Kwiminyaka embalwa edlulileyo, ukwanda kwezaphuko ze-humeral fractures (PHFs) kunyuke ngaphezu kwe-28%, kwaye izinga lotyando linyuke ngaphezu kwe-10% kwizigulana ezineminyaka engama-65 nangaphezulu. Ngokucacileyo, ukuncipha koxinano lwamathambo kunye nokwanda kwenani lokuwa zezona zinto zibalulekileyo ezibangela umngcipheko kubantu abadala abakhulayo. Nangona kukho unyango olwahlukeneyo lotyando olukhoyo lokulawula ii-PHF ezifudukeleyo okanye ezingazinzanga, akukho mvumelwano malunga nendlela engcono yotyando kubantu abadala. Uphuhliso lwee-angle stabilization plates lubonelele ngokhetho lonyango lotyando lwee-PHFs, kodwa izinga eliphezulu leengxaki ezifikelela kwi-40% kufuneka liqwalaselwe. Ezona zixhaphakileyo kukwanda kokuwa ngokukhutshelwa ngaphandle kunye nokukhutshelwa ngaphandle kunye ne-avascular necrosis (AVN) yentloko ye-humeral.
Ukunciphisa ukwaphuka komzimba, ukubuyiselwa kwe-humeral moment, kunye nokulungiswa ngokuchanekileyo kwe-screw phantsi kolusu kunokunciphisa ezo ngxaki. Ukulungiswa kwe-screw kudla ngokuba nzima ukukufezekisa ngenxa yomgangatho wethambo we-humerus ekufutshane obangelwa yi-osteoporosis. Ukujongana nale ngxaki, ukuqinisa ujongano lwethambo ne-screw kunye nomgangatho ophantsi wethambo ngokusebenzisa isamente yethambo ye-polymethylmethacrylate (PMMA) ejikeleze incam ye-screw yindlela entsha yokuphucula amandla okulungiswa kwe-implant.
Olu phononongo lwangoku lujolise ekuvavanyeni nasekuhlalutyeni iziphumo ze-radiographic ze-PHF ezinyangwe ngee-angled stabilization plates kunye nokwandiswa kwe-screw tip eyongezelelweyo kwizigulana ezingaphezulu kweminyaka engama-60.
Ⅰ.Izinto kunye nendlela
Izigulane ezingama-49 zizonke zenze i-angle-stabilized plating kunye ne-samente eyongezelelweyo eyongeziweyo ngee-screws ze-PHF, kwaye izigulane ezingama-24 zabandakanywa kolu phando ngokusekelwe kwiikhrayitheriya zokubandakanywa kunye nokukhutshwa.
Zonke ii-PHF ezingama-24 zahlulwahlulwa kusetyenziswa inkqubo yokwahlula i-HGLS eyaziswa nguSukthankar noHertel besebenzisa ii-CT scans zangaphambi kotyando. Ii-radiographs zangaphambi kotyando kunye nee-radiographs ezicacileyo emva kotyando zavavanywa. Ukunciphisa okwaneleyo kokuqhekeka kwafunyanwa xa i-tuberosity yentloko ye-humeral yancitshiswa kwakhona kwaye yabonisa ngaphantsi kwe-5 mm yomsantsa okanye ukufuduka. Ukukhubazeka kokunyusa kwachazwa njengokuthambekela kwentloko ye-humeral xa kuthelekiswa ne-humeral shaft engaphantsi kwe-125° kwaye ukukhubazeka kwe-valgus kwachazwa njengokungaphezulu kwe-145°.
Ukungena kwesikrufu sokuqala kwachazwa njengencam yesikrufu engena kumda we-medullary cortex yentloko ye-humeral. Ukususwa kwesikrufu sesibini kwachazwa njengokufuduka kwe-tuberosity encitshisiweyo engaphezulu kwe-5 mm kunye/okanye utshintsho olungaphezulu kwe-15° kwi-angle yokuthambekela kwesiqwenga sentloko kwi-radiograph yokulandelela xa kuthelekiswa ne-radiograph yangaphakathi kotyando.
Zonke iintlobo zotyando zenziwe ngendlela ye-deltopectoralis major. Ukunciphisa ukwaphuka kunye nokubeka ipleyiti kwenziwa ngendlela eqhelekileyo. Indlela yokwandisa isamente ngesikrufu isebenzise i-0.5 ml yesamente ukwandisa incam yesikrufu.
