Kev Tshawb Fawb Txog Kab Mob Raum Ntev: Qhov ua rau ntawm pob txha tsis txaus

Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com

Nontraumatic central fracture-dislocation ntawm lub duav nyob rau hauv tus neeg mob uas muaj mob raum kab mob thiab post gastrectomy

Ken Shimizu, Hisanori Kameda, Haruo Kawamura, Takeshi Makihara, Yukio Shimizu

Taw qhia

Nws yog qhov paub zoo tias cov neeg mob uas muaj hyperparathyroidism theem nrab tshwm sim los ntawmmob raum mob(CKD) txhim kho theem nrabosteoporosis, uas ncetawgpheej hmoo, 2 Qhov chaw tshaj plaws ntawm lub plab moginsufficiency pob txhayog pob txha pubic? Pubictawgyog feem ntau ruaj khov thiab tuaj yeem kho conservatively. Peb qhia ntawm no ib rooj plaub ntawm acetabular insufficiencytawgkho nrog tag nrho hip arthroplasty (THA). Tus neeg mob A 78-tus txiv neej muaj hnub nyoog tau tuaj xyuas peb lub tsev kho mob vim nws taug kev tsis tau vim qhov mob nyob ib puag ncig sab laug lub duav tom qab poob thaum lub Kaum Ib Hlis 2010. Nws muaj keeb kwm kho mob ntawm nephrotic syndrome (membranous nephropathy) xyoo 1995 thiab gastrectomy (mob qog noj ntshav) xyoo 2005. Thaum thawj zaug hauv tsev kho mob nthuav qhia, nws nyias nyias; Nws qhov siab yog 152.5 cm, nws qhov hnyav yog 42.7 kg, thiab nws lub cev qhov hnyav yog 18.4. Nws yws txog qhov mob hnyav thiab mob hauv ib qho kev taw qhia txog sab laug sab laug pob qij txha. Cov kev tshawb fawb soj ntsuam pom tau tias muaj peev xwm ntawm lub duavtawg. Cov duab hluav taws xob ncaj ncees qhia tsis tautawgnyob rau sab laug hip sib koom tes los yog pelvis, txawm tias hnyav heevosteoporosisnrog Singh index qib ntawm 2 tau pom nyob rau hauv lub caj dab femoral (Daim duab 1). Peb tau ua magnetic resonance imaging (MRI) kom pom qhov txawv txav ntawm lub duav pob qij txha. T1- thiab T2- cov duab hnyav tau pom cov kab ntawm cov teeb liab qis siv obliquely nyob rau hauv lub metaphysis ntawm sab laug femur, uas sawv cev rau occult intertrochanterictawg(Daim duab 2). Kev kuaj ntshav thiab kuaj zis qhia tau tias muaj ntshav liab, tsis muaj zaub mov, thiab lub raum tsis ua haujlwm (Table 1). Kev sau ntawv tso cai tau txais los ntawm tsev neeg ntawm tus neeg mob rau kev tshaj tawm cov ntaub ntawv no thiab nrog cov duab.

cistanche: tshuaj ntsuab kho osteoporosis

Nws tau mus pw hauv tsev kho mob rau kev saib xyuas kev kho mob ntawm occult intertrochanterictawgntawm sab laug femur. Hnub 10 ntawm kev mus pw hauv tsev kho mob, nws tsim kev tsis qab los, xeev siab, thiab ntuav. Cov txheej txheem thib ob ntawm kev kuaj ntshav thiab kuaj ntshav tau pom tias muaj cov tsos mob ntawm uremic vim kev ua haujlwm ntawm lub raum tsis zoo thiab metabolic acidosis (Table 2 thiab 3). Nws raug kho tam sim ntawd nrog hemodialysis.

