Emashumini ambalwa eminyaka adlule, izehlakalo ze-Proximal Humbleral Fractures (PHFS) zikhuphuke ngaphezu kwama-28%, futhi isilinganiso sokuhlinzwa sikhuphuke ngaphezu kwe-10% ezigulini ezineminyaka engama-65 nangaphezulu. Ngokusobala, ukuncipha kwamathambo kanye nenani elikhulayo lezimpophoma ziyizingozi ezinkulu kubantu abadala abadala. Yize ukwelashwa okuhlukahlukene okuhlukahlukene kutholakala ukuphatha ama-Phfs asusiwe noma angazinzile, akukho ukuvumelana kwendlela enhle kunazo zonke yokuhlinzwa asebekhulile. Ukuthuthukiswa kwamapuleti okuqinisa ama-Angle ahlinzeke ngenketho yokwelashwa yokwelashwa kokuhlinzwa kwama-phfs, kepha izinga eliphakeme elifinyelela ku-40% kumele libhekwe. Okubikwa kakhulu ukuthi ukuwohloka okungezelelweyo nge-screw admoplement kanye ne-avascular necrosis (avn) yekhanda elimunyulo.
Ukwehliswa kwe-anatomical kokuqhekeka, ukubuyiselwa komzuzu othobekile, kanye nokulungiswa okuqondile okuqondile kwesikulufa kunganciphisa izinkinga ezinjalo. Ukulungiswa kwesikulufa kuvame ukuba nzima ukukufeza ngenxa yekhwalithi yamathambo ehlehlisiwe ye-humerus ephezulu ebangelwa yi-osteoporosis. Ukubhekana nale nkinga, ukuqinisa isikhombimsebenzisi se-bone-screw ngekhwalithi enamathambo ampofu ngokusebenzisa i-polymethylmethacrylate (PMMA) ithambo kasimende ezungeze i-screw fip yindlela entsha yokuthuthukisa amandla okufakelwa.
Ucwaningo lwamanje oluhlose ukuhlola futhi luhlaziye imiphumela ye-radiographic yama-phfs aphathwa ngamapuleti wokuqinisa ama-angled kanye nokwenyuswa okwengeziwe kwesikulufa seziguli ezigulini ezineminyaka engaphezulu kwe-60.
Ⅰ.Impahla nendlela
Ingqikithi yeziguli ezingama-49 ezihlanza ama-angle-actilized Plating kanye nokwenyuswa kwamanani owengeziwe ngezikulufo zama-PHFS, kanye neziguli ezingama-24 zifakiwe ocwaningweni olususelwa ekufakweni nasemikhombeni yokufakwa.
Onke ama-Phfs angama-24 ahlukaniswa esebenzisa uhlelo lokuhlukaniswa kwe-HLL elethwa yiSukthankar neHertel esebenzisa ama-CT scans preperative. Ama-radiographs asebenza ngokulinganayo kanye nama-radiographs e-post post ahlolwa. Ukwehliswa okwanele kwe-anatomic kwe-fracture kwabhekwa kufinyelelwe lapho i-turberoty yekhanda lezinhlamvu iphinde yancishiswa futhi ikhonjiswa ngaphansi kwegebe elingu-5 mm noma ukuthuthwa. Ukukhubazeka okwengeziwe kwachazwa njengokuthambekela kwesihloko seNhloko ethobelayo esihlobene ne-Humeral Shaft engaphansi kuka-125 ° no-valgus deform yachazwa njengengaphezu kuka-145 °.
Ukungena kwesikulufa okuyisikulufa kuchazwe njengoba isikulufa ithiphu ukungena emngceleni we-cortex ye-medullary yekhanda elimhumile. Ukuhanjiswa kwamahlathi wesibili kwachazwa njengokukhishwa kwenqwaba ye-TULUBOGE engaphezu kuka-5 mm kanye / noma ushintsho olungaphezu kuka-15 ° endaweni yokuthambekela kwesiqephu sekhanda kwi-radiopograph elandelayo uma kuqhathaniswa ne-radiopograph elandelayo.
