Ukuphuka kwe-femur okubangelwa yi-intertrochanteric kubanga u-50% wokuphuka kwe-hip kubantu asebekhulile. Ukwelashwa okulondolozayo kuthambekele ezinkingeni ezifana ne-deep vein thrombosis, i-pulmonary embolism, izilonda zokucindezeleka, kanye nokutheleleka kwamaphaphu. Izinga lokufa phakathi nonyaka owodwa lidlula u-20%. Ngakho-ke, ezimweni lapho isimo somzimba sesiguli sivumela khona, ukulungiswa kwangaphakathi kokuhlinzwa kusenesikhathi kuyindlela yokwelapha ekhethwayo yokuphuka kwe-intertrochanteric.
Ukulungiswa kwangaphakathi kwezipikili ngaphakathi kwe-intramedullary okwamanje kuyindinganiso yegolide yokwelapha ukwaphuka kwe-intertrochanteric. Ezifundweni eziphathelene nezici ezithonya ukulungiswa kwangaphakathi kwe-PFNA, izici ezifana nobude bezipikili ze-PFNA, i-varus angle, kanye nomklamo kubikwe ezifundweni eziningi zangaphambilini. Kodwa-ke, akukacaci ukuthi ukujiya kwezipikili eziyinhloko kuthinta imiphumela yokusebenza. Ukuze kulungiswe lokhu, izazi zakwamanye amazwe zisebenzise izipikili zangaphakathi kwe-medullary ezinobude obulinganayo kodwa ubukhulu obuhlukile ukulungisa ukwaphuka kwe-intertrochanteric kubantu asebekhulile (abaneminyaka engaphezu kwengu-50), behlose ukuqhathanisa ukuthi kukhona yini umehluko emiphumeleni yokusebenza.
Ucwaningo luhlanganise amacala angu-191 okuqhekeka kwe-intertrochanteric ohlangothini olulodwa, wonke elashwa nge-PFNA-II internal fixation. Lapho i-lesser trochanter iphukile futhi ihlukanisiwe, kwasetshenziswa isipikili esifushane esingu-200mm; lapho i-lesser trochanter iphelele noma ingahlukanisiwe, kwasetshenziswa isipikili esifushane esingu-170mm. Ububanzi besipikili esiyinhloko busukela ku-9-12mm. Ukuqhathanisa okuyinhloko ocwaningweni kugxile kulezi zinkomba ezilandelayo:
1. Ububanzi obuncane be-trochanter, ukuhlola ukuthi indawo yayijwayelekile yini;
2. Ubudlelwano phakathi kwe-medial cortex yengxenye yekhanda nentamo kanye nengxenye ekude, ukuhlola ikhwalithi yokuncipha;
3. Ibanga Eliqondile Neliphezulu (i-TAD);
4. Isilinganiso sezinzipho nomsele (i-NCR). I-NCR yisilinganiso sobubanzi bezinzipho obuyinhloko nobubanzi bomsele obuphakathi endaweni yesikulufu esikhiyayo esikude.
Phakathi kweziguli ezingu-191 ezifakiwe, ukusatshalaliswa kwamacala ngokusekelwe kubude nobubanzi besipikili esiyinhloko kuboniswe esithombeni esilandelayo:
I-NCR ejwayelekile yayingu-68.7%. Uma kusetshenziswa lesi silinganiso njengomkhawulo, amacala ane-NCR enkulu kunesilinganiso ayebhekwa njengonobubanzi obukhulu bezinzipho eziyinhloko, kuyilapho amacala ane-NCR engaphansi kwesilinganiso ayebhekwa njengobubanzi bezinzipho eziyinhloko obuncane. Lokhu kwaholela ekuhlukanisweni kweziguli eqenjini le-Thick Main Nail (amacala angu-90) kanye neqembu le-Thin Main Nail (amacala angu-101).
Imiphumela ikhombisa ukuthi bekungekho mehluko obalulekile ngokwezibalo phakathi kweqembu le-Thick Main Nail kanye neqembu le-Thin Main Nail ngokwe-Tip-Apex Distance, i-Koval score, izinga lokuphulukiswa eliphuzile, izinga lokuhlinzwa kabusha, kanye nezinkinga zamathambo.
Ngokufanayo nalolu cwaningo, isihloko sanyatheliswa ku-"Journal of Orthopaedic Trauma" ngo-2021: [Isihloko Sesihloko].
Ucwaningo luhlanganise iziguli ezingu-168 ezikhulile (ezineminyaka engaphezu kuka-60) ezinezinhlungu ze-intertrochanteric, zonke zelashwe ngezinzipho ze-cephalomedullary. Ngokusekelwe kububanzi bezinzipho eziyinhloko, iziguli zahlukaniswa zaba yiqembu elingu-10mm kanye neqembu elinobubanzi obungaphezu kuka-10mm. Imiphumela iphinde yabonisa ukuthi bekungekho mehluko obalulekile ngokwezibalo emazingeni okusebenza kabusha (kungaba jikelele noma okungathelelani) phakathi kwamaqembu amabili. Abalobi balolu cwaningo basikisela ukuthi, ezigulini ezikhulile ezinezinhlungu ze-intertrochanteric, ukusebenzisa isinzipho esiyinhloko esingu-10mm ububanzi kwanele, futhi asikho isidingo sokusilungisa ngokweqile, njengoba sisengafinyelela imiphumela emihle yokusebenza.
Isikhathi sokuthunyelwe: Feb-23-2024
