Ukuphuka kwe-femoral intertrochanteric kuwukuphuka kwe-hip okuvame kakhulu emtholampilo futhi kungenye yezinkinga ezintathu ezivame kakhulu ezihlobene ne-osteoporosis kubantu asebekhulile. Ukwelashwa okulondolozayo kudinga ukuphumula embhedeni isikhathi eside, okubeka izingozi ezinkulu zezilonda zokucindezeleka, izifo zamaphaphu, i-pulmonary embolism, i-deep vein thrombosis, nezinye izinkinga. Ubunzima bokuncelisa bubalulekile, futhi isikhathi sokululama side, okubeka umthwalo osindayo emphakathini nasemindenini. Ngakho-ke, ukungenelela kokuhlinzwa kusenesikhathi, noma nini lapho kubekezelelwa, kubalulekile ekufinyeleleni imiphumela emihle yokusebenza kokuphuka kwe-hip.
Njengamanje, ukufakwa kwangaphakathi kwe-PFNA (proximal femoral nail antirotation system) kubhekwa njengendinganiso yegolide yokwelashwa kokuhlinzwa kokuphuka kwe-hip. Ukuthola ukwesekwa okuhle ngesikhathi sokunciphisa ukuphuka kwe-hip kubalulekile ekuvumeleni ukuzivocavoca kwasekuqaleni. I-Intraoperative fluoroscopy ifaka phakathi i-anteroposterior (AP) kanye ne-lateral views ukuhlola ukwehla kwe-femoral anterior medial cortex. Kodwa-ke, kungase kuvele izingxabano phakathi kwemibono emibili ngesikhathi sokuhlinzwa (okungukuthi, okuhle ngokubuka eceleni kodwa hhayi ngokubuka ngaphambili, noma okuphambene nalokho). Ezimweni ezinjalo, ukuhlola ukuthi ukunciphisa kuyamukeleka yini nokuthi ukulungiswa kuyadingeka yini kudala inkinga eyinselele kodokotela. Izazi ezivela ezibhedlela zasekhaya ezifana ne-Oriental Hospital kanye ne-Zhongshan Hospital zibhekane nale nkinga ngokuhlaziya ukunemba kokuhlola ukwesekwa okuhle nokubi ngaphansi kokubukwa kwe-anteroposterior kanye ne-lateral besebenzisa ama-CT scans angemva kokuhlinzwa njengendinganiso.
▲ Umdwebo ubonisa ukwesekwa okuhle (a), ukwesekwa okungathathi hlangothi (b), kanye nokusekelwa okungekuhle (c) kwamaphethini okuphuka kwenqulu ekubukeni kwe-anteroposterior.
▲ Umdwebo ubonisa ukwesekwa okuhle (d), ukwesekwa okungathathi hlangothi (e), kanye nokusekelwa okungekuhle (f) kwamaphethini okuphuka kwenqulu ekubukeni kwecala.
Lesi sihloko sihlanganisa idatha yamacala avela ezigulini ezingu-128 ezinezinqe eziphukile. Izithombe ze-anteroposterior kanye nezithombe ze-lateral zanikezwa odokotela ababili ngokwehlukana (oyedwa onolwazi oluncane kanye nomunye onolwazi oluningi) ukuze kuhlolwe ukwesekwa okuhle noma okungekuhle. Ngemva kokuhlolwa kokuqala, kwahlolwa kabusha ngemva kwezinyanga ezimbili. Izithombe ze-CT zangemva kokuhlinzwa zanikezwa uprofesa onolwazi, owanquma ukuthi icala lalihle noma alihle, esebenza njengendinganiso yokuhlola ukunemba kokuhlolwa kwesithombe ngodokotela ababili bokuqala. Ukuqhathanisa okuyinhloko kulesi sihloko kungokulandelayo:
（1）Ingabe kukhona umehluko obalulekile ngokwezibalo emiphumeleni yokuhlola phakathi kodokotela abangenalo ulwazi oluningi nabanolwazi oluningi ekuhlolweni kokuqala nokwesibili? Ngaphezu kwalokho, lesi sihloko sihlola ukuvumelana phakathi kwamaqembu phakathi kwamaqembu angenalo ulwazi oluningi nabanolwazi oluningi kokubili ekuhlolweni kanye nokuvumelana kwangaphakathi kwamaqembu phakathi kokuhlolwa okubili.
