I-Proximal femoral fractures ngokuvamile ibonakala ukulimala komtholampilo okubangelwa ukuhlukumezeka okukhulu kwamandla.Ngenxa yezici ze-anatomical ze-proximal femur, umugqa wokuphuka uvame ukulala eduze nendawo ye-articular futhi ungadlulela ekuhlanganyeleni, okwenza ungakufanelekeli ukulungiswa kwe-intramedullary nail.Ngenxa yalokho, ingxenye enkulu yamacala isathembele ekulungisweni kusetshenziswa ipuleti nesistimu yesikulufu.Kodwa-ke, izici ze-biomechanical zamapuleti angashintshiwe zibeka engcupheni enkulu yezinkinga ezifana nokwehluleka kokulungiswa kwepuleti elingemuva, ukugqabuka kokulungisa kwangaphakathi, kanye nokudonsa ngezikulufu.Ukusetshenziswa kosizo lwamapuleti aphakathi ukuze kulungiswe, nakuba kusebenza kahle, kuza nezithiyo zokwanda kokuhlukumezeka, isikhathi eside sokuhlinzwa, ukwanda kwengozi yokutheleleka kwangemva kokuhlinzwa, kanye nomthwalo owengeziwe wezezimali ezigulini.
Uma kubhekwa lokhu kucatshangelwa, ukuze kufinyelelwe ibhalansi enengqondo phakathi kwezithiyo ze-biomechanical zamapuleti e-lateral single kanye nokuhlukumezeka kokuhlinzwa okuhlobene nokusetshenziswa kwamapuleti amabili aphakathi nendawo nangemuva, izazi zakwamanye amazwe ziye zasebenzisa indlela ehilela ukulungisa ipuleti elingemuva ngokulungiswa kwesikulufa se-percutaneous. ohlangothini oluphakathi.Le ndlela ibonise imiphumela emihle yomtholampilo.
Ngemuva kwe-anesthesia, isiguli sibekwe endaweni ephansi.
Isinyathelo 1: Ukunciphisa ukuphuka.Faka inaliti ye-Kocher engu-2.0mm ku-tuberosity ye-tibial, ukudonsa ukuze usethe kabusha ubude bomlenze, futhi usebenzise iphedi yamadolo ukuze ulungise ukugudluka kwendiza ye-sagittal.
Isinyathelo sesi-2: Ukubekwa kwepuleti lensimbi elingemuva.Ngemva kokuncishiswa okuyisisekelo ngokudonsa, sondela ngokuqondile ku-distal lateral femur, khetha ipuleti lokukhiya ubude elifanelekile ukuze ugcine ukuncipha, bese ufaka izikulufu ezimbili ekugcineni okuseduze nokukude kokuphuka ukuze ulondoloze ukuncishiswa kokuphuka.Kuleli qophelo, kubalulekile ukuqaphela ukuthi izikulufu ezimbili ezikude kufanele zibekwe eduze nangaphambili ngangokunokwenzeka ukuze ugweme ukuphazamisa ukubekwa kwezikulufu ezimaphakathi.
Isinyathelo sesi-3: Ukubekwa kwezikulufu zekholomu emaphakathi.Ngemva kokuzinzisa ukuphuka ngepuleti lensimbi elingemuva, sebenzisa i-2.8mm screw-guided drill ukuze ungene nge-condyle emaphakathi, indawo yenaliti ebekwe maphakathi noma ngemuva kwendawo ye-distal femoral block, ngaphandle nangaphezulu, ingene ngokuphambene. ithambo le-cortical.Ngemva kokuncishiswa kwe-fluoroscopy ngendlela egculisayo, sebenzisa i-drill engu-5.0mm ukuze udale imbobo bese ufaka isikulufu sethambo esikhansela esingu-7.3mm.
