Kubagwa kugabanya kugabanuka gukabije.

Kugabanya gufunga ni tekinike iteye ubwoba ishobora gukoreshwa ku ivuza rihamye zidafite imivurungano yo kuvura, kandi zikaba zicibwa ku gaciro k'ubuvuzi, kandi zikaba zicibwa ku gahato, kuvugurura imiyoboro y'imyambaro, imivurungano y'ibinyabuzima, ibiti by'ubukorikori Kuvunika, nibindi, gukuraho kurimbuka kwamaraso mugugabanuka kwangirika.

Kuvunika ijosi rya femur

(I) gukurura

Umurwayi ashyirwa muburiri, kandi traction ya tuberoial ikorwa hamwe nigitambo cyakozwe mumwanya utabogamye hamwe no kuzunguruka imbere. Uburemere bwo gukurungura buratandukanye kumuntu, muri rusange kg 6-9, nigihe cyo gukururwa ntigomba kurenza amasaha 12. 90% by'abarwayi barashobora kugera ku myigaragambyo.

(B) Gufunga Manipulative

Niba gukurura binaniwe kugera ku bisabwa, kwifashisha intoki birashobora kongerwaho, uyobowe na Epide wo mu Byapimwe:

1. Uburyo bwa MC Elvenny

Intego ni ugukosora igitereko, kuzenguruka hanze igihome cyagize ingaruka no kongera imbaraga zo gukurura, hanyuma uzunguruka imbere no gusubira imbere mu ngingo yibasiwe kugirango ugere ku ntego yo kwishyiriraho intego yo kwishyiriraho intego yo kwishyiriraho intego yo kwishyiriraho intego yo kwiyongera.

2. Uburyo buyobora

Umurwayi aryamye hasi, yunamye ikibuno cyatewe na 90 °, gukurura ibirenge bya femore yiminota 2 kugeza kuri 3, ahanini bihinduranya, kandi ahanini byerekana ko byangiritse hanze, ahanini byerekana ko bigenda neza. Mbere yo gukora ikosora imbere, imashini ya C-ARM yakoreshejwe kugirango igenzure.

(C) Urushinda rwinshi rwa prictique

Niba gusubiramo bidagezweho nuburyo bwavuzwe haruguru, mubisanzwe byerekana ko umutwe wumunya femoral wacitse cyangwa ko habaye ugutandukana kuzunguruka hagati yumutwe nijosi (ishusho 1a hariho kwinjiza ahantu hagati yumutwe nijosi. (Ibi birashobora kubaho muri ubwo busitani II, III, cyangwa ubwoko bwa IV). Muri uru rubanza, kuzunguruka ingingo zakozwe kugirango ufate icyemezo cyumutwe nijosi ntibikiri byiza. Kugirango wirinde gutegurwa no kwisubiraho, umushinyaguzi wa Percaneous Prisiki irashobora gukoreshwa mugusubiramo.

• Umushimuno wa 3.0 kugeza kuri 3.5

• Gushimangira imbaraga za pring, uruzitiro rwa kabiri ruzenguruka rurashobora kwinjizwamo 4-5 ugereranije nurukingo, hamwe nurushinge rwinshi rusigaye hanze yuruhu.

• Binyuze mu fungurira cyane, inshinge ebyiri z'amagufi yimigenzo ya 3,5.

• Umukoresha afite ibice bibiri byimirizo umurizo hamwe namaboko yombi kandi ahindura igice cyumutwe nijora kugirango ahuze hamwe nubufatanye bwumufasha (Igishushanyo 1c-e).

• Nyuma yo guhuza birashimishije, amagufwa ya man yinjijwe kumutwe munini wo gukosorwa by'agateganyo, kandi imigozi myinshi yuzuye yinjizwa mu mutwe wa femorale (Igishusho 1F).

