Kutyoka kwechiuno pakati petrochanteric ndiko kutyoka kwechiuno kunonyanya kuwanzoitika mukiriniki uye ndeimwe yemitsetse mitatu inowanzo tyoka ine chekuita ne osteoporosis kune vakwegura. Kurapa kwakarongeka kunoda kuzorora kwenguva refu pamubhedha, zvichikonzera njodzi huru yemaronda ekumanikidzwa, hutachiona hwemapapu, embolism yemapapu, deep vein thrombosis, nezvimwe zvinetso. Dambudziko rekuyamwisa rakakura, uye nguva yekupora yakareba, zvichiisa mutoro unorema panzanga nemhuri. Nokudaro, kuvhiyiwa kwekutanga, chero nguva zvichikwanisika, kwakakosha kuti pave nemigumisiro yakanaka pakutyoka kwechiuno.
Parizvino, kugadziriswa kwemukati kwePFNA (proximal femoral nail antirotation system) kunoonekwa senzira yakanaka yekurapa kuputsika kwechiuno. Kuwana rutsigiro rwakanaka panguva yekudzikiswa kwekuputsika kwechiuno kwakakosha kuti kubvumidzwe kurovedza muviri kwekutanga. Intraoperative fluoroscopy inosanganisira anteroposterior (AP) uye lateral views kuti vaongorore kudzikiswa kwefemoral anterior medial cortex. Zvisinei, kusawirirana kunogona kuitika pakati pemaonero maviri panguva yekuvhiyiwa (kureva, positive in lateral view asi kwete in anteroposterior view, kana zvinopesana). Muzviitiko zvakadaro, kuongorora kana kudzikiswa kwacho kuchigamuchirwa uye kana kugadziriswa kuchidikanwa kunopa dambudziko rakaoma kune vanachiremba. Nyanzvi kubva kuzvipatara zvemuno zvakaita seOriental Hospital neZhongshan Hospital dzakagadzirisa nyaya iyi nekuongorora kururama kwekuongorora rutsigiro rwakanaka nerusina kunaka pasi peanteroposterior nelateral views vachishandisa postoperative three-dimensional CT scans seyakajairika.
▲ Dhayagiramu inoratidza rutsigiro rwakanaka (a), rutsigiro rwakasununguka (b), uye rutsigiro rwakaipa (c) maitiro ekutyoka kwechiuno muchimiro che anteroposterior.
▲ Dhayagiramu inoratidza rutsigiro rwakanaka (d), rutsigiro rwakasununguka (e), uye rutsigiro rwakaipa (f) maitiro ekutyoka kwechiuno mumaonero edivi.
Nyaya iyi inosanganisira data revarwere 128 vane mapfupa akatyoka muhudyu. Mifananidzo yepamberi pechifuva nepadivi yakapihwa vanachiremba vaviri vakasiyana (mumwe asina ruzivo rwakawanda uye mumwe ane ruzivo rwakawanda) kuti vaongorore rutsigiro rwakanaka kana rusina kunaka. Mushure mekuongororwa kwekutanga, kuongororwazve kwakaitwa mushure memwedzi miviri. Mifananidzo yeCT mushure mekuvhiyiwa yakapihwa purofesa ane ruzivo, uyo akaona kana nyaya yacho yaive yakanaka kana kuti isina kunaka, zvichishanda sechiyero chekuongorora kururama kwekuongororwa kwemifananidzo navanachiremba vaviri vekutanga. Kuenzanisa kukuru muchinyorwa ndekwekuti:
（1）Pane musiyano wakakosha here mumhedzisiro yekuongorora pakati pevanachiremba vasina ruzivo rwakawanda uye vane ruzivo rwakawanda muongororo yekutanga neyechipiri? Pamusoro pezvo, chinyorwa chinoongorora kuwirirana pakati pemapoka pakati pemapoka asina ruzivo rwakawanda uye ane ruzivo rwakawanda pakuongorora uye kuwirirana pakati pemapoka maviri aya.
（2）Uchishandisa CT senzira yepamusoro yekuyera, chinyorwa chinoongorora kuti ndechipi chakavimbika pakuongorora hunhu hwekudzikiswa kweropa: kuongororwa kwedivi kana kuti kwepamberi.
Mhedzisiro yekutsvagisa
1. Muongororo mbiri, neCT senzira yekuongororwa, pakanga pasina misiyano yakakosha muhuwandu hwekunzwa, kujeka, mwero wenhema, mwero wenhema, nezvimwe zvinhu zvine chekuita nekuongorora kwehunhu hwekudzikira kwechirwere zvichibva paX-rays pakati pevanachiremba vaviri vane ruzivo rwakasiyana.
2. Mukuongorora kuderedzwa kwehunhu, tichitora ongororo yekutanga semuenzaniso:
- Kana paine kubvumirana pakati pekuongorora kwe anteroposterior ne lateral (zvese zvakanaka kana kuti zvisina kunaka), kuvimbika mukufanotaura kuderedzwa kwehunhu pa CT ndeye 100%.
- Kana paine kusawirirana pakati pekuongorora kwe anteroposterior ne lateral, kuvimbika kwe lateral assessment criteria mukufanotaura kuderedzwa kwemhando yeCT kwakakwira.
▲ Dhayagiramu inoratidza rutsigiro rwakanaka rwunoratidzwa mumaonero epamberi pechiso asi ruchionekwa serusina kunaka mumaonero epadivi. Izvi zvinoratidza kusawirirana mumhedzisiro yekuongorora pakati pemaonero epamberi pechiso nepadivi.
▲ Kugadziriswa kweCT kwemativi matatu kunopa mifananidzo yekutarisa ine makona akawanda, zvichishanda sechiyero chekuongorora kunaka kwekudzikira kwebvudzi.
Mumitemo yekare yekuderedza kutyoka kwemapfupa pakati petrochanteric, kunze kwekutsigira kwakanaka uye kusina kunaka, kunewo pfungwa yekutsigira "kwakasiyana", zvichireva kudzikiswa kwemuviri. Zvisinei, nekuda kwematambudziko ane chekuita nekugadziriswa kwefluoroscopy uye kuoneka kwemaziso evanhu, "kudzikiswa kwemuviri" kwechokwadi hakupo, uye nguva dzose pane kutsauka kudiki kune kudzikiswa "kwakanaka" kana "kwakaipa". Chikwata chakatungamirwa naZhang Shimin paYangpu Hospital muShanghai chakaburitsa bepa (reference chaiyo yakanganwika, ingafara kana mumwe munhu akakwanisa kuripa) richiratidza kuti kuwana rutsigiro rwakanaka mukutyoka kwemapfupa pakati petrochanteric kunogona kukonzera mhedzisiro iri nani yekushanda zvichienzaniswa nekuderedzwa kwemuviri. Nokudaro, tichifunga nezvechidzidzo ichi, kuedza kunofanirwa kuitwa panguva yekuvhiyiwa kuti pave nerutsigiro rwakanaka mukutyoka kwemapfupa pakati petrochanteric, mune maonero epamberi nepadivi.
Nguva yekutumira: Ndira-19-2024
