Kukho iintlobo ezimbini zeendlela zotyando, izikrufu zepleyiti kunye nezikhonkwane ze-intramedullary, eyokuqala ibandakanya izikrufu zepleyiti ngokubanzi kunye nezikrufu zeplate yokucinezela i-AO, kwaye le yokugqibela ibandakanya izikhonkwane ezivaliweyo nezivulekileyo zokubuyela emva okanye ezibuyisela umva. Ukhetho lusekelwe kwindawo ethile kunye nohlobo lokuphuka.
I-Intramedullary pin fixation ineenzuzo zokubonakaliswa okuncinci, ukuchithwa okuncinci, ukulungiswa okuzinzile, akukho mfuneko yokulungiswa kwangaphandle, njl. Kufanelekile phakathi kwe-1/3, i-1/3 ephezulu ye-femur fracture, i-multi-segmental fracture, i-pathological fracture. Ukuphuka kwe-1/3 ephantsi, ngenxa ye-medullary cavity enkulu kunye namathambo amaninzi akhansela, kunzima ukulawula ukujikeleza kwepini ye-intramedullary, kwaye ukulungiswa akukhuselekanga, nangona kunokomelezwa ngezikhonkwane, kodwa kufanelekile ngakumbi. kwizikrufu zeplate yentsimbi.
I Open-internal Fixation for Fracture of Femur Shaft ngeIntramedullary Nail
(1) I-Incision: I-lateral okanye i-posterior lateral ye-femoral incision yenziwe igxile kwindawo yokuphuka, kunye nobude be-10-12 cm, ukusika ngesikhumba kunye ne-fascia ebanzi kunye nokutyhila i-lateral femoral muscle.
I-lateral incision yenziwa kumgca phakathi kwe-trochanter enkulu kunye ne-condyle esecaleni ye-femur, kunye ne-skin incision ye-posterior lateral incision iyafana okanye kancinane kamva, umahluko omkhulu kukuba i-lateral incision yahlula i-vastus lateralis muscle. , ngelixa i-posterior lateral incision ingena kwi-posterior interval ye-vastus lateralis muscle ngokusebenzisa i-vastus lateralis muscle. (Umfanekiso 3.5.5.2-1, 3.5.5.2-2).
I-anterolateral incision, ngakolunye uhlangothi, yenziwa ngomgca ukusuka kwi-anterior superior iliac spine ukuya kumda wangaphandle we-patella, kwaye ifikeleleke nge-lateral femoral muscle kunye ne-rectus femoris muscle, enokuthi yonakalisa i-intermediary femoral muscle kunye ne-nerve. amasebe kwi-lateral femoral muscle kunye namasebe e-rotator femoris externus artery, kwaye ngoko kunqabile okanye akukaze kusetyenziswe (umzobo 3.5.5.2-3).
(2) Ukubonakaliswa: Ukwahlula kwaye utsale i-lateral femoral muscle phambili kwaye uyifake ngexesha layo kunye ne-biceps femoris, okanye usike ngokuthe ngqo kwaye uhlukanise i-lateral femoral muscle, kodwa ukopha kuninzi. Sika i-periosteum ukuveza iziphelo eziphezulu kunye nezisezantsi ezaphukileyo ze-femur fracture, kwaye ubonise ububanzi ukuya kuthi ga kwinqanaba elinokuthi liqwalaselwe kwaye libuyiselwe, kwaye lihlube izicubu ezithambileyo kancinci kangangoko.
(3) Ukulungiswa kokulungiswa kwangaphakathi: Yongeza ilungu elichaphazelekayo, uveze isiphelo esaphukileyo esiphezulu, faka i-plum blossom okanye i-V-shaped intramedullary inaliti, kwaye uzame ukulinganisa ukuba ubukhulu benaliti bufanelekile. Ukuba kukho ukucutha kwe-medullary cavity, i-medullary cavity expander ingasetyenziselwa ukulungisa ngokufanelekileyo kunye nokwandisa i-cavity, ukuze kuthintelwe inaliti ukuba ingakwazi ukungena kwaye ingakwazi ukukhutshelwa ngaphandle. Lungisa isiphelo saphukileyo esisondeleyo kunye nesibambi sethambo, faka inaliti ye-intramedullary ngokuphindaphindiweyo, ungene kwi-femur ukusuka kwi-trochanter enkulu, kwaye xa isiphelo senaliti sityhala ulusu, yenza incision encinci ye-3cm kuloo ndawo, kwaye uqhubeke nokufaka. inaliti ye-intramedullary ide ibonakale ngaphandle kwesikhumba. Inaliti ye-intramedullary ihoxisiwe, iqondiswe kwakhona, idluliselwe kwi-foramen ukusuka kwi-trochanter enkulu, kwaye emva koko ifakwe ngokusondeleyo kwindiza yecandelo le-cross-section. Iinaliti eziphuculweyo ze-intramedullary zineziphelo ezincinci ezijikelezayo ezinemingxuma yokukhupha. Emva koko akukho mfuneko yokuba ukhuphe kwaye utshintshe indlela, kwaye inaliti inokukhutshelwa ngaphandle kwaye ibethelwe kube kanye. Kungenjalo, inaliti inokufakwa umva ngepini yesikhokelo kwaye iveze ngaphandle kwe-trochanteric incision enkulu, kwaye ke i-intramedullary pin inokufakwa kwi-medullary cavity.
