Emashumini ambalwa eminyaka adlule, izehlakalo zokuphuka kwe-humeral fractures (PHFs) zikhuphuke ngamaphesenti angaphezu kwama-28, futhi izinga lokuhlinzwa lenyuke ngamaphesenti angaphezu kuka-10 ezigulini ezineminyaka engu-65 nangaphezulu. Ngokusobala, ukuncipha kwamathambo kanye nenani elikhulayo lokuwa yizici ezinkulu eziyingozi ekwandeni kwabantu asebekhulile. Nakuba kutholakala izindlela zokwelapha ezihlukene zokuhlinzwa zokuphatha ama-PHF asusiwe noma angazinzile, akukho ukuvumelana mayelana nendlela yokuhlinzwa engcono kakhulu yabantu asebekhulile. Ukuthuthukiswa kwamapuleti okuzinzisa ama-engeli kunikeze inketho yokwelapha yokwelashwa kokuhlinzwa kwama-PHF, kodwa izinga eliphezulu lenkinga elifika ku-40% kufanele licatshangelwe. Okuvame ukubikwa kakhulu ukuwa kwe-adduction nge-screw dislodgement kanye ne-avascular necrosis (AVN) yekhanda elithambile.
Ukuncishiswa kwe-anatomical kokuphuka, ukubuyiselwa kwesikhashana se-humeral, nokulungiswa okunembile kwe-subcutaneous kwesikulufu kunganciphisa izinkinga ezinjalo. Ukulungiswa kwezikulufu kuvame ukuba nzima ukufeza ngenxa yekhwalithi yamathambo esengozini ye-proximal humerus ebangelwa ukukhumuzeka kwamathambo. Ukuze kuxazululwe le nkinga, ukuqinisa isixhumi esibonakalayo se-bone-screw ngekhwalithi embi yethambo ngokusebenzisa i-polymethylmethacrylate (PMMA) ye-bonecement eduze kwethiphu yesikulufu kuyindlela entsha yokuthuthukisa amandla okulungisa okufakwayo.
Ucwaningo lwamanje luhloselwe ukuhlola nokuhlaziya imiphumela ye-radiographic yama-PHF alashwe ngamapuleti okusimamisa anama-engeli kanye nokwengezwa kwethiphu lesikulufu esengeziwe ezigulini ezineminyaka engaphezu kwengama-60.
Ⅰ.Izinto kanye nendlela
Isamba seziguli ze-49 zenze i-angle-stabilized plating kanye nokwengezwa kukasimende okwengeziwe ngezikulufo zama-PHFs, futhi iziguli ze-24 zifakwe ocwaningweni ngokusekelwe kunqubo yokufakwa nokukhipha.
Wonke ama-PHF angama-24 ahlukaniswa kusetshenziswa uhlelo lokuhlukanisa lwe-HGLS olwethulwa ngabakwaSukthankar no-Hertel kusetshenziswa izikena ze-CT zangaphambi kokuhlinzwa. Kwahlolwa ama-radiographs ngaphambi kokuhlinzwa kanye nama-postoperative plain radiographs. Ukuncishiswa okwanele kwe-anatomic kwe-fracture kucatshangelwa ukuthi kufinyelelwe lapho i-tuberosity yekhanda elithambile iphinde yancishiswa futhi ibonise ngaphansi kwe-5 mm yegebe noma ukufuduka. Ukukhubazeka kwe-Adduction kwachazwa njengokuthambekela kwekhanda le-humeral elihlobene ne-humeral shaft engaphansi kuka-125 ° futhi ukukhubazeka kwe-valgus kwachazwa njengokungaphezu kuka-145 °.
Ukungena kwesikulufu okuyinhloko kwachazwa njengethiphu yesikulufu engena emngceleni we-medullary cortex yekhanda elithambile. Ukususwa kokuphuka kwesibili kwachazwa njengokugudluzwa kwe-tuberosity encishisiwe engaphezu kuka-5 mm kanye/noma ushintsho olungaphezu kuka-15° ku-engeli yokuthambekela yesiqephu sekhanda ku-radiograph elandelwayo uma kuqhathaniswa ne-radiograph yangaphakathi kokusebenza.
Konke ukuhlinzwa kwenziwa ngendlela enkulu ye-deltopectoralis. Ukuncishiswa kokuphuka kanye nokubeka ipuleti kwenziwa ngendlela evamile. Indlela yokwengeza isikulurufu sikasimende isetshenziswe u-0.5 ml kasimende ekwandiseni ithiphu lesikulufu.
