Ukuphulwa kwentamo ye-Femoral yinto eqhelekileyo kunye nokulimala okunokubangela ukuba oogqirha bamathambo, ngenxa yonikezelo lwegazi olubuthathaka, iziganeko zokuphuka kwe-non-union kunye ne-osteonecrosis ziphezulu, unyango oluchanekileyo lwe-femoral neck fracture luseyingxabano, abaninzi abaphengululi bakholelwa ukuba izigulane ezingaphezu kweminyaka eyi-65 ubudala zinokuthi ziqwalaselwe iminyaka engaphantsi kwe-65 ubudala kunye ne-65 iminyaka yobudala. ekhethiweyo utyando lokulungiswa kwangaphakathi, kwaye impembelelo enkulu kakhulu ekuhambeni kwegazi ibangelwa ukuphulwa kohlobo lwe-subcapsular yentamo ye-femal. I-Subcapital fracture yentamo ye-femoral inefuthe elibi kakhulu le-haemodynamic, kunye nokunciphisa ukuvala kunye nokulungiswa kwangaphakathi kuseyindlela yonyango yesiqhelo yokuphulwa kwe-subcapital neck ye-femoral neck. Ukunciphisa okulungileyo kukulungele ukuzinzisa ukuphuka, ukukhuthaza ukuphulukiswa kwe-fracture kunye nokukhusela i-necrosis yentloko ye-femoral.
Oku kulandelayo yimeko eqhelekileyo ye-femoral neck subcapital fracture ukuxoxa ngendlela yokwenza ukulungiswa kwangaphakathi okuvaliweyo kunye ne-screw cannulated.
Ⅰ Ulwazi olusisiseko lwetyala
Ulwazi lwesigulane: indoda eneminyaka engama-45 ubudala
Isikhalazo: intlungu ye-hip ekhohlo kunye nokunciphisa umsebenzi kwiiyure ze-6.
Imbali: Isigulane sawela phantsi xa sihlamba, sibangela intlungu kwi-hip ekhohlo kunye nokunciphisa umsebenzi, ongenakukwazi ukukhululeka ngokuphumla, kwaye wangeniswa kwisibhedlele sethu ngokuphuka kwentamo ye-femur ekhohlo kwii-radiographs, kwaye wangeniswa esibhedlele kwimeko ecacileyo yengqondo kunye nomoya ompofu, ukukhalaza ngentlungu kwi-hip ekhohlo kunye nokulinganiselwa komsebenzi, kwaye akazange akhulule ukunyakaza kwakhe emva kokutya kunye nokulimala kwakhe okwesibini.
Ⅱ UVavanyo loMzimba (uHlolo loMzimba wonke kunye noHlolo lweNgcali)
T 36.8°C P87 beats/min R20 beats/min BP135/85mmHg
Uphuhliso oluqhelekileyo, ukutya okunesondlo, indawo yokungenzi nto, ingqondo ecacileyo, intsebenziswano ekuhlolweni. Umbala wolusu uyinto eqhelekileyo, i-elastic, i-edema okanye i-rash, akukho kwandiswa kwee-lymph nodes ezingaphezulu emzimbeni wonke okanye kwindawo yendawo. Ubungakanani bentloko, i-morphology eqhelekileyo, akukho ntlungu yoxinzelelo, ubunzima, iinwele ziyabengezela. Bobabini abafundi bayalingana ngobukhulu kwaye bangqukuva, kunye ne-reflex yokukhanya obuthathaka. Intamo yayithambile, i-trachea yayiphakathi, i-thyroid gland yayingakhuliswanga, isifuba sasinomlinganiso, ukuphefumla kwancitshiswa kancinane, kwakungekho nto ingaqhelekanga kwi-cardiopulmonary auscultation, imida yentliziyo yayiqhelekile kwi-percussion, isantya senhliziyo sasiyi-87 beats / min, isigqi sentliziyo sasiyi-Qi yayingekho intlungu, intlungu kunye ne-ab yayingekho, intlungu kunye ne-ab. Isibindi kunye ne-spleen zange zibonwe, kwaye kwakungekho kuthamba kwizintso. I-diaphragms yangaphambili kunye ne-posterior ayizange ihlolwe, kwaye akukho ziphene zomgudu, izitho eziphezulu kunye nezitho zangaphantsi zasekunene, kunye nokunyakaza okuqhelekileyo. I-reflexes ye-Physiological yayikhona kwi-neurological examination kunye ne-pathological reflexes ayizange ifuneke.
Kwakungekho ukudumba okucacileyo kwe-hip ekhohlo, iintlungu ezicacileyo zoxinzelelo kumbindi we-groin ekhohlo, ukunciphisa ukujikeleza kwangaphandle ukukhubazeka kwelungu lasekhohlo elisezantsi, ukuthamba kwe-axis ye-axis ye-left longitudinal (+), ukungasebenzi kakuhle kwe-hip, imvakalelo kunye nomsebenzi weenzwane ezintlanu zonyawo lwasekhohlo zilungile, kunye ne-dorsal arterial pulsation yesiqhelo.
Ⅲ Iimviwo ezincedisayo
Ifilimu ye-X-ray ibonise: i-femoral neck yasekhohlo i-subcapital fracture, i-dislocation yesiphelo esaphukileyo.
Uvavanyo oluseleyo lwe-biochemical, i-X-ray yesifuba, i-bone densitometry, kunye ne-ultrasound yemibala ye-veins enzulu yemilenze engezantsi ayizange ibonise ukungaqhelekanga okucacileyo.
