Iyiphi kulezi zindlela ezilandelayo ezisetshenziswayo ukulungisa ukuphuka kwe-intertrochanteric?

I-Intertrochanteric fracture ye-femur, eyaziwa nangokuthi i-intertrochanteric fracture, i-extra-articular capsule fracture. Ukubonakaliswa okuyinhloko kwe-intertrochanteric fracture ubuhlungu obuphawulekayo bendawo nokuvuvukala, i-ecchymosis ejulile, ukungakwazi kwesiguli ukuma noma ukuhamba, ukunciphisa okuphawulekayo, ukukhubazeka kwangaphakathi nokujikeleza kwangaphandle kwesitho esithintekile, kanye nomkhawulo wokunyakaza okusebenzayo nokungahambi kahle kwe-hip joint kunoma iyiphi isiqondiso.

I-Epidemiology

1. Iningi labo lihlobene ne-osteoporosis, evame kakhulu kubantu asebekhulile, abesifazane abaningi kunabesilisa.

2. Isigameko sihlobene nobuhlanga, ubulili kanye nesifunda.

3. ukulimala okuvamile kubantu asebekhulile, iminyaka yobudala yokuphuka kwe-intertrochanteric ye-femur yiminyaka engu-75.2. Kwakungekho mehluko obalulekile eminyakeni yobudala yokuhlukana kwe-intertrochanteric phakathi kwamadoda nabesifazane.

4. Ngenxa yokugeleza kwegazi okucebile ku-trochanter, ukuphuka akuvamile ukuphulukisa, kodwa kulula ukwenzeka ukuguqulwa kwe-hip, futhi kunezinkinga eziningi ezibangelwa ukuphumula kombhede isikhathi eside ezigulini esezikhulile, futhi izinga lokugula nokufa liyi-15% -20%, ngakho-ke kubizwa ngokuthi ukuphuka kokugcina kubantu asebekhulile.

Indlela yokulimala

1. Abantu abadala abasebasha balimala kakhulu, kufanele banake ubuchopho, isifuba, isisu nezinye izingxenye zokulimala; abantu asebekhulile ikakhulukazi ukuguga umsebenzi we nezitho ukuxhumanisa impendulo ukushelela ukwehla kanye nokuwa okubangelwa.

2. Udlame oluqondile: umthelela oqondile endaweni enkulu ye-trochanter. Uma umzimba uwela phansi ngamandla aseceleni lapho uwa.

3. Udlame olungaqondile: umzimba usontekile ngesikhathi sokuwa, futhi i-hip ingaphansi kwengcindezi ye-inversion kanye ne-angle yangaphambili ngesikhathi esifanayo.

4. I-Pathological fracture, enye yezimila zamathambo ezivamile.

5. I-Intertrochanteric fracture ikakhulukazi yenziwa udlame olungaqondile.

Ukubonakaliswa komtholampilo

1. Isethulo esiyisisekelo siyafana nesokuphuka kwentamo yesifazane, ngobuhlungu bendawo, ukuvuvukala kanye nokulinganiselwa kokusebenza kwesitho esithintekile.

2. Ngenxa yokuthi i-extra-articular capsule fracture, akukho mkhawulo we-capsule ehlangene, ngakho-ke ukukhubazeka kokujikeleza kwangaphandle okufushane (ama-90 degrees) kwesitho esingezansi kubi kakhulu.

3. Ubuhlungu be-axial percussion.

4. I-hematoma yendawo inzima kakhulu, futhi kungase kube nokulimaza okubanzi okungaphansi kwesikhumba.

5. Ezigulini esezikhulile, zivame ukubandala kuneziguli zentamo yesifazane, futhi ingxenye enkulu yeziguli ziye zaba nesifo sohlangothi sangaphambilini.

Ukuxilongwa

Umlando wokuhlukumezeka okusobala, ubuhlungu esithweni esithintekile, kanye nomkhawulo wokunyakaza. Ukufinyeza nokukhubazeka kokujikeleza kwangaphandle kwesitho esingezansi kubonakala kufika ku-90°. Ukuhlolwa kwe-X-ray kuvame ukudingeka ukuze kutholakale ukuxilongwa futhi ukuthayipha kusekelwe kuma-radiographs. Izimpawu ze-intertrochanteric fracture zifana nalezo zokuphuka kwentamo yesifazane, kodwa lesi sakamuva asibi kakhulu kunesokuqala mayelana nobuhlungu bendawo, ukuvuvukala, ukulahlekelwa umsebenzi, nokunciphisa isitho esithintekile, futhi isitho esithintekile ngokuvamile sinokuguquguquka okuncane kwe-hip kanye nokuguqa kwamadolo kanye nokukhubazeka kokujikeleza kwangaphandle, ngokuvamile phakathi kuka-45 ° -60 °.

