Ngokuphathelele izikrufu zentloko nentamo, isebenzisa uyilo lwezikrufu ezimbini zezikrufu ezilaxayo kunye nezikrufu zokucinezela. Ukudibana okudibeneyo kwezikrufu ezimbini kuphucula ukumelana nokujikeleza kwentloko yefemoral.
Ngexesha lenkqubo yokufaka isikrufu sokucinezela, intshukumo ye-axial yesikrufu sokulaxa iqhutywa ngumsonto we-occlusal phakathi kwesikrufu sokucinezela kunye nesikrufu sokulaxa, kwaye uxinzelelo lokulwa nokujikeleza luguqulwa lube luxinzelelo oluthe tyaba kwisiphelo sokuqhekeka, ngaloo ndlela luphucula kakhulu amandla okulwa nokujikeleza kwesikrufu. Sika ukusebenza. Izikrufu ezi-2 zidibene ukuze kuthintelwe isiphumo "se-Z".
Uyilo lwesiphelo esikufutshane senzipho esiphambili esifana neso se-joint prosthesis lwenza umzimba wenzipho uhambelane ngakumbi nomgodi we-medullary, kwaye uhambelane ngakumbi neempawu ze-biomechanical ze-proximal femur.
Amanyathelo Otyando
Isikhundla: Isigulana sinokukhetha indawo engasecaleni okanye elele phantsi. Xa isigulana silele phantsi, kwitafile yokusebenza enemisebe okanye itafile yokudonsa amathambo. Icala eliphilileyo lesigulana liyatsalwa kwaye liqiniswe kwi-bracket, kwaye icala elichaphazelekayo liyatsalwa kwi-10°-15° ukuze kube lula ukuhambelana nomngxuma we-medullary.
Ukuseta kwakhona ngokuchanekileyo: Tsala ilungu elichaphazelekayo ngebhedi yokutsala ngaphambi kokuba usebenze, kwaye ulungise indlela yokutsala phantsi kwe-fluoroscopy ukuze ilungu elichaphazelekayo libe kwindawo yokujikeleza okuncinci kwangaphakathi kunye nendawo yokunyusa. Uninzi lwaphuka lunokulungiswa kwakhona kakuhle. Ukuseta kwakhona ngaphambi kotyando kubaluleke kakhulu kwaye Ingongoma kukuba, ungayinqumli ngokulula ukuba akukho kuncipha okwanelisayo. Oku kunokonga ixesha lokusebenza kwaye kunciphise ubunzima ngexesha lokusebenza. Ukuba ukunciphisa kunzima, ungenza i-incision encinci ngexesha lokusebenza kwaye usebenzise i-push rod, i-retractor, i-reduction forceps, njl.njl. ukunceda ekunciphiseni. Amacala amancinci angaphakathi nangaphandle ahlukene, kwaye akukho mfuneko yokulungisa ngokuphindaphindiweyo. Isiphelo sokwaphuka sinokusetwa kwakhona ngokuzenzekelayo xa isikrufu soxinzelelo sifakwe ngaphakathi ngexesha lokusebenza.
Ukunciphisa i-trochanter encinci: Uyilo lwezinzipho ze-intramedullary alufuni ukuqhubeka kwe-medial cortex. Ngokubanzi, akukho mfuneko yokunciphisa iqhekeza le-trochanter fracture elincinci, kuba umsebenzi wokunciphisa i-closed reduction ongaphantsi kakhulu awunampembelelo ingako ekujikelezeni kwegazi kwesiphelo se-fracture, kwaye i-fracture kulula ukuyiphilisa. Nangona kunjalo, i-coxa varus kufuneka ilungiswe ngaphambi kokuba i-screw ibekwe, kwaye ixesha lokuya emhlabeni kunye nexesha lokuthwala ubunzima emva kotyando kufuneka lihlehliswe ngokufanelekileyo.
Indawo yokusikwa: Kwenziwa ukusika okude okungange-3-5 cm kwisiphelo esikufutshane se-apex enkulu ye-trochanter malunga nenqanaba lomqolo we-anterior superior iliac. Intambo yeKirschner ingafakwa kwicala langaphandle le-proximal femur, kwaye ilungiswe ukuze ihambelane ne-axis ende ye-femur phantsi kwe-C-arm fluoroscopy, ukuze indawo yokusika ichaneke ngakumbi.
