I-Intertrochanteric fractures ye-akhawunti ye-femur ye-50% ye-hip fractures kubantu abadala. Unyango lwe-Conservative luvame ukuba neengxaki ezifana ne-vein thrombosis enzulu, i-pulmonary embolism, izilonda zoxinzelelo, kunye nosulelo lwe-pulmonary. Izinga lokusweleka kunyaka omnye lidlula i-20%. Ngoko ke, kwiimeko apho imeko yomzimba yesigulane ivumela, ukulungiswa kwangaphambili kokuhlinzwa kwangaphakathi kunyango olukhethiweyo lwe-intertrochanteric fractures.
Ukulungiswa kwangaphakathi kwe-Intramedullary nail okwangoku kusemgangathweni wegolide wonyango lwe-intertrochanteric fractures. Kuphononongo kwizinto eziphembelela ukulungiswa kwangaphakathi kwePFNA, izinto ezinje ngobude bezikhonkwane zePFNA, i-varus angle, kunye noyilo ziye zaxelwa kwizifundo ezininzi zangaphambili. Nangona kunjalo, akukacaci ukuba ubukhulu besikhonkwane esiphambili buchaphazela iziphumo zokusebenza. Ukujongana nale nto, abaphengululi bamazwe angaphandle baye basebenzisa izikhonkwane ze-intramedullary ezinobude obulinganayo kodwa ubukhulu obuhlukeneyo ukulungisa i-intertrochanteric fractures kubantu asebekhulile (iminyaka> 50), ejolise ukuthelekisa ukuba kukho ukungafani kwiziphumo zokusebenza.
Uphononongo lubandakanya iimeko ze-191 zokuqhekeka kwe-intertrochanteric unilateral, zonke ziphathwa nge-PFNA-II ukulungiswa kwangaphakathi. Xa i-trochanter encinci yaphuka kwaye ikhutshwe, isikhonkwane esifutshane se-200mm sisetyenzisiwe; xa i-trochanter encinci yayilungile okanye ingabanjwanga, i-170mm ye-ultra-short nail isetyenziswe. Ububanzi besikhonkwane esiphambili buvela kwi-9-12mm. Uthelekiso oluphambili kuphononongo lujolise kwezi zalathisi zilandelayo:
1. Ububanzi obungaphantsi kwetrochanter, ukuvavanya ukuba ukubekwa bekusemgangathweni;
2. Ubudlelwane phakathi kwe-cortex ye-medial ye-head-neck fragment kunye ne-distal fragment, ukuvavanya umgangatho wokunciphisa;
3. I-Tip-Apex Distance (TAD);
4.I-Nail-to-canal ratio (NCR). I-NCR ngumlinganiselo wedayamitha yesikhonkwane esingundoqo kwidayamitha ye-medullary ye-distal locking screw plane.
Phakathi kwezigulane ze-191 ezibandakanyiweyo, ukuhanjiswa kwamatyala ngokusekelwe kubude kunye nobubanzi besikhonkwane esiphambili kuboniswe kulo mfanekiso ulandelayo:
Umndilili we-NCR ube ngama-68.7%. Ukusebenzisa lo mndilili njengongqameko, iimeko ezine-NCR ezinkulu kunomndilili zaye zajongwa njengobubanzi besikhonkwane esityebileyo, ngelixa iimeko ezine-NCR ezingaphantsi komndilili zazijongwa njengezona zikhonkwane ezinobubanzi obuncinci. Oku kukhokelele ekwahlulweni kwezigulane kwiqela leZikhonkwane eziNcinci (iimeko ezingama-90) kunye neqela leZikhonkwane eziNcinci (iimeko ezili-101).
Iziphumo zibonisa ukuba akukho mahluko abalulekileyo ngokwezibalo phakathi kweqela leNzipho eNcinci kunye neqela leSikhonkwane esiNcinci ngokwemigaqo yeTip-Apex Distance, inqaku le-Koval, ukulibaziseka kwesantya sokuphilisa, izinga lokusebenza kwakhona, kunye neengxaki ze-orthopedic.
Ngokufanayo nesi sifundo, inqaku lapapashwa kwi "Journal of Orthopedic Trauma" ngo-2021: [Isihloko seNqaku].
Uphononongo lubandakanya izigulane ezisebekhulile ze-168 (iminyaka> i-60) kunye ne-intertrochanteric fractures, zonke ziphathwa ngezikhonkwane ze-cephalomedullary. Ngokusekelwe kububanzi besikhonkwane esiphambili, izigulane zahlulwa zibe liqela le-10mm kunye neqela elinobubanzi obungaphezu kwe-10mm. Iziphumo zibonise kwakhona ukuba akukho ntlukwano ephawulekayo kwimilinganiselo yokusebenza kwakhona (nokuba iyonke okanye i-non-infectious) phakathi kwamaqela amabini. Ababhali bophononongo bacebisa ukuba, kwizigulane ezisele zikhulile ezineefractures ze-intertrochanteric, ukusebenzisa isikhonkwane esingundoqo se-10mm ububanzi kwanele, kwaye akukho mfuneko yokubuyisela ngokugqithisileyo, njengoko kusenokufikelela kwiziphumo zokusebenza ezifanelekileyo.
Ixesha lokuposa: Feb-23-2024
