Kuvharwa kudzikisira kuvhiya kwekudzikisa magumo emhedzisiro.

Kuderedzwa kwakavharwa ndiko kusanzwisisika kwehunyanzvi uko kunogona kushandisirwa mapepa akagadzikana pasina kupora kweropa, akanyanya kuderera stem fractures, etc., kubvisa kuparadzwa kweropa kuyerera kweropa nekukasira kuderedzwa.

Kupwanyika kwemutsipa weiyo femur

(I) traction

Murwere anoiswa mumubhedha, uye tibier tubosity traction inoitwa neyemba yakakanganisika muchinhu chisina kwayakarerekera nekupfava kwemukati. Kurera kwehunhu kwakasiyana kubva kumunhu kusvika kumunhu, kazhinji 6-9 kg, uye nguva yekutengesa haifanire kupfuura maawa gumi nemaviri. 90% yevarwere vanogona kuzadzisa kudzoreredza nehurongwa.

(B) yakavharwa manipulative repositioning

Kana traction ikatadza kuzadzisa iyo inodzikama zvinodiwa, bhuku rekushandura rinogona kuwedzerwa, pasi pepidural anesthesia:

1. Mc elvenny nzira

Chinangwa ndechekugadzirisa iyo pelvis, tenderera kunze kwesimba rakakanganisika uye kuwedzera simba rekutengeserana, uye rinozotenderera mukati medzinza uye kudzoreredza mukati mekukakavara kuve chinangwa chekudzoreredza chinangwa chekudzokorora.

2. Kutungamira nzira

Murwere wakarara pasi, pfugama muhudyu akakanganisa nebvi, tendererai neyechikadzi. Usati waita zvemukati zvekugadziriswa, iyo C-ARM muchina waishandiswa kuratidza.

(C) percutaneous chinjo prying maitiro

Kana kudzokorora kwacho hakuwanikwe nenzira dziri pamusoro apa, zvinowanzoratidza kuti musoro wechikadzi waputswa kana kuti pane kupatsanurana kwemusoro nemutsipa (Mufananidzo 1a), kana kuti kune kuiswa kumwe pakati pemusoro nemutsipa. (Izvi zvinogona kuitika mune chero yebindu II, III, kana IV mhando). Mune ino kesi, kutenderera iyo yakakanganisika bhurumu yekudyara musoro uye mutsipa kukanganisika hazvisisiri kushanda. Kuti udzivise kusawirirana uye kudzoreredza, socutaneous sando prying maitiro anogona kushandiswa kugadzirisa kupwanyika.

• A 3.0- kusvika 3.5-mm-diameter pfupa rakatenderedzwa nepakati peganda reCommuto, uye tsono yakatenderedzwa yakadzika kusvika padanho rechikadzi pasi pekutariswa kweC-ARM CINE (Mufananidzo 1B).

• Kusimbisa iyo prying simba, tsono yechipiri yemapfupa denderedzwa inogona kuiswa 4-5 mm yakafanana neiyi tsono, nekupera kweshanhire kwasara kunze kweganda.

• Kuburikidza neTrochanter Greater, maviri mm Diameter Bone denderedzwa anodhonzwa

• Mushandi anobata maviri maseti emiswe ine maviri uye inogadzirisa musoro uye mutsipa zvikamu zvekutungamirira pamwe neyako imwe pamwe nekubatana kweMubatsiri (Mufananidzo 1C-E).

• Mushure mekunge kuwiriranwa kwacho kugutsikana, pfupa repfupi rakaiswa pabhenji rakakwenenzverwa mumusoro wechikadzi kuti riwedzere kugadziriswa kwechinguvana

Iyo yakavharwa yekudzora nzira inotsanangurwa pamusoro inogona kuwana iyo inodiwa kuderedzwa mune anenge 98% yeyakagwinya echikadzi. Zvirinani kuenderana kwekupwanya, kungave kwakavharwa kana kuiswa, zviri nani proong. Kazhinji, degree rekutambanudzwa discatian rinoratidzwa paX-Ray iri pasi peiyo chaiyo degree rekunakisa disclocation. Sezvo kukanganisika kwekukanganisa kwakanangana nekupora kwekupwanya uye mukana weNecrosis yemusoro wechikadzi, zvinodikanwa kuti uve nekutonga kwakaringana kweiyo X-ray firimu mushure mekutunganidzwa. Kana iyo s-yakavezwa curve isina kunyorwa

Mufananidzo 1 mutsipa wechikadzi kupwanya kwakagadziriswa neFocutaneous Flyle Prying

Mufananidzo 2 Chemukati mutsipa bracture X-RAIYS ine kuenderera mberi kwekunze muAnatomical Alignment uye inopindirana kwekunze curve mune isina-anatomical alignment

Femori stem kupwanya

Iyo yakavharwa yekudzikiswa maitiro inogona kubatsira mukugadziriswa kwechikadzi stem kupwanya pasina kana kupa ropa kumagumo, uye inogona kushandiswa kugadziriswa kwemukati neyakagadziriswa yemukati neyakagadziriswa.

