Karyewar ƙashin ƙugu ta hanyar haɗin gwiwa ita ce karyewar ƙashin ƙugu da aka fi sani a asibiti kuma tana ɗaya daga cikin karyewar ƙashin ƙugu guda uku da aka fi sani da osteoporosis a cikin tsofaffi. Maganin da aka saba yi yana buƙatar hutawa na dogon lokaci a gado, wanda ke haifar da babban haɗarin ciwon matsi, kamuwa da cututtukan huhu, embolism na huhu, thrombosis na jijiyoyin jini, da sauran matsaloli. Wahalar jinya tana da mahimmanci, kuma lokacin murmurewa yana da tsawo, yana sanya nauyi mai yawa ga al'umma da iyalai. Saboda haka, yin tiyata da wuri, duk lokacin da aka jure, yana da mahimmanci don cimma sakamako mai kyau a cikin karyewar ƙashin ƙugu.
A halin yanzu, gyaran ciki na PFNA (tsarin hana juyawar ƙusa na kusa da ƙusa) ana ɗaukarsa a matsayin ma'aunin zinare don maganin tiyata na karyewar ƙusa. Samun tallafi mai kyau yayin rage karyewar ƙusa yana da mahimmanci don ba da damar motsa jiki da wuri. Fluoroscopy na ciki ya haɗa da anteroposterior (AP) da ra'ayoyi na gefe don tantance raguwar ƙwayar tsakiya ta gaba ta femoral. Duk da haka, rikice-rikice na iya tasowa tsakanin ra'ayoyi biyu yayin tiyata (watau, tabbatacce a ra'ayi na gefe amma ba a ra'ayi na anteroposterior ba, ko akasin haka). A irin waɗannan yanayi, kimantawa ko ragewar ta karɓuwa ce kuma ko ana buƙatar gyara yana haifar da matsala mai ƙalubale ga masu aikin asibiti. Masana daga asibitoci na gida kamar Asibitin Gabas da Asibitin Zhongshan sun magance wannan batu ta hanyar nazarin daidaiton tantance tallafi mai kyau da mara kyau a ƙarƙashin ra'ayoyi na anteroposterior da na gefe ta amfani da na'urorin CT masu girma uku bayan tiyata a matsayin ma'auni.
▲ Zane-zanen yana nuna goyon baya mai kyau (a), goyon baya mai tsaka-tsaki (b), da kuma goyon baya mara kyau (c) alamu na karyewar kugu a cikin hangen nesa na gaba.
▲ Zane-zanen yana nuna goyon baya mai kyau (d), goyon baya mai tsaka-tsaki (e), da kuma goyon baya mara kyau (f) na karyewar kugu a gefen gani.
Labarin ya ƙunshi bayanai daga marasa lafiya 128 da suka samu karyewar kugu. An ba likitoci biyu hotuna daban-daban (ɗaya mai ƙarancin ƙwarewa da ɗaya mai ƙarin ƙwarewa) a lokacin tiyata don tantance goyon baya mai kyau ko mara kyau. Bayan tantancewar farko, an sake yin kimantawa bayan watanni 2. An ba da hotunan CT bayan tiyata ga wani farfesa mai ƙwarewa, wanda ya tantance ko yanayin ya kasance mai kyau ko mara kyau, wanda ya zama mizani don tantance daidaiton kimantawar hoto ta likitoci biyu na farko. Manyan kwatancen da ke cikin labarin sune kamar haka:
(1) Shin akwai bambance-bambance masu mahimmanci a kididdiga a cikin sakamakon kimantawa tsakanin likitoci marasa ƙwarewa da ƙwararru a kimantawa ta farko da ta biyu? Bugu da ƙari, labarin ya binciki daidaito tsakanin ƙungiyoyi tsakanin ƙungiyoyi marasa ƙwarewa da ƙwararru don kimantawa da daidaito tsakanin ƙungiyoyi tsakanin kimantawa biyu.
(2) Ta amfani da CT a matsayin ma'aunin zinare, labarin yana bincika wanne ne ya fi inganci don tantance ingancin raguwar: kimantawa ta gefe ko ta gaban baya.
Sakamakon bincike
1. A zagaye biyu na kimantawa, tare da CT a matsayin ma'aunin tunani, babu wani bambanci mai mahimmanci a kididdiga a cikin hankali, takamaiman aiki, ƙimar tabbataccen aiki na ƙarya, ƙimar rashin inganci, da sauran sigogi da suka shafi kimanta ingancin ragewa bisa ga X-ray ɗin da ake yi a lokacin tiyata tsakanin likitoci biyu masu matakai daban-daban na ƙwarewa.
2. A cikin kimanta ingancin ragewa, ɗauki kimantawa ta farko a matsayin misali:
- Idan akwai yarjejeniya tsakanin kimantawa anteroposterior da a gefe (duka masu kyau ko kuma marasa kyau), amincin da ake da shi wajen hasashen ingancin rage CT shine 100%.
- Idan akwai rashin jituwa tsakanin kimantawa a baya da a gefe, ingancin ka'idojin kimantawa a gefe wajen hasashen ingancin rage tasirin CT ya fi girma.
▲ Zane-zanen yana nuna goyon baya mai kyau da aka nuna a cikin hangen nesa na gaba yayin da yake bayyana a matsayin mara kyau a cikin hangen nesa na gefe. Wannan yana nuna rashin daidaito a cikin sakamakon kimantawa tsakanin hangen nesa na gaba da na gefe.
▲ Sake gina CT mai girma uku yana ba da hotunan lura da kusurwa da yawa, wanda ke aiki a matsayin mizani don kimanta ingancin raguwa.
A cikin ƙa'idodin da suka gabata na rage karyewar intertrochanteric, ban da tallafi mai kyau da mara kyau, akwai kuma manufar tallafi "tsaka tsaki", wanda ke nuna raguwar tsarin jiki. Duk da haka, saboda matsalolin da suka shafi ƙudurin fluoroscopy da kuma fahimtar idon ɗan adam, ainihin "ragewar tsarin jiki" a ka'ida ba ya wanzuwa, kuma koyaushe akwai ƙananan karkacewa zuwa ga rage "mai kyau" ko "mara kyau". Ƙungiyar da Zhang Shimin ya jagoranta a Asibitin Yangpu da ke Shanghai ta buga wata takarda (an manta da takamaiman bayanin da aka ambata, za ta yaba idan wani zai iya samar da shi) tana nuna cewa samun tallafi mai kyau a cikin karyewar intertrochanteric na iya haifar da sakamako mafi kyau idan aka kwatanta da ragewar tsarin jiki. Saboda haka, idan aka yi la'akari da wannan binciken, ya kamata a yi ƙoƙari yayin tiyata don samun tallafi mai kyau a cikin karyewar intertrochanteric, duka a cikin hangen nesa na anteroposterior da na gefe.
Lokacin Saƙo: Janairu-19-2024
