Vuhandzuri byo hunguta lebyi pfalekeke bya ku tshoveka ka swirho swa le hansi ka le hansi.

Closed reduction is the minimally invasive technique that can be used for stable fractures of extremities with no loss of blood flow, no risk of infection, fast functional recovery, significantly reduced medical costs, and can be used for closed reduction hollow nail and intramedullary pin fixation treatment of various unstable fractures, such as femoral neck fractures, femoral stem fractures, tibiofibular fractures, humeral stem fractures, etc., ku herisa ku onhiwa ka ku khuluka ka ngati hi ku hunguteka ka incisional.

Ku tshoveka ka nhamu ya femur .

(i) Ku koka .

Muvabyi u vekiwa emubedweni, naswona tibial tuberosity traction yi endliwa hi xirho lexi khumbekaka eka xiyimo xa neutral na ku rhendzeleka ka le ndzeni lokutsongo. Ndzilo wa traction wa hambana kuya hi munhu, hi xitalo 6-9 kg, naswona nkarhi wa ku koka awu fanelanga ku tlula 12 wa tiawara. 90% wa vavabyi va nga fikelela ku vekiwa nakambe hi ku koka.

(b) Ku vekiwa nakambe ka xiyimo xa manipulative loku pfalekeke .

Loko ku koka ku tsandzeka ku fikelela swilaveko swa ku vekiwa nakambe, ku vekiwa nakambe hi voko swi nga engeteriwa, ehansi ka epidural anesthesia:

1. MC elvenny ndlela .

Xikongomelo iku lulamisa pelvis, ku rhendzeleka ehandle ka xirho lexi khumbekaka naku engetela matimba ya traction, kutani endzeni swi rhendzeleka endzeni naku tlherisela endzhaku endzeni ka xirho lexi khumbekaka ku fikelela xikongomelo xo tlhela xi vekiwa.

2. Ndlela ya Leadbetter .

Muvabyi u etlela ehansi, a gombonyokisa hip na matsolo leyi khumbekaka hi 90°, ku koka hi ku landzelela femoral axis ya xirho lexi khumbekaka ku ringana 2 ku ya eka 3 wa timinete, kutani endzeni xi rhendzeleka endzeni ka xirho lexi khumbekaka na ku xi olovisa hi ku olova, endzhaku ko tlhela ku vekiwa, ku hunguta hi ku olova ku tlhela ku vekiwa. Loko ku nga si endliwa ku khomiwa ka le ndzeni, muchini wa C-ARM wu tirhisiwile ku tiyisisa.

(c) Thekiniki yo pryle needle needle percutaneous .

Loko ku vekiwa nakambe ku nga fikeleriwa hi tindlela leti nga laha henhla, hi ntolovelo swi kombisa leswaku nhloko ya femoral yi tshovekile kumbe leswaku ku vile na ku hambana ka ku rhendzeleka exikarhi ka nhloko na nhamu (Xifaniso 1a), kumbe leswaku ku na ku nghenisiwa kun’wana exikarhi ka nhloko na nhamu. (Leswi swi nga humelela eka muxaka wihi na wihi wa ntanga wa II, III, kumbe IV). Eka xiyimo lexi, ku rhendzeleka ka xirho lexi khumbekaka ku dovetail ku tshoveka ka nhloko na nhamu a swa ha tirhi. Leswaku ku papalatiwa ku tsemiwa na ku vekiwa nakambe, thekiniki ya percutaneous needle prying yi nga tirhisiwa ku tlhela yi veka ku tshoveka.

• Naliti ya xirhendzevutani ya marhambu ya 3.0- kuya eka 3.5-mm-diameter yi nghenisiwa hiku kongoma hi nhlonge 1 kuya eka 2 cm ehansi ka laha ku hlanganaka inguinal ligament na femoral artery kuya emahlweni ka nhloko ya femoral, naswona naliti yi rhendzeleka kuya ehansi kuya exikarhi ka nhloko ya femoral ehansi ka vulawuri bya C-Arm Machine (xifaniso xa 1b).

• Ku tiyisisa matimba yo prying, naliti ya vumbirhi ya xirhendzevutani ya marhambu yinga nghenisiwa 4-5 mm parallel eka naliti leyi, laha makumu ya naliti yanga sala ehandle ka nhlonge.

• Hiku tirhisa trochanter leyikulu, ti needles timbirhi ta 3.5 mm diameter ta marhambu ya xirhendzevutani ti boriwa hi percutaneous hiku landza angle ya cervical stem xikan’we na angle ya anterior tilt, swifika emakumu yale kule ya femoral neck fracture (unga hundzi eka fracture) naku siya makumu ya needle ehandle ka nhlonge.

