Afɔkpodzi ƒe kɔ ƒe gbagbã nye ƒumeŋuɖui ƒe abi siwo wodoa goe wu le atikewɔƒewo dometɔ ɖeka, eye dɔnɔ tsitsi akpa gãtɔ nyea akɔta ƒe gbagbã ƒe 50% kple edzivɔ. Akɔntabubuwo ɖee fia be akɔta ƒe kɔ ƒe gbagbã dzi ɖe edzi vivivi le ƒe ʋɛ siwo va yi me, eye nyɔnuwo dzie wòdzɔna wu ŋutsuwo. Vertigo, tagbɔdɔléle, dɔléle vɔ̃ɖi kple dzitodzito me dɔléle le ame tsitsiwo me kple abi siwo ŋusẽ geɖe xɔxɔ le sɔhɛwo me nye nusiwo ate ŋu ana afɔkpodzi ƒe kɔ nagbã.
Le ƒe ʋɛ siwo va yi me la, nu geɖe siwo wotsɔ léa ememenuwo ɖe te abe gavi siwo me do le, gavi siwo ŋu ŋusẽ le (DHS), gavi siwo wotsɔna ƒoa akɔta (HSH), gavi siwo wotsɔ lãa afɔkpodzi si te ɖe wo nɔewo ŋu, ɖa siwo wotsɔ gbugbɔa nuwo gbugbɔna, kple Gamma ɖawo do. Le nusiwo wotsɔ léa ememe nu siawo dome la, gavi siwo me do le ye wozãna wu. Numekukuwo ɖee fia be amekola akpa gãtɔ lɔ̃a gavi siwo me do le tsɔ daa akɔta ƒe gbagbã siwo womeʋu o, eye amekolawo ƒe akpa gã aɖe tiae be yewoazã gavi siwo me do le na akɔta ƒe kɔ ƒe gbagbã siwo woɖe ɖa. 3 parallel akpa aɖe threaded hollow screw fixation nye ememe fixation ƒomevi si dzi woda asi ɖo wu.
Afɔkpodzi ƒe kɔ ƒe gbagbã ƒe ŋutilã ƒe wɔwɔme
Fifia wolɔ̃ ɖe edzi be ʋuka siwo le afɔkpodzi ƒe ta ŋue nye nu vevitɔ kekeake si kpɔa ŋusẽ ɖe afɔkpodzi ƒe gbagbã ƒe dɔyɔyɔ kple afɔkpodzi ƒe ta ƒe kuku dzi. Nusiwo gblẽ le afɔkpodzi ƒe ta ƒe ʋu ƒe lãmenugbagbeviwo ŋue nye dɔléle vevitɔ si nana afɔkpodzi ƒe ta ƒe ʋuka me ʋu ƒe sisi. Numekuku aɖe si wowɔ ɖe ɖoɖo nu le akɔta ƒe kɔ ƒe ʋukawo ƒe wɔwɔme ŋu ɖee fia be epiphyseal vascular network kple arterial system si le inferior supporting zone ate ŋu anye xɔtuɖoɖo veviwo hena ʋu ƒe sisi ɖe afɔkpodzi ƒe ta me le afɔkpodzi ƒe kɔ ƒe gbagbã megbe, ale be le dɔwɔwɔ me ƒe tomekuku kple edede eme wòate ɖe afɔkpodzi ƒe titina nuto ŋu alesi wòanya wɔe ate ŋu aɖe abi si woate ŋu awɔ le atikewɔwɔ me na ʋuka si le ƒu me mɔnu.
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Nɔnɔmetata 1 Ʋu ƒe sisi yi afɔkpodzi ƒe ta, ŋgɔgbe (a) kple megbe (b) kpɔkpɔ. Vovototo le ʋu ƒe sisi yi afɔkpodzi ƒe ta me, gake axadzi kple titina ƒe akɔta ƒe ʋukawo dzɔna tso afɔkpodzi ƒe ʋuka goglo me le dɔnɔ 60% me.
