I-Femoral intertrochanteric fracture iwukuphuka kwe-hip okuvame kakhulu ekusebenzeni komtholampilo futhi ingenye yezingxenye ezintathu ezivame kakhulu ezihlobene ne-osteoporosis kubantu asebekhulile.Ukwelashwa okuvamile kudinga ukuphumula kombhede isikhathi eside, okubeka engcupheni enkulu yezilonda zokucindezela, izifo zamaphaphu, i-pulmonary embolism, i-deep vein thrombosis, nezinye izinkinga.Ubunzima bobuhlengikazi bubalulekile, futhi isikhathi sokululama side, sibeka umthwalo osindayo emphakathini nasemindenini.Ngakho-ke, ukungenelela kokuhlinzwa kusenesikhathi, noma nini lapho kubekezelelwa, kubalulekile ukuze kuzuzwe imiphumela emihle yokusebenza ekuqhekekeni kwe-hip.
Njengamanje, i-PFNA (i-proximal femoral nail antirotation system) ukulungiswa kwangaphakathi kubhekwa njengezinga legolide lokwelashwa kokuhlinzwa kokuphuka kwe-hip.Ukuthola ukwesekwa okuhle ngesikhathi sokunciphisa ukuphuka kwe-hip kubalulekile ukuze kuvunyelwe ukuzivocavoca okusebenzayo kusenesikhathi.I-Intraoperative fluoroscopy ihlanganisa i-anteroposterior (AP) kanye nokubukwa kwe-lateral ukuhlola ukuncishiswa kwe-femoral anterior medial cortex.Kodwa-ke, izingxabano zingase ziphakame phakathi kwemibono emibili ngesikhathi sokuhlinzwa (okungukuthi, okuhle ekubukeni kwe-lateral kodwa hhayi ekubukeni kwe-anteroposterior, noma ngokuphambene nalokho).Ezimweni ezinjalo, ukuhlola ukuthi ingabe ukunciphisa kuyamukeleka yini nokuthi ukulungiswa kuyadingeka yini kubangela inkinga eyinselele kubasebenzi basemtholampilo.Izazi ezivela ezibhedlela zasekhaya ezifana ne-Oriental Hospital ne-Zhongshan Hospital ziye zabhekana nalolu daba ngokuhlaziya ukunemba kokuhlola ukwesekwa okuhle nokubi ngaphansi kokubukwa kwe-anteroposterior kanye ne-lateral kusetshenziswa izikena ze-CT ezinezinhlangothi ezintathu zangemuva kokuhlinzwa njengezinga elijwayelekile.
▲ Umdwebo ubonisa ukwesekwa okuhle (a), ukusekela okungathathi hlangothi (b), nokusekela okungalungile (c) amaphethini we-hip fractures ekubukeni kwe-anteroposterior.
▲ Umdwebo ubonisa ukwesekwa okuhle (d), ukusekela okungathathi hlangothi (e), nokusekela okungalungile (f) amaphethini we-hip fractures ekubukeni kwe-lateral.
I-athikili ihlanganisa idatha yecala evela ezigulini ze-128 ezine-hip fractures.Izithombe ze-intraoperative anteroposterior kanye ne-lateral zanikezwa ngokuhlukana kodokotela ababili (oyedwa onokuhlangenwe nakho okuncane futhi oyedwa onokuhlangenwe nakho okwengeziwe) ukuze bahlole ukwesekwa okuhle noma okungenakho.Ngemva kokuhlola kokuqala, ukuhlolwa kabusha kwenziwa ngemva kwezinyanga ezi-2.Izithombe ze-postoperative ze-CT zanikezwa uprofesa onolwazi, owanquma ukuthi leli cala lihle noma alikho, elisebenza njengezinga lokuhlola ukunemba kokuhlolwa kwesithombe odokotela ababili bokuqala.Ukuqhathanisa okuyinhloko esihlokweni kungokulandelayo:
(1) Ingabe kunomehluko obalulekile ngokwezibalo emiphumeleni yokuhlola phakathi kodokotela abanolwazi oluncane nabanolwazi olunzulu ekuhloleni kokuqala nokwesibili?Ukwengeza, i-athikili ihlola ukuvumelana kwe-intergroup phakathi kwamaqembu anolwazi oluncane nanolwazi olunzulu kukho kokubili ukuhlola kanye nokuvumelana kwe-intragroup phakathi kokuhlola okubili.