• Pasi pepidural anesthesia, murwere ari kurara pamubhedha (ganda renyama rakakanganisika hadzina kukanganiswa mbichana. Kuregererwa nemhasuru kudhonza, uye kunogona kururamisa otomatiki nehurongwa, saka anoshanda anongoda kururamisa anterior-posterior uye yakazotevera kudzikiswa kwemugumo wakaputsika wetsika).

• Anoshanda anoshandisa maoko maviri kuti akanganisa ruoko rwakakanganisika uye akabata maoko pamwe (Mufananidzo 3 uye Mufananidzo 4), uye unoruramisa-posterior kutamiswa kamwechete kwekushandisa simba rekunyengerera remagazini.

• Semuenzaniso, kana chidimbu cheproximal che fracture ichidzingwa kunze uye anteriorly, imwe sourmarm inoshandiswa kutsvedza chikamu chechikamu chepakati uye pasi. Iyo imwe forearm inotsvedza iyo distal cracture secraw Munguva yekudzoreredza maitiro, mubatsiri anofanira kuwedzera simba rekutengesa uye chengetedza femur kubva pakutenderera.

• Kana kupunzika kwemugumo kwakasunganidzwa, kurira kwakapetwa, panguva ino, mubatsiri anofanira kuramba achichengetedza traction, asi kuderedza simba rekutengesa.

• Kana kukanganiswa kwacho kwakanyatsoenderana neC-ruoko ruoko (kana zvichine shanduko diki, chengetedza tsika iyi, kupandukira tambo yakakanganisika uye nekuita tauro, uye wozoita intrameduutlary chipikiri chechipikiri.

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Fig. 3 Anterior-posterior uye anotevera kutungamirwa kwekupwanya kunogadziriswa panguva imwe chete nekuputira maoko akakomberedza uye kushandisa maoko pamwe chete, uchishandisa chiremba wepazasi emagazini ese ari maviri.

Mufananidzo 4 Chemukati Tsika Fracture Repositioning Mechanics Scematic

• Kune varwere vane hombe kutapudzwa, vasina kubudirira kudzora

• Mushure mekutakura humbo hwakakanganisika pane traction chimiro uye kuongororwa kweC-ruoko kunoratidza kuti kuongororwa kwekupwanya kwakagadziriswa, kuguma kwemberi kuchinjirwa kune kuenderera mberi nekudzoreredza kufambiswa uye kuwiriraniswa muOrtsment mumufananidzo weOristatic of the herm of fitem.

• Nekuti kunetsana kweiyo tsandanyama dzechidimbu

• Nekudaro, panguva ino, nekuda kwekushaiwa rutsigiro runoshanda pakupera kwechikadzi zvakarembera, uye panguva ino Kubviswa kweiyo distal yekupera kupera kunogona kurangwa nekugadzirisa kureba kweiyo brace.

• Kana iyo yepashure pekushamisika yeiyo distal Fracture ichiri kugadziriswa, iyo proximal chipikiri cheiyo yeThe Bossa Repositioning tsvimbo yakamutswa zvine mwero kumberi kushungurudza proximal bracture yeiyo feks kumashure nekushandisa iyo lever yeiyo yekudzosera tsvimbo, nokudaro inodzoreredzwa inoenderana neyekudzosera a1dac289d=Orthopedic Implants Arthroscopy Shavi Shstem M-30-11

• Mushure mekunge kupwanya kwakabatanidzwa, ipini refu inotungamira inoiswa mu distal kupwanya cavity yekupedzisa iyo yakavharwa reset. Iyo intramedullary inodzosera tsvimbo inonyanya kushanda mukugadzirisa iyo yekuchinjika, kutapwa, uye zvekutenderera zvekutenderera zvakajairika zvakajairwa muProximal Femur (Mufananidzo 5).

• Zvekuseri kwekutevera kwekutungamira, kuvhurwa kwemugumo wakakwenenzverwa kwetsvimbo intrarellary inogona kugadziriswa kuti itungamire nzvimbo refu yekutungamira mune distal bracture yekuzadza kuderedzwa kwekuvharwa.

• Imwe nzira yekudzikiswa yakavharwa ndeyekukanda mbichana mbichana muchipfupikiso chepfu mugadzi Mushure mekunge kupwanya kuchizotaurwa, chipikiri chakabatanidzwa, chakapindirwa muProximal uye Distal Medillary Cavity yekukanganisa kupedzisa kugadziriswa kwemukati (Mufananidzo 7).

