Ọkpụkpụ olu femoral bụ otu n'ime mmerụ ahụ nke orthopedic a na-ahụkarị na omume ụlọ ọgwụ, na ihe ka ọtụtụ n'ime ndị ọrịa agadi na-aza ihe karịrị 50% nke mgbawa hip. Dị ka ọnụ ọgụgụ si kwuo, ọnụ ọgụgụ ndị na-agbaji n'olu femoral ejiri nwayọọ nwayọọ na-abawanye n'afọ ndị na-adịbeghị anya, na-enwe mmetụta dị elu na ụmụ nwanyị karịa ụmụ nwoke. Vertigo, dementia, ọrịa na-adịghị mma na ọrịa obi na ndị agadi na ume ike na-eto eto bụ ihe ize ndụ dị ukwuu maka mgbaji olu femoral.
N'afọ ndị na-adịbeghị anya, ọtụtụ ihe ndozi ime ụlọ dị ka screws oghere, screws power hip (DHS), screw hip screws (HSH), efere femoral dị nso, mbọ nrụgharị, na mbọ Gamma apụtala. N'ime ihe ndozi ndị a dị n'ime, skru oghere bụ ihe a na-ejikarị eme ihe. Nnyocha egosiwo na ihe ka ọtụtụ n'ime ndị dọkịta na-awa ahụ na-ahọrọ screws oghere maka ọgwụgwọ nke mgbaji na-enweghị isi, na akụkụ dị ukwuu nke ndị dọkịta na-awa ahụ na-ahọrọ iji skru oghere maka mgbaji olu femoral. Ndozi ihe nkedo 3 pallel partially threaded hollow screw fixation bụ ụdị nrụnye nke ime n'ime.
Njirimara anatomical nke mgbaji olu femoral
A nabatara ugbu a na usoro vaskụla nke isi femoral bụ ihe kachasị mkpa na-emetụta ọgwụgwọ mgbaji na isi femoral necrosis. Mmebi nke usoro inye ọbara nke isi femoral bụ isi ihe na-akpata pathological nke ischemic necrosis nke isi femoral. Nnyocha nyocha nke usoro akwara vaskụla nke olu femoral chọpụtara na netwọkụ epiphyseal vaskụla na sistemụ akwara nke mpaghara nkwado dị ala nwere ike ịbụ ihe dị mkpa maka idobe ọbara na isi femoral mgbe mgbawa n'olu femoral, nke mere na ịkụ ala na ịkụnye intraoperative dị nso dị ka o kwere mee na mpaghara etiti nke femoral isi nwere ike belata mmerụ ahụ nke ọma nke ọma. usoro.
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Ọgụgụ 1 Ọbara na-enye isi femoral, anterolateral (a) na azụ (b). Enwere mgbanwe dị na ọbara na-enye isi femoral, mana akwara azụ azụ na medial spinofemoral arteries sitere na akwara femoral miri emi na 60% nke ndị ọrịa.
(1) Ọtụtụ n'ime ọbara na-enye isi femoral na-abịa site na mpụta rotor femoral artery.
(2) Ọ na-enye alaka 3 ma ọ bụ anọ na-akwado akwara eriri. Alaka ndị a na-aga azụ azụ na n'elu n'akụkụ akụkụ retroflexed nke olu synovial nke femur ruo na nsọtụ cartilaginous nke isi femoral. The arịa dị n'ime gburugburu ligament.
(3) Nke sitere na akwara foramen occuta artery. Alaka na-arịgo nke etiti rotor femoral artery.
(4) Na-enye nnukwu trochanter nke femur ma mepụta mgbanaka akwara na mpụta rotor femoral artery.
Oghere skru maka mgbaji n'olu femoral
N'ụlọ ọgwụ, enwere ike iji skru ọkpụkpụ kagbuo atọ nke 6.5 mm ma ọ bụ 7.0 mm ma ọ bụ 7.3 mm maka ndozi na ndị ọrịa na-eto eto ma ọ bụ ndị agadi ma ọ bụ ndị agadi nwere ezigbo ọkpụkpụ. Ekwesịrị itinye ntụzịaka iji dobe ntu atọ ahụ nwere oghere ka ha na-adakọ ọnụ iji nye ohere maka mkpakọ mgbaji agbaji. N'ime olu femoral, a ga-agbanye ihe nkedo ahụ n'akụkụ ọnụ ya, na-elezi anya na a na-etinye ihe nkedo ahụ n'ime isi femoral ọ bụghị n'ofe eriri mgbaji, n'ihi na nke a bụ nanị ụzọ isi nweta mkpakọ n'etiti njedebe. Ekwesịrị imechi skru ndị ahụ ma gosipụta ya ugboro ugboro na intraoperative. Ọ bụrụ na ejiri akwa traction, traction ga-adị jụụ. Enwere ike idowe skru oghere n'oge ọ bụla. A ghaghị ime fluoroscopy nke ihu, akụkụ, na 45 ° oblique iji hụ na kposara adịghị abanye na nkwonkwo hip.
