Ob peb xyoos dhau los, qhov tshwm sim ntawm qhov sib thooj humeral fractures (PHFs) tau nce ntau dua 28%, thiab qhov kev phais tau nce ntau dua 10% hauv cov neeg mob hnub nyoog 65 xyoo thiab laus dua. Obviously, txo qis pob txha ceev thiab nce tus naj npawb ntawm kev ntog yog qhov tseem ceeb ntawm cov neeg laus coob zuj zus. Txawm hais tias muaj ntau yam kev kho mob phais muaj los tswj cov PHFs uas tsis muaj chaw nyob lossis tsis ruaj khov, tsis muaj kev pom zoo rau txoj kev phais zoo tshaj plaws rau cov neeg laus. Txoj kev loj hlob ntawm lub kaum ntse ntse daim phiaj tau muab kev kho mob rau kev kho mob phais ntawm PHFs, tab sis qhov teeb meem siab txog li 40% yuav tsum tau txiav txim siab. Feem ntau tshaj tawm yog adduction vau nrog cov ntsia hlau dislodgement thiab avascular necrosis (AVN) ntawm lub taub hau humeral.
Kev txo qis ntawm cov pob txha, kev kho dua tshiab ntawm lub sijhawm humeral, thiab kev kho kom raug subcutaneous ntawm cov ntsia hlau tuaj yeem txo cov teeb meem zoo li no. Screw fixation feem ntau nyuaj rau kev ua tiav vim kev cuam tshuam cov pob txha zoo ntawm qhov sib thooj humerus tshwm sim los ntawm osteoporosis. Txhawm rau daws qhov teeb meem no, ntxiv dag zog rau cov pob txha-ntsia hlau cuam tshuam nrog cov pob txha tsis zoo los ntawm kev siv polymethylmethacrylate (PMMA) pob txha cement nyob ib ncig ntawm cov ntsia hlau taub yog ib txoj hauv kev tshiab los txhim kho lub zog kho ntawm cov cog cog.
Txoj kev tshawb fawb tam sim no tsom rau kev soj ntsuam thiab txheeb xyuas cov txiaj ntsig hluav taws xob ntawm PHFs kho nrog lub kaum ntse ntse stabilization daim hlau thiab ntxiv cov ntsia hlau taub augmentation rau cov neeg mob laus dua 60 xyoo.
Ⅰ.Khoom siv thiab txoj kev
Tag nrho ntawm 49 tus neeg mob tau txais lub kaum ntse ntse plating thiab ntxiv cov cement augmentation nrog cov ntsia hlau rau PHFs, thiab 24 tus neeg mob tau suav nrog hauv txoj kev tshawb fawb raws li kev suav thiab cais tawm.
Tag nrho 24 PHFs tau muab cais ua ke siv HGLS kev faib tawm cov txheej txheem qhia los ntawm Sukthankar thiab Hertel siv kev kuaj ua ntej CT. Preoperative radiographs thiab postoperative plain radiographs raug soj ntsuam. Qhov kev txo qis ntawm lub cev txaus ntawm cov pob txha raug txiav txim siab ua tiav thaum lub tuberosity ntawm lub taub hau humeral tau rov txo qis thiab pom tsawg dua 5 hli ntawm qhov sib txawv lossis kev hloov pauv. Adduction deformity tau txhais raws li ib tug inclination ntawm lub taub hau humeral txheeb ze rau lub humeral ncej ntawm tsawg tshaj li 125 ° thiab valgus deformity tau txhais tias ntau tshaj 145 °.
Thawj qhov ntsia hlau nkag tau txhais tau tias yog cov ntsia hlau taub nkag mus rau ciam teb ntawm medullary cortex ntawm lub taub hau humeral. Secondary fracture displacement tau txhais tias yog ib qho kev hloov ntawm qhov txo tuberosity ntau tshaj 5 mm thiab / los yog ib tug hloov ntawm ntau tshaj 15 ° nyob rau hauv lub inclination lub kaum sab xis ntawm lub taub hau fragment nyob rau hauv kev soj ntsuam radiograph piv nrog rau intraoperative radiograph.
Tag nrho cov kev phais tau ua los ntawm ib txoj hauv kev loj deltopectoralis. Kev txo cov pob txha thiab qhov chaw phaj tau ua raws li tus qauv. Screw-cement augmentation txheej txheem siv 0.5 ml ntawm cov cement rau ntsia hlau taub hau augmentation.
