Ukulimazeka kwentamo yabesifazane kungukulimala okujwayelekile futhi okulimazayo kodokotela abahlinzayo be-orthopedic, ngenxa yokupheliswa kwegazi okubuthakathaka, iziguli eziningi zikholelwa ukuthi iziguli ezingaphezu kweminyaka engama-65 ubudala zingabhekwa njengezinhlobonhlobo zeminyaka yobudala engama-65 ubudala zingakhethwa ngokulungiswa kwangaphakathi Ukuhlinzwa, kanye nomthelela omkhulu kakhulu ekuhambeni kwegazi kubangelwa ukwahlukaniswa kohlobo lwe-subsapsure entanyeni yabesifazane. Ukuqhekeka kwe-subcapital yentamo yabesifazane kunomthelela onzima kakhulu we-haemodynamic, futhi ukuncishiswa okuvaliwe nokulungiswa kwangaphakathi kuseyindlela yokwelashwa ejwayelekile yokuqhekeka kwentamo yabesifazane. Ukuncishiswa okuhle kunesimo sokuzinza ukwaphulwa, ukukhuthaza ukuphulukiswa kwe-fracture kanye nokuvimbela i-femol head necrosis.
Lokhu okulandelayo kuyicala elijwayelekile le-Femol Floveral New Subcapital Fracture ukuze uxoxe ngokuthi ungawenza kanjani ukuvalwa kwangaphakathi okuvaliwe ngesikulufa esixhunyiwe.
Ⅰ imininingwane eyisisekelo yecala
Imininingwane yesineke: Owesilisa oneminyaka engama-45 ubudala
Isikhalazo: Ubuhlungu be-hip besokunxele kanye nomkhawulo womsebenzi amahora angu-6.
UMLANDO: Isiguli sawa phansi ngenkathi sigeza, sibangela izinhlungu okhalweni olungakwesobunxele kanye nomkhawulo womsebenzi we-fomur wesobunxele emisebeni yesobunxele emisebeni yesobunxele emisebeni yangakwesobunxele, futhi wamukelwa futhi wawungazange adle naye futhi engazange adle ngokwakhe amathumbu ngemuva kokulimala.
Ukuhlolwa ngokomzimba (wonke umzimba hlola & isheke lochwepheshe)
T 36.8 ° C P87 Beats / Min R20 Beats / Min BP135 / 85MmHG
Ukuthuthuka okujwayelekile, ukondliwa okuhle, isikhundla esibonakalayo, imcabango ecacile, ngokubambisana ekuhlolweni. Umbala wesikhumba ujwayelekile, i-elastic, akukho i-edema noma i-adema, akukho ukwandiswa kwezindawo ze-lymph ezingekho emzimbeni wonke noma endaweni yendawo. Ubukhulu bekhanda, i-morphology ejwayelekile, akukho buhlungu bokucindezela, isisindo, izinwele ezicwebezelayo. Bobabili abafundi balingana ngosayizi futhi bayindilinga, nge-Reflex ebucayi yokukhanya. Intamo yayithambile, i-trachea yayigxile, indlala yegilo ayikhuli, isifuba sasincishiswa kancane, ukuphefumula kwenhliziyo kwakuyinto enobuhlungu be-purcuscion, kwakungekho buhlungu bezinhliziyo noma buhlungu. Isibindi noSplen abatholwanga, futhi kwakungekho sisa ezinsiyeni. I-anterior ne-posterior diaphragms ayihloliwe, futhi kwakungekho zingasebenzi komgogodla, izinyawo eziphezulu kanye nemilenze ephansi yangakwesokudla, ngokunyakaza okujwayelekile. Ukukhalipha komzimba kwakukhona ekuhlolweni kwemizwa kanye nokukhalipha kwe-pathological akuzange kukhanye.
Kwakungekho ukuvuvukala okusobala kwe-hip yangakwesobunxele, izinhlungu zokucindezela ezibonakalayo ezikuphakathi kwe-groin yangakwesobunxele, ukuncipha kwangaphandle ukuqubuka kwesobunxele, ukujula kwe-hip axituninal axis axis axis, +
Ⅲ Ukuhlolwa okusizayo
Ifilimu le-X-ray likhonjisiwe: I-Feat Feoferal New Fembutha Ye-Subcapital Fracture, ukuhanjiswa kwesiphetho esaphukile.
Konke okunye ukuhlolwa kwe-biochemical, isifuba i-X-ray, i-bone densitometry, kanye nemibala ye-ultrasound yemithambo ejulile yemilenze ephansi ayikhombisanga lutho olungajwayelekile.
