Chirurgie ya réduction fermée mpo na ba fractures ya ba extremités ya nse.

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., kosilisa kobebisama ya bopanzani ya makila na nzela ya kokitisa ya incision.

Fracture ya kingo ya femur .

(i) Traction .

Batie mobeli na mbeto, mpe traction ya tuberosité tibiale esalemaka na enama oyo ezo bela na position neutre na rotation interne ya moke. Kilo ya traction ekeseni na moto na moto, mingi mingi 6-9 kg, mpe ntango ya traction esengeli te koleka ngonga 12. 90% ya ba malades bakoki kozua repositionnement na traction.

(b) Repositionnement manipulatif fermé .

Soki traction elongi te kozua ba exigences ya repositionnement, repositionnement manual ekoki kobakisama, na anesthésie épidurale :

1. MC ELVENNY Méthode .

Ntina ezali ya kobongisa bassin, kobalola na libanda enama oyo ezokaki mpe kobakisa nguya ya traction, mpe na nsima kobalola na kati mpe kozongisa na kati enama oyo ezokaki mpo na kozwa ntina ya kozongisa esika.

2. Méthode ya leadbetter .

Mobɛli alali plat na mabele, gumba hanche mpe genoux oyo ezokaki na 90°, traction na nzela ya axe fémorale ya enama oyo ezo bela na boumeli ya 2 kino 3 minutes, sima kobalola na kati enama oyo ezo bela mpe ko flexionner yango na pete, sima ya kozongisa, kokitisa na malembe enama oyo ezo bela, mpe soki makolo oyo ezo bela emonani te ete ebalukaka libanda, yango mingi mingi ezo lakisa mingi. Yambo ya kosala fixation interne, machine C-arm esalemaki pona ko vérifier.

(c) Technique ya prying ya aiguilles percutanées .

Soki repositionnement ezuami te na ba méthodes oyo ezali likolo, mingi mingi elakisaka soit que mutu ya fémorale ebukamaki soit que ezalaki na séparation ya rotation entre mutu na kingo (Figure 1A), soit que insertion ezala quelque part entre le tête et le kingo. (Oyo ekoki kosalema na mitindo nyonso ya elanga II, III, to IV). Na likambo oyo, kobalola enama oyo ezokaki mpo na kokanga motó mpe kobukana ya nkingo ezali lisusu malamu te. Pona ko éviter incision na repositionnement, technique ya prying ya aiguille percutanée ekoki kosalelama pona ko repositionner fracture.

• Aiguilles circulaires ya mikuwa ya 3,0 kino 3,5 mm ekotisami na verticale na nzela ya loposo 1 kino 2 cm na se ya jonction ya ligament inguinal mpe artérie fémorale na liboso ya motó ya femur, mpe aiguilles ebalukaka na mozindo na katikati ya motó ya femur na nse ya supervision).

• Mpo na kolendisa nguya ya boloko, aiguilles ya mibale ya cercle ya mikuwa ekoki kotiama 4-5 mm parallèlement na aiguilles oyo, na suka ya aiguilles oyo etikali libanda ya loposo.

• Na nzela ya trochanter monene, ba aiguilles circulaires mibale ya diamètre 3,5 mm e percée percutanée en accord na angle ya tige cervicale mpe angle ya inclinaison antérieure, ekomaka na suka ya distal ya fracture ya cou fémur (eleka na fracture te) mpe kotika suka ya aiguilles libanda ya loposo.

• Opérateur asimbi ba ensembles mibale ya mikila ya aiguilles na maboko mibale mpe abongisi biteni ya fracture ya motó mpe ya nkingo mpo na kozala na boyokani moko na mosusu na boyokani ya mosungi (Figure 1C-E).

• Sima ya alignment ya alignment ezali satisfaisant, broche ya rond ya mikuwa oyo ekotisami na trochanter monene e visé na tête fémorale mpo na fixation temporaire, mpe na sima ba vis creuses ebele ekotisami na tête fémorale (Figure 1F).