Konke ukuhlinzwa kwenziwa ngendlela enkulu ye-deltopeckalis. Ukwehliswa kwe-Fracture kanye nokubekwa kwepuleti kwenziwa ngendlela ejwayelekile. I-Screen-Cement Augmentation Techch esetshenziselwa usimende ongu-0,5 ml kasimende for screw tip Augmentation.
Ukungasebenzi kahle kwenziwa nge-postoperatively endaweni yangokwezifiso ye-sling yehlombe amasonto ama-3. Ukunyakaza okusebenzayo okuningana nokusizwa okusebenzayo ngokuguqulwa kobuhlungu kwaqalwa kabusha izinsuku ezi-2 postoperatively ukufezekisa uhla oluphelele lokuhamba (ROM).
Ⅱ.Umphumela.
Imiphumela: Iziguli ezingamashumi amabili nane zazifakiwe, ziseminyakeni engu-77,5 (ibanga, iminyaka engama-62-96). Amashumi amabili nanye kwakungabesifazane kwathi abathathu babengowesilisa. Ama-gractures amahlanu ahlukene, ama-12 3-Part fractures, kanye nokuqhekeka okungu-7 okwenziwa ngamanani ayisikhombisa kwaphathwa ngokuhlinzwa kusetshenziswa amapuleti okuqinisa ama-angled kanye nokwenyuselwa kokwenyuswa kwamanani wesikulufa. Amathathu kwa-24 ama-fractures ayengamakhanda athobekile. Ukuncishiswa kwe-anatomic kufinyelelwa ezigulini eziyi-12 kwezingu-24; Ukuncishiswa okuphelele kwe-Cortex ye-Medial Cortex kwatholakala ezigulini eziyi-15 kwezingu-24 (62.5%). Ezinyangeni ezi-3 ngemuva kokuhlinzwa, iziguli ezingama-20 kwezingu-21 (95.2%) zithole inyunyana yabakwa-Fracture, ngaphandle kweziguli ezi-3 ezidinga ukuhlinzwa kusenesikhathi.
Isiguli esisodwa sakha ukuthuthwa kwesibili kwangemuva (ukujikeleza okungemuva kwesiqephu sekhanda lezinhliziyo ezingama-7 ngemuva kokuhlinzwa. Ukubuyekezwa kwenziwa nge-arthroplasty ephelele yehlombe ezi-3 ngemuva kokuhlinzwa. Ukungena kwesikulufu esiyingqayizivele ngenxa yokuvuza komakhalemu we-intraarticular cent (ngaphandle kokuguguleka okukhulu kokuhlanganiswa) kubhekwa ezigulini ezi-3 (2 zazo ezazinamakhanda athobekile) ngesikhathi sokulandela i-radioperative. Ukungena kwesikulufa kutholwe ku-C ungqimba lwepuleti yokuqina kwe-angle ezigulini ezi-2 naku-e under kwenye (Fig. 3). 2 Kulezi ziguli ezi-3 ngemuva kwalokho zakha i-avascular necrosis (AVN). Iziguli ezihlaselwe kabusha ezihlaselwe kabusha ngenxa yokuthuthukiswa kwe-AVN (Amatafula 1, 2).
Ⅲ.Ingxoxo.
Ukuhlunga okuvame kakhulu ekuqhekekeni kwama-humeral amuntu (ama-PHFS), ngaphandle kokuthuthukiswa kwe-avascular necrosis (AVN), kungukuvuselelwa kwesikulufa ngokuwohloka okulandelayo okwengezo okuthengiswayo kwesiqephu sekhanda. Lolu cwaningo luthole ukuthi ukwengezelelwa kwesiko lokungezela ukwengezela ukwengezela ukwengezelelwa kwezinga le-95.2% ezinyangeni ezi-3, izinga lokufuduka lesibili, isilinganiso se-AVN se-16.7%, kanye nenani eliphelele lokubuyekezwa kwe-16.7%. Ukwengezwa kokwenyuswa kokwenyuswa kwamakhasi kuholele endaweni yokusuka yesibili kuholele ku-4.2% kuphela ngaphandle kokuwohloka kokungezelelwa, okuyisilinganiso esiphansi uma kuqhathaniswa ne-13.7-16% evamile yokulungiswa kwepuleti evamile. Sincoma kakhulu ukuthi kwenziwe imizamo yokuthola ukwehliswa okwanele kwe-anatomic, ikakhulukazi ye-cortex ethobekile yokulungiswa kwama-angled Plate of Phfs. Noma ngabe isikulufa esingeziwe se-time ties se-augmentation siyasetshenziswa, izindlela ezaziwayo zokuhluleka kufanele zibhekwe.
