Msomali wa Humerus Intramedullary: Njira Yabwino Yothetsera Matenda a Humeral Fractures

Kuphulika kwa humerus, fupa lakumtunda kwa mkono, kungakhudze kwambiri zochita za munthu tsiku ndi tsiku komanso moyo wabwino. Kuchiza fractures kumafuna kuganizira mozama zinthu zosiyanasiyana, kuphatikizapo mtundu wa fracture, malo, ndi makhalidwe a odwala. Njira imodzi yopangira opaleshoni yomwe yadziwika kwambiri m'zaka zaposachedwa ndikugwiritsa ntchito msomali wa humerus intramedullary. Nkhaniyi ikufotokoza ubwino, njira zopangira opaleshoni, zoopsa, ndi kukonzanso zomwe zimagwirizanitsidwa ndi njira yochizirayi.

Mawu Oyamba

Pamene kupasuka kumachitika mu humerus, kungayambitse kupweteka kwakukulu, kuyenda kochepa, ndi kuwonongeka kwa ntchito. Njira zochiritsira zachikhalidwe, monga kuponyera kapena plating, zili ndi malire ake, ndipo kufunafuna mayankho ogwira mtima kunayambitsa kukula kwa msomali wa intramedullary.

Kodi Humerus Intramed ullary Nail ndi chiyani?

Msomali wa humerus intramedullary ndi chipangizo chachipatala chomwe chimapangidwira kuti chikhazikike ndikulimbikitsa machiritso a fractures mu humeral shaft. Amakhala ndi ndodo yayitali yachitsulo yomwe imayikidwa pakati pa dzenje la fupa, kupereka bata ndi chithandizo panthawi ya machiritso. Msomali nthawi zambiri umapangidwa ndi titaniyamu kapena chitsulo chosapanga dzimbiri ndipo umabwera mosiyanasiyana kuti ukhale ndi matupi a odwala osiyanasiyana.

Zizindikiro za Humerus Intramedullary Nail

Misomali ya Humerus intramedullary imagwiritsidwa ntchito kwambiri pochiza ma fractures apakati komanso proximal humeral fractures. Zimakhala zogwira mtima kwambiri pa zophuka zomwe zimafuna kukhazikika kokhazikika, monga fractures kapena fractures yokhudzana ndi kusamuka kwakukulu. Kuonjezera apo, njirayi ndi yoyenera kwa odwala omwe ali ndi mafupa osauka kapena pamene chikhalidwe chopanda kulemera chikufunidwa.

Njira Yopangira Opaleshoni ya Humerus Intramedullary Nail

Preoperative Planning

Opaleshoni isanachitike, kukonzekera bwino musanachite opaleshoni ndikofunikira. Izi zikuphatikizapo kuunika mwatsatanetsatane momwe fracture ikuyendera, thanzi la wodwalayo, ndi kuvulala kulikonse komwe kumakhudzana. X-rays, CT scans, kapena MRI angagwiritsidwe ntchito kuti amvetse bwino za fracture ndi kukonzekera njira ya opaleshoni moyenerera.

Malo Odwala

Panthawi ya opaleshoni, wodwalayo nthawi zambiri amakhala pampando wa m'mphepete mwa nyanja kapena lateral decubitus position. Kusankha kumadalira zomwe dokotala wachita opaleshoni komanso malo ophwanyika. Kuyika bwino kumatsimikizira mwayi wopezeka pamalo osweka komanso kumathandizira kuyika misomali.

Incision ndi Access

Kudulidwa kumapangidwira pamalo opangira opaleshoni kuti apeze fupa losweka. Kutalika ndi malo omwe amadulidwa zimadalira mtundu wa fracture ndi malo ake pamodzi ndi humer. Kusamalira minofu yofewa mosamala ndikofunikira kuti muchepetse kuvulala komanso kuchepetsa chiopsezo cha matenda.

