Ukwelashwa okuhliswa kwama-stem fractures namaphoyinti wezobuchwepheshe

Ukuvinjelwa kwesisindo se-postoperative kufanele kugcinwe ngekhilogremu eyodwa kuze kube yilapho kutholakale ukuphulukiswa okubalulekile kwe-fracture (imvamisa izinyanga ezintathu) Izehlakalo zonyaka zingama-13 kuye kwangama-20 kubantu abangu-100 000 futhi kutholakale ukuthi zikhuphuka nge-Age.HSF inokusatshalaliswa kweminyaka yobudala, enesibalo sokuqala esenzeka kumadoda aphakathi kwamandla aphakathi kweminyaka, okuvame ukulimala ekulimaleni kwezicubu ezithambile. Isiqongqo sesibili senzeka kwabesifazane abaphakathi kweminyaka engama-60 no-80 ubudala, imvamisa kulandela usizi lwamandla aphansi.

Ukwelashwa okuhlinza

一. Ukulungiswa kwangaphakathi ngePhatisi Yesikhumbuzo Esiyisisekelo

Izinkomba:

• I-Radial Nerve Palsy (RNP) ku-HSF akuyona inkomba yokuhlinzwa ngoba ihlotshaniswa nesilinganiso esiphakeme sokululama okuzenzakalelayo (bheka futhi - izinkinga / i-radiel nerve engezansi).

• Ngenye indlela, noma yikuphi ukulimala kwe-vascular okudinga ukulungiswa noma i-bypass kuyinkomba ephelele yokwelashwa kokuhlinzwa kokuphuka, njengoba ukulungiswa okuqinile kuvikela i-anastomosis ye-vascular.

• Kulesi simo esithile, ukulungiswa kwangaphakathi ngeplate kushesha futhi kuthembeke kakhulu kune-IMN ngoba ukulungiswa kwemithambo kwenziwa ngendlela eqondile (imvamisa indlela yempilo).

• I-HSF ene-proximal noma i-distal intra-acticular eyengeziwe ngesinye isimo lapho i-orf enamapuleti iyindlela engcono.

  
  

Ukudalulwa Kuhlinzwa:

• Ama-fractures atholakala kwi-proximal kanye / noma ephakathi nengxenye yesithathu aphathwa kusetshenziswa indlela ye-anterelataral yasendulo.

• Lapho kudingeka, le ndlela inwetshwa kude ukuze iveze yonke i-humerus.

• Kodwa-ke, le ndlela ayinconyelwe ukuqhekeka kwe-distal intra-articular fractures.

• Ama-fractures we-distalt yesithathu avame ukudalulwa indlela yokuhlukanisa ehlukanisayo.

• Ukuqhekeka kwesithathu okuphakathi nendawo okuphakathi nendawo, indlela eguquliwe engemuva echazwe nguGerwin et Al30 ingaveza ama-76-94% we-humerus (kuya ngokukhululwa kwe-radial nepre).

  
  

Amasu okuhlinza:

• Isiguli sibekwa endaweni yesihlalo solwandle ngendlela ye-antelolantal. Ukusetshenziswa kwe-Arm brace kusiza ukugcina ukuqondanisa kwesiqu sokuthobeka. Ukuvezwa kwangemuva, isikhundla samuva yisikhundla esithandwayo.

• Ukwakhiwa kwepuleti okulungele kuqukethe ipuleti yensimbi engu-4.5 mm noma okulinganayo futhi kufanele kumboze okungenani ama-cortices ayi-6 ngaphezulu nangaphansi kwesayithi lokuphuka, kepha ama-cortices ayi-8 ayakhethwa.

• Lapho kudingeka, inhlanganisela yepuleti elincane nelincane liyanconywa, njengepuleti elifushane le-tubular ukuze lilondoloze ukubuyiselwa kabusha (ukwaphuka kwe-transverfy noma uvemvane ucezu), olusengezwa ngepuleti elincane le-4,5 ukuze kulungiswe umngcele wokugcina.

• Ukuqhekeka kwesithathu kwe-distal, ipuleti le-postolior lateral lateral

  
  

Ukusetshenziswa kwezikulufo ezikhiya ku-HSF kuhlala kuyimpikiswano

• Uma uqhathanisa amapuleti okukhiya ngamapuleti angewona akhiya ama-fractures ahlanganisiwe ngekhwalithi enhle yamathambo, akukho nzuzo ye-biomechanical in tersonion, ukugoba noma ukuqina kwe-axial kuzo zombili izakhiwo.