(2) Isebenzisa i-CT njengereferensi evamile yegolide, i-athikili iphenya ukuthi yikuphi okuthembeke kakhulu ekuhloleni ikhwalithi yokunciphisa: ukuhlolwa kwe-lateral noma kwe-anteroposterior.
Imiphumela yocwaningo
1. Emizuliswaneni emibili yokuhlola, nge-CT njengezinga lereferensi, kwakungekho umehluko obalulekile wezibalo ekuzweleni, ukucaciswa, izinga lokuvuma okungamanga, izinga elingalungile elingamanga, kanye neminye imingcele ehlobene nokuhlolwa kwekhwalithi yokunciphisa ngokusekelwe ekuhlinzekweni kwe-X- imisebe phakathi kodokotela ababili abanamazinga ahlukene okuhlangenwe nakho.
2.Ekuhlolweni kwekhwalithi yokwehliswa, ukuthatha ukuhlolwa kokuqala njengesibonelo:
- Uma kukhona isivumelwano phakathi kokuhlolwa kwe-anteroposterior kanye ne-lateral (kokubili okuhle noma kokubili okungekho), ukwethembeka ekubikezeleni ikhwalithi yokunciphisa ku-CT ngu-100%.
- Uma kunokungavumelani phakathi kokuhlolwa kwe-anteroposterior kanye ne-lateral, ukwethembeka kwenqubo yokuhlola ye-lateral ekubikezeleni ikhwalithi yokunciphisa ku-CT kuphezulu.
▲ Umdwebo ubonisa ukusekela okuhle okuboniswe ekubukeni kwe-anteroposterior ngenkathi kubonakala sengathi akuyona into enhle ekubukeni kwe-lateral.Lokhu kubonisa ukungqubuzana kwemiphumela yokuhlola phakathi kokubuka kwe-anteroposterior kanye ne-lateral.
▲ Ukwakhiwa kabusha kwe-CT enezinhlangothi ezintathu kunikeza izithombe zokubuka ezinezinhlangothi eziningi, ezisebenza njengezinga lokuhlolwa kwekhwalithi yokunciphisa.
Ezindinganisweni zangaphambilini zokunciphisa ukuphuka kwe-intertrochanteric, ngaphandle kokusekelwa okuhle nokubi, kukhona nomqondo wokwesekwa "okungathathi hlangothi", okusho ukuncishiswa kwe-anatomical.Kodwa-ke, ngenxa yezinkinga ezihlobene nokulungiswa kwe-fluoroscopy kanye nokubonakala kwamehlo omuntu, "ukuncipha kwe-anatomical" kweqiniso akukho, futhi kukhona njalo ukuchezuka okuncane okuya ekwehliseni "okuhle" noma "okubi".Ithimba eliholwa u-Zhang Shimin esibhedlela sase-Yangpu e-Shanghai lishicilele iphepha (inkomba ethize ekhohliwe, ingajabulela uma othile engayinikeza) eliphakamisa ukuthi ukuzuza ukusekelwa okuhle ekuqhekekeni kwe-intertrochanteric kungase kuphumele emiphumeleni engcono yokusebenza uma kuqhathaniswa nokuncishiswa kwe-anatomical.Ngakho-ke, kucatshangelwa lolu cwaningo, imizamo kufanele yenziwe ngesikhathi sokuhlinzwa ukuze kuzuzwe ukwesekwa okuhle ekuqhekekeni kwe-intertrochanteric, kokubili ekubukeni kwe-anteroposterior kanye ne-lateral.
Isikhathi sokuthumela: Jan-19-2024
