Kaw txo kev phais kom txo qis sab hauv pob txha.

Kaw txo yog cov txheej txheem minimally invasive uas yuav siv tau rau ruaj khov fractures ntawm extremities nrog tsis poob ntawm cov ntshav khiav, tsis muaj kev pheej hmoo ntawm kev kis kab mob, ceev functionality rov qab, txo nqi kho mob, thiab yuav siv tau rau kaw txo hollow ntsia hlau thiab intramedullary pin fixation kho ntawm ntau yam tsis ruaj tsis khov fractures, xws li femoral caj dab moribulars, tibfe fractures. pob txha, humeral qia fractures, thiab lwm yam, tshem tawm kev puas tsuaj ntawm cov ntshav ntws los ntawm incisional txo.

Kev tawg ntawm lub caj dab ntawm lub femur

(I) Traction

Tus neeg mob tau muab tso rau hauv txaj, thiab tibial tuberosity traction yog ua los ntawm cov ceg ntoo cuam tshuam rau hauv qhov chaw nruab nrab nrog kev sib hloov me me. Qhov hnyav ntawm traction txawv ntawm ib tug neeg mus rau ib tug neeg, feem ntau 6-9 kg, thiab lub sij hawm ntawm traction yuav tsum tsis txhob ntau tshaj 12 teev. 90% ntawm cov neeg mob tuaj yeem ua tiav repositioning los ntawm traction.

(B) kaw manipulative repositioning

Yog tias traction tsis ua tiav cov kev xav tau ntawm kev hloov pauv, phau ntawv hloov pauv tuaj yeem muab ntxiv, hauv qab tshuaj loog epidural:

1. MC Elvenny txoj kev

Lub hom phiaj yog txhawm rau txhim kho lub plab, sab nraud tig lub caj dab cuam tshuam thiab ua kom lub zog traction, thiab tom qab ntawd tig sab hauv thiab sab hauv thim rov qab cov ceg ceg cuam tshuam kom ua tiav lub hom phiaj ntawm kev rov ua haujlwm.

2. Leadbetter txoj kev

Tus neeg mob pw ncaj nraim rau hauv av, khoov lub duav thiab lub hauv caug los ntawm 90 °, traction raws femoral axis ntawm cov ceg ceg cuam tshuam rau 2 mus rau 3 feeb, tom qab ntawd tig sab hauv lub cev cuam tshuam thiab maj mam flex nws, tom qab rov pib dua, maj mam txo qis tus ceg ceg, thiab yog tias tus cuam tshuam ko taw tsis zoo li sab nraud tig, nws feem ntau qhia tau zoo. Ua ntej kev txhim kho sab hauv, lub tshuab C-arm tau siv los txheeb xyuas.

(C) Percutaneous koob prying txheej txheem

Yog tias qhov kev hloov pauv tsis ua tiav los ntawm cov txheej txheem saum toj no, nws feem ntau qhia tau hais tias lub taub hau femoral tau tawg los yog tias muaj kev sib hloov ntawm lub taub hau thiab caj dab (Daim duab 1A), lossis tias muaj qhov ntxig rau qhov chaw ntawm lub taub hau thiab caj dab. (Qhov no tuaj yeem tshwm sim hauv ib qho ntawm Garden II, III, lossis IV hom). Nyob rau hauv cov ntaub ntawv no, rotating cuam tshuam limb mus dovetail lub taub hau thiab caj dab tawg yog tsis zoo. Txhawm rau kom tsis txhob muaj qhov txiav thiab rov ua dua, cov txheej txheem percutaneous koob prying tuaj yeem siv los kho qhov tawg.

• Ib tug 3.0- mus rau 3.5-mm-inch pob txha ncig koob yog ntxig vertically los ntawm daim tawv nqaij 1 mus rau 2 cm hauv qab ntawm qhov sib tshuam ntawm inguinal ligament thiab cov hlab ntsha femoral mus rau pem hauv ntej ntawm lub taub hau femoral, thiab rab koob yog tig ntxaum mus rau qhov chaw ntawm lub taub hau femoral nyob rau hauv kev saib xyuas ntawm lub tshuab 1B (Figurem).

