Utyando lokunciphisa oluvaliweyo lwezaphulelo ezisezantsi.

Ukunciphisa okuvaliweyo yindlela yokunciphisa encinci engasetyenziselwa ukuphuka okuzinzileyo ngaphandle kokulahleka kwegazi, akukho mngcipheko wokusuleleka, ukubuyiswa ngokukhawuleza kokusebenza, ukunciphisa iindleko zonyango, kwaye ingasetyenziselwa ukunciphisa ukuvalwa kwesikhonkwane esingenanto kunye ne-intramedullary pin fixation unyango lweefractures ezingazinzanga, ezifana ne-femoral neck fractures, i-femoral neck fractures, i-humeral stem fractures, njl., Ukuphelisa ukutshatyalaliswa kokuhamba kwegazi ngokunciphisa ukusika.

Ukuqhekeka kwentamo ye-femur

(I) Ukutsala

Isigulane sibekwe ebhedeni, kwaye i-tibial tuberosity traction yenziwa kunye nelungu elichaphazelekayo kwindawo engathathi hlangothi kunye nokujikeleza okuncinci kwangaphakathi. Ubunzima bokutsalwa buhluka ukusuka kumntu ukuya kumntu, ngokubanzi i-6-9 kg, kwaye ubude bexesha lokutsalwa akufanele budlule iiyure ezili-12. I-90% yezigulane zinokufikelela ekubuyiselweni ngokutsha ngokutsalwa.

(B) ivaliwe i-manipulative repositioning

Ukuba i-traction ayiphumelelanga ukufezekisa iimfuno zokubeka kwakhona, ukufakwa ngokutsha kwe-manual kunokongezwa, phantsi kwe-epidural anesthesia:

1. MC Elvenny indlela

Injongo kukulungisa i-pelvis, ukujikeleza kwangaphandle umlenze ochaphazelekayo kunye nokwandisa amandla okubamba, kwaye emva koko ujikeleze ngaphakathi kwaye uhoxise ngaphakathi umlenze ochaphazelekayo ukuze ufezekise injongo yokubuyisela.

2. Indlela engcono yokukhokela

Isigulana silala phantsi, sigobe i-hip echaphazelekayo kunye namadolo nge-90 °, i-traction kunye ne-axis ye-femoral yomlenze ochaphazelekayo kwi-2 ukuya kwi-3 imizuzu, emva koko ujikeleze ngaphakathi umlenze ochaphazelekayo kwaye uguqule ngokukhawuleza, emva kokusetha kwakhona, unciphise ngobumnene umlenze ochaphazelekayo, kwaye ukuba unyawo oluchaphazelekayo alubonakali lujikeleza ngaphandle, lubonisa ukubuyisela kwakhona ukuphumelela. Ngaphambi kokwenza ukulungiswa kwangaphakathi, umatshini we-C-arm wawusetyenziselwa ukuqinisekisa.

(C) Ubuchule bokukrola inaliti yePercutaneous

Ukuba ukubekwa kwakhona akufezekiswanga ngeendlela ezi ngasentla, ngokuqhelekileyo kubonisa ukuba intloko ye-femal yaphukile okanye ukuba kukho ukuhlukana okujikelezayo phakathi kwentloko nentamo (Umfanekiso 1A), okanye ukuba kukho ukufakwa kwindawo ethile phakathi kwentloko nentamo. (Oku kunokwenzeka nakweyiphi na iGadi II, III, okanye IV iintlobo). Kule meko, ukujikelezisa ilungu elichaphazelekayo ukuze lidibanise intloko kunye nokwaphuka kwentamo akusasebenzi. Ukuze ugweme ukusika kunye nokubekwa kwakhona, ubuchule bokucoca inaliti ye-percutaneous ingasetyenziselwa ukubeka kwakhona ukuphuka.

• I-3.0- ukuya kwi-3.5-mm-diameter boneliti setyhula ifakelwe ngokuthe nkqo eluswini 1 ukuya ku-2 cm ngezantsi kwesiphambuka somthambo we-inguinal kunye nomthambo we-femoral ukuya phambi kwentloko ye-femoral, kwaye inaliti ijikeleziswa nzulu kumbindi wentloko ye-femoral phantsi kweliso lomatshini we-C-arm1 (umatshini we-FigureB).

