Oprehyɛn a wɔatoto mu a wɔtew so ma nipadua no ase a abubu.

Closed reduction yɛ ɔkwan a ɛnyɛ den koraa a wobetumi de adi dwuma ama akisikuru a ɛyɛ den a mogya nkɔ mu, asiane biara nni ho sɛ ɛbɛka ɔyare mmoawa, ɛyɛ adwuma ntɛmntɛm, ayaresa ho ka so tew kɛse, na wobetumi de adi dwuma ama closed reduction hollow nail ne intramedullary pin fixation ayaresa a ɛyɛ akisikuru ahorow a entumi nnyina, te sɛ femoral neck fractures, femoral stem fractures, tibiofibular akisikuru, humeral dua a abubu, . ne nea ɛkeka ho, a ɛma mogya a ɛsen no sɛe denam ntwitwiridii a wɔtew so no so.

Asen no kɔn a abubu

(I) Nneɛma a wɔtwetwe

Wɔde ɔyarefo no to mpa so, na wɔde ɔhonam akwaa a ɛka no no yɛ tibial tuberosity traction wɔ tebea a ɛnyɛ nea ɛfa biribiara ho a wɔdannan ne mu brɛoo. Ɛsono sɛnea wɔtwetwe no mu duru wɔ onipa biara mu, mpɛn pii no ɛyɛ kilogram 6-9, na ɛnsɛ sɛ bere tenten a wɔde twetwe no boro nnɔnhwerew 12. Ayarefo 90% betumi anya repositioning denam traction so.

(B) wɔatoto manipulative repositioning

Sɛ traction ntumi nnya ahwehwɛde ahorow a ɛfa repositioning a, wobetumi de nsa de repositioning aka ho, wɔ epidural anesthesia ase:

1. MC Elvenny kwan a wɔfa so yɛ no

Botae no ne sɛ wobesiesie akyi berɛmo no, wɔbɛdannan ɔhonam akwaa a ɛka no no akɔ akyi na ama tumi a ɛtwetwe no akɔ soro, na afei wɔadannan wɔ mu na wɔatwe ɔhonam akwaa a ɛka no no akɔ akyi na ama wɔadu atirimpɔw a ɛne sɛ wɔbɛsan de asi baabi foforo no ho.

2. Leadbetter kwan a wɔfa so yɛ adwuma

Ɔyarefo no da fam petee, kotow asen ne ne kotodwe a ayɛ no yaw no 90°, twe ne ho fa asen a ɛwɔ ɔhonam akwaa a ɛka no no so simma 2 kosi 3, afei ɔdannan ɔhonam akwaa a ayɛ no yaw no wɔ mu na ɔbɔ no brɛoo, bere a ɔsan de si hɔ akyi no, ɔbrɛ ɔhonam akwaa a ɛka no no ase brɛoo, na sɛ ɛte sɛ nea nan a ayɛ no yaw no ntumi nkyinkyin akyi a, ne fã kɛse no ara kyerɛ sɛ wɔasan asiesie no yiye. Ansa na wɔbɛyɛ emu fixation no, na wɔde C-arm afiri no dii dwuma de hwɛɛ sɛ ɛyɛ nokware anaa.

(C) Ɔkwan a wɔfa so hwehwɛ ade a wɔde fa honam ani

Sɛ wɔantumi amfa akwan a ɛwɔ atifi hɔ no antumi ankɔ baabi foforo a, ɛtaa kyerɛ sɛ wɔabubu asen ti no anaasɛ mpaapaemu a ɛkyinkyini wɔ ti ne kɔn ntam (Mfonini 1A), anaasɛ wɔde biribi ahyɛ ti ne kɔn ntam baabi. (Eyi betumi aba wɔ Turo II, III, anaa IV ahorow no mu biara mu). Wɔ eyi mu no, sɛ wɔdannan ɔhonam akwaa a ɛka no ma ɛne ti ne kɔn a abubu no hyia a, ɛnyɛ nea etu mpɔn bio. Nea ɛbɛyɛ na wɔakwati sɛ wɔbɛtwitwa na wɔasan de asi baabi foforo no, wobetumi de ɔkwan a wɔfa so hwehwɛ ade a wɔde fa honam ani no adi dwuma de asan de nea abubu no asi baabi foforo.

