Femoral intertrochanteric fracture ke ho robeha ha letheka ho tloaelehileng ka ho fetisisa litsing tsa bongaka 'me ke e' ngoe ea tse tharo tse tloaelehileng tse amanang le lefu la masapo ho batho ba tsofetseng.Kalafo e sa lebelloang e hloka ho phomola nako e telele betheng, ho beha likotsi tse phahameng tsa liso tsa khatello, tšoaetso ea matšoafo, pulmonary embolism, deep vein thrombosis, le mathata a mang.Bothata ba booki bo bohlokoa, 'me nako ea ho hlaphoheloa e telele, e beha moroalo o boima sechabeng le malapeng.Ka hona, ho kenella ka pele ho opereishene, neng kapa neng ha ho mamelleha, ke habohlokoa bakeng sa ho finyella liphello tse ntle tsa ts'ebetso ea ho robeha ha letheka.
Hajoale, PFNA (proximal femoral Nail antirotation system) ho lokisoa ha kahare ho nkuoa e le tekanyetso ea khauta bakeng sa kalafo ea opereishene ea ho robeha ha letheka.Ho fumana ts'ehetso e ntle nakong ea ho fokotsa ho robeha ha letheka ke habohlokoa bakeng sa ho lumella boikoetliso ba pele bo sebetsang.Intraoperative fluoroscopy e kenyelletsa anteroposterior (AP) le maikutlo a ka morao ho lekola phokotso ea cortex ea botšehali ea anterior medial.Leha ho le joalo, likhohlano li ka 'na tsa hlaha pakeng tsa maikutlo a mabeli nakong ea opereishene (ke hore, e ntle ka pono ea lateral empa eseng ka pono ea anteroposterior, kapa ka tsela e fapaneng).Maemong a joalo, ho lekola hore na phokotso e ea amoheleha le hore na tokiso ea hlokahala ho baka bothata bo boima ho lingaka.Litsebi tse tsoang lipetleleng tsa malapeng tse kang Oriental Hospital le Zhongshan Hospital li buile ka taba ena ka ho hlahloba ho nepahala ha ho hlahloba tšehetso e ntle le e mpe tlas'a maikutlo a anteroposterior le lateral a sebelisa li-postoperative tse tharo-dimensional CT scans e le tekanyetso.
▲ Setšoantšo se bontša tšehetso e ntle (a), tšehetso e sa nke lehlakore (b), le tšehetso e mpe (c) mekhoa ea ho robeha ha letheka ka pono ea anteroposterior.
▲ Setšoantšo se bontša tšehetso e ntle (d), tšehetso e sa nke lehlakore (e), le tšehetso e mpe (f) mekhoa ea ho robeha ha letheka ka pono ea lateral.
Sehlooho sena se kenyelletsa lintlha tsa linyeoe tse tsoang ho bakuli ba 128 ba nang le fractures ea letheka.Litšoantšo tsa intraoperative anteroposterior le lateral li ile tsa fanoa ka thoko ho lingaka tse peli (e nang le phihlelo e fokolang le e 'ngoe e nang le phihlelo e ngata) ho hlahloba tšehetso e ntle kapa e seng ntle.Ka mor'a tlhahlobo ea pele, tlhahlobo e ncha e ile ea etsoa ka mor'a likhoeli tse 2.Litšoantšo tsa postoperative CT li ile tsa fanoa ho moprofesa ea nang le phihlelo, ea ileng a etsa qeto ea hore na nyeoe eo e ne e le ntle kapa e se e ntle, e sebetsang e le tekanyetso ea ho hlahloba ho nepahala ha litlhahlobo tsa litšoantšo ke lingaka tse peli tsa pele.Lipapiso tsa sehlooho sengolong ke tse latelang:
(1) Na ho na le liphapang tsa bohlokoa tsa lipalo-palo liphethong tsa tlhahlobo lipakeng tsa lingaka tse se nang boiphihlelo le tse nang le boiphihlelo litlhahlobong tsa pele le tsa bobeli?Ho phaella moo, sengoloa se hlahloba ho lumellana ha lihlopha pakeng tsa lihlopha tse se nang phihlelo le tse nang le phihlelo bakeng sa litlhahlobo ka bobeli le ho lumellana ha lihlopha pakeng tsa liteko tse peli.
(2) Ho sebelisa CT e le sesupo sa maemo a khauta, sengoloa se etsa lipatlisiso hore na ke sefe se tšepahalang haholoanyane bakeng sa ho lekola boleng ba phokotso: tlhahlobo ea morao-rao kapa ea anteroposterior.
Liphetho tsa lipatlisiso
1. Likarolong tse peli tsa litlhahlobo, ka CT e le tekanyetso ea litšupiso, ho ne ho se na phapang e kholo ea lipalo-palo ka kutloisiso, ho khetheha, tekanyo e fosahetseng ea bohata, tekanyo e fosahetseng ea bohata, le litekanyetso tse ling tse amanang le tlhahlobo ea boleng ba phokotso e thehiloeng ho intraoperative X- mahlaseli lipakeng tsa lingaka tse peli tse nang le maemo a fapaneng a boiphihlelo.
2.Ha ho hlahlojoa boleng ba phokotso, ho nka tlhahlobo ea pele e le mohlala:
- Haeba ho na le tumellano pakeng tsa litlhahlobo tsa anteroposterior le lateral (tse peli tse ntle kapa tse peli tse seng ntle), ho tšepahala ho bolela esale pele boleng ba ho fokotsa ho CT ke 100%.
- Haeba ho na le ho se lumellane pakeng tsa litlhahlobo tsa anteroposterior le lateral, ho tšepahala ha litekanyetso tsa tlhahlobo ea lateral ho bolela esale pele boleng ba ho fokotsa ho CT bo phahameng.
▲ Setšoantšo se bontša tšehetso e ntle e bontšitsoeng ponong ea anteroposterior ha e ntse e bonahala e se e ntle ka lehlakoreng la lateral.Sena se bontša ho se lumellane ho liphello tsa tlhahlobo pakeng tsa maikutlo a anteroposterior le lateral.
▲ Ho tsosolosoa ha CT ea likarolo tse tharo ho fana ka litšoantšo tsa ho shebella mahlakore a mangata, tse sebetsang e le tekanyetso ea tlhahlobo ea boleng ba ho fokotsa.
Litaelong tse fetileng tsa ho fokotsa fractures ea intertrochanteric, ntle le ts'ehetso e ntle le e mpe, ho boetse ho na le maikutlo a "ho se nke lehlakore" ho tšehetsa, ho bolelang ho fokotseha ha anatomical.Leha ho le joalo, ka lebaka la litaba tse amanang le ho rarolla fluoroscopy le mahlo a motho discernibility, 'nete "anatomical phokotso" theory ha e eo, 'me kamehla ho na le ho kheloha hanyenyane mabapi le "positive" kapa "negative" phokotso.Sehlopha se etelletsoeng pele ke Zhang Shimin Sepetlele sa Yangpu se Shanghai se phatlalalitse pampiri (tšupiso e tobileng e lebetsoeng, e ka ananela haeba motho e mong a ka e fana) e fana ka maikutlo a hore ho fumana tšehetso e ntle ho fractures ea intertrochanteric ho ka fella ka liphello tse molemo tsa ts'ebetso ha li bapisoa le ho fokotseha ha anatomical.Ka hona, ha ho nahanoa ka thuto ena, boiteko bo lokela ho etsoa nakong ea opereishene ho finyella tšehetso e ntle ho fractures ea intertrochanteric, ka maikutlo a anteroposterior le lateral.
Nako ea poso: Jan-19-2024
