Ukwelashwa kokuhlinzwa kwe-humeral stem fractures namaphuzu obuchwepheshe

Umkhawulo wesisindo se-postoperative kufanele ugcinwe umkhawulo wekhilogremu eyodwa kuze kube yilapho kutholakala ukuphulukiswa okuphawulekayo kokuphuka (ngokuvamile izinyanga ezintathu).Ukuphuka kwe-Humeral stem fractures (HSF) kuvamile ngokuqhathaniswa, kubala cishe u-1% kuya ku-5% wakho konke ukuphuka. Isigameko sonyaka singu-13 kuya ku-20 kubantu abangu-100,000 futhi kutholakale ukuthi sanda ngeminyaka.I-HSF inokusabalalisa kweminyaka yobudala be-bimodal, nenani eliphakeme lokuqala lenzeka emadodeni phakathi kweminyaka engu-21 no-30 ubudala kulandela ukuhlukumezeka okukhulu kwamandla, ngokuvamile okuholela ekuqhekekeni okuhlangene kanye nokulimala kwezicubu ezithambile ezihambisanayo. Isilinganiso esiphezulu sesibili senzeka kwabesifazane abaphakathi kweminyaka engama-60 nengama-80 ubudala, ngokuvamile kulandela ukuhlukumezeka kwamandla aphansi.

Ukwelashwa ngokuhlinzwa

一. Ukulungiswa kwangaphakathi ngepuleti lokubeka kabusha le-incisional

Izinkomba:

• I-Radial nerve palsy (RNP) ku-HSF ayiyona inkomba yokuhlinzwa ngoba ihlotshaniswa nezinga eliphezulu lokululama ngokuzenzekelayo (bheka futhi - Izinkinga/I-Radial Nerve ngezansi).

• Ngaphandle kwalokho, noma yikuphi ukulimala kwemithambo yegazi okudinga ukulungiswa noma ukudlula kuyinkomba ephelele yokwelashwa kokuhlinzwa kokuphuka, njengoba ukulungiswa okuqinile kuvikela i-anastomosis ye-vascular.

• Kulesi simo, ukulungiswa kwangaphakathi ngepuleti kuyashesha futhi kunokwethenjelwa kune-IMN ngoba ukulungiswa kwe-vascular kwenziwa ngendlela eqondile (ngokuvamile indlela ephakathi).

• I-HSF ene-proximal noma i-distal intra-articular extension ingesinye isimo lapho i-ORIF enamapuleti iyindlela engcono kakhulu.

  
  

Ukuchayeka ngokuhlinzwa:

• Amafracture atholakala engxenyeni eseduze kanye/noma emaphakathi yesithathu aphathwa kusetshenziswa indlela yakudala ye-anterolateral.

• Uma kudingeka, le ndlela inwetshwa kude ukuze kuvezwe yonke i-humer.

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

• Ukuphuka kwe-distal yesithathu kuvame ukuvezwa indlela yokuhlukaniswa kwe-triceps.

• Ngokuhlukana kwe-distal naphakathi kwesithathu, indlela engemuva eguquliwe echazwe nguGerwin et al30 ingadalula i-76-94% ye-humerus (kuye ngokuthi ukukhululwa kwe-radial nerve kanye nokukhululwa kwe-septal).

  
  

Amasu okuhlinza:

• Isiguli sibekwe endaweni yesihlalo solwandle ukuze kusetshenziswe indlela ye-anterolateral. Ukusetshenziswa kwe-brace yengalo kusiza ukugcina ukuqondanisa kwe-humeral stem. Ngokuchayeka ngemuva, indawo esemaceleni iyindawo ekhethwayo.

• Ukwakhiwa kwepuleti elilungile kuhlanganisa ipuleti lensimbi elingu-4.5 mm noma elilinganayo futhi kufanele limboze okungenani amakhola angu-6 ngaphezulu nangaphansi kwendawo yokuphuka, kodwa amakhola angu-8 ayakhethwa.

• Uma kudingekile, kunconywa inhlanganisela yepuleti elincane nelikhulu lezingcezu, njengepuleti lesithathu elifushane le-tubular ukuze kugcinwe ukuhlelwa kabusha (ukuphuka okuphambene noma ucezu lwevemvane), olube lulekelelwa ngepuleti elincane elingu-4.5 mm ukuze kulungiswe okokugcina ukuphuka.

• Ngokuhlukana kwesithathu kwe-distal, ipuleti le-posterior lateral preformed plate (3.5/4.5) liyanconywa ukuze kuvunyelwe ukulungiswa okuqinile kwe-epiphyseal.

