E 50% o ngā whati hope i roto i te hunga kaumātua ko ngā whati o te femur i waenga i ngā trochanteric. He ngāwari te rongoā ārai mate ki ngā raruraru pērā i te deep vein thrombosis, te pulmonary embolism, te pressure sores, me ngā mate pūkahukahu. Neke atu i te 20% te mate i roto i te tau kotahi. Nō reira, i ngā wā e āhei ai te āhua tinana o te tūroro, ko te whakatikatika ā-roto i roto i te pokanga wawe te rongoā pai mō ngā whati i waenga i ngā trochanteric.
Ko te whakapiri ā-roto o te whao intramedullary te paerewa koura mō te rongoā i ngā whati intertrochanteric. I roto i ngā rangahau mō ngā āhuatanga e pā ana ki te whakapiri ā-roto o te PFNA, kua pūrongohia ngā āhuatanga pēnei i te roa o te whao PFNA, te koki varus, me te hoahoa i roto i ngā rangahau maha o mua. Heoi, kāore anō kia mārama mēnā ka pā te matotoru o te whao matua ki ngā putanga mahi. Hei whakatika i tēnei, kua whakamahia e ngā tohunga o tāwāhi ngā whao intramedullary he rite te roa engari he rerekē te matotoru hei whakatika i ngā whati intertrochanteric i roto i ngā kaumātua (tau > 50), me te whai kia whakataurite mēnā he rerekētanga kei roto i ngā putanga mahi.
I roto i te rangahau, e 191 ngā kēhi o ngā whati i waenganui i ngā uaua o te hononga kotahi, ā, i rongoatia katoatia mā te whakapiri ā-roto PFNA-II. I te wā i whati ai, i tangohia ai te uaua iti o te hononga, i whakamahia he whao poto 200mm; i te wā i ora tonu ai, i kore rānei i tangohia te uaua iti o te hononga, i whakamahia he whao poto rawa 170mm. Ko te whānui o te whao matua i waenga i te 9-12mm. Ko ngā whakataurite matua i roto i te rangahau i arotahi ki ngā tohu e whai ake nei:
1. He iti ake te whānui o te trochanter, hei aromatawai mēnā he paerewa te tūnga;
2. Te whanaungatanga i waenga i te cortex medial o te kongakonga upoko-kaki me te kongakonga distal, hei aromatawai i te kounga o te whakaiti;
3. Tawhiti o te Tipi ki te Tihi (TAD);
4. Ōwehenga whao-ki-awa (NCR). Ko te NCR te ōwehenga o te diameter whao matua ki te diameter awa waenga i runga i te papa tīwiri raka distal.
I roto i ngā tūroro 191 i whakaurua, ko te tohatoha o ngā kēhi i runga i te roa me te whānui o te whao matua e whakaaturia ana i te pikitia e whai ake nei:
Ko te NCR toharite he 68.7%. Mā te whakamahi i tēnei toharite hei paepae, ko ngā kēhi he NCR nui ake i te toharite i kiia he matotoru ake te diameter o te whao matua, ko ngā kēhi he NCR iti iho i te toharite i kiia he angiangi ake te diameter o te whao matua. Nā tēnei i whakarōpūtia ai ngā tūroro ki te rōpū Whao Matua Matotoru (90 kēhi) me te rōpū Whao Matua Angiangi (101 kēhi).
E whakaatu ana ngā hua kāore he rerekētanga nui i waenga i te rōpū Thick Main Nail me te rōpū Thin Main Nail e pā ana ki te Tip-Apex Distance, te kaute Koval, te tere whakaora roa, te tere tāpui anō, me ngā raruraru wheua.
He rite ki tēnei rangahau, i whakaputaina tētahi tuhinga ki te "Journal of Orthopaedic Trauma" i te tau 2021: [Taitara o te Tuhinga].
I whakaurua ki te rangahau he 168 ngā tūroro kaumātua (tau > 60) he whati intertrochanteric, ā, i rongoatia katoatia ki ngā whao cephalomedullary. I runga i te diameter o te whao matua, i wehea ngā tūroro ki tētahi rōpū 10mm me tētahi rōpū he diameter neke atu i te 10mm. I whakaatu hoki ngā hua kāore he rerekētanga nui i roto i ngā tatauranga i roto i ngā reiti tāpui anō (ahakoa whānui, kāore rānei he pangia) i waenga i ngā rōpū e rua. E kī ana ngā kaituhi o te rangahau, mō ngā tūroro kaumātua he whati intertrochanteric, he rawaka te whakamahi i tētahi whao matua 10mm te diameter, ā, kāore he take mō te reaming nui, nā te mea ka taea tonu te whakatutuki i ngā putanga mahi pai.
Te wā tuku: 23-Pepuere-2024