Kulowetsa Msomali

Pambuyo popanga malo olowera, dokotalayo amalowetsa msomali wa humerus intramedullary mu ngalande ya humeral. Chitsogozo cha Fluoroscopic chimagwiritsidwa ntchito kutsimikizira kuyika kolondola komanso kulondola. Msomali umapita patsogolo kupyola fupa, kugwirizanitsa zidutswa zilizonse zomwe zachotsedwa, ndikubwezeretsa anatomu yoyenera.

Locking Screws Placement

Msomali ukayikidwa bwino, zomangira zotsekera zimayikidwa kuti ziteteze msomali mkati mwa fupa. Zomangira izi zimapereka kukhazikika kwina ndikulepheretsa kusuntha kwa axial kwa zidutswa zosweka. Chiwerengero ndi kuyika kwa zomangira zimadalira mtundu wosweka komanso zomwe dokotala wa opaleshoni angakonde.

Kutseka Chilonda

Pambuyo pa msomali ndi zomangira zili bwino, chobowolacho chimatsekedwa pogwiritsa ntchito sutures kapena staples. Kutsekedwa koyenera ndi kofunikira kuti muchiritse komanso kuchepetsa chiopsezo cha matenda. Pamalo opangira opaleshoni amavekedwa, ndikumanga bandeji wosabala kapena kuvala.

Ubwino wa Humerus Intramedullary Nail

Kugwiritsa ntchito msomali wa humerus intramedullary kumapereka maubwino angapo kuposa njira zamankhwala azikhalidwe. Zina mwazabwino zake ndi izi:

1. Kukhazikika ndi kuyanjanitsa: Msomali umapereka kukhazikika kokhazikika, kulola kulinganiza koyenera kwa zidutswa zosweka, zomwe zimalimbikitsa kuchira bwino.

2. Kusokonekera kwa minofu yofewa pang'ono: Poyerekeza ndi njira zokutira, kukhomerera kwa intramedullary kumaphatikizapo kudulidwa kwazing'ono komanso kusokonezeka kwa minofu yofewa, kuchepetsa chiopsezo cha zovuta.

3. Kukonzekera koyambirira: Msomali umapereka kukhazikika kokwanira kuti alole kusuntha koyambirira ndi kukonzanso, kulimbikitsa kuchira msanga ndi kubwezeretsa ntchito.

4. Kuchepetsa chiopsezo cha matenda: Njira yotseka yokhomerera intramedullary imachepetsa chiopsezo chotenga matenda pamalo opangira opaleshoni poyerekeza ndi njira zochepetsera komanso kukonza mkati.

Zovuta ndi Zowopsa

Ngakhale opaleshoni ya intramedullary ya humerus nthawi zambiri imakhala yotetezeka komanso yothandiza, pali zovuta komanso zoopsa zomwe zimachitika ndi njirayi. Ndikofunika kudziwa zotheka izi musanalandire chithandizo. Zina mwazovuta ndi izi:

Matenda

Opaleshoni iliyonse imakhala ndi chiopsezo chotenga matenda. Ngakhale kuti chiwopsezo cha matenda ndi chochepa kwambiri ndi misomali ya humerus intramedullary, njira zoyenera zoberekera ndi chisamaliro chapambuyo pa opaleshoni ndizofunikira kuti muchepetse ngoziyi. Pankhani ya matenda, chithandizo choyenera cha maantibayotiki komanso mwina kuchitidwa opaleshoni chingafunikire.

Malunion kapena Nonunion

Nthawi zina, fractures sizingachiritse bwino, zomwe zimapangitsa malunion (kusagwirizana kosayenera) kapena nonunion (kusowa kwa machiritso). Zinthu monga kufooka kwa mafupa, kusasunthika kosakwanira, kapena kuyenda mopitirira muyeso kungayambitse mavutowa. Kuyang’anira mwatcheru, maulendo obwerezabwereza, ndi kuchitapo kanthu panthaŵi yake kungathandize kuthetsa mavuto ameneŵa ngati abuka.

