Mumakumi mashoma emakore apfuura, chiitiko cheproximal humeral fractures (PHFs) chakawedzera neinopfuura 28%, uye chiyero chekuvhiya chakawedzera neinopfuura 10% muvarwere vane makore makumi matanhatu nemashanu zvichikwira. Zviripachena, kuderera kwepfupa density uye kuwedzera kwenhamba yekudonha ndiyo huru yengozi zvinhu mukuwedzera kwevanhu vakura. Kunyangwe marapiro akasiyana ekuvhiya aripo ekugadzirisa vakadzingwa kana kusagadzikana maPHF, hapana kubvumirana pane yakanakisa nzira yekuvhiya yevakweguru. Kugadzirwa kwemakona ekudzikamisa mahwendefa kwakapa sarudzo yekurapa yekuvhiya kurapwa kwePHFs, asi iyo yakanyanya kuomarara mwero unosvika makumi mana muzana unofanirwa kutariswa. Inonyanya kutaurwa ndeye adduction collapse with screw dislodgement uye avascular necrosis (AVN) yehumeral head.
Anatomical kudzikiswa kwekutyoka, kudzoreredzwa kwehumeral nguva, uye kwakaringana subcutaneous kugadzirisa kwe screw kunogona kuderedza matambudziko akadaro. Screw fixation inowanzoomerwa kubudirira nekuda kwekukanganisa bhonzo kunaka kweproximal humerus inokonzerwa neosteoporosis. Kugadzirisa dambudziko iri, kusimbisa bhonzo-screw interface nehurombo husina kunaka nekushandisa polymethylmethacrylate (PMMA) bone simenti yakatenderedza screw tip inzira nyowani yekuvandudza simba rekugadzirisa rekuisa.
Chidzidzo chemazuva ano chine chinangwa chekuongorora nekuongorora mhedzisiro yeradiographic yePHFs inobatwa neangled kudzikamisa mahwendefa uye yakawedzera screw tip augmentation muvarwere vanopfuura makore makumi matanhatu.
Ⅰ.Zvinhu uye Nzira
Huwandu hwevarwere ve49 vakawana angle-yakagadzikana plating uye yakawedzera simende kuwedzera nema screws ePHFs, uye varwere makumi maviri nemana vakaverengerwa muchidzidzo zvichienderana nekubatanidzwa uye kusabatanidzwa maitiro.
Ese makumi maviri nemana PHF akaiswa muchikamu pachishandiswa HGLS classification system yakaunzwa naSukthankar naHertel vachishandisa preoperative CT scans. Preoperative radiographs pamwe chete nepostoperative plain radiographs yakaongororwa. Yakakwana anatomic kuderedzwa kwekuputsika kwaionekwa seyakagadziriswa apo tuberosity yehumeral musoro yakaderedzwa zvakare uye yakaratidza isingasviki 5 mm yegap kana kutama. Adduction deformity yakatsanangurwa sekurerekera kwemusoro wehumeral maererano neiyo humeral shaft isingasviki 125 ° uye valgus deformity yakatsanangurwa inopfuura 145 °.
Primary screw penetration yakatsanangurwa se screw tip inopinda mumuganhu we medullary cortex yehumeral head. Secondary fracture displacement yakatsanangurwa sekutamiswa kwekuderedzwa kwe tuberosity inopfuura 5 mm uye / kana kushanduka kweanopfuura 15 ° mukona yekutenderera kwechikamu chemusoro pane yekutevera radiograph kana ichienzaniswa neiyo intraoperative radiograph.
Kuvhiya kwese kwakaitwa kuburikidza ne deltopectoralis nzira huru. Kuputsika kuderedzwa uye kuiswa kweplate kwakaitwa nenzira yakajairika. Screw-cement augmentation technique yakashandiswa 0.5 ml yesimende ye screw tip augmentation.
Immobilization yakaitwa mushure mekuvhiyiwa mune tsika ruoko chipfuramabwe chepfudzi kwemavhiki e3. Kwekutanga kufambisa uye kunobatsira kufamba kwakasimba nekurwadziwa modulation kwakatangwa 2 mazuva mushure mekushanda kuti uwane huwandu hwakazara hwekufamba (ROM).
Ⅱ.Mhedzisiro.
Results: Varwere makumi maviri nevana vakabatanidzwa, vane makore epakati pemakore 77.5 (range, 62-96 makore). Makumi maviri nemumwe vaive vakadzi uye vatatu vaive varume. Zvishanu 2-chikamu chakatyoka, 12 3-chikamu chakatyoka, uye zvinomwe 4-chikamu chakatyoka zvakarapwa nekuvhiyiwa pachishandiswa angled kudzikamisa mahwendefa uye kuwedzera sikuru-simende augmentation. Matatu e24 akatyoka aive humeral head fractures. Anatomic kuderedzwa kwakawanikwa mu12 yevarwere ve24; kuderedzwa kwakakwana kweiyo medial cortex yakawanikwa mu15 yevarwere ve24 (62.5%). Pamwedzi ye3 mushure mekuvhiyiwa, 20 yevarwere ve21 (95.2%) vakanga vawana mubatanidzwa wekuputsika, kunze kwevarwere ve3 vaida kuvhiyiwa kwekutanga.