  
  

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Mufananidzo 5 Kunyengera kweiyo Proximal Fracture Chikamu chekuvharwa kudzoreredza uchishandisa iyo intrameduutery inodzosera tsvimbo

Mufananidzo 6 Yakavharwa kuderedzwa uchishandisa schanz chipikiri chakaiswa mune unilateral pfupa cortex pamapepa ekupwanya

Mufananidzo 7 wakavharwa kuderedzwa Intramedullary zvipikiri zvechipikiri zvechirume cractared cracture yeiyo fral stech inomira uchishandisa iyo SChanz mbichana

Ankle Fracture

(A) Kugadzirira Kunzvera

• Radiographic kuongororwa: Iyo yakajairwa yekufungidzira kufungidzira kunofanirwa kusanganisira 3 zvikamu: anteroposter

• Kana maAnkle Joint akakuvara zvakanyanya mukati uye kunze kwenyika uye talus ichadzingwa kusvika gumi nemaviri madhigirii (Mufananidzo 11). Static radiographs hairatidze kunyatso kugadzikana kweiyo ashle yakabatanidzwa. Kushushikana radiographs uye MRI kunogona kuvandudza kuongororwa kwekugadzikana kweiyo ashle Joint uye ligament kukuvara (Mufananidzo 12).

• Mune ino kesi, mhando yekukuvara kweAnkle inofanira kuve yakatemwa nenzira chaiyo neyekukuvara uye radiological data yemumambo yakakanganisika kuitira kuti itungamire nenzira chaiyo yekudzoreredza uye kugadzirisa.

• Dzimwe nguva mbozha iri nyore yekukona inogona kunge iri chikamu chakati wandei.

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Mufananidzo 8 kumberi uye kumashure chinzvimbo

Mufananidzo 9 Ankle Points (15 ° Yekutenderera kwemukati)

Mufananidzo 10 Lateral chinzvimbo

Mufananidzo 11 Kubhururuka Kwekutiza sezviri pachena kwakasanganiswa nekuvimbika

Mufananidzo 12 Kushushikana Radiograph (Triangular Ligament Rupture)

(Ii) anesthesia

Chikadzi uye Sciatic nerve Anesthesia inowanzo kutorwa.

(C) reset maitiro

Iyo yepashure-yekukunze inotenderera mhando yekuvharwa kudzoreredza inoitwa mune iyo yekuraira kwekunze ANKLE-YEMAHARA ANKLE-POTERIOR TIBLEFILULE IN Union. Iyo posterior kutenderera-kwemukati inotenderera mhando inoitwa mune yakarongeka yemukati yeAnkle-kunze kwenyika.

• Panyaya yePosterior-yekunze kutenderera Tortation IV, murwere anoiswa supine uye ibvi rakachinjika pa 90 ° kuti uzorodze triceps.

• Vabatsiri vaviri vakabata chikamu chePoplite.

• Mubatsiri anodurura tsoka inotenderera tsoka mumukati kuti ugadzirise iyo yekudzima kwekutenderera (Mufananidzo 13). Paunenge uchisundira mugumo wekupedzisira kune tibial rutivi uye kudhonza iyo diski tibia kuenda kudivi rekutenderera, mubatsiri anotenderera nekukasira kuunganidzwa kuti udzorere kutamiswa kwekunze uye talus (Mufananidzo 14).

• Chengetedza kutenderera kwemukati-kutenderera kwemukati-dorsal extension. Ipapo iyo Posterior Ankle Fract block inobatwa neThumbs mbiri, iwo mana eminwe anokomberedza Thumbs, uye thumbs pushs and squeeze padiki tibia kuti udzorere teserior ashle (Mufananidzo 15).

• Pakupedzisira, mushandi anosundidzira menduru yedumbu kumashure uye pasi neye zvigunwe kuti zviise zvakare (Mufananidzo 16). Vabatsiri vaviri vanochengeta tsoka uye kubhururuka mune yepamhepo kutenderera-kwemukati kutenderera-dorsal nzvimbo yekugadzirira yekugadzirira.

Mufananidzo 13 Traction Kururamisa Kwekunze Kutenderera Kuremara

Mufananidzo 14 Kururamisa kwekutungamira kwekutungamira kweiyo yekunze abvunzo uye talus

Mufananidzo 15 Kururamisa kwePosterior Ankle Shift

Mufananidzo 16 Kururamisa Kwemukati Kurumwa Kwemukati

Iyo yekutenderera-kutenderera-kwemukati yekudzokorora maitiro akapesana neyekutenderera-kutenderera-kwekunze kudzoreredza maitiro uye kunoitwa muhurongwa hwekunze kwenyama-yekunze.

Matenga sei kuti utenge orthopedic mispende uye zviridzwa zveOrthopedic?

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