Uhlobo

I-AO kanye ne-Evans-Jensen fracture yizinhlobo ezimbili ezivame ukusetshenziswa kakhulu, futhi kulezi ezimbili, uhlobo lwe-AO fracture yilona oluvame kakhulu.

U-Evans-Jensen uyathayipha

Thayipha I: Ukuphuka okulula kwe-intertrochanteric okunomugqa wokuphuka owehlayo ukusuka kokuphakeme ukuya kokuphansi, ngaphandle kokususwa kanye nokuzinza.

Uhlobo II: Ukufuduka kuhlanganiswe nokuphuka kwe-rotor avulsion encane, kodwa i-femoral spur iqinile (i-femoral spur iyipuleti lethambo elicinene elitholakala ekujuleni kwentamo yesifazane kanye nokuhlangana komzimba we-rotor encane.

Uhlobo lwe-III: Kuhlanganiswe ukuphuka kwe-trochanteric okukhulu nokunqwabelana kokuphuka kwe-femoral spur, nokususwa endaweni, ngokuvamile ngokuphuka kwe-rotor yangemuva.

Uhlobo lwe-IV: Ingxenye ye-3 ye-fracture ehlanganiswe nokuhlukana okuphindaphindiwe kwe-trochanter encane, okungase kwethulwe ngokuphuka kwentamo ye-femoral kanye ne-coronal surface ye-trochanter enkulu.

Uhlobo V: ukuphuka okungasekelwe ngemuva kwe-lateral ne-medial (inhlanganisela yezinhlobo ze-III nezi-IV).

Thayipha u-R: ukuhlukana kwe-intertrochanteric yangaphambili ene-oblique fracture line kusuka ku-medial ephakeme kuya kwe-lateral engaphansi, okungenzeka ihlotshaniswe nokuphuka kwe-rotor encane kanye nokubhujiswa komgogodla wesifazane.

Ukuthayipha kwe-AO

A1.1 Umugqa wokuphuka udlula umugqa we-inter-rotor

A1.2 Ukuphuka kudlula ku-trochanter enkulu

A1.3 Ukuphuka okudlula ngaphansi kwe-trochanter encane

A2.1 Ukuphuka ngocezu lwethambo olu-1 oluhlanganisiwe

A2.2 Ukuphuka ngezingcezu zamathambo ezihlanganisiwe eziningi

A2.3 Ukuphuka okunwebeka ngaphezu kuka-1 cm ngaphansi kwe-trochanter encane

A3.1 Umumo we-oblique olula

A3.2 Umumo oguquguqukayo olula

I-A3.3 Izimisele

Ukwelashwa

Ukuzinza kokulungiswa kwangaphakathi kwama-fractures ngokuvamile kuncike ezintweni ezinhlanu: ikhwalithi yethambo, uhlobo lokuphuka, ukunciphisa, ukukhethwa kokulungiswa kwangaphakathi, kanye nesimo sokulungiswa kwangaphakathi ngokuphathelene nethambo. Ukubeka kabusha ukuqhekeka kubalulekile ekuzinzeni ngemva kokulungiswa kwangaphakathi futhi kufanele kuhloswe ukuzuza ukuma kabusha kwe-anatomic noma ukuma okuzinzile okungezona kwe-anatomic. Kafushane, inhloso yokubeka kabusha ukuthola ukuzinza kwe-fracture. Indlela yokubeka kabusha ingavalwa noma i-incision. Kungakhathaliseki ukuthi yinkimbinkimbi yohlobo lwe-fracture, ukunciphisa okuvaliwe kufanele kuzanywe kuqala.

• I-Power Hip Dowel (DHS)

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Izinzuzo eziyinhloko ze-DHS Power Hip Screws.

• Isikulufu sinomphumela oqinile wokulungisa ngaphakathi kwekhanda lesifazane, ngisho nasesimweni se-osteoporosis.

• Indlela yokutshuza emkhonweni ivimbela ukungena kokuphela kwezipikili ekhanda lesifazane noma i-acetabulum kanye nokudluliswa okuqondile kwamandla adonsela phansi angemahle ethanjeni.

• I-power gliding mechanism igcina ukuphuka kusendaweni futhi inciphisa okungeyona inyunyana.

• Inomsebenzi ombaxambili wokucindezelwa nokutshuza, okunomphumela wokucindezela oguquguqukayo nomile.

  
  

• I-Power Hip Dowel (DCS)

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  I-DCS kanye namapuleti okusika angama-95 ama-anticrotal fractures:

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Izinzuzo eziyinhloko ze-DCS power condylar screw ziyi.

• Ingakwazi ukukhetha kahle indawo yokungena yesikulufu ngokusho kwesimo esithile sokuphuka, futhi ukusebenza kulula.

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• Isikulufu sokuqina kokucindezela amandla siku-engeli engakwesokudla kupuleti, esihlangabezana nezimfuneko ze-biomechanical zenyonga. Ngesikhathi sokuthwala isisindo, amandla angalungile aqale asetshenziswe engalweni emfushane yepuleti bese ahlakazeka kusikulufa ngasinye, ukuze ukucindezeleka kuhlakazwe futhi ukulungiswa kuqine ngendlela engavamile.