Uburyo bufunze bwasobanuwe haruguru burashobora kugera ku kugabanya 98% yo kuvunika imigezi. Nibyiza guhuza kuvunika, byaba bifunze cyangwa byateganijwe, nibyiza cyane. Mubisanzwe, urwego rwo kwimvira kunyerera rwerekanwe kuri x-ray ntabwo ari munsi yurwego nyarwo rwo kwitegura. Kubera ko guhuza ibintu bigira ingaruka mu buryo butaziguye gukiza kumeneka no gushaka urujijo rw'umutwe wa femorale, birakenewe kugira urubanza ruke rwa firime X-Ray nyuma yo kuvunika. Niba umurongo wa S-umeze neza cyangwa uhagarikwa, byerekana ko ijosi ry'ijosi ritarageze ritagera kuri anatomical (Ishusho 2).

Igicapo 1 Guvunika ijosi

Igishushanyo 2 Gukuramo ijosi rya femoral X-Imirasire hamwe numurongo uhoraho mubintu anatomike no guhagarika umurongo wo hanze mubintu bitarimo anatomical

Kuvunika femoral

Ubuhanga bwa gufunga burashobora gufasha muguhuza igituba cya femoral utangiza imyenda yoroshye cyangwa amazi yoroshye kugirango ukemure imbere, kandi urashobora gukoreshwa mugukosora imbere hamwe nisumigisho.

• Munsi ya Epide wo mu Byapimwe, umurwayi aryamye ku buriri (uruhu rwibintu byibasiwe ntibufashe umuvuduko wumurwayi kugirango urwanye umukandara wumurwayi hamwe na patel yo kuzunguruka hejuru kandi Abimuwe no gukurura imitsi, kandi birashobora gukosorwa mu buryo bwikora ukurikije tract, kugirango uyikoresha akeneye gukosora Imbere-inyuma no kwimura imyambaro yinyuma kandi kuruhande rwimpera yinyuguti).

• Umukoresha akoresha amaboko yombi kugirango azenguruke ingingo yibasiwe kandi afata amaboko hamwe (Ishusho ya 3 nigishushanyo cya 4), kandi akosora kwimura imbere no mu rwego rwo kwimura imyanya icyarimwe.

• Kurugero, niba igice cya Proximale cyometseho hejuru no mu manza, ukuboko kwomwe gakoreshwa mukanda igice cya preximare imbere no hepfo. Urundi rubanza rwatsinze igice cyo kuvunika kure cyane kandi hejuru kugirango rugushikarize imbaraga zo kwimura (gusubiramo ikwiye kwimura icyerekezo no gusubiramo neza. Mugihe cyo gusubiramo, umufasha agomba kongera imbaraga zo gukurura no gukomeza femu kuzunguruka.

• Iyo kuvunika kurangizwa ahanini, amajwi yo guswera amagufwa agomba kumva, muri iki gihe, umufasha agomba gukomeza gukurura, ariko agabanya imbaraga zo gukurura.

• Iyo kuvunika akenshi bihujwe na mashini ya C-ARM (niba haracyariho nabi, kora ibintu bimwe kugirango umenye neza igihimbano, hanyuma ugakwirakwiza igitambaro cyibasiwe no gukwirakwiza igitambaro cyibasiwe.

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Igishushanyo cya 3 Imbere-Inyuma yo Kwimura neza Kuri Igihe kimwe no Gupfunyika Amaboko Yagize ingaruka, Ukoresheje imbaraga zisimba zamaboko.

Igishushanyo 4 Stem Stem Stem Gusubiramo Ubukanishi Schematic

• Ku barwayi bafite kwimurwa cyane, gukoresha nabi cyangwa kunanirwa kunanirwa, uburinganire bwo kubaga bukoreshwa mugushira hamwe nimbaraga zimwe na zimwe zo kugabanya ibikoresho, ishobora no kugabanya neza kuvunika femoral stoction.

