Emashumini ambalwa eminyaka edlule, ukwanda kokuqhekeka kwe-humeral proximal (PHFs) kukhuphuke ngaphezu kuka-28%, kanti izinga lokuhlinzwa likhuphuke ngaphezu kuka-10% ezigulini ezineminyaka engu-65 nangaphezulu. Ngokusobala, ukwehla kobuningi bamathambo kanye nokwanda kwenani lokuwa kuyizinto eziyingozi kakhulu kubantu asebekhulile abakhulayo. Nakuba ukwelashwa okuhlukahlukene kokuhlinzwa kuyatholakala ukuphatha ama-PHF angenamakhaya noma angazinzile, akukho ukuvumelana ngendlela engcono kakhulu yokuhlinzwa kwasebekhulile. Ukuthuthukiswa kwama-angle stabilization plates kunikeze inketho yokwelashwa kokuhlinzwa kwama-PHF, kodwa izinga eliphezulu lezinkinga elifika ku-40% kumele licatshangelwe. Okuvame ukubikwa kakhulu ukuwa kwe-adduction ngokuphuma kwesikulufu kanye ne-avascular necrosis (AVN) yekhanda le-humeral.
Ukunciphisa ukuphuka komzimba, ukubuyiselwa kwesikhashana se-humeral, kanye nokulungiswa okunembile kwesikulufu ngaphansi kwesikhumba kunganciphisa izinkinga ezinjalo. Ukulungiswa kwesikulufu kuvame ukuba nzima ukukufeza ngenxa yekhwalithi yethambo elibuthakathaka le-humerus eseduze ebangelwa yi-osteoporosis. Ukuze kuxazululwe le nkinga, ukuqinisa isixhumi sethambo nesikulufu ngekhwalithi yethambo elibi ngokusebenzisa i-polymethylmethacrylate (PMMA) bone cement ezungeze isihloko sesikulufu kuyindlela entsha yokuthuthukisa amandla okulungiswa kwesilayidi.
Ucwaningo lwamanje luhlose ukuhlola nokuhlaziya imiphumela ye-x-ray yama-PHF aphathwe ngama-angled stabilization plates kanye nokwandiswa okwengeziwe kwe-screw tip ezigulini ezineminyaka engaphezu kwengu-60.
Ⅰ.Izinto kanye Nendlela
Iziguli ezingu-49 sezizonke zafakwa i-plating ezizinzile ngama-angle kanye nokwandiswa kwesimende okwengeziwe ngezikulufo ze-PHF, kanti iziguli ezingu-24 zafakwa ocwaningweni ngokusekelwe ezindleleni zokufaka kanye nokukhipha.
Zonke i-PHF ezingu-24 zahlukaniswa kusetshenziswa uhlelo lokuhlukanisa lwe-HGLS olwethulwa yiSukthankar noHertel besebenzisa ama-CT scan angaphambi kokuhlinzwa. Kwahlolwa ama-radiograph angaphambi kokuhlinzwa kanye nama-radiograph alula angemva kokuhlinzwa. Ukunciphisa okwanele kokuqhekeka kwacatshangwa ukuthi kufezwe lapho i-tuberosity yekhanda le-humeral incishiswa futhi ikhombisa igebe noma ukufuduka okungaphansi kuka-5 mm. Ukukhubazeka kokwengezwa kwachazwa njengokuthambekela kwekhanda le-humeral maqondana nomgodi we-humeral ongaphansi kuka-125° kanye nokukhubazeka kwe-valgus kwachazwa njengokungaphezu kuka-145°.
Ukungena kwesikulufo okuyinhloko kwachazwa njengesihloko sesikulufo esingena emngceleni we-medullary cortex yekhanda le-humeral. Ukususwa kokuqhekeka kwesibili kwachazwa njengokufuduka kwe-tuberosity encishisiwe engaphezu kuka-5 mm kanye/noma ushintsho olungaphezu kuka-15° ekhoneni lokuthambekela kwengxenye yekhanda ku-radiograph yokulandelela uma kuqhathaniswa ne-radiograph yangaphakathi kokuhlinzwa.
Konke ukuhlinzwa kwenziwa ngendlela enkulu ye-deltopectoralis. Ukunciphisa ukuphuka kanye nokubeka ipuleti kwenziwa ngendlela ejwayelekile. Indlela yokwandisa isikulufo ngesamente isebenzise u-0.5 ml wesimende ukuze kukhuliswe izipikili zesikulufo.
