Ƙwararrun ƙwayar cuta ta mata ita ce mafi yawan raunin hip a cikin aikin asibiti kuma yana daya daga cikin nau'o'in nau'i uku da ke hade da osteoporosis a cikin tsofaffi.Maganin ra'ayin mazan jiya na buƙatar dogon hutu na gado, yana haifar da babban haɗari na ƙumburi na matsa lamba, cututtuka na huhu, ciwon huhu, thrombosis mai zurfi, da sauran rikitarwa.Wahalhalun jinya na da mahimmanci, kuma lokacin dawowa ya daɗe, yana ɗaukar nauyi mai nauyi a kan al'umma da iyalai.Sabili da haka, sa baki na farko, duk lokacin da za a iya jurewa, yana da mahimmanci don samun sakamako mai kyau na aiki a cikin karaya.
A halin yanzu, PFNA (tsarin hana ƙusa na ƙusa na kusa) na ciki ana ɗaukar ma'aunin zinare don aikin tiyata na karaya.Samun goyon baya mai kyau a lokacin raguwar raguwa na hip yana da mahimmanci don ba da damar motsa jiki na farko.Intraoperative fluoroscopy ya hada da anteroposterior (AP) da kuma ra'ayi na gefe don tantance raguwar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta.Duk da haka, rikice-rikice na iya tasowa tsakanin ra'ayoyin biyu yayin tiyata (watau tabbataccen ra'ayi na gefe amma ba a hangen gaba ba, ko akasin haka).A irin waɗannan lokuta, ƙididdige ko an yarda da raguwa kuma ko ana buƙatar daidaitawa yana haifar da matsala mai wuya ga masu aikin asibiti.Masanan asibitocin gida irin su Asibitin Oriental da Asibitin Zhongshan sun yi tir da wannan batu ta hanyar yin nazari kan sahihancin tantance tallafi mai kyau da mara kyau a karkashin ra'ayi na baya da na gefe ta hanyar yin amfani da na'urar CT scan mai fuska uku bayan tiyata.
▲ Hoton yana kwatanta goyon baya mai kyau (a), goyan bayan tsaka-tsaki (b), da maras kyau (c) alamu na karyewar hip a cikin ra'ayi na gaba.
▲ Hoton yana nuna kyakkyawan goyon baya (d), goyan bayan tsaka-tsaki (e), da maras kyaun goyan bayan (f) alamun karyewar kwatangwalo a hangen nesa.
Labarin ya haɗa da bayanan shari'ar daga marasa lafiya 128 tare da raunin hip.An ba da hotunan anteroposterior na ciki da na gefe daban-daban ga likitoci guda biyu (wanda ba shi da ƙwarewa kuma ɗaya tare da ƙarin ƙwarewa) don tantance goyon baya mai kyau ko mara kyau.Bayan tantancewar farko, an sake yin kima bayan watanni 2.An ba da hotunan CT na baya-bayan nan ga ƙwararren farfesa, wanda ya ƙayyade ko shari'ar ta kasance mai kyau ko maras kyau, wanda ke aiki a matsayin ma'auni don kimanta daidaiton hotunan hotunan da likitoci biyu na farko suka yi.Babban kwatancen labarin sune kamar haka:
(1) Shin akwai bambance-bambance masu mahimmanci a cikin sakamakon kima tsakanin ƙwararrun ƙwararrun likitoci da ƙwararrun likitoci a kima na farko da na biyu?Bugu da ƙari, labarin yana bincika daidaituwar ƙungiyoyi tsakanin ƙananan ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararru don duka ƙima da daidaiton ƙungiyoyin tsakanin kima biyu.
(2) Yin amfani da CT a matsayin ma'aunin ma'aunin zinare, labarin ya bincika abin da ya fi dacewa don kimanta ingancin raguwa: ƙima na gefe ko na gaba.
Sakamakon bincike
1. A cikin zagaye na biyu na kima, tare da CT a matsayin ma'auni na ƙididdiga, babu wani bambance-bambance masu mahimmanci a cikin hankali, ƙayyadaddun ƙayyadaddun ƙididdiga, ƙididdiga na ƙarya, ƙima mara kyau, da sauran sigogi masu dangantaka da kimantawa na raguwar ingancin dangane da intraoperative X- haskoki tsakanin likitocin biyu masu matakan kwarewa daban-daban.
2.A cikin kimanta ingancin raguwa, ɗaukar ƙimar farko a matsayin misali:
- Idan akwai yarjejeniya tsakanin ƙididdigar anteroposterior da na gefe (duka masu kyau ko duka biyun da ba su da kyau), dogara ga tsinkayar raguwa akan CT shine 100%.
- Idan akwai rashin jituwa tsakanin kima na anteroposterior da na gefe, amincin ma'aunin ƙima na gefe a cikin tsinkayar raguwar ingancin akan CT ya fi girma.
▲ Hoton yana nuna kyakkyawan goyon baya da aka nuna a cikin hangen nesa na gaba yayin da yake bayyana a matsayin mara kyau a ra'ayi na gefe.Wannan yana nuna rashin daidaituwa a cikin sakamakon kima tsakanin ra'ayi na gaba da na gefe.
▲ Sake ginawa na CT mai girma uku yana ba da hotunan kallo da yawa, yana aiki a matsayin ma'auni don kimanta ingancin raguwa.
A cikin ma'auni na baya don rage raunin intertrochanteric, baya ga goyon baya mai kyau da mara kyau, akwai kuma ra'ayi na goyon bayan "tsaka-tsaki", yana nuna raguwar jiki.Duk da haka, saboda batutuwan da suka shafi ƙudurin fluoroscopy da fahimtar ido na ɗan adam, gaskiya "raguwar jiki" a ka'idar ba ta wanzu, kuma koyaushe akwai 'yan karkata zuwa ga raguwa "tabbatacce" ko "mara kyau".Tawagar da Zhang Shimin ya jagoranta a asibitin Yangpu da ke birnin Shanghai ta buga wata takarda (takamaiman bayanin da aka manta, za a yaba idan wani zai iya ba da shi) yana ba da shawarar cewa samun ingantaccen tallafi a cikin karaya na intertrochanteric na iya haifar da ingantattun sakamako na aiki idan aka kwatanta da raguwar kwayoyin halitta.Sabili da haka, la'akari da wannan binciken, ya kamata a yi ƙoƙari a lokacin tiyata don samun goyon baya mai kyau a cikin ɓarna na intertrochanteric, duka a cikin ra'ayi na gaba da na gefe.
Lokacin aikawa: Janairu-19-2024