Ⅳ Ukuxilongwa kanye nokuxilongwa okuhlukile
Ngokusho komlando wesiguli wobuhlungu, ubuhlungu be-hip, umkhawulo womsebenzi, ukuhlolwa ngokomzimba kwemthobe ephansi kwesobunxele okunciphisa ubuhlakani bokujikeleza kwangaphandle kwe-axis, +), ifilimu yesobunxele yesobunxele, kuhlanganiswe nefilimu ye-X-ray kungatholakala ngokucacile. Ukuqhekeka kwe-trochanter nakho kungaba nobuhlungu be-hip kanye nomkhawulo womsebenzi, kepha imvamisa ukuvuvukala kwendawo kusobala, iphuzu lokucindezela litholakala e-trochanter, futhi i-angle yokujikeleza kwangaphandle ikhudlwana, ngakho-ke ingahlukaniswa nayo.
Ⅴ Ukwelashwa
Ukuncishiswa okuvaliwe kanye nokulungiswa kwangaphakathi okungekho ezweni kwenziwa ngemuva kokuhlolwa okuphelele.
Ifilimu epristiation limi ngokulandelayo
Maneuver ngokujikeleza kwangaphakathi kanye nokutholwa komlenze othintekile ngokuthunjwa okuncane kwe-lingb ethintekile ngemuva kokubuyiselwa kanye ne-fluoroscopy kukhombise ukubuyiselwa okuhle
Iphini le-kirschner libekwe phezu komhlaba oqonde ngqo entanyeni yabesifazane nge-fluoroscopy, futhi kwenziwa isikhumba esincane esenziwe ngokuya ngendawo ukuphela kwe-PIN.
I-PIN yomhlahlandlela ifakwe emgwanyeni wesifazane ifana nendawo yomzimba endaweni ye-KIRSchner PIN ngenkathi igcina ukutsheka okungaphandle kwamadigri ayi-15 ne-fluoroscopy kwenziwa
I-PIN yesiQinikelayo yesibili ifakwe ngokusebenzisa isisulu sowesifazane usebenzisa umhlahlandlela ohambisana nalokhu okuphansi kokuqondiswa kwe-PIN yeGue.
Inaliti yesithathu ifakwa ngokufana ngemuva kwenaliti yokuqala ngesiqondisi.
Usebenzisa isithombe se-fluoroscopic se-fluoroscopic, zonke izikhonkwane ezintathu ze-kirschner zabonwa zisentanyeni yabesifazane
Drill izimbobo ekuqondisweni kwe-PIN yesiqondisi, ulinganise ukujula bese ukhetha ubude obufanele bepipi elingenalutho eceleni kwe-PIN ye-PIN, kuyanconywa ukuklwebheka komgogodla we-hollow nail kuqala, okungavimba ukulahlekelwa kabusha kokusetha kabusha.
Isikulufa kwesinye isikulufo ezimbili ezihlanziwe ngenye indawo bese ubona nge
Isimo sesikhumba se-incision
Ifilimu lokubuyekezwa kwe-postoperative
Kuhlanganiswe nobudala besiguli, uhlobo lwe-Fracture, nekhwalithi yethambo, ukuncishiswa okuvaliwe kwangaphakathi kwezipikili kwakhethwa, okusebenza kahle, kungahle kube lula ukucindezelwa, kungahle kube lula ukucindezelwa, futhi izinga lokuphulukisa elinamandla liphezulu.
Ukubeka kafushane
1 Ukubekwa kwezinaliti zeKirschner emzimbeni womzimba nge-fluoroscopy kunesifiso sokuthola iphuzu nokuqondisa kokufakwa kwenaliti kanye nobubanzi bokuvela kwesikhumba;
2 Izikhonkwane ezintathu zeKistschner kufanele zibe njenge-zigzag ehambisanayo, ezihlangene, bese zisondela emaphethelweni ngangokunokwenzeka, okulungele ukuqina kokuzinza kanye nokucindezelwa kwesikhathi kamuva;
3 Iphoyinti lokungena le-Kirschner Pin kufanele likhethwe endaweni evelele kakhulu yakamuva ye-Lateral Crest ukuqinisekisa ukuthi i-PIN iphakathi kwentamo yabesifazane, ngenkathi amathiphu wezikhonkwane ezimbili eziphezulu angavukela phambili futhi abuyele emuva kanye ne-crest evelele kakhulu ukwenza ukubambelela;
4 Musa ukushayela i-kirschner pin ejulile kakhulu ngasikhathi sinye ukugwema ukungena ebusweni bendabuko, i-drill bit ingahle idonswe ngomugqa we-fracture, umuntu ukuvikela ukumba ngekhanda lowesifazane, kanti elinye lilungele ukucindezelwa kwezipikili ezingenalutho;
Izikulufa eziyize ziklebhule zibe cishe ngokucishe zibe kancane, ukwahlulela ubude besikulufa esingenalutho kuqondile, uma ubude bungekude kakhulu, ukuthola ukufakwa kwezikulumo, ukufakwa esikhundleni kwesikhashana kube kubi kakhulu ukwedlula ubude bokulungiswa okungasebenzi kahle!
Isikhathi Seposi: Jan-15-2024