Ib nrab qhov hnyav-kev coj tus kheej ntawm nws sab laug ceg nrog tus neeg taug kev tau pib 4 lub lis piam tom qab occult intertrochanterictawgntawm sab laug femur. Yim lub lis piam tom qab lubtawg, nws dheev hnov ​​mob heev nyob rau hauv lub contralateral lub duav thaum nws sawv ntawm nws lub txaj. Vim yog mob sab xis mob hnyav, nws tsis tuaj yeem sawv lossis taug kev. Ib daim duab hluav taws xob dawb pom tau tias muaj acetabulartawgnrog kev nkag mus ntawm lub taub hau femoral rau hauv lub plab (Daim duab 3). Peb tau ua ib qho MRI ntawm lub duav sib koom ua ke dua thiab pom txoj cai acetabulartawgthiab cov teeb liab hloov qhia txog hematoma ntawm txoj cai hip sib koom kab noj hniav (Daim duab 4). Kev suav tomography qhia tau hais tias lub hauv paus dislocation vim nkag mus ntawm lub taub hau femoral los ntawm lub rooj sab hauv ntawm lub pelvis yam tsis muajpob txhantawm anterior thiab posterior pelvic kab. Raws li kev tshawb pom CT, tus neeg mob tau kuaj pom tias muaj qhov nruab nrabtawg-dislocation ntawm sab xis lub duav (Daim duab 5). Kev kuaj ntshav thiab zis tau rov ua dua los txheeb xyuas qhov ua rau qhov tsis txaustawg. Cov ntshav biochemistry qhia pom qhov nce siab ntawm cov tshuaj parathyroid tsis zoo (681 pg / mL), txo qis ntawm 1.25-dihydroxy vitamin D (4.9 pg / mL), nce ntawm osteocalcin (radioimmunoassay) (25 ng / mL. ), txo qis ntawm Ca*(7.0 mg/dL), thiab ib txwm muaj cov phosphorus inorganic (4.7 mg/dL). creatinine-kho urinary N-terminal telopeptide ntawm hom 1 collagen qib siab heev ntawm 403.7 nmol pob txha collagen sib npaug / mmol creatinine. Lub osteosono-kev ntsuam xyuas Performance index (OSI) ntawm txoj cai calcaneum tau txiav txim siab siv lub tshuab kuaj xyuas pob txha ultrasound (AOS-100NW, Hitachi-Aloka Medical, Ltd..Tokyo, Nyiv). OSI yog 1.827 (× 10), uas yog 63 feem pua ​​​​ntawm cov tub ntxhais hluas txhais tau tias.

Daim duab 3Cov duab hluav taws xob ncaj qha coj los ntawm qhov pib ntawm qhov mob hauv lub duav sab xis. Ib qho acetabulartawgthiab nkag mus ntawm lub taub hau femoral mus rau midline tau pom, thiab hauv nruab nrabtawgthiab dislocation ntawm lub duav sab xis tau kuaj pom.

Daim duab 4Sib nqus resonance imaging ntawm lub duav sib koom tom qab raug mob ntawm txoj cai hip (coronal daim ntawm lub duav sib koom; sab laug, T1- hnyav duab; txoj cai, T2- hnyav daim duab).Ib acetabulartawgthiab teeb liab hloov qhia txog hematoma nyob ib ncig ntawmtawgqhov chaw tau pom nyob rau sab xis.

cistanche: tshuaj ntsuab kho osteoporosis

Daim duab 5Kev suav tomography ntawm lub duav sib koom ua ke tom qab raug mob ntawm sab xis lub duav (sab laug. multiplanar reconstruction [MPR] coronal hlais; sab xis, peb-seem [3D] rov tsim dua tom qab). Daim duab MPR qhia txog femoral taub hau deformity. Kev tsim kho 3D qhia tau hais tias lub taub hau femoral nkag mus rau hauv cheeb tsam sab hauv ntawm lub plab mog.

