Ukuhlinzwa kokunciphisa okuvaliwe kokuqhekeka komkhawulo ophansi.

Ukwehliswa okuvaliwe kuyindlela encane ehlaselayo engasetshenziselwa ukuphuka okuzinzile kwamaphethelo ngaphandle kokulahlekelwa ukugeleza kwegazi, akukho bungozi bokutheleleka, ukululama okusheshayo, izindleko zezokwelapha ezincishisiwe kakhulu, futhi ingasetshenziselwa ukunciphisa ukuvala okuvaliwe kwezipikili ezingenalutho kanye nokwelashwa kwe-intramedullary pin fixation yokuphuka okungazinzile okuhlukahlukene, njengokuphuka kwentamo ye-femoral, i-stem fractures, i-femoral neck fractures, ukuphuka kwesiqu se-humeral, njll., ukuqeda ukucekelwa phansi kokugeleza kwegazi ngokuncishiswa kwe-incision.

Ukuphuka kwentamo yesifazane

(I) Ukudonsa

Isiguli sibekwe embhedeni, futhi i-tibial tuberosity traction yenziwa ngesitho esithintekile endaweni engathathi hlangothi ngokujikeleza okuncane kwangaphakathi. Isisindo sokudonsa siyahlukahluka kumuntu nomuntu, ngokuvamile 6-9 kg, futhi ubude bokudonsa akufanele budlule amahora angu-12. I-90% yeziguli ingakwazi ukufeza ukuhlelwa kabusha ngokudonsa.

(B) ukuvala kabusha okukhohlisayo

Uma i-traction ihluleka ukufeza izidingo zokubeka kabusha, ukubeka kabusha ngesandla kungangezwa, ngaphansi kwe-epidural anesthesia:

1. MC Elvenny indlela

Inhloso ukulungisa i-pelvis, ukuzungezisa ngaphandle isitho esithintekile nokwandisa amandla okudonsa, bese uzungeza ngaphakathi futhi uhlehlise ngaphakathi umlenze othintekile ukuze ufeze injongo yokubeka kabusha.

2. Indlela engcono yokuhola

Isiguli silala phansi, sigobe i-hip ethintekile namadolo nge-90 °, ukudonsa eduze kwe-axis ye-femoral ye-axis ethintekile ye-2 kumaminithi we-3, bese uphendulela ngaphakathi kwesitho esithintekile futhi usiguquguquke kancane, ngemva kokusetha kabusha, wehlise ngobumnene isitho esithintekile, futhi uma unyawo oluthintekile lungabonakali luzungezwe ngaphandle, lubonisa ukubuyisela kabusha ukuphumelela. Ngaphambi kokwenza ukulungiswa kwangaphakathi, umshini we-C-arm wawusetshenziselwa ukuqinisekisa.

(C) I-Percutaneous needle prying technique

Uma ukuhlelwa kabusha kungafinyelelwanga ngezindlela ezingenhla, ngokuvamile kubonisa ukuthi ikhanda lesifazane liphukile noma ukuthi kube nokuhlukana okujikelezayo phakathi kwekhanda nentamo (Umfanekiso 1A), noma ukuthi kukhona ukufakwa endaweni ethile phakathi kwekhanda nentamo. (Lokhu kungenzeka kunoma yiziphi izinhlobo ze-Garden II, III, noma IV). Kulokhu, ukuzungezisa isitho esithintekile ukuze kuhlangane ukuphuka kwekhanda nentamo akusasebenzi. Ukuze ugweme ukusika nokubeka kabusha, indlela yokucubungula inaliti ye-percutaneous ingasetshenziswa ukubeka kabusha ukuphuka.

• Inaliti eyindilinga yethambo engu-3.0- kuya ku-3.5-mm-diameter ifakwa iqonde esikhumbeni 1 kuya ku-2 cm ngezansi kwalapho kuhlangana khona umsipha we-inguinal kanye nomthambo wesifazane ukuya ngaphambili kwekhanda lesifazane, futhi inaliti ijikeleziswa ijule phakathi nendawo yekhanda lesifazane ngaphansi kokuqondisa komshini we-C-arm1 (i-Figuarm1).