• Mutirhisi u khoma tisethi timbirhi ta misisi ya naliti hi mavoko hamambirhi naswona u lulamisa swiphemu swa ku tshoveka ka nhloko na nhamu ku fambisana na ntirhisano wa mupfuni (Xifaniso 1C-E).

• Endzhaku kaloko alignment yi eneriseka, bone round pin leyi nghenisiweke eka greater trochanter yi screwed eka nhloko ya femoral kuva yi lulamisiwa swa xinkarhana, naswona swikwirikiri swotala leswingana hollow switlhela swi nghenisiwa eka nhloko ya femoral (Xifaniso 1F).

Ndlela yo hunguta leyi pfalekeke leyi hlamuseriweke laha henhla yi nga fikelela ku hunguteka loku lavekaka eka kwalomu ka 98% wa ku tshoveka ka nhamu ya femoral. Loko ku ringanisiwa ku antswa ka ku tshoveka, hambi ku ri loku pfalekeke kumbe loku tsemiweke, vuprofeta byi antswa. Hi ntolovelo, mpimo wa ku tshoveka ka ku tshoveka loku kombisiweke eka X-rheyi wu le hansi ka mpimo wa xiviri wa ku tshoveka ka ku tshoveka. Tanihi leswi ku ringanana ka ku tshoveka ku khumbaka hi ku kongoma ku hola ka ku tshoveka na ku koteka ka necrosis ya nhloko ya femoral, swa laveka ku va na ku avanyisa lokunene ka filimi ya X-ray endzhaku ka ku ringanana ka ku tshoveka. Loko curve ya xivumbeko xa S yi nga olovi kumbe ku kavanyetiwa, swi kombisa leswaku ku tshoveka ka nhamu ya femoral a ku fikanga eka anatomical repositioning (Xifaniso 2).

Xifaniso 1 Ku tshoveka ka nhamu ya le xifuveni yi tlhela yi vekiwa hi ku tirhisa percutaneous needle prying .

Xifaniso 2 X-rheyi ya nhamu ya femoral leyi nga na curve ya le handle leyi yaka emahlweni eka anatomical alignment na interrupted external curve eka non-anatomical alignment .

Xirhendzevutana xa xirho xa le xifuveni .

Thekiniki ya ku hunguta leyi pfalekeke yi nga pfuneta eka ku ringanisiwa ka ku tshoveka ka nsinya wa femoral handle ko onha tinyama to olova kumbe mphakelo wa ngati eka makumu ya ku tshoveka, naswona yi nga tirhisiwa eka ku khomiwa ka le ndzeni hi xipikiri xa le ndzeni ka marhambu.

• Under epidural anesthesia, the patient is lying flat on the bed (the skin of the affected limb has not been sterilized at this time), one assistant holds the calf of the affected limb, and the other assistant pulls the patient's thigh root with a cloth belt to counteract the traction, with the affected limb in a neutral position and the patella of the knee facing upward (the femoral stem fracture is usually not rotated and displaced by muscle ku koka, naswona swi nga lulamisiwa hi ku tisungulela hi ku koka, hikwalaho mutirhisi u lava ntsena ku lulamisa ku rhurha ka le mahlweni-endzhaku na le tlhelo ka makumu lama tshovekeke ya nsinya).

• Mutirhisi u tirhisa mavoko hamambirhi ku rhendzela xirho lexi khumbekaka naswona u khoma mavoko swin’we (Xifaniso 3 na Xifaniso 4), naswona u lulamisa ku rhurha ka le mahlweni-endzhaku na le tlhelo ka ku tshoveka ka ku tshoveka hi nkarhi wun’we hi ku tirhisa matimba yo khoma ya le mahlweni ya le mahlweni.

• Xikombiso, loko xiphemu xa le kusuhi xa ku tshoveka ka femur xi rhurhisiwa ehandle na le mahlweni, voko rin’we ra le mahlweni ri tirhisiwa ku tsindziyela xiphemu xa le kusuhi xa ku tshoveka endzeni na le hansi. Forearm yin’wana yi pfotlosa xiphemu xa distal fracture ehandle na le henhla ku lomba matimba yo khoma (n’anga yo tlherisela nakambe u fanele ku va na ku avanyisa loku faneleke ka tlhelo ra ku rhurha ka ku tshoveka na mpfhuka wo rhurha a nga si tlhela a veka), leswaku ku tshoveka ku ta tlhela ku vekiwa hi ndlela leyi humelelaka hi nkarhi wun’we. Hi nkarhi wa endlelo ro veka nakambe, mupfuni u fanele ku engetela matimba ya ku koka no endla leswaku femur yi nga rhendzeleki.

