Kuphulika kwa Femoral intertrochanteric fracture ndikofala kwambiri kwa ntchafu m'machitidwe achipatala ndipo ndi chimodzi mwa zitatu zomwe zimaphwanyidwa ndi osteoporosis okalamba.Chithandizo chodziletsa chimafuna kupuma kwa nthawi yayitali, kuyika chiwopsezo chachikulu cha zilonda zam'mimba, matenda am'mapapo, embolism yam'mapapo, kutsika kwa mitsempha yakuya, ndi zovuta zina.Vuto la unamwino ndilofunika kwambiri, ndipo nthawi yochira ndi yaitali, zomwe zikubweretsa mtolo waukulu kwa anthu ndi mabanja.Chifukwa chake, kuchitidwa opaleshoni koyambirira, nthawi zonse kulekerera, ndikofunikira kuti pakhale zotsatira zabwino pakusweka kwa ntchafu.
Pakadali pano, PFNA (proximal femoral nail antirotation system) kukhazikika kwamkati kumawonedwa ngati muyezo wagolide wochizira ma opaleshoni a ntchafu za m'chiuno.Kupeza chithandizo chabwino pakuchepetsa kuphulika kwa m'chiuno ndikofunikira kuti mulole kuchita masewera olimbitsa thupi koyambirira.Intraoperative fluoroscopy imaphatikizapo anteroposterior (AP) ndi mawonedwe am'mbali kuti awone kuchepa kwa chikazi chapakati pakatikati pa cortex.Komabe, mikangano ingakhalepo pakati pa malingaliro awiriwa panthawi ya opaleshoni (ie, zabwino m'mawonedwe a lateral koma osati mu mawonekedwe a anteroposterior, kapena mosiyana).Zikatero, kuyesa ngati kuchepetsako kuli kovomerezeka komanso ngati kusintha kuli kofunikira kumabweretsa vuto lalikulu kwa madokotala.Akatswiri ochokera ku zipatala zapakhomo monga Oriental Hospital ndi Zhongshan Hospital akambirana za nkhaniyi pofufuza kulondola kwa kuthandizira kwabwino ndi koipa pansi pa mawonedwe a anteroposterior ndi lateral pogwiritsa ntchito ma postoperative atatu-dimensional CT scans monga muyezo.
▲ Chithunzichi chikuwonetsa chithandizo chabwino (a), kuthandizira osalowerera (b), ndi kuthandizira kolakwika (c) machitidwe a fractures a chiuno mu mawonekedwe a anteroposterior.
▲ Chithunzichi chikuwonetseratu chithandizo chabwino (d), kuthandizira osalowerera (e), ndi kuthandizira kolakwika (f) machitidwe a fractures a chiuno pakuwona kwapambuyo.
Nkhaniyi ikuphatikizapo nkhani za odwala 128 omwe ali ndi fractures ya m'chiuno.Zithunzi za intraoperative anteroposterior ndi lateral zinaperekedwa padera kwa madokotala awiri (mmodzi wosadziwa zambiri ndi wina wodziwa zambiri) kuti awone chithandizo chabwino kapena chosavomerezeka.Pambuyo pakuwunika koyamba, kuwunikanso kunachitika pambuyo pa miyezi iwiri.Zithunzi za postoperative CT zidaperekedwa kwa pulofesa wodziwa zambiri, yemwe adatsimikiza ngati mlanduwo unali wabwino kapena wosakhala bwino, womwe umakhala ngati muyezo wowunikira kulondola kwa kuwunika kwazithunzi ndi madokotala awiri oyamba.Kufananitsa kwakukulu m'nkhaniyi ndi motere:
(1) Kodi pali kusiyana kwakukulu muzotsatira zowunika pakati pa madokotala ocheperako komanso odziwa zambiri pakuyesa koyamba ndi kwachiwiri?Kuonjezera apo, nkhaniyi ikuyang'ana kugwirizana kwamagulu pakati pa magulu omwe sakudziwa zambiri komanso odziwa zambiri pazowunikira zonse ziwiri komanso kusasinthasintha kwamagulu pakati pa zowunika ziwirizi.
(2) Pogwiritsa ntchito CT monga golide wagolide, nkhaniyi ikufufuza zomwe ziri zodalirika powunika khalidwe lochepetsera: kuwunika kwapambuyo kapena anteroposterior.
Zotsatira za kafukufuku
1. M'magawo awiri oyesa, ndi CT monga momwe amafotokozera, panalibe kusiyana kwakukulu kwa chiwerengero cha kukhudzidwa, kutsimikizika, kulakwitsa kwabodza, kutsika kwachinyengo, ndi zina zokhudzana ndi kuyesa kuchepetsa khalidwe lochokera ku intraoperative X- kunyezimira pakati madokotala awiri ndi misinkhu zosiyanasiyana zinachitikira.
2.Pakuwunika kwa kuchepetsa khalidwe, kutenga chitsanzo choyamba monga chitsanzo:
- Ngati pali mgwirizano pakati pa kuwunika kwa anteroposterior ndi lateral (zonse zabwino kapena zosagwirizana), kudalirika pakulosera za kuchepetsa kuchepetsa pa CT ndi 100%.
- Ngati pali kusagwirizana pakati pa kuwunika kwa anteroposterior ndi lateral, kudalirika kwa njira zowunikira zowonongeka pakuwonetseratu kuchepetsa kuchepetsa pa CT ndipamwamba.
▲ Chithunzichi chikuwonetseratu chithandizo chabwino chomwe chikuwonetsedwa mu mawonekedwe a anteroposterior pamene akuwoneka ngati osakhala bwino pamawonekedwe ozungulira.Izi zikuwonetsa kusagwirizana kwa zotsatira zowunika pakati pa mawonedwe a anteroposterior ndi lateral.
▲ Kumanganso kwa CT katatu kumapereka zithunzi zowonera maulendo angapo, zomwe zimakhala ngati muyeso woyesa kuchepetsa khalidwe.
M'miyezo yapitayi yochepetsera fractures ya intertrochanteric, pambali pa chithandizo chabwino ndi choipa, palinso lingaliro la chithandizo "chosalowerera ndale", kutanthauza kuchepa kwa thupi.Komabe, chifukwa cha nkhani zokhudzana ndi kusintha kwa fluoroscopy ndi kuzindikira kwa maso aumunthu, "kuchepetsa thupi" kwenikweni kulibe, ndipo nthawi zonse pamakhala zopatuka pang'ono za kuchepetsa "zabwino" kapena "zoipa".Gulu lotsogozedwa ndi Zhang Shimin pachipatala cha Yangpu ku Shanghai lidasindikiza pepala (lolemba lodziwika bwino lomwe layiwalika, lingayamikire ngati wina angapereke) kuwonetsa kuti kupeza chithandizo chabwino pakusweka kwa intertrochanteric kungapangitse zotsatira zabwino zogwirira ntchito poyerekeza ndi kuchepa kwa thupi.Choncho, poganizira phunziroli, zoyesayesa ziyenera kuchitidwa panthawi ya opaleshoni kuti apeze chithandizo chabwino mu intertrochanteric fractures, onse mu anteroposterior ndi lateral view.
Nthawi yotumiza: Jan-19-2024
