Kuthiwani uma ukulungiswa kwangaphakathi kokuphuka kwe-inter rotator kwehluleka?

Ukuphuka kwe-Hip kulinganiselwa ukuthi kuthinta abantu abadala abangu-500,000 e-United States unyaka ngamunye. Zinomthelela omkhulu eqophelweni lempilo, okwamanje zibalwa ku-3-7% wokushona kwabantu esibhedlela kanye nezinga lokufa konyaka owodwa lika-19.4-58%. Cishe ingxenye yawo wonke ama-hip fractures yi-intertrochanteric (IT) fractures. Izimila ezimbili ezivame kakhulu ezisetshenziswa ukwelapha ukuphuka kwe-IT yi-cephalomedullary nail (CMN) kanye nesikulufu se-hip sliding (SHS).

Naphezu kwentuthuko kwezobuchwepheshe, ukungaqhubeki kwamathambo kanye nokwehluleka ukulungisa njengokungena kwekhanda lesifazane kusengenzeka futhi kungase kubangele umonakalo. Ucwaningo lwakamuva lubike izilinganiso zokuhlinza ezifika ku-6% ngezifakelo zesimanje. Izinto eziyingozi zokwehluleka ukulungisa zihlanganisa ibanga le-tip-tip (TAD) >25 mm, ukumiswa kabusha kokuphuka okunganele, amaphethini okuphuka angazinzile, ama-cephalic spikes abekwe eceleni noma ngezansi kwenkaba yekhanda lesifazane, nokuzungeza kwangaphakathi kwe-engeli yesiqu somlomo wesibeletho. Ukuguga kanye ne-osteoporosis nakho kuhlotshaniswa nokwehluleka ukulungisa.

Iziguli kanye Nezindlela

Lokhu bekuwucwaningo lweziguli ezelashwa ezikhungweni ezimbili ezingaphakathi kohlelo lokunakekelwa kwezempilo endaweni yedolobha elikhulu. Izingodo zamacala odokotela abahlinzayo ababili (i-JS kanye ne-BC) zabuzwa zonke iziguli ezathola ukulungiswa kokubuyekezwa okuqiniswe usimende ngemva kokwehluleka ukulungiswa kokuqala kokuphuka kwe-IT kusukela ngoJanuwari 2018 kuya ku-September 2021, ngemva kokugunyazwa yibhodi lokubuyekeza lesikhungo. Ukusetshenziswa kokuqinisa usimende ngesikhathi sokuhlinzwa kokubuyekezwa kwaqinisekiswa yirekhodi lezokwelapha likagesi (EMR) ukubuyekezwa kwamarekhodi okusebenza kanye nama-radiographs angemuva kokuhlinzwa. Sifake zonke iziguli ezinezimpawu zokuqiniswa kukasimende ekulungiseni ukubuyekezwa ngemva kokuhluleka kwe-CMN yokuqala noma ukulungiswa kwe-SHS kwe-IT fractures (Umfanekiso 1). Asizibandakanyi iziguli ezinentamo ye-femoral noma i-subtrochanteric fractures, iziguli ezingazange zibhekane nokulungiswa kokubuyekezwa ngokuqiniswa kukasimende, neziguli ezathola i-arthroplasty ngesikhathi sokuhlinzwa kokuqala kokubuyekezwa.

Umfanekiso 1. Owesifazane oneminyaka engu-76 ubudala wabhekana ne-intramedullary nailing for the intertrochanteric fracture of the femur (A), nobuhlungu be-hip obuqhubekayo ezinyangeni ezingu-2 kamuva ngenxa yokusikwa kokufakelwa (B).

Amasu okuhlinza

Ezigulini ezithola ukulungiswa kokuqala nge-CMN, senze ukushintshwa kwekhanda lekhanda elilungisiwe kanye nokuqiniswa kukasimende wethambo. Ekuqaleni, ukusika kwe-5-cm kwenziwa ohlangothini oluseduze lwe-trochanter enkulu, ucingo oluqondisayo lwafakwa ohlangothini oluseduze lwe-nail, futhi wonke amathambo akhishwa ohlangothini oluseduze lwe-nail kusetshenziswa i-reamer evulekile. Okulandelayo, i-screwdriver ene-hexagonal yasetshenziswa ukukhulula isikulufu sokulungisa phezulu kwe-CMN (Umfanekiso 2).