• Txhawm rau ntxiv dag zog rau lub zog quab yuam, ib rab koob thib ob ntawm cov pob txha tuaj yeem muab tso rau 4-5 hli sib npaug rau cov koob no, nrog rau qhov kawg ntawm rab koob sab nraud ntawm daim tawv nqaij.

• Los ntawm qhov ntau dua trochanter, ob lub 3.5 hli txoj kab uas hla ntawm pob txha ncig koob yog drilled percutaneously raws li lub kaum sab xis ntawm lub ncauj tsev menyuam qia thiab lub kaum sab xis ntawm anterior qaij, mus txog qhov kawg ntawm lub caj dab femoral (tsis txhob hla lub pob txha) thiab tawm hauv qhov kawg ntawm rab koob sab nraum daim tawv nqaij.

• Tus neeg teb xov tooj tuav ob lub koob tails nrog ob txhais tes thiab kho lub taub hau thiab caj dab tawg ntu kom sib haum nrog kev koom tes ntawm tus pab (Daim duab 1C-E).

• Tom qab qhov kev sib raug zoo yog qhov txaus siab, cov pob txha puag ncig tus pin ntxig rau ntawm qhov loj dua trochanter yog screwed rau hauv lub taub hau femoral rau kev kho ib ntus, thiab ob peb lub hollow screws yog ces muab tso rau hauv lub taub hau femoral (Daim duab 1F).

Txoj kev txo qis uas tau piav qhia saum toj no tuaj yeem ua tiav qhov yuav tsum tau txo qis li ntawm 98% ntawm femoral caj dab pob txha. Qhov zoo dua qhov kev sib dhos ntawm cov pob txha, txawm tias kaw los yog incised, qhov zoo dua qhov kev tshwm sim. Feem ntau, qhov degree ntawm pob txha dislocation pom ntawm X-ray yog tsawg dua qhov tseeb ntawm pob txha tawg. Txij li cov pob txha pob txha ncaj qha cuam tshuam rau kev kho mob ntawm pob txha thiab qhov ua tau ntawm necrosis ntawm lub taub hau femoral, nws yog ib qho tsim nyog yuav tsum muaj kev txiav txim siab ntawm X-ray zaj duab xis tom qab kev sib tsoo pob txha. Yog hais tias S-shaped nkhaus tsis du los yog cuam tshuam, nws qhia tau hais tias lub caj dab femoral tsis tau mus txog anatomical repositioning (Daim duab 2).

Daim duab 1 Femoral caj dab tawg repositioned los ntawm percutaneous koob prying

Daim duab 2 Femoral caj dab tawg X-rays nrog nruam sab nraud nkhaus nyob rau hauv anatomical alignment thiab cuam tshuam sab nraud nkhaus nyob rau hauv uas tsis yog-anatomical alignment

Femoral qia tawg

The closed reduction technique can assist in the alignment of the femoral stem fracture without damaging any soft tissues or blood supply to the fracture end, and can be used for internal fixation with an intramedullary nail.

• Nyob rau hauv cov tshuaj loog epidural, tus neeg mob tau pw ncaj nraim ntawm lub txaj (cov tawv nqaij ntawm cov ceg tawv tsis tau ua kom tsis muaj menyuam nyob rau lub sijhawm no), ib tus neeg pabcuam tuav tus menyuam mos ntawm cov ceg tawv, thiab lwm tus neeg pabcuam rub tus neeg mob tus ncej puab cov hauv paus nrog daim ntaub siv los tiv thaiv qhov traction, nrog rau kev cuam tshuam ntawm ceg ceg nyob rau hauv ib qho chaw nruab nrab ntawm lub hauv caug thiab lub hauv caug. Cov pob txha tawg feem ntau tsis tig thiab txav los ntawm cov leeg rub, thiab tuaj yeem kho tau los ntawm traction, yog li tus neeg teb xov tooj tsuas yog yuav tsum tau kho qhov anterior-posterior thiab lateral displacement ntawm qhov tawg kawg ntawm qia).

• Tus neeg teb xov tooj siv ob sab caj npab los puag ncig tus ceg ceg thiab tuav tes ua ke (Daim duab 3 thiab daim duab 4), thiab kho qhov anterior-posterior thiab sab nraub qaum ntawm qhov tawg ntawm ib zaug los ntawm kev siv oblique clamping quab yuam ntawm ob sab caj npab.

