Okulongoosa okukendeeza okuggaddwa ku kumenya kw’ebitundu by’omubiri ebya wansi.

Closed reduction is the minimally invasive technique that can be used for stable fractures of extremities with no loss of blood flow, no risk of infection, fast functional recovery, significantly reduced medical costs, and can be used for closed reduction hollow nail and intramedullary pin fixation treatment of various unstable fractures, such as femoral neck fractures, femoral stem fractures, tibiofibular fractures, humeral stem fractures, etc., okumalawo okusaanyaawo omusaayi okutambula nga kikendeeza ku musaayi.

Okumenyeka kw’ensingo y’omugongo .

(i) Okusika .

Omulwadde ateekebwa mu kitanda, era tibial tuberosity traction ekolebwa n’ekitundu ekikoseddwa mu mbeera ya neutral n’okukyukakyuka okw’omunda okutono. Obuzito bw’okusika bwawukana okusinziira ku muntu, okutwalira awamu kkiro 6-9, era ebbanga ly’okusika teririna kusukka ssaawa 12. Abalwadde 90% basobola okutuuka ku kuddamu okuteekebwa mu kifo nga bayita mu kusika.

(b) Okuzzaawo enkola y’okukozesa ebyuma ebiggaddwa .

Singa okusika kulemererwa okutuuka ku byetaago by’okuddamu okuteeka, okuddamu okuteeka mu kifo ekimu kuyinza okugattibwako, wansi w’okubudamya epidural:

1. MC Elvenny Enkola .

Ekigendererwa kwe kutereeza ekisambi, okukyusakyusa ebweru ekitundu ekikoseddwa n’okwongera ku mpalirizo y’okusika, n’oluvannyuma ne zikyusa munda ne zizza munda ekitundu ekikoseddwa okutuuka ku kigendererwa ky’okuddamu okuteekebwa mu kifo.

2. Enkola ya LeadBetter .

Omulwadde agalamidde ku ttaka, koona ekisambi n’okugulu okukoseddwa 90°, okusika okuyita ku kisenge ky’ekisambi ky’ekitundu ekikoseddwa okumala eddakiika 2 ku 3, olwo munda ozimbulukuse ekitundu ekikoseddwa n’okukinyiga mu ngeri etali ya maanyi, oluvannyuma lw’okuddamu okuteekawo, mpola mpola ekitundu ekikoseddwa, era singa ekigere ekikoseddwa tekirabika nga kizimbulukuka ebweru nga kizimbulukuka, kikendeeza nnyo okuddamu okutuukirizibwa. Nga tetunnakola kunyweza kwa munda, ekyuma kya C-arm kyakozesebwa okukakasa.

(c) Enkola ya percutaneous needle prying .

Singa okuddamu okuteekebwa mu kifo tekituukibwako mu nkola ezo waggulu, kitera okulaga oba nti omutwe gw’ekisambi gumenyese oba nti wabaddewo okwawukana okw’enzitowererwa wakati w’omutwe n’ensingo (Ekifaananyi 1a), oba nti waliwo okuyingizibwa awalala wakati w’omutwe n’ensingo. (Kino kiyinza okubaawo mu bika byonna eby’olusuku II, III, oba IV). Mu mbeera eno, okukyusakyusa ekitundu ky’omubiri ekikoseddwa okumenya omutwe n’ensingo tekikyali kikola. Okusobola okwewala okusala n’okuddamu okuteeka mu kifo, enkola ya percutaneous needle prying esobola okukozesebwa okuddamu okuteeka okumenya.

• Empiso eyeetooloovu eyekulungirivu eya 3.0- okutuuka ku 3.5-mm-diameter eyingizibwa mu vertikal okuyita mu lususu 1 ku 2 cm wansi w’enkulungo y’omusipi gw’omu lubuto n’omusuwa gw’ekisambi okutuuka mu maaso g’omutwe gw’ekisambi, era empiso ekyusibwakyusibwa mu buziba okutuuka mu makkati g’omutwe gw’ekisambi wansi w’okulabirirwa kw’ekyuma kya C-Emmundu (Figulie 1b).

• Okunyweza amaanyi ga prying, empiso ey’okubiri eyeetooloovu esobola okuyingizibwa mm 4-5 nga zikwatagana n’empiso eno, ng’enkomerero y’empiso erekeddwa ebweru w’olususu.

