwangaphandle, ngokuqhelekileyo phakathi kwe-45 ° -60 °.

Uhlobo

I-AO kunye ne-Evans-Jensen fractures zimbini ezisetyenziswa ngokuqhelekileyo iintlobo zokuphuka, kwaye kwezi zimbini, uhlobo lwe-AO fracture luxhaphake kakhulu.

Evans-Jensen ukuchwetheza

Uhlobo I: Ukuqhekeka kwe-intertrochanteric elula kunye nomgca wokuqhekeka ojikelezayo ukusuka phezulu ukuya ngaphantsi, ngaphandle kokufuduka kunye nokuzinza.

Uhlobo lwe-II: Ukufuduswa okudityaniswe ne-rotor avulsion fracture encinci, kodwa i-femoral spur ilungile (i-femoral spur yiplate yamathambo exineneyo ehlala ngaphakathi kwintamo ye-femoral kunye nokudibanisa komzimba we-rotor encinci.

Uhlobo lwe-III: Ukudibanisa i-trochanteric fracture enkulu kunye nokuqokelela i-fracture ye-femoral spur, kunye nokufuduka, ngokuphindaphindiweyo kunye ne-posterior inter-rotor fracture.

Uhlobo lwe-IV: I-3-part fracture idibaniswe ne-fracture edibeneyo ye-trochanter encinci, enokuthi ibonise ngokuqhekeka kwentamo ye-femoral kunye ne-coronal surface ye-trochanter enkulu.

Uhlobo lwe-V: i-posterior lateral kunye ne-medial fracture engaxhaswanga (ukuhlanganiswa kweentlobo ze-III kunye ne-IV).

Uhlobo lwe-R: ukuphulwa kwe-intertrochanteric yangaphambili kunye ne-oblique fracture line ukusuka kwi-medial ephezulu ukuya kwi-lateral ephantsi, enokuthi idibaniswe ne-rotor encinci kunye nokutshatyalaliswa kwe-femoral spine.

Ukuchwetheza kwe-AO

A1.1 Umgca wokuqhekeka udlula kumgca we-inter-rotor

A1.2 Ukwaphuka okudlula kwi-trochanter enkulu

A1.3 Ukuqhekeka okudlula ngaphantsi kwe-trochanter encinci

A2.1 Ukuqhekeka kunye neqhekeza lethambo eli-1

A2.2 Ukuqhekeka ngamaqhekeza amathambo adibeneyo

I-A2.3 I-fracture eyandisa ngaphezu kwe-1 cm ngaphantsi kwe-trochanter encinci

A3.1 Imilo ye-oblique elula

A3.2 Imilo elula enqamlezileyo

A3.3 Uzimisele

Unyango

Ukuzinza kokulungiswa kwangaphakathi kweefractures ngokuqhelekileyo kuxhomekeke kwizinto ezintlanu: umgangatho wethambo, uhlobo lokuphuka, ukunciphisa, ukukhethwa kokulungiswa kwangaphakathi, kunye nokuma kokulungiswa kwangaphakathi ngokubhekiselele kwithambo. Ukubekwa ngokutsha kwe-fracture kubalulekile kuzinzo emva kokulungiswa kwangaphakathi kwaye kufuneka kujolise ekufezekiseni okanye ukuhlaliswa kwe-anatomic okanye i-stable non-anatomic reposition. Isishwankathelo, injongo yokubuyisela indawo kukufumana ukuzinza kwe-fracture. Indlela yokubeka kwakhona inokuvalwa okanye i-incisional. Kungakhathaliseki ukuba bunzima bohlobo lwe-fracture, ukunciphisa ukuvalwa kufuneka kuzanywe kuqala.

• Idoli yeHip yaMandla (DHS)

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Iinzuzo eziphambili ze-DHS Power Hip Screws.

• I-screw inefuthe eliqinileyo lokulungiswa ngaphakathi kwentloko ye-femoral, nakwimeko ye-osteoporosis.

• Indlela yokutyibilika kwi-sleeve ikhusela ukungena kwesiphelo sesikhonkwane kwintloko ye-femoral okanye i-acetabulum kunye nokuhanjiswa ngokuthe ngqo komxhuzulane ongalunganga kwithambo.

• Indlela yokutyibilika kwamandla igcina ukwaphuka kwindawo kwaye inciphisa umanyano.

• Inomsebenzi ombini wokunyanzeliswa kunye nokutyibilika, kunye nefuthe eliguqukayo kunye ne-static.

  
  

• I-Power Hip Dowel (DCS)

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  I-DCS kunye neepleyiti zokusika ze-95 ze-anticrotal fractures:

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Iinzuzo eziphambili ze-DCS amandla e-condylar screw zi.