Ⅳ Ukuxilongwa kunye nokuxilongwa ngokwahlukileyo
Ngokwembali yesigulane sokwenzakala, intlungu ye-hip ekhohlo, ukulinganiselwa komsebenzi, ukuhlolwa komzimba wecala elisezantsi elisekhohlo linciphisa ukujikeleza kwangaphandle, ukuthamba kwe-groin kucacile, intlungu esezantsi ye-longitudinal axis kowtow intlungu (+), ukungasebenzi kwe-hip ekhohlo, kudibaniswa nefilimu ye-X-ray inokufunyaniswa ngokucacileyo. I-fracture ye-trochanter ingaba nentlungu ye-hip kunye nokunciphisa umsebenzi, kodwa ngokuqhelekileyo ukuvuvukala kwendawo kuyabonakala, indawo yoxinzelelo ifumaneka kwi-trochanter, kwaye i-angle yokujikeleza yangaphandle inkulu, ngoko inokuhlukana kuyo.
Ⅴ Unyango
Ukunciphisa okuvaliweyo kunye nokulungiswa kwangaphakathi kwesikhonkwane kwangaphakathi kwenziwa emva koviwo olupheleleyo.
Ifilimu yangaphambi kokusebenza ngolu hlobo lulandelayo
Ukuhamba ngokujikeleza kwangaphakathi kunye nokutsalwa kwelungu elichaphazelekayo kunye nokuxhwilwa okuncinci kwelungu elichaphazelekayo emva kokubuyiselwa kunye ne-fluoroscopy ibonise ukubuyisela okulungileyo.
I-Kirschner pin yafakwa phezu komzimba kwicala lentamo ye-femoral ye-fluoroscopy, kwaye i-skin incision encinci yenziwa ngokwendawo yokuphela kwepini.
Iphini yesikhokelo ifakwe kwintanyeni ye-femoral ngokunxusene nomphezulu womzimba kwicala le-Kirschner pin ngelixa igcina ukuthambeka kwangaphambili okumalunga ne-15 degrees kwaye kwenziwa i-fluoroscopy.
Isikhonkwane sesibini sesikhokelo sifakwe kwi-femoral spur kusetyenziswa isikhokelo esihambelana necala elingaphantsi kwesalathiso sephini lokuqala.
Inaliti yesithathu ifakwe ngokuhambelana nomva wenaliti yokuqala ngesikhokelo.
Isebenzisa umfanekiso osecaleni wesele we-fluoroscopic, zontathu izikhonkwane zeKirschner zibonwe zingaphakathi kwentamo ye-femoral.
Gqoka imingxuma kwicala lesikhonkwane sesikhokelo, ulinganise ubunzulu kwaye emva koko ukhethe ubude obufanelekileyo besikhonkwane esinomngxuma esijijwe ecaleni kwephini lesikhokelo, kuyacetyiswa ukuba ujije kumqolo we-femoral wesikhonkwane esimgongxo kuqala, esinokuthintela ilahleko yokusetha kwakhona.
Screw kwezinye ezimbini ezinkonkxiweyo Screw enye emva kwenye kwaye ubone nge
Imeko yokusikwa kwesikhumba
Ifilimu yokuphonononga emva kokuhlinzwa
Ukudibaniswa nobudala besigulane, uhlobo lokuphuka, kunye nomgangatho wamathambo, ukucutha okuvaliweyo okuvaliweyo ukulungiswa kwangaphakathi kwesikhonkwane kwakhethwa, okunenzuzo yokulimala okuncinci, umphumo oqinisekileyo wokulungiswa, ukusebenza okulula kunye nokulula ukukwazi, kunokunyanzeliswa kwamandla, isakhiwo esingenalutho sikulungele ukuchithwa kwe-intracranial, kwaye izinga lokuphulukisa ukuphuka liphezulu.
Isishwankathelo
1 Ukubekwa kweenaliti ze-Kirschner kumphezulu womzimba kunye ne-fluoroscopy kukulungele ukumisela inqaku kunye necala lokufakwa kwenaliti kunye noluhlu lwesikhumba;
2 Izikhonkwane ezintathu zeKirschner kufuneka zinxusene, zijikwe zigzag, kwaye zisondele emphethweni kangangoko, ezinceda ukuqiniswa kokwaphuka kunye noxinzelelo lokutyibilika kamva;
3 I-Kirschner pin entry point esezantsi kufuneka ikhethwe kwindawo evelele kakhulu ye-femoral crest ukuqinisekisa ukuba i-pin iphakathi kwentamo ye-femoral, ngelixa iincam zeepini ezimbini eziphezulu zinokuthi zityibilike phambili kwaye zibuyele ngasemva kunye neyona crest evelele kakhulu ukuququzelela ukubambelela;
4 Musa ukuqhuba i-Kirschner pin inzulu kakhulu ngexesha elinye ukuze ugweme ukungena kwindawo ye-articular, i-drill bit ingagrunjwa kumgca wokuphuka, enye kukuthintela ukubhobhoza ngentloko ye-femoral, kwaye enye ihambelana nokuxinzelela kwezikhonkwane;
5 Izikhonkwane ezigobileyo zijijelwe kwi-screws eziphantse zaze zadlula kancinci, gweba ubude be-screws emgongxweni buchanekile, ukuba ubude abukho kude kakhulu, zama ukunqanda ukutshintshwa rhoqo kwezikrufu, ukuba i-osteoporosis, ukutshintshwa kwezikhonkwane kube yinto engavumelekanga yokulungisa izikhonkwane, kuba i-prognosis yesigulana yokulungiswa okusebenzayo kwezikrufu, kodwa ubude bobude be-screws bubi kakhulu kunobude be-screws. kungcono noko!
Ixesha lokuposa: Jan-15-2024
