I-Femoral neck fracture ingenye yezingozi ezivame ukuhlangana nazo emisebenzini yomtholampilo, iningi leziguli esezikhulile ezibala ngaphezu kwe-50% ye-hip fractures. Ngokwezibalo, izehlakalo zokuphulwa kwentamo ye-femoral ziye zanda kancane kancane eminyakeni yamuva, nezibalo eziphezulu kwabesifazane kunamadoda. I-Vertigo, i-dementia, i-malignancy kanye nesifo se-cardiopulmonary kubantu asebekhulile kanye nokulimala okuphezulu kwamandla kubantu abasha yizici eziyingozi kakhulu zokuphulwa kwentamo yesifazane.
Eminyakeni yamuva, izinto eziningi zokulungisa zangaphakathi ezifana nezikulufu ezingenalutho, izikulufo zehip zamandla (DHS), izikulufu zehip ezishelelayo (HSH), amapuleti e-proximal femoral dissection, izipikili zokwakha kabusha, nezinzipho ze-Gamma ziye zavela. Phakathi kwalezi zinto zokulungisa zangaphakathi, izikulufu ezingenalutho yizona ezisetshenziswa kakhulu. Ucwaningo luye lwabonisa ukuthi iningi lodokotela abahlinzayo likhetha izikulufu ezingenalutho ekwelapheni ukuqhekeka okungashiyiwe, futhi ingxenye enkulu yodokotela abahlinzayo ikhetha ukusebenzisa izikulufu ezingenalutho ukuphuka kwentamo yesifazane esusiwe. Ukulungiswa kwesikulufu esingenalutho esingu-3 okuthungelwe kancane kuyindlela eyamukeleka kakhulu yokulungisa kwangaphakathi.
Izici ze-anatomical ze-femoral neck fractures
Manje sekuyamukelwa ngokuvamile ukuthi ukwakheka kwemithambo yekhanda lesifazane kuyisici esibaluleke kakhulu esithinta ukuphulukiswa kokuphuka kanye ne-necrosis yekhanda lesifazane. Ukulimala kwezakhiwo zokuhlinzeka ngegazi zekhanda lesifazane kuyisici esiyinhloko se-pathological ye-ischemic necrosis yekhanda lesifazane. Ucwaningo oluhlelekile lwe-vascular anatomy yentamo yesifazane lwathola ukuthi inethiwekhi ye-epiphyseal vascular network kanye nesistimu ye-arterial yendawo ephansi esekela ingase ibe izakhiwo ezibalulekile zokugcina ukunikezwa kwegazi ekhanda lesifazane ngemva kokuphuka kwentamo yesifazane, ukuze ukubhoboza kwe-intraoperative nokufakwa ngokuseduze ngangokunokwenzeka esifundeni esiphakathi nendawo yezokwelapha kungasiza ekunciphiseni ukulimala kwekhanda le-femoral. uhlelo lwe-intraosseous vascular system.
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Umfanekiso 1 Ukunikezwa kwegazi ekhanda lesifazane, ukubukwa kwe-anterolateral (a) nangemuva (b). Kukhona ukuhlukahluka ekunikezeni igazi ekhanda lesifazane, kodwa i-lateral ne-medial spinofemoral arteries iphuma emthanjeni ojulile we-femoral ku-60% yeziguli.
(1) Igazi eliningi eliya ekhanda lesifazane livela kumthambo we-femoral rotor ongemuva.
(2) Ikhipha amagatsha ama-3 noma ama-4 asekela umthambo oyibhande. Lawa magatsha ahamba phambili naphezulu ahambisana nengxenye eguquguqukayo yentamo ye-synovial ye-femur ukuya emaphethelweni we-cartilaginous wekhanda lesifazane. Izitsha ezingaphakathi kwe-ligament eyindilinga.
(3) Itholakala kumthambo we-foramen occulta. Igatsha elikhuphukayo le-medial rotor femoral artery.
(4) Ihlinzeka nge-trochanter enkulu ye-femur futhi yakhe iringi ye-arterial ene-lateral rotor femoral artery.
