Ukuqhekeka kwe-femoral intertrochanteric yeyona nto ixhaphakileyo kwi-clinical practice kwaye yenye yeendlela ezintathu ezixhaphakileyo zokuqhekeka kwe-hip ezinxulumene ne-osteoporosis kubantu abadala. Unyango oluhlala luhleli lufuna ukuphumla ebhedini ixesha elide, nto leyo ebangela umngcipheko ophezulu wezilonda zoxinzelelo, usulelo lwemiphunga, i-pulmonary embolism, i-deep vein thrombosis, kunye nezinye iingxaki. Ubunzima bokuncancisa bubalulekile, kwaye ixesha lokuchacha lide, nto leyo ebeka umthwalo onzima kuluntu nakwiintsapho. Ke ngoko, utyando lwangethuba, nanini na xa lunokunyamezeleka, lubalulekile ekufezekiseni iziphumo ezilungileyo zokuqhekeka kwe-hip.
Okwangoku, ukulungiswa kwangaphakathi kwe-PFNA (proximal femoral nail antirotation system) kuthathwa njengomgangatho olungileyo wonyango lotyando lwe-hip fractures. Ukufumana inkxaso entle ngexesha lokunciphisa i-hip fractures kubalulekile ukuvumela umthambo wokuqala. I-Intraoperative fluoroscopy ibandakanya i-anteroposterior (AP) kunye ne-lateral views ukuvavanya ukunciphisa i-femoral anterior medial cortex. Nangona kunjalo, iingxabano zinokuvela phakathi kwembono ezimbini ngexesha lotyando (oko kukuthi, i-positive kwi-lateral view kodwa kungekhona kwi-anteroposterior view, okanye ngokuchaseneyo). Kwiimeko ezinjalo, ukuvavanya ukuba ukunciphisa kuyamkeleka na kwaye ukuba ukulungiswa kuyadingeka na kubangela ingxaki enzima kubasebenzi bezonyango. Iingcali ezivela kwizibhedlele zasekhaya ezifana ne-Oriental Hospital kunye ne-Zhongshan Hospital zijongane nalo mba ngokuhlalutya ukuchaneka kokuvavanya inkxaso entle nengalunganga phantsi kwe-anteroposterior kunye ne-lateral views zisebenzisa i-postoperative three-dimensional CT scans njengomgangatho.
▲ Lo mzobo ubonisa inkxaso eyakhayo (a), inkxaso engathathi cala (b), kunye nenkxaso engalunganga (c) iipatheni zokuqhekeka kwesinqe kumbono we-anteroposterior.
▲ Lo mzobo ubonisa inkxaso eyakhayo (d), inkxaso engathathi cala (e), kunye nenkxaso engalunganga (f) yeepateni zokuqhekeka kwethanga kwicala elingasemva.
Eli nqaku liquka idatha yeziganeko ezivela kwizigulana ezili-128 ezinezihlunu eziqhekekileyo. Imifanekiso ye-anteroposterior kunye neyasecaleni yanikwa oogqirha ababini ngokwahlukeneyo (omnye onamava amancinci nomnye onamava amaninzi) ukuvavanya inkxaso eyakhayo okanye engeyiyo eyakhayo. Emva kovavanyo lokuqala, uvavanyo olutsha lwenziwa emva kweenyanga ezi-2. Imifanekiso ye-CT emva kotyando yanikwa uprofesa onamava, owagqiba kwelokuba ityala lilungile okanye alilunganga, esebenza njengomgangatho wokuvavanya ukuchaneka kovavanyo lomfanekiso ngoogqirha ababini bokuqala. Uthelekiso oluphambili kweli nqaku lulandelayo:
（1）Ngaba kukho umahluko obalulekileyo ngokwezibalo kwiziphumo zovavanyo phakathi koogqirha abangenamava kangako nabangenamava ngakumbi kuvavanyo lokuqala nolwesibini? Ukongeza, eli nqaku lihlola ukuhambelana phakathi kwamaqela phakathi kwamaqela angenamava kangako nabangenamava ngakumbi kuzo zombini iimvavanyo kunye nokuhambelana kwangaphakathi kwamaqela phakathi kovavanyo olubini.
(2) Isebenzisa i-CT njengereferensi yegolide, eli nqaku liphanda ukuba yeyiphi ethembekileyo ngakumbi ekuvavanyeni umgangatho wokunciphisa: uvavanyo olusecaleni okanye olungaphambili.
Iziphumo zophando
1. Kwimijikelo emibini yovavanyo, kunye ne-CT njengomgangatho oqhelekileyo, bekungekho mahluko abalulekileyo ngokwezibalo kubuntununtunu, ukucaca, izinga elingalunganga, izinga elingalunganga, kunye nezinye iiparameter ezinxulumene novavanyo lomgangatho wokunciphisa ngokusekelwe kwi-X-rays yangaphakathi kotyando phakathi koogqirha ababini abanamanqanaba ahlukeneyo amava.
2. Kuvavanyo lomgangatho wokunciphisa, thabatha uvavanyo lokuqala njengomzekelo:
- Ukuba kukho ukuvumelana phakathi kovavanyo lwe-anteroposterior nolwecala (zombini zilungile okanye azilungile), ukuthembeka ekuqikeleleni umgangatho wokwehla kwi-CT yi-100%.
- Ukuba kukho ukungavisisani phakathi kovavanyo lwe-anteroposterior nolwe-lateral, ukuthembeka kweendlela zovavanyo lwe-lateral ekuqikeleleni umgangatho wokunciphisa kwi-CT kuphezulu.
▲ Lo mzobo ubonisa inkxaso entle eboniswe kumbono we-anteroposterior ngelixa ibonakala ingekho ntle kumbono we-lateral. Oku kubonisa ukungangqinelani kwiziphumo zovavanyo phakathi kwe-anteroposterior kunye ne-lateral views.
▲ Ukwakhiwa kwakhona kwe-CT enamacala amathathu kubonelela ngemifanekiso yokujonga enee-engile ezininzi, esebenza njengomgangatho wokuvavanya umgangatho wokuncipha.
Kwimigangatho yangaphambili yokunciphisa ukwaphuka kwe-intertrochanteric, ngaphandle kwenkxaso elungileyo nengalunganga, kukwakho nengcamango yenkxaso "engathathi cala", ethetha ukunciphisa i-anatomical. Nangona kunjalo, ngenxa yemiba enxulumene nokusombulula i-fluoroscopy kunye nokuqondwa kwamehlo omntu, "ukunciphisa i-anatomical" yokwenyani ngokwethiyori akukho, kwaye kusoloko kukho ukuphambuka okuncinci ekuncipheni "okuhle" okanye "okubi". Iqela elikhokelwa nguZhang Shimin kwiSibhedlele saseYangpu eShanghai lipapashe iphepha (isalathiso esithile silibalekile, singavuya ukuba umntu angalinika) elicebisa ukuba ukufumana inkxaso elungileyo kwi-intertrochanteric fractures kunokubangela iziphumo ezisebenzayo ezingcono xa kuthelekiswa nokunciphisa i-anatomical. Ke ngoko, xa sicinga ngolu phononongo, kufuneka kwenziwe imizamo ngexesha lotyando lokufumana inkxaso elungileyo kwi-intertrochanteric fractures, zombini kwi-anteroposterior kunye ne-lateral views.
Ixesha leposi: Jan-19-2024