Ukuvimbela ukunyakaza kwenziwa ngemva kokuhlinzwa ngesilingi sengalo esenziwe ngokwezifiso sehlombe amasonto ama-3. Ukunyakaza okusebenzayo kwasekuqaleni okusizwayo nokusizayo kanye nokuguqulwa kobuhlungu kwaqalwa ezinsukwini ezi-2 ngemva kokuhlinzwa ukuze kufezwe uhla oluphelele lokunyakaza (ROM).
Ⅱ.Umphumela.
Imiphumela: Iziguli ezingamashumi amabili nane zifakiwe, zineminyaka ephakathi kuka-77.5 (ibanga, iminyaka engu-62-96). Ezingamashumi amabili nanye kwakungabesifazane kanti ezintathu kwakungabesilisa. Ukuphuka okuhlanu okunezingxenye ezimbili, ukuphuka okungu-12 okunezingxenye ezintathu, kanye nokuphuka okuyisikhombisa okunezingxenye ezine kwelashwa ngokuhlinzwa kusetshenziswa amapuleti okuzinza aqondile kanye nokwandiswa okwengeziwe kwesikulufo-samente. Ukuphuka okuthathu kwakungukuphuka kwekhanda elithambile. Ukuncipha kokwakheka komzimba kutholakale ezigulini eziyi-12 kwezingu-24; ukuncipha okuphelele kwe-medial cortex kutholakale ezigulini eziyi-15 kwezingu-24 (62.5%). Ezinyangeni ezi-3 ngemva kokuhlinzwa, iziguli ezingu-20 kwezingu-21 (95.2%) zase zifinyelele ukuhlanganiswa kokuphuka, ngaphandle kweziguli ezintathu ezazidinga ukuhlinzwa kokubuyekezwa kusenesikhathi.
Isiguli esisodwa saqala ukufuduka kwesibili kusenesikhathi (ukujikeleza kwangemuva kwengxenye yekhanda le-humeral) emavikini ayi-7 ngemuva kokuhlinzwa. Ukubuyekezwa kwenziwa nge-arthroplasty yehlombe eliphelele elibuyela emuva ezinyangeni ezi-3 ngemuva kokuhlinzwa. Ukungena kwesikulufu okuyinhloko ngenxa yokuvuza okuncane kwesimende ngaphakathi kwe-articular (ngaphandle kokuguguleka okukhulu kwejoyinti) kwabonwa ezigulini ezi-3 (ezimbili zazo ezazinezimpaphe zekhanda le-humeral) ngesikhathi sokulandelela nge-radiographic ngemuva kokuhlinzwa. Ukungena kwesikulufu kwatholakala kungqimba lwe-C lwepuleti lokuzinza kwe-angle ezigulini ezi-2 kanye nakungqimba lwe-E kolunye (Isithombe 3). Ezimbili zalezi ziguli ezi-3 kamuva zaba ne-avascular necrosis (AVN). Iziguli zahlinzwa kabusha ngenxa yokuthuthukiswa kwe-AVN (Amathebula 1, 2).
Ⅲ.Ingxoxo.
Inkinga evame kakhulu ekuqhekekeni kwe-humeral proximal (PHFs), ngaphandle kokuthuthukiswa kwe-avascular necrosis (AVN), ukuhlukana kwezikulufo kanye nokuwa okulandelayo kwengxenye yekhanda le-humeral. Lolu cwaningo luthole ukuthi ukukhushulwa kwesikulufo se-cement-screw kuholele esilinganisweni sokuhlanganiswa esingu-95.2% ezinyangeni ezi-3, izinga lokufuduka lesibili elingu-4.2%, izinga le-AVN elingu-16.7%, kanye nezinga lokubuyekezwa eliphelele elingu-16.7%. Ukukhushulwa kwesikulufo se-cement kuholele esilinganisweni sokufuduka sesibili esingu-4.2% ngaphandle kokuwa kokukhushulwa, okuyizinga eliphansi uma kuqhathaniswa nesilinganiso esingu-13.7-16% ngokulungiswa kwepuleti elijwayelekile eliyi-angled. Sincoma kakhulu ukuthi kwenziwe imizamo yokufeza ukunciphisa okwanele kwe-anatomic, ikakhulukazi i-medial humeral cortex ekufakweni kwepuleti eliyi-angled lama-PHF. Ngisho noma kusetshenziswa ukukhushulwa kwe-screw tip eyengeziwe, izindlela zokwehluleka ezingaba khona ezaziwayo kumele zicatshangelwe.
