I-proximal humerus fractures ingenye yezifo ezivame kakhulu ku-trauma orthopedics, futhi iningi lama-humerus fractures ama-low-energy osteoporotic fractures kubantu asebekhulile.
Nakuba iningi le-proximal humerus fractures lingelashwa ngendlela elondolozayo, i-10-15% yokuphuka isadinga ukwelashwa okuhlinzayo, okuhlanganisa ukulungiswa kwepuleti lokuncishiswa kwe-incision, ukulungiswa kwangaphakathi kwe-intramedullary nail yokunciphisa ukuvala, kanye nokushintshwa okuhlangene.
Isinqumo sokwelashwa kudingeka sisekelwe esimweni somzimba wesiguli, umbono waso, lokho okulindelwe ngokwengqondo, kanye nohlobo lokuphuka.
Ukusetha kabusha nokulungiswa kokuphuka kwezimo eziphuthumayo
【Isincomo】Ngokwephulwa kwe-proximal humeral more tuberosity (uhlobo lwe-NEER 2 ukuphuka ingxenye) okuhlanganiswe nokugudluka kwehlombe, ukuhlolwa kwe-CT kwangaphambi kokuhlinzwa, ngaphandle kokuphuka kwentamo yokuhlinzwa, ukumiswa kabusha kanye nokubhuleka nge-brace ehlombe ebuhlungu ngaphansi kwezimo eziphuthumayo (izinga lokuncoma eliqinile: 6.20%).
2. Ukulawulwa kwezinhlungu ezibuhlungu ngaphambi kokuhlinzwa
【Okunconyiwe】Iziguli ezinokwephuka kwe-humerus okusondele zikhetha i-analgesia yangaphambi kokuhlinzwa nge-acetaminophen yomlomo noma ama-NSAID, futhi ama-opioid omlomo angengezwa uma umphumela ungemuhle (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 73.8%).
3. Imfundo yezithunywa zevangeli ngaphambi kokusebenza
[Isincomo] Imfundo yangaphambi kokusebenza kufanele yenziwe ngendlela ehlukene futhi enezimo eziningi. (Izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma eliqinile: 83.8%)
4. Ukuhlolwa kokudla okunomsoco ngaphambi kokuhlinzwa kanye nokwelashwa okusekelayo
【Isincomo】Ukuqedela ukuhlolwa kokudla okunomsoco ezigulini engakapheli amahora angama-24 zingeniswe kanye nokuhlinzeka ngokungenelela kokudla okunomsoco ezigulini ezisengozini yokondleka. (Izinga lokuncoma lochwepheshe: 98.5%; izinga lokuncoma eliqinile: 55.9%)
5. Ukuhlolwa kwe-glucose ye-perioperative kanye nokulawulwa esigulini esinesifo sikashukela
【Isincomo】Umgomo onconyiwe wokulawula i-glycemic ezigulini eziningi ezinesifo sikashukela ezihlinzwa ukuzikhethela ngu-7.8 kuya ku-10.0 mmol/L.
6. Ukulawulwa kokuvuvukala kwezicubu ezithambile esikhathini sokusebenza
【Okunconyiwe】Ezigulini ezihlinzwa ngokukhethekile ngenxa yokuphuka kwe-humerus, izindlela eziningi zomzimba zinikezwa ukunciphisa ukuvuvukala ngesikhathi sokuhlinzwa. (Izinga lokuncoma lochwepheshe: 98.5%; izinga lokuncoma eliqinile: 80.9%)
7. Ukuphathwa kokudla kwangaphambi kokuhlinzwa
【Okunconyiwe】 Iziguli ezinokuhlinzwa okukhethekile zingadla iziphuzo ezicacile amahora ama-2 ngaphambi kokuhlinzwa nokudla okunesitashi noma imikhiqizo yobisi amahora ayi-6 ngaphambi kokuhlinzwa. (Izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma eliqinile: 76.5%)
8. Ukuphathwa kwe-catheter yomchamo we-perioperative
【Isincomo】I-catheterization ye-perioperative yomchamo ayinconyelwe ekuhlinzweni okuseduze kokuphuka kwe-humerus (Izinga lokuncoma lochwepheshe: 100%; Izinga lokuncoma eliqinile: 78.6%)
9. Ukusetshenziswa kwe-Prophylactic kwezidakamizwa ze-perioperative antimicrobial
【Okunconyiwe】Ezigulini ezinokwephuka kwe-humerus okusondele okudinga i-endoprosthesis noma ukushintshwa kwamalunga, ukusetshenziswa kwe-prophylactic kwe-cephalosporins yesizukulwane sokuqala nesesibili kuyanconywa ukuze kuvinjelwe ukutheleleka ngesikhathi sokuhlinzwa. (Izinga lokuncoma lochwepheshe: 97.1%; izinga lokuncoma eliqinile: 73.5%)
10. Ukukhetha i-anesthesia
【Okunconyiwe】I-Anesthesia inconywa ukuthi isebenzise indlela yokubulala izinzwa evamile ehlanganisiwe ye-block block, ukhethe izidakamizwa ukuze ugweme ukungasebenzi kahle kwezitho ze-systemic ezigulini esezikhulile, futhi unake ukuqinisa ukuqapha (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 71.4%).