1, Specific ịwa ahụ ọrụ usoro.
Were ntu ntu 'triangle tụgharịrị, nke a na-ejikarị eme ihe na ụlọ ọgwụ, dịka ọmụmaatụ.
a. Nke mbụ, n'okpuru fluoroscopy, jiri X-ray na ụgbọ elu abụọ nke fluoroscopy iji chọpụta nhazi nke ntụtụ nduzi ala na nke etiti.
b. A na-eme mbepụ akpụkpọ anụ nke na-agbatị 2-3 cm nso.
c. A na-ekewa oyi akwa fascial n'akụkụ mbepụ ahụ na ihe nkesa Cobb na-ekewapụ eriri ogologo ogologo n'akụkụ akwara femoral dị n'akụkụ.
d. Debe agịga nduzi n'ọnọdụ ebe ụgbọ elu abụọ ahụ zuru oke.
e. A na-etinye otu ntụtụ nduzi n'akụkụ ihu nke olu femoral na onye inyeaka iji chọpụta akụkụ ihu ihu.
f. Mgbe edozichara pin ntuziaka nke mbụ, a na-amata ntụtụ ntụzịaka nke posterosuperior na anterosuperior site na iji ntuziaka ndị yiri ya iji nweta nkwado cortical azụ na ihu n'ime olu femoral.
g. A na-eme nke a site n'itinye pin ndu n'elu obere trochanter n'akụkụ cortex olu femoral distal site na ọkpụkpụ femoral; A na-etinye ntụtụ ntụzịaka abụọ na-esote na nso nso n'ụdị ejiji, dị ka o kwere mee na 5 mm site na cortex ihu na azụ; A na-edozizi omimi ntinye nke pin ndu ka ọ ruo 5 mm n'okpuru cartilage; N'ikpeazụ, a na-emegharị oghere ahụ, tụọ ya, a na-agbanyekwa ihe nkedo oghere nwere nrụgide.
h. Jide n'aka na ị gaghị abanye agịga n'okpuru obere trochanter ma na-aga nso n'akụkụ ọkpụkpụ femoral.
i. Jide n'aka na ntụtụ nduzi eri edobere n'okpuru nkwonkwo.
j. Ekwela ka ntụtụ nduzi banye n'elu articular.
k. Kpebie ogologo ịghasa kwesịrị ekwesị site na ịlele ogologo pin ndu wee wepụ 5 mm.
l. Ọtụtụ mgbe, a na-eji skru na-egwupụta onwe ya, ma mgbe ụfọdụ, a na-achọ ka ndị ọrịa na-eguzosi ike n'ihe nwere ọkpụkpụ ọkpụkpụ.
m. Ọ bụrụ na ohere kwere, enwere ike iji spacer.
n. Ihe nkedo nke anọ (nhazi diamond) nwere ike ịdị mkpa maka ndị na-eguzosi ike n'ihe nwere mgbaji mgbaji dị n'azụ nke akụkụ aka.
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Ọ bụ ezie na kposara oghere maka mgbaji n'olu femoral ugbu a bụ ihe a na-ahụkarị, a ka nwere nghọtahie dị iche iche gbasara ọnụọgụ na nhazi nke skru nke ịwa ahụ etinyere oghere, na-adaberekarị na mmasị onye ọrụ; ihe ndị dị ka ọkpụkpụ ọkpụkpụ nke onye ọrịa, ike ịghasa, na ịga nke ọma nke ọgwụgwọ nwekwara mmetụta.
1. Ọnụ ọgụgụ nke kposara oghere.
A na-edobe mgbaji n'olu femoral na skru 2-4 oghere.
N'ọtụtụ ọnọdụ, a na-eji skru 3 mee ihe n'ihi na ha nwere ike iguzogide nrụgide ihu siri ike, mee ka nkwụsi ike dịkwuo elu, ma belata nkwụsị nke njedebe mgbawa.
Maka mgbaji n'olu femoral nwere akụkụ Pauwells> 50 °, skru 2 nwere ezi uche.
N'ime ndị ọrịa nwere mgbaji siri ike nke dị n'azụ femoral olu, a kwadoro skru 4 oghere.
Agbanyeghị, omume a na-eme ugbu a ka na-eji skru 3 oghere maka ndozi.
2. Nhazi nke oghere ịghasa.
Mgbe a na-eji skru 3 oghere mee ihe maka ime ime nke ọkpụkpụ femoral n'olu, a na-ekwenyekarị na a ga-agbaso echiche nke ' mkpakọ sliding ', nke mere na 3 screws etinyere na-ejikọta ibe ha na orthogonal anya ma nwee nhazi triangular na n'akụkụ anya.
