Kwelashwa kanjani ukuphuka kwe-periprosthetic?

Inhloso

Ukuphuka kwe-Periprosthetic ye-proximal femur kuyinkinga enkulu ku-hip arthroplasty. Isigameko esibikiwe singu-3.5% eminyakeni engama-20 ngemuva kokufakelwa kwasekuqaleni futhi siyanda ngezigameko zokushintshwa kwamalunga. Ukuphuka kwe-intraoperative ngokuvamile kuhlotshaniswa neziqu ezingakhokhiwe. Ngokuvamile, ukuphuka kwenzeka kubantu abadala asebekhulile abawela ngaphansi kokuhlinzwa. Nakuba kunomehluko wamazwe ngamazwe ekusetshenzisweni kweziqu zikasimende nezingafakwanga, abukho ubufakazi obucacile bokuthi uhlobo olulodwa lwesiqu esihlanganisiwe luhlotshaniswa nengozi ephakeme yokuphuka kunomunye. I-Vancouver classification system ye-periprosthetic femoral fracture iye yamukelwa kabanzi odokotela abahlinzayo futhi iboniswe ukuthi ithembekile.

Inhloso eyinhloko yalolu cwaningo kwakuwukunquma ubudlelwano phakathi kwesigaba se-Vancouver sokuphuka kwesiqu esisasimende nokungagxiliwe. Inhloso yesibili kwakuwukuphenya umehluko ezicini eziyisisekelo zeziguli ezinezinhlobo ezimbili zokuphuka.

Izimpahla nezindlela

Isiguli:

1. Uchungechunge lweziguli ezine-proximal periprosthetic fractures elandelanayo.

2. Iziguli kuphela ezinama-primary hip periprosthetic fractures zifakiwe.

3. Iziguli ezine-intraoperative fractures, ukubuyekezwa kwe-hip fractures, kanye ne-interprosthetic fractures azifakiwe.

   
   

Irekhodi ledatha:

1. I-radiography yedijithali kanye ne-computed tomography esekelwe kumadokhumenti kagesi kanye nokuhlaziywa.

2. Imininingwane eyisisekelo erekhodiwe ihlanganisa iminyaka, ubulili, inkomba yesisindo somzimba, nokuncipha kokuhamba ngaphambi kokuqala noma ukuncika komnakekeli.

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Irekhodi lemininingwane yokuhlinzwa:

1. Isikhathi sokufakelwa kokuqala, inkomba ye-arthroplasty (i-osteoarthritis noma i-fracture), uhlobo lwesiqu (esimisiwe noma esingafakwanga), kanye nohlobo lwe-arthroplasty (ingqikithi noma i-semiarthroplasty) yafakwa.

2. Amarekhodi ezithombe anemininingwane ahlanganisa ukuhlukaniswa kweVancouver, isikhundla se-varus vertebral, kanye nokuhlukaniswa kwe-Dorr.

3. I-Stem geometry (i-conical noma i-compound yeziqu zikasimende, eziqondile noma ezimise okwe-wedge zeziqu ezingafakwanga) zaqoshwa ngokusekelwe ekubukeni kwe-radiographic.

4. Ukunqunywa kokuhlukaniswa kweVancouver kwakusekelwe ekutholweni kwezithombe kanye nokutholwe ngaphakathi kokuhlinzwa ezigulini ezihlinzayo.

5. Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa ukuhlolwa okuguquguqukayo okuqhubekayo kwe-T-test kanye nokuhlolwa okuqondile kukaFisher kokuguquguquka kwezigaba ukuze kuqhathaniswe izici eziyisisekelo kanye nokuhlukaniswa kwe-Vancouver kweziguli emaqenjini e-stem afakwe usimende futhi angafakwanga.

6. Zonke izivivinyo bezinezinhlangothi ezimbili nezinga lokubaluleka elingu-0.05. Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa inguqulo ye-GraphPad Prism engu-8.0.0.

   
   

Imiphumela

Inombolo yeziguli:

1. Ziyi-1181 iziguli ezihlonzwe ngokubuza imininingwane yesibhedlela.

2. Iziguli ezingama-978 ezine-non-periprosthetic proximal femur fractures azifakwanga.

3. Phakathi kweziguli ezisele ze-203, i-8 yayine-intraoperative fractures, i-6 yayine-revision periprosthetic fractures, kanti i-17 yayine-periprosthetic fractures yedivayisi yokulungisa i-hip joint, engazange ifakwe ngaphandle.

