I-Intertrochanteric fractures ye-akhawunti ye-femur ye-50% ye-hip fractures kubantu asebekhulile.Ukwelashwa okuvamile kujwayele ukuba nezinkinga ezifana ne-deep vein thrombosis, i-pulmonary embolism, izilonda zokucindezela, kanye nezifo zamaphaphu.Izinga lokufa phakathi nonyaka owodwa lidlula ama-20%.Ngakho-ke, ezimweni lapho isimo somzimba wesiguli sivumela, ukulungiswa kwangaphakathi kokuhlinzwa kwangaphambi kwesikhathi kuyindlela ekhethwayo yokwelashwa kwe-intertrochanteric fractures.
Ukulungiswa kwangaphakathi kwezinzipho ze-Intramedullary njengamanje kuyindinganiso yegolide yokwelapha ukuphuka kwe-intertrochanteric.Ocwaningweni lwezinto ezithonya ukulungiswa kwangaphakathi kwe-PFNA, izici ezifana nobude bezinzipho ze-PFNA, i-varus angle, kanye nomklamo kuye kwabikwa ezifundweni eziningi ezedlule.Noma kunjalo, akukacaci ukuthi ubukhulu be-nail eyinhloko buthinta imiphumela yokusebenza.Ukuze kubhekwane nalokhu, izazi zakwamanye amazwe ziye zasebenzisa izinzipho ze-intramedullary ezinobude obulinganayo kodwa ubukhulu obuhlukene ukuze kulungiswe ukuphuka kwe-intertrochanteric kubantu asebekhulile (iminyaka engu-> 50), kuhloswe ukuqhathanisa ukuthi kukhona umehluko emiphumeleni yokusebenza.
Ucwaningo lwaluhlanganisa amacala e-191 e-unilateral intertrochanteric fractures, wonke aphathwe nge-PFNA-II ukulungiswa kwangaphakathi.Lapho i-trochanter encane iphuka futhi ihlukaniswa, kwasetshenziswa isipikili esifushane esingu-200mm;lapho i-trochanter encane yayiphelele noma ingahlukanisiwe, kwasetshenziswa isipikili esifushane kakhulu esingu-170mm.Ububanzi be-nail eyinhloko busuka ku-9-12mm.Ukuqhathanisa okuyinhloko ocwaningweni kugxile kulezi zinkomba ezilandelayo:
1. Ububanzi be-trochanter encane, ukuhlola ukuthi ukuma bekusezingeni yini;
2. Ubudlelwano phakathi kwe-medial cortex ye-head-neck fragment kanye ne-distal fragment, ukuhlola ikhwalithi yokunciphisa;
3. Ibanga le-Tip-Apex (TAD);
4.I-Nail-to-canal ratio (NCR).I-NCR isilinganiso sobubanzi bezinzipho eziyinhloko kuya kububanzi bomsele we-medullary endizeni yesikulufu sokukhiya i-distal.
Phakathi kweziguli ze-191 ezifakiwe, ukusatshalaliswa kwamacala okusekelwe kubude nobubanzi bezipikili eziyinhloko kuboniswa emfanekisweni olandelayo:
I-NCR evamile yayingama-68.7%.Kusetshenziswa lesi silinganiso njengomkhawulo, amacala ane-NCR amakhulu kunesilinganiso ayebhekwa njengobukhulu bezinzipho obukhulu, kuyilapho amacala ane-NCR engaphansi kwesilinganiso ayebhekwa njengobubanzi obuncane bezinzipho obuyinhloko.Lokhu kwaholela ekuhlukanisweni kweziguli zibe yiqembu le-Thick Main Nail (amacala angama-90) kanye neqembu le-Thin Main Nail (amacala ayi-101).
Imiphumela ikhombisa ukuthi awukho umehluko obalulekile ngokwezibalo phakathi kweqembu le-Thick Main Nail kanye neqembu le-Thin Main Nail ngokuya nge-Tip-Apex Distance, isikolo se-Koval, izinga lokuphulukisa elibambezelekile, izinga lokusebenza kabusha, kanye nezinkinga zamathambo.
Ngokufanayo nalolu cwaningo, indatshana yashicilelwa ku-"Journal of Orthopedic Trauma" ngo-2021: [Isihloko Sesihloko].
Ucwaningo lwaluhlanganisa iziguli ezikhulile ze-168 (iminyaka> engu-60) ezine-intertrochanteric fractures, zonke eziphathwa ngezinzipho ze-cephalomedullary.Ngokusekelwe kububanzi bezipikili eziyinhloko, iziguli zahlukaniswa zaba yiqembu le-10mm kanye neqembu elinobubanzi obukhulu kuno-10mm.Imiphumela iphinde yabonisa ukuthi kwakungekho umehluko ophawulekayo wezibalo kumazinga okusebenza kabusha (okungaba jikelele noma okungatheleleki) phakathi kwamaqembu amabili.Ababhali bocwaningo basikisela ukuthi, ezigulini esezikhulile ezine-intertrochanteric fractures, ukusebenzisa isikhonkwane esiyinhloko esingu-10mm ububanzi kwanele, futhi asikho isidingo sokuvuselela ngokweqile, njengoba kusengakwazi ukuzuza imiphumela emihle yokusebenza.
Isikhathi sokuthumela: Feb-23-2024