• Wɔde dompe kurukuruwa ade a ne kɛse yɛ mm 3.0 kosi 3.5 hyɛ honam ani gyina hɔ tẽẽ wɔ inguinal ligament ne femoral artery no nhyiam ase kɔ asen ti no anim, na wɔdannan ade no kɔ akyiri kodu asen ti no mfinimfini wɔ C-arm afiri no hwɛ ase (Mfonini 1B).

• Sɛnea ɛbɛyɛ na tumi a ɛhwehwɛ ade no mu ayɛ den no, wobetumi de ade a ɛto so abien a ɛyɛ kurukuruwa a ɛyɛ nnompe ahyɛ mu a ɛne ade yi di nsɛ mm 4-5, na wɔagyaw ade no awiei wɔ honam ani.

• Wɔnam trochanter kɛse no so tu nnompe kurukuruwa nnade abien a ne kɛse yɛ mm 3.5 wɔ honam ani sɛnea awotwaa no dua no anim ne anim a ɛdannan no hyia, na ɛkɔ asen no kɔn a abubu no awiei akyirikyiri (nfa abubuw no mu) na wogyaw ade no awiei wɔ honam ani.

• Ɔyɛ adwuma no de ne nsa mmienu kura nnade dua mmienu no mu na ɔsesa ti ne kɔn mu abubuo afã ahodoɔ no ma ɛne wɔn ho wɔn ho hyia denam ɔboafoɔ no adwumayɛ so (Mfonini 1C-E).

• Bere a wɔayɛ no pɛpɛɛpɛ akyi no, wɔde dompe kurukuruwa pin bi a wɔde ahyɛ trochanter kɛse no mu no hyɛ asen no ti mu ma wɔde si hɔ bere tiaa bi, na afei wɔde nkɔnsɔnkɔnsɔn pii a ɛyɛ tokuru hyɛ asen ti no mu (Mfonini 1F).

Ɔkwan a wɔfa so tew so a wɔatoto mu a yɛaka ho asɛm wɔ atifi hɔ no betumi anya tew a wɔhwehwɛ wɔ bɛyɛ 98% wɔ asen kɔn a abubu no mu. Dodow a abubuw no hyia yiye, sɛ́ ɛyɛ nea wɔato mu anaasɛ wɔatwa no, dodow no ara na nkɔmhyɛ no ye. Mpɛn pii no, sɛnea abubu no mu a ɛpae a wɔda no adi wɔ X-ray so no sua sen sɛnea abubu no mu apaapae ankasa. Esiane sɛ akisikuru no a ɛne ne ho hyia no nya akisikuru no ayaresa ne sɛnea ebetumi aba sɛ asen no ti no bɛwuwu no so nkɛntɛnso tẽẽ nti, ɛho hia sɛ wonya X-ray sini no ho atemmu a ɛteɛ wɔ akisikuru no a ɛne ne ho hyia no akyi. Sɛ S-shaped curve no nnyɛ torotoro anaasɛ wɔatwa mu a, ɛkyerɛ sɛ femoral neck fracture no nnya nduu anatomical repositioning (Mfonini 2).

Mfonini 1 Femoral neck fracture a wɔsan de si hɔ denam percutaneous needle prying so

Mfonini 2 Femoral neck fracture X-rays a ɛkɔ so akyi curve wɔ anatomical alignment mu ne interrupted external curve wɔ non-anatomical alignment mu

Femoral dua a ɛpaapae

Ɔkwan a wɔfa so tew so a wɔatoto mu no betumi aboa ma asen no dua a abubu no ahyia a ɛrensɛe ntini a ɛyɛ mmerɛw biara anaa mogya a ɛkɔ abubu no awiei, na wobetumi de nnadewa a ɛwɔ asen no mu ahyɛ mu.

• Wɔ epidural anesthesia ase no, ɔyarefo no da mpa no so petee (wɔnhyɛɛ ɔhonam akwaa a asɛe no honam ani saa bere yi), ɔboafo biako kura ɔhonam akwaa a ayɛ no yaw no nantwi ba, na ɔboafo foforo no de ntama abɔso twe ɔyarefo no asen ntini no de siw twetwe no ano, na ɔhonam akwaa a ɛka no no gyina baabi a ɛnyɛ nea ɛfa biribiara ho na kotodwe no akyi kwan no hwɛ soro (femoral stem fracture no yɛ mpɛn pii no, ɛnyɛ nea ɛkyinkyini na ntini na ɛtu twe, na wobetumi de twetwe asiesie no ara kwa, enti nea ehia ara ne sɛ nea ɔde di dwuma no siesie dua no awiei a abubu no anim-akyi ne akyi a ɛtwetwe no).

