Mumakumi emakore apfuura, kuwanda kwemapfupa ekupwanyika kwemapfupa emusana (PHFs) kwakawedzera neanopfuura 28%, uye huwandu hwekuvhiyiwa hwakawedzera neanopfuura 10% muvarwere vane makore 65 zvichikwira. Zviri pachena kuti kudzikira kwehuremu hwemapfupa uye kuwedzera kwehuwandu hwekudonha ndizvo zvinhu zvikuru zvinokonzera njodzi muhuwandu hwevanhu vakwegura vari kuwedzera. Kunyangwe kurapwa kwakasiyana-siyana kwekuvhiyiwa kuripo kugadzirisa maPHF asina kugadzikana kana asina kugadzikana, hapana kubvumirana pane nzira yakanakisa yekuvhiya kune vakwegura. Kugadzirwa kwema angle stabilization plates kwakapa sarudzo yekurapa maPHF ekuvhiya, asi huwandu hwakawanda hwematambudziko hunosvika 40% hunofanira kufungwa nezvahwo. Zvinonyanya kutaurwa ndezvekudonha kwekuwedzerwa kwemapfupa nekubuda kwescrew uye avascular necrosis (AVN) yemusoro wehuma.
Kuderedzwa kwekutyoka kwemuviri, kudzorerwa kwehumeral moment, uye kugadziriswa kwakarurama kwe screw pasi peganda kunogona kuderedza matambudziko akadaro. Kugadziriswa kwe screw kunowanzo kuve kwakaoma nekuda kwekusagadzikana kwehunhu hwemapfupa e proximal humerus kunokonzerwa ne osteoporosis. Kugadzirisa dambudziko iri, kusimbisa mapfupa-screw interface ne mapfupa asina kunaka nekushandisa polymethylmethacrylate (PMMA) bone cement yakatenderedza muromo we screw inzira itsva yekuvandudza simba rekugadzirisa re implant.
Chidzidzo ichi chaive nechinangwa chekuongorora nekuongorora mhedzisiro yeX-ray yePHF dzakarapwa nema angled stabilization plates pamwe nekuwedzera screw tip incrementation muvarwere vane makore anopfuura makumi matanhatu.
Ⅰ.Nyaya uye Maitiro
Varwere vanosvika makumi mana nevapfumbamwe vakagadziriswa angle-stabilized plating uye vakawedzera simende ne screws dzePHF, uye varwere makumi maviri nevana vakabatanidzwa muchidzidzo ichi zvichibva pane zvinodiwa zvekubatanidzwa uye zvekuregererwa.
MaPHF ese makumi maviri nemana akarongwa achishandisa nzira yeHGLS classification system yakaunzwa naSukthankar naHertel vachishandisa CT scans vasati vavhiyiwa. MaX-ray epamberi pekuvhiyiwa pamwe chete nemaX-ray akajairika mushure mekuvhiyiwa akaongororwa. Kudzikiswa kwakakwana kwekuputika kwemapfupa kwakafungidzirwa kana tuberosity yemusoro wehumeral yaderedzwa zvakare uye yakaratidza nzvimbo iri pasi pe5 mm yemukana kana displacement. Kusagadzikana kwekuwedzera kwakatsanangurwa sekutsamira kwemusoro wehumeral zvichienzaniswa nehumeral shaft iri pasi pe125° uye valgus deformity yakatsanangurwa seinopfuura 145°.
Kupinda kwe screw kwekutanga kwakatsanangurwa se screw tip inopinda mumuganhu we medullary cortex ye humeral head. Kufamba kwe secondary fracture kwakatsanangurwa sekufamba kwe tuberosity yakaderera inopfuura 5 mm uye/kana kuchinja kweinopfuura 15° mu inclination angle ye head fragment pa follow-up radiograph zvichienzaniswa ne intraoperative radiograph.