• Nyuma yo gushyira ingingo yanduye kumurongo wo gukururika hamwe nibizamini bya C-ART byerekana ko kwimurwa gukabije gukosorwa, iherezo ryibintu byangiritse birashobora guhindurwa imbere kugirango bisubiremo kugabanuka no guhuza ibitekerezo bya orotostatic yigiti cyamashanyarazi.

• Kuberako imitsi yimitsi iyobowe irashobora gukina imyanya yoroheje yo guhagarika imiti yinyenga zumunyabwenge, kuvunika ibiti bishimishije mu buryo bushimishije muri orthogonal X-ray ishusho ya x-ray.

• Ariko, muri iki gihe, kubera kubura inkunga nziza ku mpera z'igice cyacitse ku rugero rukomeye, kandi muri iki gihe, igitambaro cyo kwimuka gikabije cyo gutomborwa no gutegura uruhu no kurambika amabati, n'inyuma Kwimura ivunika kurangira birashobora gukosorwa muguhindura uburebure bwa fuge.

• Niba imyanya yinyuma yimyandikire ya kure irakosowe, umusumari wimisumari yashizwemo byateganijwe mu mwobo munini cyangwa inkuta za poshex, hanyuma inzitizi yongeye kwinjizwa mu mwobororamuco ya Femur, hanyuma ikiganza cya Intramediry Inkoni yo gusubiramo irazamuka imbere kugirango ikemure ivuruke ryinyuma rya feri isubira inyuma, bityo ikagarura guhuza hamwe no kuvunika kwanyuma,

• Nyuma yo kuvunika bihujwe, umurongo muremure PIN winjijwe mu mwobo wa kure kugirango urangize gusubiramo. Intramedislary Repovitoring Inkoni ifatika cyane mugukosora Flexion, gushimuta, hamwe nubumuga bwo hanze busanzwe mubihe bya Feximile Fexir (Ishusho 5).

• Kubisigaye bisigaye, gufungura impera yinkoni ya Intramedlary irashobora guhinduka kugirango iyobore igice kinini kiyoboye PIN yometse kuri Loality

• Ubundi buryo bwo kugabanya gufunga ni ugukoresha imisumari ya Schanz mumagufwa Cortex kuruhande rwumucyo urangira kandi uhindure imisure ya Schanz kumusumari (Ishusho 6). Nyuma yo kuvunika bihuye neza, umusumari wa Intramedullary winjijwe mukazi kagereranijwe kandi wa kure ya fracture kugirango urangize gukosora imbere (Ishusho 7).

  
  

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Igishushanyo 5 Gukoresha igice cya Fexime Proxine kubisubiramo bifunze ukoresheje Intevu yongeye kuvugurura inkoni

Igishushanyo 6 Kugabanuka ukoresheje imisumari ya Schanz yashyizwe mumagufwa adashyize ahagaragara Cortex kumurangizo

Igishushanyo 7 Kugabanuka Intramedullary Gukosora imisumari yo kuvunika imikino myinshi

Kuvunika kkle

(A) Gutegura mbere

• Isuzuma rya radiyo: Isuzuma risanzwe ryo gushushanya rigomba kuba rikubiyemo ibyiciro 3: Anteroposition (Ishusho ya 8), ingingo ya Ank (15 ° Kuzunguruka imbere) (Ishusho 9), hamwe na kuruhande (Ishusho (Ishusho (Ishusho ya 10).

• Iyo ankle yakomerekejwe cyane na talis na talis izamurwa kuri dogere 11 zitandukanye (ishusho ya 11). Radiyo ihamye ntabwo yerekana neza ituze ryikimonyo. SHAKA Radiographs na MRI birashobora kunoza isuzuma ryimikorere yinkunga yinono hamwe na Ragaram (Ishusho 12).

• Muri uru rubanza, ubwoko bwibikomere bugurumana neza na Mechanism yimvune na radiologiya yamakuru yibyangiritse kugirango ayobore neza imyigaragambyo no gukosorwa.

