Posterior dislocation yejojo yehudyu inonyanya kukonzerwa nechisimba chisina kunanga chakasimba senjodzi dzemotokari.Kana paine kutsemuka kwemusoro wemukadzi, inonzi Pipkin fracture.Kutyoka kwePipkin hakuwanzo kuwanikwa mukiriniki, uye chiitiko chayo chinosvika 6% yehudyu dislocation.Sezvo Pipkin fracture iri intra-articular fracture, kana ikasabatwa zvakanaka, arthritis inoshungurudza inogona kuitika mushure mekushanda, uye kune ngozi ye femoral head necrosis.Muna Kurume 2016, munyori akabata nyaya yePipkin type I fracture, uye akashuma data yayo yekiriniki uye yekutevera sezvinotevera.
Clinical Data
Murwere, Lu, murume, ane makore makumi maviri nemaviri, akapinzwa muchipatara nekuda kwe "kuzvimba uye kurwadziwa muhudyu yekuruboshwe kunokonzerwa netsaona yemotokari, uye kuita kushoma kwemaawa mashanu".Kuongororwa kwepanyama: zviratidzo zvakakosha zvaive zvakagadzikana, cardio pulmonary abdominal kuongorora yakanga isina kunaka, kuruboshwe rwezasi rwakanga rwuri flexion shortening deformity, chiuno chekuruboshwe chakanga chakazvimba zviri pachena, kunyorova kwepakati pekuruboshwe kwaiva kwakanaka, kurwadziwa kukuru kwetrochanter percussion uye chikamu chezasi. Longitudinal percussion pain yaive yakanaka.Basa rinoshanda rekubatanidzwa kwehudyu rekuruboshwe rinogumira, uye marwadzo ekuita maitiro akaoma.Kufamba kwechigunwe chekuruboshwe kwakajairika, kunzwa kweruboshwe rworuboshwe hachina kuderedzwa zvakanyanya, uye peripheral blood supply yakanaka.Kuongorora kwekubatsira: Mafirimu e-X-ray emakumbo maviri ehudyu panzvimbo yakarurama yakaratidza kuti chimiro chepfupa chekuruboshwe kwechikadzi chemusoro chakanga chisingaregi, chakabviswa shure uye kumusoro, uye zvimedu zviduku zvakaputsika zvakaonekwa muacetabulum.
Kubvuma kuongororwa
Kutyoka kwemusoro wemukadzi wekuruboshwe nekutsemuka kwejojo rehudyu.Mushure mekubvumirwa, kubviswa kwehudyu yekuruboshwe kwakaderedzwa nemaoko ndokuzobviswa zvakare.Mushure mekuvandudza kuongorora kusati kwaitwa, kuputika kwechikadzi chekuruboshwe uye kuputika kwechiuno kwakabatwa nekuderedzwa kwakazaruka uye kugadziriswa kwemukati pasi peanesthesia yakawanda mudhipatimendi rekukurumidzira.
Iyo posterolateral approach incision yekuruboshwe hip joint yakatorwa, nehurefu hunenge 12Cm.Munguva yekushanda, kuputsika kwakawanikwa pakusungirirwa kwemukati wemukati we ligamentum teres femoris, nekuparadzaniswa kwakajeka uye kubviswa kwekupedzisira kwakaputsika, uye ukuru hwepamusoro pe3.0Cm yakaonekwa mu acetabulum × 2.5Cm fracture fragments.50mL peripheral blood yakatorwa kugadzirira platelet rich plasma (PRP), uye PRP gel yakashandiswa pakutyoka.Mushure mekunge chivharo chekutyoka chadzorerwa, matatu eFinnish INION 40mm anogona kunyura screws (2.7mm mudhayamita) akashandiswa kugadzirisa pakatyoka.Yakawanikwa kuti articular surface ye femoral head cartilage yakanga yakatsetseka, kuderedzwa kwaive kwakanaka, uye kugadziriswa kwemukati kwaive kwakasimba.Mubatanidzwa wehudyu uchagadzikiswa zvakare, uye mubatanidzwa wehudyu unoshanda uchave usina kukweshana uye kutsemuka.C-arm irradiation yakaratidza kuderedzwa kwakanaka kwekutyoka kwemusoro wemukadzi uye kubatana kwehudyu.Mushure mekugeza ronda, suture iyo posterior joint capsule, gadzira patsva kumira kwekunze rotator tsandanyama, suture the fascia lata uye subcutaneous tishu ganda, uye chengeta drainage chubhu.
