Ukuchithwa kwe-posterior ye-hip joint kubangelwa ubundlobongela obunamandla obungathanga ngqo njengeengozi zendlela.Ukuba kukho ukuphuka kwentloko ye-femal, kubizwa ngokuba yi-Pipkin fracture.I-Pipkin fracture inqabile kwiklinikhi, kwaye iziganeko zayo zibalelwa malunga ne-6% ye-hip dislocation.Ekubeni i-Pipkin fracture i-intra-articular fracture, ukuba ayiphathwa kakuhle, i-arthritis ebuhlungu ingenzeka emva kokusebenza, kwaye kukho umngcipheko we-femoral head necrosis.Ngo-Matshi 2016, umbhali waphatha imeko ye-Pipkin yohlobo lwe-fracture ye-I, kwaye yabika idatha yayo yeklinikhi kunye nokulandelwa ngolu hlobo lulandelayo.
Idatha yeklinikhi
Isigulane, uLu, oyindoda, oneminyaka engama-22 ubudala, wangeniswa esibhedlele ngenxa "yokudumba kunye nentlungu kwi-hip ekhohlo ebangelwa yingozi yendlela, kunye nomsebenzi olinganiselwe kwiiyure ze-5".Uvavanyo lomzimba: iimpawu ezibalulekileyo zazizinzile, uvavanyo lwe-cardio pulmonary abdominal lwalubi, umlenze ongezantsi wasekhohlo wawune-flexion shortening deformity, i-hip yasekhohlo yayidumbile ngokucacileyo, i-groin ye-groin midpoint tenderness yayilungile, intlungu enkulu ye-trochanter percussion kunye nomlenze ongezantsi. iintlungu ze-longitudinal percussion zazilungile.Umsebenzi osebenzayo we-hip joint ekhohlo ulinganiselwe, kwaye intlungu ye-passive ye-passive inzima.Ukuhamba kwenzwane ekhohlo kuqhelekile, ukuvakalelwa kwecala elisezantsi lasekhohlo akuncitshiswa kakhulu, kwaye i-peripheral blood supply ilungile.Uvavanyo oluncedisayo: Iifilimu ze-X-ray ze-double hip joints kwindawo echanekileyo zibonise ukuba isakhiwo sethambo lentloko ye-femoral yasekhohlo yayiyekile, ikhutshwe ngasemva nangaphezulu, kwaye iinqununu ezincinci zokuphuka zibonakala kwi-acetabulum.
Ukuxilongwa kokwamkelwa
Ukuqhekeka kwentloko ye-femal ekhohlo kunye nokuchithwa kwe-hip joint.Emva kokungeniswa, ukuchithwa kwe-hip ekhohlo kwancitshiswa ngesandla kwaye kwaphinda kwachithwa kwakhona.Emva kokuphucula uviwo lwangaphambili, ukuphuka kwentloko ye-femoral ekhohlo kunye nokuchithwa kwe-hip kuphathwe ngokunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi phantsi kwe-anesthesia jikelele kwisebe eliphuthumayo.
I-posterolateral approach incision ye-joint hip ekhohlo ithathwe, kunye nobude malunga ne-12Cm.Ngethuba lokusebenza, i-fracture ifunyenwe kwi-attachment ye-medial inferior ligamentum teres femoris, kunye nokuhlukana okucacileyo kunye nokufuduka kwesiphelo esiphukileyo, kunye nobukhulu malunga ne-3.0Cm yabonwa kwi-acetabulum × i-2.5Cm i-fracture fragments.I-50mL yegazi le-peripheral yathathwa ukulungiselela i-platelet rich plasma (PRP), kwaye i-PRP gel isetyenziswe kwi-fracture.Emva kokuba ibhloko yokuqhekeka ibuyiselwe, izikrufu ezintathu ze-INION 40mm zaseFinnish ezifunxayo (2.7mm ububanzi) zasetyenziselwa ukulungisa ukuphuka.Kwafunyaniswa ukuba i-articular surface ye-femoral head cartilage yayilula, ukunciphisa kwakukuhle, kwaye ukulungiswa kwangaphakathi kwakuqinile.Umdibaniso we-hip uya kuphinda uhlaziywe, kwaye i-joint hip esebenzayo ayiyi kukhululeka kunye nokuchithwa.I-C-arm irradiation ibonise ukunciphisa okulungileyo kwe-femoral head fracture kunye ne-hip joint.Emva kokuhlamba isilonda, suture i-capsule ehlangeneyo yangasemva, uphinde uphinde umise ukumisa kwe-rotator muscle yangaphandle, suture i-fascia lata kunye ne-subcutaneous tissue skin, kwaye ugcine ityhubhu yokukhupha amanzi.
