Rufewar tiyata don rage raunin da ya faru.

Rufe raguwa shine dabarar da ba ta da yawa wacce za a iya amfani da ita don barga karaya na extremities ba tare da asarar jini ya kwarara ba, babu hadarin kamuwa da cuta, saurin aiki dawo da, rage farashin kiwon lafiya sosai, kuma za a iya amfani da shi don rufaffiyar raguwa m ƙusa da intramedullary fil gyarawa na daban-daban m fractures, kamar femoral wuyansa karaya, femoral karaya karaya, femoral kara karaya, femoral kara karaya. karaya, da dai sauransu, kawar da lalatawar jini ta hanyar raguwar incisional.

Karya daga wuyan femur

(I) Tashin hankali

An sanya mai haƙuri a cikin gado, kuma ana yin jigilar tibial tuberosity traction tare da raunin da ya shafa a cikin tsaka-tsakin tsaka-tsaki tare da juyawa mai sauƙi na ciki. Nauyin jan hankali ya bambanta daga mutum zuwa mutum, gabaɗaya 6-9 kg, kuma tsawon lokacin juzu'i bai kamata ya wuce sa'o'i 12 ba. 90% na marasa lafiya na iya cimma matsaya ta hanyar jan hankali.

(B) rufe manipulative repositioning

Idan gogayya ta kasa cimma buƙatun mayar da matsayi, za a iya ƙara sanyawa ta hannu, ƙarƙashin maganin sa barci:

1. Hanyar MC Elvenny

Manufar ita ce a gyara ƙashin ƙugu, a waje da abin da ya shafa a waje da kuma ƙara ƙarfin motsa jiki, sa'an nan kuma a cikin ciki da kuma mayar da abin da ya shafa don cimma manufar sakewa.

2. Hanya mafi kyawu

Mai haƙuri yana kwance a ƙasa, ya lanƙwasa hip da gwiwa ta 90 °, jujjuyawa tare da axis femoral na gabobin da abin ya shafa na tsawon mintuna 2 zuwa 3, sannan a juya sashin da abin ya shafa a hankali sannan a sassauta shi, bayan an sake saita shi, a hankali ya rage sashin da abin ya shafa, kuma idan ƙafar da ta shafa ba ta bayyana a waje tana jujjuyawa ba, yana nuna nasara. Kafin yin gyaran ciki, an yi amfani da injin C-arm don tabbatarwa.

(C) Dabarar prying ɗin allura mai ɗaci

Idan ba a cimma matsaya ta hanyoyin da ke sama ba, yawanci yana nuna ko dai an karye kan femoral ko kuma an sami rabuwar juyawa tsakanin kai da wuya (Hoto na 1A), ko kuma akwai wani wuri tsakanin kai da wuya. (Wannan na iya faruwa a kowane nau'in Lambun II, III, ko IV). A wannan yanayin, jujjuya gaɓoɓin da abin ya shafa don ƙulla karayar kai da wuya ba ta da tasiri. Don guje wa tsinkewa da sakewa, ana iya amfani da dabarar prying ɗin allura mai tsini don mayar da karyewar.

• Ana shigar da allurar madauwari na kashi 3.0- zuwa 3.5-mm a tsaye a tsaye ta cikin fata 1 zuwa 2 cm ƙasa da mahaɗin ligament na inguinal da jijiyar femoral zuwa gaban kan femoral, kuma allurar tana juyawa zurfi zuwa tsakiyar kan femoral karkashin kulawar injin C-arm (Figure 1B).

• Don ƙarfafa ƙarfin prying, ana iya shigar da allura madauwari na kashi na biyu 4-5 mm daidai da wannan allura, tare da ƙarshen allurar da aka bari a waje da fata.

• Ta hanyar mafi girma trochanter, biyu 3.5 mm diamita kashi madauwari allura da aka hako percutaneously daidai da kwana na cervical tushe da kuma kusurwar karkatar da baya, kai nesa karshen karye wuyan femoral (kada ku wuce ta cikin karaya) da kuma barin karshen allura a waje da fata.

• Mai aiki yana riƙe da nau'i biyu na wutsiyar allura tare da hannaye biyu kuma yana daidaita sassan ɓarkewar kai da wuyansa don daidaitawa da juna tare da haɗin gwiwar mataimaki (Figure 1C-E).