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• Inombolo enkulu kancane yezikulufu ze-DCS ekuqhekezeni inyusa ukuqina, futhi indawo yokuphuka ingafakwa ibhuloho futhi ilungiswe, ngaleyo ndlela inciphise izehlakalo zezinkinga zangemva kokuhlinzwa.

I-Proximal Femoral Locking Isipikili sangaphakathi komongo wethambo (PFN)

Izinzuzo zokulungiswa kwe-PFN.

• Ububanzi bezinzipho ezincane (imvamisa engu-9mm), bungakwazi ukushayelelwa ngaphandle kokunwetshwa. (iphakeme kunomkhawulo owugqinsi we-caudal we-Gamma nail - 17mm)

• Ukuphela okuseduze kwe-PFN kune-camber ecishe ibe ngu-6 degrees, inciphisa i-engeli ye-valgus futhi isuse isidingo sokuhlehla okuqinile kwangaphakathi phakathi nokudonsa.

• Umkhawulo ongaphezulu uvumela ukubekwa kwezikulufu ezimbili ekhanda lesifazane, ngokungezwa kwesikulufa esiphikisana nokujikeleza kanye nokuthwala kwezinzipho ezimbili entanyeni yesifazane, okwandisa ukumelana nokukhathala.

• Ibanga phakathi kwembobo yokukhiya i-distal kanye nesiphetho esikude se-nail eyinhloko (isandiso esine-tapered) yinde, enganciphisa ukugxila kwengcindezi esiqwini sesifazane.

• Ukuhlukumezeka okuncane uma kuqhathaniswa.

Izinzipho ze-Gammar

Izinzuzo ze-Gammar nail fixation.

• Kuyindlela yokulungisa i-intramedullary engenele kancane ene-incision encane kanye nokulimala okuncane.

• I-Gamma nail ihlanganisa ngokuqinile i-femur engaphezulu nentamo yesifazane ngokuhlanganiswa kwe-intramedullary nail kanye ne-tension screw, futhi isipikili se-intramedullary siqiniswa yi-distal self-locking nail, evimbela ukujikeleza nokunciphisa ukugudluka futhi inikeza ukulungiswa okuthembekile.

Ukuthuthukiswa kwe-Gammar - PFNA

Ukukhethwa kwesilungisi sangaphakathi (PFNA).

• Okwakhelwe ngaphakathi okufanelekile kokuqhekeka kwe-intertrochanteric okungazinzile kwe-femur.

• Ilungisa ngokuqinile ikhanda nentamo yesifazane futhi ivimbele ukujikeleza kokuphela kokuphuka.

• Igwema izinkinga ezinjengokugoqa ngenxa yokuqina kwethambo ngemva kokulahlekelwa ukusekela okuphakathi, ukuguqulwa kokuguqulwa, nokusika ngaphandle kwekhanda lesifazane ngokufaka.

• Ifanele cishe wonke ama-intertrochanteric fractures, ikakhulukazi ama-fractures angazinzile (isb. i-intertrochanteric fractures yangaphambili) kanye ne-osteoporosis ehlangene.

• Kusenesigameko esithile sezinkinga, njengokuvuvuka kwekhanda lesifazane, okwenza kube nzima ukumiselela ezinye izilungiso zangaphakathi.

Ukushintshwa Okuhlangene Okwenziwayo

Izinkomba zokuhlinzwa okwenziwa esikhundleni sokuhlanganisa ngokuhlukana kwe-intertrochanteric ye-femur:

• Ubudala obungaphezu kweminyaka engama-80.

• Ukuphuka kwe-intertrochanteric okuzinzile nokungazinzile.

• I-Bone osteoporosis isobala, futhi ukulungiswa kwangaphakathi kunzima ukulungisa ngokuphumelelayo.

• Akukho umkhawulo obalulekile wokunyakaza kwe-hip noma kwamadolo ngaphambi kokulimala.

• Isimo somzimba wonke singakubekezelela ukwelashwa kokuhlinzwa.

Iziguli ezingakwazi ukwelashwa embhedeni isikhathi eside.

Izinzuzo: ukuma kwangaphambi kokuhlinzwa phansi. Gwema izinkinga ezihambisana nombhede. Nweba isikhathi sokusinda futhi uthuthukise izinga lempilo.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

Ngoba CZMEDITECH , sinomugqa womkhiqizo ophelele kakhulu wezimila zokuhlinza amathambo kanye namathuluzi ahambisanayo, imikhiqizo ehlanganisa izimila zomgogodla, izipikili ze-intramedullary, ipuleti lokuhlukumezeka, I-locking plate, 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 umhlaba Izifakelo zamathambo kanye nezimboni zezinsimbi.

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