• Ukuze kuqiniswe amandla e-prying, inaliti yesibili eyindilinga yethambo ingafakwa 4-5 mm ngokuhambisana nale naliti, ekugcineni kwenaliti ishiywe ngaphandle kwesikhumba.

• Ngokusebenzisa i-trochanter enkulu, izinaliti ezimbili eziyindilinga eziyindilinga ezinobubanzi obungu-3.5 mm zibhojwa ngokulinganayo ngokuhambisana ne-angle yesiqu somlomo wesibeletho kanye ne-angle yokutsheka kwangaphambili, zifinyelele ekugcineni kokuhlukana kwentamo yesifazane (ungadluli ukuphuka) futhi ushiye ukuphela kwenaliti ngaphandle kwesikhumba.

• U-opharetha ubamba amasethi amabili emisila yenaliti ngezandla zombili futhi ulungise izingxenye zokuphuka kwekhanda nentamo ukuze zihambelane ngokubambisana nomsizi (Umfanekiso 1C-E).

• Ngemuva kokuthi ukuqondanisa sekwanele, iphinikhodi eyindilinga yethambo efakwe ku-trochanter enkulu igoqwa ekhanda lesifazane ukuze ilungiswe isikhashana, bese kufakwa izikulufu ezimbalwa ekhanda lesifazane (Umfanekiso 1F).

Indlela yokunciphisa evaliwe echazwe ngenhla ingafinyelela ukunciphisa okudingekayo mayelana ne-98% ye-femoral neck fractures. Ukuqondanisa kangcono kokuphuka, kungakhathaliseki ukuthi kuvaliwe noma kunqunywe, kungcono ukubikezela. Ngokuvamile, izinga lokuhlukana kokuphuka eliboniswe ku-X ray lingaphansi kwezinga langempela lokuhlukana kokuphuka. Njengoba ukulungiswa kwe-fracture kuthinta ngokuqondile ukuphulukiswa kokuphuka kanye nokwenzeka kwe-necrosis yekhanda lesifazane, kuyadingeka ukuba kube nokwahlulela okulungile kwefilimu ye-X-ray ngemva kokuhlelwa kwe-fracture. Uma ijika elimise okwe-S lingasheleli noma liphazamisekile, libonisa ukuthi ukuphuka kwentamo yesifazane akukafinyeleli ekubekweni kabusha kwe-anatomical (Umfanekiso 2).

Umfanekiso 1 Ukuphuka kwentamo ye-Femoral kubekwe kabusha ngokucija inaliti ye-percutaneous

Umfanekiso 2 Ukuphuka kwentamo yesifazane Ama-X-ray anejika langaphandle eliqhubekayo ekuqondaneni kwe-anatomical kanye nejika langaphandle eliphazamisekile ekuqondaniseni okungezona kwe-anatomical.

Ukuphuka kwesiqu sesifazane

Inqubo yokunciphisa evaliwe ingasiza ekuqondaneni kwe-femoral stem fracture ngaphandle kokulimaza noma yiziphi izicubu ezithambile noma ukunikezwa kwegazi ekugcineni kokuphuka, futhi ingasetshenziselwa ukulungiswa kwangaphakathi ngesipikili se-intramedullary.

• Ngaphansi kwe-epidural anesthesia, isiguli silele phansi embhedeni (isikhumba sesitho esithintekile asizange sivalwe inzalo ngalesi sikhathi), umsizi oyedwa ubamba ithole lesitho esithintekile, kanti omunye umsizi udonsa impande yethanga lesiguli ngebhande lendwangu ukuze avimbele ukudonsa, umlenze othintekile usesimweni sokungathathi hlangothi futhi i-patella ye-stem ye-femo ngokuvamile ibheke phezulu. isuswe ukudonsa kwemisipha, futhi ingalungiswa ngokuzenzakalelayo ngokudonsa, ngakho-ke opharetha udinga kuphela ukulungisa ukufuduka kwangaphambili-ngemuva nangemuva kokuphela kwesiqu esiphukile).

• Umsebenzisi usebenzisa izingalo zombili ukuze azungeze isitho esithintekile futhi abambe izandla ndawonye (Umfanekiso wesi-3 kanye noMfanekiso 4), futhi alungise ukugudluka okungaphambili-ngemuva nangemuva kokuphuka ngesikhathi esisodwa ngokusebenzisa amandla okugoqa e-oblique azo zombili izingalo.

