Kule minyaka ingamashumi idlulileyo ishumi elidlulileyo, izehlo zeefreyimu ze-proximal (PHFs) inyuke ngaphezulu kwe-28%, kwaye ireyithi yoqhaqho inyuke ngaphezulu kwe-10% kwizigulana ezineminyaka engama-65 nangaphezulu. Ngokucacileyo, ukuncipha koxinano lwethambo kunye nokwanda kwenani leendlela zezona zinto zintle zomngcipheko kwinani labantu abadala. Nangona i-chiging yonyango eyahlukeneyo iyafumaneka ukuze ilawule i-SHF ezifudukayo okanye ezingazinzanga, akukho vumelanayo ngowona ndlela ibalaseleyo yokutya utyando. Ukuphuhliswa kweepleyiti zokuzinza ze-Angle kunikeze inketho yonyango lonyango lonyango lwe-PHFs, kodwa inqanaba eliphezulu lokungqinelana ukuya kuthi ga kwiipesenti ezingama-40% kufuneka liqwalaselwe. Eyona ixhasiweyo ixhaphake i-oxduct iwa nge-screw dislodadges kunye ne-avrosis ye-avrosis (Avn) yentloko ye-humeral.
Ukuncitshiswa kwe-Aatomical yokuqhekeka, ukubuyiselwa komzuzu we-humeral, kunye nokulungiswa ngokuchanekileyo kwe-screw kunokunciphisa ezo ngxaki. Ukulungiswa kwesibhakabhaka kusoloko kunzima ukufezekisa ngenxa yomgangatho wethambo olwenziwe kwi-proximal humersus obangelwa yi-osteopororosis. Ukulungisa le ngxaki, ukomeleza i-bone-screen yethambo kunye nomgangatho wethambo elihlwempuzekileyo ngokusebenzisa i-polymethylmetrhacrylate (PMMA) I-BOE STATE Ingcebiso entsha yokuphucula amandla okulungisa.
Isifundo sangoku sijolise ekuvavanyeni kwaye sihlalutye iziphumo ze-radiographic zithwalwa zizilotha zokuzinza ze-engiles kunye ne-screen encotsheni yezigulana kwizigulana ezingaphezulu kweminyaka engama-60.
Ⅰ.Izixhobo kunye nendlela
Zizonke ezi-49 ezinesifo se-Angle-I-Angle yokuSebenzisa kunye nokongezwa kwesandiso kunye ne-screws ye-PHFs, kwaye izigulana ezingama-24 zibandakanyiwe kwisifundo ngokusekwe ekufakweni kwekhutshelwe kunye nokubandakanywa.
Zonke ezingama-24 ze-24 ze-SHF zidwelisiwe kusetyenziswa inkqubo ye-HGLS yokuhlelwa kwaziswe yiSokthankhar kunye ne-hertel esebenzisa i-CT ye-CT. I-primography Primobs kunye nendawo ye-postopeages evaliweyo yavavanywa. Ukuncitshiswa okwaneleyo kwe-anatomic yokwaphuka kwakuthathwa njengokufezekiswa xa i-tuberosity yentloko ye-fitural yancitshiswa iphinde yancitshiswa kwaye ibonakalise ngaphantsi kwe-5 mm yomsele okanye ukufuduswa. Ukuphuculwa kwesidimango kuchazwa njengokuqulunqwa kwentloko ye-humeral kunxulumene ne-suft engaphantsi kwe-125 ° kunye ne-qualm \ ° stoment yachazwanga ngaphezulu kwe-145 °.
Ukungena kwesikreyithi esiyintloko kwachazwa njenge-screw tit ingena kumda we-cartel yentloko yentloko ye-humeral. Ukuqhekeka kwesahlulo senqanaba lesibini kuchazwa njengokufuduswa kwe-tuberosity encitshisiweyo ngaphezulu kwe-5 mm kunye / okanye utshintsho olungaphezulu kwe-15 ° kwi-Angle yoTitshala kwi-radiograph yentloko ethe tyaba kwi-radiograph ye-intraoperative.