• Piv txwv li, yog hais tias lub zeem muag ntawm lub femur fracture yog tsiv tawm sab nraud thiab sab nrauv, ib lub hauv pliaj yog siv los nyem qhov sib thooj ntawm cov pob txha sab hauv thiab sab hauv. Lwm lub forearm squeezes lub distal fracture ntu sab nraud thiab sab nraud kom qiv lub zog clasping (tus kws kho mob rov kho dua yuav tsum muaj kev txiav txim siab ntawm qhov tawg tawg thiab qhov kev ncua deb ua ntej rov pib dua), kom qhov tawg tuaj yeem rov ua tiav ib zaug. Thaum lub sij hawm repositioning txheej txheem, tus pab yuav tsum tau nce lub traction quab yuam thiab kom lub femur los ntawm rotating.

• Thaum qhov kawg ntawm qhov tawg yog qhov pib lapped, lub suab ntawm cov pob txha mos yuav tsum tau hnov, lub sijhawm no, tus neeg pab yuav tsum tseem tuav lub zog traction, tab sis txo lub zog traction.

• Thaum cov pob txha tawg tau ua raws li lub tshuab C-arm (yog tias tseem muaj me ntsis misalignment, ua qee qhov kev hloov kho kom paub tseeb tias cov pob txha tawg tau sib luag), tswj cov traction, tshuaj tua kab mob thiab kis tau cov phuam, thiab tom qab ntawd ua cov ntsia hlau kho intramedullary.

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Fig. 3 Qhov kev hloov ntawm sab xub ntiag thiab sab nraub qaum ntawm qhov tawg yog kho tib lub sijhawm los ntawm kev qhwv ob txhais caj npab nyob ib ncig ntawm cov ceg tawv thiab tuav tes ua ke, siv lub zog clamping ntawm ob sab caj npab.

Daim duab 4 Femoral qia tawg repositioning mechanics schematic

• Rau cov neeg mob uas muaj pob txha tawg loj, tsis ua tiav kaw kev tswj hwm lossis kev puas tsuaj comminuted, lub txaj phais traction tuaj yeem siv rau kev txo qis nrog qee qhov cuab yeej siv zog, uas tuaj yeem ua tiav kaw qhov txo qis ntawm femoral qia tawg.

• Tom qab tso cov ceg ntoo cuam tshuam rau ntawm tus ncej traction rau traction thiab C-arm kev ntsuam xyuas qhia tau hais tias qhov sib tshooj ntawm cov pob txha tawg tau raug kho, qhov kawg ntawm qhov cuam tshuam tuaj yeem raug kho rau sab hauv kom rov qab kho qhov sib npaug thiab kev sib haum xeeb hauv cov duab orthostatic ntawm cov qia femoral.

• Vim tias qhov nro ntawm tus ncej puab cov leeg nyob rau hauv traction tuaj yeem ua lub luag haujlwm ntawm cov nqaij mos ntawm lub femoral qia fractures, feem ntau ntawm cov femoral qia fractures tuaj yeem tau txais kev sib haum xeeb ntau dua hauv daim duab orthogonal x-ray.

• Txawm li cas los xij, nyob rau lub sijhawm no, vim tias tsis muaj kev txhawb nqa zoo ntawm qhov kawg ntawm qhov tawg ntu nyob rau hauv qhov cuam tshuam ntawm lub ntiajteb txawj nqus, qhov tawg ntu ntawm lub femoral qia feem ntau yog txav mus rau tom qab, thiab lub sijhawm no, cov phuam qhwv caj dab uas tsis muaj menyuam tuaj yeem muab tso rau sab tom qab ntawm daim tawv nqaij ntawm daim tawv nqaij, thiab qhov kawg ntawm daim tawv nqaij. thiab tom qab hloov chaw ntawm qhov distal tawg kawg tuaj yeem kho los ntawm kev kho qhov siab ntawm txoj hlua khi.