• Ngakolunye uhlangothi, lapho ubhekene nekhwalithi enamathambo ampofu, ukusetshenziswa kwamapuleti okukhiya kungaba yinzuzo.

• Esifundweni se-biomechanical esenziwe nguGardner et al. Ngokukhethekile amamodeli we-Osteoporotic Fracture, izakhiwo ezingama-34 ezingezona ezikhiya zazingazinzile kakhulu kunokukhiya noma izinhlaka ezihlanganisiwe.

Ukuhlukaniswa kwepuleti okuhlaselayo kancane kuyindlela yokuhlinzwa okubonakala kunikeza inani lempumelelo ephezulu kanye nezinga eliphansi lezinkinga. Kodwa-ke, ocwaningweni olubusayo olubandakanya iziguli ezingama-76, uVan de Wall et al. Kuboniswe lokho kuzinhlanga okuphelele kwama-stem fractures awodwa aqhakambisa kakhulu ukunciphisa isikhathi sokuphulukisa i-radiographic kuqhathaniswa nokuqina okuhlobene.

Ukuphathwa Kwe-Prostoperative:

• Imvamisa, ukulungiswa okuzinzile kutholakala ngokusetshenziswa kwepuleti. Ngakho-ke, isiguli sivunyelwe ukwenza imisebenzi esebenzayo futhi esebenzayo ngaphandle kokukhawulelwa ngohlu lokuhamba lwehlombe noma i-elbow.

• I-sling ingasetshenziswa izinsuku eziningana zokuphathwa kwezinhlungu.

• Ukuvinjelwa kwesisindo se-postoperative kufanele kugcinwe ngekhilogremu eyodwa kuze kube yilapho kutholwa ukwelashwa okubalulekile kwe-Fracture (imvamisa izinyanga ezintathu).

• Iziguli ezincane zivunyelwe ukuthwala isisindo lapho kuvunyelwe khona (isib. Ukudinga imitshingo ukuhamba), kodwa ezigulini ezindala lokhu kufanele kuxoxwe ngazo ngesisekelo secala.

Kubikwe imiphumela

• Amanani okuphulukisa ngemuva kokufakwa kwamapulangwe aqhamuka kuma-87% afinyelela kuma-96%, anesikhathi sokuphulukisa amasonto ayi-12.

• Amanani okuhambisana nawo asuka ku-5% afinyelela ku-25%, ngezinkinga ezivame kakhulu ezingezinhle ezifana nokutheleleka, i-osteonecrosis kanye ne-malonion.

• I-RNP ethathwe ngokwezokwelapha iyingozi yokusondela kwezimo ezithobekile. I-streferrt et al50 yabuyekezwa amacala angama-261 we-HSF aphathwe ngo-Orif futhi athola ukuthi i-RNP itholakele ngo-7.1% wezindlela ze-anzolageral, kanye ne-17.9% yezindlela ezigciniwe zeTriceps.

• Ngakho-ke, kubalulekile ukukhomba nokuvikela i-radial nerve kuyo yonke imidwebo evulekile.

  
  

二. I-intramenduvary nail

Izinkomba:

• Ngokweqiniso, i-IMN inganikeza izinzuzo ze-biomechanical nezehliselayo eziphakeme kakhulu ngokulinganisa

• Ngokombono we-biomechanity, ukuma kwensiza kwensiza kuqondaniswa ne-axis yemishini yesiqu esiminyanisi.

• Ngalesi sizathu, ukufakwa kufakwe amabutho aphansi aphansi futhi kuvumela ukwaba umthwalo okungcono. Izinkomba zokuhlinzwa ze-intrametundary Kiling ziyefana ne-plating.

• Kodwa-ke, njengoba kushiwo ngaphambili, ezinye iziqhekezo zilungele kangcono iplanethi kunokungena.

• Izici ze-Fracture namaphethini atholakele aphakeme kune-IMN kukhona ama-pathologic futhi aqhamuke ama-fractures, izilonda ezihlukanisiwe kanye nama-osteoporotic fractures.

• Ama-transver we-transverse aphakathi nendawo aphakathi nendawo nawo ayizinkomba ezinhle ze-IMN.

• Ngaphezu kwalokho, izipikili zingafakwa ngokuvela okuncane, okunciphisa ukwehla kwezicubu ezithambile uma kuqhathaniswa nendlela yokuqoqa.