• Okuyita mu trochanter esinga obunene, empiso bbiri ezeetooloovu z’amagumba eza mm 3.5 zisimibwa nga zigoberera enkoona y’ekikolo ky’omumwa gwa nnabaana n’enkoona y’okusitula okw’omu maaso, okutuuka ku nkomerero ey’ewala ey’okumenya ensingo y’ekisambi (toyita mu kikutuka) n’okuleka enkomerero y’obwetaavu ebweru w’olususu.

• Omukozi akwata ebitundu ebibiri eby’emikira gy’empiso n’emikono gyombi era n’atereeza ebitundu by’okumenya omutwe n’ensingo okukwatagana ne munne n’enkolagana y’omuyambi (Ekifaananyi 1C-E).

• Oluvannyuma lw’okulaganya okumatiza, ppini eyetooloovu ey’amagumba eyingizibwa ku kitundu ekinene eky’omutawaana (Greater Trochanter) esitulwa mu mutwe gw’ekisambi okusobola okunyweza okumala akaseera, era olwo sikulaapu eziwerako ezirimu ebituli ne ziyingizibwa mu mutwe gw’ekisambi (Figure 1f).

Enkola y’okukendeeza okuggaddwa eyogeddwako waggulu esobola okutuuka ku kukendeeza okwetaagisa mu bitundu nga 98% eby’okumenya ensingo y’ekisambi. Okukwatagana kw’okumenya, ka kibeere nga kuggaddwa oba nga kutemeddwa, okuteebereza gye kukoma okuba okulungi. Ebiseera ebisinga, ddiguli y’okuseeseetula kw’emmeeme eragiddwa ku X-ray eba ntono okusinga ddiguli entuufu ey’okuseeseetula kw’emmeeme. Okuva alignment ya fracture bwe ekosa butereevu okuwona kw’okumenya n’okusobola oku necrosis of the femoral head, kyetaagisa okuba n’okusalawo okutuufu ku x-ray film oluvannyuma lw’okusengeka okumenya. Singa enkokola eringa S eba teseeyeeya oba nga esaliddwako, kiraga nti okumenya ensingo y’ekisambi tekutuuse ku kuzzaawo mubiri (Figure 2).

Ekifaananyi 1 Okumenya ensingo y’ekisambi nga kiddamu okuteekebwa mu kifo ky’empiso ey’okuyita mu lususu .

Ekifaananyi 2 Obulago bw’ekisambi Okumenya x-rays nga zirina enkokola ey’ebweru egenda mu maaso mu kukwatagana kw’omubiri n’okusalako okw’ebweru mu kukwatagana okutali kwa anatomical .

okumenya ekikolo ky’ekisambi .

Enkola y’okukendeeza okuggaddwa esobola okuyamba mu kulaganya okumenya kw’ekikolo ky’ekisambi awatali kwonoona bitundu bigonvu oba omusaayi gwonna okutuuka ku nkomerero y’okumenya, era esobola okukozesebwa okunyweza munda n’omusumaali ogw’omu lubuto.

• Under epidural anesthesia, the patient is lying flat on the bed (the skin of the affected limb has not been sterilized at this time), one assistant holds the calf of the affected limb, and the other assistant pulls the patient's thigh root with a cloth belt to counteract the traction, with the affected limb in a neutral position and the patella of the knee facing upward (the femoral stem fracture is usually not rotated and displaced by muscle Okusika, era bisobola okutereezebwa mu ngeri ey’otoma nga bisika, kale omukozi yeetaaga okutereeza kyokka eky’okusengulwa eky’omu maaso n’eky’ebbali eky’enkomerero y’ekikolo eyamenyeka).

• Omukozi akozesa emikono gyombi okwetooloola ekitundu ekikoseddwa era n’akwata emikono awamu (Ekifaananyi 3 n’ekifaananyi 4), n’okutereeza okusengulwa okw’omu maaso okw’emabega n’okw’ebbali okw’okumenya omulundi gumu ng’akozesa amaanyi g’okunyweza ag’omuggundu ag’engalo zombi.