4. Ziyi-172 iziguli ezifakiwe ngemuva kokuvalelwa ngaphandle.

5. Wonke ama-fracture enzeka ngemva kokuwa. Iqembu le-Femoral stem bone Cement liphuka emacaleni angama-84 ngaphandle kukasimende

6. Kwakukhona ukuphuka kwe-88 eqenjini.

   
   

Izici eziyisisekelo:

1. Kube nomehluko omkhulu phakathi kwamaqembu ngobudala, isikhathi sokufakelwa kokuqala, izinkomba ze-arthroplasty yokuphuka kwentamo yesifazane, i-hemiarthroplasty eyinhloko, ukubekwa kwe-varus stem, kanye ne-index mass body.

2. Ikakhulukazi, eqenjini likasimende, iningi laliyi-hemiarthroplasty.

3. Kwakungekho mehluko obalulekile phakathi kwamaqembu maqondana nocansi, ukuhlukaniswa kwe-Dorr, nokuncipha kokuhamba kwangaphambili noma ukuncika komnakekeli.

4. Eqenjini likasimende, iziqu eziningi zazicijile kanti ezinye zaziyimiklamo eyinhlanganisela.

5. Eqenjini elingafakwanga usimende, iziqu eziningi zaziqondile kanti ezinye zazimise okwe-wedge.

   
   

Izigaba zeVancouver:

1. Ukuphuka kwe-VancouverB2 kuhlukaniswa kwaba amaphethini amane okuphuka ahlukene: okuchazwe ngaphambilini 'ukuqhuma', i-clamshell, namaphethini e-helical, kanye nephethini ye-clamshell 'reverse' esanda kubonwa. Ukuvela kwe-X-ray kommeleli kochungechunge kanye nokuboniswa kwesithombe okuhambisanayo kuyaboniswa (Umfanekiso 1).

2. Ukuphuka kwe-Burst and spiral fractures kwakuhlotshaniswa kakhulu neziqu zikasimende, kanti ukuphuka kwe-flap kwakuhlotshaniswa kakhulu neziqu ezingafakwanga.

3. Iphethini ye-clamshell ehlane yenzeka ngokufanayo kuzo zombili iziqu.

4. Ukuhlotshaniswa kwama-subtypes okuhlukaniswa kwe-Vancouver, okuhlanganisa izinhlobo ezine zokuphuka kwe-B2 ezichazwe ngenhla, ne-stem geometry ibonisa inkambiso evamile ezinhlotsheni zokuphuka.

Xoxa

Kuze kube manje, lolu ucwaningo olukhulu kakhulu lokuqhathanisa ngokuqondile ubudlelwano phakathi kokuqhekeka kwe-stem periprosthetic kasimende nokungafakwanga kanye nokuhlukaniswa kwe-Vancouver:

• Awukho umehluko obalulekile ebudlelwaneni phakathi kweziqu zikasimende nezingafakwanga usimende ohlotsheni lwe-Vancouver uhlobo A, B, noma C. Isigameko se-VancouverB2 fractures sasifana kuwo womabili amaqembu, okubonisa isigameko esifanayo seziqu ezinzile nezingazinzile ekuqhekekeni kwe-periprosthetic kuwo womabili amaqembu.

• Ngokuphambene, uFenelon et al. kuhlaziywe ukuphuka kwe-periprosthetic ngeziqu zikasimende nezingafakwanga. Kuyacaca ukuthi isibalo seziguli eziphuke eVancouver B2 naseB3 siphezulu kakhulu.

• Phillips et al. chaza iphethini 'yokuqhuma' esetshenziswa kakhulu yamasegimenti esiqu sikasimende 'kanye nokuqhekeka' eduze kwebhantshi likasimende, elifana 'nekhanda lembazo'. Lokhu kuphuka kutholakale ukuthi kuhlotshaniswa kakhulu neziqu zikasimende kulolu cwaningo.

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• Imvelo ephezulu ehambisanayo yalokhu kuphuka iphakamisa ukukhathazeka mayelana nokucisha amathambo, futhi lezi ziphuka ngokuvamile zidinga ukususwa ngokucophelela kukasimende nokudlula nge-distal bear stem.

