Intertrochanteric fractures yefemur account ye50% yehudyu kuputsika kune vakwegura.Conservative kurapwa kunowanzoitika kumatambudziko akadai seyakadzika vein thrombosis, pulmonary embolism, maronda ekumanikidza, uye kutapukira kwepulmonary.Nhamba yekufa mukati megore rimwe inodarika 20%.Nokudaro, mumamiriro ezvinhu apo chirwere chemuviri chemurwere chinobvumira, kutanga kwekuvhiya kwemukati kugadzirisa ndiyo inosarudzwa kurapwa kwe intertrochanteric fractures.
Intramedullary chipikiri yemukati kugadzirisa parizvino ndiyo chiyero chegoridhe chekurapa kwe intertrochanteric fractures.Muzvidzidzo pamusoro pezvinhu zvinopesvedzera PFNA yemukati gadziriso, zvinhu zvakaita sePFNA chipikiri kureba, varus angle, uye dhizaini zvakataurwa muzvidzidzo zvakawanda zvakapfuura.Zvisinei, hazvisati zvanyatsojeka kana kuwanda kwembambo huru kunokanganisa migumisiro yekushanda.Kugadzirisa izvi, nyanzvi dzedzimwe nyika dzakashandisa intramedullary mbambo dzine urefu hwakaenzana asi hukobvu hwakasiyana kugadzirisa intertrochanteric fractures muvanhu vakwegura (zera> 50), nechinangwa chekuenzanisa kana pane kusiyana kwemigumisiro yekushanda.
Chidzidzo chacho chaisanganisira zviitiko zve 191 zve unilateral intertrochanteric fractures, zvose zvakabatwa nePFNA-II mukati mekugadzirisa.Apo iyo trochanter diki yakatsemuka uye yakavharwa, 200mm mbambo pfupi yakashandiswa;apo iyo trochanter diki yaive yakasimba kana isina kuvharwa, 170mm yekupedzisira-pfupi chipikiri yakashandiswa.Iyo dhayamita yembambo huru yakabva pa9-12mm.Kuenzanisa kukuru muchidzidzo kwakanangana nezviratidzo zvinotevera:
1. Lesser trochanter width, kuongorora kana positioning yaiva mureza;
2. Ukama huri pakati pepakati cortex yemusoro-mutsipa fragment uye distal fragment, kuongorora kunaka kwekuderedza;
3. Tip-Apex Distance (TAD);
4.Nail-to-canal ratio (NCR).NCR ndiyo chiyero cheiyo dhayamita yembambo kune medullary canal dhayamita pane distal locking screw ndege.
Pakati pevarwere ve191 vaisanganisira, kugoverwa kwemakesi zvichienderana nehurefu uye dhayamita yembambo huru inoratidzwa mumufananidzo unotevera:
Avhareji yeNCR yaive 68.7%.Tichishandisa avhareji iyi sechikumbaridzo, nyaya dzine NCR dzakakura kupfuura avhareji dzaionekwa sedzine dhayamita huru dzembambo, nepo zviitiko zvine NCR isingasviki paavhareji zvaionekwa seine dhayamita yembambo yakatetepa.Izvi zvakakonzera kurongwa kwevarwere muboka reThick Main Nail (90 kesi) uye Thin Main Nail boka (101 kesi).
Mhedzisiro yacho inoratidza kuti pakanga pasina misiyano yakakura pakati peboka reThick Main Nail neboka reThin Main Nail maererano neTip-Apex Distance, Koval score, kunonoka kupora, rate reoperation, uye matambudziko emapfupa.
Zvakafanana nechidzidzo ichi, chinyorwa chakabudiswa mu "Journal of Orthopedic Trauma" muna 2021: [Musoro weChinyorwa].
Chidzidzo chacho chaisanganisira varwere vane 168 vakwegura (zera> 60) vane intertrochanteric fractures, vose vanobatwa ne cephalomedullary nails.Kubva pahupamhi hwembambo huru, varwere vakakamurwa kuva 10mm boka uye boka rine dhayamita rakakura kupfuura 10mm.Mhedzisiro yacho yakaratidzawo kuti pakanga pasina misiyano yakakosha mumitengo yekushandazve (zvingave zvakazara kana zvisingatapukirwe) pakati pemapoka maviri.Vanyori vekudzidza vanoratidza kuti, muvarwere vakwegura vane intertrochanteric fractures, kushandisa 10mm dhayamita mbambo huru yakakwana, uye hapana chikonzero chekugadzirisa zvakanyanya, sezvo zvichiri kukwanisa kuwana zvibereko zvakanaka zvekushanda.
Nguva yekutumira: Feb-23-2024
