Kukho iintlobo ezimbini zeendlela zotyando, izikrufu zepleyiti kunye neepini ze-intramedullary, eyokuqala iquka izikrufu zepleyiti eziqhelekileyo kunye nezikrufu zepleyiti ye-AO system compression plate, kwaye eyokugqibela iquka iipini ze-retrograde ezivaliweyo nezivulekileyo okanye ze-retrograde. Ukhetho lusekelwe kwindawo ethile kunye nohlobo lokwaphuka.
Ukufakelwa kwephini ngaphakathi kwe-medullary kuneengenelo zokuvezwa okuncinci, ukukrazulwa kancinci, ukufakelwa okuzinzileyo, akukho mfuneko yokufakelwa kwangaphandle, njl. Ifanelekile kwi-1/3 ephakathi, ukwaphuka kwe-1/3 ephezulu ye-femur, ukwaphuka kwamacandelo amaninzi, ukwaphuka kwe-pathological. Kwi-1/3 esezantsi yokwaphuka, ngenxa ye-medullary cavity enkulu kunye namathambo amaninzi arhoxisiweyo, kunzima ukulawula ukujikeleza kwephini ngaphakathi kwe-medullary, kwaye ukufakelwa akukhuselekanga, nangona kunokomelezwa ngezikrufu, kodwa kufanelekile ngakumbi kwizikrufu zepleyiti yentsimbi.
I-Open-internal Fixation yokwaphuka kwe-Femur Shaft ene-Intramedullary Nail
(1) Ukusikwa: Ukusikwa kwe-femoral ecaleni okanye ngasemva kwenziwa phakathi kwindawo yokuqhekeka, ubude bayo buyi-10-12 cm, kusikwa ulusu kunye ne-fascia ebanzi kwaye kutyhile umsipha we-femoral ecaleni.
Ukusikwa kwecala kwenziwa kumgca ophakathi kwe-trochanter enkulu kunye ne-lateral condyle ye-femur, kwaye ukusikwa kwesikhumba kwe-posterior lateral incision kuyafana okanye kusemva kancinci, umahluko ophambili kukuba i-lateral incision yahlula i-vastus lateralis muscle, ngelixa i-posterior lateral incision ingena kwi-posterior interval ye-vastus lateralis muscle nge-vastus lateralis muscle. (Umzobo 3.5.5.2-1, 3.5.5.2-2).
Kwelinye icala, ukusikwa kwe-anterolateral kwenziwa ngomgca osuka kumqolo we-anterior superior iliac ukuya kumda wangaphandle we-patella, kwaye kufikelelwa kuwo nge-lateral femoral muscle kunye ne-rectus femoris muscle, enokwenzakalisa i-intermediary femoral muscle kunye namasebe e-nerve kwi-lateral femoral muscle kunye namasebe e-rotator femoris externus artery, kwaye ngenxa yoko ayisetyenziswa rhoqo okanye ayisetyenziswa rhoqo (Umzobo 3.5.5.2-3).
（2） Ukuvezwa: Yahlula kwaye utsale umsipha we-lateral femoral phambili uze uwufake ngexesha lawo kunye ne-biceps femoris, okanye usike ngokuthe ngqo kwaye wahlukanise umsipha we-lateral femoral, kodwa ukopha kungaphezulu. Sika i-periosteum ukuze utyhile iziphelo eziphezulu nezisezantsi eziqhekekileyo zokuqhekeka kwe-femur, kwaye utyhile umda ukuya kuthi ga kwinqanaba lokuba unokubonwa kwaye ubuyiselwe, kwaye ukhulule izicubu ezithambileyo kancinci kangangoko.
（3）Ukulungisa indawo engaphakathi: Nciphisa ilungu elichaphazelekayo, uveze isiphelo esiqhekekileyo esikufutshane, faka i-plum blossom okanye inaliti ye-intramedullary enomfanekiso we-V, uze uzame ukulinganisa ukuba ubukhulu benaliti bufanelekile na. Ukuba kukho ukuncitshiswa kwe-medullary cavity, i-medullary cavity expander ingasetyenziselwa ukulungisa nokwandisa i-cavity ngokufanelekileyo, ukuze ithintele inaliti ukuba ingakwazi ukungena kwaye ingakwazi ukutsalwa. Lungisa isiphelo esiqhekekileyo esikufutshane ngesibambi sethambo, faka inaliti ye-intramedullary ngasemva, ungene kwi-femur ukusuka kwi-trochanter enkulu, kwaye xa isiphelo senaliti sityhala ulusu phezulu, yenza ukusika okuncinci kwe-3cm kwindawo leyo, uze uqhubeke nokufaka inaliti ye-intramedullary ide ivezwe ngaphandle kolusu. Inaliti ye-intramedullary iyarhoxiswa, iqondiswe kwenye indawo, idlule kwi-foramen ukusuka kwi-trochanter enkulu, ize ifakwe kufutshane nendawo ye-cross-section. Iinaliti ze-intramedullary eziphuculweyo zineziphelo ezincinci ezijikelezileyo ezinemingxunya yokukhupha. Emva koko akukho mfuneko yokutsala uze utshintshe indlela oya kuyo, kwaye inaliti ingaphoswa ize iphoswe kube kanye. Okanye, inaliti ingafakwa ibuyele emva ngephini yesikhokelo ize ivezwe ngaphandle kwe-greater trochanteric incision, ize iphini ye-intramedullary ifakwe kwi-medullary cavity.