• Capello et al. ichaze ukuphuka 'i-flip-flop' ehlobene neziqu ezingafakwanga usimende, futhi okutholakele kubonisa lokhu okutholakele. I-fracture isuka kusisekelo esimaphakathi se-trochanter enkulu, idlulela ku-cortex ephakathi, futhi igcine i-lateral cortex, i-distal kuya ku-trochanter encane. Ukwandiswa kwesifunda se-talar kanye nokuncipha kwesiqu izimpawu ze-radiographic zokungaqini kwesiqu. Ucwaningo lwangaphambilini lubonise ukuhlotshaniswa okubalulekile kwalokhu kuphuka neziqu ezingakhokhiwe ezinemiklamo emise okwe-anatomical kanye ne-wedges, futhi lolu cwaningo lusekela le nhlangano.

• I-Grammatopolous et al ichaza uchungechunge lwamaphethini okuphuka kwe-helical ekuqhekekeni kwe-periprosthetic eneziqu zikasimende, ngokuvamile ezihlotshaniswa nezingcezu ezihlukanisiwe ze-wedge kanye nokuqala okunzima. Inani lokuqhekeka kwe-helical esiqwini sikasimende landa kakhulu kulolu chungechunge, olungase lubonise ukuthambekela kokuqhekeka okuzungeze isiqu esine-tubular esine-cemented ukuze sisakaze ngendlela efana nethambo lemvelo.

• Ekuhlaziyweni kwe-radiographic kwenani elikhulu le-periprosthetic fractures, ithimba locwaningo libone iphethini yokuphuka engachazwanga ngaphambili ezincwadini. Ukuphuka kuvela ku-calcar ephakathi edlula ku-lateral cortex, okushiya i-medial cortex iphelele. Lolu hlobo lokuphuka lubizwa 'ukuhlehla' kwegobolondo le-clamshell, ucwaningo oluthathe njengokuphuka okuvamile kwe-Vancouver B2.

• Leli gama likhethwe ngenxa yezizathu ezimbili: okokuqala, liyisithombe sesibuko 'flip', futhi okwesibili, liziphatha njengokuhlehla kwe-oblique proximal ye-femoral fracture, ngokugudluka okufanayo kwe-supralateral komthumbi edonsa ucezu oluseduze . Ukuphuka okufanayo kwenzeka ngeziqu zikasimende nezingafakwanga (Umfanekiso 2).

• Nakuba inhloso yalolu cwaningo bekungekhona ukuphenya imiphumela yokwelashwa, kulolu cwaningo, ukuhlehla kwe-flip-flop fractures ngokuvamile kwabuyekezwa nge-arthroplasty yesiqu esithwala umthwalo we-distal kanye nokulungiswa kwezingcezu eziseduze zokuphuka ngezintambo ze-cerclage noma amapuleti.

• Isibonelo sesiguli esiphathwe ngale ndlela siboniswa, sibonisa ukuphumelela kokuphulukisa (Umfanekiso 3).

Umfanekiso 2 Reverse iphethini yokuphuka kwe-flip-top.

Umfanekiso 3 Ukulungiswa kwe-arthroplasty kanye ne-cerclage wire for retrograde flap fractures.

Isiphetho

Ngokohlelo lokuhlukaniswa kwe-Vancouver, izinhlobo zokuphuka kwe-periprosthetic zinezigameko ezifanayo zokuphuka kwe-periprosthetic kuma-prostheses kasimende nangenasimende. Ngakho-ke, izehlakalo zeziqu ezizinzile nezingazinzile ngemva kokuphuka zazilingana emaqenjini amabili. Ukuhlonza amaphethini amane ahlukene okuphuka kwe-VancouverB2, okuhlanganisa nephethini esanda kubonwa ehlanekezelwe ye-flip-flop, kuzosiza odokotela abahlinzayo ukuhlonza ukungazinzi kwesiqu. Kudingeka izifundo zesikhathi esizayo ukuze kuphenywe ubudlelwano phakathi kohlobo lokuphuka kanye nesu lokwelapha ukuze kunqunywe ukubaluleka komtholampilo kokutholwe kwalolu cwaningo.

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