Izikulufu ezingenalutho zokuphuka kwentamo yesifazane
Ngokomtholampilo, izikulufu ezintathu zethambo ezikhanselwayo ezingenalutho ezingu-6.5 mm noma 7.0 mm noma 7.3 mm zingasetshenziselwa ukulungiswa ezigulini ezincane noma ezigulini ezineminyaka ephakathi noma ezindala ezinekhwalithi enhle yamathambo. Umhlahlandlela kufanele usetshenziswe ukugcina izinzipho ezi-3 ezingenalutho zihambisana ukuze uvumele ukucindezelwa kokuphuka kokuslayida. Ngaphakathi kwentamo yesifazane, izikulufu kufanele zifakwe phakathi emaphethelweni, kuqikelelwe ukuthi izikulufu zixhunywe ekhanda lesifazane hhayi ngaphesheya komugqa wokuphuka, njengoba lena kuwukuphela kwendlela yokuthola ukucindezelwa phakathi kwamaphethelo. Izikulufu kufanele ziqiniswe futhi ziqinisekiswe ngokuphindaphindiwe ngokuhlinzwa. Uma kusetshenziswa umbhede wokudonsa, ukudonsa kufanele kukhululeke. Izikulufu ezingenalutho nazo zingabekwa nge-percutaneously. I-frontal, lateral, ne-45° oblique fluoroscopy kufanele yenziwe ukuze kuqinisekiswe ukuthi izikulufu azingeni ekuhlanganyeleni kwe-hip.
1, Amasu okuhlinzwa okukhethekile.
Thatha 'unxantathu ohlanekezelwe' ukubekwa kwezinzipho, okuvame ukusetshenziswa emtholampilo, njengesibonelo.
a. Okokuqala, ngaphansi kwe-fluoroscopy, sebenzisa i-X-ray ezindizeni ezimbili ze-fluoroscopy ukuze unqume ukuhlelwa kwezikhonkwane zomhlahlandlela ophansi naphakathi.
b. Kwenziwa ukusika kwesikhumba okunwebeka ngo-2-3 cm eduze.
c. Isendlalelo se-fascial sihlukaniswa eduze kwe-incision futhi isihlukanisi se-Cobb sisetshenziselwa ukuhlukanisa imicu ye-longitudinal eduze kwemisipha ye-femoral yangemuva.
d. Beka inaliti yomhlahlandlela endaweni lapho zombili izindiza ziphelele khona.
e. Iphinikhodi eyodwa yomhlahlandlela yabekwa eduze kwesici sangaphambili sentamo yesifazane nomsizi ukuze kunqunywe i-engeli yokutsheka yangaphambili.
f. Ngemuva kokulungiswa kwephinikhodi yokuqala yomhlahlandlela, izikhonkwane zomhlahlandlela we-posterosuperior kanye ne-anterosuperior zikhonjwa kusetshenziswa iziqondiso ezihambisanayo ukuze zithole ukwesekwa kwe-cortical yangaphambili kanye ne-anterior ngaphakathi kwentamo yesifazane.
g. Lokhu kwenziwa ngokufaka iphinikhodi ngenhla kwe-lesser trochanter eduze kwe-distal femoral neck cortex ngomgogodla wesifazane; izikhonkwane eziqondisayo ezimbili ezilandelayo zifakwe eduze ngendlela efanayo, phezulu ngangokunokwenzeka futhi 5 mm ukusuka ku-cortex yangaphambili nengemuva; ukujula kokungena kwephini lomhlahlandlela bese kulungiswa ukuze kufinyelele ku-5 mm ngaphansi kwe-cartilage; ekugcineni, imbobo iyahlelwa kabusha, ikalwe, futhi isikulufu esingenalutho esicindezelwe siyafakwa ngesikulufu.
h. Qinisekisa ukuthi awufaki inaliti engezansi kwe-trochanter encane futhi uhambe eduze nomgogodla wesifazane.
i. Qiniseka ukuthi iphinikhodi yomhlahlandlela ibekwe ngaphansi kwelunga.
j. Ungavumeli iphinikhodi ukuthi ingene endaweni ye-articular.
