Ukuqhekeka kwentamo ye-femoral yinto eqhelekileyo kwaye enokuba yingozi kakhulu koogqirha bamathambo, ngenxa yokunikezelwa kwegazi okubuthathaka, ukuxhaphaka kokuqhekeka okungahambelaniyo kunye ne-osteonecrosis kuphezulu, unyango olufanelekileyo lokuqhekeka kwentamo ye-femoral lusaphikisana, uninzi lweengcali zikholelwa ukuba izigulana ezingaphezu kweminyaka engama-65 ubudala zinokuqwalaselwa kwi-arthroplasty, kwaye izigulana ezingaphantsi kweminyaka engama-65 ubudala zinokukhethwa ukuze zifakwe utyando lwangaphakathi, kwaye eyona mpembelelo imbi kakhulu ekuhambeni kwegazi ibangelwa kukuqhekeka kohlobo lwe-subcapsular kwentamo ye-femoral. Ukuqhekeka kwentamo ye-femoral subcapital kunempembelelo enkulu ye-hemodynamic, kwaye ukunciphisa okuvaliweyo kunye nokulungiswa kwangaphakathi kuseyindlela eqhelekileyo yonyango lokuqhekeka kwentamo ye-femoral subcapital. Ukunciphisa okulungileyo kunceda ekuzinziseni ukuqhekeka, ukukhuthaza ukuphiliswa kokuqhekeka kunye nokuthintela i-necrosis yentloko ye-femoral.
Oku kulandelayo yimeko eqhelekileyo yokuqhekeka kwentamo ye-femoral neck ukuze kuxoxwe ngendlela yokwenza ukulungiswa kwangaphakathi kwe-closed-displacement nge-cannulated screw.
Ⅰ Ulwazi olusisiseko lwetyala
Ulwazi lwesigulana: indoda eneminyaka engama-45 ubudala
Isikhalazo: iintlungu zesinqe sasekhohlo kunye nokunciphisa umsebenzi iiyure ezi-6.
Imbali: Isigulana siwile ngelixa sihlamba, nto leyo ebangela iintlungu esinqeni sasekhohlo kunye nokunqongophala komsebenzi, okwakungenakuncedwa kukuphumla, kwaye sangeniswa esibhedlele sethu ngenxa yokwaphuka kwentamo yefemur yasekhohlo kwi-radiographs, kwaye sangeniswa esibhedlele sinengqondo ecocekileyo nomoya obuhlungu, sikhalaza ngentlungu esinqeni sasekhohlo kunye nokunqongophala komsebenzi, kwaye sasingakhange sitye kwaye sasingakhange sizikhulule ekushukumeni kwamathumbu okwesibini emva kokwenzakala.
Ⅱ Uvavanyo Lomzimba (Ukuhlolwa Komzimba Wonke kunye Nokuhlolwa Kweengcali)
T 36.8°C P87 beats/min R20 beats/min BP135/85mmHg
Uphuhliso oluqhelekileyo, ukutya okunempilo, indawo engasebenziyo, ingqondo ecacileyo, ukusebenzisana xa uhlolwa. Umbala wolusu uqhelekile, uthambile, akukho ukudumba okanye ukurhawuzelela, akukho kukhula kwee-lymph nodes ezingaphezulu emzimbeni wonke okanye kwindawo yasekuhlaleni. Ubungakanani bentloko, imo eqhelekileyo, akukho ntlungu yoxinzelelo, ubunzima, iinwele ziyakhazimla. Zombini ii-pupil ziyalingana ngobukhulu kwaye zingqukuva, zine-reflex yokukhanya ebukhali. Intamo yayithambile, i-trachea yayiphakathi, i-thyroid gland yayingakhuliswanga, isifuba sasilingana, ukuphefumla kwakufinyeziwe kancinci, akukho ngxaki kwi-cardiopulmonary auscultation, imida yentliziyo yayiqhelekile xa kudlalwa, isantya sentliziyo sasingama-87 beats/min, isingqisho sentliziyo sasiyi-Qi, isisu sasithe tyaba kwaye sithambile, akukho ntlungu yoxinzelelo okanye intlungu yokubuyela umva. Isibindi kunye ne-spleen azizange zifunyanwe, kwaye akukho bumuncu kwizintso. Ii-diaphragm zangaphambili nezangasemva azizange zihlolwe, kwaye akukho kukhubazeka komqolo, amalungu aphezulu kunye namalungu asezantsi asekunene, kunye nentshukumo eqhelekileyo. Ii-reflexes ze-physiological zazikho kuvavanyo lwe-neurological kwaye ii-reflexes ze-pathological azizange zivele.
Bekungekho ukudumba okucacileyo kwesinqe sasekhohlo, iintlungu zoxinzelelo ezicacileyo embindini wesinqe sasekhohlo, ukukhubazeka okufutshane kokujikeleza kwangaphandle kwesinqe sasekhohlo esisezantsi, ukuthamba kwe-axis ende yelungu lasekhohlo (+), ukungasebenzi kakuhle kwesinqe sasekhohlo, imvakalelo kunye nomsebenzi weenzwane ezintlanu zonyawo lwasekhohlo bezilungile, kwaye i-dorsal arterial pulsation yonyawo yayiqhelekile.
Ⅲ Uvavanyo oluncedisayo
Ifilimu ye-X-ray ibonise: ukwaphuka kwentloko ye-femoral yentamo yasekhohlo, ukuqhekeka kwesiphelo esiqhekekileyo.
Ezinye izifundo ze-biochemical, i-chest X-ray, i-bone densitometry, kunye ne-color ultrasound yemithambo enzulu yamalungu asezantsi azizange zibonise naluphi na uphazamiseko olucacileyo.