• Isibonelo, uma ingxenye eseduze yokuphuka kwe-femur isuswa ngaphandle nangaphandle, ingalo eyodwa isetshenziselwa ukuminyanisa ingxenye eseduze yokuphuka phakathi naphansi. Enye ingalo icindezela ingxenye ye-distal fracture ibheke ngaphandle nangaphezulu ukuze iboleke amandla okubamba (udokotela wokusetha kabusha kufanele abe nesinqumo esifanele sesiqondiso sokususwa kwe-fracture kanye nebanga lokufuduka ngaphambi kokusetha kabusha), ukuze ukuphuka kusethwe kabusha ngempumelelo ngesikhathi esisodwa. Phakathi nenqubo yokubeka kabusha, umsizi kufanele akhulise amandla okudonsa futhi agcine i-femur ingajikelezi.

• Lapho ukuphela kwe-fracture kuhlanganiswe ngokuyisisekelo, umsindo omncane wokuhlikihla amathambo kufanele uzwakale, ngalesi sikhathi, umsizi kufanele aqhubeke egcina ukudonsa, kodwa anciphise amandla okudonsa.

• Uma ukuphuka kuqondaniswe ngokuyisisekelo umshini we-C-arm (uma kusekhona ukungahambi kahle kancane, yenza izinguquko ezithile ukuze uqiniseke ukuthi ukuphuka kuyahambisana), gcina ukuhlehla, ukhiphe amagciwane esithweni esithintekile futhi usakaze ithawula, bese wenza ukulungiswa kwe-intramedullary nail.

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Umfanekiso 3 Ukugudluka okungaphambili-ngemuva nangemuva kokuphuka kulungiswa ngesikhathi esifanayo ngokusonga izingalo zombili esithweni esithintekile nokuhlanganisa izandla ndawonye, ​​kusetshenziswa amandla okubamba izandla zombili.

Umfanekiso 4 Isikimu sokuphuka kwesiqu se-Femoral

• Ezigulini ezinokususwa okukhulu kokuphuka, ukuxhaphazwa okuvaliwe okungaphumelelanga noma ukuphuka okuncishisiwe, umbhede wokuhlinza ungasetshenziselwa ukunciphisa okuvaliwe ngamandla athile ensimbi, okungase futhi kuqedele ngempumelelo ukuncishiswa okuvaliwe kokuphuka kwesiqu sesifazane.

• Ngemva kokubeka isitho esithintekile kuhlaka lwe-traction for traction kanye nokuhlolwa kwe-C-arm kubonisa ukuthi ukukhishwa kwe-fracture okweqayo kulungisiwe, ukuphela kwe-distal yesitho esithintekile kungalungiswa ngaphakathi ukuze kuqhutshekwe nokubuyisela ukuqondanisa nokuqondanisa emfanekisweni we-orthostatic we-femoral stem.

• Ngenxa yokuthi ukushuba kwemisipha yethanga ngaphansi kokudonsa kungadlala indima ethambile yokuhlukanisa izicubu ekuqhekekeni kwesiqu sesifazane, iningi lokuphuka kwesiqu sesifazane lingathola ukuqondana okwanelisa kakhudlwana esithombeni se-x-ray ye-orthogonal.

• Kodwa-ke, ngalesi sikhathi, ngenxa yokuntuleka kokusekelwa okuphumelelayo ekugcineni kwengxenye yokuphuka ngaphansi komphumela wamandla adonsela phansi, ingxenye ye-distal fracture ye-femoral stem isuswa kakhulu ngemuva, futhi ngalesi sikhathi, i-brace eyinyumba ehlanganiswe ngethawula ingafakwa ohlangothini olungemuva lwe-distal fracture ye-distal fracture kanye nokuphela kwe-stereriing yesikhumba kanye ne-postileriing ishidi. ukugudluzwa kokuphela kwe-distal fracture kungalungiswa ngokulungisa ukuphakama kwe-brace.