（2）Sisebenzisa i-CT njengereferensi yegolide ejwayelekile, lesi sihloko sihlola ukuthi yikuphi okuthembekile kakhulu ekuhloleni ikhwalithi yokunciphisa: ukuhlolwa kwe-lateral noma kwe-anteroposterior.
Imiphumela yocwaningo
1. Emijikelezweni emibili yokuhlolwa, nge-CT njengendinganiso yokubhekisela, bekungekho mehluko obalulekile ngokwezibalo ekuzweleni, ukucacisa, izinga lokuhlehlisa elingamanga, izinga lokuhlehlisa elingamanga, kanye neminye imingcele ehlobene nokuhlolwa kwekhwalithi yokwehla ngokusekelwe kuma-X-ray angaphakathi kokuhlinzwa phakathi kodokotela ababili abanamazinga ahlukene olwazi.
2. Ekuhlolweni kwekhwalithi yokunciphisa, ukuthatha ukuhlolwa kokuqala njengesibonelo:
- Uma kukhona ukuvumelana phakathi kokuhlolwa kwe-anteroposterior kanye ne-lateral (kokubili okuhle noma kokubili okungekho okuhle), ukuthembeka ekubikezeleni ikhwalithi yokwehla kwe-CT kungu-100%.
- Uma kukhona ukungavumelani phakathi kokuhlolwa kwe-anteroposterior kanye ne-lateral, ukuthembeka kwezindlela zokuhlola ze-lateral ekubikezeleni ikhwalithi yokunciphisa ku-CT kuphakeme.
▲ Umdwebo ubonisa ukwesekwa okuhle okuboniswe embonweni we-anteroposterior ngenkathi kubonakala kungenabo okuhle embonweni we-lateral. Lokhu kubonisa ukungahambisani emiphumeleni yokuhlola phakathi kwemibono ye-anteroposterior kanye ne-lateral.
▲ Ukwakhiwa kabusha kwe-CT okunezinhlangothi ezintathu kunikeza izithombe zokubuka ezinezinhlangothi eziningi, okusebenza njengendinganiso yokuhlola ikhwalithi yokwehla.
Ezindinganisweni zangaphambilini zokunciphisa ukwaphuka kwe-intertrochanteric, ngaphandle kokusekelwa okuhle nokubi, kukhona nomqondo wokusekelwa "okungathathi hlangothi", okusho ukunciphisa umzimba. Kodwa-ke, ngenxa yezinkinga ezihlobene nokulungiswa kwe-fluoroscopy kanye nokubonakala kwamehlo omuntu, "ukunciphisa umzimba" kwangempela akukho ngokombono, futhi kuhlale kukhona ukuphambuka okuncane ekuncishisweni "okuhle" noma "okungekuhle". Ithimba eliholwa nguZhang Shimin eSibhedlela saseYangpu eShanghai lashicilela iphepha (inkomba ethile ekhohliwe, ingabonga uma othile engakunikeza) eliphakamisa ukuthi ukuthola ukwesekwa okuhle ekuqhekekeni kwe-intertrochanteric kungabangela imiphumela engcono yokusebenza uma kuqhathaniswa nokunciphisa umzimba. Ngakho-ke, uma sicabangela lolu cwaningo, kufanele kwenziwe imizamo ngesikhathi sokuhlinzwa ukuze kutholakale ukwesekwa okuhle ekuqhekekeni kwe-intertrochanteric, kokubili ekubukeni kwe-anteroposterior kanye ne-lateral.
Isikhathi sokuthunyelwe: Jan-19-2024