• Rimwe na rimwe, kuvunika kworoheje gukabije kw'ibirenge bishobora kuba bimwe mu bigo bigoye 'MaisonNeuve gucika bugufi bya fibula hamwe n'imvune rusange, triofibula ihuriweho, bityo tibiofubula yose igomba gusuzumwa ku mazi.

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Igishushanyo 8 Imbere N'INGENZI

Igishushanyo 9 Ingingo ya Ankle (15 ° yo kuzunguruka imbere)

Igishushanyo 10 kuruhande

Igicapo 11 Kuvuka kugaragara bigaragara ko yahujwe no kwiba

Igicapo 12 Stress Radiograp (Inyabutatu Rupture)

(Ii) anesthesia

Igiti cya femoral na scatiatiya gikunze gufatwa.

(C) gusubiramo tekinike

Ubwoko bwinyuma bwinyuma bwuruhererekane rufunze rukorwa muburyo bwa Akkle-yimbere yimbere-yinyuma yinyuma ya tibiofibular. Ubwoko bwinyuma-ubwoko bwo kuzunguruka imbere bukorwa muburyo bwa Akle-yo hanze.

• Kubijyanye na pasterImari-yo hanze Ubwoko bwa IV, umurwayi ashyizwe supune kandi ivi yuzuye kuri 90 ° yoroshya amabereri yinyana.

• Abafasha babiri bafata igice cya popliteal igikubuzima namaguru, kandi tract ikoreshwa mubyerekezo byacitse (imbaraga zo gukurura zidakwiye kurenza urugero kugirango wirinde kwiyongera.

• Umufasha akuramo ikirenge azenguruka ikirenge kugirango akosore ubumuga bwo kuzunguruka hanze (Ishusho 13). Mugihe usunika iherezo rya kure yerekeza kuruhande rwa tibial hanyuma ukurura tibia ya kure yerekeza ku ruhande rwa fibular, umufasha w'imbere arahindukira kandi atarambura akaguru no gukosora akanywaho kugirango akosore ibirenge byo hanze na Talus (Ishusho 14).

• Komeza kuzunguruka imbere-kuzunguruka imbere-kwagura. Noneho kuvunika inyuma yinyuma bifatwa na thumbs zombi, intoki enye zizengurutse tibia ya mandal, kandi zombi zikanda kure, mugihe ukurura tibia ya kure kugirango usubize akaguru (ishusho 15).

• Hanyuma, umukoresha asunika akanwa ka Licial inyuma no hepfo hamwe na thumbs kugirango usubiremo (Ishusho 16). Abafasha babiri babungabunge ikirenge n'amaguru mu rwego rwo kuzunguruka imbere - kuzunguruka mu gihugu-mu buryo bwo kwitegura gukosorwa.

Igicapo 13 Gukwirakwiza Ubumuga bwo Kuzunguruka hanze

Igicapo 14 Gukosora Kumurwa kuruhande rwa Ankle yo hanze

Igicapo 15 Gukosora Imbere Yimbere

Igicapo 16 Gukosora Kwimurwa kw'imbere

Nyuma yo kuzunguruka-inzira yo kwikuramo imbere ni ikinyuranyo cya nyuma-kuzunguruka-gusubiramo hanze kandi bikorwa muburyo bwa Akle-yo hanze.

Nigute wagura amagufwa hamwe nibikoresho bya orthopedic?

Kuri Czmeditech , dufite umurongo wuzuye wibicuruzwa byubasaguro orthopperic bitera kandi nibikoresho bihuye, ibicuruzwa birimo Umugongo, Intramedillary Imisumari, Isahani, gufunga isahani, cranial-maxillofacial, prostas, ibikoresho by'ingufu, ibicuruzwa byo hanze, arthroscopy, Kwitaho ku matungo n'ibikoresho byabo byo gushyigikira.

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