Nzira yekudzivirira sei 'in-out-in' kuiswa kwefemoral neck screws panguva yekuvhiyiwa?

"Pakutyoka kwemutsipa kwevakadzi vasiri vechikuru, nzira inonyanya kushandiswa yekugadzirisa mukati i'inverted triangle' configuration ine screws nhatu. Makururu maviri akaiswa pedyo neanterior neposterior cortices yemutsipa wefemoral, uye siruu imwe yakaiswa pazasi. Mukuona anteroposterior, proximal two screwing screws view alateral, in a-screwsing the pattern overlayp '3-screw' pateni inocherechedzwa.

"Iyo inonzi medial circumflex femoral artery ndiyo inonyanya kugovera ropa kumusoro wemukadzi." Kana masiruu akaiswa 'in-out-in' pamusoro pechikamu chemashure chemutsipa wemukadzi, zvinoisa njodzi yekukuvara kweiatrogenic vascular, zvinogona kukanganisa kubuda kweropa kumutsipa wemukadzi uye, nekudaro, kukanganisa kupora kwemapfupa."

"Kudzivirira kuitika kwechiitiko che'in-out-in' (IOI), apo screws dzinopfuura nekunze kwecortex yehuro yemukadzi, ichibuda mucortical bone, uye kupindazve muhuro hwemukadzi uye musoro, nyanzvi munyika uye kunze kwenyika dzakashandisa nzira dzakasiyana-siyana dzekuongorora. Kuora mwoyo mupfupa. Nokudzidza hukama huri pakati pezvisungo zvakaiswa pamusoro pemashure emutsipa wemukadzi uye acetabulum mukuona kwe anteroposterior, munhu anogona kufanotaura kana kuongorora ngozi yeIOI."

▲ Mufananidzo unoratidza cortical bone imaging yeacetabulum mu anteroposterior view of the hip joint.

Chidzidzo chacho chaisanganisira varwere ve104, uye hukama huri pakati pekortical bone yeacetabulum nemashure emashure akaongororwa. Izvi zvakaitwa kuburikidza nekuenzanisa pa-X-rays uye inowedzerwa ne postoperative CT reconstruction kuti iongorore hukama huri pakati pezviviri. Pakati pevarwere ve104, 15 yakaratidza zvakajeka IOI chiitiko pa-X-rays, 6 yakanga ine data isina kukwana yekufungidzira, uye 10 yakanga ine screws yakamira pedyo zvakanyanya nepakati pemutsipa wemukadzi, zvichiita kuti kuongororwa kusashanda. Naizvozvo, huwandu hwemakumi manomwe nenhatu ematare edzimhosva akabatanidzwa mukuongorora.

Mumakesi makumi manomwe nenhatu akaongororwa, paX-rays, makesi makumi mana nemaviri aive nema screws akaiswa pamusoro pe cortical bone yeacetabulum, ukuwo makumi matatu nerimwe aive nema screws pazasi. CT simbiso yakaratidza kuti chiitiko cheIOI chakaitika mu59% yezviitiko. Ongororo yedata inoratidza kuti paX-rays, screws yakaiswa pamusoro pecortical bone yeacetabulum yaive nekunzwa kwe90% uye chaiyo ye88% mukufanotaura chiitiko cheIOI.

▲ Case One: Hip joint X-ray mu anteroposterior view inoratidza screws yakaiswa pamusoro pe cortical bone yeacetabulum. CT coronal uye transverse maonero anosimbisa kuvapo kweIOI phenomenon.

▲ Nyaya Yechipiri: Hip joint X-ray mu anteroposterior view inoratidza screws yakamira pasi pe cortical bone yeacetabulum. CT coronal uye transverse maonero anosimbisa kuti posterior screws ari zvachose mukati pfupa cortex.