Xoxa
I-Pipkin fracture yi-intra-articular fracture.Unyango olulondolozayo luhlala lunzima ukufezekisa ukunciphisa okufanelekileyo, kwaye kunzima ukugcina ukunciphisa.Ukongezelela, intsalela yamathambo akhululekileyo kwi-joint ikwandisa ukunxiba kwe-intra-articular, ekulula ukubangela i-arthritis ebuhlungu.Ukongezelela, ukuchithwa kwe-hip kudibaniswa nokuphuka kwentloko ye-femoral kuxhomekeke kwi-necrosis yentloko ye-femoral ngenxa yokulimala kwe-femoral head blood supply.Izinga le-femoral necrosis yentloko liphezulu kubantu abadala abancinci emva kokuphuka kwentloko ye-femal, ngoko ke uphando oluninzi lukholelwa ukuba utyando olungxamisekileyo kufuneka lwenziwe kwiiyure ze-12.Isigulane saphathwa ngokunciphisa ngesandla emva kokungeniswa.Emva kokunciphisa ngempumelelo, ifilimu ye-X-ray yabonisa ukuba isigulane siphinde sachithwa kwakhona.Kwakucatshangelwa ukuba ibhloko yokuphuka kwi-articular cavity iya kuchaphazela kakhulu ukuzinza kokunciphisa.Ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi kwenziwa kwimeko engxamisekileyo emva kokungeniswa ukunciphisa uxinzelelo lwentloko ye-femal kunye nokunciphisa amathuba okuba necrosis yentloko ye-femoral.Ukhetho lwendlela yotyando lukwabalulekile kwimpumelelo yotyando.Ababhali bakholelwa ukuba indlela yokuhlinzwa kufuneka ikhethwe ngokubhekiselele kwisikhokelo sokuchithwa kwentloko ye-femoral, ukubonakaliswa kokuhlinzwa, ukuhlelwa kwe-fracture kunye nezinye izinto.Esi sigulane sisifo se-posterolateral dislocation ye-hip joint edityaniswe nokuphulwa kwentloko ye-femoral ephakathi kunye nephantsi.Nangona indlela yangaphambili ingaba lula ngakumbi ukuvezwa kwe-fracture, indlela ye-posterolateral ikhethwe ekugqibeleni ngenxa yokuba ukuchithwa kwe-fracture yentloko ye-femoral yi-posterior dislocation.Ngaphantsi kwamandla anamandla, i-capsule ehlangeneyo yangasemva yonakalisiwe, kwaye i-posterolateral blood supply yentloko ye-femal yonakalisiwe.Indlela ye-posterolateral inokukhusela i-capsule edibeneyo yangaphambili engabonakaliyo, Ukuba indlela yangaphambili isetyenziswe kwakhona, i-capsule edibeneyo yangaphambili iya kunqunyulwa ivuleke, eya kutshabalalisa igazi eliseleyo lentloko ye-femal.
Isigulana sasigxininiswe nge-screws ezi-3 ezixhamlayo, ezinokudlala ngaxeshanye indima yokulungiswa koxinzelelo kunye ne-anti-rotation ye-fracture block, kunye nokukhuthaza ukuphiliswa kakuhle kwe-fracture.
I-PRP iqulethe izinto eziphakamileyo zokukhula, ezifana ne-platelet-derived growth factor (PDGF) kunye ne-transfer growth factor - β (TGF) β), i-Vascular endothelial growth factor (VEGF), i-insulin-like growth factor (IGF), ukukhula kwe-epidermal factor (EGF), njl. Kwiminyaka yakutshanje, abanye abaphengululi baye baqinisekisa ukuba i-PRP inamandla acacileyo okwenza ithambo.Kwizigulane ezineentloko ze-femoral fracture, amathuba okuba necrosis yentloko ye-femoral emva kokusebenza iphezulu.Ukusebenzisa i-PRP ekupheleni kokuphuka kweqhekeza kulindeleke ukuba kukhuthaze ukuphulukiswa kwe-fracture kwangaphambili kwaye kugweme ukwenzeka kwe-femoral head necrosis.Esi sigulana sasingenayo i-necrosis ye-femoral head necrosis ngaphakathi kwe-1 unyaka emva kokusebenza, kwaye yafumana kakuhle emva kokusebenza, okudinga ukulandelwa okuqhubekayo.
[Umxholo weli nqaku uveliswa kwakhona kwaye kwabelwana ngawo.Asinaxanduva ngezimvo zeli nqaku.Nceda uqonde.]
Ixesha lokuposa: Mar-17-2023