Ịwa ahụ mbelata emechiri emechi maka mgbaji ọkpụkpụ dị ala.

Mbelata mechiri emechi bụ usoro mmekpa ahụ nke pere mpe nke enwere ike iji maka mgbaji agbaji nke nsọtụ na-enweghị ọnwụ nke ọbara, enweghị ihe ize ndụ nke ibute ọrịa, mgbake na-arụ ọrụ ngwa ngwa, ọnụ ahịa ọgwụ belatara nke ukwuu, enwere ike iji ya maka mbelata oghere oghere na ntu intramedullary pin fixation ọgwụgwọ dị iche iche na-adịghị akwụ ụgwọ, dị ka femoral olu mgbaji, femoral stem fractures, femoral stem fractures. mgbaji, wdg, na-ewepụ mbibi nke ọbara na-erugharị site na mbelata mbepụ.

Mgbaji n'olu femur

(I) traktị

A na-etinye onye ọrịa ahụ n'ihe ndina, a na-eme traction tibial tuberosity traction na akụkụ ahụ emetụtara na ọnọdụ na-anọpụ iche na ntụgharị dị nro dị n'ime. Ibu nke traction dịgasị iche site na mmadụ gaa na onye, ​​​​n'ozuzu 6-9 n'arọ, na ogologo oge nke traction ekwesịghị gafere 12 awa. 90% nke ndị ọrịa nwere ike nweta repositioning site traction.

(B) Ndozigharị mkpagharị mechiri emechi

Ọ bụrụ na traction emezughị ihe a chọrọ, a ga-agbakwunye ndogharị akwụkwọ ntuziaka, n'okpuru nhụsianya epidural:

1. Usoro MC Elvenny

Ebumnuche bụ iji dozie pelvis, n'èzí na-atụgharị akụkụ ahụ emetụtara ma mee ka ike traction dịkwuo elu, wee gbanwee n'ime ma na-atụgharị n'ime ya iji nweta nzube nke ntughari.

2. Ụzọ kacha mma

Onye ọrịa ahụ na-edina ala n'ala, na-ehulata hip na ikpere site na 90 °, traction tinyere femoral axis nke akụkụ ahụ emetụtara maka 2 ruo 3 nkeji, wee gbanwee n'ime akụkụ ahụ emetụtara ma gbanwee ya n'ụzọ dị nro, mgbe emezigharị ya, jiri nwayọọ belata akụkụ ahụ emetụtara, ma ọ bụrụ na ụkwụ emetụtaghị ka ọ na-atụgharị n'èzí, ọ na-egosi na ọ ga-aga nke ọma. Tupu ịme nhazi nke ime, a na-eji igwe C-arm iji nyochaa.

(C) Usoro nke ịgbatị agịga na-egbu egbu

Ọ bụrụ na enwetaghị ngbanwe site na ụzọ ndị dị n'elu, ọ na-egosikarị ma ọ bụ na agbajiwo isi femoral ma ọ bụ na enweela nkewa ntụgharị n'etiti isi na olu (Njirimara 1A), ma ọ bụ na enwere ntinye ebe n'etiti isi na olu. (Nke a nwere ike ime n'ụdị Ogige II, III, ma ọ bụ IV). N'okwu a, ịtụgharị akụkụ ahụ emetụtara iji mee ka mgbaji isi na olu adịghịzi arụ ọrụ. Iji zere mbepụ na ntughari, enwere ike iji usoro na-apịpụta agịga na-agbaji agbaji.

• A na-etinye agịga okirikiri ọkpụkpụ 3.0 ruo 3.5mm nke kwụ ọtọ site na akpụkpọ ahụ 1 ruo 2 cm n'okpuru njikọ nke inguinal ligament na akwara femoral n'ihu isi femoral, na agịga na-atụgharị miri emi ruo etiti isi femoral n'okpuru nlekọta nke igwe C-arm (Fig).