Ⅳ Uxilongo kunye noxilongo olwahlukileyo
Ngokwembali yesigulana yokwenzakala, iintlungu zesinqe sasekhohlo, umda womsebenzi, uvavanyo lomzimba lwelungu lasekhohlo elisezantsi elifinyezayo ukuguquguquka kokujikeleza kwangaphandle, ukuthamba kwemisipha kubonakala, intlungu ye-longitudinal axis kowtow esezantsi elisezantsi elisezantsi (+), ukungasebenzi kakuhle kwesinqe sasekhohlo, kunye nefilimu ye-X-ray kunokuchongwa ngokucacileyo. Ukuqhekeka kwe-trochanter kunokuba neentlungu zesinqe kunye nokunciphisa umsebenzi, kodwa ngokuqhelekileyo ukudumba kwendawo kuyabonakala, indawo yoxinzelelo ikwi-trochanter, kwaye i-angle yokujikeleza yangaphandle inkulu, ngoko ke inokwahlulwa kuyo.
Ⅴ Unyango
Ukunciphisa okuvaliweyo kunye nokufakelwa kwangaphakathi kwezipikili ezingenanto kwenziwa emva kokuhlolwa okupheleleyo.
Ifilimu yangaphambi kotyando ilandelayo
Ukujika kwangaphakathi kunye nokutsalwa kwelungu elichaphazelekayo kunye nokutsalwa kancinci kwelungu elichaphazelekayo emva kokubuyiselwa kunye ne-fluoroscopy kubonise ukubuyiselwa okuhle.
Iphini likaKirschner labekwa phezu komzimba kwicala lentamo ye-femoral ukuze kwenziwe i-fluoroscopy, kwaza kwenziwa ulusu oluncinci ngokwendawo esikuyo isiphelo sephini.
Iphini yesikhokelo ifakwa kwintamo ye-femoral ehambelana nomphezulu womzimba kwicala lephini yeKirschner ngelixa igcina ukuthambekela kwangaphambili malunga ne-15 degrees kwaye kwenziwa i-fluoroscopy
Iphini yesibini yesikhokelo ifakwa nge-femoral spur kusetyenziswa isikhokelo esihambelana necala elingaphantsi kwecala lephini yokuqala yesikhokelo.
Inaliti yesithathu ifakwe ngakwicala elingasemva kwenaliti yokuqala ngesikhokelo.
Kusetyenziswa umfanekiso wecala we-fluoroscopic frog, zonke izikhonkwane ezintathu zeKirschner zabonakala zingaphakathi kwentamo ye-femoral
Gqobhoza imingxunya kwicala lesikhonkwane sesikhokelo, ulinganise ubunzulu uze ukhethe ubude obufanelekileyo besikhonkwane esingenanto esifakwe kwisikhonkwane sesikhokelo, kucetyiswa ukuba uqhoboshele umqolo we-femoral wesikhonkwane esingenanto kuqala, nto leyo enokuthintela ukulahleka kokuseta kwakhona.
Faka ezinye izikrufu ezimbini ezifakwe kwi-cannulated, esinye emva kwesinye uze ubone ngaphaya
Imeko yokusikwa kolusu
Ifilimu yokujonga emva kotyando
Xa idibene nobudala besigulana, uhlobo lokwaphuka, kunye nomgangatho wethambo, ukulungiswa kwangaphakathi kwezipikili ezingenanto kuye kwakhethwa, okunezibonelelo zokulimala okuncinci, isiphumo sokuqina esiqinisekileyo, ukusebenza okulula kunye nokulula ukukuqonda, ucinezelo olunamandla, isakhiwo esingenanto silungele ukuthomalalisa ubuchopho, kwaye izinga lokuphiliswa kwamathambo liphezulu.
Isishwankathelo
1 Ukubekwa kweenaliti zikaKirschner kumphezulu womzimba nge-fluoroscopy kuyanceda ekumiseleni indawo kunye necala lokufakwa kwenaliti kunye nobubanzi bokunqunyulwa kwesikhumba;
2 Iiphini ezintathu zikaKirschner mazibe zifanayo, zijijeke ngendlela eguqulweyo, kwaye zibe kufutshane nomphetho kangangoko kunokwenzeka, nto leyo enceda ekuzinziseni ukuqhekeka kunye nokucinezelwa kokutyibilika kamva;
3 Indawo yokungena yeKirschner pin esezantsi kufuneka ikhethwe kwindawo evelele kakhulu ye-lateral femoral crest ukuqinisekisa ukuba i-pin iphakathi kwentamo ye-femoral, ngelixa iincam zee-pin ezimbini eziphezulu zinokutyibilika phambili nangasemva ecaleni kwe-crest evelele kakhulu ukuze kube lula ukunamathela;
4 Musa ukutyhala iphini yeKirschner nzulu kakhulu ngaxeshanye ukuze ungangeni kumphezulu we-articular, i-drill bit ingagqojozwa kumgca wokuqhekeka, enye yeyokuthintela ukugqobhozwa kwintloko ye-femoral, kwaye enye ilungele ukucinezelwa kwezipikili ezingenanto;
5 Izikrufu ezingenanto zifakwe ngaphakathi kancinci, gweba ubude besikrufu esingenanto buchanekile, ukuba ubude abukude kakhulu, zama ukuphepha ukutshintshwa rhoqo kwezikrufu, ukuba i-osteoporosis, ukutshintshwa kwezikrufu kuba kukulungiswa okungasebenziyo kwezikrufu, kuba isigulane siqikelela ukuba ukulungiswa kwezikrufu kusebenza kakuhle, kodwa ubude bezikrufu bumbi kancinci kunobude bokulungiswa okungasebenzi kakuhle kwezikrufu bungcono kakhulu!
Ixesha leposi: Jan-15-2024
