A cikin 'yan shekarun da suka gabata, yawan karyewar ƙashi a ƙashin ƙugu (PHFs) ya ƙaru da fiye da kashi 28%, kuma yawan tiyatar ya ƙaru da fiye da kashi 10% a cikin marasa lafiya 'yan shekara 65 zuwa sama. Babu shakka, raguwar yawan ƙashi da ƙaruwar yawan faɗuwa manyan abubuwan haɗari ne ga yawan tsofaffi da ke ƙaruwa. Duk da cewa akwai hanyoyin tiyata daban-daban don magance matsalolin PHF da suka ɓace ko marasa ƙarfi, babu wata yarjejeniya kan mafi kyawun hanyar tiyata ga tsofaffi. Ci gaban faranti masu daidaita kusurwa ya samar da zaɓin magani don maganin tiyata na PHF, amma dole ne a yi la'akari da yawan rikitarwa har zuwa kashi 40%. Mafi yawan rahotanni sune rugujewar ɗagawa tare da cire sukurori da avascular necrosis (AVN) na kan ƙashin ƙugu.
Rage karyewar jiki, dawo da yanayin humeral, da kuma daidaita sukurori na ƙarƙashin ƙasa na iya rage irin waɗannan matsalolin. Sau da yawa yana da wuya a cimma gyaran sukurori saboda lalacewar ingancin ƙashi na proximal humerus wanda osteoporosis ke haifarwa. Don magance wannan matsalar, ƙarfafa haɗin ƙashi da sukurori tare da ƙarancin ingancin ƙashi ta hanyar amfani da simintin ƙashi na polymethylmethacrylate (PMMA) a kusa da ƙarshen sukurori sabuwar hanya ce ta inganta ƙarfin gyara na dashen.
Binciken da aka yi a yanzu yana da nufin kimantawa da kuma nazarin sakamakon rediyo na PHFs da aka yi wa magani da faranti masu daidaita lanƙwasa da kuma ƙarin ƙarin ƙarar sukurori ga marasa lafiya sama da shekaru 60.
Ⅰ.Kayan aiki da Hanya
Jimillar marasa lafiya 49 sun yi amfani da fenti mai daidaita kusurwa da ƙarin ƙarin siminti da sukurori don PHFs, kuma an haɗa marasa lafiya 24 a cikin binciken bisa ga sharuɗɗan haɗawa da keɓewa.
An rarraba dukkan PHF guda 24 ta amfani da tsarin rarraba HGLS da Sukthankar da Hertel suka gabatar ta amfani da na'urar daukar hoton CT kafin tiyata. An tantance hotunan rediyo kafin tiyata da kuma hotunan rediyo bayan tiyata. An yi la'akari da cewa an samu isasshen raguwar karyewar jiki lokacin da aka sake rage girman kan humerus kuma ya nuna kasa da mm 5 na gibi ko matsuguni. An bayyana nakasar a matsayin karkatawar kan humerus dangane da shaft na humeral na kasa da 125° kuma an bayyana nakasar valgus a matsayin fiye da 145°.
An bayyana shigar sukurori a matsayin ƙarshen sukurori da ke ratsa iyakar medullary cortex na kan humeral. An bayyana ƙaura ta karyewar kashi ta biyu a matsayin sauyawar raguwar bututun da ya wuce 5 mm da/ko canjin sama da 15° a kusurwar karkata na ɓangaren kai a kan hoton rediyo na gaba idan aka kwatanta da hoton rediyo na lokacin tiyata.
An yi dukkan tiyatar ta hanyar hanyar deltopectoralis mai girma. An yi rage karyewar da kuma sanya faranti a wuri ɗaya ta hanyar da aka saba. An yi amfani da dabarar ƙara sukurori da siminti 0.5 ml na siminti don ƙara ƙarshen sukurori.
An yi aikin hana motsi bayan tiyata a cikin wani majajjawa na musamman don kafada na tsawon makonni 3. An fara motsi mai aiki da sauri tare da gyaran ciwo bayan kwana 2 bayan tiyata don cimma cikakken kewayon motsi (ROM).
Ⅱ.Sakamakon.
Sakamako: An haɗa da marasa lafiya ashirin da huɗu, waɗanda matsakaicin shekarunsu ya kai shekaru 77.5 (tsakanin shekaru, shekaru 62-96). Mata ashirin da ɗaya ne, maza uku kuma maza ne. An yi wa karaya biyar masu sassa biyu, karaya 12 masu sassa uku, da kuma karaya bakwai masu sassa huɗu tiyata ta amfani da faranti masu daidaita kusurwa da ƙarin ƙarin ƙara siminti. Uku daga cikin karaya 24 sun kasance karaya ta kai ta humeral. An sami raguwar jiki a cikin marasa lafiya 12 daga cikin 24; an sami cikakken raguwar medial cortex a cikin marasa lafiya 15 daga cikin 24 (62.5%). A watanni 3 bayan tiyata, marasa lafiya 20 daga cikin 21 (95.2%) sun sami haɗin karyewa, sai dai marasa lafiya 3 waɗanda suka buƙaci tiyatar gyara da wuri.
Wani majiyyaci ya sami matsala ta biyu da wuri (juyawa bayan ɓangaren kan humeral) makonni 7 bayan tiyata. An yi gyaran fuska da gyaran kafada gaba ɗaya bayan watanni 3 bayan tiyata. An lura da shigar sukurori na farko saboda ƙaramin zubar siminti a cikin haɗin gwiwa (ba tare da babban yashewar haɗin gwiwa ba) a cikin marasa lafiya 3 (2 daga cikinsu sun sami karyewar kan humeral) yayin bin diddigin rediyo bayan tiyata. An gano shigar sukurori a cikin layin C na farantin daidaita kusurwa a cikin marasa lafiya 2 da kuma a cikin layin E a wani (Hoto na 3). 2 daga cikin waɗannan marasa lafiya 3 daga baya sun sami cutar necrosis na jijiyoyin jini (AVN). Marasa lafiya sun yi tiyatar gyara saboda ci gaban AVN (Tebur 1, 2).
