Kubaga kugabanya gufunga kubice byo hasi.

Kugabanya gufunga ni tekinike yibasirwa cyane ishobora gukoreshwa kumeneka ihamye yimitsi idatakaza umuvuduko wamaraso, nta ngaruka zo kwandura, gukira vuba, kugabanuka kwamafaranga yubuvuzi, kandi irashobora gukoreshwa muburyo bwo kugabanya gufunga imisumari yimisumari no kuvura imiti ivura imvune zinyuranye zidahungabana, nko kuvunika kwijosi ryumugore, kuvunika kwangirika kwamaraso, kugabanuka kwa tibiofibular.

Kuvunika kw'ijosi ry'igitsina gore

(I) Gukurura

Umurwayi ashyirwa muburiri, kandi tibial tuberosity traction ikorwa hamwe ningingo zanduye muburyo butabogamye hamwe no kuzenguruka imbere. Uburemere bwo gukwega buratandukanye kubantu, muri rusange kg 6-9, kandi igihe cyo gukwega ntigishobora kurenza amasaha 12. 90% by'abarwayi barashobora kugera kubisubiramo bikurura.

(B) gufunga manipulative repositioning

Niba gukwega kunanirwa kugera kubisabwa byo kwimurwa, gusubiramo intoki birashobora kongerwaho, munsi ya anesthesia epidural:

1. MC Uburyo bwa Elvenny

Ikigamijwe ni ugukosora igitereko, kuzenguruka hanze ingingo zanduye no kongera imbaraga zo gukurura, hanyuma kuzunguruka imbere no gukuramo imbere ingingo zanduye kugirango ugere ku ntego yo kwimurwa.

2. Uburyo bwiza

Umurwayi aryamye hasi, yunamye ikibuno n'amavi byatewe na 90 °, gukwega umurongo wigitsina gore wigice cyanduye mugihe cyiminota 2 kugeza kuri 3, hanyuma ukazenguruka imbere ingingo yanduye hanyuma ukayihindura byoroheje, nyuma yo gusubirana, kumanura buhoro buhoro ingingo yanduye, kandi niba ikirenge cyanduye kidasa nkizunguruka hanze, ahanini byerekana gusubirana neza. Mbere yo gukora imbere imbere, imashini ya C-arm yakoreshejwe mugusuzuma.

(C) Ubuhanga bwo gutondagura inshinge

Niba gusimburwa bitagerwaho nuburyo bwavuzwe haruguru, mubisanzwe byerekana ko umutwe wigitsina gore wacitse cyangwa ko habayeho gutandukana kuzunguruka hagati yumutwe nijosi (Ishusho 1A), cyangwa ko hari ikintu cyinjijwe hagati yumutwe nijosi. (Ibi birashobora kugaragara muburyo ubwo aribwo bwose bwo mu busitani II, III, cyangwa IV). Muri iki gihe, kuzunguruka ingingo zanduye kugirango dovetail ivunika umutwe nijosi ntibikiri byiza. Kugirango wirinde gukomeretsa no guhindurwa, tekinike yo gutera inshinge ya percutaneous irashobora gukoreshwa kugirango isubize kuvunika.

• Urushinge rw'amagufwa ya 3.0- kugeza kuri 3,5-mm yinjizwa mu buryo buhagaritse binyuze mu ruhu rwa cm 1 kugeza kuri 2 munsi y’isangano ry’imitsi ya inguinal na arteriire femorale imbere yumutwe wigitsina gore, kandi urushinge ruzunguruka cyane rwagati rwumutwe wigitsina gore iyobowe na mashini ya C-arm (Ishusho 1B).

• Kugirango ushimangire imbaraga zogusunika, urushinge rwa kabiri ruzengurutse amagufwa rushobora kwinjizwamo mm 4-5 ugereranije nuru rushinge, hamwe nurushinge rwa urushinge rusigaye hanze yuruhu.

• Binyuze muri trochanter nini, inshinge ebyiri zumurambararo wa diametre 3,5 zumucyo uzengurutswe muburyo bukurikije inguni yigitereko cyinkondo y'umura hamwe nu mfuruka yimbere, bigera kumpera ya kure yo kuvunika ijosi ryigitsina gore (ntunyure kumeneka) hanyuma usige iherezo ryurushinge hanze yuruhu.