• Okugeza, singa ekitundu eky’okumpi eky’okumenya ekisambi kisengulwa ebweru ne mu maaso, omukono gumu ogw’omu maaso gukozesebwa okusika ekitundu eky’okumpi eky’okumenya munda ne wansi. Omukono omulala ogw’omu maaso gusika ekitundu ky’okumenya eky’ewala ebweru n’okudda waggulu okwewola amaanyi agakwata (omusawo azzaawo alina okuba n’okusalawo okutuufu okw’obulagirizi bw’okusengulwa kw’emmeeme n’obuwanvu bw’okusengulwa nga tannaddamu kuteekawo), okumenya kusobole okuddamu okuteekebwawo obulungi mu kiseera ekimu. Mu nkola y’okuzzaawo ekifo, omuyambi alina okwongera ku maanyi g’okusika n’okukuuma ekisambi obutakyukakyuka.

• Enkomerero y’emmeeme bw’eba efuuse ennyindo okusinga, eddoboozi ery’okusika amagumba eritali ddene lirina okuwulirwa, mu kiseera kino, omuyambi alina okukuuma okusika, naye okukendeeza ku maanyi g’okusika.

• Okumenya bwe kusinga okusengekebwa ekyuma kya C-arm (bwe waba nga wakyaliwo akatono akatali ka bulijjo, kola ennongoosereza ezimu okukakasa nti enkomerero z’okumenya zikwatagana), kuuma okusika, okutta obuwuka ku kitundu ekikoseddwa n’okusaasaanya akatambaala, n’oluvannyuma okukola okutereeza omusumaali ogw’omu kisenge.

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Ekifaananyi 3 Okusengulwa okw’omu maaso okw’emabega n’okw’ebbali okw’okumenya kutereezebwa mu kiseera kye kimu nga kuzinga emikono gyombi ku kitundu ekikoseddwa ne kikwata emikono awamu, nga tukozesa amaanyi aganyweza ag’omukono ogw’omu maaso.

Ekifaananyi 4 Ekikolo ky’ekisambi Okuddamu okuteeka mu kifo ensengekera schematic .

• Ku balwadde abalina okusengulwa okunene okw’okumenya, okukozesa okumenya okuggaddwa okutali kwa buwanguzi oba okumenya okutali kwa bulijjo, ekitanda ky’okusika eky’okulongoosa kisobola okukozesebwa okukendeeza okuggaddwa n’amaanyi agamu ag’ebikozesebwa, ekiyinza n’okumaliriza obulungi okukendeeza okuggaddwa okw’okumenya ekikolo ky’ekisambi.

• Oluvannyuma lw’okuteeka ekitundu ekikoseddwa ku fuleemu y’okusika okusika n’okukebera kwa C-arm kiraga nti okusengulwa kw’okumenya okukwatagana kutereezeddwa, enkomerero ey’ewala ey’ekitundu ekikoseddwa esobola okutereezebwa munda okwongera okuzzaawo okulaganya n’okulaganya mu kifaananyi ekigolokofu eky’ekikolo ky’ekisambi.

• Olw’okuba okusika kw’ebinywa by’akabina wansi w’okusika kuyinza okuzannya ekifo ekigonvu eky’okusiba ku kikolo ky’ekisambi okumenya, okumenya kw’ekikolo ky’ekisambi okusinga kuyinza okufuna okukwatagana okumatiza okusingawo mu kifaananyi kya X-ray eky’obugwenyufu.

• However, at this time, due to the lack of effective support at the distal end of the fracture segment under the effect of gravity, the distal fracture segment of the femoral stem is mostly displaced posteriorly, and at this time, the sterile towel-covered brace can be placed on the posterior side of the distal fracture end after sterilization and skin preparation and laying of sterile sheets, and the posterior displacement wa enkomerero y’okumenya ewala esobola okutereezebwa ng’otereeza obuwanvu bw’omukono.

• Singa okusengulwa okw’emabega okw’ekitundu eky’ewala eky’ewala kuba kukyali tekutereezeddwa, omusumaali ogw’okumpi guyinza okuteekebwawo mu ngeri ey’okuyita mu lususu ku ntikko y’ekitundu ekinene eky’omutawaana oba ekisengejja eky’ekika kya pyriform, n’oluvannyuma omuggo ogw’okuddamu okuteekebwa mu kisenge (intramedullary repositioning rod). mu maaso okunyigiriza okumenya okumpi kw’omugongo emabega nga tukozesa ekiwato ky’omuggo oguddamu okuteekebwa, bwe kityo ne kizzaawo okukwatagana n’okumenya ewala okusenguddwa emabega, .

