Ukuphuka kwentamo ye-femoral kuwukulimala okuvamile futhi okungase kube yingozi kodokotela abahlinzayo bamathambo, ngenxa yokunikezwa kwegazi elibuthakathaka, izehlakalo zokuphulwa kwe-non-union kanye ne-osteonecrosis ziphakeme, ukwelashwa okuphelele kokuphuka kwentamo ye-femoral kuseyimpikiswano, izazi eziningi zikholelwa ukuthi iziguli ezingaphezu kweminyaka engu-65 ubudala zingabhekwa njenge-65 yeminyaka yobudala, iziguli ezingaphansi kweminyaka engu-6 ubudala zingabhekwa njenge-65 ubudala. ekhethiwe ukuze kuhlinzekwe ukulungiswa kwangaphakathi, futhi umthelela omkhulu kakhulu ekugelezeni kwegazi kubangelwa ukuphulwa kohlobo lwe-subcapsular lwentamo yesifazane. Ukuphuka kwe-subcapital yentamo ye-femoral kunomthelela omubi kakhulu we-haemodynamic, futhi ukunciphisa okuvaliwe nokulungiswa kwangaphakathi kuseyindlela yokwelapha evamile yokuphuka kwe-subcapital yentamo yesifazane. Ukwehliswa okuhle kusiza ekuqiniseni ukuphuka, ukukhuthaza ukuphulukiswa kokuphuka nokuvimbela i-necrosis yekhanda lesifazane.
Okulandelayo yisimo esijwayelekile sokuphuka kwentamo ye-femoral ukuze kuxoxwe ngokuthi kwenziwa kanjani ukulungisa kwangaphakathi okuvalekile ngesikulufu se-cannulated.
Ⅰ Ulwazi oluyisisekelo lwecala
Imininingwane yesiguli: owesilisa oneminyaka engama-45 ubudala
Isikhalazo: ubuhlungu be-hip kwesokunxele kanye nomkhawulo womsebenzi amahora angu-6.
Umlando: Isiguli sawela phansi ngenkathi sigeza, sibangela ubuhlungu ku-hip kwesokunxele kanye nomkhawulo womsebenzi, obungenakukhululeka ngokuphumula, futhi sangeniswa esibhedlela sethu ngokuphuka kwentamo ye-femur yesokunxele kuma-radiographs, futhi sangeniswa esibhedlela esimweni esicacile somqondo nomoya ompofu, ekhononda ngobuhlungu ku-hip kwesokunxele kanye nomkhawulo womsebenzi, futhi akazange akhulule ukunyakaza kwakhe ngemva kokudliwa kwesibili futhi akazange akhulule ukunyakaza kwakhe kwesibili.
Ⅱ Ukuhlolwa Komzimba (Ukuhlola Umzimba Wonke Nokuhlolwa Kochwepheshe)
T 36.8°C P87 beats/min R20 beats/min BP135/85mmHg
Ukuthuthukiswa okuvamile, ukudla okunomsoco, isimo sokungenzi lutho, isimo sengqondo esicacile, ukubambisana ekuhlolweni. Umbala wesikhumba ujwayelekile, unwebeka, awukho edema noma ukuqubuka, akukho ukwanda kwama-lymph nodes emzimbeni wonke noma endaweni. Usayizi wekhanda, i-morphology evamile, ubuhlungu bengcindezi, isisindo, izinwele ziyacwebezela. Bobabili abafundi bayalingana ngosayizi futhi bayindilinga, bane-reflex yokukhanya ebucayi. Intamo yayithambile, i-trachea yayiphakathi nendawo, indlala yegilo ayizange ikhuliswe, isifuba sasinokulinganisa, ukuphefumula kwakufinyezwa kancane, kwakungekho ukungavamile kwe-cardiopulmonary auscultation, imingcele yenhliziyo yayivamile lapho kushaywa khona, ukushaya kwenhliziyo kwakungama-87 beats / min, isigqi senhliziyo sasiyi-Qi, ubuhlungu benhliziyo babungekho, ubuhlungu be-ab bungekho, ubuhlungu be-ab bungekho. Isibindi nobende akuzange kubonakale, futhi kwakungekho ububele ezinso. Ama-diaphragms angaphambili nangemuva awazange ahlolwe, futhi kwakungekho ukukhubazeka komgogodla, izitho ezingenhla kanye nezitho ezingezansi kwesokudla, nokunyakaza okuvamile. I-physiological reflexes yayikhona ekuhlolweni kwe-neurological kanye ne-pathological reflexes ayizange ikhishwe.
Kwakungekho ukuvuvukala okusobala kwe-hip kwesokunxele, ubuhlungu obucacile bokucindezela phakathi nendawo ye-groin yesokunxele, ukukhubazeka kokujikeleza kwangaphandle kwangaphandle kwesitho esingaphansi kwesobunxele, ukuthamba kwe-axis ye-axis ephansi yesokunxele (+), ukungasebenzi kahle kwe-hip yesokunxele, ukuzwa kanye nomsebenzi wezinzwane ezinhlanu zonyawo lwesokunxele KULUNGILE, futhi ukushaya kwe-arterial foot dorsal kwakujwayelekile.
Ⅲ Izivivinyo ezisizayo
Ifilimu ye-X-ray ibonisiwe: ukuphuka kwentamo ye-femoral kwesokunxele, ukuhlukaniswa kokuphela okuphukile.
Okunye ukuhlola kwamakhemikhali ezinto eziphilayo, i-X-ray yesifuba, i-bone densitometry, kanye ne-ultrasound yombala wemithambo ejulile yezitho ezingezansi akuzange kubonise ukungavamile okusobala.