• Ukomeleza i-prying force, ithambo lesibini inaliti yesetyhula inokufakwa kwi-4-5 mm ngokuhambelana nale naliti, kunye nokuphela kwenaliti eshiywe ngaphandle kwesikhumba.

• Ngokusebenzisa i-trochanter enkulu, iinaliti ezimbini ze-3.5 mm ububanzi betyhula zityhulwa nge-percutaneously ngokuhambelana ne-angle ye-stem yomlomo wesibeleko kunye ne-angle ye-tilt yangaphambili, ukufikelela ekupheleni kwe-distal ye-femoral neck fracture (ungadluli kwi-fracture) kwaye ushiye ekupheleni kwenaliti ngaphandle kwesikhumba.

• Umqhubi ubamba iiseti ezimbini zomsila wenaliti ngezandla zombini kwaye ulungelelanise amacandelo entloko kunye nentamo yokuphuka ukuze ahambelane kunye nentsebenziswano yomncedisi (Umfanekiso 1C-E).

• Emva kokuba ulungelelwaniso lube lolwanelisayo, iphini elingqukuva lethambo elifakwe kwi-trochanter enkulu likrwelwa kwintloko ye-femoral ukuze kulungiswe okwethutyana, kwaye izikrufu ezininzi eziholoholo zifakwa kwintloko ye-femoral (Figure 1F).

Indlela yokunciphisa evaliweyo echazwe ngasentla inokufezekisa ukunciphisa okufunekayo malunga ne-98% yokuphulwa kwentamo ye-femal. Okungcono ukulungelelaniswa kweqhekeza, nokuba ivaliwe okanye ifakwe, i-prognosis ingcono. Ngokuqhelekileyo, iqondo le-fracture dislocation eliboniswe kwi-X-reyi lingaphantsi kweqondo lokwenyani lokuchithwa kwe-fracture. Ekubeni ulungelelwaniso lokwaphuka luchaphazela ngokuthe ngqo ukuphulukiswa kokuphuka kunye nokwenzeka kwe-necrosis yentloko ye-femal, kuyimfuneko ukuba ube nesigwebo esichanekileyo sefilimu ye-X-ray emva kokulungelelaniswa kwe-fracture. Ukuba i-curve ene-S ayilungile okanye iphazamisekile, ibonisa ukuba i-femoral neck fracture ayizange ifike kwi-anatomical repositioning (Umfanekiso 2).

Umzobo 1 Ukwaphuka kwentamo ye-Femoral iphinde yabekwa ngokutsha ngenaliti ye-percutaneous

Umzobo we-2 Ukwaphuka kwentamo ye-Femoral I-X-rays kunye ne-curve yangaphandle eqhubekayo kwi-anatomical alignment kunye nokuphazamiseka kwe-curve yangaphandle kwi-non-anatomical alignment.

Ukuqhekeka kwesiqu se-Femoral

Indlela yokunciphisa ivaliweyo inokuncedisa ukulungelelaniswa kwe-femoral stem fracture ngaphandle kokulimaza naziphi na izicubu ezithambileyo okanye ukunikezelwa kwegazi ukuya ekupheleni kokuphuka, kwaye ingasetyenziselwa ukulungiswa kwangaphakathi kunye nesikhonkwane se-intramedullary.

• Ngaphantsi kwe-anesthesia ye-epidural, isigulane silele phantsi ebhedini (isikhumba selungu elichaphazelekayo alizange lihlanjululwe ngeli xesha), omnye umncedisi ubamba ithole lomlenze ochaphazelekayo, kwaye omnye umncedisi udonsa ingcambu yethanga lesigulane ngebhanti yelaphu ukuchasana ne-traction, kunye nelungu elichaphazelekayo kwindawo engathathi hlangothi kwaye i-patella ye-stem ejikelezayo idla ngokujonga phezulu kunye ne-rota. ukufuduka ngokutsalwa kwemisipha, kwaye inokulungiswa ngokuzenzekelayo ngokutsalwa, ngoko ke umqhubi ufuna kuphela ukulungisa i-anterior-posterior and lateral displacement of the end of the stem).