• Umukoresha afite imirongo ibiri yumurizo wurushinge n'amaboko yombi kandi ahindura ibice byavunitse umutwe nijosi kugirango ahuze hamwe nubufatanye bwumufasha (Ishusho 1C-E).

• Nyuma yo guhuza birashimishije, igufwa ryamagufwa ryinjijwe kuri trocanter nini ryinjizwa mumutwe wigitsina gore kugirango gikosorwe byigihe gito, hanyuma imigozi myinshi yubusa ihita yinjizwa mumutwe wumugore (Ishusho 1F).

Uburyo bwo kugabanya gufunga bwasobanuwe haruguru burashobora kugera ku kugabanuka gusabwa hafi 98% yo kuvunika ijosi ryumugore. Nibyiza guhuza kuvunika, kwaba gufunze cyangwa gutemaguwe, nibyiza guhanura. Mubisanzwe, urwego rwo gutandukana rwavunitse rwerekanwe kuri X-ray ruri munsi yurwego nyarwo rwo kuvunika. Kubera ko guhuza kuvunika bigira ingaruka ku buryo butaziguye gukira kwavunitse ndetse no kuba bishoboka ko na nérosose yo mu mutwe w’umugore, birakenewe ko hafatwa icyemezo cyukuri cya firime X-ray nyuma yo guhuza kuvunika. Niba umurongo S ufite umurongo utagororotse cyangwa ngo uhagarike, byerekana ko kuvunika ijosi ryigitsina gore bitageze kuri anatomique (Ishusho 2).

Igishushanyo 1 Ivunika ry ijosi ryumugore ryasubiwemo inshinge zidasanzwe

Igishushanyo cya 2 Ivunika ry ijosi ryumugore X-imirasire hamwe nu murongo uhoraho wo hanze muguhuza anatomique no guhagarika umurongo wo hanze muburyo budahuje

Ivunika ry'umugore

Tekinike yo kugabanya ifunze irashobora gufasha muguhuza kuvunika kw'igitsina gore bitarinze kwangiza imyenda yoroheje cyangwa gutanga amaraso kugeza kumeneka, kandi birashobora gukoreshwa mugukosora imbere hamwe numusumari winjiye.

• Muri anesthesia epidural, umurwayi aryamye hejuru yigitanda (uruhu rwigihimba cyanduye ntirwakumiriwe muri iki gihe), umufasha umwe afata inyana yurugingo rwanduye, undi umufasha akurura umuzi wibibero byumurwayi hamwe numukandara wigitambara kugirango arwanye igikurura, kandi ingingo yanduye ntishobora gukururwa no gukururwa nigitereko cyikivi cyerekanwa hejuru, gukwega, rero uyikoresha akeneye gusa gukosora imbere-inyuma ninyuma yimurwa ryanyuma ryuruti rwacitse).

• Umukoresha akoresha amaboko yombi kugirango azenguruke ingingo yanduye kandi afashe amaboko hamwe (Ishusho ya 3 nishusho ya 4), kandi akosora icyerekezo cyimbere-cyinyuma ninyuma yimvune icyarimwe akoresheje imbaraga zifatika zifatika zamaboko yombi.

• Kurugero, niba igice cyegeranye cyavunitse cyigitsina gore cyimuwe hanze ninyuma, ukuboko kumwe gukoreshwa mugukanda igice cyegeranye cyacitse imbere no hepfo. Ubundi kuboko gukanda igice cyavunitse cya kure hanze no hejuru kugirango ugurize imbaraga zifata (umuganga wongeye kugarura agomba kuba afite icyemezo gikwiye cyerekeranye nicyerekezo cyo kwimuka hamwe nintera yimuka mbere yo gusubira), kugirango kuvunika gushobore gusubirwamo neza icyarimwe. Mugihe cyo gusubiramo, umufasha agomba kongera imbaraga zo gukurura no kurinda femur kuzunguruka.

• Iyo impera yamenetse ipfunditswe cyane, hagomba kumvikana ijwi ryoroheje ryogufata amagufwa, muriki gihe, umufasha agomba gukomeza gukurura, ariko kugabanya imbaraga zo gukurura.

• Iyo kuvunika byahujwe ahanini na mashini ya C-arm (niba hakiriho kudahuza gato, kora ibyo uhindura kugirango umenye neza ko impera zavunitse zihuye), komeza igikurura, kwanduza ingingo zanduye no gukwirakwiza igitambaro, hanyuma ukore imisumari yimbere.

