Kunezinhlobo ezimbili zezindlela zokuhlinza, izikulufu zamapuleti nezikhonkwane ze-intramedullary, eyokuqala ihlanganisa izikulufu zepuleti ezivamile nezikulufu zepuleti lokucindezelwa kwesistimu ye-AO, kanti lokhu kwakamuva kuhlanganisa izikhonkwane ezivaliwe nezivulekile zokubuyela emuva noma ezibuyisela emuva. Inketho isekelwe endaweni ethile kanye nohlobo lokuphuka.
Ukulungiswa kwephinikhodi ye-Intramedullary kunezinzuzo zokuchayeka okuncane, ukukhumula okuncane, ukulungiswa okuzinzile, asikho isidingo sokulungiswa kwangaphandle, njll. Ifaneleka phakathi kwe-1/3, i-1/3 ephezulu ye-femur fracture, i-multi-segmental fracture, i-pathological fracture. Nge-fracture ephansi ye-1/3, ngenxa yomgodi omkhulu we-medullary kanye namathambo amaningi akhansela, kunzima ukulawula ukujikeleza kwephinikhodi ye-intramedullary, futhi ukulungiswa akuvikelekile, nakuba kungaqiniswa ngezikulufo, kodwa kufaneleka kakhulu izikulufu ze-steel plate.
Ngivula Ukulungiswa Kwangaphakathi Kokuphuka Kwe-Femur Shaft Nge-Intramedullary Nail
(1) Ukusika: I-lateral noma i-posterior lateral ye-femoral incision yenziwa igxile endaweni yokuphuka, enobude obuyi-10-12 cm, ukusika esikhumbeni kanye ne-fascia ebanzi futhi kuveza imisipha ye-femoral lateral.
I-lateral incision yenziwa emugqeni ophakathi kwe-trochanter enkulu kanye ne-condyle yangemuva ye-femur, futhi ukusika kwesikhumba kwe-posterior lateral incision kuyafana noma kancane kamuva, umehluko omkhulu ukuthi i-lateral incision ihlukanisa i-vastus lateralis muscle, kuyilapho i-posterior lateral incision ingena endaweni yangemuva ye-vastus lateral ye-muscle. 3.5.5.2-1, 3.5.5.2-2).
I-anterolateral incision, ngakolunye uhlangothi, yenziwa ngomugqa osuka emgogodleni we-iliac wangaphambili ukuya emaphethelweni angaphandle e-patella, futhi ifinyelelwa nge-lateral femoral muscle kanye ne-rectus femoris muscle, engase ilimaze imisipha ye-femoral ephakathi kanye namagatsha ezinzwa kuya ku-lateral femoral muscle namagatsha e-rotator artrely noma i-externus 3.5.5.2-3).
(2) Ukuchayeka: Hlukanisa futhi udonse umsipha we-femoral ongemuva uye phambili futhi uwufake ngesikhathi sawo nge-biceps femoris, noma usike ngokuqondile futhi uhlukanise umsipha we-femoral ongemuva, kodwa ukopha kungaphezulu. Sika i-periosteum ukuze uveze iziphetho eziphukile ezingenhla nezingezansi zokuphuka kwe-femur, futhi uveze ububanzi kuze kube sezingeni lapho ingabonwa futhi ibuyiselwe, futhi ukhumule izicubu ezithambile kancane ngangokunokwenzeka.
(3) Ukulungisa ukulungiswa kwangaphakathi: Faka isitho esithintekile, uveze isiphetho esiphukile esiseduze, faka ukuqhakaza kweplamu noma inaliti ye-intramedullary emise okuka-V, bese uzama ukukala ukuthi ukujiya kwenaliti kufaneleka yini. Uma kukhona ukuncipha komgodi we-medullary, i-expander ye-medullary cavity ingasetshenziswa ukulungisa kahle nokwandisa umgodi, ukuze kuvinjwe inaliti ukuthi ingakwazi ukungena futhi ingakwazi ukukhishwa. Lungisa umkhawulo ophukile osondelene nesibambi samathambo, faka inaliti ye-intramedullary ngokubuyisela emuva, ungene ku-femur usuka ku-trochanter enkulu, futhi lapho ukuphela kwenaliti iphusha isikhumba, yenza ukusika okuncane okungama-3cm endaweni, futhi uqhubeke ufaka inaliti ye-intramedullary kuze kube yilapho ivezwa ngaphandle kwesikhumba. Inaliti ye-intramedullary ihoxiswa, iqondiswe kabusha, idluliselwe ku-foramen kusukela ku-trochanter enkulu, bese ifakwa eduze nendiza ye-cross-section. Izinaliti ze-intramedullary ezithuthukisiwe zineziphetho ezincane eziyindilinga ezinezimbobo zokukhipha. Khona-ke asikho isidingo sokukhipha futhi ushintshe indlela, futhi inaliti ingakhishwa bese ishaywa kanye. Kungenjalo, inaliti ingafakwa ihlehliselwe emuva ngephinikhodi futhi ivezwe ngaphandle kwe-trochanteric enkulu, bese iphinikhodi ye-intramedullary ingafakwa emgodini we-medullary.