• Bayan daidaitawar ta gamsu, ana zagaya fil zagaye na kashi da aka saka a mafi girma a cikin mata don gyarawa na wucin gadi, sannan a saka screws da yawa a cikin kan femoral (Hoto 1F).

Hanyar rage rufaffiyar da aka bayyana a sama zai iya cimma raguwar da ake buƙata a cikin kusan 98% na raunin wuyan mata. Mafi kyawun daidaitawar karyewar, ko rufewa ko an ƙera shi, mafi kyawun tsinkaya. Yawancin lokaci, matakin raguwar raguwa da aka nuna akan X-ray ya kasance ƙasa da ainihin digiri na raguwa. Tun da raguwar raguwa kai tsaye yana rinjayar warkar da raunin da kuma yiwuwar necrosis na shugaban mata, ya zama dole a sami madaidaicin hukunci na fim din X-ray bayan gyare-gyaren raguwa. Idan lanƙwan S-dimbin yawa ba santsi ko katsewa ba, yana nuna cewa karyewar wuyan mata bai kai ga sake fasalin jiki ba (Hoto 2).

Hoto 1 Karyawar wuyan mata da aka mayar da shi ta hanyar tsinken allura

Hoto 2 Rarrashin wuyan Femoral na mata tare da ci gaba da lanƙwan waje a cikin daidaitawar jiki da katsewar lanƙwasa na waje a cikin jeri mara kyau.

Karaya mai karayar mace

Ƙwararren raguwa na rufaffiyar zai iya taimakawa wajen daidaita ƙwayar ƙwayar ƙwayar mata ba tare da lalata kowane nau'i mai laushi ko samar da jini zuwa ƙarshen karaya ba, kuma za'a iya amfani dashi don gyaran ciki tare da ƙusa na intramedullary.

• A karkashin maganin sa barci na epidural, majiyyacin yana kwance a kan gado (fatar jikin da abin ya shafa ba a haifuwa ba a wannan lokacin), mataimaki ɗaya yana riƙe da ɗan maraƙin gaɓoɓin da abin ya shafa, ɗayan mataimaki ya ja tushen cinyar mara lafiya tare da bel ɗin zane don magance gogayya, tare da ɓangaren da ya shafa a cikin tsaka tsaki kuma ɓangarorin ƙwanƙwasa ba ta fuskantar sama (c) ja, kuma ana iya gyarawa ta atomatik ta hanyar juzu'i, don haka ma'aikacin kawai yana buƙatar gyara gaba-baya da matsuguni na ƙarshen karaya).

• Mai aiki yana amfani da hannaye biyu don kewaya gaɓar abin da ya shafa kuma yana riƙe hannaye tare (Hoto na 3 da Hoto 4), kuma yana gyara gurɓacewar gaba-baya da ta gefe guda ɗaya ta hanyar amfani da ƙarfin matse hannaye biyu.

• Misali, idan sashin kusa na karaya na femur ya koma waje da gaba, ana amfani da gaba daya don matse bangaren kusa da karaya a ciki da kasa. Dayan hannun gaba yana matse sashin karaya a waje zuwa sama don aron karfin damtse (likitan mai sake saiti ya kamata ya sami ingantaccen hukunci na jagorar ƙaura da nisan ƙaura kafin a sake saita shi), ta yadda za a iya samun nasarar sake saita karyewar lokaci ɗaya. A lokacin aikin sakewa, mataimaki ya kamata ya ƙara ƙarfin motsa jiki kuma ya kiyaye femur daga juyawa.

• Lokacin da ƙarshen karyewar ya ƙare, dole ne a ji ƙarar ƙashi mai laushi, a wannan lokacin, mataimaki ya kamata ya ci gaba da jujjuyawa, amma a rage ƙarfin juzu'i.

• Lokacin da na'urar C-arm ta daidaita karaya ta asali (idan har yanzu akwai ɗan rashin daidaituwa, yi wasu gyare-gyare don tabbatar da karaya ya ƙare daidai da juna), kula da goga, lalata gaɓoɓin da abin ya shafa kuma yada tawul, sannan a yi gyaran ƙusa na intramedullary.

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Hoto 3 Ana gyara matsuguni na gaba-baya da na gefe na karaya a lokaci guda ta hanyar nannade hannaye biyu a kusa da abin da ya shafa da kuma hada hannayensu tare, ta yin amfani da karfin matsi na gaba da gaba.