• Uma ukufuduka kwangemuva kwengxenye ye-distal fracture kungakalungiswa, isipikili esiseduze singasungulwa nge-percutaneously ku-apex ye-trochanter enkulu noma i-pyriform fossa, bese i-intramedullary repositioning rod ifakwe emgodini we-medullary we-proximal fracture segment kanye nengxenye yokuphatha ye-femur ephakanyisiwe ku-femur. phambili ngokulingene ukuze ucindezele ukuphuka okuseduze kwe-femur emuva ngokusebenzisa i-lever ye-repositioning rod, ngaleyo ndlela ibuyisela ukuqondanisa nokuhlukana kwe-distal displaced posteriorly displaced,

• Ngemuva kokuthi i-fracture iqondaniswe, iphinikhodi ende yomhlahlandlela ifakwa emgodini we-distal fracture ukuze kuqedelwe ukusetha kabusha okuvaliwe. Induku yokubeka kabusha i-intramedullary iphumelela ngokukhethekile ekulungiseni ukuguquguquka, ukuthunjwa, nokukhubazeka kokujikeleza kwangaphandle okuvamile ekuqhekekeni okuseduze kwe-proximal femur (Umfanekiso 5).

• Ngokususwa kwe-lateral okusele, ukuvulwa kwesiphetho esigobile se-intramedullary rod kungalungiswa ukuze kuqondiswe iphinikhodi ende yomhlahlandlela endaweni yokuphuka kwe-distal ukuze kuqedelwe ukunciphisa okuvaliwe.

• Enye indlela yokunciphisa okuvaliwe ukugoqa isikhonkwane se-Schanz ku-cortex yethambo ohlangothini lwesiphetho sokuphuka esisusiwe futhi ulungise ukuphela kokuphuka usebenzisa isipikili se-Schanz ukuze sincishiswe (Umfanekiso 6). Ngemuva kokuthi ukuphuka kuhambisane ngokugculisayo, isipikili se-intramedullary sifakwe emgodini we-medullary oseduze ne-distal we-fracture ukuze uqedele ukulungiswa kwangaphakathi (Umfanekiso 7).

  
  

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Umfanekiso 5 Ukuguqulwa kwesegimenti eseduze yokuphuka ukuze kumiswe kabusha okuvaliwe kusetshenziswa induku yokubeka kabusha ye-intramedullary

Umfanekiso 6 Ukuncishiswa okuvaliwe kusetshenziswa isipikili se-Schanz esibekwe ku-unilateral bone cortex ekugcineni kokuphuka.

Umfanekiso 7 Ukuvalwa kokucishiswa kwe-intramedullary nail fixation of multisegmental comminuted the stem of femoral kusetshenziswa isipikili se-Schanz

Ukuphuka kweqakala

(A) Ukulungiselela ngaphambi kokuhlinzwa

• Ukuxilongwa kwe-Radiographic: Ukuhlolwa okujwayelekile kwe-ankle imaging kufanele kufake izigaba ze-3: i-anteroposterior (Umfanekiso we-8), iphuzu le-ankle (15 ° lokujikeleza kwangaphakathi) (Umfanekiso we-9), kanye ne-lateral (Umfanekiso we-10).

• Uma i-ankle joint ilimele kakhulu i-ankle yangaphakathi nengaphandle kanye ne-talus izosuswa ku-11 degrees ehlukene (Umfanekiso we-11). Ama-radiographs aqinile awabonisi ngokunembile ukuzinza kwe-ankle joint. I-radiographs yokucindezeleka kanye ne-MRI ingathuthukisa ukuhlolwa kokuzinza kokulimala kwe-ankle kanye ne-ligament (Umfanekiso 12).

• Kulesi simo, uhlobo lokulimala kwe-ankle kufanele lunqunywe ngokunembile ngomshini wokulimala kanye nedatha ye-radiological yesitho esithintekile ukuze kuqondiswe kahle ukulungiswa kabusha nokulungiswa.

• Ngezinye izikhathi ukuphuka kwe-ankle kwangaphakathi okulula kungase kube yingxenye ye-'Maisonneuve fracture' eyinkimbinkimbi, ehlanganisa ukuphuka kwe-fibula eseduze kanye nokulimala kwe-ligament ehlangene, ngakho-ke yonke i-tibiofibula kufanele ihlolwe nge-radiographically.