Izinga elibukeziwe eliphelele le-16.7% Sebenzisa i-Screw Fip Authortion kulolu cwaningo lungaphakathi kwenani eliphansi elishicilelwe ngaphambili kwamanani amapuleti okusimisa ama-altively angela ukuqina kuma-ph asebekhulile asuka ku-13% aya ku-28%. Akukho ukulinda. Ucwaningo olungaba khona, olulawulwa, olulawulwa lwangempela olwenziwe yiHengg et al. akazange akhombise inzuzo ye-Centmer Screw Augmentation. Phakathi kweziguli ezingama-65 eziphothule ukulandela unyaka 1, ukwehluleka kwemishini kwenzeka ezigulini eziyi-9 kanye ne-3 eqenjini le-agmentation. I-AVN yaqashelwa ezigulini ezi-2 (10.3%) nakweziguli ezi-2 (5.6%) eqenjini elingathuthukiswanga. Sekukonke, kwakungekho mehluko omkhulu ekuveleni kwemicimbi emibi nemiphumela yemitholampilo phakathi kwamaqembu amabili. Yize lezi zifundo zigxile emiphumeleni yezokwelapha neye-radical, azizange zihlole imininingwane eminingi njengoba lolu cwaningo. Sekukonke, izinkinga ezitholakele kakhulu ze-radiologicals zazifana nalezo kulolu cwaningo. Azikho kulezi zifundo ezibikwa ukuvuza kosenti ye-Intra-articular cent, ngaphandle kocwaningo ngeHengg et al., Ngubani owabona lo mcimbi ongemuhle esigulini esisodwa. Esifundweni samanje, ukungena kwesikulufu sokuqala kubhekwe kabili ku-Clevel C futhi kanye lapho kunesilinganiso e, ngokuvuza kosesimende we-intra-arvicular cement ngaphandle kokuhambisana nomtholampilo. Izinto zokuqhathanisa zafakwa ngaphansi kokulawulwa kwe-fluorooscopic ngaphambi kokuvukulelwa kwesilinganiso ku-screw ngayinye. Kodwa-ke, ukubukwa okuhlukile kwe-radiographic ezikhundleni ezihlukile ze-Arm Ngaphezu kwalokho, ukuqiniswa kosesimende kwezikulufo ezisezingeni C (Screw Divergent Ukucushwa) kufanele kugwenywe ngenxa yengozi ephakeme yokungena kwesikulufu esiphambili nokuvuza kosemanzi okulandelayo. I-Cement Screw Tip Augmentation ayinconywa ezigulini ezinamakhanda amakhanda athobekile ngenxa yamandla aphezulu okuvuza okungaphakathi okubonwa kuleli phethini we-fracture (abonwa ezigulini ezi-2).
VI. Isiphetho.
Ekwelashweni kwama-phfs ngamapuleti aqiniswe ama-angle kusetshenziswa usimende we-PMMA, i-Centmer Screw Tip Auteration iyindlela ethembekile yokuhlinza ethuthukisa ukufakwa kwamathambo ethanjeni, okuholela endaweni ephansi yesibili ka-4.2% ezigulini ze-osteoporotic. Uma kuqhathaniswa nezincwadi ezikhona, izehlakalo ezengeziwe ze-avascular necrosis (AVN) zaqashelwa ikakhulukazi emaphethini wokuphuka kanzima futhi lokhu kufanele kubhekwe. Ngaphambi kohlelo lokusebenza lwe-Cement, noma yikuphi ukuvuza kosemanzi we-intraarticular kumele kukhishwe ngokucophelela ngabaphathi abaphakathi. Ngenxa yengozi enkulu yokuvuza kwesenti ye-intraartiarji kuhlumela ekhanda, asincomi ukwengezwa kwesiko lesiko lesikhisi kulokhu kuqhekeka.
Isikhathi sePosi: Aug-06-2024
