A cikin 'yan shekarun da suka gabata, abubuwan da suka faru na raunin raunin da ya faru (PHFs) ya karu da fiye da 28%, kuma yawan aikin tiyata ya karu da fiye da 10% a cikin marasa lafiya masu shekaru 65 da haihuwa. Babu shakka, rage yawan kashi da yawan faɗuwa sune manyan abubuwan haɗari a cikin karuwar yawan tsofaffi. Kodayake ana samun jiyya daban-daban na tiyata don gudanar da PHFs da aka yi gudun hijira ko maras tabbas, babu yarjejeniya kan mafi kyawun tsarin tiyata ga tsofaffi. Haɓaka faranti na kwantar da hankulan kusurwa ya ba da zaɓin magani don maganin tiyata na PHFs, amma dole ne a yi la'akari da yawan rikitarwa har zuwa 40%. Mafi yawan rahoton shine rugujewar rugujewa tare da rushewar dunƙulewa da kuma avascular necrosis (AVN) na kan humeral.
Rage karyewar halittar jiki, maido da lokacin humeral, da daidaitaccen gyaran kafa na dunƙule na iya rage irin waɗannan rikice-rikice. Gyaran dunƙule sau da yawa yana da wahala a samu saboda ƙarancin ƙashi na kusancin humerus wanda osteoporosis ke haifar da shi. Don magance wannan matsala, ƙarfafa haɗin gwiwar kashi-kashi tare da ƙashi mara kyau ta hanyar yin amfani da simintin kashi na polymethylmethacrylate (PMMA) a kusa da tip ɗin wani sabon tsari don inganta ƙarfin gyarawa na dasa.
Binciken na yanzu yana da nufin kimantawa da kuma nazarin sakamakon rediyo na PHFs da aka bi da su tare da faranti na kwantar da hankali da kuma ƙarin ƙarar ƙararrawa a cikin marasa lafiya fiye da shekaru 60.
Ⅰ.Material da Hanya
Jimillar marasa lafiya na 49 sun sami kwanciyar hankali a kusurwa da ƙarin haɓakar ciminti tare da sukurori don PHFs, kuma an haɗa marasa lafiya 24 a cikin binciken dangane da ƙa'idodin haɗawa da cirewa.
Duk 24 PHFs an rarraba su ta amfani da tsarin rarraba HGLS wanda Sukthankar da Hertel suka gabatar ta amfani da CT scans na farko. An kimanta radiyon da aka riga aka yi aiki da kuma faifan rediyo na bayan aiki. An yi la'akari da isassun raguwar ƙwayar ƙwayar cuta lokacin da aka sake rage tuberosity na kan humeral kuma ya nuna kasa da 5 mm na rata ko ƙaura. An bayyana nakasar ƙara a matsayin karkatawar kan humeral dangane da ramin humeral na ƙasa da 125° kuma an ayyana nakasar valgus sama da 145°.
An ayyana shigar farko na dunƙulewa a matsayin dunƙule tip ɗin da ke ratsa kan iyakar ƙwanƙolin medullary na kan humeral. An bayyana ƙaurawar ɓarna na biyu a matsayin ƙaurawar raguwar tuberosity fiye da 5 mm da / ko canji fiye da 15 ° a cikin kusurwar karkatar da kai a kan radiyo mai biyo baya idan aka kwatanta da rediyon intraoperative.
An yi duk aikin tiyata ta hanyar babbar hanyar deltopectoralis. An yi raguwar karyewa da sanya faranti a daidaitaccen tsari. Screw-cement augmentation dabara amfani da 0.5 ml na siminti domin dunƙule tip augmentation.
An yi rashin motsa jiki bayan tiyata a cikin majajjawar hannu ta al'ada don kafada na makonni 3. An fara ƙaddamar da ƙaddamarwa na farko da kuma taimakon motsi mai aiki tare da gyaran gyare-gyare na ciwo 2 kwanakin baya bayan aiki don cimma cikakkiyar motsi (ROM).
Ⅱ.Sakamakon.
Sakamako: An haɗa marasa lafiya ashirin da huɗu, tare da matsakaicin shekaru 77.5 (shekaru, 62-96). 21 mata ne uku kuma maza. An yi maganin karaya mai kashi biyar, kashi 12 3, da karaya guda bakwai ta hanyar tiyata ta hanyar amfani da faranti na kwantar da hankali da kuma ƙarin ƙarar siminti. Uku daga cikin karaya 24 sun samu karaya ne a kai. An samu raguwar kwayoyin halitta a cikin 12 na marasa lafiya 24; An sami cikakkiyar raguwar ƙwayar ƙwayar cuta a cikin 15 na marasa lafiya na 24 (62.5%). A cikin watanni 3 bayan tiyata, 20 daga cikin marasa lafiya 21 (95.2%) sun sami haɗin gwiwar karaya, sai dai marasa lafiya 3 waɗanda suka buƙaci tiyata da wuri.
Ɗaya daga cikin majiyyaci ya haɓaka ƙaura na farko (juyawa na baya na guntun humeral) makonni 7 bayan tiyata. An yi bita tare da juyar da jimillar arthroplasty na kafada watanni 3 bayan tiyata. An lura da shigar farko na dunƙulewa saboda ƙananan ɗigon siminti na intraarticular (ba tare da babban yazawar haɗin gwiwa ba) a cikin marasa lafiya 3 (2 daga cikinsu suna da raunin kai) yayin bin diddigin rediyo. An gano shigar da dunƙule a cikin C Layer na kwandon kwantar da hankali a cikin marasa lafiya 2 da kuma a cikin E Layer a wani (Fig. 3). 2 daga cikin waɗannan marasa lafiya 3 daga baya sun haɓaka necrosis na avascular (AVN). An yi wa marasa lafiya aikin tiyata saboda haɓakar AVN (Tables 1, 2).