k. Nquma ubude besikulufa esifanele ngokulinganisa ubude bephinikhodi bese ukhipha u-5 mm.
l. Ngokuvamile kusetshenziswa izikulufu zokuzithepha, zokuzibhoboza, kodwa ngezinye izikhathi ukubhobolwa kwangaphambili kwe-lateral cortex kuyadingeka ezigulini ezithembekile ezinethambo eliwugqinsi.
m. Uma isikhala sivuma, i-spacer ingasetshenziswa.
n. Isikulufu sesi-4 (uhlelo lwedayimane) lungase ludingeke kwabaqotho abanokuphuka okunzima okunciphile kwesici esingemuva sesandla.
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Nakuba izikulufu ezingenalutho zokuphuka kwentamo yesifazane sezivame kakhulu, kusenokwehluka kwemibono mayelana nenombolo nokucushwa kwezikulufu ezingenalutho ezibekwe ngokuhlinzwa, ngokuvamile kuye ngokuthi u-opharetha akuthandayo; izici ezifana nokuminyana kwamathambo esiguli, amandla ngezikulufu, kanye nempumelelo yokwelashwa nakho kunomthelela.
1, Inombolo yezikulufu ezingenalutho.
Ukuphuka kwentamo ye-Femoral kuvame ukulungiswa ngezikulufu ezingenalutho ezingu-2-4.
Ezimweni eziningi, kusetshenziswa izikulufu ezi-3 ngoba zingakwazi ukumelana nezingcindezi zangaphambili eziqinile, zandise ukuzinza, futhi zinciphise ukugudluzwa kokuphela kokuphuka.
Ngokuphuka kwentamo yesifazane nge-engeli ye-Pauwells >50°, izikulufu ezingu-2 zinengqondo kakhudlwana.
Ezigulini ezinokuphuka kanzima kwentamo ye-femoral engemuva, kuye kwakhuthazwa izikulufu ezi-4 ezingenalutho.
Kodwa-ke, umkhuba okhona kusewukusebenzisa izikulufu ezingenalutho ezi-3 ukuze zilungiswe.
2. Ukucushwa kwesikulufa esingenalutho.
Uma izikulufu ezi-3 ezingenalutho zisetshenziselwa ukulungisa kwangaphakathi ukuphuka kwentamo yesifazane, ngokuvamile kunenkolelo yokuthi ithiyori 'yokuminyanisa ngokuslayida' kufanele ilandelwe, ukuze izikulufu ezi-3 ezitshaliwe ziqondane ngokubuka kwe-orthogonal futhi zibe nokucushwa kukanxantathu ekubukeni okuseceleni.
Ngale ndlela, izikulufi ezingenalutho ezilinganayo ezintathu zinganikeza ukusekela okuhle komshini futhi zenze ithrekhi yokushelela, ukuze ibhulokhi yokuphuka ikwazi ukuslayida eduze kwe-axis yentamo ye-femoral ngaphansi kokufinyela kwemisipha ye-hip, idale ingcindezi ekugcineni kokuphuka futhi ikhuthaze ukuphulukiswa kokuphuka.
Kodwa-ke, ukuthi izikulufu ezi-3 ezingenalutho zibekwe ku-orthotriangular noma ukulungiswa kukanxantathu ohlanekezelwe kube yimpikiswano.
Intuthuko yendlela yokulungisa isikulufu esingenalutho yokuphuka kwentamo yesifazane
Yuenyongviwat et al. uklame umhlahlandlela omusha wokumba ohambisanayo olungisekayo wokubekwa kwezikulufu ezingenalutho ekwelapheni ukuphuka kwentamo yesifazane ngokulungiswa kwangaphakathi, futhi wathola ukuthi lo mhlahlandlela omusha unganciphisa isikhathi sokusebenza kanye nenani lemibono ye-intraoperative fluoroscopic uma kuqhathaniswa nendlela yendabuko, ngaleyo ndlela kuzuzwe imiphumela yokuhlinzwa egculisayo.
