Kuchotsa misomali ya intramedullary ndi njira yokhazikika, popeza wopanga aliyense amapereka zida zoyenera zochotsera. Komabe, kufunikira kwenikweni kochotsa msomali wathunthu wa intramedullary ndikosowa. Msomali wa intramedullary ukang'ambika, zinthu zimakhala zovuta kwambiri. Panthawiyi, zida ndi njira zapadera zimafunikira kuchotsa msomali wa intramedullary.
Kuchotsa misomali ya Universal intramedullary ndikuchotsa misomali yosweka imapezeka pamsika, ndipo ma seti awa angathandize kuthetsa mavuto omwe ali pamwambawa. Komabe, opaleshoni yakhungu sivomerezedwa popanda zida zapadera.
Ndondomeko yomwe misomali ya intramedullary imachotsedwa ndiyofunika kwambiri. Musanachotse kukhazikika kwamkati, mchira uyenera kupezeka ndikuwugwira. Chipewa cha mchira nthawi zina chimakhala chovuta kuchizindikira pa X-ray, ndipo pachifukwa ichi, madokotala ena samalimbikitsa kugwiritsa ntchito kapu ya mchira pokhapokha atawonjezera kutalika kwa msomali wa intramedullary. Mukachotsa kapu ya mchira, gwiritsani ntchito mkono wowongolera kuti mugwire msomali wa intramedullary, kenako pitilizani kuchotsa msomali wotseka. Ziyenera kukumbukiridwa kuti zokhoma zonse ziyenera kuchotsedwa musanayese kuchotsa pini yayikulu. Ngati Mlengi wa intramedullary msomali sangadziwike, m`pofunika mokwanira kuvumbulutsa caudal mapeto a intramedullary msomali kumveketsa limagwirira ake kugwira, kuphatikizapo ulusi mtundu ndi kukula, ndi kusankha yoyenera m'zigawo chida. Ngati kugwirizana kwangwiro sikungatheke, njira yogwiritsira ntchito chida chochotsa tapered ingathandize kugwira mchira wa intramedullary msomali. Ngati fupa likulowa mu dzenje la misomali kapena pamwamba pa msomali likuganiziridwa, msomali ukhoza kuponyedwa mkati mamilimita angapo ndi nyundo yotsetsereka musanachotse.
Mafotokozedwe osiyanasiyana a zisoti za mchira amapangidwa kuti athandizire kusankha kwa intraoperative ndikuwonetsetsa kuchotsa msomali wa intramedullary.
![kapu ya intramedullary msomali]()
Madokotala angapo odziwa zambiri afotokozera mwachidule njira zambiri zothyoka za intramedullary kuchotsa misomali. Ngati mapeto osweka a fracture ayenera kutsegulidwa kuti ayeretsedwe ndi kuchepetsa, msomali wa intramedullary ukhoza kuchotsedwa kupyolera kumapeto kwake. Pansipa, tikuwonetsa mwachidule njira zina zochotsera zomwe sizikufuna kuwonekera kwa mathero osweka.
Momwe mungachotsere msomali wosweka wa intramedullary?
Nthawi zambiri, sikovuta kwambiri kuchotsa gawo lokhazikika la msomali wosweka wa intramedullary. Gawo loyandikira litachotsedwa, zimakhala zovuta momwe mungachotsere gawo lakutali popanda kutsegula fracture fragment. Kubwezeretsanso ngalande ya proximal medullary ndi mamilimita angapo kumathandizira kuchotsa misomali yakutali.
Pogwiritsa ntchito phata lalitali kapena laparoscopic forceps, mbali ya distal nthawi zina imatha kugwidwa ndikuchotsedwa bwino. Komabe, ma forceps aatali samapereka mphamvu yogwira mwamphamvu, ndipo kuchotsa bwino kumadalira ngati mbali ya distal yamasuka.
Kuyendetsa msomali wochepa kwambiri wa intramedullary kapena chowongolera pamanja mu msomali wosweka wa distal kumathandizanso kuchotsa. Poyendetsa galimoto, pini yotsekera ya distal iyenera kusungidwa kuti isasunthikenso mbali ya distal panthawi yoyendetsa. Msomali wochepa kwambiri wa intramedullary kapena manual reamer wapeza mgwirizano wolimba ndi gawo la distal, chotsani msomali wokhoma wa distal ndikugogodanso kuti muchotse gawo losweka la distal.
