Ukususwa kwangemuva kwe-hip joint ngokuvamile kubangelwa udlame olungaqondile oluqinile njengezingozi zomgwaqo.Uma kukhona ukuphuka kwekhanda lesifazane, kubizwa ngokuthi i-Pipkin fracture.Ukuphuka kwe-pipkin akuvamile emtholampilo, futhi izehlakalo zakhona zenza cishe u-6% wokugudluka kwenyonga.Njengoba i-Pipkin fracture i-intra-articular fracture, uma ingaphathwa kahle, i-arthritis ehlukumezayo ingase yenzeke ngemva kokusebenza, futhi kunengozi ye-femoral head necrosis.Ngo-March 2016, umbhali welapha icala lokuphuka kwe-Pipkin I, futhi wabika idatha yayo yomtholampilo kanye nokulandelela ngale ndlela elandelayo.
Idatha Yomtholampilo
Isiguli, uLu, owesilisa, oneminyaka engu-22 ubudala, ungeniswe esibhedlela ngenxa "yokuvuvukala nobuhlungu enqulwini yangakwesobunxele okubangelwa ingozi yomgwaqo, nokusebenza okulinganiselwe amahora angu-5".Ukuhlolwa ngokomzimba: izimpawu ezibalulekile zazizinzile, ukuhlolwa kwe-cardio pulmonary bebdominal kwakungalungile, umlenze ophansi wesobunxele wawuyi-flexion shortening deformity, i-hip yesokunxele yayivuvukele ngokusobala, ububele be-groin midpoint kwesokunxele bebuhle, ubuhlungu obukhulu be-trochanter percussion kanye nomlenze ophansi. ubuhlungu be-longitudinal percussion babulungile.Umsebenzi osebenzayo wokuhlanganyela kwe-hip kwesokunxele ulinganiselwe, futhi ubuhlungu bomsebenzi we-passive bunzima.Ukunyakaza kozwane lwesobunxele kuyinto evamile, ukuzwa kwesitho esingezansi kwesokunxele akuncishisiwe kakhulu, futhi ukunikezwa kwegazi kwe-peripheral kuhle.Ukuhlola okusizayo: Amafilimu e-X-ray ahlangene ama-hip aphindwe kabili endaweni efanele abonisa ukuthi isakhiwo samathambo sekhanda lesifazane lesokunxele sasinqamuka, sihlakazekile emuva nangaphezulu, futhi izingcezu ezincane zokuphuka zazibonakala ku-acetabulum.
Ukuxilongwa kokungena
Ukuphuka kwekhanda lesifazane kwesokunxele nokugudluka kwelunga le-hip.Ngemuva kokungeniswa, ukukhishwa kwe-hip yesokunxele kwancishiswa mathupha kwaphinde kwakhishwa futhi.Ngemuva kokuthuthukisa ukuhlolwa kwangaphambi kokuhlinzwa, ukuphuka kwekhanda le-femoral kwesokunxele kanye nokukhishwa kwe-hip kwaphathwa ngokunciphisa okuvulekile nokulungiswa kwangaphakathi ngaphansi kwe-anesthesia jikelele emnyangweni ophuthumayo.
I-posterolateral approach incision ye-hip joint kwesokunxele ithathwe, ngobude obungaba ngu-12Cm.Ngesikhathi sokusebenza, ukuphuka kwatholakala ekunamathiselwe kwe-medial inferior ligamentum teres femoris, ngokuhlukaniswa okusobala nokufuduka kokuphela okuphukile, futhi ubukhulu obungaba ngu-3.0Cm bubonwe ku-acetabulum × 2.5Cm izingcezu zokuphuka.Igazi le-peripheral elingu-50mL lathathwa ukuze kulungiswe i-platelet rich plasma (PRP), futhi ijeli ye-PRP yasetshenziswa ekuqhekekeni.Ngemva kokubuyiselwa kwebhulokhi yokuphuka, izikulufu ezintathu ze-Finnish INION 40mm ezimuncwa (ububanzi obungu-2.7mm) zisetshenziswe ukulungisa ukuphuka.Kwatholakala ukuthi i-articular surface ye-femoral head cartilage yayibushelelezi, ukunciphisa kwakukuhle, futhi ukulungiswa kwangaphakathi kwakuqinile.I-hip joint izosethwa kabusha, futhi i-hip joint esebenzayo ngeke ibe nokungqubuzana nokukhishwa.I-C-arm irradiation ibonise ukunciphisa okuhle kokuphuka kwekhanda lesifazane kanye nokuhlangana kwe-hip.Ngemva kokugeza isilonda, supha i-capsule ehlangene yangemuva, yakha kabusha ukuma komsipha ojikelezayo wangaphandle, supha i-fascia lata nesikhumba sezicubu ezingaphansi, futhi ugcine ishubhu lokudonsa amanzi.