UFilipov et al. yakhelwe i-biplane esekelwa kabili isikulufu fixation (BDSF), lapho indawo yokungena yezikulufu ezintathu ezingenalutho itholakala endaweni ewugqinsi cortical of the proximal femoral stem, kanye nezikulufu ezintathu zisuswe ngokulinganayo endaweni ezungezile yekhanda lesifazane, ngaleyo ndlela zakhe izindiza ezimbili. Le ndlela ivumela ukwesekwa kwe-cortical kabili, ngaleyo ndlela inikeze amandla okulungisa okwanele ngesikhathi sokunyakaza.
Ukuhlolwa kwe-Biomechanical kusetshenziswa izibonelo ze-cadaveric kubonise ukuthi indlela yokulungisa ye-BDSF inikeza ukulungiswa okungcono kunendlela yokulungisa unxantathu ohlanekezelwe ovamile. Imiphumela yokuhlolwa kwe-biomechanical kusetshenziswa ama-cadaveric specimens ibonise ukuthi usimende we-calcium phosphate oqiniswe isikulufu esingenalutho kuthuthukisa kakhulu ukuzinza kwesikulufu esingenalutho sokuphuka kwentamo yensikazi, kwathuthukisa ukumelana nokucindezelwa kwentamo yesifazane, kanye nokuqina komgogodla okuthuthukisiwe, okunenani elikhulu lomtholampilo.
Ngenxa yamathuba aphezulu e-femoral head necrosis ngemva kokulungiswa kwezinzipho ezingenalutho zokuphuka kwentamo yesifazane, ezinye izindlela ziye zasetshenziswa ngokuqhubekayo ukusiza ukulungiswa kwangaphakathi kwezinzipho ezingenalutho ukuze kuncishiswe izinkinga ezifana ne-femoral head necrosis. Imbangela eyinhloko ye-femoral head necrosis ngemva kokuphuka kwentamo yowesifazane ukulahlekelwa ukugeleza kwegazi ekhanda lesifazane, ngakho-ke ukugxila kokwelashwa kuyindlela yokuthuthukisa ukugeleza kwegazi. Ukwethulwa kokuxhunyelelwa kwe-periosteum okuhlinzekwe ngegazi endaweni ye-necrotic yekhanda lesifazane kanye nokugcwaliswa kwangaphandle kwesigxobo esisele ngongqimba olukhulayo kuzokwenza kube lula ukuhlukaniswa kwe-periosteum exhunyelelwe kuma-osteoblasts kanye nokuvuselelwa kwamahlumela e-vascular, okunomthelela kokubili kwe-osteogenic kanye ne-revascular
Isifinyezo
Ukulungiswa kwesikulufa esingenalutho sokuphuka kwentamo ye-femoral kuyindlela ephumelela kakhulu yokulungisa, enezinzuzo zokusebenza okulula, isikhathi esifushane sokusebenza, ukuhlukumezeka okuncane, ukulungiswa okuthembekile kanye nokululama ngokushesha ngemva kokuhlinzwa. Kodwa-ke, ngenxa yezimpawu ze-anatomical ze-femoral neck fractures, izinkinga ze-ischemic necrosis yekhanda lesifazane kanye nokungahlangani kwe-fracture akukwazi ukugwema ngokuphelele ukulungiswa kwangaphakathi kwe-femoral neck fractures. Ngakho-ke, izinkomba zokusetshenziswa kwale ndlela yokulungisa zidinga ukucaciswa ngaphambi kokusetshenziswa, futhi iziguli esezikhulile ezinezinsika ezinzima zentamo ye-femoral kanye nesimo esimpofu esijwayelekile esidinga umsebenzi wokuqala kufanele sigweme ukusebenzisa ukulungiswa kwangaphakathi kwe-femoral neck fractures ngangokunokwenzeka. Izici eziyingozi ezithinta ukubikezelwa kwesiguli, njengohlobo lokuphuka, ukuqina kwamathambo, kanye nesimo sokusebenza kwesiguli, kufanele futhi kucatshangelwe ukuze kuncishiswe izinkinga zesikhathi eside emva kokuhlinzwa futhi ngaleyo ndlela kuthuthukiswe umphumela wokwelapha we-femoral neck fractures.
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