• Inokukhetha ngokuchanekileyo indawo yokungena ye-screw ngokwemeko ethile yokuphuka, kwaye ukusebenza kukulungele.

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• Isikrufu sokunyanzeliswa kwamandla sikwi-engile echanekileyo kwipleyiti, ehlangabezana neemfuno ze-biomechanical ze-hip. Ngethuba lokuthwala ubunzima, amandla angalunganga aqala ukusetyenziswa kwingalo emfutshane yeplate kwaye emva koko ahlakazwe kwi-screw nganye, ukwenzela ukuba uxinzelelo luhlakazeke kwaye ukulungiswa kuqine ngokukodwa.

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• Inani elincinci elincinci le-screw ze-DCS kwi-fracture likwandisa ukuqina, kwaye indawo yokuphuka inokuthi ifakwe ibhulorho kwaye ilungiswe, ngaloo ndlela inciphisa izehlo zeengxaki ze-postoperative.

Isikhonkwane esiBonelekileyo sokutshixa iFemoral Intramedullary (PFN)

Izinto ezilungileyo zokulungiswa kwePFN.

• Idayamitha yesikhonkwane esincinci (eqhele ukuba yi-9mm), inokuqhutywa ngaphandle kokwandiswa. (iphezulu kunesiphelo esityebileyo se-caudal ye-Gamma isikhonkwane - 17mm)

• Isiphelo esisondeleyo se-PFN sine-camber eqikelelweyo yee-degrees ze-6, ukunciphisa i-angle ye-valgus kunye nokuphelisa isidingo sokurhoxiswa okunamandla kwangaphakathi ngexesha lokutsalwa.

• Isiphelo esiphezulu sivumela ukufakwa kwezikhonkwane ezibini kwintloko ye-femal, kunye nokongezwa kwe-screw anti-rotation kunye ne-double nail bearing kwi-neck ye-femoral, eyandisa ukuxhathisa ukukhathala.

• Umgama phakathi komngxuma wokutshixa we-distal kunye nesiphelo se-distal yesikhonkwane esiphambili (i-tapered extension) ide, enokunciphisa uxinzelelo loxinzelelo kwi-stem femoral.

• Umothuko ungaphantsi.

Izikhonkwane zeGammar

Izinto ezilungileyo zokulungisa izikhonkwane zeGammar.

• Yindlela yokulungiswa kwe-intramedullary encinci kunye ne-incision encinci kunye nokwenzakala okuncinci.

• Isikhonkwane seGamma sidibanisa ngokuqinileyo i-femur ephezulu kunye nentamo ye-femoral ngokudibanisa i-intramedullary nail kunye ne-tension screw, kunye ne-intramedullary nail igxininiswe yi-distal self-locking nail, ethintela ukujikeleza kunye nokunciphisa ukufuduka kwaye ibonelele ukulungiswa okuthembekileyo.

Ukuphuculwa kweGammar - PFNA

Ukhetho lwesilungisi sangaphakathi (PFNA).

• Indawo efanelekileyo eyakhelweyo kwi-intertrochanteric fractures engazinzanga ye-femur.

• Ilungisa ngokuqinileyo intloko ye-femal kunye nentamo kwaye inqande ukujikeleza kokuphela kokuphuka.

• Ukuthintela iingxaki ezifana nokuwa ngenxa yokutshatyalaliswa kwamathambo emva kokulahlekelwa kwenkxaso ye-medial, ukuguqulwa kwe-inversion, kunye nokunqunyulwa kwentloko ye-femal kunye nokufakwa.

• Ifanelekile phantse zonke iifractures ze-intertrochanteric, ngakumbi kwiifractures ezingazinzanga (umz. i-intertrochanteric fractures yangaphambili) kunye ne-osteoporosis edibeneyo.

• Kusekho iziganeko ezithile zeengxaki, ezifana ne-femoral head avulsion, okwenza kube nzima ukubuyisela ezinye izilungiso zangaphakathi.

Utshintsho oludibeneyo lweArtificial

Izalathiso zotyando olwenziwe endaweni yelungu lokwenziwa koqhaqho lwe-intertrochanteric ye-femur:

• Ubudala ngaphezu kweminyaka engama-80.

• Ukuqhekeka kwe-intertrochanteric edibeneyo kunye engazinzanga.

• I-Bone osteoporosis ibonakala, kwaye ukulungiswa kwangaphakathi kunzima ukulungisa ngokufanelekileyo.

• Akukho mda obalulekileyo wokuhamba kwe-hip okanye idolo phambi kokulimala.

• Imeko yomzimba wonke inokunyamezela unyango lotyando.

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

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