Posterior dislocation ntawm lub duav pob qij txha feem ntau yog tshwm sim los ntawm muaj zog indirect kev nruj kev tsiv xws li kev huam yuaj.Yog tias muaj pob txha taub hau femoral, nws hu ua Pipkin fracture.Pipkin tawg yog qhov tsis tshua muaj nyob hauv tsev kho mob, thiab nws qhov xwm txheej muaj txog li 6% ntawm lub duav dislocation.Txij li thaum Pipkin tawg yog ib qho kev puas tsuaj ntawm cov pob txha, yog tias nws tsis ua haujlwm zoo, kev mob caj dab tuaj yeem tshwm sim tom qab ua haujlwm, thiab muaj kev pheej hmoo ntawm femoral taub hau necrosis.Nyob rau lub Peb Hlis 2016, tus sau tau kho qhov teeb meem ntawm Pipkin hom I pob txha, thiab tau tshaj tawm nws cov ntaub ntawv kho mob thiab ua raws li hauv qab no.
Cov ntaub ntawv kho mob
Tus neeg mob, Lu, txiv neej, hnub nyoog 22 xyoo, tau mus pw hauv tsev kho mob vim "qhov o thiab mob ntawm lub duav sab laug los ntawm kev sib tsoo, thiab kev ua si tsawg rau 5 teev".Kev tshuaj xyuas lub cev: cov cim tseem ceeb tau ruaj khov, kev kuaj mob plawv plawv tsis zoo, sab laug sab ceg yog flexion shortening deformity, sab laug lub duav tau o pom tseeb, sab laug sab laug puab tais midpoint tenderness yog qhov zoo, qhov zoo tshaj plaws trochanter percussion mob thiab qis qis. longitudinal percussion mob tau zoo.Lub active kev ua ub no ntawm sab laug hip ob leeg yog txwv, thiab qhov mob ntawm passive kev ua si yog heev hnyav.Kev txav ntawm cov ntiv taw sab laug yog qhov qub, qhov kev xav ntawm sab laug qis qis qis qis, thiab cov ntshav peripheral tau zoo.Kev kuaj xyuas: X-ray films ntawm ob lub hip pob qij txha nyob rau hauv txoj cai txoj hauj lwm pom tau hais tias cov pob txha qauv ntawm sab laug femoral taub hau yog tsis tu ncua, dislocated rov qab thiab upwards, thiab me me tawg tawg tawg nyob rau hauv lub acetabulum.
Kev kuaj mob nkag
Sab laug femoral taub hau tawg nrog dislocation ntawm pob qij txha.Tom qab nkag mus, sab laug hip dislocation yog manually txo thiab ces dislocated dua.Tom qab txhim kho qhov kev kuaj mob ua ntej, sab laug femoral taub hau tawg thiab lub duav dislocation tau kho nrog qhib txo thiab kho sab hauv raws li kev siv tshuaj loog hauv chav kho mob xwm txheej ceev.
Lub posterolateral mus kom ze incision ntawm sab laug hip ob leeg tau noj, nrog ib tug ntev ntawm txog 12Cm.Thaum lub sijhawm ua haujlwm, qhov tawg tau pom ntawm qhov txuas ntawm qhov nruab nrab ntawm qhov nruab nrab tsis zoo ligamentum teres femoris, nrog rau kev sib cais thiab kev txav ntawm qhov kawg ntawm qhov tawg, thiab qhov loj ntawm li 3.0Cm tau pom nyob rau hauv acetabulum × 2.5Cm tawg tawg tawg.50mL cov ntshav peripheral tau muab coj los npaj platelet nplua plasma (PRP), thiab PRP gel tau siv rau pob txha.Tom qab cov pob txha tawg tau rov qab los, peb Finnish INION 40mm absorbable screws (2.7mm inch) tau siv los kho cov pob txha.Nws tau pom tias cov pob txha pob txha pob txha ntawm pob txha pob txha ntawm pob txha pob txha ntawm pob txha pob txha yog du, qhov txo qis yog qhov zoo, thiab kev txhim kho sab hauv yog ruaj khov.Lub duav pob qij txha yuav tsum tau rov pib dua, thiab lub duav pob qij txha yuav tsum tsis muaj kev sib txhuam thiab dislocation.C-arm irradiation pom zoo txo qis ntawm femoral taub hau tawg thiab lub duav pob qij txha.Tom qab ntxuav lub qhov txhab, suture lub posterior sib koom capsule, reconstruct lub nres ntawm sab nraud rotator nqaij, suture lub fascia lata thiab subcutaneous cov ntaub so ntswg ntawm daim tawv nqaij, thiab khaws cia ib tug kua raj.