• Ɔyɛ adwuma no de ne nsa abien no nyinaa twa ɔhonam akwaa a ɛka no ho hyia na ɔde nsa no bom (Mfonini 3 ne Mfonini 4), na ɔteɛteɛ akisikuru no anim-akyi ne akyi a ɛtwetwe no prɛko pɛ denam tumi a ɛkyekyere a ɛyɛ oblique clamping force a ɛwɔ anim nsa abien no nyinaa mu no so.

• Sɛ nhwɛso no, sɛ wɔdan asen a abubu no fã a ɛbɛn no kɔ abɔnten ne anim a, wɔde anim nsa biako piapia akisikuru no fã a ɛbɛn no kɔ mu ne fam. Anim nsa foforo no piapia afã a ɛwɔ akyirikyiri a ɛpaapae no kɔ abɔnten ne soro de fɛm tumi a ɛkyekyere no (ɛsɛ sɛ oduruyɛfo a ɔsan siesie no no nya atemmu a ɛfata wɔ ɔkwan a abubuw no tu kɔ baabi foforo ne kwan a ɛkɔ baabi foforo no ho ansa na wɔasan de asi hɔ), sɛnea ɛbɛyɛ a wobetumi asan de abubuw no asi hɔ yiye bere koro mu. Bere a wɔresan de asi baabi foforo no, ɛsɛ sɛ ɔboafo no ma tumi a ɛtwetwe no yɛ kɛse na ɔmma asen no ntumi nkyinkyin.

• Sɛ wɔde lap abubu no awiei titiriw a, ɛsɛ sɛ wɔte nnyigyei a ɛyɛ mmerɛw a ɛrebɔ dompe no, saa bere yi de, ɛsɛ sɛ ɔboafo no da so ara kura twetwe mu, nanso ɛtew tumi a ɛtwetwe no so.

• Sɛ C-abasa afiri no na ɛma abubu no hyia titiriw (sɛ ɛda so ara yɛ nea ɛnhyia kakra a, yɛ nsakrae bi na ama woahwɛ ahu sɛ abubu no awiei ne wɔn ho wɔn ho hyia), kɔ so twetwe no mu, kum ɔyare mmoawa wɔ ɔhonam akwaa a ɛka ho no mu na trɛw mpopaho no mu, na afei yɛ nnadewa a ɛwɔ medullary no mu.

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Mfonini 3 Wɔsiesie akisikuru no anim-akyi ne akyi a ɛkɔ baabi foforo no bere koro mu denam nsa abien no nyinaa a wɔde kyekyere ɔhonam akwaa a ɛka ho no so na wɔde nsa no bom, de tumi a wɔde kyekyere nsa abien no nyinaa di dwuma no so.

Mfonini 4 Femoral stem fracture repositioning mfiridwuma ho nhyehyɛe

• Wɔ ayarefo a wɔn akisikuru kɛse atu, wɔatoto mu a entumi nyɛ yiye anaasɛ wɔabubu a wɔabubu no fam no, wobetumi de oprehyɛn twetwe mpa adi dwuma de atoto mu a wɔde adwinnade ahoɔden bi atew so, a ɛno nso betumi awie asen dua a abubu no a wɔato mu no so awie wɔ ɔkwan a etu mpɔn so.

• Bere a wɔde ɔhonam akwaa a ɛka no no ato traction frame no so ma wɔatwe na C-abasa nhwehwɛmu no ada no adi sɛ wɔasiesie abubuw a ɛkata so no akyi no, wobetumi ayɛ nsakrae wɔ ɔhonam akwaa a ɛka no no awiei a ɛwɔ akyirikyiri no mu akɔ mu de asan de ahyiadi ne nea ɛne ne ho hyia bio wɔ orthostatic mfonini a ɛwɔ asen no dua no mu no aba.

• Esiane sɛ asen ntini a ɛtwetwe wɔ twetwe ase no betumi adi dwuma wɔ ntini a ɛyɛ mmerɛw a ɛbɔ wɔ asen no dua a abubu no so nti, asen ntini a abubu no mu dodow no ara betumi anya ahyiadi a ɛma abotɔyam kɛse wɔ orthogonal x-ray mfonini no mu.