Zonke utyando lwenziwa ngendlela enkulu kaDeltopectolis. Ukuncitshiswa kwe-Fraction kunye nendawo yeplate kwenziwa ngendlela esemgangathweni. I-screw-cendo operation yendlela yokusebenza isetyenziswe i-0.5 ml yesamente yesamente ye-screw encopho.
Ukunyanzelwa kwenziwe ngeposi kwingalo yesiko lesiqhelo segxalaba leeveki ezintathu. Ukuhamba ngokubonakalayo kunye nokuncediswa kokusebenza okusebenzayo kunye nemo yemodareyitha yentlungu yaqalwa kwiintsuku ezi-2 ngokuchanekileyo ukufezekisa uluhlu olupheleleyo lwentshukumo (ROM).
Ⅱ.Iziphumo.
Iziphumo: Amashumi amabini anesihlanu abaguli babandakanywa, kunye neminyaka engama-77,5 yeminyaka engama-77,5 (uluhlu, iminyaka engama-62-96). Abangamashumi amabini ananye baba ngababhinqileyo, abathathu bengamadoda. Amanzi amahlanu ayi-2, iqhekeza eli-12 lenxalenye, kwaye ukwaphulwa kwesixhenxe kwaphathwa ngobuqhetseba kusetyenziswa iipleyiti ze-engiles kunye nesandiso esongezelelweyo sesamente. Isithathu seziqwenga ezingama-24 sasiyintloko yentloko yentloko. Ukuncitshiswa kwe-Aatomic kwaphunyezwa kubaguli abangama-24; Ukuncitshiswa ngokupheleleyo kwe-cortex ye-medial ifezekisiwe kwizigulana eziyi-24 (i-62.5%). Kwiinyanga ezi-3 emva kotyando, abangama-20 kwabaguli (95.2%) baphulukene nemanyano, ngaphandle kwabaguli abathathu abafuna utyando lwangethuba.
Isigulana esinye isigulana esiphuhliselwe kwisibini sokususwa kwesibini (ukujikeleza kwabasemva kwentloko yentloko yesiqwengana sentloko) emva kweeveki ezisi-7 emva kotyando. Uhlaziyo lwenziwa nge-arthroplast yeenyanga ezintathu emva kotyando. I-Prict Strinetion ye-Screw ngenxa yokuvuza amaxabiso amancinci (ngaphandle kokukhukuliseka okukhulu kwendlela edibeneyo) yaqwalaselwa kwizigulana ezi-3 (ezi-2 ezaziqhiphuka umxholo) ngexesha lokulandelwa kwe-radiographic. Ingubo yokwahlula-nyezwa ifunyenwe kwi-CAR ye-CAR ye-CAGLE STEATE STETE kwizigulana ezi-2 nakwi-E 2 kwezi zithili zi-3 emva koko zaqulunqa i-avascular necrosis (Avn). Izigulana zenziwa utyando oluhlaziyiweyo ngenxa yophuhliso lwe-AVN (iitafile 1, 2).
Ⅲ.Ingxoxo.
Eyona nto ibaluleke kakhulu kwi-proximal ye-proximal ye-proximal, ngaphandle kokuphuhliswa kwe-nevascular necrosis (Avn), i-screw dislowgement ye-subloction yentloko yentloko. Olu phononongo lufumanise ukuba isikhafu sesandiso saphumela kwi-95.2% kwiinyanga ezi-3, izinga lezibini zenqanaba lesibini le-4.2%, ireyithi ye-AVN ye-16.7% ye-16.7%. Ukukhutshwa kwesamente kwezikrelemnqa kuphumela kwinqanaba le-4.2% ngaphandle kwazo nakuphi na ukuwa, ixabiso elisezantsi xa kuthelekiswa malunga ne-13.7-16% enesithambisi esiqhelekileyo seplate. Sincoma ngamandla ukuba iinzame zenziwe ukufezekisa ukuncitshiswa okwaneleyo kwe-aatomic, ngakumbi i-himex ye-himeral ye-humeral kwi-Anglet Plet yePlfs. Nokuba i-screen eyongezelelweyo ye-Screw isetyenzisiwe, kufuneka ithathelwe ingqalelo ngokufanelekileyo.