Mumwe murwere akagadzira kutanga kwechipiri chechipiri (posterior rotation ye humeral head fragment) mavhiki e7 mushure mekuvhiyiwa. Kudzokorora kwakaitwa nereverse yakazara mafudzi arthroplasty 3 mwedzi mushure mekuvhiyiwa. Primary screw penetration nekuda kwechidiki intraarticular simenti leakage (pasina kukukurwa kukuru kwejoinhi) yakaonekwa muvarwere ve3 (2 yavo yaive nehumeral head fractures) panguva yekutevera radiographic kutevera. Screw penetration yakaonekwa muC C yekona yekudzikamisa ndiro muvarwere ve2 uye muE layer mune imwe (Fig. 3). 2 yevarwere ve3 vakazogadzira avascular necrosis (AVN). Varwere vakavhiyiwa zvakare nekuda kwekuvandudzwa kweAVN (Tables 1, 2).
Ⅲ.Kukurukurirana.
Dambudziko rinonyanya kuitika muproximal humeral fractures (PHFs), kunze kwekuvandudzwa kweavascular necrosis (AVN), screw dislodgement nekuzotevera adduction kuputsika kwehumeral head fragment. Ongororo iyi yakawana kuti simende-screw augmentation yakakonzera mubatanidzwa we95.2% mumwedzi mitatu, yechipiri displacement rate ye4.2%, AVN rate ye16.7%, uye yakazara revision rate ye16.7%. Cement augmentation of screws yakakonzera kusimuka kwechipiri kwe4.2% pasina kudonha kweadduction, iri mwero wakaderera kana uchienzaniswa neanosvika 13.7-16% neyakajairwa angled plate fixation. Isu tinokurudzira zvakasimba kuti kuedza kuitwe kudzikamisa anatomic kwakaringana, kunyanya yemedial humeral cortex mune angled plate fixation yePHFs. Kunyangwe kana yakawedzera screw tip augmentation ikaiswa, inozivikanwa nzira yekutadza inofanirwa kutariswa.
Huwandu hwedzokorodzo hwese hwe16.7% uchishandisa screw tip augmentation muchidzidzo ichi huri mukati meiyo yakadzikira yeakambodhindwa ongororo mareti echinyakare angular kudzikamisa mahwendefa muPHFs, ayo aratidza kudzokororwa kwehuwandu hwevanhu vakwegura kubva pa13% kusvika 28%. Kwete kumirira. Iwo anotarisira, asina kurongeka, anodzorwa akawanda macenter kudzidza akaitwa naHengg et al. haina kuratidza kubatsirwa kwecement screw augmentation. Pakati pevarwere ve65 vakapedza 1-gore kutevera, kukanganisa kwemagetsi kwakaitika muvarwere ve9 uye 3 muboka rekuwedzera. AVN yakaonekwa muvarwere ve2 (10.3%) uye mune 2 varwere (5.6%) muboka risina kusimbiswa. Pakazara, pakanga pasina misiyano yakakosha mukuitika kwezviitiko zvakashata uye mhedzisiro yekiriniki pakati pemapoka maviri. Kunyange zvazvo zvidzidzo izvi zvakatarisa pamigumisiro yekliniki uye yeradiological, havana kuongorora radiographs zvakadzama sechidzidzo ichi. Pakazara, matambudziko akaonekwa neradiologically akafanana neaya ari muchidzidzo ichi. Hapana chezvidzidzo izvi zvakashuma intra-articular simenti kuvuza, kunze kwechidzidzo chaHengg et al., Vakaona chiitiko ichi chakaipa mune mumwe murwere. Muchidzidzo chazvino, kupinza kwepuraimari kwekutanga kwakaonekwa kaviri padanho C uye kamwe padanho E, paine yakazotevera intra-articular simende kuvuza pasina kukosha kwekiriniki. Kusiyanisa zvinhu kwakaiswa pasi pefluoroscopic control simende isati yaiswa kune imwe neimwe screw. Nekudaro, maonero akasiyana eradiographic panzvimbo dzakasiyana dzemaoko anofanirwa kuitwa uye kuongororwa zvakanyanya kuti abvise chero yekutanga screw penetration isati yaiswa simende. Pamusoro pezvo, simende inosimbisa zvikukutu padanho C (screw divergent configuration) inofanirwa kudzivirirwa nekuda kwenjodzi huru yekupinza sikururu uye kunotevera kuvuza kwesimende. Cement screw tip augmentation haikurudzirwi kune varwere vane humeral head fractures nekuda kwekukwanisa kwepamusoro kwe intraarticular leakage inoonekwa mune iyi fracture pattern (inocherechedzwa muvarwere ve2).
VI. Mhedziso.
Mukurapa kwePHFs ne-angle-stabilized plates vachishandisa PMMA simenti, simenti screw tip augmentation inzira yakavimbika yekuvhiya iyo inosimudzira kugadzirisa kwekuisa kune pfupa, zvichikonzera kuderera kwechipiri chekusimuka kwe4.2% muvarwere vane osteoporotic. Kuenzaniswa nemabhuku aripo, kuwedzera kwechiitiko cheavascular necrosis (AVN) yakaonekwa kunyanya mumaitiro akaoma ekuputsika uye izvi zvinofanira kuverengwa. Pamberi pekuisa simende, chero intraarticular simende inodonha inofanira kubviswa nekuchenjera nekusiyanisa pakati pekutonga. Nekuda kwenjodzi huru yekudonha kwe intraarticular simende mukutsemuka kwemusoro, isu hatikurudzire simende screw tip augmentation mukutyoka uku.
Nguva yekutumira: Aug-06-2024