• Nanso, saa bere yi, esiane mmoa a etu mpɔn a enni hɔ wɔ akisikuru no fã a ɛwɔ akyirikyiri no awiei wɔ tumi a ɛtwe ade ba fam no nkɛntɛnso ase nti, asen no dua no fã a abubu a ɛwɔ akyirikyiri no mu dodow no ara tu kɔ akyi, na saa bere yi de, wobetumi de abɔso a wɔde mpopaho akata so a ɛnyɛ ɔyare mmoawa no ahyɛ akyi fã a ɛwɔ akyirikyiri abubu no awiei bere a wɔayɛ sterilization ne honam ani ahosiesie na wɔde ntama a ɛnyɛ sterile agu, ne akyi no a wotu wɔn fi wɔn afie mu wobetumi asiesie distal fracture awiei no denam brace no sorokɔ a wɔbɛsesa so.

• Sɛ wɔda so ara nsiesiee akyi a ɛtu a ɛwɔ akyirikyiri no fã a ɛpaapae no a, wobetumi de nnadewa a ɛbɛn no asi hɔ wɔ honam ani wɔ trochanter kɛse no atifi anaa pyriform fossa no atifi, na afei wɔde intramedullary repositioning poma no ahyɛ medullary cavity a ɛwɔ proximal fracture fã a ɛwɔ femur no mu no mu, na wɔama intramedullary repositioning poma no nsa no so a ɛkɔ anim wɔ ɔkwan a ɛfata so sɛnea ɛbɛyɛ a wɔbɛbrɛ asen no mu akisikuru a ɛbɛn no ase akɔ akyi denam poma a wɔde san de si baabi foforo no lever a wɔde bedi dwuma no so, na wɔnam saayɛ so asan ne akyirikyiri abubuw a wɔatu afi akyi no ahyia, .

• Sɛ wɔde abubuw no hyia wie a, wɔde akwankyerɛ pin tenten bi hyɛ abubuw a ɛwɔ akyirikyiri no mu de wie reset a wɔato mu no. Intramedullary repositioning rod no tu mpɔn titiriw wɔ flexion, abduction, ne external rotation deformities a ɛtaa ba wɔ proximal fractures of the proximal femur mu no siesie mu (Mfonini 5).

• Sɛ residual lateral displacement, wobetumi ayɛ nsakrae wɔ intramedullary poma no awiei a ɛyɛ kurukuruwa no bue no mu ma akyerɛ akwankyerɛ pin tenten no kwan akɔ distal fracture cavity no mu de awie closed reduction no.

• Ɔkwan foforo a wɔfa so tew so a wɔatoto mu ne sɛ wɔde Schanz nnadewa bɛbɔ nnompe no mu wɔ nnompe no fã a ɛwɔ akisikuru no awiei a wɔatu no no nkyɛn na wɔde Schanz nnadewa no asiesie abubuw no awiei ama wɔatoto so atew (Mfonini 6). Sɛ wɔde akisikuru no hyia yiye wie a, wɔde nnadewa a ɛwɔ medullary no mu no hyɛ akisikuru no proximal ne distal medullary cavity no mu de wie emu fixation no (Mfonini 7).

  
  

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Mfonini 5 Nsakraeɛ a ɛfa proximal fracture fã no ho ma closed repositioning denam intramedullary repositioning rod no so

Mfonini 6 Closed reduction denam Schanz nnadewa a wɔde ahyɛ ɔfã biako dompe cortex wɔ abubuw awiei

Mfonini 7 Closed reduction intramedullary nail fixation a ɛwɔ multisegmental comminuted fracture of the femoral stem a wɔde Schanz nnadewa no di dwuma

Ankle a abubu

(A) Ahosiesie a wɔyɛ ansa na wɔayɛ oprehyɛn

• Radiographic diagnosis: Ɛsɛ sɛ standard ankle imaging evaluation no de afã 3 ka ho: anteroposterior (Mfonini 8), ankle point (15° of internal rotation) (Mfonini 9), ne lateral (Mfonini 10).

• Sɛ ankle nkwaa no pira kɛse a, ankle ne talus no mu ne akyi no bɛtu akɔ soro akodu digrii ahorow 11 (Mfonini 11). Radiographs a ɛwɔ baabiara no nkyerɛ sɛnea ankle nkwaa no gyina pintinn no pɛpɛɛpɛ. Stress radiographs ne MRI betumi ama nhwehwɛmu a wɔyɛ wɔ sɛnea ankle nkwaa no gyina pintinn ne ligament a asɛe no atu mpɔn (Mfonini 12).

