Kule minyaka imbalwa idlulileyo, iziganeko zokwaphuka kwe-humeral (PHFs) ziye zanda ngaphezu kwe-28%, kwaye izinga lotyando liye landa ngaphezu kwe-10% kwizigulane ezineminyaka engama-65 ubudala nangaphezulu. Ngokucacileyo, ukuncipha kokuxinana kwamathambo kunye nokunyuka kwenani lokuwa zizinto eziphambili zomngcipheko ekwandeni kwabantu abadala. Nangona unyango lotyando olwahlukeneyo lukhona ukuze kulawuleke ii-PHFs ezisusiweyo okanye ezingazinzanga, akukho mvumelwano ngeyona ndlela ilungileyo yotyando lwabantu abadala. Ukuphuhliswa kweepleyiti zokuzinzisa i-angle kunikeze ukhetho lonyango kunyango lotyando lwe-PHFs, kodwa izinga eliphezulu lokuxakeka ukuya kuma-40% kufuneka liqwalaselwe. Eyona ngxelo ixhaphakileyo kukuhla kwe-adduction kunye ne-screw dislodgement kunye ne-avascular necrosis (AVN) yentloko ye-humeral.
Ukunciphisa i-anatomical yokwaphuka, ukubuyisela umzuzu we-humeral, kunye nokulungiswa okuchanekileyo kwe-subcutaneous ye-screw kunokunciphisa iingxaki ezinjalo. Ukulungiswa kwe-Screw kudla ngokuba nzima ukufikelela ngenxa yomgangatho wethambo ophazamisekileyo we-proximal humerus ebangelwa yi-osteoporosis. Ukujongana nale ngxaki, ukuqinisa i-bone-screw interface kunye nomgangatho ophantsi wamathambo ngokusebenzisa i-polymethylmethacrylate (PMMA) i-samente yethambo ejikeleze i-screw tip yindlela entsha yokuphucula amandla okulungiswa kokufakelwa.
Uphononongo lwangoku lujolise ekuvavanyeni nasekuhlalutyeni iziphumo zeradiographic ze-PHFs eziphathwe ngeepleyiti zokuzinzisa ezine-angle kunye ne-screw incam eyongeziweyo kwizigulane ezingaphezulu kweminyaka engama-60.
Ⅰ.Izinto eziphathekayo kunye nendlela
I-totali yezigulane ze-49 ziye zafumana i-angle-stabilized plating kunye ne-samente eyongezelelweyo yokwandisa kunye ne-screws ye-PHFs, kwaye izigulane ze-24 zifakwe kwisifundo esisekelwe kwimilinganiselo yokubandakanywa kunye nokukhutshwa.
Zonke ii-PHF ezingama-24 zahlelwa kusetyenziswa inkqubo yokuhlelwa kwe-HGLS eyaziswa yi-Sukthankar kunye ne-Hertel isebenzisa ii-CT scans zangaphambili. Iiradiographs zangaphambi kokusebenza kunye ne-postoperative plain radiographs zavavanywa. Ukunciphisa okwaneleyo kwe-anatomic ye-fracture kwakucatshangelwa ukuba kuphunyeziwe xa i-tuberosity yentloko ye-humeral iphinda iyancipha kwaye ibonise ngaphantsi kwe-5 mm ye-gap okanye ukufuduka. I-adduction deformity ichazwe njengokuthambekela kwentloko ye-humeral ngokubhekiselele kwi-humeral shaft engaphantsi kwe-125 ° kunye nokukhubazeka kwe-valgus kuchazwe ngaphezu kwe-145 °.
Ukungena kwesijivu okusisiseko kwachazwa njengencam yesijivu esingena kumda we-medullary cortex yentloko ye-humeral. Ukufuduswa kwe-fracture yesibini kwachazwa njengokufuduswa kwe-tuberosity encitshisiweyo engaphezu kwe-5 mm kunye / okanye utshintsho olungaphezulu kwe-15 ° kwi-angle inclination ye-head fragment kwi-radiograph yokulandelela xa kuthelekiswa ne-radiograph ye-intraoperative.
Lonke utyando lwenziwa ngendlela enkulu ye-deltopectoralis. Ukunciphisa i-fracture kunye nokubekwa kweplate kwenziwa ngendlela eqhelekileyo. Indlela yokwandisa i-Screw-cement isetyenziswe nge-0.5 ml yesamente ukunyusa i-screw tips.