• Lokhu kuyiqiniso ikakhulukazi ekuqhekekeni kwengxenye yesithathu ephakathi kwe-humerus.

Incebo kuhlinzwa:

• Isikhundla esifanele sale nqubo sisesihlalweni sasolwandle. Ukusetshenziswa kwe-arm brace kuwusizo kakhulu ekulondolozeni ukuqondanisa kweShaft kanye nokwenza izikulufa ezikhiyiwe ze-distal freehand.

• Iphuzu lokungena lincike ekwakhiweni kwezipikili, kepha imvamisa litholakala emhlanganweni we-turneluty enkulu kanye ne-artural forve of the head ye-tratleral, okusho ukuthi imisipha ye-rotator cuff kumele ungene.

• Kule nqubo, kunconywa ukwenza indlela yokuhlukanisa ye-deltoId ukubona ngeso lengqondo i-supraspinatus tendon.

• Eqinisweni, lapho ungena ekhanda lezinhlanya phakathi kwe-supraspinatus tendon, umuntu uzozithola enkabeni yekhanda endizeni ye-sagittal.

• Kubalulekile ukusebenzisa i-keratomile ngaphansi kwe-fluoroscopy ukuqinisekisa ukuthi iphuzu lokungena lisesimweni esamukelekayo kuzo zombili izindiza ze-sagittal nezenkolo.

• Ngemuva kwalokhu, ucingo lomhlahlandlela kufanele luthuthuke kakhulu ngaphambi kokuvula i-supraspinatus tendon endusly ngaphansi kombono oqondile.

• Isinyathelo esilandelayo siqukethe ukuvula umsele phezu kwenaliti yeKistschner, ukuqinisekisa ukuthi ukuqhekeka kuqondaniswe ngeTracTaction kanye / noma ukukhohlisa kwangaphandle, bese kuqhubekela phambili umhlahlandlela ku-intromuvary Canol phansi ku-elbow.

• Ukuvuselelwa kutholakale kuzuzisa iziguli ezincane futhi kungadingeki ngaso sonke isikhathi ezigulini ezindala.

• Ukubekwa kwe-distal bolt, ukukhiya i-AP kuphephile futhi kudinga indlela encane engama-2-3 cm ukunciphisa ingozi yokulimala kwezinzwa ze-myOCutaneouth.

• Ekugcineni, ukufana kwe-IMN kuphakeme ku-Retrograde Imn ngenxa yezinkinga ezithile zokugcina kubandakanya ukuphazamiseka kwe-supracondylar, ukulahleka kwe-elbow eyengezwa, kanye ne-heterotopic ossification.

  
  

Ukunakwa okukhethekile okudinga ukukhokhwa kubude be-nail ekhethiwe, njengoba izipikili ezinde kakhulu zingaholela emaphutheni amabili ezobuchwepheshe:

• Ukuphazamiseka endaweni ye-Fracture phakathi nail nomthelela

• kanye / noma izipikili ziphuma esikhaleni esingaphansi komhlaba

  
  

Nge-Proximal Helix yesithathu noma i-Oblique Fractures ende, ababhali bancoma indlela evulekile evulekile yokunciphisa ukwaphuka okulandelwa ngokulungiswa ngocingo lwendandatho. Eqinisweni, kulokhu okufihlakele kwe-subtype, izicubu ze-deltoid zivame ukwehla isiqephu se-proximal fracture ngenkathi i-pectoralis enkulu idonsa isiqephu se-distal fracture ngokulandelana, okukhulisa ubungozi bomuntu ongafanele noma ukuphulukisa.

Ukuphathwa kwe-postoperative

• Iziguli zikhuthazwa ukuthi zenze ukunyakaza okusebenzayo nokusebenzayo kwehlombe ne-elbow njengoba kubekezelelwe.

• Ama-slings angasetshenziswa izinsuku ezimbalwa zokulawulwa kobuhlungu.

• Imikhawulo yokuphakanyiswa kwesisindo se-postoperative igcinwa ngekhilogremu eyodwa kuze kube yilapho ukuphulukiswa kokuqhekeka kubonakala (imvamisa izinyanga ezintathu).