Vim tias nws yog neeg laus thiab muaj ntau yam teeb meem kho mob, peb xaiv THA es tsis yog qhib kev txo qis thiab kho lub plab sab hauv. Kev phais tau ncua kwv yees li 6 lub lis piam tom qab acetabulartawgtso cai rau stabilization ntawm cov ntaub so ntswg mos ntawm lubtawgqhov chaw. Peb siv txoj hauv kev tom qab mus rau lub duav sib koom. Peb tshem tawm lub taub hau femoral thiab muab tso rau hauv ib lub pob zeb zeb. Cov pob txha morselized tau tov nrog cov pob txha tsim thiab ntim nruj rau hauv cov acetabulum freshened. Tom qab ntawd, lub nplhaib acetabular (Lima Corporate, Udine, Ltalis) tau muab tso rau hauv acetabulum rau kev tsim kho dua tshiab, thiab ZCA Snap-In Cup (Zimmer, Warsaw, Indiana, USA) tau muab tso rau hauv qhov chaw. Rau cov femur, Versys Cemented Stem (Zimmer, USA) tau cemented nyob rau hauv qhov chaw (Daim duab 6). Lub cev hnyav ntawm sab xis yog pib 2 lub lis piam tom qab kev phais. Nws raug tso tawm 10 lub lis piam tom qab kev phais ntawm ko taw siv tus neeg taug kev Japanese. Nws tau tshaj tawm tias tsis muaj mob nyob rau hauv txoj cai pob qij txha li ntawm 18 lub hlis tom qab phais. Txawm hais tias nws xav tau lub rooj zaum muaj log mus rau qhov deb, nws muaj peev xwm taug kev nrog tus pas nrig rau ib qho luv luv hauv tsev.

cistanche: tshuaj ntsuab kho osteoporosis

Kev sib tham

Lub pathobiology ntawm cov pob txha metabolism hauv cov neeg mob CKD(mob raum mob)yog qhia nyob rau hauv daim duab 7. Tus neeg mob nyob rau hauv tsab ntawv ceeb toom no twb tau tsim ib tug thib ob hyperparathyroidism tshwm sim los ntawm lub raum tsis ua hauj lwm nyob rau hauv lub sij hawm ntawm kev kuaj thawj zaug Nws kuj muaj postgastrectomy undernutrition thiab malabsorption ntawm vitamin D.Lub 4 lub lis piam ntawm pw so tom qab sab laug occult. hiptawgtej zaum yuav muaj cov pob txha resorption, ua rau cov pob txha tawg loj heev, uas yuav ua rau muaj qhov tsis zoo ntawm lub hauv paus.tawg- dislocation ntawm lub duav.

Daim duab 7Mob pob txha metabolism hauv cov neeg mob nrogmob raum mob.1,25(OH),D,1,25-dihydroxy vitamin D;IP, inorganic phosphorus.

Pentecost et al. cais kev nyuaj siabpob txhaua qaug zogpob txha, uas tshwm sim thaum txawv txav kev nyuaj siab yog siv rau cov pob txha nrog ib txwm elastic kuj, thiabinsufficiency pob txha, uas yog tsim los ntawm kev sib dhos thiab rov ua dua ntawm cov txheej txheem sab nraud rau cov pob txha tsis zoo elasticity 4. Muaj ntau yam kab mob hauv qab uas tuaj yeem ua rauinsufficiency pob txha, suav nrog geriatricosteoporosis, rheumatoid mob caj dab, kho qhov ncauj steroid, hemodialysis radiotherapy rau cov kab mob malignant, thiab CKD(mob raum mob).

Muaj ntau cov ntaub ntawv qhia txogpob txhantawm pelvis vim pob txha fragility -5. Raws li Goto et al, tom ntej no feem ntau qhov chaw ntawmtsis txaustawgtxuam nrog rheumatoid mob caj dab, tom qab tus txha nraub qaum, yog lub plab mog. Txawm li cas los xij, feem ntau ntawm pelvictsis txauspob txhahauv lawv txoj kev kawm tau pubicpob txhapob txha, thiab lawv tsis suav nrog acetabularinsufficiency pob txha. Lwm cov kev tshawb fawb tau tshaj tawm txog cov mob me me ntawm lub plab pelvic fractures kuaj pom los ntawm radiographs lossis MRI ib leeg uas tau ua tiav nrog kev kho mob.,10. Txawm li cas los xij, tsuas muaj qee qhov xwm txheej qhia txog kev puas tsuaj hauv nruab nrab thiab qhov tawg ntawm lub duav xav tau kev kho mob phais.