Hoto 4 Karya karaya na mata na sake fasalin tsarin dabara

• Ga marasa lafiya tare da ƙaƙƙarfan ƙaura, magudin da ba a yi nasara ba ko raunin da ya faru, ana iya amfani da gadon motsa jiki na tiyata don rufewa tare da wasu ƙarfin kayan aiki, wanda kuma zai iya kammala rufewar raguwa na karaya na femoral.

• Bayan sanya abin da ya shafa a kan firam ɗin da aka yi amfani da shi don ƙaddamarwa da kuma gwajin C-arm ya nuna cewa an gyara gyaran gyare-gyaren raguwa, za a iya daidaita ƙarshen ƙarshen abin da ya shafa a ciki don ƙara mayar da daidaituwa da daidaitawa a cikin hoton orthostatic na femoral stem.

• Saboda tashin hankali na tsokoki na cinya a ƙarƙashin gogayya na iya taka rawa mai laushi mai laushi a kan karayar ƙwayar mata, mafi yawan raunin ƙwayar mata na iya samun daidaituwa mai gamsarwa a cikin hoton x-ray na orthogonal.

• Duk da haka, a wannan lokaci, saboda rashin ingantaccen goyon baya a m karshen kashi kashi karkashin sakamakon nauyi, da m karaya sashi na femoral kara ne mafi yawa gudun hijira a baya, da kuma a wannan lokaci, da bakararre tawul-rufe takalmin gyaran kafa za a iya sanya a kan na baya gefe na distal karaya sashi a ƙarƙashin rinjayar da m karaya sashi na femoral karaya ne mafi yawa gudun hijira a baya, da kuma a wannan lokaci, da bakararre tawul rufaffiyar takalmin gyare-gyare za a iya sanya a kan na baya gefe na distal karaya sashi a karkashin sakamako na nauyi, da m karaya sashi na femoral tushe ne mafi yawa gudun hijira a baya, da kuma a wannan lokaci, da bakararre tawul lullube takalmin gyare-gyare za a iya sanya a kan na baya gefe na distal karaya kashi a karkashin sakamakon da fata fata fata fata da fata fata. Za'a iya gyara ƙarshen karyewar nesa ta hanyar daidaita tsayin takalmin gyaran kafa.

• Idan har yanzu ba a gyara matsuguni na baya na sashin karaya ba, za a iya kafa ƙusa mai kusanci a cikin koli na mafi girma trochanter ko pyriform fossa, sa'an nan kuma an shigar da sandar repositioning intramedullary a cikin rami na medullary na kusancin ɓarnawar sashin ƙwanƙwasa da ƙusa reposition. Ana ɗagawa a matsakaici gaba don rage raunin kusanci na femur baya ta hanyar amfani da lever na sandar sake sanyawa, don haka maido da daidaitawa tare da karaya mai nisa na baya,

• Bayan an daidaita karayar, ana saka fil ɗin jagora mai tsayi a cikin rami mai nisa don kammala sake saitin rufaffiyar. Sanda mai sakawa na intramedullary yana da tasiri musamman wajen gyaran gyare-gyaren gyare-gyare, gyare-gyare, da kuma nakasar jujjuyawar waje da aka saba a cikin ɓarna na kusa na mace mai kusa (Hoto 5).

• Don ƙaura ta gefe, buɗewar ƙarshen sandar intramedullary mai lanƙwasa za'a iya daidaita shi don jagorantar fil ɗin jagora mai tsayi zuwa cikin rami mai nisa don kammala raguwar rufaffiyar.

• Wata hanyar rufaffiyar raguwa ita ce a dunƙule ƙusa Schanz a cikin kashin kasusuwa a gefen ƙarshen karayar da aka yi gudun hijira da kuma daidaita ƙarshen karaya ta hanyar ƙusa Schanz don rufewa (Hoto 6). Bayan karaya ya daidaita daidai, an saka ƙusa na intramedullary a cikin rami na kusa da nisa na karaya don kammala gyaran ciki (Hoto 7).

  
  

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Hoto 5 Yin amfani da ɓangaren ɓarna na kusa don rufewa ta hanyar amfani da sandar sake sanyawa ta intramedullary.

Hoto 6 Rufe raguwa ta amfani da ƙusa Schanz da aka sanya a cikin kashin kashi ɗaya a ƙarshen karaya.