• Ezimweni eziningi, ukuthwala isisindo kuvunyelwe

  
  

Kubikwe okutholakele:

• Izincwadi ezisetshenziswayo zokukhiya amadivaysi okukhiya izipikili zokuphatha i-HSF akuhambelani. Ngakolunye uhlangothi, inani elibikiwe le-bone nonunion lihluka kakhulu (phakathi kuka-0% no-14%), ngesigameko esiphakeme kakhulu ezizukulwaneni ezindala zezinzipho. Ngakolunye uhlangothi, izehlakalo zezinkinga zamahlombe (kufaka phakathi izinhlungu, ukuqunjelwa, ukulahlekelwa ukunyakaza noma amandla) (kusuka ku-6% kuya ku-100%) kubikwe ezincwadini ezedlule.

• Ingxenye yenkinga ingachazwa ngokuhlukumezeka okungaphansi kwe-tendon ngenxa yokungasebenzi okungamahlalakhona okubangelwa yizipikili ezivimbela izinzipho, izicubu ze-scar kanye / noma ukulimala kwe-cutfuf ye-rotator kule ndawo ebucayi ye-isovascularlity.

• Abalobi abaningana bachaze izindlela ezihlukile zokugwema lesi sifunda se-hypovascular futhi balungise i-tendon ngendlela enokuqonda, ekhombisa amanani aphansi wokungasebenzi kahle ehlombe.

  
  

Ukwelashwa okulondoloziwe kwe-HSF kunikeze imiphumela emihle yokusebenza kanye namazinga aphezulu okupholisa okungenani ama-80% eziguli. Ngalesi sizathu, kusele ukwelashwa kokukhethwa kwe-HSF eningi. Uma ukuqondanisa akwamukeleki, ukuhlinzwa kufanele kubhekwe. Lokhu kuyiqiniso ikakhulukazi ezigulini ezingaphezu kweminyaka engama-55 ubudala ezethule nge-Proximal yesithathu exakile ukuqhekeka (isilinganiso sokuphulukisa esiphansi). Ngokuphathelene nokwelashwa okuhlinzayo, izincwadi azikhombisi noma yimuphi umehluko ophawule phakathi kwamapuleti kanye ne-IMN ngokuya ngamanani okuphulukisa noma izinkinga zezinzwa ze-radial, kepha izinkinga zehlombe (ukuncishiswa kanye nobubanzi obuncishisiwe) kungenzeka nge-IMN. Ngakho-ke, i-cuff kumele iphethwe ngokucophelela zombili endaweni yokungena nangesikhathi sokuvalwa.

Maqondana Czmeditech

Iqhutshwa ukholo lokuthi wonke umuntu kule planethi efanelekele ukunakekelwa kwempilo okungcono. ICzmeditech  isebenza ngentshiseko ukusiza abanye baphile ngesibindi. Siyaziqhenya lapho iziguli ezizuze kakhulu futhi zibe nempilo engcono ngenxa yemikhiqizo yethu kanye nemikhiqizo yethu yezinyawo zethu ziye zanda emazweni angaphezu kwangama-70, lapho iziguli, odokotela nabalingani ngokufanayo bathembela khona  Czmeditech ukuze badlulele phambili. Njalo ukufakwa kwamathambo okwenziwa yi-US kuhlangabezana namazinga aphezulu kakhulu.

Siqale uhambo olungejwayelekile nge-Orthopedic limisa eminyakeni engu-13 edlule. Kule nqubo, umugqa wokukhiqiza uhlukaniswe zaba izimila ze umgogodla, ukuhlukumezeka, I-Cranial-maxillofacial, UProsuthesis, Amathuluzi Amandla, Finators yangaphandle, I-Arthroscopy  futhi Ukunakekelwa kwezilwane , kanye ne izinsimbi  ezisetshenziswa ezinqubo ezihlobene nokuhlinzwa.

Zonke izinto zethu ezingavuthiwe zivela kubahlinzeki bekhwalithi ephezulu kwekhaya nakwamanye amazwe. Uma kukhulunywa ngekhwalithi, asikaze sigcine izindleko emhlanganweni wethu ukuze sihlale sihamba phambili, lapho sabeka ilebhu yethu yokuhlola ukuqinisekisa ikhwalithi ebonakalayo eluhlaza. Yonke imishini yethu yokukhiqiza ingeniswa kusuka e-USA, eJalimane, iJapan kanye nemikhiqizo ephezulu efuywayo ekhaya ukuze iqinisekise ukunemba kwawo wonke umkhiqizo esingawenza.

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