Ⅲ.Tattaunawa.
Mafi yawan rikice-rikice a cikin karaya mai kusanci (PHFs), baya ga ci gaban necrosis na jijiyoyin jini (AVN), shine tarwatsewa tare da rugujewar guntun kan humeral na gaba. Wannan binciken ya gano cewa haɓakar siminti-screw ya haifar da ƙimar ƙungiyar 95.2% a cikin watanni 3, ƙimar ƙaura na biyu na 4.2%, ƙimar AVN na 16.7%, da jimlar bita na 16.7%. Ƙarfafa siminti na sukurori ya haifar da ƙimar ƙaura na biyu na 4.2% ba tare da rushewar rugujewa ba, wanda shine ƙananan ƙimar idan aka kwatanta da kusan 13.7-16% tare da gyaran farantin kusurwa na al'ada. Muna ba da shawara mai ƙarfi cewa a yi ƙoƙari don samun isassun raguwar anatomic, musamman na tsaka-tsaki na humeral cortex a cikin gyaran farantin kusurwa na PHFs. Ko da an yi amfani da ƙarin ƙarar tip, sanannen yuwuwar gazawar dole ne a yi la'akari da ƙa'idodin gazawar.
Matsakaicin adadin bita na 16.7% ta amfani da ƙaran tip a cikin wannan binciken yana cikin ƙananan kewayon ƙimar bita da aka buga a baya don faranti na daidaitawa na angular na gargajiya a cikin PHFs, waɗanda suka nuna ƙimar bita a cikin yawan tsofaffi daga 13% zuwa 28%. Babu jira. Binciken mai zuwa, bazuwar, binciken cibiyar sarrafawa da Hengg et al. bai nuna fa'idar ƙara siminti ba. Daga cikin jimillar marasa lafiya na 65 da suka kammala biyan shekaru 1, gazawar injiniya ta faru a cikin marasa lafiya 9 da 3 a cikin rukunin haɓakawa. An lura da AVN a cikin marasa lafiya na 2 (10.3%) kuma a cikin marasa lafiya 2 (5.6%) a cikin ƙungiyar da ba ta haɓaka ba. Gabaɗaya, babu wani bambance-bambance masu mahimmanci a cikin abubuwan da suka faru na mummunan yanayi da sakamakon asibiti tsakanin ƙungiyoyin biyu. Kodayake waɗannan karatun sun mayar da hankali kan sakamakon asibiti da na rediyo, ba su kimanta radiyon dalla-dalla ba kamar wannan binciken. Gabaɗaya, matsalolin da aka gano ta hanyar rediyo sun yi kama da waɗanda ke cikin wannan binciken. Babu ɗayan waɗannan binciken da aka ba da rahoton leak ɗin ciminti na intra-articular, sai dai binciken da Hengg et al., wanda ya lura da wannan mummunan lamari a cikin majiyyaci ɗaya. A cikin binciken da aka yi yanzu, an lura shigar firamare na farko sau biyu a matakin C kuma sau ɗaya a matakin E, tare da zubar da siminti na cikin-articular na gaba ba tare da wani mahimmanci na asibiti ba. An yi allurar bambance-bambance a ƙarƙashin ikon fluoroscopic kafin a yi amfani da ƙaran siminti a kowane dunƙule. Koyaya, ya kamata a aiwatar da ra'ayoyin rediyo daban-daban a wurare daban-daban na hannu kuma a kimanta su da kyau don kawar da duk wani shiga tsakani na farko kafin aikace-aikacen siminti. Bugu da ƙari, ya kamata a guji ƙarfafa siminti na sukurori a matakin C (tsarin daidaitawa daban-daban) saboda babban haɗarin shiga babban dunƙulewa da ɗigon siminti na gaba. Ba a ba da shawarar haɓaka tip ɗin siminti ba a cikin marasa lafiya tare da raunin kai na humeral saboda babban yuwuwar yuwuwar ɗigon jini da aka lura a cikin wannan ƙirar karaya (wanda aka lura a cikin marasa lafiya 2).
VI. Kammalawa.
A cikin jiyya na PHFs tare da faranti masu daidaitawa ta hanyar amfani da siminti na PMMA, ciminti screw tip augmentation shine ingantaccen fasaha na tiyata wanda ke inganta gyaran gyare-gyaren da aka dasa zuwa kashi, wanda ya haifar da ƙananan ƙaura na biyu na 4.2% a cikin marasa lafiya na osteoporotic. Idan aka kwatanta da wallafe-wallafen da ake da su, an sami karuwar abubuwan da ke faruwa na avascular necrosis (AVN) musamman a cikin nau'i mai tsanani na karaya kuma dole ne a yi la'akari da wannan. Kafin aikace-aikacen siminti, duk wani ɗigon siminti na intraarticular dole ne a cire shi a hankali ta hanyar tsaka-tsakin gudanarwa. Saboda babban haɗarin yayan siminti na intraarticular a cikin karyewar kai, ba mu bada shawarar ƙara dunƙule siminti a cikin wannan karaya ba.
Lokacin aikawa: Agusta-06-2024