  
  

Ukusetshenziswa kwezikulufu zokukhiya ku-HSF kuseyimpikiswano

• Uma uqhathanisa amapuleti okukhiya namapuleti angavali ama-fractures ahlanganisiwe anekhwalithi enhle yamathambo, ayikho inzuzo ye-biomechanical ku-torsion, ukugoba noma ukuqina kwe-axial kuzo zombili izakhiwo.

• Ngakolunye uhlangothi, lapho ubhekene nekhwalithi ephansi yamathambo, ukusetshenziswa kwamapuleti okukhiya kungase kube nenzuzo.

• Ocwaningweni lwe-biomechanical olwenziwa nguGardner et al. ikakhulukazi amamodeli okuphuka kwe-osteoporotic, izakhiwo ezingakhiyi ezingama-34 zazizinzile kakhulu kunezakhiwo zokukhiya noma ezihlanganisiwe.

I-splicing yamapuleti angenele kancane inketho yokuhlinzwa ebonakala inikeza izinga eliphezulu lempumelelo kanye nezinga eliphansi lenkinga. Kodwa-ke, ocwaningweni lokubuyela emuva olubandakanya iziguli ezingama-76, u-van de Wall et al. kubonise ukuthi ukuzinza okuphelele kokuphuka kwesiqu se-humeral kukodwa kusifinyeza kakhulu isikhathi sokuphulukiswa kwe-radiographic uma kuqhathaniswa nokuzinza okuhlobene.

Ukuphathwa kwangemva kokuhlinzwa:

• Ngokuvamile, ukulungiswa okuzinzile kutholakala ngokusetshenziswa kwepuleti. Ngakho-ke, isiguli sivunyelwe ukwenza imisebenzi esebenzayo futhi esebenzayo-esizwayo ngaphandle kokunqunywa ububanzi bokunyakaza kwehlombe noma indololwane.

• Isihlilingi singasetshenziswa izinsuku ezimbalwa ukulawula ubuhlungu.

• Umkhawulo wesisindo wangemva kokuhlinzwa kufanele ugcinwe ungaphezu kwekhilogremu eyodwa kuze kube yilapho kutholakala ukuphulukiswa okuphawulekayo kokuphuka (imvamisa izinyanga ezintathu).

• Iziguli ezisencane zivunyelwe ukuthwala isisindo lapho kuvunyelwe khona (isb., ukudinga izinduku ukuhamba), kodwa ezigulini esezikhulile lokhu kufanele kuxoxwe ngakho ngakunye.

Imiphumela ebikiwe

• Amazinga okuphulukisa ngemva kokucwenga asukela ku-87% kuya ku-96%, nesikhathi sokuphulukisa esimaphakathi samaviki ayi-12.

• Amazinga ezinkinga asukela ku-5% kuye ku-25%, nezinkinga ezingaqondile ezivame kakhulu ezifana nokutheleleka, i-osteonecrosis, ne-malunion.

• I-RNP etholakala ngokwezokwelapha iyingozi yezindlela eziningi ze-humeral stem. U-Streufert et al50 ubuyekeze izimo ze-261 ze-HSF eziphathwe nge-ORIF futhi wathola ukuthi i-RNP etholakala ngokwemithi yenzeke ku-7.1% yezindlela ze-anterolateral, i-11.7% yezindlela ezihlukanisiwe ze-triceps, kanye ne-17.9% yezindlela ezigciniwe ze-triceps.

• Ngakho-ke, kubalulekile ukukhomba nokuvikela i-radial nerve kuwo wonke ama-dissection avulekile.

  
  

二. I-Intramedullary nail

Izinkomba:

• Ngokwethiyori, i-IMN ingahlinzeka ngezinzuzo ze-biomechanical nezokuhlinzwa ezingcono kune-plating

• Ngokombono we-biomechanical, ukuma kwe-intramedullary yedivayisi kuhambisana ne-eksisi yomshini yesiqu se-humeral.

• Ngenxa yalesi sizathu, okokufakelwa kungaphansi kwamandla aphansi okugoba futhi kuvumela ukwabelana ngomthwalo ongcono. Izinkomba zokuhlinzwa zokubethelwa kwezipikili ze-intramedullary ziyefana nezokucwecwa.

• Kodwa-ke, njengoba kushiwo ngaphambili, amanye ama-fracture afaneleka kangcono ukubethelwa kunokubethela.

• Izici zokuphuka namaphethini okutholwe ukuthi aphakeme kune-IMN kukhona ukuphuka kwe-pathologic nokuseduze, izilonda zesigaba, nokuphuka kwe-osteoporotic.

• Ukuphuka okulula okuphakathi nendawo kwesithathu nakho kuyizinkomba ezinhle ze-IMN.

• Ngaphezu kwalokho, uzipho lungafakwa ngokusika okuncane, okunciphisa ukukhumula kwezicubu ezithambile uma kuqhathaniswa nendlela yokucwenga.