(1) Ʋu si yia afɔkpodzi ƒe ta ƒe akpa gãtɔ tsoa afɔkpodzi ƒe ʋuka si le axadzi si woyɔna be lateral rotor femoral artery me.
(2) Eɖea alɔ 3 alo 4 siwo léa ʋuka si wotsɔ ka blae la ɖe te la dona. Alɔ siawo zɔa mɔ yia megbe kple dzi to afɔkpodzi ƒe kɔ si le ƒunukpeƒe ƒe akpa si wogbugbɔ ƒo ɖe megbe la dzi va ɖoa afɔkpodzi ƒe ta ƒe nugbɔ si le abe ƒunukpeƒe ene. Ʋuka siwo le lãkusi goglo la me.
(3) Woɖee tso foramen occulta ʋuka me. Medial rotor femoral artery ƒe alɔdze si le dzi yim.
(4) Enaa afɔkpodzi ƒe trochanter gãtɔ eye wòwɔa ʋuka ƒe asigɛ kple lateral rotor femoral artery.
Kplu siwo me do le na afɔkpodzi ƒe kɔ ƒe gbagbã
Le dɔdamɔnu nu la, woate ŋu azã ƒu ƒe ʋuƒo etɔ̃ siwo me do le siwo ƒe didime nye milimeta 6.5 alo milimeta 7.0 alo milimeta 7.3 atsɔ atɔ te wo le dɔnɔ siwo metsi o alo dɔnɔ siwo xɔ ƒe titina alo esiwo tsi wu siwo ƒe ƒu ƒe nyonyome nyo la ŋu. Ele be woatsɔ mɔfianu aɖe ana ɖa 3 siwo me do le la nasɔ ɖe wo nɔewo nu be woate ŋu aƒoe ɖe gbagbãƒe si le ʋuʋum la nu. Le afɔkpodzi ƒe kɔ me la, ele be woatsɔ gaviawo aƒo ɖe eƒe goawo dzi, eye woakpɔ egbɔ be wotsɔ ka ƒo gaviawo ɖe afɔkpodzi ƒe ta me ke menye to fli si me wogbã la dzi o, elabena esia koe nye mɔ si dzi woato akpɔ nutete le nuwuƒewo dome. Ele be woabla gaviawo sesĩe eye woaɖo kpe wo dzi enuenu le dɔwɔwɔ na wo me. Ne wozã abati si hea nu la, ele be woaɖe nusi hea nu la dzi akpɔtɔ. Woate ŋu atsɔ gavi siwo me do le hã ade ŋutigbalẽ me. Ele be woawɔ ŋgɔgbe, axadzi, kple 45° oblique fluoroscopy be woakpɔ egbɔ be gaviawo mege ɖe akɔta ƒe ƒunukpeƒea o.
1、amekoko ƒe dɔwɔwɔ ƒe mɔnu tɔxɛwo.
Tsɔ 'inverted triangle' nail placement, si wozãna zi geɖe le atikewɔnyawo me, abe kpɔɖeŋu ene.
a. Gbã la, le fluoroscopy te la, zã X-ray le fluoroscopy ƒe yameʋu eve me nàtsɔ anya alesi mɔfianu siwo le ete kple titina la le.
b. Woɖea ŋutigbalẽ si kekena sentimeta 2-3 le teƒe si te ɖe eŋu.
c. Woɖea fascial layer la ɖe vovo le afisi wotsoe eye wozãa Cobb separator tsɔ ma ka didi siwo le lateral femoral muscle la me.
d. Da mɔfianu ƒe aŋea ɖe teƒe si yameʋu eveawo siaa de blibo le.
e. Wotsɔ mɔfianu ɖeka da ɖe afɔkpodzi ƒe kɔ ƒe ŋgɔgbekpa dzi kple kpeɖeŋutɔ aɖe be woatsɔ anya dzogoe si dzi woakɔ ŋgɔgbea.
f. Ne wobla mɔfianu gbãtɔ vɔ la, wozãa mɔfianu siwo sɔ kple wo nɔewo tsɔ dea dzesi megbe kple ŋgɔgbe ƒe mɔfianu be woakpɔ megbe kple ŋgɔgbe ƒe akɔta ƒe kpeɖeŋutɔ le afɔkpodzi ƒe kɔ me.