Ukunganyakazi kwenziwa ngemva kokuhlinzwa ku-sling ingalo yangokwezifiso ehlombe amaviki angu-3. Ukunyakaza okusebenzayo kokuqala nokusiza okusebenzayo ngokuguquguquka kobuhlungu kwaqalwa izinsuku ezingu-2 ngemuva kokuhlinzwa ukuze kuzuzwe uhla olugcwele lokunyakaza (ROM).
Ⅱ.Umphumela.
Imiphumela: Iziguli ezingamashumi amabili nane zifakiwe, ezineminyaka yobudala ephakathi kweminyaka engu-77.5 (ububanzi, iminyaka engu-62-96). Amashumi amabili nanye ngabesifazane kanti abathathu ngabesilisa. Ukuphuka okuyizingxenye ezi-2, okungu-12 okuyizingxenye ezi-3, kanye nezingxenye ezingu-4 eziyisikhombisa zelashwa ngokuhlinzwa kusetshenziswa amapuleti okuqinisa ama-angle kanye nokwengeza isikulufu sikasimende. Izingxenye ezintathu kwezingu-24 zaphuka amakhanda angama-humeral. Ukuncishiswa kwe-anatomic kwafinyelelwa ezigulini eziyi-12 kwezingama-24; ukuncishiswa okuphelele kwe-medial cortex kwafinyelelwa ezigulini eziyi-15 kwezingama-24 (62.5%). Ezinyangeni ezingu-3 ngemva kokuhlinzwa, iziguli ezingu-20 kwezingu-21 (95.2%) zazizuze inyunyana yokuphuka, ngaphandle kweziguli ezi-3 ezazidinga ukuhlinzwa kokubuyekezwa kwangaphambi kwesikhathi.
Isiguli esisodwa saqala ukufuduka kwesibili kokuqala (ukujikeleza kwangemuva kwesiqephu sekhanda le-humeral) amasonto angu-7 ngemva kokuhlinzwa. Ukubuyekeza kwenziwa nge-reverse total shoulder arthroplasty izinyanga ezingu-3 ngemva kokuhlinzwa. Ukungena kwesikulufu esiyinhloko ngenxa yokuvuza kukasimende okuncane kwe-intraarticular (ngaphandle kokuguguleka okukhulu kwesihlanganisi) kubonwe ezigulini ze-3 (i-2 yazo eyaphuka amakhanda a-humeral) ngesikhathi sokulandelwa kwe-radiographic yangemva kokuhlinzwa. Ukungena kwe-screw kutholwe kungqimba lwe-C lwepuleti lokuzinzisa i-engeli ezigulini ze-2 naku-E ungqimba kwenye (Fig. 3). Ezi-2 zalezi ziguli ezi-3 kamuva zathola i-avascular necrosis (AVN). Iziguli zahlinzwa ngokubuyekezwa ngenxa yokuthuthukiswa kwe-AVN (Amathebula 1, 2).
Ⅲ.Ingxoxo.
Inkinga ejwayeleke kakhulu ekuqhekekeni kwe-humeral proximal (PHFs), ngaphandle kokuthuthukiswa kwe-avascular necrosis (AVN), i-screw dislodgement kanye nokuwa okulandelayo kwe-adduction fragment ye-humeral head fragment. Lolu cwaningo luthole ukuthi ukwengezwa kwesikulufu sikasimende kubangele izinga lenyunyana elingu-95.2% ezinyangeni ezi-3, izinga lokufuduka kwesibili elingu-4.2%, izinga le-AVN elingu-16.7%, kanye nenani eliphelele lokubuyekeza elingu-16.7%. Ukukhuliswa kukasimende kwezikulufu kuphumele esilinganisweni sesibili sokugudluka esingu-4.2% ngaphandle kwanoma yikuphi ukuwa kwe-adduction, okuyizinga eliphansi uma liqhathaniswa nesilinganiso esicishe sibe ngu-13.7-16% esinokulungiswa kwepuleti le-engeli elivamile. Sincoma ngokuqinile ukuthi kwenziwe imizamo yokuzuza ukuncipha okwanele kwe-anatomic, ikakhulukazi i-medial humeral cortex ekulungisweni kwepuleti eline-angle lama-PHF. Ngisho noma ukusetshenziswa okwengeziwe kwethiphu lesikulufa kusetshenziswa, imibandela yokwehluleka eyaziwayo kufanele inakwe.
