Kuthiwani uma ukulungiswa kwangaphakathi kohlaka lwe-rotator kuhluke kuhluleka?

Ama-Hip Fractures alinganiselwa kuthinta abantu abadala abangama-500,000 e-United States unyaka ngamunye. Banomthelela omkhulu kwikhwalithi yempilo, njengamanje kubalwa ngo-3-7% wokufa kwabantu esibhedlela kanye nesilinganiso sonyaka wokufa kuka-19.4-58%. Cishe uhhafu wazo zonke iziphaphuthuli ze-hip zingu-intertrochantteteric (it). Lezi zinkuni ezimbili ezivame kakhulu ezisetshenziselwa ukwelapha izipikili ze-cephalomedullary nail (CMN) kanye nesikulufa esishelelayo se-hip (SHS).

Naphezu kwentuthuko kwezobuchwepheshe, ukwehluleka kwamathambo nokulungisa ukwehluleka okufana nokungena kwekhanda lowesifazane kusenzeka futhi kungalimaza kakhulu. Izifundo zakamuva zibikiwe amanani afinyelela kwayi-6% ngezimpawu zesimanje. Izici zobungozi zokuhluleka kokulungiswa zifaka ibanga le-tip-tip Ukuguga kanye ne-osteoporosis kuhlotshaniswa nokuhluleka kokulungiswa.

Iziguli Nezindlela

Lolu kwakuwucwaningo olubusayo lweziguli eziphathwa khona ezikhungweni ezimbili ezitholakala ngaphakathi kohlelo lwezempilo endaweni enkulu yedolobha. Icala lezingodo zodokotela abahlinzayo ababili (JS kanye ne-BC) babuzwa ngazo zonke iziguli ezithole ukulungiswa kwesimo sokwenza isikhumba - Ukulungiswa kokuvuselelwa kwesimende ngemuva kokwehluleka kokulungiswa kokuqala kwaJanuwari 2018 kuya kuSepthemba 2021, ngemuva kokuvunywa yiBhodi Lokubuyekezwa Kwezikhungo. Ukusetshenziswa kokuqiniswa kukasimende ngesikhathi sokuhlinzekwa kabusha kwaqinisekiswa kuqinisekiswe ngerekhodi lezokwelapha (i-EMR) lokubuyekezwa kwamarekhodi okusebenza kanye nemisebe ye-postoperative. Sifaka zonke iziguli ezinezimpawu zokuqiniswa okwenziwe ngesibili ekuvuseleleni kahle ukulungiswa ngemuva kokuhluke kwe-CMN noma ukulungiswa kwe-SHS kokuhluzeka kwe-IT fractures (Umdwebo 1). Sikhiphe iziguli ngentamo yabesifazane noma ama-subtrochantteric fractures, iziguli ezingazange zihlasele ukulungiswa kabusha ngokuqiniswa kosekhukhweni, kanye neziguli ezazihlanza i-arthroplasty ngesikhathi sokuhlinzwa kokuqala kabusha.

Umdwebo 1. Owesifazane oneminyaka engama-76 ubudala uhlangene nokufihlela kwe-intertrochanterteric of femur (a), onobuhlungu obuphikelelayo be-hip ezinyangeni ezi-2 kamuva ngenxa ye-incision (b).

Amasu okuhlinza

Ezigulini ezithola ukulungiswa kokuqala nge-CMN, senze indawo eshintshiwe yekhanda le-NIP kanye nokuqiniswa kosekhukhweni lwamathambo. Ekuqaleni, kwenziwa i-5-cm exinision ohlangothini lwe-proxilal lwe-trochanter enkulu, ucingo lomhlahlandlela lwabekwa ohlangothini lwe-proxilal lwesipikili, futhi wonke amathambo asuswe ohlangothini lweProximal lwesipikili esebenzisa i-reamer evulekile. Okulandelayo, i-hexagonal screwdriver yayisetshenziselwa ukukhulula isikulufa sokulungisa ngaphezulu kwe-CMN (Umdwebo 2).

Umdwebo 2, i-Fluoroscopy ye-Intraperaterative ekhombisa ukuheha i-hexagonal screwdriver ehilelekile futhi ukhulula isikulufa esibekwe esabelwe ngaphambili.