Umdwebo obonisa inqubo yokunciphisa nokulungisa ukuphuka.Owesifazane oneminyaka engama-74 ubudala onokuphuka kwe-distal femoral intra-articular (AO 33C1).(A, B) Ama-radiographs angemuva ngaphambi kokuhlinzwa abonisa ukugudluka okuphawulekayo kokuphuka kwe-distal femoral;(C) Ngemva kokwehliswa kokuphuka, ipuleti elingemuva langaphandle lifakwa ngezikulufu ezivikela zombili iziphetho eziseduze nezikude;(D) Isithombe se-Fluoroscopy esibonisa indawo egculisayo yocingo lomhlahlandlela ophakathi;(E, F) Ama-radiographs angemuva kokuhlinzwa angemuva kanye ne-anteroposterior ngemva kokufakwa kwesikulufu sekholomu emaphakathi.
Phakathi nenqubo yokunciphisa, kubalulekile ukucabangela amaphuzu alandelayo:
(1) Sebenzisa intambo yomhlahlandlela ene-screw.Ukufakwa kwezikulufu zekholomu emaphakathi kubanzi uma kuqhathaniswa, futhi ukusebenzisa intambo yomhlahlandlela ngaphandle kwesikulufu kungase kuholele ku-engeli ephezulu ngesikhathi sokubhoboza i-condyle emaphakathi, kuyenze ithambekele ekusheleleni.
(2) Uma izikulufu zepuleti elingemuva zibamba ngempumelelo i-lateral cortex kodwa zehluleka ukuthola ukulungiswa okusebenzayo kwe-dual cortex, lungisa inkomba yesikulufu siye phambili, okuvumela izikulufu ukuthi zingene ohlangothini olungaphambili lwepuleti elingemuva ukuze lifinyelele ukuqiniswa kwe-cortex ekabili egculisayo.
(3) Ezigulini ezine-osteoporosis, ukufaka iwasha ngesikulufu sekholomu emaphakathi kungavimbela isikulufu ukuthi singasikeki ethanjeni.
(4) Izikulufu ekugcineni kwepuleti zingase zivimbe ukufakwa kwezikulufu zekholomu emaphakathi.Uma ukuvinjelwa kwesikulufu kuhlangatshezwana nayo ngesikhathi sokufakwa isikulufu sekholomu emaphakathi, cabanga ukukhipha noma ukubeka kabusha izikulufu ezikude ze-lateral plate, unikeze kuqala ukubekwa kwezikulufu zekholomu emaphakathi.
Icala 2. Isiguli sesifazane, esineminyaka engu-76 ubudala, esinokwephuka kwe-distal femoral extra-articular.(A, B) Ama-X-ray wangaphambi kokuhlinzwa abonisa ukususwa okuphawulekayo, ukukhubazeka kwe-angular, nokugudluzwa kwendiza ye-coronal yokuphuka;(C, D) Ama-X-ray angemuva kokuhlinzwa ekubukeni kwe-lateral kanye ne-anteroposterior ebonisa ukulungiswa ngepuleti yangaphandle yangaphandle ehlanganiswe nezikulufu zekholomu ephakathi;(E, F) Ama-X-ray okulandelela ezinyangeni ezingu-7 ngemva kokuhlinzwa aveza ukuphulukiswa okuhle kakhulu kokuphuka ngaphandle kwezimpawu zokwehluleka ukulungisa kwangaphakathi.
Icala 3. Isiguli sesifazane, esineminyaka engu-70 ubudala, esinokwephuka kwe-periprosthetic eduze kokufakelwa kwesifazane.(A, B) I-X-ray yangaphambi kokuhlinzwa ebonisa ukuphuka kwe-periprosthetic eduze kokufakelwa kwesifazane ngemva kwe-arthroplasty ephelele yamadolo, nokuphuka kwe-articular extra-articular kanye nokulungiswa kokufakelwa okuzinzile;(C, D) Ama-X-ray angemuva kokuhlinzwa abonisa ukulungiswa ngepuleti langaphandle elingaphandle elihlanganiswe nezikulufu zekholomu ephakathi ngokusebenzisa indlela engaphezulu;(E, F) Ama-X-ray okulandelela ezinyangeni ezingu-6 ngemva kokuhlinzwa aveza ukuphulukiswa okuhle kakhulu kokuphuka, nokulungiswa kwangaphakathi endaweni.
Isikhathi sokuthumela: Jan-10-2024