• Lokhu kuyiqiniso ikakhulukazi ngokuphuka kwengxenye yesithathu emaphakathi ye-humerus.

Indlela yokuhlinza:

• Indawo ekahle yesiguli yale nqubo isesihlalweni sasebhishi. Ukusetshenziswa kwe-brace yengalo kusiza kakhulu ekugcineni ukuhleleka kwe-shaft kanye nokwenza izikulufu zokukhiya ze-distal zamahhala.

• Iphuzu lokungena lincike ekwakhiweni kwe-nail, kodwa ngokuvamile litholakala lapho kuhlangana khona i-tuberosity enkulu kanye ne-articular surface yekhanda elinomswakama, okusho ukuthi imisipha ye-rotator cuff kumele ingene.

• Ngale nqubo, kunconywa ukwenza indlela yokuhlukanisa i-deltoid ukuze ubone ngeso lengqondo i-supraspinatus tendon.

• Eqinisweni, lapho kungena ekhanda le-humeral phakathi kwe-tendon ye-supraspinatus, umuntu uzozithola ephakathi kwekhanda endizeni ye-sagittal.

• Kubalulekile ukusebenzisa i-keratomile ngaphansi kwe-fluoroscopy ukuqinisekisa ukuthi indawo yokungena isesimweni esamukelekayo kuzo zombili izindiza ze-sagittal kanye ne-coronal.

• Ngemuva kwalokhu, ucingo lomhlahlandlela kufanele luthuthukiswe phambili ngaphambi kokuvula ithenda ye-supraspinatus ubude ngaphansi kombono oqondile.

• Isinyathelo esilandelayo sihlanganisa ukuvula umsele phezu kwenaliti ye-Kirschner, ukuqinisekisa ukuthi ukuphuka kuhambisana nokudonsa kanye/noma ukukhwabanisa kwangaphandle, bese uqhubekisela phambili umhlahlandlela ku-canal ye-intramedullary wehle uze ufike endololwaneni.

• Ukubuyisela emuva kutholakale kunenzuzo ezigulini ezisencane futhi akudingekile ngaso sonke isikhathi ezigulini ezindala.

• Ekubekweni kwebholithi ye-distal, ukukhiya kwe-AP kuphephe kakhudlwana futhi kudinga indlela encane engu-2-3 cm ukunciphisa ubungozi bokulimala kwenzwa ye-myocutaneous.

• Okokugcina, i-IMN ehambisanayo ingcono kune-IMN yokubuyisela emuva ngenxa yezinkinga ezithile zamuva ezihlanganisa ukuphuka kwe-supracondylar okubangelwa ukwelashwa, ukulahlekelwa kwesandiso sendololwane, kanye ne-heterotopic ossification.

  
  

Kudingeka ukunakwa okukhethekile kubude bezipikili ezikhethiwe, njengoba izinzipho ezinde kakhulu zingaholela emaphutheni amabili obuchwepheshe:

• Ukuphazamiseka endaweni yokuphuka ngesikhathi sezipikili zomthelela

• kanye/noma izinzipho eziphumela esikhaleni se-subacromial

  
  

Nge-proximal third helix noma i-oblique fractures ende, ababhali batusa indlela evulekile encane yokunciphisa ukuphuka okulandelwa ukulungiswa ngentambo ye-ring tie. Eqinisweni, kulolu hlobo oluncane lokuphuka, umsipha we-deltoid uthambekele ekuthumbeni ucezu olusondelene lokuphuka kuyilapho i-pectoralis enkulu idonsa ingxenye yokuphuka kwe-distal, okwandisa ingozi ye-osseous nonunion noma ukulibaziseka ukuphulukiswa.

Ukuphathwa kwangemva kokuhlinzwa

• Iziguli zikhuthazwa ukuba zenze ukunyakaza okusebenzayo nokusebenzayo kwehlombe nendololwane njengoba kubekezelelwe.

• Izihlilingi zingasetshenziswa izinsuku ezimbalwa ukulawula ubuhlungu.

• Imikhawulo yokuphakamisa isisindo ngemuva kokuhlinzwa igcinwa ifinyelela kukhilogremu eyodwa kuze kubonakale ukuphulukiswa kokuphuka (imvamisa izinyanga ezintathu).

• Ezimweni eziningi, ukuthwala isisindo kuvunyelwe

  
  

Okutholakele okubikiwe:

• Izincwadi zokusetshenziswa kwemishini yokukhiya yezinzipho zokuphatha i-HSF azihambisani. Ngakolunye uhlangothi, izinga elibikiwe le-bone nonunion liyahlukahluka kakhulu (phakathi kuka-0% no-14%), nesigameko esiphezulu kakhulu ezizukulwaneni ezindala zezipikili. Ngakolunye uhlangothi, izigameko zezinkinga zehlombe (kuhlanganise nobuhlungu, ukufakwa, ukulahlekelwa ukunyakaza noma amandla) (kusukela ku-6% kuya ku-100%) kuye kwabikwa ezincwadini zangaphambilini.