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Igishushanyo cya 3 Kwimura imbere-inyuma no kuruhande rwavunitse bikosorwa icyarimwe mukuzenguruka amaboko yombi kuzenguruka ingingo zanduye no gufatana amaboko hamwe, ukoresheje imbaraga zo gufatisha amaboko yombi.

Igicapo 4 Gucika uruti rwigitsina gore rusubiramo imashini

• Ku barwayi bafite kuvunika kwinshi, gukoreshwa nabi gufunze cyangwa kuvunika kwavunitse, uburiri bwo kubaga bwo kubaga bushobora gukoreshwa mu kugabanya gufunga hamwe ningufu zimwe na zimwe zikoreshwa, zishobora no kurangiza neza kugabanya kuvunika kw'igiti cy'umugore.

• Nyuma yo gushyira ingingo yibasiwe kumurongo wo gukwega hanyuma isuzuma rya C-arm ryerekana ko kwimura kuvunika gukabije gukosorwa, impera ya kure yingingo zanduye zishobora guhindurwa imbere kugirango irusheho kugarura guhuza no guhuza mumashusho ya orthostatike yuruti rwumugore.

• Kuberako impagarara yimitsi yibibero ikururwa irashobora kugira uruhare runini rwo gutandukanya ibice byigitsina gore, kuvunika kwinshi kwigitsina gore birashobora kubona guhuza gushimishije mumashusho ya x-ray ya orthogonal.

• Ariko, muri iki gihe, kubera kubura inkunga ifatika ku mpera y’igice cyavunitse bitewe ningaruka za rukuruzi, igice cyavunitse cya kure cyurugingo rwigitsina gore ahanini cyimurwa inyuma, kandi muriki gihe, igitambaro gitwikiriye igitambaro cya sterile gishobora gushyirwa kuruhande rwinyuma yimvune ya kure nyuma yo gutandukanya no gutandukanya uruhu no gutandukanya impapuro za sterile. ya brace.

• Niba iyimurwa ryinyuma ryigice cyavunitse cya kure kitarakosorwa, umusumari wa hafi urashobora gushirwaho muburyo butaziguye hejuru yisonga rya trochanter nini cyangwa pyriform fossa, hanyuma inkoni yimbere yimitsi yinjizwa mumyanya ya medullary igice cyavunitse cyegeranye nikigero cyimyanya ndangagitsina yazamuye imbere. femur isubira inyuma ukoresheje leveri yinkoni isimburwa, bityo igarura guhuza hamwe no kuvunika kwinyuma kwimuwe kure,

• Nyuma yo kuvunika guhuza, pin ndende yo kuyobora yinjizwa mumyanya ya kure yamenetse kugirango irangize gusubiramo. Inkoni yo guhinduranya ingirakamaro ifite akamaro kanini mugukosora ihindagurika, gushimuta, hamwe nubumuga bwo kuzenguruka hanze bikunze kugaragara mubice byavunitse byigitsina gore (Ishusho 5).

• Kubisigara bisigaye byimurwa, gufungura impera yagoramye yinkoni yimbere irashobora guhindurwa kugirango bayobore pin ndende iyobora mu cyuho cyavunitse cya kure kugirango irangize kugabanuka gufunze.

• Ubundi buryo bwo kugabanya gufunga ni ugusunika umusumari wa Schanz muri cortex yamagufwa kuruhande rwimvune yimuwe hanyuma ugahindura impera yamenetse ukoresheje umusumari wa Schanz kugirango ugabanye gufunga (Ishusho 6). Nyuma yo kuvunika guhuza neza, umusumari winjiye winjizwa mumyanya yegeranye kandi ya kure ya medullary yavunitse kugirango urangize gukosora imbere (Ishusho 7).

  
  

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Igicapo 5 Gukoresha igice cyavunitse cyegeranye kugirango gifungurwe hifashishijwe inkoni yo gusimbuza intramedullary

Igicapo 6 Kugabanuka gufunze ukoresheje umusumari wa Schanz ushyizwe mumagufwa yamagufwa atabogamye kumutwe

Igicapo 7 Gufunga gufunga imisumari yimbere yo gukosora ibice byinshi byavunitse byavunitse byuruti rwigitsina gore ukoresheje umusumari wa Schanz

Kuvunika amaguru

(A) Gutegura mbere yo gutangira

• Isuzuma rya radiografiya: Isuzuma risanzwe ryerekana amashusho rigomba kuba rikubiyemo ibyiciro 3: anteroposterior (Igicapo 8), ingingo y'ibirenge (15 ° yo kuzunguruka imbere) (Ishusho 9), no kuruhande (Ishusho 10).