Ukuthintela ukuhambahamba kwenziwa emva kotyando nge-sling yengalo eyenzelwe wena kangangeeveki ezi-3. Intshukumo esebenzayo yasekuqaleni encediswayo kunye nokuguqulwa kwentlungu kwaqaliswa kwiintsuku ezi-2 emva kotyando ukuze kufezekiswe uluhlu olupheleleyo lwentshukumo (ROM).
Ⅱ.Isiphumo.
Iziphumo: Kuqukwe izigulana ezingamashumi amabini anesine, ezineminyaka ephakathi kwengama-77.5 (uluhlu, iminyaka engama-62-96). Ezingamashumi amabini ananye zaziziintombi kwaye ezintathu zaziziindoda. Iziqwenga ezihlanu ezineenxalenye ezimbini, iziqwenga ezili-12 ezineenxalenye ezintathu, kunye neziqwenga ezisixhenxe ezineenxalenye ezine zanyangwa ngotyando kusetyenziswa iipleyiti zokuzinzisa ezigobileyo kunye nokwandiswa kwesamente eyongezelelweyo. Ezithathu kwezingama-24 zeziqwenga zentloko ye-humeral. Ukuncipha kwe-anatomic kufezekisiwe kwizigulana ezili-12 kwezingama-24; ukuncipha okupheleleyo kwe-medial cortex kufezekisiwe kwizigulana ezili-15 kwezingama-24 (62.5%). Kwiinyanga ezi-3 emva kotyando, izigulana ezingama-20 kwezingama-21 (95.2%) zazifikelele kwi-fracture union, ngaphandle kwezigulana ezi-3 ezazifuna utyando lokuhlaziya kwangethuba.
Esinye isigulana safumana ukufuduka kwesibini kwangoko (ukujikeleza kwangemva kwenxalenye yentloko ye-humeral) kwiiveki ezi-7 emva kotyando. Uhlaziyo lwenziwa nge-arthroplasty yegxalaba elingasemva kwiinyanga ezi-3 emva kotyando. Ukungena kwesikrufu sokuqala ngenxa yokuvuza okuncinci kwesamente ngaphakathi kwe-articular (ngaphandle kokukhuhlana okukhulu kwelungu) kwabonwa kwizigulana ezi-3 (ezi-2 zazo zazineziphuphu zentloko ye-humeral) ngexesha lokulandelela i-radiographic emva kotyando. Ukungena kwesikrufu kwafunyanwa kumaleko we-C wepleyiti yozinzo lwe-angle kwizigulana ezi-2 nakwimaleko ye-E kwenye (Umzobo 3). Ezi-2 kwezi zigulana zi-3 kamva zafumana i-avascular necrosis (AVN). Izigulana zafumana utyando lokuhlaziywa ngenxa yophuhliso lwe-AVN (Iitheyibhile 1, 2).
Ⅲ.Ingxoxo.
Eyona ngxaki ixhaphakileyo kwiingxaki zokuqhekeka kwe-humeral proximal (PHFs), ngaphandle kophuhliso lwe-avascular necrosis (AVN), kukukhutshelwa ngaphandle kweeskrubu kunye nokuwa kwe-adduction fragment yentloko ye-humeral. Olu phononongo lufumanise ukuba ukwandiswa kwe-cement-screw kubangele izinga lomanyano lwe-95.2% kwiinyanga ezi-3, izinga lokufuduka lesibini le-4.2%, izinga le-AVN le-16.7%, kunye nezinga lokuhlaziywa lilonke le-16.7%. Ukwandiswa kwe-cement yeeskrubu kubangele izinga lokufuduka lesibini le-4.2% ngaphandle kokuwa kwe-adduction, elilizinga eliphantsi xa lithelekiswa ne-13.7-16% kunye nokulungiswa kweplate eqhelekileyo ye-angled. Sicebisa ngamandla ukuba kwenziwe imizamo yokufezekisa ukunciphisa okwaneleyo kwe-anatomic, ngakumbi i-medial humeral cortex ekufakweni kweplate ye-angled ye-PHFs. Nokuba kusetyenziswa ukwandiswa kwe-screw tip eyongezelelweyo, kufuneka kuqwalaselwe iikhrayitheriya zokungaphumeleli ezaziwayo.
