Kunezinhlobo ezimbili zezindlela zokuhlinza, izikulufo zepuleti kanye nezikhonkwane ze-intramedullary, eyokuqala ifaka izikulufo zepuleti ezijwayelekile kanye nezikulufo zepuleti zokucindezela uhlelo lwe-AO, kanti eyesibili ifaka izikhonkwane ze-retrograde noma ze-retrograde ezivaliwe nezivulekile. Ukukhetha kusekelwe endaweni ethile kanye nohlobo lokuphuka.
Ukufakwa kwephini ngaphakathi kwe-medullary kunezinzuzo zokuchayeka okuncane, ukukhumula okuncane, ukuqina okuzinzile, asikho isidingo sokufakwa kwangaphandle, njll. Kufanelekile ukuphuka kwe-1/3 ephakathi, ukuphuka kwe-femur ephezulu ye-1/3, ukuphuka kwezingxenye eziningi, ukuphuka kwe-pathological. Ekuqhekekeni kwe-1/3 engezansi, ngenxa yomgodi omkhulu we-medullary kanye namathambo amaningi akhanselayo, kunzima ukulawula ukujikeleza kwephini ngaphakathi kwe-medullary, futhi ukuqina akuphephile, yize kungaqiniswa ngezikulufo, kodwa kufaneleka kakhulu kuzikulufo zepuleti lensimbi.
Ukulungiswa Kwangaphakathi Okuvulekile Kokuphuka Komgodi We-Femur Ngezinzipho Zangaphakathi
(1) Ukusikwa: Ukusikwa kwe-femoral lateral noma posterior lateral kwenziwa phakathi nendawo yokuphuka, ubude obuyi-10-12 cm, okusika isikhumba kanye ne-fascia ebanzi bese kwembula imisipha ye-femoral lateral.
Ukusikwa kwe-lateral kwenziwa emgqeni ophakathi kwe-trochanter enkulu kanye ne-lateral condyle ye-femur, kanti ukusikwa kwesikhumba kwe-posterior lateral incision kuyafana noma kamuva kancane, umehluko omkhulu ukuthi i-lateral incision ihlukanisa imisipha ye-vastus lateralis, kuyilapho i-posterior lateral incision ingena esikhaleni sangemuva semisipha ye-vastus lateralis ngemisipha ye-vastus lateralis. (Isithombe 3.5.5.2-1, 3.5.5.2-2).
Ngakolunye uhlangothi, ukusikwa kwe-anterolateral kwenziwa ngomugqa osuka emgogodleni we-anterior superior iliac kuya emaphethelweni angaphandle e-patella, futhi kufinyelelwa kuwo ngemisipha ye-lateral femoral kanye nemisipha ye-rectus femoris, okungalimaza imisipha ye-intermediary femoral kanye namagatsha ezinzwa emsipha we-lateral femoral kanye namagatsha e-rotator femoris externus artery, ngakho-ke akuvamile noma akukaze kusetshenziswe (Isithombe 3.5.5.2-3).
（2） Ukuvezwa: Hlukanisa bese udonsa imisipha ye-lateral femoral phambili bese uyifaka ngesikhathi sayo esiphakathi ne-biceps femoris, noma usike futhi uhlukanise ngqo imisipha ye-lateral femoral, kodwa ukopha kukhulu. Sika i-periosteum ukuze uveze iziphetho eziphukile eziphezulu nezingezansi zokuphuka kwe-femur, bese wembula ububanzi ngezinga lokuthi bungabonakala futhi bubuyiselwe, bese ususa izicubu ezithambile kancane ngangokunokwenzeka.
（3）Ukulungisa ukuqina kwangaphakathi: Khipha isitho esithintekile, uveze ingxenye ephukile eseduze, faka i-plum blossom noma inaliti ye-intramedullary enomumo ongu-V, bese uzama ukukala ukuthi ubukhulu benaliti bufanelekile yini. Uma kukhona ukuncishiswa kwendawo ye-medullary, i-medullary cavity expander ingasetshenziswa ukulungisa nokukhulisa indawo kahle, ukuze kuvinjelwe inaliti ukuthi ingakwazi ukungena futhi ingakwazi ukukhishwa. Lungisa ingxenye ephukile eseduze ngesibambi sethambo, faka inaliti ye-intramedullary emuva, ungene ku-femur usuka ku-trochanter enkulu, futhi lapho ingxenye yenaliti isunduza isikhumba phezulu, yenza ukusika okuncane okungu-3cm endaweni, bese uqhubeka nokufaka inaliti ye-intramedullary uze ivezwe ngaphandle kwesikhumba. Inaliti ye-intramedullary iyahoxiswa, iqondiswe kabusha, idlule ku-foramen usuka ku-trochanter enkulu, bese ifakwa eduze kwendawo evundlile. Izinaliti ze-intramedullary ezithuthukisiwe zineziphetho ezincane eziyindilinga ezinezimbobo zokukhipha. Khona-ke asikho isidingo sokukhipha nokushintsha indlela, futhi inaliti ingabhobozwa bese ibhobozwa kanye. Ngaphandle kwalokho, inaliti ingafakwa emuva ngephini yokuqondisa bese ivezwa ngaphandle kwe-groove trochanteric incision, bese iphini yangaphakathi ingafakwa emgodini we-medullary.
