Kunezinhlobo ezimbili zezindlela zokuhlinza, izikulufu zeplanethi kanye nezikhonkwane ze-intramenduvary, owayengukuqala kufaka phakathi izikulufo ezijwayelekile zepuleti kanye nezikulufo zohlelo lwe-ao compression cloeple Ukukhetha kususelwa kwisiza esithile nohlobo lokuqhekeka.
Ukulungiswa kwe-Intramentary Pin kunezinzuzo zokuvezwa okuncane, ukugaya okuncane, ukulungiswa okuzinzile, asikho isidingo sokulungiswa kwangaphandle, njll. Ilungele ukuphazamiseka okuphakathi nendawo, ukuqhekeka kwe-multi-segmental, ukuqhekeka kwe-pathological. Okwe-1/3, ngenxa ye-cavity enkulu ye-medullary kanye nethambo eliningi le-medullary kanye nethambo eliningi elikhanyisiwe, kunzima ukulawula ukujikeleza kwe-PIN ye-intramedullary, futhi ukulungiswa akuphephile, kepha kufanelekile ngezikulufo zeplate yensimbi.
Ngiyakuvulela ukulungiswa kwangaphakathi kwe-fracture ye-femur shaft nge-intramedullary nail
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I-lateral incision yenziwa emugqeni phakathi kwe-trochanter enkulu kanye ne-wateral eyonansi ye-femur, kanye nokwehluka kwesikhumba okuvela kamuva nje, kanti ukuvela kwangemuva kwangemuva kungena isikhathi sokuvalwa kwangemuva kwemisipha ye-vastous latalis ngokusebenzisa umsipha we-vastous latalis. (Umkhiwane 3.5.5.2-1,3.5.5.2-2).
Ukuvela kwe-anterelateral, ngakolunye uhlangothi, kwenziwa ngomugqa ovela emgogodleni ophakeme we-Iliac emaphethelweni angaphandle e-patella, futhi kutholakala imisipha yabesifazane yasemuva kanye namagatsha e-rotator femoris artery, futhi ngenxa yalokho akuvamile noma akukaze kusetshenziswe (umkhiphelo 3.5.5.2-3).
. Sika i-periosteum ukuze uveze imiphetho ephukile nangaphansi ephukile yokuqhekeka kwe-femur, futhi uveze ubukhulu ngezinga elingakanani bungabonwa futhi bubuyiselwe, bese ukhumula izicubu ezithambile ngangokunokwenzeka.
. Uma kunokuncishiswa kwe-medullary cavity, i-medullary cavity Excander ingahle isetshenziselwe ukulungisa kahle nokwandisa umgodi, ukuze ivimbele ngenalithi ngokungakwazi ukungena futhi ukungakwazi ukukhishwa. Lungisa isiphetho esiphukile esiphethe ithambo, faka inaliti ye-intramerary ngokuqondile, ungene endaweni ye-Frochanter, lapho ukuphela kwenaliti kudlulela khona isikhumba, bese uqhubeka nokufaka inaliti ye-intramerary kuze kube yilapho kuvezwa ngaphandle kwesikhumba. Inaliti ye-intramentary ihoxisiwe, iqondiswe kabusha, idlule kwi-foramen kusuka ku-trochanter enkulu, bese ifaka umdlandla endizeni yesigaba sesiphambano. Izinaliti ezithuthukisiwe ze-intrametuvary zineziphetho ezincane eziyindilinga ezinezimbobo zokukhishwa. Lapho-ke asikho isidingo sokukhipha futhi sishintshe indlela, futhi inaliti ingagawulwa bese iphawulwa kanye. Ngenye indlela, inaliti ingafakwa ukubuyisa kabusha nge-PIN yomhlahlandlela futhi ivezwe ngaphandle kwe-Greater Trochanterteric Incision, bese iphini le-intramerary lingafakwa emgodini we-medullary.