• Loko makumu ya fracture kahle kahle ya lapped, mpfumawulo wo olova wo rhurhumela wa marhambu wufanele ku twiwa, eka nkarhi lowu, mupfuni wa ha fanele ku hlayisa traction, kambe ku hunguta matimba ya traction.

• Loko ku tshoveka hi xisekelo ku ringanisiwa hi muchini wa C-arm (loko ku ha ri na ku nga ringani nyana, endla mindzulamiso yin’wana ku tiyisisa leswaku makumu ya ku tshoveka ya fambisana), hlayisa ku koka, ku dlaya switsongwatsongwana eka xirho lexi khumbekaka na ku hangalasa thawula, ivi u endla ku vekiwa ka swipikiri swa le ndzeni ka xirho xa le ndzeni.

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Fig. 3 Ku rhurha ka le mahlweni-endzhakuni na le tlhelo ka ku tshoveka ku lulamisiwile hi nkarhi wun’we hi ku phutsela mavoko hamambirhi eka xirho lexi khumbekaka na ku khomana hi mavoko, hi ku tirhisa matimba yo khoma ya le mahlweni hi vumbirhi bya wona.

Xifaniso xa 4 Xikimi xa ku tlhela ku vekiwa ka xirho xa le xifuveni xa femoral .

• Eka vavabyi lava nga na ku rhurha lokukulu ka ku tshoveka, ku cinca loku pfalekeke loku nga humelelangiki kumbe ku tshoveka ka ti-comminuted, mubedo wa ku koka wa vuhandzuri wu nga tirhisiwa eka ku hunguta loku pfalekeke hi matimba yo karhi ya switirhisiwa, leswi na swona swi nga tlhelaka swi hetisa kahle ku hunguteka loku pfalekeke ka ku tshoveka ka nsinya wa femoral.

• Endzhaku ko veka xirho lexi khumbekaka eka furemu ya traction ku koka naswona ku kamberiwa ka C-arm ku kombisa leswaku ku rhurha ka ku tshoveka loku hlanganisaka ku lulamisiwile, makumu ya le kule ya xirho lexi khumbekaka ya nga lulamisiwa endzeni ku ya emahlweni ku vuyisela ku ringanana na ku ringanisiwa eka xifaniso xa orthostatic xa nsinya wa femoral.

• Hikuva ku nonoka ka misiha ya le ndzeni ka khwiri ehansi ka traction swinga tlanga xiphemu xa soft tissue splinting eka femoral stem fracture, vunyingi bya ti femoral stem fractures tinga kuma alignment leyi enerisaka swinene eka xifaniso xa orthogonal X-ray.

• Kambe, eka nkarhi lowu, hikwalaho ka ku pfumaleka ka nseketelo lowu tirhaka eka makumu ya le kule ya xiphemu xa ku tshoveka ehansi ka mbuyelo wa matimba ya nkoka-misava, xiphemu xa le kule xa ku tshoveka ka nsinya wa femoral xi rhurhisiwa ngopfu endzhaku, naswona eka nkarhi lowu, sterile towel-covered brace yi nga vekiwa eka xiphemu xa le ndzhaku xa stererior xa sterilization na ku vekiwa ka nhlonge ya sterilization na ku vekiwa ka sterilization ya sterilization na ku vekiwa ka sterilization ya le handle ka sterilization na sterilization ya le handle. Makumu ya distal fracture yanga lulamisiwa hiku lulamisa ku tlakuka ka brace.

• Loko ku rhurha ka le ndzhaku ka xiphemu xa ku tshoveka ka le kule ku nga si lulamisiwa, xipikiri xa le kusuhi xi nga simekiwa hi ku tirhisa nhlonge eka nhlohlorhi ya trochanter leyikulu kumbe fossa ya pyriform, ivi endzhaku ka sweswo ku nghenisiwa nhonga ya le ndzeni ka xirho xa le ndzeni ka xirho xa le ndzeni ka xirho xa le ndzeni xa xirho xa le ndzeni xa xirho xa le ndzeni xa xirho xa le ndzeni xa le xikarhi ka xirho xa le ndzeni xa xirho xa le ndzeni xa xirho xa le ndzeni xa le ndzeni. Ku yisa emahlweni ku tshikilela ku tshoveka ka le kusuhi ka femur endzhaku hi ku tirhisa lever ya nhonga yo tlhela yi vekiwa, xisweswo yi vuyisela ku ringanana na ku tshoveka ka le kule ka le kule loku rhurheriweke endzhaku, .