Umfanekiso 2, i-fluoroscopy yangaphakathi kokusebenza ebonisa i-screwdriver ene-hexagonal ibamba futhi ixegisa isikulufu esisethiwe esibethelwe ngaphambilini.

I-1-2 cm eguquguqukayo enqamulayo ibe isenziwa phansi nge-iliotibial fascia (ITB) fascia. Isipikili sekhanda sangempela sisuswa ngomhlahlandlela onentambo ehlanekezelwe (Umfanekiso 3). Esimeni sokubhobozwa kwekhanda lesifazane, umhlahlandlela ongenalutho onesikulufu sokukhiya i-distal usetshenziswa ukuze kuvinjelwe ukuvuza kukasimende ekuhlanganyeleni (Umfanekiso 3A). Ngokukhethekile, i-matrix yaqala ukujovwa ngemva kokususwa kwezingqimba ezimbili zangaphandle ze-cannula ezintathu zase zifakwa endaweni enembobo ngokuphinda kufakwe izingqimba ezimbili zangaphandle.

Umfanekiso wesi-3, izithombe ze-Intraoperative anteroposterior (A) kanye ne-lateral (B) zesinye isiguli esibonisa ikhanda lesifazane eline-interstitial bone defect graft.

Okulandelayo, isitho siyafinyezwa bese ukuphuka kuphinde kubekwe endaweni engaphezulu ye-exostosis ukuze kulungiswe kabusha. Ezimeni zokuphulukiswa kwe-malunion noma i-fibrous, i-osteotomy ye-percutaneous yenziwa kusetshenziswa i-1/4' bone gouge ene-anterolateral approach. Lokhu akuvamile kudingekile, kodwa kusebenza kakhulu uma kudingeka ukuze kukhiqizwe i-angle ye-stem yomlomo wesibeletho ethuthukisiwe (okuhlosiwe>130 °).

Isikulufu esisha noma i-spiral blade sibe sesifakwa ethanjeni le-subchondral ekhanda lesifazane eduze kwe-axis yentamo yesifazane, qiniseka ukuthi uqaphele ukuthi ungangeni ekhanda (Umfanekiso 4). Isikulufu sibekwe ngamabomu sigwema ipheshana lezinzipho zangaphambilini, kodwa sisakhombe ekugcineni maphakathi nekhanda lesifazane. (Umfanekiso 5)

Umfanekiso we-4, i-Anteroposterior (A) kanye ne-lateral (B) izithombe zesinye isiguli ezibonisa ukufakwa kwenaliti ye-kerfing endleleni ye-nail entsha yekhanda.

Umfanekiso wesi-5, i-fluoroscopy yangaphakathi kokusebenza ebonisa ukufakwa kwensingo entsha ye-cephalomedullary eduze komzila wezintambo zikamhlahlandlela, okwathi ngokuhamba kwesikhathi kwaqiniswa isikulufu esisethiwe.

Ekugcineni, ikhanda lesifazane ligcwele usimende wethambo kusetshenziswa isistimu ye-samente yethambo lomjovo (Umfanekiso 6). Ukunakekela kuthathwa ukuze kugwenywe ukukhishwa ejoyintini ngokusebenzisa ama-radiograph esikhathi sangempela nokulungisa ukujula nokuma kwe-cannula kasimende.

Umfanekiso wesi-6, Ukufanekisa okubonisa ukwanda kukasimende ekuqaleni (A), ukugcwaliswa kancane kancane (B) kuze kugcwaliswe iphutha lekhanda lesifazane (C).

Ezigulini ezithola ukulungiswa kokuqala kwe-SHS, sisusa i-SHS bese sibeka i-CMN ende. ngemva kokwenza ukusika okungu-5-cm phakathi nendawo ngezansi kwe-trochanter enkulu nokuhlonza i-ITB, ukusika kuhlakazwa phansi ku-lateral plate. Zonke izikulufu zamapuleti zikhishwa kusetshenziswa isikrudrayiva sesandla esifanele bese ipuleti elingemuva liyakhishwa. Izikulufu ze-tension bese zisuswa ngomhlahlandlela wentambo ehlehlayo njengoba kuchazwe ngaphambilini ukuze kumiswe kabusha ukuphuka kuzinga elikhulu le-valgus. Ukusika okungu-5-cm bese kwenziwa ekugcineni kwe-trochanter enkulu njengoba kuchazwe ngaphambilini. Intambo yomhlahlandlela ifakwa ekugcineni okusondele kakhulu kwe-trochanter enkulu futhi ithuthukele esiqwini sesifazane. I-reamer evulekile yethulwa endleleni ye-guidewire. I-guide wire-tipped guidewire ibe isifakwa phakathi nendawo ye-distal femur ngaphansi kwezinga le-patella. Okulandelayo, ukuphindaphinda kabusha kwenziwa kuze kube yilapho kuzwakala ukundindizela emhlane. Zonke iziguli zethu zithole isikhonkwane eside se-CMN nge-TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA).