• Umqhubi usebenzisa iingalo zombini ukujikeleza umlenze ochaphazelekayo kwaye ubambe izandla kunye (Umfanekiso 3 kunye noMzobo 4), kwaye ulungise i-anterior-posterior and lateral displacement of the fracture kanye kanye ngokusebenzisa i-oblique clamping force of forearms zombini.

• Ngokomzekelo, ukuba i-proximal segment ye-femur fracture ifuduka ngaphandle nangaphandle, enye i-forearm isetyenziselwa ukukhama icandelo elisondeleyo lokuphuka ngaphakathi nangaphantsi. Enye i-forearm icinezela i-distal fracture segment ngaphandle nangaphezulu ukuboleka amandla okubamba (ugqirha wokusetha kwakhona kufuneka abe nesigwebo esifanelekileyo sokuhamba kwe-fracture kunye nomgama wokufuduka ngaphambi kokusetha kwakhona), ukwenzela ukuba i-fracture inokubuyiselwa ngempumelelo ngexesha elinye. Ngethuba lenkqubo yokubuyisela, umncedisi kufuneka akhulise amandla okubamba kwaye agcine i-femur ijikeleza.

• Xa isiphelo sokuphuka sigxininiswe ngokusisiseko, isandi esincinci sokuxubha ithambo kufuneka sive, ngeli xesha, umncedisi kufuneka aqhubeke egcina i-traction, kodwa anciphise amandla okubamba.

• Xa i-fracture ihambelana ngokusisiseko ngumatshini we-C-arm (ukuba kusekho ukungahambi kakuhle okuncinci, yenza uhlengahlengiso oluthile ukuze uqinisekise ukuba i-fracture iphela ihambelana nomnye), gcina i-traction, i-disinfecting ilungu elichaphazelekayo kwaye usasaze itawuli, uze wenze ukulungiswa kwe-intramedullary nail.

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Umzobo 3 I-anterior-posterior and lateral displacement ye-fracture ilungiswa ngexesha elifanayo ngokugubungela iingalo zombini kwilungu elichaphazelekayo kunye nokudibanisa izandla kunye, usebenzisa i-clamping force of forearms zombini.

Umzobo 4 Ukwaphuka kwesikhondo sobuxhakaxhaka bobuxhakaxhaka be-Femoral

• Kwizigulane ezinokufuduswa okukhulu kwe-fracture, ukunyanzelwa okuvaliweyo okungaphumelelanga okanye ukuqhekeka okwenziwe, ibhedi ye-traction yotyando ingasetyenziselwa ukunciphisa okuvaliweyo kunye ne-instrument force ethile, enokuthi igqibe ngokufanelekileyo ukunciphisa ukucuthwa kwe-femoral stem fracture.

• Emva kokubeka umlenze ochaphazelekayo kwisakhelo sokutsalwa kwentambo kunye noviwo lwe-C-arm lubonisa ukuba i-displacement ye-fracture edibeneyo ilungisiwe, isiphelo se-distal somlenze ochaphazelekayo sinokulungiswa ngaphakathi ukuze siphinde sibuyisele ukulungelelaniswa kunye nokulungelelaniswa kumfanekiso we-orthostatic we-femoral stem.

• Ngenxa yokuba ukunyanzeliswa kwemisipha yethanga phantsi kwe-traction kunokudlala indima ethambileyo ye-tissue splinting kwi-femoral stem fracture, ininzi ye-femoral stem fractures inokufumana ukulungelelaniswa okwanelisayo kumfanekiso we-orthogonal x-ray.

• Nangona kunjalo, ngeli xesha, ngenxa yokungabikho kwenkxaso esebenzayo ekupheleni kwecandelo lokuqhekeka phantsi kwefuthe lomxhuzulane, isahlulo se-distal fracture ye-femoral stem ininzi ifuduka ngasemva, kwaye ngeli xesha, i-brace eyinyumba egqunywe ngetawuli inokubekwa kwicala elingasemva le-distal fracture kunye ne-posterilation sheet kunye nokulungiswa kwe-posterior. ukufuduka kokuphela kwe-distal fracture kunokulungiswa ngokulungelelanisa ukuphakama kwebrace.

