Incazelo ye-Intertrochanteric Fractures of the Femur
I-Intertrochanteric fractures ye-femur (eyaziwa nangokuthi i-trochanteric fractures) ibhekisela ekuqhekekeni okwenzeka kusukela phansi kwentamo yesifazane kuya ezingeni elingaphezulu kwe-trochanter encane. Izimpawu zihlanganisa ubuhlungu bendawo, ukuvuvukala, i-ecchymosis. Iziguli azikwazi ukuhamba, ngokufinyeza, i-adduction, nokujikeleza kwangaphandle kwesitho esithintekile, kanye nobubanzi obulinganiselwe bokunyakaza kokuhlangana kwe-hip.
Lezi ziqephu zibalelwa ku-3% - 4% wakho konke ukuphuka emzimbeni kanye no-35.7% wokuphuka kwenyonga. Izehlakalo zikhula ngokukhula, zivame kakhulu kubantu abangaphezu kweminyaka engama-70 ubudala, futhi zivame kakhulu kwabesifazane kunabesilisa.
I-Anatomy Esetshenzisiwe Ye-Intertrochanteric Fractures of the Femur
Unxantathu Wewadi
Indawo esengozini engunxantathu yakhiwe endaweni emaphakathi lapho i-femoral neck trabeculae cross. Kubantu asebekhulile abane-osteoporosis, le ndawo igcwele amafutha kuphela.
I-Femoral Calcar
Ipuleti eliminyene lethambo elitholakala ngemuva - eliphakathi nendawo lapho kuhlangana khona intamo yesifazane kanye nomphini ojulile we-trochanter encane. Kuyisandiso se-posterior - medial cortex ye-femoral shaft ethanjeni elikhansela futhi iyindawo yokusetshenziswa komthwalo we-eccentric ku-proximal femur.
Ukuhlelwa kwe-Hip Bone Trabeculae
Ukuhlelwa kwamandla omshini we-proximal femur:
(1) Ibanga lesi-6; (2) Ibanga lesi-5; (3) Ibanga lesi-4; (4) Ibanga lesi-3; (5) Ibanga lesi-2; (6) Ibanga loku-1
Izindlela Zokulimala Kwe-Intertrochanteric Fractures of the Femur
Ukulimala Okuphezulu Kwamandla Ezigulini Ezincane
Ukuphuka kwe-Intertrochanteric ezigulini ezincane kuvame ukubangelwa ukulimala kwamandla aphezulu njengokuwa endaweni ephakeme kanye nezingozi zezimoto. Lezi zimo zingase ziholele ekuqhekekeni okukhulu, futhi iziguli kudingeka ziqashwe ngeso elibukhali ngokulimala okuhlobene, okuhlanganisa lezo ezisekhanda, umgogodla, nezitho zethoracic nesisu.
Izici Zokuwa Ezigulini Ezikhulile
I-90% ye-intertrochanteric fractures kubantu asebekhulile ibangelwa ukuwa. Izici ezinomthelela ekuthambekeni kokuwa kwabantu asebekhulile zihlanganisa ukungaboni kahle, ukuncipha kokuqina kwemisipha, umfutho wegazi ongazinzile, ukuncipha kokusabela, izifo zemithambo yegazi, izifo zamathambo namalunga.
Ukuthi ukuwa kuphumela ekuqhekekeni kunqunywa yizici ezinhlanu ezilandelayo: ubunzima be-osteoporosis, isiqondiso sokuwa, ikakhulukazi lapho inqulu noma indawo eseduze nenqulu ishaya phansi, ukungakwazi ukukhalipha kokuzivikela ukuze kuncishiswe amandla ekwindla, ukungakwazi kwe-hip izicubu ezithambile ukumunca amandla anele, kanye namandla anganele e-hip.
Izinhlobo Zodlame kanye Nezindlela Zesenzo
Udlame Oluqondile: Ukulimala okuphezulu - okunamandla kusebenza ngokuqondile enqulwini, njengezingozi zomgwaqo noma ukuwa lapho inqulu ithinteke ngokuqondile, okuholela ekuqhekekeni.