Ukuvela okuguqukayo kwe-1-2 cm kwenziwa phansi nge-iLiotiolial Fascia (ITB). Ikhanda lasekuqaleni lekhanda lisuswa ngomhlahlandlela we-reverse ohlanganisiwe (Umdwebo 3). Endabeni ye-Femor Head Fordation, umhlahlandlela ongenamvundela onesikulufo esikhiyiwe distal kusetshenziswa ukuze uvikele ukuvuza kuka usimende ungene ku-Joint (Umdwebo 3a). Ngokukhethekile, i-matrix yaqala ukufakwa ngemuva kokususwa kwezendlalelo zangaphandle ze-Can Canland bese ifaka endaweni ebekwe ngenhlanganisela ngezendlalelo ezimbili zangaphandle.

Umdwebo 3, i-Intraperative antteroporeorirer (a) kanye ne-lateral (b) izithombe zesinye isiguli esibonisa ikhanda lesifazane nge-interstitic bone inkinga ngokuxhunyelelwa.

Okulandelayo, i-limb itholwa bese kukhishwa i-fracture ku-exestosis ngaphezulu kwe-exestosis yokuvuselelwa kabusha. Ezimweni zokuphulukiswa kwe-malonion noma ye-fibrous, kwenziwa i-osteotomy ye-percutaneous esebenzisa i-aptentatals ngendlela ye-anzolageral. Lokhu akudingekile kakhulu ukukhiqiza i-angle ye-cervical stem (okuhlosiwe> 130 °).

Isikulufa esisha noma i-spiral slowle bese ibekwa ithambo elingaphansi kwekhanda labesifazane eceleni kwe-axis yentamo yabesifazane, uqiniseke ukuthi uqaphela ukuthi ungangeni ekhanda (isithombe 4). Isikulufa sibekwe ngenhloso yokugwema ipheshana langaphambilini langaphambilini, kepha nokho likhomba ukuphela enkabeni yekhanda lowesifazane. (Umdwebo 5)

Umdwebo 4, i-anteropostereor (a) kanye ne-lateral (b) izithombe zesinye isiguli esibonisa ukufakwa kwenaliti yeKerfing endleleni yekhanda elisha lekhanda.

Umdwebo 5, i-fluoroscopy ye-intraperative ekhombisa ukufakwa kwe-cephalomedullary entsha entsha eduze kwendlela ye-wire yomhlahlandlela, eyayisekelwa ngemuva kwesikulufa esisethiwe.

Ekugcineni, inhloko yowesifazane igcwele usimende wamathambo usebenzisa uhlelo lwamathambo okujoyina (Umdwebo 6). Ukunakekelwa kuthathwa ukugwema ukukhishwa ekuhlanganiseni ngokusebenzisa ama-radiographs wesikhathi sangempela kanye nokushintsha ukujula nokuqonda kwe-cannula enesikhungu.

Umdwebo 6, ukucabanga okubonisa ukwanda kwesimende ekuqaleni (a), ukugcwaliswa kwezingane kancane kancane

Ezigulini ezithola ukulungiswa kokuqala kwe-SHS, sisusa ama-SHS bese sibeka i-CMN ende. Ngemuva kokwenza i-incision engu-5-cm maphakathi ne-trochanter enkulu futhi ekhomba i-ITB, ukuvela kuhlaselwa phansi epuletini lamuva. Zonke izikulufa zepuleti zisuswa kusetshenziswa i-screwdriver efanelekile neplate lateral ziyasuswa. Izikulufo zokungxabano zisuswa ngesiqondisi sentambo esibuyela emuva njengoba ngaphambili kuchazwe ukuthi uphinde ubeke kabusha ukuqhekeka ngezinga elikhulu le-Valgus. I-incision engu-5-cm yenziwa lapho kwenziwa esiqeshini se-trochanter enkulu njengoba kuchaziwe ngaphambili. Intambo yomhlahlandlela ifakwe ekugcineni kwe-trochanter enkulu kakhulu futhi yathuthuka esiqwini sowesifazane. I-reamer evulekile yethulwa endleleni yesiqondisi. Umhlahlandlela omude we-ball-tidped uvalwe enkabeni ye-distal femur ngaphansi kwezinga le-patella. Okulandelayo, ukuthuthukiswa okuqhubekayo kwenziwa kuze kube yilapho uTremor wazwakala emhlalwane. Zonke iziguli zethu zithole isipikili eside se-CMN nge-TFN-Advanced (TFNA) Femperal Foolimal Femorveraly Kiling System (Deputy-Synthes, Raynham, MA).