N'ụzọ dị otú a, ndị atọ yiri oghere kposara nwere ike inye ezigbo n'ibu nkwado na-etolite a slide track, nke mere na mgbaji ngọngọ nwere ike slide tinyere femoral olu axis n'okpuru nkwekọrịta nke hip mọzụlụ, na-eme ka nrụgide na mgbaji njedebe na-akwalite mgbaji na-agwọ ọrịa.
Agbanyeghị, ma skru 3 nwere oghere ka edobere na nhazi triangular orthotriangular ma ọ bụ tụgharịrị agbanweela bụ arụmụka.
Ọganihu na usoro nhazi ihe mkpuchi oghere maka mgbaji olu femoral
Yuenyongviwat et al. e mere ọhụrụ kemeghi myiri mkpọpu ndu ndu maka ọnyịnye nke oghere kposara na ọgwụgwọ nke femoral olu mgbaji site esịtidem fixation, na chọpụtara na nke a ọhụrụ ndu nwere ike ibelata ọrụ oge na ọnụ ọgụgụ nke intraoperative fluoroscopic echiche tụnyere na omenala usoro, si otú ọbọ afọ ojuju ịwa ahụ pụta.
Filipov et al. emebere igwe kwụ otu ebe na-akwado BDSF (BDSF), nke ebe ntinye nke skru atọ nwere oghere dị na mpaghara cortical nke dị n'akụkụ akụkụ femoral nke dị nso, na kposara atọ ahụ na-agbadakwa n'akụkụ akụkụ nke isi femoral, si otú a na-akpụ ụgbọ elu abụọ. Ụzọ a na-enye ohere maka nkwado cortical okpukpu abụọ, si otú a na-enye ike nhazi zuru oke n'oge mmegharị ahụ.
Nnwale biomechanical site na iji ụdị cadaveric gosipụtara na usoro nhazi BDSF na-enye ndozi dị mma karịa usoro nhazi triangle atụgharị atụgharị. Nsonaazụ nke nnwale biomechanical site na iji ụdị cadaveric gosipụtara na ciment simenti calcium phosphate na-eme ka nkwụsi ike nke oghere oghere nke mgbaji n'olu femoral dịkwuo mma, na-eme ka nguzogide mkpakọ nke olu femoral dịkwuo mma, ma mee ka isi ike dị mma, nke bara uru ụlọ ọgwụ.
N'ihi nnukwu ohere nke isi femoral necrosis mgbe a na-edozi ntu oghere maka mgbaji n'olu femoral, a na-eji ụzọ ndị ọzọ eme ihe iji nyere aka n'ime ntu oghere dị n'ime iji belata nsogbu dị ka isi femoral necrosis. Isi ihe na-akpata necrosis isi femoral mgbe ọkpụkpụ femoral n'olu bụ mfu nke ọbara na-eruba n'isi femoral, ya mere a na-elekwasị anya na ọgwụgwọ bụ otu esi emeziwanye ọbara. Ntinye nke periosteum nke a na-enye n'ọbara n'ime mpaghara necrotic nke isi femoral na njuputa apụta nke oghere ndị fọdụrụ site na oyi akwa na-emepụta ga-eme ka ọdịiche nke periosteum anyado n'ime osteoblasts nakwa dị ka mweghachi nke vaskụla sprouts, nke nwere ma osteogenic na revaskụla mmetụta.
Nchịkọta
Ndozi oghere oghere maka mgbaji olu femoral bụ usoro nhazi dị irè nke ọma, nke nwere uru nke ọrụ dị mfe, obere oge ọrụ, obere trauma, nhazi a pụrụ ịdabere na ya na mgbake ngwa ngwa postoperative. Otú ọ dị, n'ihi njirimara anatomical nke ọkpụkpụ femoral n'olu, nsogbu nke ischemic necrosis nke isi femoral na enweghị njikọ nke mgbaji ka enweghị ike izere kpamkpam site na ntinye nke ime ime maka ọkpụkpụ femoral olu. Ya mere, ihe ngosi maka iji usoro nhazi a dị mkpa ka a dokwuo anya tupu e jiri ya mee ihe, na ndị agadi na-arịa ọrịa na-agbaji n'olu femoral na-adịghị mma na ọnọdụ izugbe na-adịghị mma na-achọ ọrụ n'oge kwesịrị izere iji ntinye nke ime ime maka ọkpụkpụ femoral n'olu dị ka o kwere mee. Ihe ndị dị ize ndụ na-emetụta prognosis nke onye ọrịa, dị ka ụdị mgbawa, ọkpụkpụ ọkpụkpụ, na ọnọdụ ọrụ onye ọrịa, kwesịkwara iburu n'uche iji belata nsogbu ndị na-adịte aka na-adịte aka ma si otú ahụ meziwanye ọgwụgwọ ọgwụgwọ nke ọkpụkpụ femoral n'olu.
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