Xoxa
I-Pipkin fracture i-intra-articular fracture.Ukwelashwa okulondolozayo kuvame ukuba nzima ukuzuza ukuncipha okufanele, futhi kunzima ukugcina ukuncipha.Ngaphezu kwalokho, izingcezu zamathambo zamahhala ezisele ekuhlanganyeleni zandisa ukugqokwa kwe-intra-articular, okulula ukubangela isifo samathambo esibuhlungu.Ukwengeza, ukukhishwa kwe-hip kuhlangene nokuphuka kwekhanda lesifazane kujwayele ukuba necrosis yekhanda lesifazane ngenxa yokulimala kokunikezwa kwegazi kwekhanda lesifazane.Izinga le-femoral necrosis yekhanda liphakeme kubantu abadala abasebasha ngemva kokuphuka kwekhanda lesifazane, ngakho ucwaningo oluningi lukholelwa ukuthi ukuhlinzwa okuphuthumayo kufanele kwenziwe phakathi namahora angu-12.Isiguli salashwa ngokuncishiswa mathupha ngemva kokungeniswa.Ngemva kokunciphisa ngempumelelo, ifilimu ye-X-ray yabonisa ukuthi isiguli saphinde saxoshwa.Kwakucatshangwa ukuthi i-fracture block emgodini we-articular izothinta kakhulu ukuzinza kokunciphisa.Ukunciphisa okuvulekile nokulungiswa kwangaphakathi kwenziwa esimweni esiphuthumayo ngemva kokungeniswa ukuze kuncishiswe ingcindezi yekhanda lesifazane nokunciphisa amathuba okuba necrosis yekhanda lesifazane.Ukukhetha indlela yokuhlinzwa nakho kubalulekile empumelelweni yokuhlinzwa.Ababhali bakholelwa ukuthi indlela yokuhlinzwa kufanele ikhethwe ngokulandela isiqondiso sokukhishwa kwekhanda lesifazane, ukuvezwa kokuhlinzwa, ukuhlukaniswa kwe-fracture nezinye izici.Lesi siguli siyi-posterolateral dislocation ye-hip joint ehlangene nokuphuka kwekhanda le-female eliphakathi nendawo elingaphansi.Nakuba indlela yangaphambili ingase ibe lula kakhulu ukuvezwa kwe-fracture, indlela ye-posterolateral yagcina ikhethiwe ngoba ukukhishwa kwe-fracture yekhanda lesifazane kungukuxoshwa kwangemuva.Ngaphansi kwamandla aqinile, i-capsule ehlangene ye-posterior yonakalisiwe, futhi ukunikezwa kwegazi kwe-posterolateral kwekhanda lesifazane kuye konakaliswa.Indlela ye-posterolateral ingakwazi ukuvikela i-capsule ehlangene yangaphambili engalimele, Uma indlela yangaphambili isetshenziswa futhi, i-capsule ehlangene yangaphambili izosikwa ivuleke, ezobhubhisa ukunikezwa kwegazi okusele kwekhanda lesifazane.
Isiguli sasilungiswe ngezikulufu ezi-3 ezimuncayo, ezingadlala ngesikhathi esisodwa indima yokulungiswa kokucindezela kanye nokujikeleza kwe-block fracture block, futhi kukhuthaze ukuphulukiswa okuhle kokuphuka.
I-PRP iqukethe ukugxila okuphezulu kwezinto zokukhula, njenge-platelet-derived growth factor (PDGF) kanye nesici sokukhula sokudlulisa - β (TGF) β) , I-Vascular endothelial growth factor (VEGF), i-insulin-like growth factor (IGF), isici sokukhula kwe-epidermal (EGF), njll Eminyakeni yamuva, ezinye izazi ziye zaqinisekisa ukuthi i-PRP inekhono elicacile lokuyenga amathambo.Ezigulini ezinokuphuka kwekhanda lesifazane, amathuba okuba necrosis yekhanda lesifazane ngemva kokuhlinzwa aphezulu.Ukusebenzisa i-PRP ekugcineni okuphukile kwe-fracture kulindeleke ukuthi kukhuthaze ukuphulukiswa kwe-fracture kusenesikhathi futhi kugweme ukuvela kwe-femoral head necrosis.Lesi siguli sasingenayo i-necrosis yekhanda lesifazane phakathi konyaka we-1 ngemuva kokuhlinzwa, futhi salulama kahle ngemva kokuhlinzwa, okudinga ukulandelwa okwengeziwe.
[Okuqukethwe yile ndatshana kukhiqizwa kabusha futhi kwabelwana ngakho.Asinacala ngemibono yalesi sihloko.Sicela uqonde.]
Isikhathi sokuthumela: Mar-17-2023