Ukunyanzeliswa kwe-immobilization kwenziwa emva kokusebenza kwi-sling yengalo yesiko kwigxalaba kwiiveki ze-3. Ukuhamba kwangaphambili kunye nokuncedisa ukunyakaza okusebenzayo kunye nokuguqulwa kweentlungu kwaqaliswa iintsuku ze-2 emva kokusebenza ukuze kuphunyezwe uluhlu olupheleleyo lokunyakaza (ROM).
Ⅱ.Isiphumo.
Iziphumo: Izigulane ezingamashumi amabini anesine zifakwe, kunye nobudala obuphakathi kwe-77.5 iminyaka (uluhlu, iminyaka eyi-62-96). Amashumi amabini ananye ngabafazi kwaye abathathu bengamadoda. Izahlulo ezihlanu ze-2-part fractures, i-12 3-part fractures, kunye nesixhenxe se-4-part fractures yaphathwa ngotyando kusetyenziswa iipleyiti zokuzinzisa i-angled kunye ne-screw-cement augmentation eyongezelelweyo. Izahlulo ezintathu kwezingama-24 yayiziintloko ezibuhlungu. Ukunciphisa i-anatomic kwaphunyezwa kwi-12 yezigulane ze-24; ukuncitshiswa ngokupheleleyo kwe-medial cortex kwaphunyezwa kwizigulane ezili-15 kwezingama-24 (62.5%). Kwiinyanga ze-3 emva kokuhlinzwa, i-20 yezigulane ze-21 (95.2%) ziye zafumana umanyano lwe-fracture, ngaphandle kwezigulane ze-3 ezifuna utyando lokuhlaziya kwangaphambili.
Esinye isigulane savelisa ukufuduka kwesibini kwangaphambili (ukujikeleza ngasemva kweqhekeza lentloko ye-humeral) iiveki ze-7 emva kokuhlinzwa. Ukuhlaziywa kwenziwa nge-reverse total shoulder arthroplasty kwiinyanga ezi-3 emva kokuhlinzwa. Ukungena kwe-screw ephambili ngenxa yokuvuza kwe-cement encinci ye-intraarticular (ngaphandle kokukhukuliseka okukhulu kwe-joint) kwabonwa kwizigulane ze-3 (i-2 yazo yayinentloko ye-humeral fractures) ngexesha lokulandelwa kwe-radiographic postoperative. Ukungena kwe-Screw kufunyenwe kwi-C layer ye-angle stabilization plate kwizigulane ze-2 kunye ne-E layer kwenye (umzobo 3). I-2 kwezi zigulane ze-3 emva koko zaphuhliswa i-avascular necrosis (AVN). Izigulane zenze utyando oluhlaziyiweyo ngenxa yokuphuhliswa kwe-AVN (Iitheyibhile 1, 2).
Ⅲ.Ingxoxo.
Eyona ngxaki ixhaphakileyo kwi-proximal humeral fractures (PHFs), ngaphandle kophuhliso lwe-avascular necrosis (AVN), kukukhutshwa kwesijivu kunye nokuwa okulandelayo kweqhekeza lentloko ye-humeral. Olu pho nonongo lufumene ukuba i-cement-screw augmentation yabangela umanyano lwe-95.2% kwiinyanga ze-3, izinga lokufuduka kwesibini le-4.2%, izinga le-AVN le-16.7%, kunye nereyithi yokuhlaziya i-16.7%. Ukwandiswa kwesamente kwizikrufu kubangele izinga lesibini lokufuduswa kwe-4.2% ngaphandle kokuwa kwe-adduction, elizinga eliphantsi xa lithelekiswa malunga ne-13.7-16% kunye nokulungiswa kwepleyiti ye-angled yesiqhelo. Sicebisa ngamandla ukuba kwenziwe iinzame zokufezekisa ukuncipha okwaneleyo kwe-anatomic, ngakumbi i-medial humeral cortex kwi-angled plate fixation ye-PHFs. Nokuba kusetyenziswe ulwandiso olongezelelweyo lwencam yesikrufu, iindlela ezaziwayo zokungaphumeleli ezinokuthi ziqwalaselwe kufuneka ziqwalaselwe.
