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 nethambo elininzi lokukhansela, kunzima ukulawula ukujikeleza kwepini ye-intramedullary, kwaye ukulungiswa akukhuselekanga, nangona kunokomelezwa ngezikhonkwane, kodwa kulungele ngakumbi kwi-screws plate yensimbi.
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, kunye nokwahlukana okukhulu kukuba i-lateral incision ihlukanisa i-vastus lateralis muscle, ngelixa i-posterior lateral incision ingena kwi-posterior lateral ye-muscle ye-vastus lateral ye-muscle. 3.5.5.2-1, 3.5.5.2-2).
I-anterolateral incision, ngakolunye uhlangothi, yenziwa ngomgca osuka kwi-anterior superior iliac spine ukuya kumda wangaphandle wepatella, kwaye ifikeleleke kwi-lateral femoral muscle kunye ne-rectus femoris muscle, enokuthi yenze umonakalo we-femoral muscle kunye namasebe e-nerve ukuya kwi-lateral femoral muscle kunye namasebe e-rotator artrely okanye i-externus ye-rotator 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 esiqhekekileyo esiqhekezayo kunye nesibambi sethambo, faka inaliti ye-intramedullary retrogradely, ungene kwi-femur ukusuka kwi-trochanter enkulu, kwaye xa isiphelo senaliti sityhala ulusu, yenza i-incision encinci ye-3cm kuloo ndawo, kwaye uqhubeke ufaka inaliti ye-intramedullary de 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. (Umfanekiso 3.5.5.2-4).
Emva kokulungiswa, zama intshukumo ye-passive yelungu kwaye uqaphele nakuphi na ukungazinzi. Ukuba kuyimfuneko ukutshintsha inaliti ye-intramedullary enzima, inokususwa kwaye ithathelwe indawo. Ukuba kukho ukukhulula okuncinci kunye nokungazinzi, isikrufu singongezwa ukomeleza ukulungiswa. (Umfanekiso 3.5.5.2-4).
Inxeba lada lagungxulwa lavalwa ngokweengqimba. I-anti-rotation boot boot yangaphandle iyafakwa.
II Plate Screw Ukulungiswa kwangaphakathi
Ukulungiswa kwangaphakathi kunye ne-screws plate yensimbi ingasetyenziselwa kuzo zonke iindawo ze-femoral stem, kodwa i-1/3 ephantsi ifaneleka ngakumbi kulolu hlobo lokulungiswa ngenxa ye-medullary cavity ebanzi. Ipleyiti yentsimbi eqhelekileyo okanye ipleyiti yentsimbi yokucinezela iAO ingasetyenziswa. Le yokugqibela yomelele ngakumbi kwaye igxininiswe ngokuqinileyo ngaphandle kokulungiswa kwangaphandle. Nangona kunjalo, akukho namnye kubo onokuphepha indima yokufihla uxinzelelo kwaye ahambelane nomgaqo wamandla alinganayo, ekufuneka aphuculwe.
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 ngokwemigangatho. Ngokuxhomekeke kuhlobo lwezikrufu zeplate ezisetyenzisiweyo, kwagqitywa ukuba okanye ungasebenzisi ukulungiswa kwangaphandle nge-plaster.
Ixesha lokuposa: Mar-27-2024