• Yog tias qhov kev hloov pauv tom qab ntawm cov pob txha pob txha tseem tsis tau kho, tus ntsia hlau ze ze tuaj yeem tsim tau percutaneously ntawm lub apex ntawm ntau dua trochanter los yog pyriform fossa, thiab tom qab ntawd tus pas nrig intramedullary repositioning yog muab tso rau hauv medullary kab noj hniav ntawm lub proximal fracture segment of the segment, pas nrig yog tsa nruab nrab rau pem hauv ntej kom depress lub proximal fracture ntawm lub femur rov qab los ntawm kev siv lub zog ntawm lub repositioning pas nrig, yog li rov kho cov kev sib raug zoo nrog lub posteriorly distal puas,

• Tom qab cov pob txha tawg tau zoo sib xws, ib daim ntawv qhia ntev yog muab tso rau hauv qhov chaw tawg tawg kom ua tiav qhov kaw rov qab. Lub intramedullary repositioning pas nrig yog tshwj xeeb tshaj yog zoo nyob rau hauv kho qhov flexion, abduction, thiab sab nraud rotation deformities muaj nyob rau hauv proximal fractures ntawm proximal femur (Daim duab 5).

• Rau qhov seem sab nraud, qhov qhib ntawm qhov nkhaus kawg ntawm tus pas nrig intramedullary tuaj yeem hloov kho kom coj tus pin ntev mus rau hauv qhov chaw tawg tawg kom ua tiav qhov kev txo qis.

• Lwm txoj kev ntawm kev kaw qhov txo qis yog txhawm rau ntsia hlau Schanz ntsia hlau rau hauv cov pob txha cortex ntawm sab ntawm cov pob txha tawg ntawm qhov kawg thiab kho qhov tawg ntawm qhov kawg los ntawm txoj kev ntawm Schanz ntsia hlau rau kev txo qis (Daim duab 6). Tom qab cov pob txha tawg tau zoo sib xws, cov ntsia hlau intramedullary tau muab tso rau hauv qhov sib thooj thiab qhov nruab nrab ntawm cov kab noj hniav ntawm cov pob txha kom ua tiav cov kev kho sab hauv (Daim duab 7).

  
  

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Daim duab 5 Manipulation ntawm proximal tawg ntu rau kaw repositioning siv lub intramedullary repositioning pas nrig

Daim duab 6 Kaw txo siv Schanz ntsia thawv tso rau hauv lub pob txha unilateral cortex ntawm qhov kawg ntawm pob txha

Daim duab 7 Kaw txo intramedullary ntsia thawv fixation ntawm ib tug multisegmental comminuted puas ntawm lub femoral qia siv Schanz ntsia thawv

pob taws pob txha

(A) Kev npaj ua ntej

• Kev kuaj pom hluav taws xob: Kev ntsuas pob taws tus qauv yuav tsum muaj 3 theem: anteroposterior (Daim duab 8), pob taws taw tes (15 ° ntawm kev sib hloov sab hauv) (Daim duab 9), thiab sab nraud (Daim duab 10).

• Thaum pob qij txha raug mob hnyav lub pob taws sab hauv thiab sab nraud thiab talus yuav raug hloov mus rau 11 qib sib txawv (Daim duab 11). Cov duab hluav taws xob zoo li qub tsis qhia meej txog kev ruaj ntseg ntawm pob taws pob taws. Stress radiographs thiab MRI tuaj yeem txhim kho qhov kev ntsuam xyuas ntawm kev ruaj ntseg ntawm pob taws pob qij txha thiab ligament puas (Daim duab 12).

• Hauv qhov no, hom kev raug mob pob taws yuav tsum raug txiav txim siab los ntawm cov txheej txheem ntawm kev raug mob thiab cov ntaub ntawv hluav taws xob ntawm cov ceg ntoo cuam tshuam kom raug coj mus rau qhov chaw thiab kho kom raug.

• Qee lub sij hawm ib qho yooj yim ntawm pob taws pob taws tuaj yeem yog ib feem ntawm qhov nyuaj 'Maisonneuve fracture', uas kuj suav nrog cov pob txha pob txha thiab cov pob qij txha ua ke, yog li tag nrho tibiofibula yuav tsum tau kuaj xyuas.

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Daim duab 8 Pem hauv ntej thiab nram qab txoj hauj lwm

Daim duab 9 Pob Tawb cov ntsiab lus (15 ° ntawm kev sib hloov sab hauv)

Daim duab 10 Lateral txoj hauj lwm

Daim duab 11 Kev tawg tawg pom meej meej ua ke nrog kev tawg

Daim duab 12 Stress radiograph (triangular ligament rupture)

(II) tshuaj loog

Feem ntau siv femoral thiab sciatic paj tshuaj loog.