Hoto 7 Rufewar raguwar ƙusa na intramedullary na ƙwanƙwasa sassa daban-daban na karayar mace ta amfani da ƙusa Schanz

Karyawar idon sawu

(A) Shirye-shiryen riga-kafi

• Binciken radiyo: Ma'auni na ƙirar idon kafa ya kamata ya haɗa da matakai 3: anteroposterior (Figure 8), idon idon (15 ° na juyawa na ciki) (Figure 9), da kuma a gefe (Figure 10).

• Lokacin da haɗin gwiwa ya ji rauni mai tsanani na ciki da na waje idon kafa da talus za a yi gudun hijira zuwa digiri 11 daban-daban (Hoto 11). Rubuce-rubucen radiyo na tsaye baya nuna daidai daidai da kwanciyar hankali na haɗin gwiwa. Radiyon danniya da MRI na iya inganta ƙima na kwanciyar hankali na haɗin gwiwa da lalacewar ligament (Figure 12).

• A wannan yanayin, nau'in raunin idon ya kamata a ƙayyade daidai ta hanyar tsarin rauni da kuma bayanan rediyo na ɓangaren da ya shafa don daidaitawa da daidaitawa daidai.

• Wani lokaci raunin idon sawu mai sauƙi na iya zama wani ɓangare na ƙarin rikitarwa 'Maisonneuve fracture', wanda kuma ya haɗa da raunin fibula na kusa da raunin jijiya, don haka duk tibiofibula ya kamata a duba ta hanyar rediyo.

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Hoto 8 Matsayi na gaba da na baya

Hoto 9 Makiyan idon sawu (15° na juyawa na ciki)

Hoto 10 Matsayi na gefe

Hoto 11 Karya matsuguni a fili hade da karkacewa

Hoto 12 Danniya rediyograph (triangular ligament rupture)

(II) Anesthesia

Yawanci ana shan maganin jijiya na mata da sciatic.

(C) dabarar sake saiti

Nau'in juyawa na baya-na waje na rufaffiyar sakewa ana yin shi a cikin tsari na waje na waje-cikin idon kafa-bayan idon kafa-ƙananan ƙungiyar tibiofibular. Ana yin nau'in juyawa na baya-nau'in jujjuyawar ciki a cikin tsari na idon kafa na waje-na waje.

• A cikin yanayin jujjuyawar nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau’in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau’in juyawa na waje, an sanya mai haƙuri a kwance kuma an jujjuya gwiwa a 90 ° don shakatawa maraƙi triceps.

• Mataimakan biyu suna riƙe da ɓangaren popliteal na cinya da ƙafa, kuma ana amfani da ƙugiya a cikin hanyar nakasar karaya (ƙarfin motsi bai kamata ya wuce kima ba don guje wa kara rauni).

• Mataimakin da ke jan ƙafar yana juya ƙafar zuwa ciki don gyara nakasar jujjuyawar waje (Hoto 13). Yayin da ake tura ƙarshen nesa zuwa gefen tibial da kuma ja da tibia mai nisa zuwa gefen fibular, mataimaki ya juya cikin ciki kuma ya shimfiɗa haɗin gwiwa don gyara ƙaura na waje da talus (Hoto 14).

• Ci gaba da jujjuyawar ciki - jujjuyawar ciki - matsayi tsawo. Sa'an nan kuma toshe karayar idon sawun na baya yana riƙe da manyan yatsotsi biyu, yatsunsu huɗu suna kewaye da tibia mai nisa, kuma duka manyan yatsotsin suna turawa suna matsi da nisa, yayin da suke ja da tibia mai nisa don sake saita idon sawun na baya (Hoto 15).

• A ƙarshe, mai aiki yana tura sawun tsaka-tsaki baya da ƙasa tare da manyan yatsa don sake saita shi (Hoto 16). Mataimakan biyu suna kula da ƙafa da ƙafar ƙafa a cikin jujjuyawar ciki-cikin jujjuyawar ciki-tsawon dorsal a cikin shiri don gyarawa.

Hoto 13 Gyaran juzu'i na nakasar jujjuyawar waje

Hoto 14 Gyaran motsi na gefe na idon idon waje da talus

Hoto 15 Gyaran motsin idon kafa na baya

Hoto 16 Gyaran ƙaurawar idon idon cikin gida

Tsarin sake jujjuyawar juzu'i na ciki shine akasin tsarin jujjuyawar juzu'i-na waje kuma ana yin shi a cikin tsari na ƙafar ƙafar ƙafa na waje.

Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?

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