Udlame Olungaqondile: Ukuhlukunyezwa komzimba kubeka inqulu ibe yi-varus kanye nengcindezi ye-angulation phambili. Nge-trochanter encane njenge-fulcrum, icindezelwa kakhulu, futhi kungase kube nomthelela wokudonsa we-iliopsoas muscle, okwenza ucezu lwethambo olumise okwevemvane. I-trochanter enkulu ingase futhi yakhe ingxenye yethambo ehlukanisiwe ngenxa yokudonsa okunamandla kwe-gluteus medius muscle.
Ukuhlukaniswa Komtholampilo kwe-Intertrochanteric Fractures ye-Femur
Evans Classification
Okuvame ukusetshenziswa kakhulu ekusebenzeni komtholampilo. U-Evans uhlukanise ama-intertrochanteric fractures abe yizinhlobo ezimbili:
Thayipha I:Trans - trochanteric fractures Ngokuvumelana nokuzinza ngaphambi nangemva kokunciphisa, iphinde ihlukaniswe yaba ama-subtypes angu-4:
Ⅰa: Ukuphuka kwezingxenye ezimbili ngaphandle kokususwa endaweni.
Ⅰb: Ukuphuka kwezingxenye ezimbili nokugudluzwa, i-medial cortex ayishintshile, futhi ukuphuka kuzinzile ngemva kokwehliswa.
Ⅰc: I-trochanter encane imahhala, inokususwa kokuphuka kanye nokukhubazeka kwe-varus; noma i-trochanter enkulu iyisiqeshana sethambo esihlukile.
Ⅰd: Ngokungeziwe ekuqhekekeni kwe-intertrochanteric, kokubili ama-trochanter amakhulu namancane aba yizicucu zamathambo ezihlukene, ezinokukhubazeka kwe-varus.
Phakathi kwazo, izinhlobo ezithi Ⅰa kanye no-Ⅰb ziyizinhlobo ezizinzile, kanti ezinye ziyizinhlobo ezingazinzile.
Uhlobo II:Ukuhlehla - ukuhlukana kwe-oblique intertrochanteric
Uhlobo II ukuhlehla - ukuhlukana kwe-trochanteric, nomugqa wokuphuka unwebeka ngokugobile ukusuka ngezansi kwe-trochanter enkulu ukuya engxenyeni engenhla ye-trochanter encane.
Ukuhlelwa kwe-AO
Uhlobo A1: Okubili okulula - ukuphuka kwezingxenye nge-trochanter, ngokusekelwa okuhle kwe-medial bone cortex kanye ne-lateral bone cortex eqinile.
Eduze komugqa we-intertrochanteric.
Nge-trochanter enkulu.
Ngokusebenzisa i-trochanter encane.
Thayipha i-A2: Ukuphuka okwenziwe nge-trochanter, ngokuphuka kwe-cortex ephakathi ezindizeni ezimbili, kodwa i-lateral bone cortex ihlala injalo.
Ngesiqephu esisodwa sokuphuka esimaphakathi.
Ngezingcezu ezimbalwa zokuphuka okuphakathi.
Inweba ngaphezu kuka-1 cm ngaphansi kwe-trochanter encane.
Uhlobo A3: Ukuhlehla - ukuphuka kwe-intertrochanteric, nokuphuka kwe-lateral cortex futhi.
I-Oblique.
Phenduka.
Ukuzibophezela.
Ngokuvamile, izinhlobo ze-A1.1 kuye ku-A2.1 zibhekwa njengezizinzile, futhi izinhlobo ezithi A2.2 kuye ku-A3.3 zibhekwa njengezingaqinile.