• Endzhaku kaloko ku tshoveka ku ringanisiwile, pini yo leha ya guide yi nghenisiwa eka distal fracture cavity ku hetisa ku pfariwa ka reset. Intramedullary repositioning rod yi tirha ngopfu eku lulamiseni ka flexion, abduction, na external rotation deformities leyi tolovelekeke eka proximal fractures ya proximal femur (Xifaniso 5).

• Eka residual lateral displacement, ku pfuleka ka curved end ya intramedullary rod swinga lulamisiwa ku kongomisa guide pin yo leha eka distal fracture cavity kuva ku hetisisiwa kuhunguteka loku pfalekeke.

• Ndlela yin’wana ya kuhunguteka loku pfalekeke iku screw xipikiri xa Schanz eka bone cortex eka tlhelo ra makumu ya fracture lawa ya rhurheriweke naku lulamisa makumu ya fracture hiku tirhisa xipikiri xa Schanz kuva xihunguteka lexi pfalekeke (Figure 6). Endzhaku ka loko ku tshoveka ku ringanisiwile hi ndlela leyi enerisaka, xipikiri xa intramedullary xi nghenisiwa eka proximal na distal medullary cavity ya fracture ku hetisisa fixation ya le ndzeni (Xifaniso 7).

  
  

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Xifaniso 5 Ku tirhisiwa ka xiphemu xa proximal fracture xa ku tlhela u veka ndhawu hi ku tirhisa intramedullary repositioning rod .

Xifaniso xa 6 Ku hunguteka loku pfalekeke hi ku tirhisa xipikiri xa Schanz lexi vekiweke eka xirho xa marhambu ya tlhelo rin’we emakumu ka ku tshoveka .

Xifaniso xa 7 Ku hungutiwa loku pfalekeke ka intramedullary nail fixation ya multisegmental commnuned fracture ya nsinya wa femoral hi ku tirhisa xipikiri xa Schanz .

Xirhendzevutana xa ku tshoveka .

(a) Ku lunghiselela ka le mahlweni ka vuhandzuri .

• Ku kamberiwa ka radiographic: Ku kamberiwa ka swifaniso swa ankle swa ntolovelo swi fanele ku katsa swiyenge swa 3: anteroposterior (Xifaniso 8), ndhawu ya mavoko (15° ya ku rhendzeleka ka le ndzeni) (Xifaniso 9), na le tlhelo (Xifaniso 10).

• Loko nhlangano wa mavoko wu vavisekile swinene endzeni na le handle ka xirhendzevutana na talus swi ta rhurhisiwa ku ya eka 11 wa tidigri to hambana (Xifaniso xa 11). Ti radiograph leti nga cinciki a ti kombisi kahle ku tiya ka nhlangano wa mavoko. Ti-radiograph ta ntshikilelo na MRI swi nga antswisa ku kamberiwa ka ku tiya ka ku onhaka ka nhlangano wa ankle na ligament (Xifaniso xa 12).

• Eka xiyimo lexi, muxaka wa ku vaviseka ka mavoko wu fanele ku kumiwa kahle hi endlelo ra ku vaviseka na datha ya radiological ya xirho lexi khumbekaka leswaku ku ta kongomisiwa kahle ku vekiwa nakambe na ku vekiwa.

• Minkarhi yin'wana ku tshoveka ka le xikarhi ka le xikarhi ka mavoko ku nga va xiphemu xa ku tshoveka loku rharhanganeke swinene ka 'maisonneuve', loku tlhelaka ku katsa ku tshoveka ka fibula ya le kusuhi na ku vaviseka ka ligament loku hlanganisiweke, hikwalaho tibiofibula hinkwayo yi fanele ku kamberiwa hi ndlela ya radiographic.

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Xifaniso xa 8 Xiyimo xa le mahlweni na xa le ndzhaku .

Xifaniso xa 9 Tinhla ta mavoko (15° ya ku rhendzeleka ka le ndzeni) .

Xifaniso xa 10 Xiyimo xa le tlhelo .

Xifaniso 11 Ku rhurha ka ku tshoveka swi tikomba ku hlanganisiwile na ku tshukatshuka .

Xifaniso 12 Radiograph ya ntshikelelo (ku phatluka ka ligament ya triangular) .

(ii) murhi wo dlaya ku pfimba .

Hi ntolovelo ku tekiwa femoral na sciatic nerve anesthesia.