Izinga lokuhlaziywa lilonke le-16.7% kusetyenziswa ukwandiswa kwe-screw tip kolu phononongo lingaphakathi koluhlu oluphantsi lwamazinga okuhlaziywa apapashwe ngaphambili kwiiplate zendabuko zokuzinzisa i-angular kwi-PHFs, ezibonise amazinga okuhlaziywa kubantu abadala ukusuka kwi-13% ukuya kwi-28%. Akukho kulinda. Uphononongo olucwangcisiweyo, oluhleliweyo, olulawulwayo oluneziko ezininzi olwenziwe nguHengg et al. aluzange lubonise inzuzo yokwandiswa kwe-screw yesamente. Phakathi kwezigulane ezingama-65 ezigqibe ukulandelela unyaka omnye, ukusilela koomatshini kwenzeke kwizigulane ezili-9 kunye nezi-3 kwiqela lokwandiswa. I-AVN yabonwa kwizigulane ezi-2 (10.3%) kunye nakwizigulane ezi-2 (5.6%) kwiqela elingaphuculwanga. Lilonke, bekungekho mahluko abalulekileyo ekwenzekeni kweziganeko ezimbi kunye neziphumo zeklinikhi phakathi kwamaqela amabini. Nangona ezi zifundo zigxile kwiziphumo zeklinikhi neze-radiological, azizange zivavanye ii-radiographs ngokweenkcukacha ezifana nolu phononongo. Lilonke, iingxaki ezifunyenwe nge-radiological zazifana nezo zikwisifundo. Akukho nanye kwezi zifundo ebike ukuvuza kwesamente ngaphakathi kwe-articular, ngaphandle kophando olwenziwe nguHengg et al., ababone esi siganeko sibi kwisigulana esinye. Kolu phononongo, ukungena kwe-primary screw kubonwe kabini kwinqanaba C kwaye kube kanye kwinqanaba E, kunye nokuvuza kwesamente ngaphakathi kwe-articular ngaphandle kokubaluleka kweklinikhi. Izinto ezichaseneyo zafakwa phantsi kolawulo lwe-fluoroscopic ngaphambi kokuba kusetyenziswe ukongezwa kwesamente kwi-screw nganye. Nangona kunjalo, kufuneka kwenziwe iimbono ezahlukeneyo ze-radiographic kwiindawo ezahlukeneyo zengalo kwaye zihlolwe ngononophelo ukuze kuthintelwe naluphi na ukungena kwe-screw yokuqala ngaphambi kokusetyenziswa kwesamente. Ngaphezu koko, ukuqinisa isamente kwe-screws kwinqanaba C (ulungiselelo lwe-screw divergent) kufuneka kuthintelwe ngenxa yomngcipheko ophezulu wokungena kwe-screw ephambili kunye nokuvuza kwesamente okulandelayo. Ukwandiswa kwe-screw tip yesamente akukhuthazwa kwizigulana ezine-humeral head fractures ngenxa yamandla aphezulu okuvuza ngaphakathi kwe-articular okubonwe kule patheni yokuqhekeka (kubonwe kwizigulana ezi-2).
VI. Isiphelo.
Kunyango lwe-PHFs ngeepleyiti ezizinziswe yi-angle-stabilized kusetyenziswa i-PMMA cement, i-cement screw augmentation yindlela yotyando ethembekileyo ephucula ukufakwa kwe-implant emathanjeni, nto leyo ekhokelela kwizinga eliphantsi lokufuduka kwesibini le-4.2% kwizigulane ezine-osteoporosis. Xa kuthelekiswa neencwadi ezikhoyo, ukwanda kwe-avascular necrosis (AVN) kwabonwa ikakhulu kwiipateni ezinzima zokuqhekeka kwaye oku kufuneka kuthathelwe ingqalelo. Ngaphambi kokusetyenziswa kwesamente, naluphi na ukuvuza kwesamente ngaphakathi kwe-articular kufuneka kukhutshwe ngononophelo ngokusebenzisa i-contrast medium. Ngenxa yomngcipheko ophezulu wokuvuza kwesamente ngaphakathi kwe-articular kwii-humeral head fractures, asicebisi i-cement screw augmentation kule fracture.
Ixesha lokuthumela: Agasti-06-2024
