I roto i ngā tekau tau kua pahure ake nei, kua piki ake te maha o ngā whati o te humerus proximal (PHF) mā te neke atu i te 28%, ā, kua piki ake te auau pokanga mā te neke atu i te 10% i roto i ngā tūroro 65 tau te pakeke, neke atu rānei. He mārama, ko te hekenga o te kiato o te wheua me te pikinga o te maha o ngā hinganga he tino take mōrearea i roto i te hunga kaumātua e piki haere ana. Ahakoa he maha ngā maimoatanga pokanga e wātea ana hei whakahaere i ngā PHF kua nekehia, kua kore rānei e pumau, kāore he whakaae whānui mō te huarahi pokanga pai rawa atu mō ngā kaumātua. Nā te whanaketanga o ngā pereti whakau koki kua whakaratohia he kōwhiringa maimoatanga mō te maimoatanga pokanga o ngā PHF, engari me whai whakaaro ki te auau raruraru teitei tae atu ki te 40%. Ko ngā mea e tino pūrongohia ana ko te hinganga o te adduction me te wetewete o te tīwiri me te avascular necrosis (AVN) o te pane humerus.
Mā te whakaiti i te āhua o te whati, te whakahokinga mai o te kaha o te humerus, me te whakapiri tika ki raro i te kiri o te tīwiri ka taea te whakaiti i ēnei raruraru. He uaua te whakatutuki i te whakapiri tīwiri nā te ngoikore o te kounga o te wheua o te humerus proximal i puta mai i te osteoporosis. Hei whakatika i tēnei raruraru, ko te whakapakari i te hononga wheua-tīwiri me te kounga wheua ngoikore mā te whakamahi i te sima wheua polymethylmethacrylate (PMMA) huri noa i te pito tīwiri he huarahi hou hei whakapai ake i te kaha whakapiri o te whakaurunga.
Ko te whāinga o tēnei rangahau o nāianei he aromatawai me te tātari i ngā hua x-ray o ngā PHF i rongoatia ki ngā pereti whakau koki me te whakanui ake i te pito tīwiri i roto i ngā tūroro neke atu i te 60 tau te pakeke.
Ⅰ.Rauemi me te Tikanga
E 49 ngā tūroro katoa i whakakīia ki te koki me te tāpiri i te sima ki te whakamahi i ngā tīwiri mō ngā PHF, ā, e 24 ngā tūroro i whakaurua ki te rangahau i runga i ngā paearu whakauru me te kore whakauru.
I whakarōpūtia ngā PHF katoa e 24 mā te whakamahi i te pūnaha whakarōpūtanga HGLS i whakaurua mai e Sukthankar rāua ko Hertel mā te whakamahi i ngā matawai CT i mua i te pokanga. I aromatawaitia ngā whakaahua X-ray i mua i te pokanga me ngā whakaahua X-ray i muri i te pokanga. I kiia kua tutuki te whakaiti hanganga tika o te whati ina whakaitihia anō te ngongo o te pane o te humerus, ā, he iti iho i te 5 mm te āputa, te nekehanga rānei. Ko te hapa tāpiri i tautuhia ko te piko o te pane o te humerus e pā ana ki te rakau humerus he iti iho i te 125°, ā, ko te hapa valgus i tautuhia he neke atu i te 145°.
Ko te werohanga tuatahi o te tīwiri i tautuhia ko te werohanga o te pito tīwiri ki te rohe o te cortex medullary o te pane humerus. Ko te nekehanga o te whati tuarua i tautuhia ko te nekehanga o te tuberositas kua whakaitihia neke atu i te 5 mm me/ranei he huringa neke atu i te 15° o te koki piko o te wāhanga pane i te whakaahua X-ray whai muri i te whakataurite ki te whakaahua X-ray i te wā o te pokanga.
I whakahaerehia ngā pokanga katoa mā te huarahi deltopectoralis major. I whakahaerehia te whakaiti i te whati me te whakanoho pereti i runga i te tikanga paerewa. I whakamahia te 0.5 ml o te sima hei whakanui i te pito o te tīwiri mā te tikanga whakanui sima-whiri.
I muri i te pokanga, i whakahaerea te whakapūmau i te nekehanga i roto i tētahi whitiki ringa ritenga mō te pakihiwi mō ngā wiki e 3. I tīmatahia ngā nekehanga ngāwari me ngā nekehanga āwhina me te whakatikatika mamae i ngā rā e 2 i muri i te pokanga kia tutuki ai te whānuitanga o te nekehanga (ROM).
Tuarua.Te mutunga.
Ngā Hua: E rua tekau mā whā ngā tūroro i whakaurua, ko te pakeke toharite he 77.5 tau (te whānuitanga, 62-96 tau). E rua tekau mā tahi he wahine, e toru he tāne. E rima ngā whati wāhanga-rua, e 12 ngā whati wāhanga-toru, me e whitu ngā whati wāhanga-whā i rongoatia mā te whakamahi i ngā pereti whakau koki me te whakanui ake i te tīwiri-sima. E toru o ngā whati 24 he whati pane humerus. I tutuki te whakaiti hanganga i roto i te 12 o ngā tūroro 24; i tutuki te whakaiti katoa o te cortex medial i roto i te 15 o ngā tūroro 24 (62.5%). I te 3 marama i muri i te pokanga, e 20 o ngā tūroro 21 (95.2%) kua tutuki te hononga whati, engari ko te 3 ngā tūroro i hiahia kia pokanga wawe.
