Ukuqhekeka kwe-intertrochanteric ye-femur kubangela i-50% yokuqhekeka kwe-hip kubantu abadala. Unyango oluhlala luhleli lunokubangela iingxaki ezifana ne-deep vein thrombosis, i-pulmonary embolism, izilonda zoxinzelelo, kunye nosulelo lwemiphunga. Izinga lokufa kungakapheli unyaka omnye lidlula i-20%. Ke ngoko, kwiimeko apho imeko yomzimba yesigulana ivumela, ukulungiswa kwangaphakathi kotyando kwangoko lolona nyango lukhethwayo lokuqhekeka kwe-intertrochanteric.
Ukulungiswa kwangaphakathi kwezipikili ngaphakathi kwe-intramedullary okwangoku yeyona ndlela ilungileyo yokunyanga ukwaphuka kwe-intertrochanteric. Kwizifundo malunga nezinto ezichaphazela ukulungiswa kwangaphakathi kwe-PFNA, izinto ezifana nobude bezipikili ze-PFNA, i-engile ye-varus, kunye noyilo ziye zaxelwa kwizifundo ezininzi zangaphambili. Nangona kunjalo, akukacaci ukuba ubukhulu bezipikili eziphambili buchaphazela iziphumo zokusebenza. Ukujongana noku, iingcali zamanye amazwe zisebenzise izipikili zangaphakathi ezinobude obulinganayo kodwa ubukhulu obahlukeneyo ukulungisa ukwaphuka kwe-intertrochanteric kubantu abadala (abaneminyaka engaphezulu kwama-50), bejonge ukuthelekisa ukuba kukho umahluko kwiziphumo zokusebenza.
Olu phononongo luquke iimeko ezili-191 zokwaphuka kwe-intertrochanteric kwelinye icala, zonke zinyangwa nge-PFNA-II internal fixation. Xa i-lesser trochanter yaqhekeka yaza yaqhekeka, kwasetyenziswa isikhonkwane esifutshane esingama-200mm; xa i-lesser trochanter yayiphelele okanye ingaqhekekanga, kwasetyenziswa isikhonkwane esifutshane esingama-170mm. Ububanzi besikhonkwane esiphambili babuqala kwi-9-12mm. Uthelekiso oluphambili kolu phononongo lugxile kwezi mpawu zilandelayo:
1. Ububanzi obuncinci be-trochanter, ukuvavanya ukuba indawo ebekiweyo ibiyiyo eqhelekileyo na;
2. Ubudlelwane phakathi kwe-medial cortex ye-head-neck fragment kunye ne-distal fragment, ukuvavanya umgangatho wokunciphisa;
3. Umgama weNcam-iNcam (TAD);
4. Umlinganiselo wezipikili ukuya kumjelo (NCR). I-NCR ngumlinganiselo wobubanzi beenzipikili eziphambili ukuya kububanzi bemijelo ephakathi kwiplani yesikrufu esitshixayo esikude.
Phakathi kwezigulana ezili-191 ezibandakanyiweyo, ukusasazwa kwamatyala ngokusekelwe kubude nobubanzi besikhonkwane esiphambili kuboniswe kumfanekiso olandelayo:
I-NCR ephakathi yayiyi-68.7%. Xa kusetyenziswa lo myinge njengomlinganiselo, iimeko ezine-NCR ezingaphezulu kunomyinge zazithathwa njengezinobubanzi obukhulu bezinzipho eziphambili, ngelixa iimeko ezine-NCR ngaphantsi kunomyinge zazithathwa njengezinobubanzi obukhulu bezinzipho eziphambili. Oku kukhokelele ekubeni izigulane zahlulwe zibe liqela le-Thick Main Nail (iimeko ezingama-90) kunye neqela le-Thin Main Nail (iimeko ezili-101).
Iziphumo zibonisa ukuba bekungekho mahluko ubalulekileyo ngokwezibalo phakathi kweqela le-Thick Main Nail kunye neqela le-Thin Main Nail ngokwe-Tip-Apex Distance, i-Koval score, izinga lokuphiliswa elilibazisekileyo, izinga lotyando kwakhona, kunye neengxaki zamathambo.
Ngokufanayo nolu phando, inqaku lapapashwa kwi "Journal of Orthopaedic Trauma" ngo-2021: [Isihloko seNqaku].
Olu phononongo luquke izigulane ezikhulileyo ezili-168 (ezineminyaka engaphezulu kwama-60) ezinezihlunu ze-intertrochanteric, zonke zinyangwe ngezipikili ze-cephalomedullary. Ngokusekelwe kububanzi bezipikili eziphambili, izigulane zahlulwe zaba liqela le-10mm kunye neqela elinobubanzi obungaphezulu kwe-10mm. Iziphumo zikwabonise ukuba akukho mahluko abalulekileyo ngokwezibalo kumanqanaba okuphinda kusebenze (nokuba ngokubanzi okanye angosuleliyo) phakathi kwamaqela amabini. Ababhali bolu phononongo bacebisa ukuba, kwizigulane ezikhulileyo ezinezihlunu ze-intertrochanteric, ukusebenzisa izipikili eziphambili ezinobubanzi be-10mm kwanele, kwaye akukho mfuneko yokuzilungisa ngokugqithisileyo, njengoko kusenokufumana iziphumo ezilungileyo zokusebenza.
Ixesha leposi: Februwari-23-2024