Ⅲ.Tattaunawa.
Matsalar da ta fi yawa a cikin karyewar ƙashi na humeral (PHFs), ban da ci gaban avascular necrosis (AVN), ita ce rugujewar sukurori tare da rugujewar ƙarin gutsuttsuran kan humeral. Wannan binciken ya gano cewa ƙaruwar sukurori-siminti ya haifar da ƙimar haɗin kai na 95.2% a cikin watanni 3, ƙimar ƙaura ta biyu na 4.2%, ƙimar AVN na 16.7%, da jimlar ƙimar gyara na 16.7%. Ƙara sukurori na siminti ya haifar da ƙimar ƙaura ta biyu na 4.2% ba tare da rugujewar ƙarin gutsuttsura ba, wanda shine ƙaramin ƙimar idan aka kwatanta da kusan 13.7-16% tare da daidaita faranti mai kusurwa na al'ada. Muna ba da shawarar sosai da a yi ƙoƙari don cimma isasshen raguwar anatomical, musamman na tsakiya na tsakiya a cikin daidaita faranti mai kusurwa na PHFs. Ko da an yi amfani da ƙarin ƙarin tip na sukurori, dole ne a yi la'akari da sanannun ƙa'idodin gazawar yuwuwar.
Jimillar adadin gyaran fuska na 16.7% ta amfani da ƙarawar gefen sukurori a cikin wannan binciken yana cikin ƙananan kewayon ƙimar gyaran fuska da aka buga a baya don faranti na daidaitawa na kusurwa na gargajiya a cikin PHFs, wanda ya nuna ƙimar gyara a cikin tsofaffi waɗanda suka kama daga 13% zuwa 28%. Babu jira. Binciken da aka yi, wanda aka tsara, wanda aka sarrafa ta hanyar da Hengg et al. suka gudanar bai nuna fa'idar ƙarawar sukurori na siminti ba. Daga cikin jimillar marasa lafiya 65 waɗanda suka kammala bin diddigin shekara 1, gazawar injiniya ta faru a cikin marasa lafiya 9 da 3 a cikin rukunin haɓaka. An lura da AVN a cikin marasa lafiya 2 (10.3%) da kuma a cikin marasa lafiya 2 (5.6%) a cikin rukunin da ba a inganta ba. Gabaɗaya, babu wani babban bambanci a cikin faruwar abubuwan da suka faru marasa kyau da sakamakon asibiti tsakanin ƙungiyoyin biyu. Duk da cewa waɗannan nazarin sun mayar da hankali kan sakamakon asibiti da na rediyo, ba su kimanta hotunan rediyo dalla-dalla kamar wannan binciken ba. Gabaɗaya, matsalolin da aka gano ta hanyar rediyo sun yi kama da waɗanda ke cikin wannan binciken. Babu ɗaya daga cikin waɗannan binciken da ya ba da rahoton zubewar siminti a cikin ƙashin ƙugu, sai dai binciken da Hengg et al. suka yi, waɗanda suka lura da wannan mummunan lamari a cikin wani majiyyaci. A cikin wannan binciken, an lura da shigar siminti na farko sau biyu a matakin C da kuma sau ɗaya a matakin E, tare da zubewar siminti a cikin ƙashin ƙugu ba tare da wani tasiri na asibiti ba. An yi allurar kayan bambanci a ƙarƙashin ikon fluoroscopic kafin a yi amfani da ƙara siminti a kowane sukurori. Duk da haka, ya kamata a yi ra'ayoyi daban-daban na rediyo a wurare daban-daban na hannu kuma a tantance su sosai don kawar da duk wani shigar siminti na farko kafin a yi amfani da siminti. Bugu da ƙari, ya kamata a guji ƙarfafa siminti na matakin C (tsarin bambance-bambancen sukurori) saboda haɗarin shigar siminti na babban sukurori da zubewar siminti na gaba. Ba a ba da shawarar ƙara girman siminti ga marasa lafiya da ke da karyewar kai na humeral saboda babban yuwuwar zubewar kai a cikin ƙashin ƙugu da aka gani a cikin wannan tsarin karyewar (an lura da shi a cikin marasa lafiya 2).
VI. Kammalawa.
A fannin maganin PHFs da faranti masu daidaita kusurwa ta amfani da simintin PMMA, ƙara girman gefen sukurori na siminti wata hanya ce ta tiyata mai inganci wadda ke ƙara haɗa dashen dashen zuwa ƙashi, wanda ke haifar da ƙarancin ƙaura na biyu na kashi 4.2% ga marasa lafiya da ke fama da osteoporosis. Idan aka kwatanta da littattafan da ake da su, an lura da ƙaruwar yawan kamuwa da cutar avascular necrosis (AVN) galibi a cikin yanayin karyewar da ta yi tsanani kuma dole ne a yi la'akari da hakan. Kafin a shafa siminti, dole ne a cire duk wani zubewar siminti a cikin jijiyoyin jini ta hanyar amfani da matsakaici mai kama da juna. Saboda babban haɗarin zubewar siminti a cikin jijiyoyin jini a cikin karyewar kai na humeral, ba mu ba da shawarar ƙara girman sukurori na siminti a cikin wannan karyewar ba.
Lokacin Saƙo: Agusta-06-2024