• Oluvannyuma lw’okumenya okusengekebwa, ppini empanvu eraga mu kisenge ky’emmeeme eky’ewala okumaliriza okuzzaawo okuggaddwa. Omuggo ogw’okuddamu okuteeka mu kisenge (intramedullary repositioning rod) gukola bulungi nnyo mu kulongoosa okufukamira, okubumba, n’obulema bw’okuzimbulukuka obw’ebweru obutera okubeerawo mu kumenya okumpi kw’ekisambi eky’okumpi (Figure 5).

• Ku kusengulwa okw’ebbali okusigaddewo, okuggulawo enkomerero y’omuggo ogw’omu lubuto ogukooneddwa kuyinza okutereezebwa okulungamya ppini empanvu ey’okulungamya mu kisenge ky’okumenya eky’ewala okumaliriza okukendeeza okuggaddwa.

• Enkola endala ey’okukendeeza okuggaddwa kwe kusikula omusumaali gwa Schanz mu kitundu ky’amagumba ku ludda lw’enkomerero y’okumenya okusenguddwa n’okutereeza enkomerero y’okumenya ng’okozesa omusumaali gwa Schanz okukendeeza ku kuggala (Figure 6). Oluvannyuma lw’okumenya okusengekebwa mu ngeri ematiza, omusumaali ogw’omu lubuto guyingizibwa mu kisenge eky’okumpi n’eky’ewala eky’okumenya okumaliriza okunyweza okw’omunda (Figure 7).

  
  

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Ekifaananyi 5 Okukozesa ekitundu ky’okumenya okumpi (proximal fracture segment) okusobola okuddamu okuteekebwa mu kifo ekiggaddwa nga tukozesa omuggo ogw’okuddamu okuteeka mu kisenge .

Ekifaananyi 6 Okukendeeza okuggaddwa nga okozesa omusumaali gwa Schanz oguteekeddwa mu kitundu ky’amagumba eky’oludda olumu ku nkomerero y’okumenya .

Ekifaananyi 7 Okukendeeza okuggala okunyweza omusumaali ogw’omu lubuto ogw’okumenya kw’ekikolo ky’ekisambi nga tukozesa omusumaali gwa Schanz .

okumenya enkizi .

(a) Okuteekateeka nga tebannaba kulongoosa .

• Okuzuula ebifaananyi ku bbanga: Okukebera okukuba ebifaananyi mu kisambi (standard ankle imaging evaluation) kulina okubeeramu emitendera 3: AnteroPosterior (Ekifaananyi 8), ensonga y’enkizi (15° ey’okuzimbulukuka okw’omunda) (Ekifaananyi 9), n’eky’ebbali (Ekifaananyi 10).

• Ekiyungo ky’enkizi bwe kifuna obuvune obw’amaanyi enkizi ey’omunda n’ey’ebweru ne Talus ejja kusengulwa okutuuka ku diguli ez’enjawulo 11 (Ekifaananyi 11). Ebifaananyi bya static radiographs tebiraga bulungi butebenkevu bw’ekiyungo ky’enkizi. Ebifaananyi eby’oku situleesi ne MRI bisobola okulongoosa mu kwekenneenya okutebenkera kw’ekiwanga n’omusuwa gw’omu kifuba (Figure 12).

• Mu mbeera eno, ekika ky’obuvune bw’enkizi kisaana okusalibwawo mu butuufu enkola y’obuvune n’ebikwata ku bitundu by’omubiri (radiological data) eby’ekitundu ky’omubiri ekikosebwa okusobola okulungamya obulungi enkola y’okuzzaawo n’okunyweza.

• Oluusi okumenya kw'enkizi okwangu kuyinza okuba ekitundu ky'okumenya 'Maisonneuve okusingawo okuzibu ennyo', nga muno mulimu n'okumenya kw'ekiwujjo eky'okumpi n'obuvune bw'omusuwa ogw'okugatta, kale tibiofibula yonna erina okwekebejjebwa mu ngeri ya radiographic.

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Ekifaananyi 8 Ekifo eky’omu maaso n’eky’emabega .

Ekifaananyi 9 Ensonga z’enkizi (15° ez’okuzimbulukuka okw’omunda) .

Ekifaananyi 10 Ekifo eky’ebbali .

Ekifaananyi 11 Okusengulwa kw’okumenya kirabika nga kugatta wamu n’okuseeseetula .

Ekifaananyi 12 Okukuba ebifaananyi mu ngeri ey’okunyigirizibwa (okukutuka kw’omusipi ogw’enjuyi essatu) .