Ukubuyiselwa okunye kokuqhekeka. Ukuqondanisa kwe-anatomical kungatholakala ngokusebenzisa isisekelo se-proximal intramenduval PIN ngokuhlangana ne-Bone Pry Pivoting, TracTaction, kanye ne-Fracture topping. Ukulungiswa kutholakala nomnikazi wethambo, futhi i-PIN ye-Intramentary iqhutshwa ukuze umgodi wokukhishwa kwe-PIN uqondiswe ngemuva ukuze uvumelane nokuhlaselwa kwabesifazane. Ukuphela kwenaliti kufanele kufinyelele engxenyeni efanele yokuphela kokuphela kokuqhekeka, kepha hhayi ngongqimba lwe-cartilage, futhi ukuphela kwenaliti kufanele kushiywe 2cm ngaphandle kwe-trochanter, ukuze kususwe kamuva.
Ngemuva kokulungiswa, zama ukunyakaza okusheshayo kwe-ling bese ubheka noma yikuphi ukungazinzi. Uma kudingekile ukufaka esikhundleni senaliti enkulu ye-intramelvary, ingasuswa futhi ithathelwe indawo. Uma kunokukhulula okuncane nokungakwazi, isikulufa singangezwa ukuze siqinise ukulungiswa. (Fig 3.5.5.2-4).
Isilonda sagcina sifushelwe futhi savalwa ngezingqimba. I-anti-yangaphandle yokujikeleza kwe-rotation boot iyafakwa.
II Plate Screw Focing Yangaphakathi
Ukulungiswa kwangaphakathi ngezikulufo zensimbi zensimbi zingasetshenziswa kuzo zonke izingxenye zesiqu sowesifazane, kepha i-1/3 ephansi ilungele lolu hlobo lokulungiswa ngenxa ye-cavity ebanzi. Ipuleti yensimbi ejwayelekile noma ipuleti yensimbi yokucindezela kwe-AO ingasetshenziswa. Okokugcina kuqinile futhi kulungiswe ngokuqinile ngaphandle kokulungiswa kwangaphandle. Kodwa-ke, akekho noyedwa ongakugwema iqhaza le-Stress Masking futhi uvumelane nomgomo wamandla alinganayo, okudinga ukwenziwa ngcono.
Le ndlela inebanga elikhudlwana elikhonkotha, ukulungiswa okwengeziwe kwangaphakathi, okuthinta ukuphulukiswa, futhi kunamaphutha.
Lapho kunokuntuleka kwezimo ze-PIN ye-Intramengrary, i-Old Fracture Medullary Curvature noma ingxenye enkulu yokungahambi kahle futhi ephansi 1/3 yokuqhekeka kwe-Fracture iyavumelana nezimo.
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(2) (2) Ukuvezwa kokuqhekeka, futhi kuya ngezimo, kufanele kulungiswe futhi kulungiswe ngaphakathi ngezikulufa zeplate. Ipuleti kufanele libekwe ohlangothini lwengxabano ye-lateral, izikulufo kufanele zidlule kwi-cortex ezinhlangothini zombili, futhi ubude bepuleti kufanele bube yizikhathi ezingama-4-5 ububanzi bethayi. Ubude bepuleti buhlandwe amahlandla ama-4 kuye kwayisishiyagalombili ububanzi bethambo elikhubazekile. Amapuleti ayi-6 kuye kwayi-8 asetshenziswa kakhulu ku-femur. Izicucu ezinkulu zamathambo ezibekiwe zingalungiswa ngezikulufo ezingezekile, futhi inani elikhulu le-Bone Graffs lingabekwa ngesikhathi esifanayo ohlangothini lwe-medial lokuqhekeka okususiwe. (Fig 3.5.5.2-5).
Hlambulula futhi uvale izingqimba. Kuya ngohlobo lwezikulufo zeplate ezisetshenzisiwe, kwathathwa isinqumo sokuthi noma cha ukusebenzisa ukulungiswa kwangaphandle noma ngodaka.
Isikhathi Sokuthumela: Mar-27-2024