Méthode ya réduction fermée oyo elobami likolo ekoki kozua réduction oyo esengeli na soki 98% ya ba fractures ya cou fémorale. Soki alignment ya fracture ezali malamu, ezala ya kokangama to ya kokata, pronostic ekozala malamu. Mbala mingi, degré ya dislocation ya fracture oyo elakisami na rayon X ezali moke koleka degré ya solo ya dislocation ya fracture. Lokola alignment ya fracture e affectaka directement guérison ya fracture mpe possibilité ya nécrose ya tête fémorale, il faut kozala na jugement correct ya film ya rayons X après alignment ya fracture. Soki courbe en forme ya S ezali lisse te to ekatisami te, ezali kolakisa que fracture ya cou fémorale ekomi na repositionnement anatomique te (Figure 2).

Figure 1 Fracture ya cou fémorale repositionné na pry ya aiguilles percutanées .

Figure 2 Ba rayons X ya fracture ya cou fémorale na courbe extérieure continue na alignment anatomique na courbe extérieure interrompue na alignment non anatomique .

Fracture ya tige ya fémorale .

Technique ya réduction fermée ekoki ko aider na alignment ya fracture ya tige fémorale sans ko bebisa ba tissus doux to alimentation ya makila na fin ya fracture, mpe ekoki kozala utilisé mpo na fixation interne na ongle intramédullaire.

• 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 kobenda, mpe ekoki kobongisama automatiquement na nzela ya traction, yango wana opérateur asengeli kaka ko corriger déplacement antérieur-postérieur mpe latéral ya suka ya lititi oyo ebukani).

• Opérateur asalelaka maboko mibale mpo na kozinga enama oyo ezokaki mpe asimbi maboko esika moko (Figure 3 mpe Figure 4), mpe abongisi déplacement antérieur-postérieur mpe latéral ya fracture na mbala moko na kosalelaka force oblique ya clamping ya ba avant-bras nionso mibale.

• Na ndakisa, soki eteni ya penepene ya fracture ya femur elongolami na libanda mpe na liboso, liboso ya loboko moko esalelamaka mpo na kofina eteni ya penepene ya fracture na kati mpe na nse. Liboke mosusu ya liboso efinamaka eteni ya fracture distal na libanda mpe likolo mpo na kodefa nguya ya bokangami (monganga ya bozongisi asengeli kozala na bosambisi malamu ya nzela ya bopanzani ya kobukana mpe ntaka ya bopanzani yambo ya kozongisa yango), mpo ete fracture ekoki kozala na elonga ya kozongisama na esika moko. Na tango ya repositionnement, assistant asengeli komatisaka force ya traction mpe kosala que fémur ebalukaka te.

• Tango suka ya fracture ezali essentiellement lapped, son ya ko frotter ya mikuwa ya pete esengeli koyokama, na tango oyo, assistant asengeli kaka ko maintenir traction, kasi ko réduire force ya traction.

• Tango fracture ezali essentiellement aligné na machine C-arm (soki ezali kaka na mua misalignment, sala mua ba ajustements mpo na kosala que ba fins ya fracture e correspondre moko na mosusu), maintenir traction, désinfecter limbe affecté mpe ko panza serviette, mpe na sima kosala fixation ya ba ongles intramédullaires.

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Fig. 3 Déplacement antérieur-postérieur et latéral ya fracture e corrigé en même temps na ko envelopper maboko mibale zinga zinga ya limbe affecté mpe ko claspage maboko esika moko, en utilisant force de serrage ya ba avant-bras nionso mibale.

Figure 4 Fracture ya ba tiges fémorales Mécanique ya repositionnement schématique .

• Mpo na ba maladi oyo bazali na déplacement ya fracture ya monene, manipulation fermée oyo elongaki te to ba fractures comminurées, mbeto ya traction ya lipaso ekoki kosalelama mpo na réduction fermée na mwa force instrumentale, oyo ekoki mpe kosilisa malamu réduction fermée ya fracture ya tige fémorale.