Ukubuyiselwa okuqhubekayo kokuphuka. Ukulungiswa kokwakheka komzimba kungatholakala ngokusebenzisa i-leverage yephini ye-intramedullary eseduze ne-bone pry pivoting, traction, kanye ne-fracture topping. Ukuqina kufezwa ngesibambi sethambo, bese iphini ye-intramedullary iqhutshwa ukuze imbobo yokukhipha iphini iqondiswe ngemuva ukuze ivumelane nokugoba kwe-femoral. Ukuphela kwenaliti kufanele kufinyelele engxenyeni efanele yokuphela okude kokuphuka, kodwa hhayi ngengqimba ye-cartilage, futhi ukuphela kwenaliti kufanele kushiywe ku-2cm ngaphandle kwe-trochanter, ukuze isuswe kamuva. (Umfanekiso 3.5.5.2-4).
Ngemva kokuqinisa, zama ukunyakaza okungashukumi kwesitho bese ubona noma yikuphi ukungaguquguquki. Uma kudingeka ukufaka esikhundleni senalithi ejiyile yangaphakathi kwe-medullary, ingasuswa bese ifakwa esikhundleni sayo. Uma kukhona ukukhululeka okuncane nokungaguquguquki, kungafakwa isikulufu ukuze kuqiniswe ukuqinisa ukuqinisa. (Umfanekiso 3.5.5.2-4).
Ekugcineni inxeba lahlanzwa futhi lavalwa ngezingqimba. Kufakwa ibhuzu leplasta eliphikisana nokujikeleza kwangaphandle.
Ukulungiswa Kwangaphakathi Kwesikulufa Sepuleti II
Ukuqinisa kwangaphakathi ngezikulufo zepuleti lensimbi kungasetshenziswa kuzo zonke izingxenye zesiqu se-femoral, kodwa ingxenye engezansi engu-1/3 ifaneleka kakhulu kulolu hlobo lokuqinisa ngenxa yomgodi obanzi we-medullary. Ipuleti lensimbi elijwayelekile noma ipuleti lensimbi yokucindezela i-AO lingasetshenziswa. Leli lokugcina liqinile futhi liqinile ngaphandle kokuqinisa kwangaphandle. Kodwa-ke, akekho kubo ongagwema indima yokuvala ukucindezeleka futhi avumelane nomgomo wamandla alinganayo, okudingeka athuthukiswe.
Le ndlela inobubanzi obukhulu bokuhlubuka, ukuqina kwangaphakathi okwengeziwe, okuthinta ukuphulukiswa, futhi inezinkinga.
Uma kungekho izimo ze-intramedullary pin, ukugoba kwe-medullary medullary endala noma ingxenye enkulu yendlela engadluleki kanye nengxenye engezansi ye-1/3 yokuqhekeka kuvumelana nezimo kalula.
(1) Ukusikwa kwe-femoral noma kwe-lateral incision.
(2)(2) Ukuvezwa kokuqhekeka, futhi kuye ngezimo, kufanele kulungiswe futhi kulungiswe ngaphakathi ngezikulufo zepuleti. Ipuleti kufanele libekwe ohlangothini lokucindezeleka oluseceleni, izikulufo kufanele zidlule ku-cortex ezinhlangothini zombili, futhi ubude bepuleti kufanele bube izikhathi ezingu-4-5 zobubanzi bethambo endaweni yokuqhekeka. Ubude bepuleti buphindwe izikhathi ezingu-4 kuya kwezingu-8 ubukhulu bethambo eliqhekekile. Amapuleti ayizimbobo ezingu-6 kuya kwezingu-8 avame ukusetshenziswa ku-femur. Izingcezu ezinkulu zamathambo ezihlanganisiwe zingalungiswa ngezikulufo ezengeziwe, futhi inani elikhulu lama-graft amathambo lingabekwa ngesikhathi esifanayo ohlangothini oluphakathi lokuqhekeka okuhlanganisiwe. (Isithombe 3.5.5.2-5).
Hlanza bese uvala ngezendlalelo. Kuye ngohlobo lwezikulufo zepuleti ezisetshenzisiwe, kwanqunywa ukuthi kufanele kufakwe i-fixation yangaphandle nge-plaster noma cha.
Isikhathi sokuthunyelwe: Mashi-27-2024