11. I-Intraoperative blood pressure contro
[Isincomo] Ukwehliswa okumaphakathi komfutho wegazi kufanele kunakwe ukuze kuncishiswe ukulahleka kwegazi kwe-intraoperative for proximal humeral fractures, kodwa iziguli esezikhulile ezine-comorbidities eziningi kufanele zinake ukugcina ukuzinza kwe-hemodynamic ukuze kugwenywe ukuchithwa okwanele kwezicubu nezitho (isilinganiso sokuncoma kochwepheshe: 100%; izinga lokuncoma elinamandla: 61.9%).
12. Ukuphathwa kwevolumu ye-intraoperative
[Isincomo] Sebenzisa isu lokulawula uketshezi olugxile emgomweni, futhi izidakamizwa ze-vasoactive zinganikezwa i-prophylactically phakathi ne-anesthesia evamile ukuvimbela ukugcwala koketshezi (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 69.1%).
13. Ukulawulwa kwegazi ngokuhlinza
[Izincomo] I-hypotension elawulwa nge-intraoperative ayinconyelwe ekuqhekekeni kwe-humeral eseduze, ikakhulukazi ezigulini esezikhulile, kanye nokumpontshelwa igazi nge-intraoperative kanye ne-tranexamic acid ingasetshenziswa. Ukuhlolwa kwangaphakathi kokuhlinzwa kwe-HGB <80g/L kuncoma ukumpontshelwa igazi le-allogeneic (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 73.8%).
14. Ukuvimbela i-hypothermia ye-intraoperative
[Izincomo] Iziguli ezine-proximal humeral fractures kufanele ziqinise ukuqapha izinga lokushisa ngaphakathi kokuhlinzwa futhi zithathe izinyathelo ezihlukahlukene zokulondoloza izinga lokushisa eliyisisekelo ngaphezu kuka-36 ° C (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 76.2%).
15. Ukukhetha indlela yokuhlinzwa
(1) Ukuphuka kwesiteji se-proximal humerus
[Isincomo] Isiteji sika-Neer siyanconywa ngesiteji sokuphuka kwe-humerus (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma eliqinile: 83.3%).
(2) Indlela yokuhlinzwa
Uhlelo lokuhlinza kufanele lukhethwe ngokusekelwe ku-morphology yokuphuka, ikhwalithi yamathambo, isimo somzimba nesengqondo yesiguli nezinye izici ezifanele.
[Incomo] Izinto zokulungisa zangaphakathi zingakhethwa ngokuya ngohlobo lokuphuka kanye nokuminyana kwamathambo, njengepuleti noma izinzipho ze-intramedullary; ezigulini esezikhulile ezine-osteoporosis okunzima ukusetha kabusha noma ukulungisa, ukuhlukana kwe-4-part (kanye nokukhishwa kwe-fracture), ukuphuka kwe-3-part ne-osteoporosis enzima, ukuhlukana kwe-split kanye ne-anatomical neck fracture, ukuguqulwa okuhlangene kwehlombe kukhethiwe, futhi ukuhlehliswa kwe-joint joint kunconywa uma kuhlanganiswe ne-rotator cuff rate rate : isilinganiso se-rotator 0 esincomayo: isilinganiso se-rotator 0 sincoma. 71.4%).