Ukukhuluma

Isu lethu lisebenzisa ukuqiniswa kwesimende sethambo ngesikhathi sokubukeza kabusha. Ukuqiniswa kwesimende samathambo okulungisela kokuqala kwama-osteoporotic proximal frur fractures kufundile futhi kukhombisile imiphumela emihle ye-biomechaline nemitholampilo. Ukubuyekezwa kwakamuva kubike ukuthi ukuqiniswa kwesimende sethambo kuholele ekutheni kube khona imithwalo ephakeme ephakeme, kuncishiswe ukufuduka okufakiwe, kanye nezinkinga ezimbalwa nokuvuselelwa okuqhathaniswa nokulungiswa okungatheni. Isifundo esifundwa ngokungahleliwe, esinemihlobiso sibuye sabika futhi ukuthi akukho zinguquko noma iziqephu ezibonakalayo zokufuduka kwe-CMN eqenjini eliqinisiwe likasimende uma liqhathaniswa namacala ayisithupha eqenjini elingezona amacala.

Ukufa kwe-Hip Fracture kuphakeme. Ucwaningo lwakamuva luchaze isilinganiso sokufa kwabantu esibhedlela esingu-3-7%, ngokuncipha kweminyaka elilodwa kuncipha kusuka ngo-19,4% kuya ku-58%. Ikakhulu, ukuqhekeka kwe-IT kuboniswe ukuphendula ngama-27% okufa konyaka. Uchungechunge lwethu lomtholampilo lwalusikhombisile ukungabi nokufa kwabantu esibhedlela kanye nesilinganiso sonyaka wokufa kuka-13.6%, okuphansi okuqhathaniswa nezincwadi. Ngoba ukuhamba kombhede kusenesikhathi ngemuva kokuhlinzwa kuhlotshaniswa nokufa okuphansi, i-avevation enhle kanye nemiphumela esebenzayo ochungechungeni lwethu kungachaza ukufa okuphansi okubonwa ezigulini zethu.

Ukugcina

Ukulungiswa kwesibuyekezo okuqinisiwe kuka-Cement-Redformed kuyindlela esebenzayo, ephephile, futhi engabizi kakhulu yokuhluleka kwe-Interstrochantteric Fractic Fractiore Fracture ukwehluleka ezigulini asebekhulile nge-Acetabular Bone Stock.

Iziguli ezinokulungiswa okuhlulekile kwama-intertrochantteric fracteric fractices alandelwa ukulungiswa kokubukeza kanye nokwelashwa okuqinisiwe kosimende kubonise imiphumela emihle yesikhathi eside emtholampilo kanye nekhwalithi yempilo. Inqubo yayisetshenziswa kuphela ezimweni lapho iningi le-acetabular acticular cerce lagcinwa futhi i-Head Nail yaqhubeka iqukethwe ngaphakathi kwentamo yabesifazane. Uma kucatshangelwa ukulinganiselwa kokubuyekezwa kwe-arthroplasty ezigulini ezindala ngobuhlakani, le nqubo ikhombisa ukuthembela ngokuphepha nangokucophelela ukunciphisa izinkinga ezinkulu ngenkathi kunciphisa isikhathi sokusebenza kanye nezindleko kuleli qembu leziguli.

Ungayithenga kanjani izimila zamathambo namathuluzi ama-orthopedic?

Ingomane I-CZMeditech , sinomugqa womkhiqizo ophelele we-Orthopedic Surgery izimila nezinsimbi ezihambisanayo, imikhiqizo kubandakanya izimila ze-spine, Izipikili ze-intramentundary, Ipuleti le-Trauma, Ukukhiya ipuleti, I-Cranial-maxillofacial, UProsuthesis, Amathuluzi Amandla, Finators yangaphandle, I-Arthroscopy, ukunakekelwa kwezilwane kanye nezinsimbi zabo ezisekelayo.

Ngaphezu kwalokho, sizibophezele ekuthuthukiseni ngokuqhubekayo imikhiqizo emisha kanye nokwandisa imigqa yomkhiqizo, ukuze sihlangabezane nezidingo zokuhlinzwa zodokotela neziguli eziningi, futhi zenze inkampani yethu icindezele ngokwengeziwe ezindaweni zonke zemboni yama-orthopedic kanye nemboni yezinsimbi.

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