g. Wowɔa esia to mɔfianu aɖe dede trochanter suetɔ tame le distal femoral neck cortex to femoral spine dzi; wotsɔa mɔfianu eve siwo kplɔe ɖo dea teƒe si te ɖe wo nɔewo ŋu le mɔ si sɔ nu, yi dzi alesi woate ŋui eye wòdidi tso ŋgɔgbe kple megbe lãkusi gbɔ milimeta 5; emegbe wotrɔa asi le mɔfianu ƒe gege ɖe eme ƒe goglome ŋu be wòaɖo milimeta 5 le ƒunukpeƒea te; mlɔeba la, woɖea doa ɖa, dzidzenɛ, eye wotsɔa gavi si me do le si wotsɔ nyaƒoɖeamenu ƒoa nui la dea eme.
h. Kpɔ egbɔ be yemege ɖe aŋea me le trochanter suetɔ te o eye nàzɔ mɔ si te ɖe afɔkpodzi ƒe akɔta ŋu.
Nye. Kpɔ egbɔ be woda mɔfianu si ŋu ka le la ɖe ƒunukpeƒea te.
j. Mègana mɔfianu la nage ɖe ƒunukpeƒea o.
k. Kpɔ gavi ƒe didime si sɔ to mɔfianu ƒe didime dzidzedze me eye emegbe nàɖe 5 mm ɖa.
l. Zi geɖe la, wozãa gavi siwo ƒoa wo ɖokui, siwo te ŋu kua wo ɖokui, gake ɣeaɖewoɣi la, ehiãna be woaku axadziƒu do ŋgɔ le dɔnɔ wɔnuteƒe siwo ƒe ƒu le kpekpem la gome.
m. Ne teƒea ɖe mɔ la, woate ŋu azã dometsotso aɖe.
n. Ate ŋu ahiã be woatsɔ gavi 4 lia (diamond-ɖoɖo) ahiã na nuteƒewɔla siwo ƒe asi ƒe megbeƒu gbã vevie.
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Togbɔ be gavi siwo me do le na akɔta ƒe kɔ ƒe gbagbã bɔ ŋutɔ fifia hã la, nukpɔsusu vovovowo gakpɔtɔ le gavi siwo me do le siwo woda ɖe amekoko me ƒe xexlẽme kple woƒe ɖoɖo ŋu, zi geɖe la, esia nɔa te ɖe dɔwɔla la ƒe didi nu; nusiwo nye dɔnɔa ƒe ƒu ƒe kpekpeme, gavi ƒe ŋusẽ, kple atikewɔwɔ ƒe dzidzedzekpɔkpɔ hã kpɔa ŋusẽ ɖe edzi.
1、Xexlẽme si me do le screws.
Zi geɖe la, wotsɔa gavi 2-4 siwo me do le la ɖɔa afɔkpodzi ƒe kɔ ƒe gbagbãwo ɖo.
Zi geɖe la, wozãa gavi 3 elabena woate ŋu anɔ te ɖe ŋgɔgbe ƒe nuteɖeamedzi sesẽwo nu, ana woali ke ɖe edzi, eye woaɖe gbagbãƒea ƒe nuwuƒe ƒe ʋuʋu dzi akpɔtɔ.
Le afɔkpodzi ƒe kɔ ƒe gbagbã siwo ƒe Pauwells ƒe dzogoe >50° gome la, gavi 2 sɔ wu.
Le dɔnɔ siwo ƒe akɔta ƒe kɔ ƒe megbe gbã vevie gome la, wodo gavi 4 siwo me do le ɖe ŋgɔ.
Gake nuwɔna si bɔ kokokoe nye be woazã gavi 3 siwo me do le atsɔ alé wo ɖe te.
2、Ðoɖowɔwɔ na do ƒe ʋuƒo.