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Indlela yethu isebenzisa ukuqinisa usimende wethambo phakathi nokulungiswa kokubuyekeza. Ukuqiniswa kukasimende wethambo ukulungiswa kokuqala kwe-osteoporotic proximal femur fractures kuhlolisisiwe futhi kubonise imiphumela emihle ye-biomechanical kanye nemitholampilo. Ukubuyekezwa kwakamuva kubike ukuthi ukuqiniswa kukasimende wethambo kubangele imithwalo yokwehluleka okuphezulu, ukunciphisa ukufuduka kokufakelwa, kanye nezinkinga ezimbalwa nokusebenza kabusha uma kuqhathaniswa nokulungiswa okungaqinisiwe. Ucwaningo olungahleliwe, olunezikhungo eziningi luphinde lwabika ukuthi akukho ukuphinda kusetshenziswe noma iziqephu eziyizimpawu zokufuduka kwe-CMN eqenjini eliqiniswe usimende uma kuqhathaniswa namacala ayisithupha eqenjini elingaqinisiwe.

Ukufa kwe-hip fracture kuphezulu. Ucwaningo lwakamuva luchaze izinga lokufa kwabantu esibhedlela ngo-3-7%, nokufa konyaka owodwa kwehle kusuka ku-19.4% kuya ku-58%. Ikakhulukazi, ukuphuka kwe-IT kuboniswe ukuthi kubangele u-27% wokufa ngonyaka owodwa. Uchungechunge lwethu lwemitholampilo aluzange lubonise ukushona kwabantu esibhedlela kanye nezinga lokufa konyaka owodwa lika-13.6%, eliphansi kakhulu uma liqhathaniswa nezincwadi. Ngenxa yokuthi ukuhamba ngokushesha kokulala ngemva kokuhlinzwa kuhlotshaniswa nokufa okuphansi, ukuzulazula okuhle kanye nemiphumela yokusebenza ochungechungeni lwethu kungachaza ukufa okuphansi okubonwa ezigulini zethu.

Isiphetho

Ukulungiswa kokubuyekezwa okuqiniswe usimende kuyindlela ephumelelayo, ephephile, futhi engabizi kakhulu yokwehluleka ukulungiswa kwe-intertrochanteric fracture engatheleleki ezigulini esezikhulile ezine-acetabular bone stock eyanele.

Iziguli ezinokulungiswa okuhlulekile kwe-primary intertrochanteric fractures elandelwa ukulungiswa kokubuyekezwa kanye nokwelashwa okuqiniswe usimende kubonise imiphumela emihle yesikhathi eside yomtholampilo kanye nekhwalithi yokuphila. Inqubo isetshenziswe kuphela ezimweni lapho iningi le-acetabular articular surface ligcinwe futhi i-nail yekhanda yahlala iqukethwe ngaphakathi kwentamo yesifazane. Uma kucatshangelwa ukulinganiselwa kokubuyekezwa kwe-arthroplasty ezigulini esezikhulile ezibuthakathaka, le nqubo ibonisa isithembiso ekwehliseni ngokuphepha nangempumelelo izinkinga ezingathi sína kuyilapho kunciphisa isikhathi sokusebenza nezindleko kuleli qembu leziguli.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

Ngoba I-CZMEDITECH , sinomugqa womkhiqizo ophelele kakhulu wezimila zokuhlinza amathambo nezinsimbi ezihambisanayo, imikhiqizo ehlanganisa izimila zomgogodla, izipikili ze-intramedullary, ipuleti lokuhlukumezeka, ipuleti lokukhiya, i-cranial-maxillofacial, izitho zokufakelwa, amathuluzi amandla, izilungisi zangaphandle, i-arthroscopy, ukunakekelwa kwezilwane kanye namasethi amathuluzi asekelayo.

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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