Kuvhiyiwa kwese kwakaitwa kuburikidza nenzira huru ye deltopectoralis. Kuderedza kutyoka kwetsandanyama uye kuisa plate panzvimbo kwakaitwa nenzira yakajairika. Nzira yekuwedzera simende ne screw yakashandisa 0.5 ml yesimende yekuwedzera screw tip.
Kudzivirira kufamba kwemuviri mushure mekuvhiyiwa kwakaitwa nekushandisa chirauro cheruoko chakagadziriswa pafudzi kwemavhiki matatu. Kufamba kwemuviri nekukurumidza uye kwakabatsirwa nekubatsira marwadzo kwakatangwa mazuva maviri mushure mekuvhiyiwa kuti pave nekufamba kwakazara (ROM).
Ⅱ.Mugumisiro.
Mhedzisiro: Varwere makumi maviri nevana vakabatanidzwa, vane makore akaenzana nemakore 77.5 (makore 62-96). Makumi maviri nerimwe vaive vakadzi uye vatatu vaive varume. Kutsemuka kushanu kwezvikamu zviviri, kutsemuka kugumi nemaviri kwezvikamu zvitatu, uye kutsemuka kunomwe kwezvikamu zvina kwakarapwa nekuvhiyiwa uchishandisa ma angled stabilization plates uye kuwedzera screw-cement addition. Matatu ezvikamu makumi maviri nemana zvekutsemuka kwemusoro kwaive kutsemuka kwehumeral. Kuderedzwa kweanatomic kwakawanikwa muvarwere gumi nevaviri ve24; kuderedzwa kwakakwana kwemedial cortex kwakawanikwa muvarwere gumi nevashanu ve24 (62.5%). Pamwedzi mitatu mushure mekuvhiyiwa, varwere makumi maviri pa21 (95.2%) vaive vawana kukuvara kwemuviri, kunze kwevarwere vatatu vaida kuvhiyiwa nekukurumidza.
Mumwe murwere akatanga kusimuka nekukurumidza (kutenderera kwechikamu chemusoro wehumaral) mavhiki manomwe mushure mekuvhiyiwa. Kugadziriswazve kwakaitwa ne reverse total shoulder arthroplasty mwedzi mitatu mushure mekuvhiyiwa. Kupinda kwe screw nekuda kwekubuda kwe simende diki mukati me articular (pasina kukanganiswa kukuru kwejoini) kwakaonekwa muvarwere vatatu (vaviri vavo vaive vakatyoka musoro wehumaral) panguva yekutevera mushure mekuvhiyiwa ne radiographic. Kupinda kwe screw kwakaonekwa mu C layer ye angle stabilization plate muvarwere vaviri uye mu E layer mune imwe (Mufananidzo 3). Vaviri vevarwere vatatu ava vakazopedzisira vaita avascular necrosis (AVN). Varwere vakavhiyiwa zvakare nekuda kwekukura kweAVN (Matafura 1, 2).
Ⅲ.Kukurukurirana.
Dambudziko rinowanzoitika pakuputsika kwemapfupa ehumeral (PHFs), kunze kwekukura kweavascular necrosis (AVN), kuburitswa kwescrews nekuwedzera kudonha kwechikamu chemusoro wehumeral. Chidzidzo ichi chakawana kuti kuwedzera kwe cement-screws kwakaita kuti pave ne union rate ye95.2% pamwedzi mitatu, secondary displacement rate ye4.2%, AVN rate ye16.7%, uye total revision rate ye16.7%. Kuwedzera simende kwescrews kwakaita kuti pave nesecondary displacement rate ye4.2% pasina kuwedzera kudonha, inova chiyero chakaderera zvichienzaniswa neinenge 13.7-16% ne conventional angled plate fixation. Tinokurudzira zvakasimba kuti paitwe kuedza kuderedza zvakakwana anatomic, kunyanya medial humeral cortex mu angled plate fixation yePHFs. Kunyangwe kana kuwedzerwa kwe screw tip kwakawedzerwa, zvinodiwa zvinozivikanwa zvinofanirwa kufungwa nezvazvo.