Ne wozã gavi 3 siwo me do le hena afɔkpodzi ƒe kɔ ƒe gbagbã ƒe ememe léle ɖe te la, woxɔe se zi geɖe be ele be woawɔ ɖe nufiafia si nye 'sliding compression' dzi, ale be gavi 3 siwo wotsɔ de eme la sɔ kple wo nɔewo le dzogoe ene me kpɔkpɔ me eye dzogoe etɔ̃ ƒe ɖoɖo nanɔ wo ŋu le axadzikpɔkpɔ me.
To mɔ sia dzi la, gavi etɔ̃ siwo me do le siwo sɔ kple wo nɔewo ate ŋu ana mɔ̃ nyui nanɔ wo ŋu eye woawɔ mɔ si dzi woadze, ale be gbagbãƒea nate ŋu adze akɔta ƒe kɔ ƒe axadzi le akɔta ƒe lãmekawo ƒe tete te, si ana nyaƒoɖeamenu nava le gbagbãƒea ƒe nuwuwu eye wòado gbagbãƒea ƒe dɔyɔyɔ ɖe ŋgɔ.
Gake woʋli nya le nenye be woɖo gavi 3 siwo me do le la ɖe dzogoe etɔ̃ si le dzogoe ene me alo dzogoe etɔ̃ si wogbugbɔ trɔ me.
Ŋgɔyiyi siwo wowɔ le hollow screw fixation technique na afɔkpodzi ƒe kɔ ƒe gbagbã me
Yuenyongviwat kple ame bubuwo. wɔ mɔfiame yeye aɖe si woate ŋu atrɔ asi le si woatsɔ ado do si sɔ kple wo nɔewo hena gavi siwo me do le dede afɔkpodzi ƒe kɔ ƒe gbagbãwo dada me to ememe nuléle me, eye wokpɔe be mɔfianu yeye sia ate ŋu aɖe dɔwɔwɔ na ame ƒe ɣeyiɣi kple fluoroscopic nukpɔkpɔ le dɔwɔwɔ me ƒe xexlẽme dzi akpɔtɔ ne wotsɔe sɔ kple mɔnu si wozãna tsã, si ana amekokoa nadze ame ŋu.
Filipov kple exɔlɔ̃wo. wɔ biplane double-supported screw fixation (BDSF), si me screw etɔ̃ siwo me do le ƒe gege ɖe eme la le proximal femoral stem ƒe cortical nuto si le kpekpem la me, eye screw etɔ̃awo tsia tre ɖe afɔkpodzi ƒe ta ƒe go kemɛ dzi sɔsɔe, si wɔnɛ be wowɔa yameʋu eve. Mɔnu sia ɖea mɔ be woate ŋu alé lãkusi eve ɖe te, si wɔnɛ be ŋusẽ si sɔ naa nuléle ɖe nu ŋu le ʋuʋu me.
Biomechanical dodokpɔ siwo wowɔ to ame kukuwo ƒe kpɔɖeŋuwo zazã me ɖee fia be BDSF fixation mɔnu naa fixation nyuie wu inverted triangle fixation mɔnu si wozãna tsã. Nusiwo do tso biomechanical dodokpɔ siwo wowɔ tsɔ zã ame kukuwo ƒe kpɔɖeŋuwo ɖee fia be calcium phosphate cement si do ŋusẽ hollow screw fixation na be hollow screw fixation of femoral neck fractures ƒe liƒo nyo ɖe edzi ŋutɔ, ena femoral kɔ ƒe compression resistance nyo ɖe edzi, eye wòna torsional stiffness nyo ɖe edzi, si ŋu asixɔxɔ gã aɖe le le atikewɔnyawo me.