Ireyithi yohlaziyo iyonke ye-16.7% usebenzisa i-screw tip augmentation kolu phononongo ingaphakathi koluhlu olusezantsi lwereyithi yohlaziyo epapashiweyo ngaphambili kwiipleyiti zozinziso ze-angular kwi-PHFs, ezibonise amazinga okuhlaziya abantu abadala ukusuka kwi-13% ukuya kwi-28%. Hayi ukulinda. Uphononongo olulindelekileyo, olungenamkhethe, olulawulwa ngamaziko amaninzi olwenziwa nguHengg et al. akazange abonise inzuzo ye-cement screw augmentation. Phakathi kwezigulane ze-65 eziye zagqiba ukulandelelana kweminyaka eyi-1, ukungaphumeleli komatshini kwenzeka kwizigulane ze-9 kunye ne-3 kwiqela lokwandisa. I-AVN yabonwa kwizigulane ze-2 (10.3%) kunye nezigulane ze-2 (5.6%) kwiqela elingaphuculweyo. Ngokubanzi, akukho ntlukwano ebalulekileyo ekuveleni kweziganeko ezimbi kunye neziphumo zonyango phakathi kwamaqela amabini. Nangona ezi zifundo zijolise kwiziphumo zeklinikhi kunye ne-radiological, azizange zivavanye i-radiographs kwiinkcukacha ezininzi njengolu phononongo. Lilonke, iingxaki ezifunyaniswe ngemitha ziyefana nezo kolu phononongo. Akukho nanye kwezi zifundo eziye zachaza ukuvuza kwe-samente ye-intra-articular, ngaphandle kophando olwenziwa nguHengg et al., Owabona esi siganeko esibi kwisigulane esinye. Kuphononongo lwangoku, ukungena kwe-screw ephambili kwabonwa kabini kwinqanaba C kwaye kanye kwinqanaba E, kunye nokuvuza kwesamente ye-intra-articular elandelayo ngaphandle kokubaluleka kweklinikhi. Isixhobo sokuchasana safakwa phantsi kolawulo lwe-fluoroscopic ngaphambi kokuba ulwandiso lwesamente lusetyenziswe kwisikrufu ngasinye. Nangona kunjalo, iimbono ezahlukeneyo zeradiographic kwiindawo ezahlukeneyo zengalo kufuneka zenziwe kwaye zivavanywe ngononophelo ngakumbi ukuze kuthintelwe nakuphi na ukungena okuphambili kwesijivu phambi kokufakwa kwesamente. Ngaphaya koko, ukomelezwa kwezikrufu zesamente kwinqanaba C (ubumbeko lwe-screw divergent) kufuneka luthintelwe ngenxa yomngcipheko ophezulu wokungenwa kwesikrufu esingundoqo kunye nokuvuza kwesamente okulandelayo. I-Cement screw tip augmentation ayikhuthazwa kwizigulane ezineentloko ze-humeral ngenxa yekhono eliphezulu lokuvuza kwe-intraarticular ebonwe kule ndlela yokuphuka (kubonwa kwizigulane ze-2).
VI. Ukuqukumbela.
Kunyango lwe-PHFs nge-angle-stabilized plates usebenzisa i-samente ye-PMMA, i-cement screw tip augmentation yindlela ethembekileyo yotyando ephucula ukulungiswa kokufakelwa kwethambo, okubangelwa izinga eliphantsi lokufuduka kwesibini se-4.2% kwizigulane ze-osteoporotic. Xa kuthelekiswa noncwadi olukhoyo, ukwanda kweziganeko ze-avascular necrosis (AVN) zabonwa ngokukodwa kwiipateni zokuphuka okukhulu kwaye oku kufuneka kuthathelwe ingqalelo. Phambi kokufakwa kwesamente, nakuphi na ukuvuza kwesamente ye-intraarticular makungabandakanywa ngononophelo ngolawulo oluphakathi. Ngenxa yomngcipheko ophezulu wokuvuza kwesamente ye-intraarticular kwi-fractures yentloko ye-humeral, asikhuthazi ukunyusa i-cement screw tip kule fracture.
Ixesha lokuposa: Aug-06-2024