![I-Proximal humerus fracture]()
Umfanekiso 1 Owesifazane oneminyaka engama-65 ubudala onokuphuka okuyizingxenye ezi-4 zokufakwa okusondelene kwe-humeral adductor kanye ne-allograft fibular implant plate fixation ngokusika nokubeka kabusha.
16. Ukubekwa kweshubhu lokudonsa isilonda
[Izincomo] Izinkomba zokungabeki amashubhu okukhipha amanzi: ① Amasu okusebenza angavamisile (i-MIPPO kanye nezipikili ze-intramedullary); ② Ukopha okuncane. Izinkomba zokubekwa kweshubhu lokudonsa amanzi: ① ngendlela ye-pectoral deltoid, ukulungisa ipuleti lokukhiya noma ukushintshwa kwamalunga ehlombe; ② ukopha okukhulu endaweni yenxeba (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 71.4%).
17. Ukuvalwa kwenxeba
【Isincomo】Ukusikwa kokuhlinzwa kuvalwe ngokuphazanyiswa okulula, ukuthungwa kwesendlalelo ngesendlalelo (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma eliqinile: 76.2%).
18. Ukudla okubuyisela ngemva kokuhlinzwa
【Okunconyiwe】Iziguli zingadla iziphuzo ezingenazo izinsizi ngomlomo uma sezivukile ngemva kokuhlinzwa, futhi ziphinde ziqale ukudla okuvamile ngemva kwehora elingu-1-2 uma kungekho ukusabela okubi.
19. Ukukhetha isikhundla ngemuva kokuhlinzwa kanye nomsebenzi wangaphambi kwesikhathi
【Isincomo】Iziguli azidingeki zilale phansi emcamelweni ngemva kokuhlinzwa, zingathatha indawo ecishe ifane ne-recumbent futhi zikwazi ukuhamba phansi ngemva kokuvuka. I-brace yehlombe ehlukumezayo kufanele ibhuleki.
20. Izinyathelo ze-analgesic zangemva kokuhlinzwa
【Okunconyiwe】I-analgesia yangemva kokuhlinzwa ezigulini eziphuke i-humeral proximal iyanconywa ukuthi isebenzise ukuvinjelwa kwesifunda kuhlanganiswe 'imithamo yangemuva' evamile yama-NSAID, futhi uma kunesidingo, amaphampu e-analgesia azilawula wona ngomthambo noma amaphampu e-peripheral nerve block self-administered: izinga lokuphulukisa10 lincoma: isilinganiso se-expergesia 78.6%).
21. Ukuvimbela isicanucanu nokuhlanza ngemva kokuhlinzwa
[Incomo] Zonke iziguli kufanele zinikezwe imithi ye-prophylactic antiemetic 30 min ngaphambi kokuphela kokuhlinzwa. (Izinga lokuncoma lochwepheshe: 97%; izinga lokuncoma eliqinile: 47.8%)
22. Ukuvuselelwa okusebenzayo
【Isincomo】Iziguli ezine-proximal humerus fracture engaguquki futhi ezinzile kufanele ziqale izivivinyo zokubuyisela esimweni ngokushesha ngangokunokwenzeka ngemva kokuhlinzwa. Izivivinyo zokuvuselela zisiza ukubuyisela kangcono ukusebenza kwesitho esiphezulu (Izinga lokuncoma lochwepheshe: 100%; Izinga lokuncoma elinamandla: 92.9%).
23. Imibandela yokukhipha kanye nokulandelela
【Isincomo】Imibandela esebenzayo yokukhishwa kufanele isungulwe, futhi iziguli kufanele zilandelelwe njalo okungenani izinyanga eziyi-6 (izinga lokuncoma lochwepheshe: 100%; izinga lokuncoma elinamandla: 83.3%).
Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?
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Ngaphezu kwalokho, sizibophezele ekuthuthukiseni imikhiqizo emisha ngokuqhubekayo nokwandisa imigqa yemikhiqizo, ukuze sihlangabezane nezidingo zokuhlinzwa zodokotela abaningi neziguli, futhi senze inkampani yethu iqhudelane kakhulu kuwo wonke umkhakha womhlaba wonke wokufakwa kwamathambo nezinsimbi.
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