I-Femoral intertrochanteric fracture iyona nto ixhaphakileyo ye-hip fracture kwikliniki kwaye yenye yezona zinto zintathu eziqhelekileyo ezihambelana ne-osteoporosis kubantu abadala.Unyango lwe-Conservative lufuna ukuphumla ixesha elide ebhedini, kubeka imingcipheko ephezulu yezilonda zoxinzelelo, usulelo lwemiphunga, i-pulmonary embolism, i-vein thrombosis enzulu, kunye nezinye iingxaki.Ubunzima bokonga bubalulekile, kwaye ixesha lokubuyisela lide, libeka umthwalo onzima kuluntu kunye neentsapho.Ke ngoko, ungenelelo lotyando kwangethuba, nanini na lunyamezeleka, lubalulekile ukuze kuphunyezwe iziphumo ezincumisayo zokusebenza kwi-hip fractures.
Okwangoku, i-PFNA (i-proximal femoral nail antirotation system) ukulungiswa kwangaphakathi kuthathwa njengomgangatho wegolide wonyango lotyando lwe-hip fractures.Ukufumana inkxaso efanelekileyo ngexesha lokunciphisa i-hip fractures kubalulekile ekuvumeleni umthambo wokusebenza kwangaphambili.I-fluoroscopy ye-intraoperative ibandakanya i-anteroposterior (AP) kunye neembono ezisecaleni zokuvavanya ukunciphisa i-femoral anterior medial cortex.Nangona kunjalo, iingxabano zingavela phakathi kweembono ezimbini ngexesha lotyando (oko kukuthi, okulungileyo kwi-lateral view kodwa kungekhona kwi-anteroposterior view, okanye ngokuphambene).Kwiimeko ezinjalo, ukuvavanya ukuba ukuncitshiswa kuyamkeleka kwaye ukuba ukulungiswa kuyafuneka kubangela ingxaki enzima kubasebenzi bezonyango.Abaphengululi abavela kwizibhedlele zasekhaya ezifana neSibhedlele sase-Oriental kunye neSibhedlele saseZhongshan baye bajongana nalo mbandela ngokuhlalutya ukuchaneka kokuvavanya ukuxhaswa okulungileyo kunye nokungalunganga phantsi kweembono ze-anteroposterior kunye ne-lateral ngokusebenzisa i-postoperative ye-CT scans ezintathu-dimensional njengomgangatho.
▲ Umzobo ubonisa inkxaso efanelekileyo (a), inkxaso engathathi hlangothi (b), kunye nenkxaso engafanelekanga (c) iipatheni ze-hip fractures kwi-anteroposterior view.
▲ Umzobo ubonisa inkxaso efanelekileyo (d), inkxaso engathathi hlangothi (e), kunye nenkxaso engafanelekanga (f) iipatheni ze-hip fractures kwi-lateral view.
Eli nqaku libandakanya idatha yecala kwizigulane ze-128 ezine-hip fractures.I-intraoperative anteroposterior kunye nemifanekiso esecaleni yanikezelwa ngokwahlukileyo koogqirha ababini (omnye onamava amancinci kunye nomnye onamava amaninzi) ukuvavanya inkxaso efanelekileyo okanye engeyiyo.Emva kovavanyo lokuqala, ukuphononongwa kwakhona kwenziwa emva kweenyanga ezi-2.Imifanekiso ye-CT ye-postoperative yanikwa uprofesa onamava, owagqiba ukuba ityala lihle okanye lingekho, lisebenza njengomgangatho wokuvavanya ukuchaneka kokuhlolwa kwemifanekiso ngabagqirha ababini bokuqala.Uthelekiso oluphambili kwinqaku ngolu hlobo lulandelayo:
(1) Ngaba kukho ukungafani okubonakalayo kwiziphumo zovavanyo phakathi kogqirha abanamava kunye nabanamava ngakumbi kuvavanyo lokuqala nolwesibini?Ukongezelela, inqaku liphonononga ukuhambelana kweqela phakathi kwamaqela angaphantsi kwamava kunye namava amaninzi kuzo zombini iimvavanyo kunye nokuhambelana kwe-intragroup phakathi kweemvavanyo ezimbini.
(2) Ukusebenzisa i-CT njengereferensi yomgangatho wegolide, inqaku liphanda ukuba yeyiphi ethembekileyo ekuvavanyeni umgangatho wokunciphisa: uvandlakanyo olusecaleni okanye lwe-anteroposterior.
Iziphumo zophando
1. Kwimijikelo emibini yovavanyo, kunye ne-CT njengomgangatho wokubhekisela, kwakungekho nantlukwano ephawulekayo kwi-statistically, i-specificty, ireyithi elungileyo yobuxoki, izinga elibi lobuxoki, kunye nezinye iiparitha ezinxulumene nokuvavanya umgangatho wokunciphisa ngokusekelwe kwi-intraoperative X- imitha phakathi koogqirha ababini abanamanqanaba ahlukeneyo amava.
2.Kuvandlakanyo lomgangatho wokunciphisa, ukuthatha uvavanyo lokuqala njengomzekelo:
- Ukuba kukho isivumelwano phakathi kwe-anteroposterior kunye ne-lateral assessments (zombini ezilungileyo okanye zombini ezingezizo), ukuthembeka ekuqikeleleni umgangatho wokunciphisa kwi-CT yi-100%.
- Ukuba kukho ukungavumelani phakathi kovavanyo lwe-anteroposterior kunye ne-lateral, ukuthembeka kwemilinganiselo yokuhlola i-lateral yokuqikelela umgangatho wokunciphisa kwi-CT iphezulu.
▲ Umzobo ubonisa inkxaso efanelekileyo eboniswe kwimbono ye-anteroposterior ngelixa ibonakala ingekho kakuhle kwi-lateral view.Oku kubonisa ukungahambelani kwiziphumo zovavanyo phakathi kweembono ze-anteroposterior kunye ne-lateral.
▲ Ukwakhiwa kwakhona kwe-CT ye-Three-dimensional ibonelela ngemifanekiso yokujonga i-angle-angle ezininzi, isebenza njengomgangatho wovavanyo lomgangatho wokunciphisa.
Kwimigangatho yangaphambili yokunciphisa i-intertrochanteric fractures, ngaphandle kwenkxaso efanelekileyo kunye nembi, kukho nombono wenkxaso "yokungathathi hlangothi", oku kuthetha ukunciphisa i-anatomical.Nangona kunjalo, ngenxa yemibandela enxulumene nesisombululo se-fluoroscopy kunye nokubonakala kwamehlo omntu, "ukunciphisa i-anatomical" okwenyani akukho, kwaye kuhlala kukho ukutenxa okuncinci ukuya ekunciphiseni "okulungileyo" okanye "okubi".Iqela elikhokelwa nguZhang Shimin kwiSibhedlele saseYangpu eShanghai lipapashe iphepha (isalathiso esichanekileyo esikhohliwe, siya kuxabisa ukuba umntu unokubonelela) ebonisa ukuba ukufezekisa inkxaso efanelekileyo kwi-intertrochanteric fractures kunokubangela iziphumo ezingcono zokusebenza xa kuthelekiswa nokunciphisa i-anatomical.Ngoko ke, ngokuqwalasela olu cwaningo, iinzame kufuneka zenziwe ngexesha lotyando ukuze kuphunyezwe inkxaso efanelekileyo kwi-intertrochanteric fractures, zombini kwimibono ye-anteroposterior kunye ne-lateral.
Ixesha lokuposa: Jan-19-2024