Zolemba zambiri zimapereka malipoti ogwiritsira ntchito zida zomangika kuchotsa mbali yakutali ya misomali yosweka. Patsekeke dzenje la intramedullary msomali akhoza kudzazidwa ndi mawaya angapo kalozera mu kufanana pamodzi malangizo a m'zigawo mbedza kupewa decoupling pa ndondomeko m'zigawo. Njira yolozera mawaya angapo nthawi zina imakhalanso m'malo mwa mbedza zochotsa.
![Wosweka cannulated intramedullary msomali kuchotsa]()
Pomaliza, ngati njira zonse zomwe zili pamwambazi sizikuyenda bwino, kuchotsedwa kwa distal kwa msomali wa intramedullary kungayesedwe. Mwachitsanzo, gawo losweka la distal la msomali wa femoral intramedullary limachotsedwa kudzera pabowo la distal femur kudzera pamgwirizano wa bondo. Kubowola kumayang'ana kumapeto kwa msomali wa intramedullary, ndipo potseguka kwake kumakhala kokwanira kuti muzitha kuyika waya wowongolera wa azitona wokhala ndi gasket. Waya wowongolera umadutsanso mu dzenje la msomali wa intramedullary ndikutuluka kuchokera pakutsegulira kwa femur, ndipo mutu wa azitona wokhala ndi spacer ukhoza kutulutsa msomali wosweka kuchokera ku proximal femur. Njira yofananira ingagwiritsidwe ntchito pa tibia, ndikulowetsanso kutsegulira kwakutali kwa waya wowongolera pa medial malleolus. Nthawi zina, waya wa Steiner amalowetsedwa kudzera potsegula ndikugogoda pa msomali wosweka kumapeto kwa distal, kotero kuti msomali wosweka ukhoza kusuntha pang'ono, zomwe zimathandiza kubwezeretsa singano ya singano ndi kuchotsa msomali wosweka.
Momwe mungachotsere misomali yolimba ya intramedullary?
Misomali yolimba ya intramedullary nthawi zambiri imakhala yovuta kuchotsa kusiyana ndi misomali ya intramedullary. Njira zake zochotsera zimaphatikizapo kukonzanso kwa proximal medullary cavity komanso kugwira bwino kwa msomali wosweka. Nkhokwe za Laparoscopic zingagwiritsidwe ntchito pogwira misomali yosweka. Mabukuwo adanenanso za mphamvu yapadera yogwira mozungulira mchira wa msomali. Komabe, kugwiritsa ntchito zida zosiyanasiyana sikungagwire bwino msomali wosweka wa distal. Pamenepa, msomali wothyoka uyenera kugwetsedwa mbali ina ya fupa. Mfundo luso ndi ofanana ndi cannulated intramedullary msomali. Gwiritsani ntchito zida monga zobowolera zofewa ndi zikhomo zolimba zowongolera kuti mugwetse misomali yosweka molunjika mpaka kumapeto.
![chotsani msomali wosweka wa intramedullary]()
Momwe mungachotsere msomali wosweka wa intramedullary?
Mutu kapena gawo lozungulira la screwdriver yolumikizana nthawi zambiri imatha kuchotsedwa pogwiritsa ntchito screwdriver yofananira. Nthawi zina ulusi wa screw screwdriver ukhoza kutsetsereka mkati mwa fupa, zomwe zimafuna kugwedezeka mozungulira mutu wa screwps ndi screwdriver kuti amasule. Mitu yoonongeka ya screw ingafune zida zapadera zochotsera, monga zida zochotseramo mkati monga zobowolera zopingasa. Mbali yakutali ya wononga yosweka nthawi zina imamasulidwa kwathunthu, zomwe sizimakhudza kuchotsedwa kwa wononga zazikulu, ndipo zimatha kusiyidwa m'thupi ngati sizingakhudze ntchito yamankhwala yotsatira. Komabe, nthawi zina msomali wosweka wa distal ukhoza kuyambitsa kupasuka kwa iatrogenic pamene msomali waukulu umachotsedwa, ndipo m'pofunika kuchotsa. Njira yomwe imagwiritsidwa ntchito kwambiri ndi njira yopondereza ya screw, ndiko kuti, screw yayikulu imachotsedwa pamalo ake oyambirira, kotero kuti dzenje la wononga pamwamba pa fupa liri mu mzere womwewo monga bowo lotsekera la msomali wa intramedullary, ndipo phula losweka limachotsedwa pogwiritsa ntchito waya wa Steiner, ndodo yaing'ono ya malleus kapena screwdriver. Piniyo imakankhidwira kunja kudzera mu dzenje la pin mu kotekisi yopingasa ndikuchotsedwa kudzera mumsewu wosiyana.
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