• Iji mee ka ike ahụ sie ike, enwere ike ịtinye agịga okirikiri ọkpụkpụ nke abụọ 4-5 mm n'akụkụ agịga a, na njedebe nke agịga hapụrụ n'èzí akpụkpọ ahụ.

• Site na trochanter ka ukwuu, a na-agbaji agịga okirikiri ọkpụkpụ abụọ nke 3.5 mm n'ụzọ ziri ezi dịka akụkụ nke cervical stem na akụkụ nke ihu ihu, na-erute njedebe dị anya nke mgbaji olu femoral (anaghị agafe n'ọkpụkpụ) na-ahapụ njedebe nke agịga n'èzí akpụkpọ ahụ.

• Onye na-arụ ọrụ na-eji aka abụọ na-ejigide ọdụ abụọ nke ọdụdụ agịga ma na-edozi akụkụ mgbawa isi na olu iji kwado ibe ya na nkwado nke onye inyeaka (Figure 1C-E).

• Mgbe nhazi ahụ gachara, a na-awụnye ntụtụ okirikiri nke etinyere na trochanter ka ukwuu n'ime isi femoral maka idozi nwa oge, a na-etinyekwa ọtụtụ skru oghere n'ime isi femoral (Njirimara 1F).

Usoro mbelata mechiri emechi akọwapụtara n'elu nwere ike nweta mbelata achọrọ n'ihe dịka 98% nke mgbaji olu femoral. Nke ka mma nhazi nke mgbaji ahụ, ma ọ bụ mechiri emechi ma ọ bụ nke agbaji, ka mma prognosis. Ọtụtụ mgbe, ogo mgbawa mgbawa egosiri na X-ray dị obere karịa ogo mgbawa n'ezie. Ebe ọ bụ na mgbawa mgbawa na-emetụta kpọmkwem ọgwụgwọ nke mgbawa na ohere nke necrosis nke isi femoral, ọ dị mkpa inwe mkpebi ziri ezi nke ihe nkiri X-ray mgbe mgbatị ahụ gasịrị. Ọ bụrụ na akụkụ S-ọdịdị ya adịghị mma ma ọ bụ kwụsịtụrụ, ọ na-egosi na mgbaji n'olu femoral eruteghị ngbanwe nke anatomical (Nyocha 2).

Ọgụgụ 1 Agbaji n'olu femoral na-atụgharị site n'ịkpọpụta agịga percutaneous

Ọgụgụ 2 X-ray gbajiri olu femoral nwere mpụta mpụta na-aga n'ihu n'usoro nhazi anatomical yana nkwụsị mpụta n'usoro n'usoro na-abụghị nke anatomical.

Mgbaji azuokokoosisi femoral

Usoro mbelata nke mechiri emechi nwere ike inye aka na nhazi nke ọkpụkpụ femoral na-emebighị ihe ọ bụla dị nro ma ọ bụ ọbara na-enye aka na njedebe mgbawa, a pụkwara iji ya mee ihe maka ntinye n'ime ya na ntu intramedullary.

• N'okpuru ọgwụgwọ epidural anesthesia, onye ọrịa ahụ dina n'elu akwa (akpụkpọ ahụ nke akụkụ ahụ emetụtaghị n'oge a), otu onye inyeaka na-ejide nwa ehi nke akụkụ ahụ emetụtara, onye enyemaka nke ọzọ na-eji eriri akwa na-adọta mgbọrọgwụ apata ụkwụ nke onye ọrịa iji gbochie traction ahụ, ya na akụkụ ahụ emetụtara na-anọpụ iche na patella nke ikpere na-eche ihu n'elu (mkpụrụ akpụ nke ikpere na-eche ihu n'elu elu). na-adọkpụ, na enwere ike idozi ya na-akpaghị aka site na traction, ya mere, onye na-arụ ọrụ kwesịrị imezi mgbazi ihu-azụ na n'akụkụ nke njedebe gbajiri agbaji nke azuokokoosisi).