Isilinganiso sokubukeza sisonke esingu-16.7% kusetshenziswa i-screw tip augmentation kulolu cwaningo singaphakathi kwebanga eliphansi lamazinga okubuyekeza ashicilelwe ngaphambilini amapuleti endabuko okuqinisa ama-angular kuma-PHF, abonise amazinga okubuyekeza kubantu abadala asuka ku-13% kuya ku-28%. Cha ukulinda. Ucwaningo olulindelekile, olungahleliwe, olulawulwa yi-multicenter olwenziwe nguHengg et al. ayizange ibonise inzuzo yokwengezwa kwesikulufu sikasimende. Phakathi kweziguli ezingu-65 eziqede ukulandelwa konyaka we-1, ukwehluleka kwemishini kwenzeka ezigulini ze-9 kanye ne-3 eqenjini lokwandisa. I-AVN ibonwe ezigulini ze-2 (10.3%) kanye neziguli ze-2 (5.6%) eqenjini elingathuthukisiwe. Sekukonke, kwakungekho umehluko ophawulekayo ekuveleni kwezenzakalo ezimbi kanye nemiphumela yomtholampilo phakathi kwamaqembu amabili. Nakuba lezi zifundo zigxile emiphumeleni yomtholampilo neye-radiological, azizange zihlole ama-radiograph ngemininingwane eminingi njengalolu cwaningo. Sekukonke, izinkinga ezitholwe nge-radiologically zazifana nalezi zalolu cwaningo. Azikho kulezi zifundo ezibike ukuvuza kukasimende we-intra-articular, ngaphandle kocwaningo lukaHengg et al., Owabona lesi sigameko esibi esigulini esisodwa. Ocwaningweni lwamanje, ukungena okuyisisekelo kwesikulufu kwabonwa kabili ezingeni C futhi kanye ezingeni E, nokuvuza kukasimende we-intra-articular okwalandela ngaphandle kokuhambisana nomtholampilo. Into yokugqama yajovwa ngaphansi kokulawulwa kwe-fluoroscopic ngaphambi kokuthi kusetshenziswe ukukhuliswa kukasimende kusikulufa ngasinye. Kodwa-ke, ukubukwa okuhlukile kwe-radiographic ezindaweni ezihlukene zengalo kufanele kwenziwe futhi kuhlolwe ngokucophelela ukuze kukhishwe noma yikuphi ukungena okuyinhloko kwesikulufu ngaphambi kokufaka usimende. Ngaphezu kwalokho, ukuqinisa usimende kwezikulufu ezingeni C (ukulungiswa kwe-screw divergent) kufanele kugwenywe ngenxa yengozi ephezulu yokungena kwesikulufu esikhulu kanye nokuvuza kukasimende okulandelayo. Ukwengezwa kwethiphu yesikulufa se-Cement akunconywa ezigulini ezinekhanda elibuhlungu ngenxa yamandla aphezulu okuvuza kwe-intraarticular okubonwa kule phethini yokuphuka (kuqashelwe ezigulini ze-2).
VI. Isiphetho.
Ekwelapheni ama-PHF ngamapuleti azinzile nge-engeli esebenzisa usimende we-PMMA, i-cement screw tip augmentation iyindlela yokuhlinzwa enokwethenjelwa ethuthukisa ukuqiniswa kokufakelwa ethanjeni, okuholela esilinganisweni esiphansi sesibili sokugudluka esingu-4.2% ezigulini ezine-osteoporotic. Uma kuqhathaniswa nezincwadi ezikhona, ukwanda kwe-avascular necrosis (AVN) kwabonwa ikakhulukazi emaphethini okuphuka okukhulu futhi lokhu kufanele kucatshangelwe. Ngaphambi kokufaka usimende, noma yikuphi ukuvuza kukasimende we-intraarticular kufanele kukhishwe ngokucophelela ngokuphathwa okuphakathi kokuqhathanisa. Ngenxa yengozi enkulu yokuvuza kukasimende we-intraarticular ekuqhekekeni kwekhanda elinomswakama, asincomi ukukhuliswa kwethiphu lesikulufu sikasimende kulokhu kuphuka.
Isikhathi sokuthumela: Aug-06-2024