(ii) Okubudamya .

Okusannyalala kw’obusimu bw’omu kifuba n’okusannyalala kutera okutwalibwa.

(c) Enkola y’okuzzaawo .

Ekika ky’okuzimbulukuka eky’emabega-eky’ebweru eky’okuzimbulukuka okuggaddwa kikolebwa mu nsengeka y’okuyungibwa kw’enkizi n’enkizi ey’ebweru-emabega-omugongo n’omugongo ogw’okunsi. Ekika ky’okuzimbulukuka okw’emabega-eky’omunda kikolebwa mu nsengeka y’enkizi ey’omunda ey’omu kisambi n’ebweru.

• Mu mbeera y’okuzimbulukuka okw’emabega-okufuluma okw’ekika kya IV, omulwadde ateekebwa mu bbanga era okugulu ne kufukamira ku 90° okuwummuza triceps z’ennyana.

• Abayambi babiri bakwata ekitundu ky’ekisambi n’ekigere, era okusika kusiigibwa mu ludda lw’okulema kw’okumenya (amaanyi g’okusika tegalina kuba gayitiridde okwewala okusajjula obuvune).

• Omuyambi asika ekigere akyusa ekigere munda okutereeza obulema bw’okuzimbulukuka obw’ebweru (Ekifaananyi 13). Nga bw’asika enkomerero ey’ewala ng’oyolekera oludda lw’omugongo n’okusika ekisambi eky’ewala ng’eyolekera oludda oluwuzi, omuyambi munda akyuka n’agaziwa mu kugolola ekiwanga ky’enkizi okutereeza okusengulwa kw’enkizi ey’ebweru ne talus (Ekifaananyi 14).

• Kuuma ekifo eky’omunda eky’okuzimbulukuka-eky’omunda-okugaziwa. Olwo ekitundu ky’okumenyeka kw’enkizi eky’emabega kikwatibwa engalo zombi ez’engalo ensajja, engalo ennya zeetooloola ekisambi eky’ewala, era engalo zombi zisika n’okusika mu ngeri ey’ewala, ate nga zisika wansi ekisambi eky’ewala okuddamu okuteeka enkizi ey’emabega (Ekifaananyi 15).

• Mu kusembayo, omukozi asika enkizi ey’omu makkati emabega n’okukka wansi n’engalo ensajja okugiddamu (Ekifaananyi 16). Abayambi babiri bakuuma ekigere n’enkizi mu kifo eky’okugaziwa eky’okuzimbulukuka munda ekizimbulukuse munda mu nnyumba nga beetegekera okunyweza.

Ekifaananyi 13 Okutereeza okusika kw’obulema bw’okukyusakyusa okw’ebweru .

Ekifaananyi 14 Okutereeza okusengulwa okw’ebbali okw’enkizi ey’ebweru n’ettala .

Ekifaananyi 15 Okutereeza enkyukakyuka y’enkizi ey’emabega .

Ekifaananyi 16 Okutereeza okusengulwa kw’enkizi okw’omunda .

Enkola y’okuzzaawo ekifo eky’omunda-okuzimbulukuka (post-rotation-internal repositioning process) ya kikontana n’enkola y’okuzzaawo ekifo eky’ebweru (post-rotation-external repositioning process) era ekolebwa mu nsengeka y’enkizi ey’ebweru ey’omu kisambi.

Engeri y'okugulamu amagumba agateekebwamu amagumba n'ebikozesebwa mu kuzimba amagumba) .

A CZMEDITECH , tulina ekintu ekijjuvu ennyo eky'ebintu ebiteekebwa mu kulongoosa amagumba n'ebikozesebwa ebikwatagana, ebintu omuli Ebisimbibwa omugongo ., Emisumaali egy'omu lubuto ., Ekipande ky’okulumwa obuvune ., Essowaani y’okusiba ., Omutwe-Maxillofacial ., Prosthesis ., Ebikozesebwa mu maanyi ., Abatereeza eby’ebweru ., Okukebera ebinywa ., Obulabirizi bw’ebisolo n’ebikozesebwa byabwe ebibayamba.

Okugatta ku ekyo, twewaddeyo okukola ebintu ebipya obutasalako n’okugaziya layini z’ebintu, okusobola okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde abawera, era n’okufuula kkampuni yaffe okuvuganya ennyo mu nsi yonna ey’amagumba n’amakolero g’amagumba.

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