• Ukuba i-posterior displacement yecandelo le-distal fracture ayilungiswanga, isikhonkwane esisondeleyo sinokusekwa ngokuthe ngqo kwi-apex ye-trochanter enkulu okanye i-pyriform fossa, kwaye ke intonga yokubuyisela i-intramedullary ifakwe kwi-medullary cavity ye-proximal fracture segment kunye ne-handled rod iphakanyiswe kwi-femur reposition. ngokumodareyitha phambili ukucinezela i-proximal fracture ye-femur ngasemva ngokusebenzisa i-lever ye-repositioning rod, ngaloo ndlela ibuyisela ukulungelelaniswa kunye ne-posteriorly displaced displace fracture,

• Emva kokuba i-fracture ilungelelaniswe, i-pin yesikhokelo ende ifakwe kwi-distal fracture cavity ukugqiba ukusetha kwakhona okuvaliweyo. Intonga ye-intramedullary repositioning iyasebenza ngokukodwa ekulungiseni i-flexion, i-abduction, kunye nokukhubazeka okujikelezayo kwangaphandle okuqhelekileyo kwi-fractures ye-proximal femur (Umfanekiso 5).

• Ukutshatyalaliswa kwe-lateral displacement, ukuvulwa kwesiphelo esigobileyo sentonga ye-intramedullary kunokulungelelaniswa ukukhokela iphini elide lesikhokelo kwi-distal fracture cavity ukugqiba ukunciphisa okuvaliweyo.

• Enye indlela yokunciphisa okuvaliweyo kukujija isikhonkwane se-Schanz kwi-cortex yethambo kwicala lesiphelo se-fracture esusiweyo kwaye ulungelelanise isiphelo sokuphuka ngokusebenzisa isikhonkwane se-Schanz sokunciphisa okuvaliweyo (Umfanekiso 6). Emva kokuba ukuphuka kulungelelaniswa ngokwanelisayo, isikhonkwane se-intramedullary sifakwe kwi-proximal and distal medullary cavity ye-fracture ukugqiba ukulungiswa kwangaphakathi (Umfanekiso 7).

  
  

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Umzobo we-5 Ukuguqulwa kwecandelo lokuqhekeka okusondeleyo ukuze kubekwe kwindawo evaliweyo kusetyenziswa intonga yokubuyisela i-intramedullary.

Umzobo we-6 Ukunciphisa ukuvalwa usebenzisa isikhonkwane se-Schanz esibekwe kwi-cortex yamathambo e-unilateral ekupheleni kokwaphuka.

Umzobo 7 Ukunciphisa ukucuthwa kwe-intramedullary fixation ye-multisegmental comminuted fracture ye-femoral stem kusetyenziswa isikhonkwane se-Schanz.

Ukwaphuka kweqatha

(A) Ukulungiselela kwangaphambili

• Ukuxilongwa kwe-Radiographic: Uvavanyo oluqhelekileyo lwe-ankle imaging kufuneka lubandakanye izigaba ze-3: i-anteroposterior (Umfanekiso 8), i-ankle point (15 ° yokujikeleza kwangaphakathi) (Umfanekiso 9), kunye necala (umzobo 10).

• Xa i-ankle edibeneyo yonzakele kakhulu i-ankle yangaphakathi nangaphandle kunye ne-talus iya kuhanjiswa kwii-degrees ezahlukeneyo ze-11 (Umfanekiso we-11). I-radiographs engatshintshiyo ayibonakali ngokuchanekileyo ukuzinza kwe-ankle joint. I-radiographs yoxinzelelo kunye ne-MRI inokuphucula uvavanyo lokuzinza kwe-ankle kunye nomonakalo we-ligament (Umfanekiso 12).