Ukubuyiselwa ngakumbi kokuqhekeka. Ukulungelelaniswa komzimba kunokufezekiswa ngokusebenzisa i-leverage ye-proximal intramedullary pin kunye ne-bone pry pivoting, i-traction, kunye ne-fracture topping. Ukulungiswa kwenziwa nge-bone holder, kwaye i-intramedullary pin iqhutywa ukuze umngxuma wokukhupha i-pin uqondiswe ngasemva ukuze uvumelane ne-femoral curvature. Isiphelo senaliti kufuneka sifikelele kwinxalenye efanelekileyo yesiphelo se-distal sokuqhekeka, kodwa singadluli kwi-cartilage layer, kwaye isiphelo senaliti kufuneka sishiywe i-2cm ngaphandle kwe-trochanter, ukuze isuswe kamva. (Umzobo 3.5.5.2-4).
Emva kokulungiswa, zama intshukumo engashukumiyo yelungu uze ubone naluphi na ukungasebenzi. Ukuba kuyimfuneko ukutshintsha inaliti etyebileyo yangaphakathi kwe-medullary, ingasuswa kwaye ithathelwe indawo. Ukuba kukho ukukhululeka okuncinci kunye nokungasebenzi, isikrufu singongezwa ukuze kuqiniswe ukulungiswa. (Umzobo 3.5.5.2-4).
Ekugqibeleni inxeba lahlanjwa laza lavalwa ngokweemaleko. Kunxitywa isihlangu seplasta esichasene nokujikeleza kwangaphandle.
Ukulungiswa Kwangaphakathi Kwesikrufu Seplati II
Ukufakelwa kwangaphakathi ngee-screws zepleyiti yentsimbi kungasetyenziswa kuzo zonke iindawo zesiqu se-femoral, kodwa i-1/3 esezantsi ifanelekile ngakumbi kolu hlobo lokufakelwa ngenxa ye-medullary cavity ebanzi. Ipleyiti yentsimbi eqhelekileyo okanye ipleyiti yentsimbi yoxinzelelo lwe-AO ingasetyenziswa. Le yokugqibela iqinile kwaye iqinile ngaphandle kokufakelwa kwangaphandle. Nangona kunjalo, akukho namnye kubo onokuphepha indima yokufihla uxinzelelo kwaye ahambelane nomgaqo wamandla alinganayo, ekufuneka uphuculwe.
Le ndlela inoluhlu olukhulu lokuxobuka, iqinisa ngaphakathi, ichaphazela ukuphiliswa, kwaye ikwanazo neentsilelo.
Xa kungekho ngxaki ye-intramedullary pin, i-fracture medullary curvature endala okanye inxalenye enkulu ye-ingonekayo kunye ne-1/3 esezantsi ye-fracture ziyakwazi ukuguquguquka.
(1) Ukusikwa kwe-femoral okanye i-lateral incision.
(2)(2) Ukuvezwa kwesaphuko, kwaye kuxhomekeke kwiimeko, kufuneka kulungiswe kwaye kulungiswe ngaphakathi ngezikrufu zepleyiti. Ipleyiti kufuneka ibekwe kwicala loxinzelelo olusecaleni, izikrufu kufuneka zidlule kwi-cortex kumacala omabini, kwaye ubude bepleyiti kufuneka bube bubude obuphindwe ka-4-5 bobubanzi bethambo kwindawo yokuqhekeka. Ubude bepleyiti buphindwe ka-4 ukuya ku-8 ubukhulu bethambo eliqhekekileyo. Iipleyiti ezinemingxuma emi-6 ukuya kwe-8 zisetyenziswa rhoqo kwi-femur. Iziqwenga zamathambo ezinkulu eziqhekekileyo zinokulungiswa ngezikrufu ezongezelelweyo, kwaye inani elikhulu lee-graft zamathambo zinokubekwa ngaxeshanye kwicala eliphakathi lesaphuko esiqhekekileyo. (Umzobo 3.5.5.2-5).
Hlamba uze uvale ngokweengqimba. Ngokuxhomekeke kuhlobo lwezikrufu zepleyiti ezisetyenzisiweyo, kwagqitywa ekubeni kufakwe okanye kungafakwa i-external fixation nge-plaster.
Ixesha leposi: Matshi-27-2024