• Wɔ eyi mu no, ɛsɛ sɛ wɔde ɔkwan a wɔfa so pira no ne radiological data a ɛfa ɔhonam akwaa a ɛka ho no so kyerɛ sɛnea anansoaa apira no pɛpɛɛpɛ sɛnea ɛbɛyɛ a wɔbɛkyerɛ sɛnea wɔbɛsan de asi baabi foforo ne nea wɔde besi hɔ no kwan yiye.

• Ɛtɔ da bi a, medial ankle fracture a ɛnyɛ den betumi ayɛ 'Maisonneuve fracture' a ɛyɛ den kɛse no fã, a proximal fibula fracture ne ligament opira a wɔaka abom nso ka ho, enti ɛsɛ sɛ wɔde radiographic hwehwɛ tibiofibula no nyinaa mu.

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Mfonini 8 Anim ne akyi gyinabea

Mfonini 9 Ankle points (15° a ɛkyinkyini wɔ mu) .

Mfonini 10 Akyi gyinabea

Mfonini 11 Ɛda adi sɛ fracture displacement ne dislocation abɔ mu

Mfonini 12 Adwennwen radiograph (ahinanan ntini a ɛpaapae) .

(II) Nnuru a wɔde kum nipadua no

Wɔtaa fa asen ne sciatic ntini mu aduru a wɔde kum nipadua no.

(C) ɔkwan a wɔfa so siesie nneɛma

Wɔyɛ akyi-akyi kyinhyia a ɛyɛ closed repositioning no wɔ nhyehyɛe a ɛne abɔnten ankle-mfinimfini ankle-akyi ankle-inferior tibiofibular union no hyia. Wɔyɛ akyi kyinhyia-mfinimfini kyinhyia su no wɔ nhyehyɛe a ɛwɔ mu ankle-akyi ankle no mu.

• Wɔ akyi-akyi kyinhyia type IV fam no, wɔde ɔyarefo no si baabi a ɔda fam na wɔbɔ ne kotodwe no 90° de ma nantwi ba no triceps no dwo.

• Aboafo baanu kura asen no fã a ɛyɛ popliteal ne nan no, na wɔde twetwe no di dwuma wɔ baabi a abubu no asɛe (ɛnsɛ sɛ tumi a ɛtwetwe no boro so na amma opira no mu ayɛ den).

• Ɔboafoɔ a ɔtwe nan no dannan nan no kɔ mu de siesie abɔnten so kyinhyia no mu dɛmdi no (Mfonini 13). Bere a ɔpia akyirikyiri awiei no kɔ tibial fã na ɔtwe distal tibia no kɔ fibular fã no, ɔboafo no dan ne ho kɔ mu na ɔtrɛw ankle nkwaa no mu wɔ akyi de siesie abɔnten ankle ne talus no a ɛtu no (Mfonini 14).

• Kura emu kyinhyia-mfinimfini kyinhyia-akyi ntrɛwmu gyinabea no mu. Afei wɔde nsateaa abien no nyinaa kura akyi nansoaa a abubu no mu, nsateaa anan no twa asen a ɛwɔ akyirikyiri no ho hyia, na nsateaa abien no nyinaa piapia na ɛpiapia kɔ akyirikyiri, bere a ɛtwe asen a ɛwɔ akyirikyiri no kɔ fam de san de akyi nansoaa no si hɔ (Mfonini 15).

• Awiei koraa no, nea ɔyɛ adwuma no de ne nsateaa pia mfinimfini nansoaa no kɔ akyi na ɛkɔ fam de san de si hɔ (Mfonini 16). Aboafo baanu hwɛ nan ne nansoaa no so wɔ emu a ɛkyinkyini-mu ɛkyinkyini-akyi ntrɛwmu gyinabea no mu de siesie wɔn ho ma fixation.

Mfonini 13 Traction correction a ɛfa abɔnten so rotation deformity ho

Mfonini 14 Nsiesiei a ɛfa akyi a ɛtwetwe akyi anan ne talus no ho

Mfonini 15 Nsiesiei a ɛfa akyi ankle nsakrae ho

Mfonini 16 Nsiesiei a ɛfa ankle a ɛkɔ mu no ho

Akyi-akyi-mfinimfini repositioning nhyehyɛe no ne post-rotation-akyi repositioning nhyehyɛe no bɔ abira na wɔyɛ no wɔ nhyehyɛe a ɛwɔ mu ankle-akyi ankle.

Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!

Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.

Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.

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