• Sima ya kotia enama oyo ezo bela na cadre ya traction mpo na traction mpe examen ya bras C elakisaka que déplacement ya fracture oyo ezo superposer e corrigé, fin distal ya limbe affecté ekoki ko ajuster na kati mpo na ko rétablir lisusu alignment mpe alignment na image orthostatique ya tige fémorale.

• Lokola tension ya ba muscles ya cuisse sous traction ekoki ko jouer rôle ya splinting ya tissus doux na fracture ya tige fémorale, mingi ya ba fractures ya tige fémorale ekoki kozua alignment ya plus satisfaisant na image ya rayons X orthogonale.

• 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 of the Nsuka ya kobukana ya mosika ekoki kobongisama na kobongisaka bosanda ya eloko ya kokanga.

• If the posterior displacement of the distal fracture segment is still not corrected, a proximal nail can be established percutaneously at the apex of the greater trochanter or the pyriform fossa, and then the intramedullary repositioning rod is inserted into the medullary cavity of the proximal fracture segment of the femur, and the handle of the intramedullary repositioning rod is raised moderately forward Pona ko déprimer fracture proximale ya fémur en arrière en utilisant le levier ya tige ya repositionnement, ainsi azo rétablir alignment na fracture distale distale déplacée postérieure, .

• Nsima ya kopanzana ya fracture, bakɔtisaka pinɛ ya molai na kati ya esika oyo babukaka fracture distal mpo na kosilisa reset oyo ekangami. Fimbo ya repositionnement intramédullaire ezali surtout efficace na ko corriger ba déformités ya rotation ya flexion, abduction, na extérieure oyo emonanaka mingi na ba fractures proximales ya fémur proximal (Figure 5).

• Mpo na déplacement latéral résiduel, bofungoli ya suka ya courbe ya lingenda ya intramédullaire ekoki ko ajuster mpo na ko guider broche ya guide ya molayi na kati ya cavité distale mpo na kosilisa réduction fermée.

• Méthode mosusu ya réduction fermée ezali ya ko viser nsuki ya schanz na cortex ya mikuwa na ngambo ya suka ya fracture déplacée mpe ko ajuster suka ya fracture na nzela ya nsuki ya schanz mpo na réduction fermée (Figure 6). Sima ya fracture ezali aligné na ndenge ya satisfaisant, ongle intramédullaire ekotisami na kati ya cavité médullaire proximale mpe distal ya fracture mpo na kosilisa fixation interne (Figure 7).

  
  

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Figure 5 Manipulation ya segment ya fracture proximale pona repositionnement fermé en utilisant le tige de repositionnement intramédullaire .

Figure 6 Réduction fermée en utilisant un ongle de Schanz etie na cortex ya mikuwa unilatéral na suka ya fracture .

Figure 7 Fixation intramédullaire de réduction fermée ya fracture multisegmentale comminuted ya tige fémorale en utilisant le clou de Schanz .

Fracture ya cheville .

(A) Bobongisi ya liboso ya lipaso .

• Diagnostic radiographique : Evaluation standard ya image ya cheville esengeli ezala na ba phases 3 : anteropostérieur (Figure 8), point de cheville (15° ya rotation interne) (Figure 9), mpe latéral (Figure 10).

• Tango articulation ya cheville ezokaki makasi na cheville ya kati pe ya libanda pe Talus ekozala déplacé na 11 degrés différents (Figure 11). Ba radiographies ya statique elakisaka na bosikisiki te stabilité ya articulation ya cheville. Ba radiographies ya stress na IRM ekoki kobongisa évaluation ya stabilité ya ba dégâts ya articulation ya cheville na ligament (Figure 12).

• Na likambo oyo, lolenge ya kozoka ya makolo esengeli koyebana na bosikisiki na nzela ya mecanisme ya kozoka mpe ya ba données radiologiques ya enama oyo ezokaki mpo na kotambwisa malamu repositionnement mpe fixation.

• Tango mosusu fracture ya cheville médiale simple ekoki kozala partie ya fracture ya 'maisonneuve mingi koleka', oyo ezali mpe na fracture ya fibula proximal mpe blessure ya ligament combiné, yango wana esengeli examiné tibiofibula mobimba na radiographie.

