Ọkpụkpụ azụ nke nkwonkwo hip na-abụkarị ihe ike na-apụtaghị ìhè dịka ihe mberede okporo ụzọ.Ọ bụrụ na enwere mgbaji isi femoral, a na-akpọ ya mgbaji Pipkin.Ọkpụkpụ Pipkin dị obere na ụlọọgwụ, yana ihe kpatara ya na-akpata ihe dịka 6% nke mgbapụ hip.Ebe ọ bụ na mgbaji Pipkin bụ mgbawa intra-articular, ọ bụrụ na a naghị edozi ya nke ọma, ọrịa ogbu na nkwonkwo nwere ike ime mgbe arụchara ya, na enwere ihe ize ndụ nke necrosis isi femoral.Na March 2016, onye edemede ahụ mesoro otu ikpe nke Pipkin ụdị m mgbawa, ma kọọrọ ya data ụlọ ọgwụ na nsonye dị ka ndị a.
Data ụlọ ọgwụ
Onye ọrịa ahụ, Lu, nwoke, 22, anabatara n'ụlọ ọgwụ n'ihi "ọzịza na mgbu na aka ekpe nke ihe mberede okporo ụzọ kpatara, na obere ọrụ maka awa 5".Nyocha anụ ahụ: ihe ịrịba ama ndị dị mkpa kwụsiri ike, nyocha nke afọ cardio pulmonary na-adịghị mma, akụkụ aka ekpe nke dị n'akụkụ aka ekpe na-eme mgbanwe na-ebelata nrụrụ, úkwù aka ekpe zara aza n'ụzọ doro anya, ịdị nro dị n'etiti aka ekpe dị mma, nnukwu ihe mgbu nke trochanter na nrụrụ dị ala. ogologo mgbu percussion dị mma.Ọrụ na-arụsi ọrụ ike nke nkwonkwo ụkwụ aka ekpe dị oke, na ihe mgbu nke ọrụ na-agafe agafe dị njọ.Ntugharị nke mkpịsị ụkwụ aka ekpe bụ ihe nkịtị, mmetụta nke akụkụ aka ekpe nke aka ekpe adịghị ebelata nke ukwuu, na ntinye ọbara dị n'akụkụ dị mma.Nnwale inyeaka: Ihe nkiri X-ray nke nkwonkwo hip abụọ dị n'ọnọdụ ziri ezi gosiri na ọkpụkpụ ọkpụkpụ nke isi femoral aka ekpe kwụsịrị, na-atụgharị azụ na elu, na obere ihe mgbawa na-ahụ anya na acetabulum.
Nchọpụta nnabata
Ọkpụkpụ isi femoral aka ekpe na mgbawa nke nkwonkwo hip.Mgbe abatachara, a na-eji aka belata nkwụsị hip aka ekpe wee gbasaa ọzọ.Mgbe emechara nyocha nke mbụ, a na-emeso isi mgbawa femoral aka ekpe na mgbawa hip na mbelata na-emeghe na nhazi nke ime n'okpuru nchịkwa izugbe na ngalaba mberede.
A na-ewere ụzọ nkwụsị nke azụ azụ nke nkwonkwo ụkwụ aka ekpe, na ogologo nke ihe dịka 12cm.N'oge a na-arụ ọrụ, a chọtara mgbawa na ntinye nke medial inferior ligamentum teres femoris, na nkewa doro anya na nchụpụ nke njedebe gbajiri agbaji, na nha nke ihe dịka 3.0Cm ka a hụrụ n'ime akụkụ nke acetabulum × 2.5Cm.A na-ewere ọbara dị n'akụkụ 50mL iji kwadebe platelet ọgaranya plasma (PRP), ma tinye gel PRP na mgbawa ahụ.Mgbe e weghachiri ngọngọ mgbawa ahụ, a na-eji skru atọ Finnish INION 40mm absorbable (2.7mm na dayameta) dozie mgbawa ahụ.Achọpụtara na elu elu nke ọkpụkpụ isi femoral bụ nke dị nro, mbelata ahụ dị mma, na nhazi nke ime ya siri ike.A ga-emezigharị nkwonkwo hip, na nkwonkwo hip na-arụ ọrụ agaghị enwe esemokwu na nkwụsị.Mgbawa C-ogwe aka gosipụtara nke ọma mbelata nke mgbawa isi femoral na nkwonkwo hip.Mgbe ịsachara ọnya ahụ, suchie capsule nkwonkwo azụ, rụgharịa nkwụsị nke akwara rotator dị n'èzí, suchie fascia lata na akpụkpọ anụ ahụ dị n'okpuru, ma na-ejigide tube drainage.