• Iyo ingingo yibirenge yakomeretse cyane imbere yimbere ninyuma hamwe na talus bizimurwa kuri dogere 11 zitandukanye (Ishusho 11). Amaradiyo ahamye ntagaragaza neza ituze ryumutwe. Shimangira amaradiyo na MRI birashobora kunoza isuzuma ryimiterere yimitsi yangiritse hamwe nindimu (Ishusho 12).

• Muri iki gihe, ubwoko bwimvune yamaguru bugomba kugenwa neza nuburyo bwo gukomeretsa hamwe namakuru ya radiologiya yingingo zanduye kugirango bayobore neza kwimurwa no gukosorwa.

• Rimwe na rimwe, kuvunika amaguru yoroheje yo hagati bishobora kuba igice cyinshi 'Maisonneuve kuvunika ', bikubiyemo no kuvunika kwa fibula yegeranye no gukomeretsa hamwe, bityo tibiofibula yose igomba gusuzumwa kuri radiyo.

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Igicapo 8 Imbere ninyuma

Igicapo 9 Ingingo yibirenge (15 ° yo kuzunguruka imbere)

Igicapo 10 Umwanya uhagaze

Igicapo 11 Kwimura kuvunika bigaragara ko byahujwe no gutandukana

Igicapo 12 Stress radiografiya (guturika kwa mpandeshatu)

(II) Anesthesia

Anesthesia ya femorale na sciatic ubusanzwe ifatwa.

(C) gusubiramo tekinike

Ubwoko bwinyuma-bwinyuma bwubwoko bwafunzwe busubirwamo bukorwa muburyo bwimbere yinyuma-imbere imbere-imbere yinyuma-yinyuma-munsi ya tibiofibular ubumwe. Ubwoko bwinyuma-bwimbere bwubwoko bukorwa muburyo bwimbere yimbere-hanze.

• Kubijyanye no kuzenguruka inyuma-hanze yubwoko bwa IV, umurwayi ashyirwa supine kandi ivi rihindagurika kuri 90 ° kugirango woroshye inyana triceps.

• Abafasha babiri bafata igice kinini cyibibero nikirenge, kandi gukwega gukoreshwa muburyo bwo kuvunika kuvunika (imbaraga zo gukurura ntizigomba kuba nyinshi kugirango birinde gukomeretsa).

• Umufasha ukurura ikirenge azenguruka ikirenge imbere kugirango akosore ubumuga bwo kuzenguruka hanze (Ishusho 13). Mugihe usunika impera ya kure werekeza kuruhande rwa tibial hanyuma ugakurura tibia ya kure werekeza kuruhande rwa fibular, umufasha imbere arahindukira kandi arambura umugongo umugongo kugirango akosore iyimurwa ryikirenge cyo hanze na talusi (Ishusho 14).

• Komeza kuzenguruka imbere-imbere kuzenguruka-kwagura umwanya. Hanyuma kuvunika kw'inyuma yinyuma bifashwe nintoki zombi, intoki enye zizengurutse tibia ya kure, kandi ibikumwe byombi bisunika kandi bikanyunyuza kure, mugihe bikurura tibia ya kure kugirango usubize umugeri winyuma (Ishusho 15).

• Hanyuma, umukoresha asunika umugeri wo hagati ugana inyuma no hepfo hamwe nintoki kugirango ubisubiremo (Ishusho 16). Abafasha babiri bakomeza ikirenge n'amaguru mumbere imbere-kuzunguruka-imbere-kwaguka kwaguka mugutegura gukosorwa.

Igicapo 13 Gukosora gukurura ubumuga bwo kuzenguruka hanze

Igicapo 14 Gukosora kwimuka kuruhande rwibirenge byo hanze na talus

Igicapo 15 Gukosora ihindagurika ryinyuma

Igicapo 16 Gukosora kwimuka kwimbere

Inyuma ya rotation-imbere yo gusimbuza imbere ni ikinyuranyo cya nyuma yo kuzunguruka-hanze yo gusimburana kandi bigakorwa muburyo bwimbere yimbere-yimbere.

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