Kurukurai
Pipkin fracture is intra-articular fracture.Kuchengetedza kurapwa kunowanzo kuoma kuwana kuderedzwa kwakanaka, uye kwakaoma kuchengetedza kuderedzwa.Mukuwedzera, iyo yakasara yemahara zvidimbu zvebhonzo mujoinhi inowedzera iyo intra-articular kupfeka, izvo zviri nyore kukonzera traumatic arthritis.Mukuwedzera, kuputika kwehudyu pamwe chete nekutsemuka kwemusoro wevakadzi kunowanzoita femoral head necrosis nekuda kwekukuvadzwa kweropa remusoro wemukadzi.The femoral head necrosis rate yakakwirira muvakuru vechidiki mushure mekutyoka kwechikadzi, saka zvidzidzo zvakawanda zvinotenda kuti kuvhiyiwa kwekukurumidzira kunofanira kuitwa mukati meawa gumi nemaviri.Murwere akabatwa nekuderedzwa kwemanyore mushure mekubvumidzwa.Mushure mekubudirira kuderedzwa, iyo X-ray firimu yakaratidza kuti murwere akadzingwa zvakare.Zvaifungidzirwa kuti chivharo chekuputsika mu articular cavity chaizokanganisa zvikuru kugadzikana kwekuderedza.Kuvhura kuderedzwa uye kugadziriswa kwemukati kwakaitwa mukukurumidzira mushure mekubvumidzwa kuderedza kumanikidzwa kwemusoro wemukadzi uye kuderedza mukana weiyo femoral head necrosis.Kusarudzwa kwekuvhiya nzira yakakoshawo pakubudirira kwekushanda.Vanyori vanotenda kuti nzira yekuvhiya inofanira kusarudzwa maererano nehutungamiri hwemusoro wevakadzi, kubudiswa kwekuvhiya, kuparadzaniswa kwekuputsika uye zvimwe zvinhu.Uyu murwere anonzi posterolateral dislocation yejojo yehudyu yakasanganiswa nekuputsika kwepakati uye pasi pemusoro wevakadzi.Kunyange zvazvo nzira yepamberi ingave yakanyatsonaka pakuratidzwa kwekuputsika, nzira yeposterolateral yakazosarudzwa nokuti kuputsika kwemusoro wemukadzi ndeye posterior dislocation.Pasi pesimba rakasimba, posterior joint capsule yakakuvadzwa, uye posterolateral ropa remusoro wemukadzi rakakuvadzwa.Iyo posterolateral nzira inogona kuchengetedza isina kukuvadzwa anterior joint capsule, Kana nzira yepamberi inoshandiswa zvakare, anterior joint capsule ichagurwa yakazaruka, iyo ichaparadza kusara kweropa remusoro wemukadzi.
Murwere akagadziriswa ne 3 absorbable screws, iyo inogona panguva imwe chete kutamba basa rekumanikidzira kugadzirisa uye anti kutenderera kwekuputsika, uye kukurudzira kupora kwakanaka kwekuputsika.
PRP ine huwandu hwakawanda hwekukura kwezvinhu, zvakadai seplatelet-derived growth factor (PDGF) uye kuendesa kukura chinhu - β (TGF) β) , Vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), epidermal growth factor. (EGF), etc. Mumakore achangopfuura, dzimwe nyanzvi dzakatsigira kuti PRP ine simba rakajeka rekukurudzira pfupa.Kune varwere vane femoral head fracture, mukana weiyo femoral head necrosis mushure mekushanda yakanyanya.Kushandisa PRP pamucheto wakaputsika wekuputsika kunotarisirwa kukurudzira kuputsika kupora kare uye kudzivisa kuitika kwechikadzi musoro necrosis.Murwere uyu akanga asina femoral head necrosis mukati megore re1 mushure mekushanda, uye akapora zvakanaka mushure mekushanda, izvo zvinoda kuwedzera kutevera.
[Zviri muchinyorwa ichi zvakatsikiswa nekugovaniswa.Hatina mhosva yemaonero echinyorwa chino.Ndapota nzwisisa.]
Nguva yekutumira: Mar-17-2023