Sib tham
Pipkin fracture yog ib qho kev puas hlwb intra-articular.Kev saib xyuas kev kho mob feem ntau nyuaj kom ua tiav qhov kev txo qis, thiab nws nyuaj rau kev tswj qhov txo qis.Tsis tas li ntawd, cov pob txha uas tsis muaj seem nyob hauv qhov sib koom ua ke ua rau muaj kev sib koom ua ke, uas yooj yim ua rau mob caj dab.Tsis tas li ntawd, hip dislocation ua ke nrog femoral taub hau tawg yog feem ntau ua rau femoral taub hau necrosis vim raug mob ntawm femoral taub hau ntshav.Qhov femoral taub hau necrosis tus nqi siab dua hauv cov tub ntxhais hluas tom qab femoral taub hau tawg, yog li cov kev tshawb fawb feem ntau ntseeg tias kev phais xwm txheej ceev yuav tsum tau ua hauv 12 teev.Tus neeg mob tau kho nrog kev txo qis tom qab nkag.Tom qab ua tiav kev txo qis, X-ray zaj duab xis pom tias tus neeg mob tau tsiv tawm dua.Nws tau txiav txim siab tias cov pob txha pob txha hauv cov kab noj hniav yuav ua rau muaj kev cuam tshuam zoo rau kev txo qis.Qhib kev txo qis thiab kev txhim kho sab hauv tau ua thaum muaj xwm txheej ceev tom qab nkag mus kom txo tau lub siab ntawm femoral taub hau thiab txo qhov tshwm sim ntawm femoral taub hau necrosis.Kev xaiv txoj kev phais kuj tseem ceeb heev rau kev ua tiav ntawm kev ua haujlwm.Cov kws sau ntawv ntseeg tias txoj kev phais yuav tsum raug xaiv raws li cov kev taw qhia ntawm femoral taub hau dislocation, phais raug mob, kev faib cov pob txha thiab lwm yam.Tus neeg mob no yog ib tug posterolateral dislocation ntawm lub duav sib koom ua ke nrog ib tug tawg ntawm lub nruab nrab thiab inferior femoral taub hau.Txawm hais tias txoj hauv kev sab hauv tuaj yeem yooj yim dua rau kev nthuav tawm ntawm pob txha, txoj hauv kev posterolateral thaum kawg tau xaiv vim qhov tawg ntawm lub taub hau femoral yog ib qho kev cuam tshuam tom qab.Nyob rau hauv lub zog muaj zog, lub posterior sib koom capsule tau puas lawm, thiab posterolateral ntshav mov ntawm lub taub hau femoral tau puas.Txoj hauv kev posterolateral tuaj yeem tiv thaiv qhov tsis raug mob anterior sib koom ua ke tshuaj ntsiav, Yog tias txoj hauv kev rov qab siv dua, lub anterior joint capsule yuav raug txiav qhib, uas yuav rhuav tshem cov ntshav seem ntawm lub taub hau femoral.
Tus neeg mob tau kho nrog 3 absorbable screws, uas tuaj yeem ua lub luag haujlwm ntawm compression fixation thiab tiv thaiv kev sib hloov ntawm cov pob txha pob txha, thiab txhawb kev kho pob txha zoo.
PRP muaj cov ntsiab lus siab ntawm kev loj hlob, xws li platelet-derived growth factor (PDGF) thiab hloov pauv kev loj hlob - β (TGF－ β), Vascular endothelial growth factor (VEGF), insulin-zoo li kev loj hlob factor (IGF), epidermal loj hlob yam. (EGF), thiab lwm yam hauv xyoo tas los no, qee cov kws tshawb fawb tau lees paub tias PRP muaj peev xwm ua kom muaj pob txha.Rau cov neeg mob nrog femoral taub hau tawg, qhov tshwm sim ntawm femoral taub hau necrosis tom qab ua haujlwm yog siab.Kev siv PRP ntawm qhov kawg ntawm qhov tawg yog xav kom txhawb kev puas tsuaj thaum ntxov thiab zam qhov tshwm sim ntawm femoral taub hau necrosis.Tus neeg mob no tsis muaj femoral taub hau necrosis nyob rau hauv 1 xyoo tom qab kev ua haujlwm, thiab zoo zoo tom qab ua haujlwm, uas yuav tsum tau soj ntsuam ntxiv.
[Cov ntsiab lus ntawm tsab xov xwm no yog luam tawm thiab sib qhia.Peb tsis muaj lub luag haujlwm rau qhov kev xav ntawm kab lus no.Thov nkag siab.]
Post lub sij hawm: Mar-17-2023