Ukuqhekeka kwentamo ye-Femoral yinto eqhelekileyo kunye nokulimala okunokuba yingozi koogqirha bamathambo, ngenxa yonikezelo lwegazi oluthambileyo, izehlo zokuqhekeka kwe-non-union kunye ne-osteonecrosis iphezulu, unyango oluchanekileyo lokuphuka kwentamo ye-femoral luseyingxabano, abaninzi abaphengululi bakholelwa ukuba izigulane zingaphezulu. Iminyaka engama-65 ubudala ingaqwalaselwa kwi-arthroplasty, kwaye izigulane ezingaphantsi kweminyaka engama-65 ubudala zingakhethwa ukuhlinzwa kwangaphakathi, kwaye impembelelo enzima kakhulu ekuhambeni kwegazi kubangelwa ukuphulwa kohlobo lwe-subcapsular yentamo ye-femoral.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 kwi-radiographs, kwaye wangeniswa esibhedlele kwimeko ecacileyo yengqondo kunye nomoya ompofu, ekhalaza ngentlungu kwi-hip ekhohlo kunye nokunciphisa umsebenzi, kwaye akazange adle kwaye akazange azikhulule kwisigxina sakhe sesibini emva kokulimala.
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 kuncitshiswe kancinci, kwakungekho nto ingaqhelekanga kwi-cardiopulmonary auscultation, imida yentliziyo yayiqhelekile kwi-percussion, isantya sentliziyo sasiyi-87 beats / min, isingqi sentliziyo sasiyiQi, isisu sasithe tyaba kwaye sithambile, kwakungekho ntlungu yoxinzelelo okanye iintlungu eziphinda zibuyele.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 kwesinqe sasekhohlo, iintlungu ezicacileyo zoxinzelelo kumbindi we-groin ekhohlo, mfutshane ukujikeleza kwangaphandle ukukhubazeka kwelungu lasekhohlo elisezantsi, ukuthamba kwe-axis ye-axis yasekhohlo esezantsi (+), ukungasebenzi kakuhle kwe-hip, ukuva kunye nomsebenzi iinzwane ezintlanu zonyawo lwasekhohlo zazilungile, kwaye ukubetheka komthambo omqolo wonyawo kwakuqhelekile.
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 yesigulana somonzakalo, intlungu ye-hip ekhohlo, ukulinganiselwa komsebenzi, ukuhlolwa ngokomzimba kwelungu lasekhohlo elisezantsi linciphisa ukujikeleza kwangaphandle, ukuthamba kwe-groin kucacile, intlungu ye-kowtow ye-left longitudinal longitudinal axis kowtow intlungu (+), ukungasebenzi kakuhle kwe-hip ekhohlo, kudibaniswa nayo. ifilimu ye-X-reyi 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 usebenzisa isikhokelo esihambelana necala elingaphantsi kwesikhokelo sephini lokuqala lesikhokelo.
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 esikrwelwe ecaleni kwephini lesikhokelo, kuyacetyiswa ukuba ujije kumqolo we-femoral wesikhonkwane esivulekileyo kuqala, esinokuthi sithintele ilahleko. phinda usete.
Screw kwezinye ezimbini ezinkonkxiweyo Screw enye emva kwenye kwaye ubone nge
Imeko yokusikwa kwesikhumba
Ifilimu yokuphonononga emva kokuhlinzwa
Idityaniswe nobudala besigulane, uhlobo lokuphuka, kunye nomgangatho wamathambo, ukucutha okuvaliweyo okuvaliweyo ukulungiswa kwangaphakathi kwesikhonkwane, okunenzuzo yokulimala okuncinci, umphumo oqinisekileyo wokulungisa, ukusebenza okulula kunye nokulula ukuyiqonda, kunokunyanzeliswa kwamandla, isakhiwo esingenalutho sifanelekile. ukuya kwi-intracranial decompression, 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 Indawo yokungena ye-Kirschner pin esezantsi kufuneka ikhethwe kweyona ndawo ibalaseleyo ye-femoral crest ukuqinisekisa ukuba isikhonkwane siphakathi kwentamo ye-femoral, ngelixa iincam zezikhonkwane ezimbini eziphezulu zinokutyibilika phambili nangasemva kunye neyona crest ibalaseleyo. ukuququzelela ukubambelela;
4 Musa ukuyiqhubela nzulu kakhulu ipini yeKirschner ngaxeshanye ukunqanda ukungena kumphezulu we-articular, intwana ye-drill inokugrunjwa kumgca wokuqhekeka, enye kukuthintela ukugrunjwa kwentloko ye-femoral, kwaye enye inceda isikhonkwane esinomngxuma. ucinezelo
5 Izikrufu eziholoholo ezijijelwe kwiphantse kwaye zidlule kancinci, gweba ubude besikrufu esihollow buchanekile, ukuba ubude abukho kude kakhulu, zama ukunqanda ukutshintshwa rhoqo kwezikhonkwane, ukuba i-osteoporosis, ukutshintshwa kwezikrufu ngokusisiseko kube kukulungiswa okungavumelekanga. Izikhonkwane, kwi-prognosis yesigulane yokulungiswa okusebenzayo kwezikrufu, kodwa ubude bobude be-screws bubi kakhulu kunobude bokulungiswa okungenakusebenza kwezikrufu kungcono kakhulu!
Ixesha lokuposa: Jan-15-2024