Immobilization tau ua tom qab phais hauv kev cai caj npab sling rau lub xub pwg rau 3 lub lis piam. Thaum ntxov passive thiab pab txhawb kev ua haujlwm nrog kev kho mob tau pib 2 hnub tom qab ua haujlwm kom ua tiav ntau yam ntawm cov lus tsa suab (ROM).
Ⅱ.Qhov tshwm sim.
Cov txiaj ntsig: Nees nkaum plaub tus neeg mob tau suav nrog, nrog lub hnub nyoog nruab nrab ntawm 77.5 xyoo (ntau, 62-96 xyoo). Nees nkaum ib tug poj niam thiab peb yog txiv neej. Tsib 2-ntu fractures, 12 3-ntu fractures, thiab xya 4-ntu fractures raug phais kho siv lub kaum sab xis stabilization phaj thiab ntxiv ntsia hlau-cement augmentation. Peb ntawm 24 pob txha yog humeral pob txha taub hau. Anatomic txo tau ua tiav hauv 12 ntawm 24 tus neeg mob; Kev txo qis ntawm qhov nruab nrab cortex tau ua tiav hauv 15 ntawm 24 tus neeg mob (62.5%). Thaum 3 lub hlis tom qab kev phais, 20 ntawm 21 tus neeg mob (95.2%) tau ua tiav kev sib koom ua ke ntawm pob txha, tshwj tsis yog rau 3 tus neeg mob uas xav tau kev phais kho ntxov.
Ib tus neeg mob tau tsim kev hloov pauv thaum ntxov (tom qab hloov pauv ntawm lub taub hau humeral) 7 lub lis piam tom qab kev phais. Kev kho mob tau ua nrog rov qab tag nrho lub xub pwg arthroplasty 3 lub hlis tom qab kev phais. Thawj cov ntsia hlau nkag mus vim yog me me intraarticular cement to (tsis muaj kev yaig loj ntawm kev sib koom ua ke) tau pom nyob rau hauv 3 tus neeg mob (2 ntawm cov neeg muaj mob taub hau tawg) thaum lub sij hawm postoperative radiographic soj ntsuam. Cov ntsia hlau nkag tau pom nyob rau hauv C txheej ntawm lub kaum sab xis stabilization phaj hauv 2 tus neeg mob thiab hauv E txheej hauv lwm (Daim duab 3). 2 ntawm 3 tus neeg mob no tom qab tsim avascular necrosis (AVN). Cov neeg mob tau kho qhov kev phais vim yog kev txhim kho ntawm AVN (Tables 1, 2).
Ⅲ.Kev sib tham.
Cov teeb meem tshwm sim feem ntau nyob rau hauv proximal humeral fractures (PHFs), dhau li ntawm txoj kev loj hlob ntawm avascular necrosis (AVN), yog ntsia hlau dislodgement nrog tom qab adduction vau ntawm lub taub hau humeral fragment. Txoj kev tshawb no pom tias kev txhim kho cement-screw ua rau muaj kev sib koom ua ke ntawm 95.2% ntawm 3 lub hlis, qhov hloov pauv thib ob ntawm 4.2%, AVN tus nqi ntawm 16.7%, thiab tag nrho cov kev hloov kho ntawm 16.7%. Cement augmentation ntawm cov ntsia hlau ua rau qhov kev hloov pauv thib ob ntawm 4.2% yam tsis muaj kev sib tsoo, uas yog tus nqi qis dua piv rau kwv yees li 13.7-16% nrog cov pa sib tsoo phaj fixation. Peb pom zoo kom siv zog ua kom ua tiav qhov kev txo qis hauv lub cev kom txaus, tshwj xeeb tshaj yog ntawm qhov nruab nrab humeral cortex hauv angled phaj fixation ntawm PHFs. Txawm hais tias ntxiv cov ntsia hlau taub hau augmentation yog siv, cov txheej txheem paub txog qhov ua tsis tau zoo yuav tsum tau txiav txim siab.