• Kule meko, uhlobo lokulimala kwe-ankle kufuneka lugqitywe ngokuchanekileyo yindlela yokulimala kunye nedatha ye-radiological yelungu elichaphazelekayo ukwenzela ukukhokela ngokuchanekileyo ukubuyisela kunye nokulungiswa.

• Ngamanye amaxesha i-ankle elula ye-ankle fracture ingaba yinxalenye ye-'Maisonneuve fracture' enzima ngakumbi, ekwabandakanya ukuphuka kwe-fibula ehamba phambili kunye nokulimala kwe-ligament edibeneyo, ngoko yonke i-tibiofibula kufuneka ihlolwe nge-radiographically.

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Umzobo 8 Indawo yangaphambili nangasemva

Umzobo we-9 amanqaku e-ankle (15 ° yokujikeleza kwangaphakathi)

Umfanekiso we-10 Indawo esecaleni

Umzobo we-11 Ukufuduswa kwefracture ngokucacileyo kudityaniswe nokukhutshwa

Umzobo 12 Uxinzelelo lweradiyograph (ukuqhambuka kweligament engunxantathu)

(II) I-anesthesia

I-Femoral kunye ne-sciatic nerve anesthesia idla ngokuthathwa.

(C) ukuseta ngokutsha ubuchule

Uhlobo olujikelezayo lwangaphandle lwe-repositioning evaliweyo lwenziwa ngokulandelelana kwe-ankle yangaphandle-yangaphakathi ye-ankle-posterior i-ankle-inferior tibiofibular union. I-posterior rotation-internal rotation uhlobo lwenziwa ngokulandelelana kwe-ankle yangaphakathi-yangaphandle ye-ankle.

• Kwimeko ye-posterior-external rotation type IV, isigulane sibekwe phezulu kwaye idolo liguquguquka kwi-90 ° ukukhulula ithole le-triceps.

• Abancedisi ababini babambe inxalenye ye-popliteal yethanga kunye nonyawo ngokulandelanayo, kwaye i-traction isetyenziswe kwicala lokukhubazeka kwe-fracture (amandla okutsala akufanele abe ngokugqithiseleyo ukuphepha ukunyusa ukulimala).

• Umncedisi odonsa unyawo ujikeleza unyawo ngaphakathi ukuze ulungise ukukhubazeka kokujikeleza kwangaphandle (Umfanekiso 13). Ngelixa utyhala isiphelo se-distal kwicala le-tibial kunye nokutsala i-distal tibia kwicala le-fibular, umncedisi uphendulela ngaphakathi kwaye wandise umgca we-ankle ukulungisa ukufuduka kwe-ankle yangaphandle kunye ne-talus (Umfanekiso 14).

• Gcina ujikelezo lwangaphakathi-ujikelezo lwangaphakathi-i-dorsal yokwandisa indawo. Emva koko ibhlokhi yokuphuka kwe-ankle yangasemva ibanjwe zombini izithupha, iminwe emine ijikeleze i-distal tibia, kwaye zombini izithupha zityhala kwaye zicinezele kude, ngelixa zidonsa i-distal tibia ukusetha kwakhona i-ankle yangasemva (Umfanekiso 15).

• Ekugqibeleni, umqhubi utyhala i-ankle ye-medial ngasemva nangaphantsi kunye nezithupha ukuyibuyisela kwakhona (Umfanekiso 16). Abancedisi ababini bagcina unyawo kunye ne-ankle kwindawo ejikeleziweyo yangaphakathi-internal rotation-dorsal extension extension ekulungiseleleni ukulungiswa.

Umzobo 13 Ukulungiswa kokutsalwa kokukhubazeka kokujikeleza kwangaphandle

Umzobo we-14 Ukulungiswa kwe-lateral displacement ye-ankle yangaphandle kunye ne-talus

Umzobo we-15 Ukulungiswa kokutshintshwa kwe-ankle yangasemva

Umzobo we-16 Ukulungiswa kokufuduka kwe-ankle yangaphakathi

I-post-rotation-internal repositioning process ichasene ne-post-rotation-external repositioning process kwaye yenziwa ngokulandelelana kwe-ankle yangaphakathi-yangaphandle.

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

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