Mwero wekudzokorora we16.7% uchishandisa kuwedzera kwe screw tip muchidzidzo ichi uri mukati mehuwandu hwakaderera hwehuwandu hwekudzokorora hwakamboburitswa hwema angle stabilization plates echinyakare muPHFs, ayo akaratidza huwandu hwekudzokorora muvanhu vakwegura huri kubva pa13% kusvika 28%. Hapana kumirira. Chidzidzo che multicenter chinotariswa, chakarongwa, chakadzorwa naHengg et al. hachina kuratidza kubatsira kwekuwedzera simende. Pakati pevarwere makumi matanhatu nevashanu vakapedza gore rimwe chete rekutevera, kutadza kwemuchina kwakaitika muvarwere vapfumbamwe uye vatatu muboka rekuwedzera. AVN yakaonekwa muvarwere vaviri (10.3%) uye muvarwere vaviri (5.6%) muboka risina kuwedzerwa. Pakazara, pakanga pasina mutsauko wakakosha mukuitika kwezviitiko zvakaipa uye mhedzisiro yekiriniki pakati pemapoka maviri. Kunyangwe zvidzidzo izvi zvakatarisa pamhedzisiro yekiriniki neye radiology, hazvina kuongorora radiographs zvakadzama sekudzidza uku. Pakazara, matambudziko akaonekwa ne radiology akafanana neari muchidzidzo ichi. Hapana chimwe chezvidzidzo izvi chakaratidza kubuda kwesimbi mukati memuviri, kunze kwekudzidza kwakaitwa naHengg nevamwe vake, avo vakaona chiitiko ichi chakaipa mumurwere mumwe chete. Mukudzidza uku, kupinda kwesimbi mumusoro kwakaonekwa kaviri padanho C uye kamwe chete padanho E, uye kubuda kwesimbi mumusoro kwemuviri kwesimbi kwakazotevera pasina kukosha kwekiriniki. Zvinhu zvakasiyana-siyana zvakaiswa pasi pe fluoroscopic control simende isati yaiswa pa screw yega yega. Zvisinei, maonero akasiyana-siyana e x-ray munzvimbo dzakasiyana dzemaoko anofanirwa kuitwa uye kuongororwa nokungwarira kuti pasave nekupinda kwesimbi mumusoro kwesimbi isati yaiswa simende. Uyezve, kusimbisa simende mu screw padanho C (screw divergent configuration) kunofanira kudzivirirwa nekuda kwenjodzi yakakura yekupinda kwesimbi mumusoro uye kubuda kwesimbi mumusoro kwesimbi. Kuwedzera simende mumusoro hakukurudzirwi kuvarwere vane mapfupa emusoro nekuda kwemukana mukuru wekubuda kwesimbi mumusoro kwesimbi kunoonekwa muchimiro ichi chekutyoka (kwakaonekwa muvarwere vaviri).
VI. Mhedziso.
Mukurapa maPHF nema angle-stabilized plates uchishandisa PMMA cement, cement screw tip augmentation inzira yekuvhiya yakavimbika inowedzera kugadzika kweimplant kumapfupa, zvichikonzera kuti secondary displacement rate yakaderera ye4.2% muvarwere vane osteoporosis. Zvichienzaniswa nezvinyorwa zviripo, kuwedzera kweavascular necrosis (AVN) kwakaonekwa kunyanya mumapatani akatyoka zvakanyanya uye izvi zvinofanirwa kufungwa nezvazvo. Simende isati yaiswa, chero kubuda kwe intraarticular simende kunofanirwa kubviswa nekungwarira ne contrast medium administration. Nekuda kwenjodzi yakakura yekubuda kwe intraarticular cement mu humeral head breakdowns, hatikurudzire cement screw tip augmentation mukutyoka uku.
Nguva yekutumira: Nyamavhuvhu-06-2024