I puta he nekehanga tuarua i te tīmatanga (te hurihanga o muri o te wāhanga o te pane o te humerus) i roto i te 7 wiki i muri i te pokanga. I mahia te whakatikatika mā te whakahuri i te pokohiwi katoa i roto i te 3 marama i muri i te pokanga. I kitea te urunga tuatahi o te tīwiri nā te turuturu iti o te sima intraarticular (kāore he pakaru nui o te hononga) i roto i te 3 o ngā tūroro (2 o rātou he whati te pane o te humerus) i te wā o te whai muri i te whakaahua X-ray. I kitea te urunga o te tīwiri i roto i te paparanga C o te pereti whakau koki i roto i te 2 o ngā tūroro, ā, i roto i te paparanga E i roto i tētahi atu (Pikitia 3). I muri mai, 2 o ēnei tūroro 3 i puta he necrosis avascular (AVN). I whakahaerehia he pokanga whakatikatika i ngā tūroro nā te whanaketanga o te AVN (Ripanga 1, 2).
Ⅲ.Kōrero.
Ko te raruraru tino noa i roto i ngā whati humerus proximal (PHF), i tua atu i te whanaketanga o te avascular necrosis (AVN), ko te wetewete o te tīwiri me te hinganga o te wāhanga o te pane humerus. I kitea i tēnei rangahau ko te whakanui ake i te tīwiri-sima i hua ake ai he tere hononga o te 95.2% i te 3 marama, te tere nekehanga tuarua o te 4.2%, te tere AVN o te 16.7%, me te tere whakahou katoa o te 16.7%. Ko te whakanui ake i te tīwiri i hua ake ai he tere nekehanga tuarua o te 4.2% me te kore he hinganga tāpiri, he tere iti iho i te 13.7-16% me te whakapiri pereti koki tikanga. Ka tino taunaki mātou kia whakapau kaha ki te whakatutuki i te whakaiti hanganga tika, inā koa ko te cortex humerus medial i roto i te whakapiri pereti koki o ngā PHF. Ahakoa ka whakamahia he whakanui ake i te pito tīwiri, me whai whakaaro ki ngā paearu rahunga pea e mōhiotia whānuitia ana.
Ko te reiti arotake whānui o te 16.7% mā te whakamahi i te whakanui i te pito tīwiri i roto i tēnei rangahau kei roto i te awhe iti iho o ngā reiti arotake kua whakaputaina i mua mō ngā pereti whakau koki tuku iho i roto i ngā PHF, e whakaatu ana i ngā reiti arotake i roto i te taupori kaumātua mai i te 13% ki te 28%. Kāore he tatari. Ko te rangahau matapōkere, whakahaeretia, me te maha-pokapū i whakahaerehia e Hengg et al. kāore i whakaatu i te painga o te whakanui tīwiri sima. I roto i te katoa o ngā tūroro 65 i whakaoti i te aroturukitanga 1-tau, i puta te rahunga miihini i roto i te 9 tūroro me te 3 i roto i te rōpū whakanui. I kitea te AVN i roto i te 2 tūroro (10.3%) me te 2 tūroro (5.6%) i roto i te rōpū kāore i whakareihia. I te nuinga, kāore he rerekētanga nui i roto i te putanga mai o ngā pānga kino me ngā putanga haumanu i waenga i ngā rōpū e rua. Ahakoa i arotahi ēnei rangahau ki ngā putanga haumanu me te hihi-X, kāore i arotakehia ngā hihi-X me te taipitopito pērā i tēnei rangahau. I te nuinga, he rite ngā raruraru i kitea e te hihi-X ki ērā i roto i tēnei rangahau. Kāore tētahi o ēnei rangahau i kōrero mō te turuturu o te sima i roto i te hononga, engari ko te rangahau a Hengg et al., i kite i tēnei pānga kino i roto i tētahi tūroro. I roto i tēnei rangahau, i kitea te urunga tuatahi o te tīwiri e rua ngā wā i te taumata C, ā, kotahi i te taumata E, ā, i muri mai ka turuturu te sima i roto i te hononga, kāore he pānga haumanu. I werohia te rauemi rerekē i raro i te mana fluoroscopic i mua i te tāpiritanga o te whakanui sima ki ia tīwiri. Heoi, me mahi ngā tirohanga X-ray rerekē i ngā tūranga ringa rerekē, ā, me arotakehia kia āta tirohia kia kore ai e uru te tīwiri tuatahi i mua i te tāpiritanga o te sima. Hei tāpiritanga, me karo te whakakaha sima o ngā tīwiri i te taumata C (te whirihoranga rerekē o te tīwiri) nā te mea he nui ake te mōrearea o te urunga matua o te tīwiri me te turuturu o te sima i muri mai. Kāore i te tūtohutia te whakanui i te pito tīwiri sima ki ngā tūroro he whati te pane humerus nā te mea he nui te tūponotanga mō te turuturu i roto i te hononga i kitea i roto i tēnei tauira whati (i kitea i roto i te 2 tūroro).
VI. Whakamutunga.
I roto i te maimoatanga o ngā PHF me ngā pereti whakapūmau koki mā te whakamahi i te sima PMMA, he tikanga pokanga pono te whakanui i te pito tīwiri sima e whakarei ake ana i te piri o te whakaurunga ki te wheua, ka hua ake he iti te reiti nekehanga tuarua o te 4.2% i roto i ngā tūroro osteoporosis. Ki te whakatauritea ki ngā tuhinga o nāianei, i kitea he pikinga ake o te mate avascular necrosis (AVN) i roto i ngā tauira whati kino, ā, me whai whakaaro ki tēnei. I mua i te paninga sima, me āta ārai i te turuturu sima intraarticular mā te whakahaere i te rongoā rerekē. Nā te nui o te mōrearea o te turuturu sima intraarticular i roto i ngā whati pane humerus, kāore mātou e tūtohu kia whakanuia te pito tīwiri sima i roto i tēnei whati.
Wā tuku: Akuhata-06-2024