Ukubuyiselwa okwengeziwe kokuphuka. Ukuqondanisa kwe-anatomical kungafinyelelwa ngokusebenzisa amandla ephinikhodi ye-intramedullary eseduze ngokuhlangana ne-bone pry pivoting, ukudonsa, kanye nokuphuka kwe-fracture. Ukulungiswa kufinyelelwa ngesibambi samathambo, bese iphinikhodi ye-intramedullary ibe isishayelwa ukuze imbobo yokukhipha iphinikhodi iqondiswe ngemuva ukuze ihambisane nokugoba kwesifazane. Ukuphela kwenaliti kufanele kufinyelele engxenyeni efanele yokuphela kwe-distal ye-fracture, kodwa hhayi ngokusebenzisa ungqimba lwe-cartilage, futhi ukuphela kwenaliti kufanele kushiywe i-2cm ngaphandle kwe-trochanter, ukuze isuswe kamuva. (Fig 3.5.5.2-4).
Ngemva kokulungiswa, zama ukunyakaza kwengalo futhi ubheke noma yikuphi ukungazinzi. Uma kudingekile ukufaka esikhundleni senaliti ye-intramedullary enkulu, ingasuswa futhi ishintshwe. Uma kukhona ukuxega nokungazinzi okuncane, isikulufu singangezwa ukuze kuqiniswe ukulungiswa. (Umfanekiso 3.5.5.2-4).
Inxeba lagcina liguquliwe futhi lavaleka ngezingqimba. Kufakwa ibhuthi ye-plaster yokuzungeza yangaphandle.
II Plate Screw Ukulungiswa Kwangaphakathi
Ukulungiswa kwangaphakathi ngezikulufu zepuleti lensimbi kungasetshenziswa kuzo zonke izingxenye zesiqu sesifazane, kodwa i-1/3 ephansi ifaneleka kakhulu kulolu hlobo lokulungisa ngenxa yomgodi obanzi we-medullary. Ipuleti lensimbi elijwayelekile noma ipuleti lensimbi yokucindezela i-AO lingasetshenziswa. Lesi sakamuva siqinile futhi siqinile ngaphandle kokulungiswa kwangaphandle. Kodwa-ke, akekho kubo ongagwema indima yokufihla ukucindezeleka futhi ahambisane nomgomo wamandla alinganayo, okudingeka athuthukiswe.
Le ndlela inobubanzi obukhudlwana bokuxebula, ukulungiswa okwengeziwe kwangaphakathi, okuthinta ukuphulukiswa, futhi inezinkinga.
Uma kunokuntuleka kwezimo zephinikhodi ye-intramedullary, i-curvature ye-medullary ye-fracture endala noma ingxenye enkulu yokungahambeki kanye ne-1/3 engezansi yokuphuka kuyavumelana nezimo.
(1)Ukusika kwe-lateral femoral noma ngemuva kwe-lateral.
(2)(2) Ukuvezwa kokuphuka, futhi kuye ngezimo, kufanele kulungiswe futhi kulungiswe ngaphakathi ngezikulufu zamapuleti. Ipuleti kufanele ibekwe ohlangothini lwe-lateral tension, izikulufo kufanele zidlule ku-cortex nhlangothi zombili, futhi ubude bepuleti kufanele bube izikhathi ezingu-4-5 ububanzi bethambo endaweni yokuphuka. Ubude bepuleti buyizikhathi ezi-4 kuya kweziyi-8 ububanzi bethambo eliphukile. Amapuleti angama-6 kuya kwangu-8 avame ukusetshenziswa ku-femur. Izingcezu ezinkulu zamathambo ezihlanganisiwe zingalungiswa ngezikulufo ezengeziwe, futhi inani elikhulu lama-grafts amathambo lingafakwa ngesikhathi esifanayo ohlangothini oluphakathi lwe-fracture comminuted. (Fig 3.5.5.2-5).
Hlanza futhi uvale ngezingqimba. Kuye ngohlobo lwezikulufu zepuleti ezisetshenzisiwe, kwanqunywa ukuthi kusetshenziswe ukulungiswa kwangaphandle nge-plaster noma cha.
Isikhathi sokuthumela: Mar-27-2024
