Ko te whati o te hope i waenganui i ngā uaua o te femur te whati hope tino noa i roto i te mahi haumanu, ā, ko tētahi o ngā whati e toru e tino noa ana e pā ana ki te osteoporosis i roto i ngā kaumātua. Ko te maimoatanga matatapu me roa te takoto i runga i te moenga, he nui te mōrearea o ngā mate pēhanga, ngā mate pūkahukahu, te embolism pūkahukahu, te thrombosis uaua hohonu, me ētahi atu raruraru. He nui te uauatanga o te nēhi, ā, he roa te wā whakaora, he taumaha te kawenga ki te hapori me ngā whānau. Nō reira, he mea nui te pokanga wawe, ina taea, kia tutuki ai ngā hua pai mō ngā whati hope.
I tēnei wā, ko te PFNA (proximal femoral nail antirotation system) te paerewa koura mō te maimoatanga pokanga o ngā whati hope. He mea nui te whakatutuki i te tautoko pai i te wā e whakaitihia ana ngā whati hope kia taea ai te whakakorikori mahi wawe. Kei roto i te fluoroscopy i te wā e pokanga ana ngā tirohanga anteroposterior (AP) me te taha hei aromatawai i te whakaiti o te femoral anterior medial cortex. Heoi, tera pea ka puta he taupatupatu i waenga i ngā tirohanga e rua i te wā e pokanga ana (arā, he pai i te tirohanga taha engari kāore i te tirohanga anteroposterior, i te ritenga kē rānei). I roto i ēnei take, ko te aromatawai mēnā he pai te whakaiti me te mea e hiahiatia ana he whakatikatika he raruraru uaua mō ngā kaimahi haumanu. Kua arohia tēnei take e ngā tohunga mai i ngā hōhipera o te rohe pērā i te Oriental Hospital me te Zhongshan Hospital mā te tātari i te tika o te aromatawai i te tautoko pai me te tautoko kino i raro i ngā tirohanga anteroposterior me te taha mā te whakamahi i ngā matawai CT toru-ahu i muri i te pokanga hei paerewa.
▲ E whakaatu ana te hoahoa i ngā tauira tautoko pai (a), tautoko kūpapa (b), me te tautoko kino (c) o ngā whati hope i te tirohanga anteroposterior.
▲ E whakaatu ana te hoahoa i ngā tauira tautoko pai (d), tautoko kūpapa (e), me te tautoko kino (f) o ngā whati hope i te tirohanga taha.
Kei roto i te tuhinga ngā raraunga take mai i te 128 tūroro whati hope. I tukuna motuhaketia ngā whakaahua anteroposterior me lateral i te wā o te pokanga ki ngā tākuta e rua (kotahi he iti ake te wheako, ko tētahi he nui ake te wheako) hei aromatawai i te tautoko pai, kāore rānei. I muri i te aromatawai tuatahi, i whakahaerehia he aromatawai anō i muri i te 2 marama. I tukuna ngā whakaahua CT i muri i te pokanga ki tētahi ahorangi mātau, nāna i whakatau mēnā he pai, kāore rānei he pai te take, hei paerewa mō te aromatawai i te tika o ngā aromatawai whakaahua e ngā tākuta tuatahi e rua. Ko ngā whakataurite matua o te tuhinga e whai ake nei:
（1）He rerekētanga nui ā-tatauranga kei roto i ngā hua aromatawai i waenga i ngā tākuta iti ake te wheako me ngā tākuta nui ake te wheako i ngā aromatawai tuatahi me te tuarua? Hei tāpiri, ka tūhuratia e te tuhinga te ōritetanga i waenga i ngā rōpū iti ake te wheako me ngā rōpū nui ake te wheako mō ngā aromatawai e rua, me te ōritetanga i roto i ngā rōpū i waenga i ngā aromatawai e rua.
（2）Mā te whakamahi i te CT hei tohutoro paerewa koura, ka rangahauhia e te tuhinga ko tēhea te mea pono ake mō te aromatawai i te kounga whakahekenga: te aromatawai taha, te aromatawai anteroposterior rānei.
Ngā hua rangahau
1. I ngā wāhanga aromatawai e rua, me te CT hei paerewa tohutoro, kāore he rerekētanga nui i kitea i roto i te aro, te motuhaketanga, te reiti pai teka, te reiti kino teka, me ētahi atu tawhā e pā ana ki te aromatawai i te kounga whakaiti i runga i ngā hihi-X i te wā o te pokanga i waenga i ngā tākuta e rua he rerekē ngā taumata wheako.
2. I roto i te aromatawai i te kounga whakaiti, me tango te aromatawai tuatahi hei tauira:
- Mena he ōrite te aromatawai anteroposterior me te aromatawai lateral (he pai, he kore pai rānei), ko te pono o te matapae i te kounga whakahekenga i runga i te CT he 100%.
- Mena he rerekētanga i waenga i ngā aromatawai anteroposterior me ngā aromatawai taha, he nui ake te pono o ngā paearu aromatawai taha ki te matapae i te kounga whakahekenga i runga i te CT.
▲ E whakaatu ana te hoahoa i tētahi tautoko pai e whakaaturia ana i te tirohanga anteroposterior, engari he āhua kore-pai i te tirohanga taha. E tohu ana tēnei i te kore ōrite o ngā hua aromatawai i waenga i ngā tirohanga anteroposterior me te taha.
▲ Mā te hanga anō i te CT toru-ahu ka puta he whakaahua tirotiro koki maha, hei paerewa mō te aromatawai i te kounga whakaiti.
I roto i ngā paerewa o mua mō te whakaiti i ngā whati intertrochanteric, haunga te tautoko pai me te tautoko kino, kei reira anō te ariā o te tautoko "koretake", e tohu ana i te whakaiti anatomical. Heoi, nā runga i ngā take e pā ana ki te whakatau o te fluoroscopy me te māramatanga o te kanohi tangata, kāore he "whakaiti anatomical" pono i roto i te ariā, ā, he iti tonu ngā rerekētanga ki te whakaiti "pai" me te "kino". I whakaputa te tīma i arahina e Zhang Shimin i te Hōhipera Yangpu i Shanghai i tētahi pepa (kua warewarehia te tohutoro motuhake, ka maioha ahau mēnā ka taea e tētahi te whakarato) e kī ana ko te whakatutukitanga o te tautoko pai i roto i ngā whati intertrochanteric ka hua ake he hua mahi pai ake i te whakaiti anatomical. Nō reira, i runga i tēnei rangahau, me whakapau kaha i te wā pokanga kia whiwhi tautoko pai i roto i ngā whati intertrochanteric, i roto i ngā tirohanga anteroposterior me te taha.
Wā tuku: Hanuere-19-2024