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Umfanekiso 8 Indawo yangaphambili nangemuva

Umfanekiso 9 amaphoyinti eqakala (15° wokuzungezisa kwangaphakathi)

Umfanekiso 10 Isikhundla seLateral

Umfanekiso 11 Ukususwa kokuqhekeka ngokusobala kuhlanganiswe nokugudluka

Umfanekiso we-12 I-radiograph yokucindezeleka (ukuphuka komthambo ongunxantathu)

(II) Izinzwa

I-Femoral and sciatic nerve anesthesia ngokuvamile ithathwa.

(C) setha kabusha inqubo

Uhlobo lokujikeleza kwe-posterior-yangaphandle lwe-repositioning evaliwe lwenziwa ngokulandelana kwe-ankle-internal i-ankle-posterior i-ankle-inferior tibiofibular union. I-posterior rotation-internal rotation uhlobo lwenziwa ngokulandelana kwe-ankle yangaphakathi-yangaphandle ye-ankle.

• Endabeni ye-posterior-external rotation type IV, isiguli sibekwe phezulu futhi idolo liguquguquka ku-90 ° ukuze likhulule i-triceps yethole.

• Abasizi ababili babambe ingxenye ye-popliteal yethanga nonyawo ngokulandelanayo, futhi i-traction isetshenziswa lapho kuqondiswa khona ukukhubazeka kokuphuka (amandla okudonsa akufanele abe ngokweqile ukuze agweme ukubhebhethekisa ukulimala).

• Umsizi odonsa unyawo uzungezisa unyawo ngaphakathi ukuze alungise ukukhubazeka kokujikeleza kwangaphandle (Umfanekiso 13). Ngenkathi ephusha ukuphela kwe-distal ohlangothini lwe-tibial futhi edonsa i-distal tibia ohlangothini lwe-fibular, umsizi uphendulela ngaphakathi futhi unwebe i-ankle joint ukuze alungise ukugudluka kwe-ankle yangaphandle kanye ne-talus (Umfanekiso 14).

• Gcina ukuma kwangaphakathi kokuzungezisa-ukuzungezisa-i-dorsal extension. Khona-ke i-posterior ankle fracture block ibanjwe yizithupha zombili, iminwe emine izungeza i-distal tibia, futhi zombili izithupha zisunduze futhi zicindezele kude, kuyilapho idonsa phansi i-distal tibia ukuze usethe kabusha i-ankle yangemuva (Umfanekiso we-15).

• Ekugcineni, opharetha uphusha iqakala eliphakathi emuva naphansi ngezithupha ukuze alimise kabusha (Umfanekiso 16). Abasizi ababili bagcina unyawo kanye ne-ankle endaweni enwetshiwe yangaphakathi yokuzungezisa-i-rotation-dorsal extension ekulungiseleleni ukulungiswa.

Umfanekiso 13 Ukulungiswa kokudonsa kokukhubazeka kokujikeleza kwangaphandle

Umfanekiso we-14 Ukulungiswa kokususwa kwe-lateral kwe-ankle yangaphandle kanye ne-talus

Umfanekiso 15 Ukulungiswa kokushintshwa kweqakala langemuva

Umfanekiso 16 Ukulungiswa kokugudluka kweqakala langaphakathi

I-post-rotation-internal repositioning inqubo iphambene ne-post-rotation-external repositioning process futhi yenziwa ngokulandelana kwe-ankle yangaphakathi-yangaphandle ye-ankle.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

Ngoba I-CZMEDITECH , sinomugqa womkhiqizo ophelele kakhulu wezimila zokuhlinza amathambo nezinsimbi ezihambisanayo, imikhiqizo ehlanganisa izimila zomgogodla, izipikili ze-intramedullary, ipuleti lokuhlukumezeka, ipuleti lokukhiya, i-cranial-maxillofacial, izitho zokufakelwa, amathuluzi amandla, izilungisi zangaphandle, i-arthroscopy, ukunakekelwa kwezilwane kanye namasethi amathuluzi asekelayo.

Ngaphezu kwalokho, sizibophezele ekuthuthukiseni imikhiqizo emisha ngokuqhubekayo nokwandisa imigqa yemikhiqizo, ukuze sihlangabezane nezidingo zokuhlinzwa zodokotela abaningi neziguli, futhi senze inkampani yethu iqhudelane kakhulu kuwo wonke umkhakha womhlaba wonke wokufakwa kwamathambo nezinsimbi.

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