Inqanaba le-16.7% lisebenzisa isikhafu se-screw engxokololo kolu phononongo lingaphakathi kweepleyiti zokuhlalisa kwi-Angles, ezibonisiweyo kwi-PHFS kwi-13% ukuya kwi-28%. Akukho kulinda. Isifundo sexesha elininzi, esilawulwayo, esilawulwayo siqhutywa nguHengg et al. Khange ubonise isibonelelo se-screen yesamente yesamente. Phakathi kwezigulana ezingama-65 zizonke ezigqibileyo ukulandela unyaka omnye, ukusilela koomatshini kwenzeke kwizigulana ezi-9 kunye ne-3 kwiqela le-aunterment. I-Avn yaqwalaselwa kwizigulana ezi-2 (i-10.3%) nakwizigulana ezi-2 (5.6%) kwiqela elingaphuculweyo. Ngokubanzi, kwakungekho mahluko okwiziganeko ezibi kunye neziphumo zeklinikhi phakathi kwala maqela mabini. Nangona ezi zifundo zigxile kwiziphumo zeklinikhi neyemigrace, azizange zivavanye i-radires kwiinkcukacha ezininzi njengolu phononongo. Ngokubanzi, iingxaki ezichongiweyo zekratshi zazifana nakwezo zifundo. Akukho nanye kwezi zifundo enike ingxelo ye-intra-ye-intra ye-Intra ye-Intra, ngaphandle kwesifundo nguHongg et al., Ngubani ophephe esi sigulana singenasigulana. Kwisifundo esikhoyo, ukungena kwesikrizo esiyintloko kwaqwalaselwa kabini kwinqanaba C kwaye kube kanye kwinqanaba le-E, nge-Intratical ye-Intracior ye-Anticular ye-Anticular ye-Intrako ngaphandle kokubaluleka kweklinikhi. Impahla engafaniyo yayithathwe phantsi kolawulo lwe-Fluoroscopic ngaphambi kokuba isandiso songezelelekileyo sifakwe kwisikrikhi ngasinye. Nangona kunjalo, iimbono ezahlukeneyo ze-raditymac kwizikhundla ezahlukeneyo ezingalweni kufuneka zenziwe kwaye zivavanywe ngononophelo ukuze zingeniswe isikripthi esiyintloko ngaphambi kwesicelo sesamente. Ngapha koko, ukuqiniswa kwesamente kwizikrelem zenqanaba c (isikhafu se-screw divergent) kufuneka kuthintelwe ngenxa yomngcipheko ophezulu wokungena kwi-screen kunye ne-lesas elandelayo. I-Screen Tight Tight Ukoxhaswa kwezigulana ezingakhuthazwanga kwizigulana zentloko ye-humeral ye-quitharal ye-quity ngenxa yokuvuza okuphezulu kwe-initraticular ebonisiweyo (kubonwe kwizigulana ezi-2).
VI. Ukuqukumbela.
Kunyango lwe-PHFS kunye ne-PHETES ezinziweyo ze-Angle isebenzisa isamente ye-PMMA, isikhafu se-Science Screen i-screen ethembekileyo yokuphambana ekwandiseni inqanaba le-4 le-MAGEOPOOOROPOOROOROOROOROOROROROOROOROOROP. Xa kuthelekiswa noncwadi olukhoyo, isimo esandayo se-avascular necrosis (Avn) yaqwalaselwa ikakhulu kwiipatheni zokuqhekeza okuqatha kwaye oku kufuneka kuthathelwe ingqalelo. Phambi kwesicelo sesamente, nakuphi na ukuvuza kwe-Intratericular Suatiary kufuneka kukhutshelwe ngononophelo ngokwahlukileyo kulawulo oluphakathi. Ngenxa yomngcipheko omkhulu we-Intraaricular ye-Inderracular ye-Indel yeNtloko yeNtloko ye-Humeral Priction, asichazi-mafutha amandla e-cesment ye-operation ye-subration.
IXESHA LOKUQALA: AUG-06-2024