Ukwelashwa Kokuhlinzwa Kwe-Intertrochanteric Fractures of the Femur
Inhloso eyisisekelo yokwelashwa kokuhlinzwa ukufeza ukulungiswa okuqinile kwe-intertrochanteric fracture ngemva kokunciphisa. Ukuqina kokuqina kuncike ezicini ezilandelayo: ikhwalithi yamathambo, uhlobo lokuphuka, ukuncishiswa, ukuklanywa kwedivayisi yokulungisa yangaphakathi, kanye nokuma kokubeka kwento yokulungiswa kwangaphakathi.
Eminyakeni yamuva, izinto zokulungisa zangaphakathi zokwelapha ukuphuka kwe-intertrochanteric ziye zathuthukiswa ngokuqhubekayo futhi zabuyekezwa. Phakathi kwazo, ukulungiswa kwe-intramedullary, okufana ne-PFNA ne-INTERTAN, kuvame ukusetshenziswa njengedivayisi yokulungisa yangaphakathi evamile.
I-PFNA yokwelashwa kwe-Intertrochanteric Fractures ye-Femur
I-PFNA isetshenziselwa ukuphuka kwe-osteoporotic intertrochanteric okungazinzile okufana no-Evans Ic, i-Id, nohlobo II. Isebenza kangcono, ikhono elihle lokulwa nokujikeleza, isikhathi esifushane sokusebenza, ukulahleka kwegazi okuncane, izinkinga ezimbalwa, kanye namathuba aphansi okusikwa kwezinzipho zokukhiya, okubonisa izinzuzo zokwelashwa ezisobala.
I-PFNA ikhonjiswe ukuqhekeka kwe-osteoporotic intertrochanteric okungazinzile (njengezinhlobo ze-Evans Ic, Id, ne-II). Ibonisa ukusebenza okuphezulu okunezici ezinhle kakhulu zokulwa nokujikeleza, isikhathi esifushane sokusebenza, ukunciphisa ukulahlekelwa kwegazi, kanye nezinkinga ezimbalwa. Idizayini ye-helical blade yesistimu ihlanganisa ngempumelelo ithambo, inikeze amandla okubamba aqinile futhi yehlise kakhulu ingcuphe yokusikwa ekhanda lesifazane, inikeze izinzuzo ezihlukile zokwelapha.
I-INTERTAN yokwelashwa kwe-Intertrochanteric Fractures of the Femur
Ngokuthuthukiswa kobuchwepheshe besimanje bezokwelapha, i-INTERTAN iwuhlobo olusha lwezinzipho ze-intramedullary eziklanyelwe ngokukhethekile ukwelapha ukuphuka kwe-intertrochanteric kwe-femur. Isiphambano - ingxenye yezipikili zayo eziyinhloko yi-trapezoidal. Uma isetshenziswa ngokuhambisana ne-proximal interlocking nail ehlanganisiwe, ingavimbela umphumela 'Z'. Ukwengezwa kwesipikili sesibili esiphuma ekhanda lesifazane kwandisa umphumela wokunqanda ukujikeleza kwesikulufu se-lag. Le nail ye-intramedullary inezinhlobonhlobo zezicelo futhi ifanele iziguli ezine-osteoporosis enzima.
I-INTERTAN iyinoveli ye-intramedullary nail eklanyelwe ngokuqondile ukuphuka kwe-intertrochanteric, ebonisa intuthuko kubuchwepheshe besimanje bezokwelapha. Uzipho lwayo oluyinhloko lune-trapezoidal cross-section ukuze kube nokuzinza okuthuthukisiwe. Isigaba esiseduze sisebenzisa ukwakheka okuhlanganisiwe okuhlanganisiwe (isikulufu se-lag nesikulufu sokuminyanisa), esivimbela ngempumelelo 'Z-effect' (lapho isikulufu esisodwa sihlehla ngenkathi esinye singena ekhanda lesifazane). Isikulufu esengeziwe esisethiwe sivumela isikulufu se-lag ukuthi siqhubekele phambili ngaphakathi kwekhanda lesifazane, sikhulise amandla aso okuvimba ukuzungezisa. Lesi sikhonkwane sinezinhlobonhlobo zezinkomba futhi sifaneleka ikakhulukazi iziguli ezine-osteoporosis enzima.
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