Ⅳ Ukuxilongwa kanye nokuxilongwa okuhlukile
Ngokomlando wesiguli wokuhlukumezeka, ubuhlungu be-hip kwesokunxele, ukulinganiselwa komsebenzi, ukuhlolwa ngokomzimba kwesitho esingezansi kwesokunxele sifinyeza ukukhubazeka kwangaphandle kokujikeleza, ukuzwela kwe-groin okusobala, ubuhlungu be-longitudinal axis kowtow engezansi kwesokunxele (+), ukungasebenzi kahle kwe-hip kwesokunxele, kuhlanganiswe nefilimu ye-X-ray kungatholakala ngokucacile. I-fracture ye-trochanter ingaba nobuhlungu be-hip kanye nomkhawulo womsebenzi, kodwa ngokuvamile ukuvuvukala kwendawo kuyabonakala, iphuzu lokucindezela litholakala ku-trochanter, futhi i-angle yokujikeleza yangaphandle inkulu, ngakho-ke ingahlukaniswa nayo.
Ⅴ Ukwelashwa
Ukuncishiswa okuvaliwe nokulungiswa kwangaphakathi kwezinzipho ezingenalutho kwenziwa ngemva kokuhlolwa okuphelele.
Ifilimu yangaphambi kokuhlinzwa imi kanje
Ukuqondisa ngokuzungeza kwangaphakathi nokudonsa kwesitho esithintekile ngokuthunjwa kancane kwesitho esithintekile ngemva kokubuyiselwa kanye ne-fluoroscopy kubonise ukubuyisela okuhle
Iphinikhodi ye-Kirschner yafakwa ebusweni bomzimba ohlangothini lwentamo ye-femoral ye-fluoroscopy, futhi ukusika okuncane kwesikhumba kwenziwa ngokusho kwendawo yokuphela kwephini.
Iphinikhodi eqondisayo ifakwa entanyeni yesifazane ngokuhambisana nendawo yomzimba lapho ibheke khona iphinikhodi ye-Kirschner kuyilapho igcina ukutsheka kwangaphandle okungamadigri angu-15 futhi kwenziwa i-fluoroscopy.
Iphinikhodi yesibili yomhlahlandlela ifakwa nge-femoral spur kusetshenziswa igayidi ehambisana nendawo engaphansi yendawo yephinikhodi yokuqala.
Inaliti yesithathu ishuthekwa ngokuhambisana nengemuva yenaliti yokuqala ngomhlahlandlela.
Kusetshenziswa isithombe esingemuva sexoxo esiyi-fluoroscopic, zonke izikhonkwane ze-Kirschner zibonwe zingaphakathi kwentamo yesifazane.
Gcoba izimbobo ngendlela yephini lomhlahlandlela, ulinganise ukujula bese ukhetha ubude obufanele bezipho ezigobile ezigoqwe eduze kwephinikhodi, kunconywa ukuthi kufakwe isikulufu emgogodleni we-femoral we-nail engenalutho kuqala, okungavimbela ukulahlekelwa ukusetha kabusha.
Faka isikulufu kwezinye izikulufu ezimbili ezikheniwe ngokulandelana bese ubheka phakathi
Isimo sokusikwa kwesikhumba
Ifilimu yokubuyekeza ye-postoperative
Kuhlanganiswe neminyaka yesiguli, uhlobo lokuphuka, kanye nekhwalithi yamathambo, ukulungiswa kwangaphakathi kwe-nail okuvaliwe okuvaliwe okuvaliwe, okunezinzuzo zokuhlukumezeka okuncane, umphumela oqinisekile wokulungisa, ukusebenza okulula nokulula ukukwazi kahle, kungenziwa ukucindezelwa okunamandla, isakhiwo esingenalutho sivumela ukuwohloka kwe-intracranial, futhi izinga lokuphulukiswa kwe-fracture liphezulu.
Isifinyezo
1 Ukubekwa kwezinaliti ze-Kirschner endaweni yomzimba nge-fluoroscopy kulungele ukunquma iphoyinti nesiqondiso sokufaka inaliti kanye nobubanzi bokusikwa kwesikhumba;
2 Izikhonkwane ezintathu ze-Kirschner kufanele zihambisane, ziphenduke amazombezombe, futhi zibe seduze konqenqema ngangokunokwenzeka, okusiza ekuqiniseni ukuphuka kanye nokucindezelwa kokuslayida kamuva;
3 Indawo yokungena ephansi yephinikhodi ye-Kirschner kufanele ikhethwe endaweni evelele kakhulu ye-femoral crest ukuze kuqinisekiswe ukuthi iphinikhodi iphakathi kwentamo yesifazane, kuyilapho amathiphu amaphini amabili aphezulu angasheleleka aye phambili nangemuva eduze kwe-crest evelele kakhulu ukuze kube lula ukubambelela;
4 Ungashayeli iphinikhodi ye-Kirschner ijule kakhulu ngesikhathi esisodwa ukuze ugweme ukungena endaweni ye-articular, i-drill bit ingabholwa ngomugqa wokuphuka, enye iwukuvimbela ukubhoboza ekhanda lesifazane, kanti enye ihambisana nokucindezelwa kwezinzipho ezingenalutho;
5 Izikulufu ezingenalutho ezifakwe ku-screw cishe bese zidlula kancane, hlulela ubude besikulufu esingenalutho bunembile, uma ubude bungakude kakhulu, zama ukugwema ukushintshwa njalo kwezikulufu, uma i-osteoporosis, ukushintshwa kwezikulufu ngokuyisisekelo kuba ukuqina okungavumelekile kwezikulufu, ngenxa yokubikezela kwesiguli kokulungiswa okuphumelelayo kwezikulufu, kodwa ubude bobude bezikulufu ezikulungeni bubi kakhulu kunobude be-screw. okungcono kakhulu!
Isikhathi sokuthumela: Jan-15-2024