(C) rov pib txheej txheem

Cov kev sib hloov tom qab-sab nraud ntawm kev kaw qhov rov ua haujlwm yog ua raws li kev txiav txim ntawm sab nraud pob taws-hauv pob taws-tom qab pob taws-tsis zoo tibiofibular union. Tom qab kev sib hloov-sab hauv kev sib hloov hom yog ua nyob rau hauv qhov kev txiav txim ntawm sab hauv pob taws pob taws-sab nraum pob taws.

• Nyob rau hauv cov ntaub ntawv ntawm posterior-sab nraud rotation hom IV, tus neeg mob muab tso rau supine thiab lub hauv caug yog flexed ntawm 90 ° kom so lub calf triceps.

• Ob tug pab tuav lub popliteal ib feem ntawm tus ncej puab thiab ko taw feem, thiab traction yog siv nyob rau hauv cov kev taw qhia ntawm lub pob txha deformity (lub traction quab yuam yuav tsum tsis txhob ntau tshaj kom tsis txhob aggravating qhov raug mob).

• Tus pab rub ko taw tig ko taw sab hauv los kho qhov kev sib hloov sab nraud (Daim duab 13). Thaum thawb lub distal kawg mus rau tibial sab thiab rub lub distal tibia mus rau sab fibular, tus pab inwardly tig thiab dorsally txuas lub pob taws pob taws los kho qhov kev hloov ntawm pob taws sab nraud thiab talus (Daim duab 14).

• Tuav lub internal rotation-internal rotation-dorsal extension txoj hauj lwm. Tom qab ntawd lub pob taws pob taws tom qab yog tuav los ntawm ob tus ntiv tes xoo, plaub ntiv tes puag ncig lub pob qij txha, thiab ob tus ntiv tes xoo thawb thiab nyem distally, thaum rub lub pob qij txha rov qab los ntawm pob taws tom qab (Daim duab 15).

• Thaum kawg, tus neeg teb xov tooj thawb lub pob taws nruab nrab rov qab thiab nqes nrog tus ntiv tes xoo kom rov pib dua (Daim duab 16). Ob tug pab tuav lub ko taw thiab pob taws nyob rau hauv lub internally rotated-sab hauv rotation-dorsal extension txoj hauj lwm nyob rau hauv kev npaj rau fixation.

Daim duab 13 Traction kho ntawm sab nraud rotation deformity

Daim duab 14 Kho qhov kev hloov pauv sab nraud ntawm pob taws sab nraud thiab talus

Daim duab 15 Kho cov pob qij txha tom qab

Daim duab 16 Kho cov pob qij txha sab hauv

Cov txheej txheem post-rotation-internal repositioning yog qhov sib txawv ntawm cov txheej txheem tom qab kev sib hloov-sab nraud repositioning thiab yog ua nyob rau hauv kev txiav txim ntawm pob luj taws sab hauv pob taws.

Yuav Ua Li Cas Orthopedic Implants thiab Orthopedic Instruments?

Rau CZMEDITECH , peb muaj cov khoom lag luam ua tiav ntawm orthopedic phais implants thiab cov cuab yeej siv, cov khoom suav nrog txha caj qaum, intramedullary rau tes, kev raug mob phaj, xauv phaj, cranial-maxillofacial cov, prosthesis, cov cuab yeej siv zog, sab nraud fixators, arthroscopy, Veterinary saib xyuas thiab lawv cov cuab yeej txhawb nqa.

Tsis tas li ntawd, peb tau cog lus los tsim cov khoom tshiab thiab nthuav dav cov khoom lag luam, txhawm rau ua kom tau raws li kev xav tau ntawm kev phais ntawm ntau tus kws kho mob thiab cov neeg mob, thiab tseem ua rau peb lub tuam txhab muaj kev sib tw ntau dua nyob rau hauv tag nrho lub ntiaj teb orthopedic implants thiab instruments kev lag luam.

Peb xa tawm thoob ntiaj teb, yog li koj tuaj yeem ua tau tiv tauj peb ntawm email chaw nyob song@orthopedic-china.com rau ib qho kev tsocai pub dawb, lossis xa lus ntawm WhatsApp rau cov lus teb ceev +86- 18112515727 .

Yog xav paub ntxiv, nyem CZMEDITECH kom paub meej ntxiv.