Misela indawo yokungena: indawo yokungena iphakathi kancinci nencopho ye-trochanter enkulu, ehambelana nokuphambuka kwe-4° ecaleni kwe-axis ende ye-medullary cavity kumbono wangaphambili. Kumbono wecala, indawo yokungena kweenzipho ikwi-axis ende ye-medullary cavity;
Indawo yokungena yenaliti
IisertGi-uidePin Fi-luoroscopy
R ngokupheleleyoi-eamed
Ekubeni isiphelo esikufutshane se-InterTan main nail sityebile, uzipho lunokufakwa kuphela emva kokuphononongwa ngokupheleleyo ngexesha lokusebenza. Ukuphononongwa okukufutshane kufuneka kumiswe xa isixhobo sokuthintela i-reaming drill sichukumisa isixhobo sokungena. Nokuba i-distal femoral shaft iphononongiwe kuxhomekeke kubungakanani bomngxuma we-medullary buchongiwe. Ukuba i-X-ray yangaphambi kotyando ifumanisa ukuba umngxuma we-medullary we-proximal femoral shaft ucacile ukuba mxinwa, i-femoral shaft reamer kufuneka ilungiswe ngaphambi kokusebenza. Ukuba ukuphononongwa akwanelanga, kuya kwenza kube nzima ukufaka isikrufu. Ngexesha lenkqubo yokukrufula, inokushukuma kuluhlu oluncinci. Iindawo ezisecaleni ze-intramedullary nail kufuneka ziphetshwe, kodwa ukunqonqoza ngamandla emsileni we-nail kufuneka kuphetshwe. Ukunqonqoza okunjalo okurhabaxa kunokubangela ukuqhekeka kwamathambo ngokulula ngexesha lokusebenza okanye ukutshintshwa kokuqhekeka emva kokunciphisa.
Faka isingxobo sokukhusela izicubu ezithambileyo, gqobhoza ecaleni kwentambo yesikhokelo nge-drill, kwaye wandise umjelo we-proximal femoral we-intramedullary nail (umfanekiso ongasentla); ukuba i-medullary cavity incinci, sebenzisa i-reamed soft drill ukwandisa i-medullary cavity ibe bububanzi obufanelekileyo; qhagamshela isikhokelo faka i-InterTAN main nail kwi-medullary cavity (ngezantsi);
Pi-roximalLi-ock
Ukubekwa kwesikrufu se-Lag
Ukubekwa kwesikrufu sokucinezelwa
Skrufula isikhonkwane esitshixayo esikude
Ri-emoteLi-ock
Indebe yokuphela
Unyango Emva kotyando
Ii-antibiotics zazisetyenziswa rhoqo ukuthintela usulelo emva kweeyure ezingama-48 emva kotyando; i-calcium ye-heparin kunye neempompo zomoya eziphantsi kweemolekyuli zasetyenziswa ukuthintela i-deep vein thrombosis (DVT) kwimilenze esezantsi, kwaye izifo ezisisiseko zonyango zaqhubeka nokunyangwa. Ii-radiographs ezilula ze-pelvis kunye nee-radiographs ze-anteroposterior kunye ne-lateral ze-hip joint echaphazelekayo zazithathwa rhoqo ukuze kuqondwe ukunciphisa ukwaphuka kunye nokuqina kwangaphakathi.
Ngosuku lokuqala emva kotyando, isigulana sakhuthazwa ukuba senze i-isometric contraction ye-quadriceps femoris kwindawo elele kancinci. Ngosuku lwesibini, isigulana sayalelwa ukuba sihlale ebhedini. Ngosuku lwesithathu, isigulana senza umthambo wokujika i-hip kunye nedolo ebhedini. Akukho mthwalo kwilungu elichaphazelekayo. Khuthaza izigulana ezikwaziyo ukuthwala inxalenye yobunzima kwilungu elichaphazelekayo ngaphakathi koluhlu olunokunyamezeleka kwiiveki ezi-4 emva kotyando. Hamba kancinci kancinci nge-walker ethwele ubunzima ngokwe-X-ray yokulandelela kwiiveki ezi-6 ukuya kwezi-8. Izigulana ezingakwaziyo ukuhamba ngokuzimeleyo kwaye zine-osteoporosis enzima Kwizigulana ezikhula ngokuqhubekayo kwi-X-ray, zinokuhamba kancinci kancinci zithwele ubunzima phantsi kwenkxaso.
Umntu woQhagamshelwano: Yoyo (uMphathi weMveliso)
UMNXEBELO/I-Whatsapp: +86 15682071283
Ixesha lokuthumela: Meyi-08-2023