• Onye na-arụ ọrụ na-eji ogwe aka abụọ gbachie akụkụ ahụ emetụtara ma jide aka ọnụ (Nkeji 3 na eserese 4), ma na-edozi ngbanwe ihu-azụ na mpụta nke mgbaji ahụ ozugbo site n'iji ike njigide nke ogwe aka abụọ ahụ.

• Dịka ọmụmaatụ, ọ bụrụ na akụkụ dị nso nke mgbaji femur na-apụ n'èzí na n'ihu, a na-eji otu ogwe aka na-amanye akụkụ dị nso nke mgbaji ahụ n'ime na ala. Ogwe aka nke ọzọ na-amanye akụkụ mgbaji dị anya n'èzí na elu iji gbazite ike nkedo (dibịa na-emegharị ahụ kwesịrị inwe ikpe ziri ezi nke ntụgharị mgbawa mgbawa na anya nchụpụ tupu ịtọgharịa), ka e wee nwee ike ịtọgharịa mgbaji ahụ nke ọma n'otu oge. N'oge usoro nhazigharị, onye na-enyere aka kwesịrị ịbawanye ike traction ma mee ka femur ghara ịgbagharị.

• Mgbe njedebe gbajiri agbaji na-agbaji, a ghaghị ịnụ ụda na-ehichapụ ọkpụkpụ dị nro, n'oge a, onye inyeaka ahụ kwesịrị ịnọgide na-enwe traction, ma belata ike traction.

• Mgbe a na-ejikọta mgbaji ahụ site na igwe C-arm (ọ bụrụ na ọ ka dị ntakịrị ihe na-adịghị mma, mee mgbanwe ụfọdụ iji jide n'aka na ọkpụkpụ ahụ na-adaba na ibe ya), nọgide na-enwe traction, kpochapụ akụkụ ahụ emetụtara ma gbasaa akwa nhicha ahụ, wee mee nhazi ntu intramedullary.

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Fig. 3 A na-edozi ntugharị ihu-azụ na mpụta nke mgbaji ahụ n'otu oge ahụ site na ịpịkọta ogwe aka abụọ n'akụkụ akụkụ ahụ emetụtara ma na-ejikọta aka ọnụ, na-eji ike nkedo nke abụọ ahụ.

Ọgụgụ 4 Ụkwụ femoral agbaji agbaji na-emezigharị ihe eji arụ ọrụ schematic

• Maka ndị ọrịa nwere nnukwu mgbawa mgbawa, mmechi mechiri emechi na-enweghị ihe ịga nke ọma ma ọ bụ mgbaji agbaji agbaji, enwere ike iji akwa traction nke ịwa ahụ maka mbelata mechiri emechi site na iji ụfọdụ ike akụrụngwa, nke nwekwara ike mechie nke ọma mbelata nke mgbawa femoral stem.

• Mgbe etinyechara akụkụ ahụ emetụtara na etiti traction maka traction na nyocha C-arm na-egosi na a na-emezigharị mgbawa ahụ na-agbaji agbaji, enwere ike imezi njedebe dị anya nke akụkụ ahụ emetụtara n'ime iji nwetaghachi nhazi na nhazi na orthostatic oyiyi nke femoral stem.

• N'ihi na mgbakasị ahụ nke akwara apata ụkwụ n'okpuru traction nwere ike ịrụ ọrụ dị nro na-agbaji agbaji na femoral stem fractures, ọtụtụ n'ime ọkpụkpụ ụkwụ femoral nwere ike nweta nhazi nke na-enye afọ ojuju na foto x-ray orthogonal.

• Otú ọ dị, n'oge a, n'ihi enweghị nkwado dị irè na njedebe dị anya nke akụkụ mgbawa n'okpuru mmetụta nke ike ndọda, akụkụ ahụ dị anya nke femoral stem na-emekarị ka ọ bụrụ nke a na-akwagharị n'azụ, na n'oge a, a na-etinye akwa akwa akwa akwa akwa akwa nwere ike tinye ya n'azụ akụkụ nke distal fracture end after sterilization and sterilment displace of the skin and steriling. Enwere ike idozi nke njedebe mgbawa dị anya site n'ịgbanwe ịdị elu nke ihe nkwado ahụ.