Berman et al. qhia txog kev siv conservative kev kho mob raunruab nrabtawgthiab dislocation ntawm lub duav nyob rau hauv cov neeg mob uas mob raum tsis ua hauj lwm. Lawv tau pom tias chav kho mob tau zoo heev thaum qhov hnyav ib nrab tau pib tom qab traction thiab tsis muaj qhov hnyav rau 8 lub lis piam tab sis xav tias THA yuav tsim nyog tom qab vim qhov luv luv. Tsis tas li ntawd, Hirao et al. tau ua cov tsos mob ntawm cov neeg laus uas muaj Down syndrome nrog cov pob txha loj heev uas tsimnruab nrabtawgthiab dislocation ntawm lub duav nrog kev cia siab tias lub duav yuav raug mob ankylosis nyob rau hauv txoj hauj lwm dislocated2. Hoob no raug xaiv vim hais tias ob qho tib si mus sij hawm ntev traction thiab pw so los yog kev phais raug txiav txim siab tsis tsim nyog nyob rau hauv lub teeb ntawm tus neeg mob qhov kev nkag siab thiab kam rau ntawm txoj kev kho mob. Cov kws sau ntawv pom tias qhov mob hauv lub duav sib koom ua ke tau txo qis 7 lub hlis tom qab tustawgtab sis pom tias qhov ntau ntawm kev txav yog txwv thiab cov neeg mob tsis tuaj yeem txav tsis tau lub rooj zaum muaj log.

Cov kev kho mob loj tshaj plaws rau lub hauv siab hippob txhanrog dislocation yog qhib txo thiab THA, thiab nyob rau hauv tag nrho cov lus ceeb toom uas peb pom, THA tau ua vim qhov nyuaj ntawm anatomical internal fixation ntawm lub acetabulum protruding rau hauv lub plab mog thiab lub operative kev nyuaj siab. Fukunishi et al.13 thiab Fujinaka li al.14 tau tshaj tawm cov txiaj ntsig zoo tom qab THA tau ua tom qab 2 lub hlis yam tsis muaj qhov hnyav hauv tus neeg mob mob rheumatoid mob caj dab thiab tus neeg mob uas mob siab mob siab, raws li.

Hauv kev xaus, peb tau ntsib ib rooj plaub ntawm pelvictsis txaustawgnyob rau hauv ib tug neeg mob nrog theem nrabosteoporosisvim mob raum tsis ua hauj lwm thiab noj tsis txaus. Siv tautawgkev tiv thaiv tau nyuaj rau tus neeg mob nrog cov teeb meem saum toj no. THA nrog rau kev rov tsim kho ntawm acetabulum yog ib qho kev xaiv zoo rau cov neeg mob uas tsis muaj mob hauv nruab nrabtawg- dislocation ntawm lub duav.

cistanche: tshuaj ntsuab kho osteoporosis

Xaus

Peb qhia ntawm no ib rooj plaub ntawm nontraumaticnruab nrabtawgthiab dislocation ntawm lub duav nyob rau hauv ib tug neeg mob nrog CKD(mob raum mob). Cov neeg mob uas tsis muaj zaub mov tsis txaus vim lub raum tsis ua haujlwm ntev tuaj yeem ua rau mob hnyavtsis txauspob txhaxws li qhov no.THA nrog acetabular reconstruction siv lub nplhaib txhawb nqa thiab morselized pob txha graft tau zoo rau kev kho mob.nruab nrabtawg-dislocation ntawm lub duav nyob rau hauv tus neeg mob nrog cov teeb meem no.

cistanche: tshuaj ntsuab kho osteoporosis

Cov ntaub ntawv

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13. Fukunishi S, Fukui T, Nishio S, thiab al.Acetabular reconstruction siv KT phaj rau cov neeg mob RA nrog acetabulartsis txaustawg. Hip Joint 2009;35:519-522.

14. Fujinaka T, Yamaguchi K, Funayama A. A case ofnruab nrabtawgthiab dislocation ntawm lub duav xav tias ibinsufficiency pob txhatsis muaj kev raug mob sab nraud. Hip Joint 2010; 36: 639-641.