(c) Thekiniki yo tlherisela endzhaku .

Muxaka wa ku rhendzeleka ka le ndzhaku-ehandle ka ku vekiwa nakambe loku pfalekeke wu endliwa hi ku landzelelana ka mavoko ya le handle ya mavoko ya mavoko ya le ndzeni-ehenhla-ya le ndzhaku ka xirhendzevutani ka tibiofibular. Muxaka wa posterior rotation-internal rotation wu endliwa hi ku landzelelana ka ankle ya le ndzeni-external ankle.

• Eka xiyimo xa posterior-external rotation type IV, muvabyi u vekiwa supine naswona matsolo ya olovisiwa eka 90° ku olovisa triceps ya marhole.

• Vapfuni vambirhi va khoma xiphemu xa popliteal xa xirho xa le ndzeni na nenge hi ku landzelelana, naswona ku koka ku tirhisiwa eka tlhelo ra ku onhaka ka ku tshoveka (matimba ya ku koka a ya fanelanga ku tlula mpimo ku papalata ku nyanyisa ku vaviseka).

• Mupfuni loyi a kokaka nenge u rhendzeleka hi nenge endzeni ku lulamisa ku onhaka ka ku rhendzeleka ka le handle (Xifaniso xa 13). Loko a ri karhi a susumeta makumu ya le kule ku ya eka tlhelo ra tibial no koka tibia ya le kule yi kongoma etlhelo ra fibular, mupfuni endzeni u hundzuluka a tlhela a andlala dorsally ankle joint ku lulamisa ku rhurha ka ankle ya le handle na talus (Xifaniso 14).

• Hlayisa xiyimo xa le ndzeni xa ku rhendzeleka-ku rhendzeleka ka le ndzeni-dorsal extension. Kutani xisirhelelo xa le ndzhaku xa ku tshoveka ka mavoko xi khomiwa hi swikunwana hi vumbirhi bya swona, tintiho ta mune ti rhendzela tibia ya le kule, naswona swikunwana swi susumeta ni ku tsindziyela hi ndlela ya le kule, loko swi ri karhi swi koka ehansi tibia ya le kule leswaku swi tlhela swi veka xirhendze xa le ndzhaku (Xifaniso 15).

• Eku heteleleni, mutirhisi u susumeta xirhendze xa le xikarhi endzhaku na le hansi hi swikunwana ku xi tlherisela (Xifaniso 16). Vapfuni vambirhi va hlayisa nenge na ankle eka xiyimo xa le ndzeni lexi rhendzelekaka-ya le ndzeni xa ku rhendzeleka-dorsal extension eka ku lunghiselela ku khomiwa.

Xifaniso 13 Ku lulamisiwa ka ku koka ka ku onhaka ka le handle ka ku rhendzeleka .

Xifaniso 14 Ku lulamisiwa ka ku rhurha ka le tlhelo ka xirhendze xa le handle na talus .

Xifaniso 15 Ku lulamisiwa ka ku cinca ka le ndzhaku ka xirhendze .

Xifaniso 16 Ku lulamisiwa ka ku rhurha ka le ndzeni ka mavoko .

Endlelo ra post-rotation-internal repositioning ri hambanile na post-rotation-external repositioning process naswona ri endliwa hi ku landzelelana ka ankle-external ankle ya le ndzeni.

Ndlela Yo Xava Switirhisiwa Swa Marhambu Na Switirhisiwa Swa Marhambu.

Swa CzMediTech , hi na layini ya swikumiwa leyi heleleke swinene ya switirhisiwa swa vuhandzuri bya marhambu na switirhisiwa leswi fambelanaka na swona, switirhisiwa ku katsa na . Swilo leswi nghenisiwaka hi nkolo ., Swipikiri swa le ndzeni ka khwiri ., Xiphepherhele xa khombo ., Xiphepherhele xo pfala ., Cranial-maxillofacial ., Prosthesis ., Switirhisiwa swa Matimba ., Vahlayisi va le handle ., Arthroscopy ., Nkhathalelo wa Swiharhi na tisethi ta vona ta switirhisiwa swo seketela.

Ku engetela kwalaho, hi tiyimiserile ku ya emahlweni hi tumbuluxa swikumiwa leswintshwa na ku ndlandlamuxa milayeni ya swikumiwa, leswaku hi ta fikelela swilaveko swa vuhandzuri bya madokodela yo tala na vavabyi, na ku tlhela hi endla leswaku khamphani ya hina yi phikizana swinene eka indasitiri hinkwayo ya misava hinkwayo ya marhambu ya marhambu na switirhisiwa.

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