• Ọ bụrụ na emezighị ntugharị azụ nke akụkụ mgbaji dị anya, enwere ike guzobe ntu dị nso na nsọtụ nke nnukwu trochanter ma ọ bụ pyriform fossa, mgbe ahụ, a na-etinye mkpanaka intramedullary repositioning n'ime oghere medullary nke proximal fracturemur nke na-emegharị akụkụ nke fetradullary. a na-ebuli ya nke ọma n'ihu iji mee ka mgbaji dị nso nke femur laghachi azụ site n'iji lever nke mkpanaka ngbanwe, si otú a na-eweghachi nhazi na mgbaji dị anya nke chụpụrụ n'azụ,

• Mgbe agbajichara agbajichara, a ga-etinye pin ndu ogologo n'ime oghere mgbaji dị anya iji mechaa nrụpụta mechiri emechi. Ogwe ngbanwe nke intramedullary dị irè karịsịa n'ịdozi mgbanwe mgbanwe, nkwụsịtụ, na nrụrụ ngbanwe nke mpụga nke na-emekarị na mgbaji dị nso nke femur dị nso (Nyocha 5).

• Maka ntugharị akụkụ mpụta fọdụrụnụ, enwere ike imezi oghere nke ngwụcha mkpịrịkọ nke mkpanaka intramedullary iji duzie pin ndu ogologo n'ime oghere mgbaji dị anya iji mechaa mbelata mechiri emechi.

• Ụzọ ọzọ a na-emechi emechi bụ ịkwanye ntu Schanz n'ime ọkpụkpụ ọkpụkpụ nke dị n'akụkụ njedebe nke mgbaji a chụpụrụ ma mezie njedebe mgbaji site na ntu Schanz maka mbelata mechiri emechi (Njirimara 6). Mgbe agbajichara agbajichara nke ọma, a na-etinye ntu intramedullary n'ime oghere medullary dị nso na nke dị anya nke gbajiri agbaji iji mezue nhazi nke ime (Nyocha 7).

  
  

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Ọnụọgụ 5 Ntugharị nke akụkụ mgbawa dị nso maka ndogharị mechiri emechi site na iji mkpanaka repositioning intramedullary

Ọnụọgụ 6 Mbelata mechiri emechi site na iji ntu Schanz etinyere na cortex ọkpụkpụ dị n'akụkụ na njedebe mgbawa.

Ọgụgụ 7 Mbelata ntu intramedullary mechiri emechi nke mgbaji agbaji dị iche iche nke stem femoral site na iji ntu Schanz.

Mgbaji ụkwụ ụkwụ

(A) Nkwadebe tupu ịwa ahụ

• Nchọpụta nyocha redio: Ntụle ihe nleba anya nke nkwonkwo ụkwụ kwesịrị ịgụnye akụkụ 3: anteroposterior (Nyocha 8), nkwonkwo ụkwụ (15 Celsius nke ntụgharị n'ime) (Njirimara 9), na mpụta (Nyocha 10).

• Mgbe nkwonkwo nkwonkwo ụkwụ na-emerụ ahụ nke ukwuu, nkwonkwo ime na mpụga na talus ga-akwaga na ogo 11 dị iche iche (Nyocha 11). Igwe redio static adịghị egosipụta n'ụzọ ziri ezi nkwụsi ike nke nkwonkwo nkwonkwo ụkwụ. Radiographs nrụgide na MRI nwere ike imeziwanye nyocha nke nkwụsi ike nke nkwonkwo nkwonkwo ụkwụ na nkwonkwo nkwonkwo (Figure 12).

• N'okwu a, a ga-ekpebi ụdị mmerụ ahụ nke nkwonkwo ụkwụ n'ụzọ ziri ezi site na usoro nke mmerụ ahụ na data redio nke akụkụ ahụ emetụtara iji duzie n'ụzọ ziri ezi na nhazigharị na nhazi.