Le alesi wòate ŋu adzɔ ŋutɔ be afɔkpodzi ƒe ta nagbã le ɖa si me do le tutu vɔ megbe hena afɔkpodzi ƒe kɔ ƒe gbagbã ta la, wozã mɔnu bubuwo ɣesiaɣi tsɔ kpena ɖe ɖa si me do le ƒe ememe ƒoƒo ŋu be woaɖe kuxiwo abe afɔkpodzi ƒe ta ƒe kuku ene dzi akpɔtɔ. Nusi gbɔ afɔkpodzi ƒe ta ƒe kuku tsona le afɔkpodzi ƒe kɔ ƒe gbagbã megbe enye ʋu ƒe sisi yi afɔkpodzi ƒe ta me, eyata alesi woawɔ atike na ʋu ƒe sisi nyuie wu ŋu. Ne wotsɔ ʋu si wotsɔ do ƒunukpeƒe si wodo ɖe afɔkpodzi ƒe ta ƒe akpa si ku la kple gotagome yɔyɔ ɖe do susɔea me to ƒuƒoƒo si le miemie dzi ana vovototo si le ƒunukpeƒe si wodo la me nazu ƒumeŋuɖuiwo kpakple ʋukawo ƒe aŋgbawo ƒe gbugbɔgadzɔ, si kpɔa ŋusẽ ɖe ƒumeŋuɖui kple ʋukawo gbugbɔgawɔ siaa dzi.
Totoɖeme
Hollow screw fixation for femoral neck fracture nye fixation mɔnu si wɔa dɔ ŋutɔ, si ƒe viɖewo nye dɔwɔwɔ bɔbɔe, dɔwɔwɔ ƒe ɣeyiɣi kpui, nuveviwɔame sue aɖe, fixation si ŋu kakaɖedzi le kple dɔwɔwɔ vɔ megbe hayahaya kabakaba. Gake le akɔta ƒe kɔ ƒe gbagbã ƒe ŋutilã ƒe nɔnɔme ta la, womate ŋu aƒo asa na akɔta ƒe ta ƒe ischemic necrosis kple gbagbãƒea ƒe ƒoƒo ɖekae ƒe kuxiwo keŋkeŋ kokoko to ememe tsɔtsɔ ɖo akɔta ƒe kɔ ƒe gbagbã ŋu o. Eyata ele be woana nusiwo fia be woazã akɔtaɖonu sia zazã me nakɔ hafi woazãe, eye ele be dɔnɔ tsitsi siwo ƒe akɔta ƒe kɔ gbã vevie eye woƒe nɔnɔme mede ame dzi le goawo katã me o si hiã be woawɔ dɔ kaba la naƒo asa na ememe fixation zazã na afɔkpodzi ƒe kɔ ƒe gbagbã alesi woate ŋui. Ele be woabu afɔku siwo kpɔa ŋusẽ ɖe dɔnɔa ƒe ŋgɔdonya dzi, abe ƒu ƒe gbagbã ƒomevi, ƒu ƒe kpekpeme, kple dɔnɔa ƒe dɔwɔwɔ ƒe nɔnɔme ene hã ŋu be woaɖe kuxi siwo nɔa anyi didi le dɔwɔwɔ vɔ megbe dzi akpɔtɔ eye woato esia me ana akɔta ƒe kɔ ƒe gbagbã ƒe atikewɔwɔ me tsonu nanyo ɖe edzi.
Ale Si Nàƒle Ƒumeŋuɖuiwo Kple Ƒumeŋuɖui Dɔwɔnuwo?
Elabena CZMEDITECH , míekpɔa adzɔnuwo ƒe hatsotso si de blibo ŋutɔ si me ƒumeŋuɖui ƒe amekoko ƒe nusiwo wotsɔ dea ame me kple dɔwɔnu siwo sɔ kplii, nusiwo dometɔ aɖewoe nye akɔta ƒe akpa siwo wotsɔ dea ame me, ɖa siwo le lãkusi me, trauma plate, ʋuƒo si wotsɔ xea mɔ na nu, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, gotagome fixators, ƒunukpeƒetetedɔ (arthroscopy)., lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe kpeɖeŋutɔ dɔwɔnuwo.
Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi anɔ atike yeyewo wɔm eye míakeke adzɔnuwo ƒe hatsotsowo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho geɖe wu le xexeame katã ƒe ƒumeŋuɖui kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.
Míeɖoa nu ɖe xexeame katã, eyata àte ŋui te ɖe mía ŋu le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .
Ne èdi be yeanya nyatakaka bubuwo la,zi edzi CZMEDITECH be nàkpɔ nyatakaka bubuwo.
