Mob raum Kab Mob Li Cas Ua Rau Fracture?

Hu rau: Audrey Huaudrey.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 Shimizu1, Hisanori Kameda1, Haruo Kawamuraz, Takeshi Makihara, thiab Yukiyo Shimizu

Abstract

Lub Hom Phiaj:Cov neeg mob uas muaj hyperparathyroidism theem nrab tshwm sim los ntawmmob raum mob(CKD) txhim kho osteoporosis theem nrab, uas ncetawgpheej hmoo. Peb tshaj tawm ib rooj plaub ntawm kev tsis txauspob txhacomplex osteoporosis tshwm sim los ntawm lub raum tsis ua hauj lwm thiab gastrectomy.

Tus neeg mob:Ib tug txiv neej muaj hnub nyoog 78- xyoo uas muaj keeb kwm kho mob ntawm nephrotic syndrome thiab mob qog noj ntshav tau ntsib ib qho occult intertrochanterictawgntawm nws sab laug femur tom qab ntog.

Cov txiaj ntsig:Kaum hnub tom qab thawj zaugtawg, tus neeg mob tau kho nrog hemodialysis rau cov tsos mob uremic mob. Yim lub lis piam tom qab notawg, nws txhawb nqa txoj cai tsis txaus acetabulartawgthiab tau kho nrog tag nrho hip arthroplasty (THA).

Xaus:Rau cov neeg mob uas muaj CKD (mob raum mob), siv tautawgkev tiv thaiv yog qhov nyuaj. THA nrog rau kev tsim kho ntawm acetabulum yog ib qho kev kho mob zoo hauv cov neeg mob uas tsis muaj mob hauv nruab nrabtawg- dislocation ntawm lub duav.

Ntsiab lus:mob raum mob, theem nrab hyperparathyroidism, insufficiencytawg, centraltawg- dislocation ntawm lub duav

KEV PAB CUAM NTAWM CSITANCHE: KHO KIDNEY DISEASE & IMPROVE KIDNEY FUNCTION

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 osteoporosis theem nrab, uas nce ntxivtawgtxaus ntshai, 2). Qhov chaw tshaj plaws ntawm pelvic insufficiencytawgyog 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 kev txav ntawm sab laug lub duav 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 hauv sab laug hip sib koom tes los yog lub pelvis, txawm tias mob osteoporosis hnyav nrog Singh index qib 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 ib 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.

Table 1Initial kuaj ntshav thiab zis

Nws tau mus pw hauv tsev kho mob rau kev saib xyuas kev kho mob ntawm occult intertrochantericKev tawgntawm 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.

Rooj 2Thib ob kev kuaj ntshav thiab zis

Table 3Arterial blood gas test ntawm chav cua

Daim duab 1Daim duab xoo hluav taws xob los ntawm kev kuaj thawj zaug. Tsis muajtawgtau pom meej nyob rau sab laug lub duav. Singh Performance index rau lub caj dab femoral yog qib 2.

Daim duab 2Sib nqus resonance imaging (coronal hlais ntawm lub duav sib koom; sab laug, T1- hnyav dluab; sab xis, T2- hnyav duab). Atawgkab tau pom khiav obliquely hauv metaphysis ntawm sab laug femur.

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), qhov txo qis ntawm 1, 25-dihydroxy vitamin D, (4.9 pg / mL), nce ntawm osteocalcin (radioimmunoassay) (25 ng / mL), txo qis ntawm Ca2 ntxiv (7.0 mg/dL), thiab ib txwm muaj phosphorus (4.7 mg/L). 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 osteo sono-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 (× 109), 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 lub duav (coronal daim ntawm lub duav sib koom; sab laug, T1- hnyav duab; txoj cai, T2- hnyav duab). Ib qho acetabulartawgthiab teeb liab hloov qhia txog hematoma nyob ib ncig ntawmtawgqhov chaw tau pom nyob rau sab xis

Daim duab 5Muab xam tomography ntawm lub duav sib koom tom qab raug mob ntawm sab xis lub duav (sab laug, multiplanar reconstruction [MPR] coronal hlais; txoj cai, peb-seem [3D] reconstruction ntawm 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. Lub morselized D, (4.9 pg / mL), nce ntawm osteocalcin (radioimmunoassay) (25 ng / mL), qhov txo qis ntawm Ca2 ntxiv (7.0 mg / dL), thiab qib ib txwm ntawm inorganic phosphorus (4.7 mg/L). 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 (× 109), uas yog 63 feem pua ​​​​ntawm cov tub ntxhais hluas txhais tau tias.

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, thiab ZCA Snap-In Cup (Zimmer, Warsaw, Indiana, USA) tau muab tso rau hauv qhov chaw. Rau 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.