Izinga lokubuyekezwa eliphelele lika-16.7% kusetshenziswa ukukhushulwa kwe-screw tip kulolu cwaningo lingaphakathi kobubanzi obuphansi bezinga lokubuyekezwa elishicilelwe ngaphambilini lama-angle stabilization plates endabuko kuma-PHF, abonise amazinga okubuyekezwa kubantu asebekhulile asukela ku-13% kuya ku-28%. Akunakulinda. Ucwaningo oluningi oluhleliwe, olulawulwayo olunezikhungo eziningi olwenziwe nguHengg et al. aluzange lubonise inzuzo yokukhushulwa kwe-cement screw. Phakathi kweziguli ezingu-65 eziqede ukulandelwa konyaka owodwa, ukwehluleka komshini kwenzeke ezigulini ezingu-9 kanye nezingu-3 eqenjini lokukhushulwa. I-AVN yabonwa ezigulini ezimbili (10.3%) kanye nasezigulini ezimbili (5.6%) eqenjini elingathuthukisiwe. Sekukonke, bekungekho mehluko omkhulu ekwenzekeni kwezehlakalo ezimbi kanye nemiphumela yezokwelapha phakathi kwamaqembu amabili. Nakuba lezi zifundo zigxile emiphumeleni yezokwelapha neye-radiological, azizange zihlole ama-radiographs ngemininingwane eminingi njengalolu cwaningo. Sekukonke, izinkinga ezitholwe nge-radiological zazifana nalezo ezikulolu cwaningo. Akukho noyedwa kulezi zifundo obike ukuvuza kwesimende ngaphakathi kwe-articular, ngaphandle kocwaningo lukaHengg et al., ababone lesi sigameko esibi esigulini esisodwa. Kulesi sifundo samanje, ukungena kwesikulufo esiyinhloko kwabonwa kabili ezingeni C kanye kanye ezingeni E, kwalandela ukuvuza kwesimende ngaphakathi kwe-articular ngaphandle kokubaluleka kwezokwelapha. Izinto ezihlukile zajovwa ngaphansi kokulawulwa kwe-fluoroscopic ngaphambi kokuba kufakwe ukwandiswa kwesimende kusikulufo ngasinye. Kodwa-ke, imibono ehlukene ye-radiographic ezindaweni ezahlukene zengalo kufanele yenziwe futhi ihlolwe ngokucophelela ukuze kunqunywe noma yikuphi ukungena kwesikulufo esiyinhloko ngaphambi kokusetshenziswa kwesimende. Ngaphezu kwalokho, ukuqinisa isikulufo ngesimende ezingeni C (ukucushwa kwe-screw divergent) kufanele kugwenywe ngenxa yengozi ephezulu yokungena kwesikulufo esiyinhloko kanye nokuvuza kwesimende okulandelayo. Ukwandiswa kwe-tip yesikulufo sikasimende akukhuthazwa ezigulini ezinezimpaphe zekhanda eziphukile ngenxa yamandla aphezulu okuvuza ngaphakathi kwe-articular okubonwe kule patheni yokuphuka (okubonwe ezigulini ezimbili).
VI. Isiphetho.
Ekwelapheni ama-PHF ngamapuleti azinzile nge-angle esebenzisa i-PMMA cement, ukwandiswa kwe-cement screw tip kuyindlela yokuhlinza ethembekile ethuthukisa ukufakwa kwe-implant emathanjeni, okuholela ezingeni eliphansi lokufuduka kwesibili elingu-4.2% ezigulini ezine-osteoporosis. Uma kuqhathaniswa nezincwadi ezikhona, ukwanda kwe-avascular necrosis (AVN) kwabonwa ikakhulukazi emaphethini okuphuka okukhulu futhi lokhu kumele kucatshangelwe. Ngaphambi kokusetshenziswa kwe-cement, noma yikuphi ukuvuza kwe-cement intraarticular kumele kukhishwe ngokucophelela ngokuphathwa kwe-contrast medium. Ngenxa yengozi ephezulu yokuvuza kwe-cement intraarticular ekuqhekekeni kwekhanda le-humeral, asincomi ukwandiswa kwe-cement screw tip kulokhu kuphuka.
Isikhathi sokuthunyelwe: Agasti-06-2024