Qhov kev hloov kho tag nrho ntawm 16.7% siv cov ntsia hlau ntsoog hauv qhov kev tshawb fawb no yog nyob rau hauv qis dua ntawm qhov kev hloov kho yav dhau los rau cov ntawv txheeb xyuas cov duab angular stabilization hauv PHFs, uas tau qhia txog kev kho cov neeg laus li ntawm 13% mus rau 28%. Tsis tos. Cov yav tom ntej, randomized, tswj multicenter kawm ua los ntawm Hengg li al. tsis tau qhia qhov txiaj ntsig ntawm cement ntsia hlau augmentation. Ntawm tag nrho ntawm 65 tus neeg mob uas ua tiav 1-xyoo kev soj ntsuam, cov neeg kho tshuab tsis ua haujlwm tau tshwm sim hauv 9 tus neeg mob thiab 3 hauv pawg augmentation. AVN tau pom nyob rau hauv 2 tus neeg mob (10.3%) thiab hauv 2 tus neeg mob (5.6%) hauv pab pawg uas tsis muaj kev txhim kho. Zuag qhia tag nrho, tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm cov xwm txheej tsis zoo thiab cov txiaj ntsig kev kho mob ntawm ob pawg. Txawm hais tias cov kev tshawb fawb no tau tsom mus rau cov txiaj ntsig kho mob thiab hluav taws xob, lawv tsis tau ntsuas cov duab hluav taws xob ntau npaum li qhov kev tshawb fawb no. Zuag qhia tag nrho, radiologically kuaj pom muaj teeb meem zoo ib yam li cov hauv kev tshawb fawb no. Tsis muaj ib qho ntawm cov kev tshawb fawb no tau tshaj tawm txog kev sib tsoo ntawm cov cement, tshwj tsis yog rau txoj kev tshawb fawb los ntawm Hengg li al., uas tau soj ntsuam qhov xwm txheej tsis zoo no hauv ib tus neeg mob. Nyob rau hauv txoj kev tshawb no, thawj cov ntsia hlau nkag tau raug soj ntsuam ob zaug ntawm qib C thiab ib zaug ntawm qib E, nrog rau tom qab ntawm qhov sib txuas ntawm cov cement to tsis muaj qhov cuam tshuam txog kev kho mob. Cov khoom sib piv tau raug txhaj rau hauv qab fluoroscopic tswj ua ntej cement augmentation tau siv rau txhua tus ntsia hlau. Txawm li cas los xij, qhov sib txawv ntawm cov duab hluav taws xob sib txawv ntawm cov caj npab sib txawv yuav tsum tau ua thiab tshuaj xyuas kom zoo dua los txiav txim seb qhov kev nkag mus rau hauv lub taub hau thawj zaug ua ntej daim ntawv thov cement. Tsis tas li ntawd, cement reinforcement ntawm screws ntawm qib C (ntsia hlau divergent configuration) yuav tsum raug zam vim muaj kev pheej hmoo siab dua ntawm cov ntsia hlau loj nkag thiab cov cement tom qab. Cement ntsia hlau taub hau augmentation tsis pom zoo rau cov neeg mob uas muaj lub taub hau ntawm lub taub hau vim yog qhov muaj peev xwm loj rau cov kab mob intraarticular to pom nyob rau hauv cov qauv pob txha no (saib hauv 2 tus neeg mob).
VI. Xaus.
Hauv kev kho mob ntawm PHFs nrog lub kaum ntse ntse daim hlau siv PMMA cement, cement ntswj taub hau augmentation yog cov txheej txheem phais txhim khu kev qha uas txhim kho kev txhim kho ntawm cov pob txha rau cov pob txha, uas ua rau qhov qis qis qis ntawm 4.2% hauv cov neeg mob osteoporotic. Piv nrog rau cov ntaub ntawv uas twb muaj lawm, qhov tshwm sim ntawm avascular necrosis (AVN) tau pom feem ntau hauv cov qauv pob txha loj heev thiab qhov no yuav tsum tau coj mus rau hauv tus account. Ua ntej daim ntawv thov cement, ib qho intraarticular cement to yuav tsum tau ua tib zoo cais los ntawm qhov sib piv nruab nrab tswj. Vim muaj kev pheej hmoo siab ntawm intraarticular cement to hauv humeral taub hau tawg, peb tsis pom zoo kom cement ntsia hlau taub augmentation hauv qhov tawg no.
Post lub sij hawm: Aug-06-2024