Ukubuyiselwa okungaphezulu kokwaphuka. Ukulungelelaniswa kwe-anatomical kunokufezekiswa ngokusebenzisa i-leverage ye-proximal intramedullary pin ngokubambisana ne-bone pry pivoting, i-traction, kunye ne-fracture topping. Ukulungiswa kufezekiswa ngesibambi samathambo, kwaye iphini ye-intramedullary emva koko iqhutywe ukwenzela ukuba i-pin ye-extraction hole iqondiswe ngasemva ukuze ihambelane ne-curvature ye-femal. Ukuphela kwenaliti kufuneka kufikelele kwindawo efanelekileyo yesiphelo se-distal ye-fracture, kodwa kungekhona nge-cartilage layer, kwaye ukuphela kwenaliti kufuneka kushiywe i-2cm ngaphandle kwe-trochanter, ukwenzela ukuba isuswe kamva. 3.5.5.2-4).
Emva kokulungiswa, zama intshukumo yokwenziwa kwelungu kwaye uqaphele nakuphi na ukungazinzi. Ukuba kuyimfuneko ukutshintsha inaliti ye-intramedullary, inokususwa kwaye ithathelwe indawo. Ukuba kukho ukukhulula okuncinci kunye nokungazinzi, isikrufu singongezwa ukomeleza ukulungiswa. (Umfanekiso 3.5.5.2-4).
Inxeba ekugqibeleni lagungxulwa lavalwa ngokweengqimba. I-anti-rotation boot boot yangaphandle iyafakwa.
II Plate Screw Ukulungiswa kwangaphakathi
Ukulungiswa kwangaphakathi kunye nezikrufu zeplate yensimbi zingasetyenziselwa kuzo zonke iindawo ze-femoral stem, kodwa i-1/3 engaphantsi ifaneleke ngakumbi kulolu hlobo lokulungiswa ngenxa yobubanzi be-medullary cavity. Ipleyiti yentsimbi eqhelekileyo okanye ipleyiti yentsimbi yokucinezela iAO ingasetyenziswa. Le yokugqibela iqina ngakumbi kwaye igxininiswe ngokuqinileyo ngaphandle kokulungiswa kwangaphandle. Nangona kunjalo, akukho namnye kubo onokuphepha indima yokufihla uxinzelelo kunye nokuhambelana nomgaqo wamandla alinganayo, ekufuneka kuphuculwe.
Le ndlela inoluhlu olukhulu lwe-peeling, ukulungiswa okungaphezulu kwangaphakathi, okuchaphazela ukuphilisa, kunye neentsilelo.
Xa kukho ukunqongophala kweemeko ze-intramedullary pin, i-curvature ye-medullary endala okanye inxalenye enkulu yokungahambeki kunye ne-1/3 ephantsi ye-fracture iguquguquka ngakumbi.
(1)I-Lateral femoral okanye i-posterior lateral incision.
(2) (2) Ukuvezwa kokuqhekeka, kwaye kuxhomekeke kwiimeko, kufuneka kulungiswe kwaye kulungiswe ngaphakathi kunye nezikrufu zeplate. I-plate kufuneka ifakwe kwicala le-lateral tension, i-screws kufuneka idlule kwi-cortex kumacala omabini, kwaye ubude beplate kufuneka bube ngamaxesha angama-4-5 ububanzi bethambo kwindawo yokuphuka. Ubude beplate ngama-4 ukuya kwi-8 ububanzi bethambo eliqhekekileyo. Iiplati ezi-6 ukuya kwe-8 zisetyenziswa ngokuqhelekileyo kwi-femur. Amaqhekeza amakhulu amathambo adibeneyo anokulungiswa kunye ne-screws ezongezelelweyo, kwaye inani elikhulu lamathambo amathambo anokufakwa ngexesha elifanayo kwicala eliphakathi kwe-fracture comminuted. (Fig 3.5.5.2-5).
Pula kwaye uvale ngokwemaleko. Ngokuxhomekeke kuhlobo lwezikrufu zeplate ezisetyenzisiweyo, kwagqitywa ukuba okanye ungasebenzisi ukulungiswa kwangaphandle nge-plaster.
Ixesha lokuposa: Mar-27-2024