Mkparịta ụka
Ọkpụkpụ Pipkin bụ mgbaji n'ime akwara.Ọgwụgwọ na-agbanwe agbanwe na-esikarị ike iji nweta mbelata dị mma, ọ na-esikwa ike idowe mbelata ahụ.Tụkwasị na nke ahụ, iberibe ọkpụkpụ na-enweghị ihe fọdụrụ na nkwonkwo na-eme ka ọkpụkpụ intra-articular na-eyi, nke dị mfe ime ka ọrịa ogbu na nkwonkwo.Na mgbakwunye, mgbawa hip jikọtara ya na mgbawa isi femoral na-adịkarị mfe na necrosis isi femoral n'ihi mmerụ ahụ nke isi na-enye ọbara femoral.Ọnụ ọgụgụ isi femoral necrosis dị elu na ndị na-eto eto mgbe ọkpụkpụ isi femoral, ya mere ọtụtụ ọmụmụ kwenyere na a ga-arụ ọrụ ịwa ahụ mberede n'ime awa 12.A na-agwọ onye ọrịa ahụ site na mbelata akwụkwọ ntuziaka mgbe nnabata.Mgbe mbelata nke ọma, ihe nkiri X-ray gosipụtara na onye ọrịa ahụ gbapụrụ ọzọ.A na-ewere ya na ngọngọ mgbawa na oghere articular ga-emetụta nkwụsi ike nke mbelata.Emere mbelata oghere na imezi ihe na mberede mgbe abatachara iji belata nrụgide nke isi femoral ma belata ohere nke isi femoral necrosis.Nhọrọ nke usoro ịwa ahụ dịkwa oke mkpa maka ịga nke ọma nke ọrụ ahụ.Ndị na-ede akwụkwọ kwenyere na a ga-ahọrọ usoro ịwa ahụ dịka ntụziaka nke nkwụsị isi femoral, ikpughe ịwa ahụ, nhazi nke mgbawa na ihe ndị ọzọ.Onye ọrịa a bụ nkwụsịtụ azụ nke nkwonkwo hip jikọtara ya na mgbaji nke etiti na isi femoral nke dị ala.Ọ bụ ezie na ụzọ dị n'ihu nwere ike ịdị mma maka ikpughe nke mgbawa ahụ, a na-ahọrọ ụzọ nke posterolateral n'ihi na mgbawa mgbawa nke isi femoral bụ nkwụsị azụ.N'okpuru ike siri ike, e mebiela capsule nkwonkwo azụ, ma mebie ọbara nke dị n'azụ nke isi femoral.Usoro nke posterolateral nwere ike ichebe capsule nkwonkwo ihu na-adịghị emerụ ahụ, Ọ bụrụ na a na-eji ụzọ azụ eme ihe ọzọ, a ga-egbutu capsule nkwonkwo azụ, nke ga-ebibi ọbara fọdụrụnụ nke isi femoral.
A na-edozi onye ọrịa ahụ na skru 3 na-anabata ya, nke nwere ike ịrụ ọrụ n'otu oge nke mkpakọ mkpakọ na mgbochi ntụgharị nke ngọngọ mgbaji, ma kwalite ọgwụgwọ mgbaji.
PRP nwere nnukwu ihe na-eto eto, dị ka ihe na-eto eto na-enweta platelet (PDGF) na ihe na-ebufe ibu - β (TGF－ β) , Vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), epidermal growth factor. (EGF), wdg N'afọ ndị na-adịbeghị anya, ụfọdụ ndị ọkà mmụta ekwenyela na PRP nwere ikike doro anya ime ka ọkpụkpụ.Maka ndị ọrịa nwere mgbawa isi femoral, ohere nke isi femoral necrosis mgbe arụchara ọrụ dị elu.Iji PRP na njedebe gbajiri agbaji a na-atụ anya ịkwalite ọgwụgwọ mgbawa n'oge ma zere ihe omume nke necrosis isi femoral.Onye ọrịa a enweghị isi necrosis femoral n'ime afọ 1 mgbe ọ rụsịrị ọrụ, wee gbakee nke ọma mgbe ọ rụchara ọrụ, nke chọrọ nleba anya ọzọ.
[A na-edegharị ma kesaa ọdịnaya dị n'ime akụkọ a.Ọ bụghị anyị na-ahụ maka echiche nke akụkọ a.Biko ghọta.]
Oge nzipu: Mar-17-2023