• Ingxenye yenkinga ingachazwa ukuhlukumezeka kwe-subacromial ngenxa yokungasebenzi kahle kwe-tendon okubangelwa izipikili eziphumayo, izicubu ezibomvu kanye / noma ukulimala kwe-rotator cuff kule ndawo ebalulekile ye-isovascularity.

• Ababhali abaningana baye bachaza izindlela ezahlukene zokugwema lesi sifunda se-hypovascular futhi balungise ithenda ngendlela ehlakaniphile, ebonise amazinga aphansi okungasebenzi kahle kwehlombe.

  
  

Ukwelashwa okulondolozayo kwe-HSF kunikeze imiphumela emihle yokusebenza kanye namazinga aphezulu okuphulukisa okungenani kuma-80% eziguli. Ngalesi sizathu, ihlala iyindlela yokwelapha ekhethwayo kwabaningi be-HSF. Uma ukuqondanisa kungamukelekile, ukuhlinzwa kufanele kucatshangelwe. Lokhu kuyiqiniso ikakhulukazi ezigulini ezineminyaka engaphezu kwengu-55 ubudala ezethula ukuphuka kwe-oblique okwesithathu (izinga lokuphola eliphansi). Ngokuphathelene nokwelashwa kokuhlinzwa, izincwadi azibonisi umehluko obalulekile phakathi kwamapuleti kanye ne-IMN ngokwezinga lokuphulukisa noma izinkinga ze-radial nerve, kodwa izinkinga zehlombe (ukuvinjelwa kanye nokunciphisa ububanzi bokunyakaza) kungenzeka kakhulu nge-IMN. Ngakho-ke, i-cuff kufanele iphathwe ngokucophelela kakhulu lapho kungena khona nalapho kuvalwa.

Mayelana I-CZMEDITECH

Iqhutshwa ukholo lokuthi wonke umuntu kule planethi ufanelwe insiza yezempilo engcono. I-CZMEDITECH  isebenza ngentshiseko ukusiza abanye baphile ngokungesabi. Siyaziqhenya lapho iziguli ezihlomule kakhulu futhi zibe nempilo engcono ngenxa yemikhiqizo yethu kanye nezinyathelo zethu sezikhule zafinyelela emazweni angaphezu kuka-70, lapho iziguli, odokotela kanye nozakwethu ngokufanayo bethembele  I-CZMEDITECH ekuqhubekeleni phambili. Wonke ama-orthopedic implant akhiqizwa yithi ahlangabezana nezindinganiso zekhwalithi ephezulu kakhulu.

Saqala uhambo olungajwayelekile ngokufakwa kwamathambo eminyakeni eyi-13 edlule. Kulolu hlelo, ulayini wokukhiqiza uhlukaniswe waba izimila ze umgogodla, ukuhlukumezeka, i-cranial-maxillofacial, izitho zokufakelwa, amathuluzi kagesi, izilungisi zangaphandle, arthroscopy  futhi ukunakekelwa kwezilwane , kanye ne amathuluzi  asetshenziswa ezinkambisweni zokuhlinza ezihlobene.

Zonke izinto zethu zokusetshenziswa zivela kubahlinzeki bekhwalithi ephezulu basekhaya nabaphesheya. Uma kuziwa endabeni yekhwalithi, asilokothi sigodle izindleko kunjongo yethu yokuhlala sihamba ibanga elide, ngalokho simisa ilebhu yethu yokuhlola ukuze siqinisekise ikhwalithi yezinto ezingavuthiwe. Yonke imishini yethu yokukhiqiza ingeniswa ivela e-USA, Germany, Japan kanye nemikhiqizo ephezulu e-Domestic ukuqinisekisa ukunemba kwawo wonke umkhiqizo esiwukhiqizile.

Kutshalwe isikhathi esiningi nomzamo ekucwaningeni ngentuthuko nokukhuphula umkhiqizo wokugcina. Sinethimba labacwaningi abaqeqeshiwe, ithimba labakhiqizi kanye nethimba le-QC lokuqinisekisa ikhwalithi engcono kakhulu kanye nokwesekwa kwethimba lethu labadayisi ukuxazulula bonke ubunzima nokuhlinzeka ngesevisi engcono kakhulu ngemva kokuthengisa.

Sinothando ngokholo lwethu, sihlala sicindezela imikhawulo yolwazi lwethu ukuze sinikeze izixazululo zemikhiqizo emisha yawo wonke amakhasimende ethu emhlabeni wonke futhi senza imizamo engapheli yempilo yabantu.