KEV PAB CUAM NTAWM CSITANCHE: KHO KIDNEY DISEASE & IMPROVE KIDNEY FUNCTION

Kev sib tham

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 7Cov pob txha metabolism hauv cov neeg mob uas muaj kab mob raum tsis zoo. 1,25(OH)2D3 ,1,25-dihydroxy vitamin D3 ; 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, thiab insufficiencypob 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 rau tsis txaustawg, suav nrog geriatric osteoporosis, 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 5-8. Raws li Goto et al., tom ntej no feem ntau qhov chaw ntawm insufficiencytawgtxuam nrog rheumatoid mob caj dab, tom qab tus txha nraub qaum, yog lub plab mog. Txawm li cas los xij, feem ntau ntawm cov pob txha pelvic insufficiency fractures nyob rau hauv lawv txoj kev tshawb no yog pubic pob txha fractures, thiab lawv tsis suav nrog acetabular insufficiency.pob txha5. Lwm cov kev tshawb fawb tau qhia txog cov mob me me ntawm lub plab mogpob txhakuaj pom los ntawm radiographs lossis MRI ib leeg uas tau ua tiav nrog kev saib xyuas kev kho mob. 10. Txawm li cas los xij, tsuas muaj qee qhov xwm txheej qhia txog kev puas tsuaj hauv nruab nrab thiab dislocation ntawm lub duav xav tau kev kho mob phais.

Berman et al.reported kev siv cov kev kho mob conservative rau centraltawgthiab 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.performed symptomatic kev kho mob nyob rau hauv cov neeg laus nrog Down syndrome nrog hnyav pob txha fragility uas tsim centraltawgthiab 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.5and Fujinaka et 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 cov ntsiab lus, peb tau ntsib ib rooj plaub ntawm pelvic insufficiencytawgnyob rau hauv ib tug neeg mob uas muaj ob tug osteoporosis vim lub raum tsis ua hauj lwm thiab tsis muaj zaub mov. Kev tiv thaiv pob txha zoo yog qhov 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.

KEV PAB CUAM NTAWM CSITANCHE: KHO KIDNEY DISEASE & IMPROVE KIDNEY FUNCTION

Xaus

Peb qhia ntawm no ib rooj plaub ntawm nontraumatic centraltawgthiab dislocation ntawm lub duav nyob rau hauv tus 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 muaj kev tsis txaus siab lojpob txhazoo li no. THA nrog acetabular reconstruction siv lub nplhaib txhawb nqa thiab morselized pob txha graft tau zoo rau kev kho mob hauv nruab nrabtawg-dislocation ntawm lub duav nyob rau hauv tus neeg mob nrog cov teeb meem no.

Cov ntaub ntawv

1. Skorecki K, Green J, Brenner BM. Lub raum tsis ua haujlwm. Hauv: Harrison's Principles of Internal Medicine. 16 ed ib. Kasper DL, Braunwald E. Fauci AS, et al., Eds. McGraw-Hill, New York, 2005; 1653-1663.

2. Bringhurst FR, Demay MB, Krane SM, et al.Bone thiab mineral metabolism hauv kev noj qab haus huv thiab kab mob. Hauv: Harrison's Principles of Internal Medicine. 18th ed.Longo DL, Fauci AS, Kasper DL, et al.Eds. McGraw-Hill, New York, 2011; 3082-3095.

3. Goto Y, Tanaka T, Mishima H, et al. Kev tsis txaustawgtxuam nrog rheumatoid mob caj dab: Tsib rooj plaub. Kanto J Orthop thiab Traumatol 2005; 36: 104-108.

4. Pentecost RL, Murray RA, Brindley HH.Fatigue, insufficiency, thiab pathologicpob txha. JAMA 1964; 187: 1001-1004. [Medline] [CrossRef]

5. Morinaga Y, Souma H, Kimura M. Insufficiencytawg.J East Jpn Orthop Traumatol 2001; 44: 1275-1285.

6. Nishigaki Y, Tokunaga D, Fujioka M, et al. Peb kis ntawm pelvicpob txhahauv cov neeg mob rheumatoid mob caj dab. J East Jpn Orthop Traumatol 2003; 46:779-783.

7. Takemoto T, Suda M, Kitahara T, thiab al.Pelvic insufficiencytawg; ceeb toom ntawm 12 rooj plaub. Phau ntawv Journal of the Japanese Orthopedic Association 2002; 55: 1634-1639.

8. Yoshimine F. Kaum rau kis ntawm occult thiab insufficiencytawgntawm lub plab mog. Phau ntawv Journal of Japan Fracture Society 2007;29:524-528.

9. Hashidate H, Kamimura M, Nakagawa H, thiab al.Insufficiencytawgntawm acetabulum tsis pom kev raug mob. Mod Rheumatol 2007;17:163-166. [Medline][CrossRef]

10. Cooper KL, Beabout JW, McLeod RA. Supraacetabular tsis txauspob txha. Radiology 1985; 157: 15-17. [Medline][CrossRef]

11. Berman AT, Metzger PC, Chinitz JL. Central acetabulartawg-Dislocation thib ob rau kev qaug dab peg qaug dab peg hauv tus neeg mob lub raum mob. J Trauma 1981; 21:66-67. [Medline] [Cross-Ref]

12. Hirao Y, Ohe T, Tatsumi T, et al. Mob hnyav tsis txaustawgnyob rau hauv 2 Down's syndrome cov neeg laus. Kanto J Orthop Traumatol 2005; 36:226-229.

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

14.Fujinaka T, Yamaguchi K, Funayama A. A case of centraltawgthiab dislocation ntawm lub duav assumes ib tug insufficiency puas yam tsis muaj kev raug mob sab nraud. Hip Joint 2010;36:639-641.

KEV PAB CUAM NTAWM CSITANCHE: KHO KIDNEY DISEASE & IMPROVE KIDNEY FUNCTION