• Mgbe ụfọdụ, mgbaji ụkwụ etiti dị mfe nwere ike ịbụ akụkụ nke mgbagwoju anya 'Maisonneuve fracture', nke gụnyekwara mgbaji fibula dị nso na mmerụ ahụ jikọtara ọnụ, ya mere a ga-enyocha tibiofibula dum na redio.

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Ọgụgụ 8 Ọkwa ihu na azụ

Ọgụgụ 9 ntụpọ nkwonkwo ụkwụ (15° nke ntụgharị n'ime)

Ọgụgụ 10 Ọkwa n'akụkụ

Ọgụgụ 11 O doro anya na mgbawa mgbawa jikọtara ya na nchụpụ

Ọgụgụ 12 Mgbasa redio (triangular ligament rupture)

(II) Nkụnwụ ahụ

A na-ewerekarị mgbakasị akwara femoral na sciatic.

(C) Usoro nrụpụta

A na-eme ụdị ntụgharị nke dị n'azụ-mpụga nke imechi mechiri emechi n'usoro nke nkwonkwo ụkwụ nke dị n'ime ime-n'azụ ụkwụ-inferior tibiofibular. A na-eme ntụgharị ntụgharị azụ-ụdị ntụgharị nke ime n'usoro nke nkwonkwo ụkwụ-mpụta.

• N'ihe banyere ntụgharị ntụgharị nke azụ-mpụga nke IV, a na-etinye onye ọrịa ahụ n'ala na ikpere na-atụgharị na 90 ° iji mee ka nwa ehi triceps dị jụụ.

• Ndị na-enyere aka abụọ na-ejide akụkụ popliteal nke apata ụkwụ na ụkwụ n'otu n'otu, a na-etinyekwa traction na ntụziaka nke nrụrụ mgbawa (ike traction ekwesịghị ịdị oke iji zere imerụ ahụ ahụ).

• Onye inyeaka na-adọkpụrụ ụkwụ na-atụgharị ụkwụ n'ime iji mezie nrụrụ ntụgharị mpụta (Njirimara 13). Ka ọ na-eme ka njedebe dị anya na-aga n'akụkụ tibial ma na-adọta tibia distal n'akụkụ akụkụ fibular, onye inyeaka na-atụgharị n'ime ma na-agbatị nkwonkwo nkwonkwo ụkwụ iji mezie ngbanwe nke nkwonkwo ụkwụ na talus dị n'èzí (Nyocha 14).

• Jikwaa ngbanwe n'ime-ntụgharị n'ime ime-ọkwa ndọtị. Mgbe ahụ, a na-ejide mkpịsị ụkwụ ụkwụ azụ azụ site na mkpịsị aka abụọ, mkpịsị aka anọ na-agba gburugburu tibia distal, na mkpịsị aka abụọ na-agbanye ma na-amanye anya, ka ha na-akwatu tibia distal iji tọgharịa nkwonkwo ụkwụ azụ (Nyocha 15).

• N'ikpeazụ, onye na-arụ ọrụ na-eji mkpịsị aka ya na-akwagharị ikpere ụkwụ etiti azụ azụ na ala ka ọ tọgharịa ya (Foto 16). Ndị na-enyere aka abụọ na-edobe ụkwụ na nkwonkwo ụkwụ n'ime ngbanwe n'ime ime-atụgharị n'ime ime-ndabere n'ọnọdụ ndọtị na nkwadebe maka nhazi.

Ọgụgụ 13 Ndozi ndọtị nke nrụrụ ntụgharị nke mpụga

Ọgụgụ 14 Ndozi ntughari n'akụkụ nke nkwonkwo ụkwụ na talus

Ọgụgụ 15 Ndozi ngbanwe nke nkwonkwo ụkwụ azụ

Ọgụgụ 16 Ndozi ngbanwe nke nkwonkwo ụkwụ n'ime

Usoro ngbanwe nke ntụgharị-n'ime ime bụ ihe na-abụghị nke usoro ntụgharị-mpụga-mpụga ma na-eme ya n'usoro nke nkwonkwo ụkwụ-mpụta.

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