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Figure 8 Position ya liboso mpe ya sima .

Figure 9 Points ya cheville (15° ya rotation ya kati) .

Figure 10 Position latérale .

Figure 11 Déplacement ya fracture apparemment esangani na dislocation .

Figure 12 Radiographie ya stress ( rupture ya ligament triangulaire) .

(ii) Anesthésie .

Mbala mingi, bazwaka anesthésie ya misisa ya fémorale mpe ya sciatique.

(c) Technique ya kozongisa na esika na yango .

Lolenge ya rotation postérieure-externe ya repositionnement fermé esalemi na ordre ya union tibiofibulaire tibiofibulaire tibiofibulaire tibiofibulaire tibiofibulaire ya cheville intérieure ya cheville extérieure ya cheville extérieure. Lolenge ya rotation-rotation-interne ya sima esalemaka na ordre ya cheville ya cheville-externe interne.

• Na cas ya rotation postérieure-externe type IV, ba tiaka malade na supine mpe genoux e flexionner na 90° mpo na ko relaxer ba triceps ya ngɔmbɛ.

• Ba assistants mibale basimbaka eteni ya popliteal ya cuisse mpe makolo respectivement, mpe traction esalemi na direction ya déformité ya fracture (force ya traction esengeli te ezala excessive mpo na ko éviter ko aggraver blessure).

• Mosungi oyo azali kobenda makolo abalukaka makolo na kati mpo na kobongisa déformité ya rotation ya libanda (Figure 13). Ntango ozali kotindika nsuka ya mosika epai ya ngambo ya tibia mpe kobenda tibia ya mosika epai ya ngambo ya fibule, mosungi na kati abalukaka mpe ayeisaka na nsima lisanga ya makolo mpo na kobongisa bopanzani ya makolo ya libanda mpe talus (Figure 14).

• Bobatela position ya extension interne-rotation-interne-dorsale. Na sima bloc ya fracture ya cheville ya sima esimbami na ba pouces nionso mibale, misapi minei ezingami na tibia distal, mpe ba pouces nionso mibale epusaka mpe e squeeze na distalement, tout en benda na se tibia distal mpo na ko réinitialiser cheville ya sima (Figure 15).

• Na suka, opérateur apusaka cheville médiale na sima mpe na se na ba pouces mpo na ko réinitialiser yango (Figure 16). Ba assistants mibale ba garder makolo na cheville na position ya extension rotation-dorsale interne-rotation interne na préparation ya fixation.

Figure 13 Correction ya traction ya déformité ya rotation ya libanda .

Figure 14 Correction ya déplacement latéral ya cheville ya libanda na talus .

Figure 15 Correction ya déplacement ya cheville ya sima .

Figure 16 Bobongisi ya bopanzani ya makolo ya kati ya makolo .

Processus ya repositionnement post-rotation-interne ezali opposé na processus ya repositionnement post-rotation-externe mpe esalemaka na ordre ya cheville-extérieur interne.

Ndenge nini kosomba ba implants orthopédiques mpe ba instruments orthopédiques:

Mpo na Czmeditech , tozali na ligne ya produit très complet ya ba implants ya chirurgie orthopédique na ba instruments correspondants, ba produits y compris Ba implants ya mokuwa ya mokɔngɔ ., Ba ongles intramédullaires ., Plaque ya traumatisme ., Plaque ya kokanga ., Crânien-maxillofacial ., Prothèse ., Bisaleli ya nguya ., Ba fixateurs ya libanda ., Arthroscopie ., Soins vétérinaires mpe ba ensembles na bango ya instrument ya soutien.

En plus, tozali komipesa na kosala continuellement ba produits ya sika mpe ko augmenter ba lignes ya produits, mpo na ko répondre na ba besoins ya chirurgie ya ba médecins mpe ba malades mingi, mpe lisusu kosala que entreprise na biso ezala plus concurrentielle na industrie ya orthopédique mpe ba instruments ya mokili mobimba mobimba.

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