Kulephera kwa Implant

Nthawi zambiri, implant yomwe imagwiritsidwa ntchito pokhomerera intramedullary imatha kulephera. Izi zitha kuchitika chifukwa cha kusweka kwa implants, kumasuka, kapena kusamuka. Kusankha bwino implanta, njira yopangira opaleshoni, ndi chisamaliro chapambuyo pa opaleshoni zingachepetse chiopsezo cha kulephera kwa implants.

Kuvulala kwa Mitsempha

Panthawi ya opaleshoni, pali chiopsezo chochepa cha kuvulala kwa mitsempha, zomwe zingayambitse kuperewera kwa minyewa kapena magalimoto. Madokotala ochita opaleshoni amasamala kuti asawononge mitsempha, monga kung'ambika mosamala ndi chidziwitso choyenera cha anatomical. Zizindikiro zilizonse zokhudzana ndi mitsempha ziyenera kuuzidwa mwamsanga kwa gulu lachipatala kuti liwunike ndi kuwongolera.

Kukonzanso ndi Kuchira

Pambuyo pa opaleshoni ya humerus intramedullary misomali, pulogalamu yokonzanso bwino ndiyofunikira kuti muchiritse bwino. Ndondomeko yeniyeni yokonzanso ikhoza kukhala yosiyana malinga ndi kuopsa kwa fracture ndi zifukwa za odwala. Kulimbikitsana koyambirira, kuchita masewera olimbitsa thupi pang'onopang'ono, ndi zolimbitsa thupi zimayambitsidwa pang'onopang'ono kuti zibwezeretse ntchito ndikuwonjezera mphamvu ya minofu. Zochita zolimbitsa thupi, motsogozedwa ndi akatswiri azachipatala, zimagwira ntchito yofunika kwambiri pakuchira.

Maphunziro a Nkhani ndi Nkhani Zopambana

Odwala ambiri apeza zotsatira zabwino ndi opaleshoni ya misomali ya humerus intramedullary. Kafukufuku wina adakhudza munthu wazaka 45 yemwe adaphwanyidwa m'malo mwake. Atachitidwa opaleshoni ndi msomali wa intramedullary, wodwalayo adapeza bwino kwambiri fracture, adayambiranso kuyenda, ndipo adabwerera kuntchito yawo asanavulale mkati mwa miyezi isanu ndi umodzi.

Kuyerekeza ndi Njira Zina Zochizira

Poganizira njira zochizira matenda a humeral fractures, ndikofunikira kufananiza zabwino ndi zofooka za njira iliyonse. Ngakhale kugwiritsa ntchito msomali wa humerus intramedullary kumapereka zabwino zambiri, monga kukhazikika, kulimbikitsana koyambirira, komanso kusokonezeka kochepa kwa minofu yofewa, sikungakhale koyenera kusweka kapena wodwala aliyense. Njira zina, monga plating kapena kukonza kunja, zingakhale zokondedwa nthawi zina. Kufunsana ndi katswiri wa mafupa kudzakuthandizani kudziwa njira yoyenera yochiritsira malinga ndi momwe munthu alili.

Mapeto

Pomaliza, kugwiritsa ntchito msomali wa humerus intramedullary kwawoneka ngati njira yothandiza komanso yodalirika yochizira matenda a humeral fractures. Njira yopangira opaleshoniyi imapereka kukhazikika kokhazikika, imalimbikitsa kulimbikitsana koyambirira, ndipo imapereka maubwino angapo kuposa njira zachikhalidwe. Ngakhale pali zoopsa ndi zovuta zomwe zingagwirizane ndi ndondomekoyi, kukonzekera koyenera kwa opaleshoni, njira yabwino, ndi chisamaliro cha pambuyo pa opaleshoni zingathandize kuchepetsa nkhawazi. Ndi kukonzanso koyenera komanso kuyang'anitsitsa, odwala amatha kuchira bwino ndikubwezeretsanso luso lawo logwira ntchito.