Femoral intertrochanteric fracture ndiyo inonyanya kuparara kwehudyu mumakiriniki ekudzidzira uye ndeimwe yezvitatu zvinowanzoputsika zvine chokuita neosteoporosis kune vakwegura.Kurapa kwekuchengetedza kunoda kuzorora kwenguva refu pamubhedha, zvichiunza njodzi huru dzemaronda ekumanikidza, hutachiona hwemapapu, pulmonary embolism, deep vein thrombosis, uye mamwe matambudziko.Dambudziko rekuyamwisa rakakosha, uye nguva yekupora irefu, zvichiisa mutoro unorema kune zvese nzanga nemhuri.Naizvozvo, kupindira kwekutanga kwekuvhiya, pese pazvinoshivirira, kwakakosha kuti uwane mhedzisiro inoshanda mukutyoka kwehudyu.
Parizvino, iyo PFNA (proximal femoral nail antirotation system) kugadzirisa kwemukati kunoonekwa seyegoridhe chiyero chekuvhiya kurapwa kwehudyu fractures.Kuwana rubatsiro rwakanaka panguva yekuderedzwa kwehudyu fractures kwakakosha pakubvumira kurovedza muviri kwekutanga.Intraoperative fluoroscopy inosanganisira anteroposterior (AP) uye maonero ekupedzisira kuti aongorore kuderedzwa kwechikadzi anterior medial cortex.Zvisinei, kukakavara kunogona kubuda pakati pemaonero maviri panguva yekuvhiyiwa (kureva, zvakanaka mukuona kwemashure asi kwete mukuona kweanteroposterior, kana zvakasiyana).Mumamiriro ezvinhu akadaro, kuongorora kana kuderedzwa kunogamuchirwa uye kana kugadziriswa kunodiwa kunokonzera dambudziko rakaoma kune vashandi vekliniki.Nyanzvi dzinobva kuzvipatara zvepamba seOriental Hospital neZhongshan Hospital dzakagadzirisa nyaya iyi nekuongorora huchokwadi hwekuongorora tsigiro yakanaka uye yakaipa pasi peanteroposterior uye lateral maonero vachishandisa postoperative matatu-dimensional CT scans seyero.
▲ Mufananidzo unoratidzira rubatsiro rwakanaka (a), kutsigira kwakashata (b), uye kutsigirwa kwakashata (c) maitiro ehudyu fractures mu anteroposterior view.
▲ Mufananidzo unoratidza rubatsiro rwakanaka (d), kutsigira kwakashata (e), uye kutsigirwa kwakashata (f) maitiro ehudyu kuputsika mukuona kwemashure.
Nyaya yacho inosanganisira data yekesi kubva kuvarwere ve128 vane hip fractures.Intraoperative anteroposterior uye lateral mifananidzo yakapiwa zvakasiyana kune vanachiremba vaviri (mumwe ane ruzivo rushoma uye mumwe ane ruzivo rwakawanda) kuti aongorore rubatsiro rwakanaka kana rusina kunaka.Mushure mekuongorora kwekutanga, kuongororwazve kwakaitwa mushure memwedzi miviri.Postoperative CT mifananidzo yakapiwa kune purofesa ane ruzivo, uyo akasarudza kana nyaya yacho yakanga yakanaka kana kuti isina kunaka, ichishanda sechiyero chekuongorora kurongeka kwekuongororwa kwemifananidzo nevarapi vaviri vekutanga.Mienzaniso huru muchinyorwa ndeiyi inotevera:
(1) Pane here misiyano yakakosha mumhedzisiro yeongororo pakati pevasina ruzivo uye vane ruzivo vanachiremba mune yekutanga neyechipiri ongororo?Pamusoro pezvo, chinyorwa chinoongorora kusangana kweboka pakati pemapoka asina ruzivo uye ane ruzivo kune ese ari maviri ongororo uye intragroup kusawirirana pakati pezviongorori zviviri.
(2) Ichishandisa CT seyero yegoridhe referensi, chinyorwa chinoongorora icho chakanyanya kuvimbika pakuongorora kuderedzwa kwemhando: lateral kana anteroposterior evaluation.
Tsvagiridzo zvawanikwa
1. Muzvikamu zviviri zvekuongorora, neC CT seyero yekutarisa, pakanga pasina kusiyana kwakasiyana-siyana mukunzwa, kunyanya, chiyero chenhema, chiyero chenhema, uye mamwe maitiro ane chokuita nekuongororwa kwehutano hwekuderedza hunoenderana ne-intraoperative X- mwaranzi pakati pavanachiremba vaviri vane ruzivo rwakasiyana.
2.Mukuongororwa kwekudzikisa kunaka, kutora ongororo yekutanga semuenzaniso:
- Kana pane kubvumirana pakati peanteroposterior uye lateral assessments (zvose zvakanaka kana zvose zvisina kunaka), kuvimbika mukufanotaura kuderedzwa kwehutano paCT ndeye 100%.
- Kana pane kusawirirana pakati pe anteroposterior uye lateral assessments, kuvimbika kwe lateral assessment criteria mukufanotaura kuderedzwa kwehutano paCT yakakwirira.
▲ Mufananidzo unoratidza rubatsiro rwakanaka rwakaratidzwa mu anteroposterior view apo ichiita seisina kunaka mu lateral view.Izvi zvinoratidza kusawirirana mumigumisiro yekuongorora pakati peanteroposterior uye lateral maonero.
▲ Three-dimensional CT reconstruction inopa akawanda-angle yekucherechedza mifananidzo, inoshanda seyero yekuongorora kwekuderedza kunaka.
Mumitemo yapfuura yekuderedza intertrochanteric fractures, kunze kwekutsigirwa kwakanaka uye kusina kunaka, kunewo pfungwa ye "neutral" tsigiro, inoreva kuderedzwa kweanatomical.Nekudaro, nekuda kwenyaya dzine chekuita nekugadziriswa kwefluoroscopy uye ziso remunhu, chokwadi "anatomical reduction" hachipo, uye panogara paine kutsauka kudiki kune "zvakanaka" kana "negative" kudzikiswa.Chikwata chinotungamirwa naZhang Shimin paYangpu Hospital muShanghai chakaburitsa bepa (chaiyo chirevo chakakanganwa, chingaonga kana mumwe munhu achigona kuchipa) zvichiratidza kuti kuwana rutsigiro rwakanaka mukutyoka kwe intertrochanteric kunogona kukonzera kushanda kuri nani zvichienzaniswa nekuderedzwa kweanatomical.Nokudaro, tichifunga nezvechidzidzo ichi, kuedza kunofanira kuitwa panguva yekuvhiyiwa kuti uwane rubatsiro rwakanaka mu intertrochanteric fractures, zvose mu anteroposterior uye lateral maonero.
Nguva yekutumira: Jan-19-2024
