Ukuphuka kwentamo ye-femoral kuyisimo esivamile futhi esingaba yingozi kakhulu kodokotela abahlinzayo bamathambo, ngenxa yokutholakala kwegazi okubuthakathaka, ukwanda kokuphuka okungahlangani kanye ne-osteonecrosis kuphakeme, ukwelashwa okungcono kakhulu kokuphuka kwentamo ye-femoral kusaphikisana, izazi eziningi zikholelwa ukuthi iziguli ezingaphezu kweminyaka engama-65 ubudala zingacatshangelwa i-arthroplasty, kanti iziguli ezingaphansi kweminyaka engama-65 ubudala zingakhethwa ukuze zihlinzwe ngaphakathi, futhi umthelela omkhulu kakhulu ekugelezeni kwegazi ubangelwa ukuphuka kohlobo lwe-subcapsular kwentamo ye-femoral. Ukuphuka kwentamo ye-femoral subcapital kunomthelela omkhulu we-haemodynamic, kanti ukunciphisa okuvaliwe kanye nokulungiswa kwangaphakathi kuseyindlela yokwelapha evamile yokuphuka kwentamo ye-femoral subcapital. Ukunciphisa okuhle kusiza ekuqiniseni ukuphuka, ukukhuthaza ukuphulukiswa kokuphuka kanye nokuvimbela i-necrosis yekhanda le-femoral.
Okulandelayo yisimo esivamile sokuphuka kwentamo ye-femoral ukuze kuxoxwe ngendlela yokwenza ukulungiswa kwangaphakathi kwe-closed-displacement ngesikulufu esifakwe i-cannulated.
Ⅰ Ulwazi oluyisisekelo lwecala
Ulwazi lwesiguli: owesilisa oneminyaka engu-45 ubudala
Isikhalazo: ubuhlungu benqulu yesobunxele kanye nomkhawulo womsebenzi amahora ayi-6.
Umlando: Isiguli sawa phansi ngesikhathi sigeza, okwabangela ubuhlungu esinqeni sesobunxele kanye nokulinganiselwa kokusebenza, okwakungenakuqedwa ngokuphumula, futhi sangeniswa esibhedlela sethu ngenxa yokuphuka kwentamo ye-femur yesobunxele kuma-radiograph, futhi sangeniswa esibhedlela sisesimweni sengqondo esicacile nomoya obuthakathaka, sikhala ngobuhlungu esinqeni sesobunxele kanye nokulinganiselwa kokusebenza, futhi sasingadli futhi sasingakhululekile ekunyakazeni kwamathumbu kwaso kwesibili ngemva kokulimala.
Ⅱ Ukuhlolwa Komzimba (Ukuhlolwa Komzimba Wonke Nokuhlolwa Kochwepheshe)
T 36.8°C P87 ukushaya/min ukushaya kwe-R20/min BP135/85mmHg
Ukukhula okuvamile, ukudla okunempilo, isikhundla esingenzi lutho, ingqondo ecacile, ukubambisana ekuhlolweni. Umbala wesikhumba ujwayelekile, uyanwebeka, akukho ukuvuvuka noma ukuqubuka, akukho ukwanda kwama-lymph node angaphezulu emzimbeni wonke noma endaweni yasendaweni. Usayizi wekhanda, isimo esijwayelekile, akukho ubuhlungu bengcindezi, ubunzima, izinwele ziyacwebezela. Womabili la maqembu ayalingana ngobukhulu futhi ayindilinga, anokukhanya okuzwelayo. Intamo yayithambile, i-trachea yayigxile, i-thyroid gland yayingakhuliswanga, isifuba sasilingana, ukuphefumula kwakufinyeziwe kancane, kwakungekho ukukhubazeka ekulaleleni kwenhliziyo, imingcele yenhliziyo yayijwayelekile ekushayweni, izinga lokushaya kwenhliziyo lalingu-87/min, isigqi senhliziyo sasiyi-Qi, isisu sasiyisicaba futhi sithambile, kwakungekho ubuhlungu bengcindezi noma ubuhlungu bokubuyela emuva. Isibindi ne-spleen akuzange kutholakale, futhi kwakungekho ukuthamba ezinso. Ama-diaphragm angaphambili nangemuva awahlolwanga, futhi kwakungekho ukukhubazeka komgogodla, izitho ezingaphezulu kanye nezitho zangakwesokudla ezingezansi, ngokunyakaza okuvamile. Ama-reflex e-physiological ayekhona ekuhlolweni kwezinzwa futhi ama-reflex e-pathological awazange avele.
Kwakungekho ukuvuvukala okusobala kwesinqe sesobunxele, ubuhlungu obusobala bokucindezela maphakathi ne-groin yesobunxele, ukukhubazeka okufushane kokuzungeza kwangaphandle kwesitho esingezansi sesobunxele, ukuthamba kwe-axis ye-longitudinal axis (+), ukungasebenzi kahle kwesinqe sesobunxele, umuzwa kanye nomsebenzi wezinzwane ezinhlanu zonyawo lwesobunxele kwakulungile, kanye nokushaya kwemithambo ye-dorsal yonyawo kwakujwayelekile.
Ⅲ Ukuhlolwa kokusiza
Ifilimu ye-X-ray ibonise: ukuphuka kwentamo yesobunxele ye-femoral, ukuhlukana kwengxenye ephukile.
Okunye ukuhlolwa kwamakhemikhali, i-X-ray yesifuba, i-bone densitometry, kanye ne-color ultrasound yemithambo ejulile yemilenze engezansi akubonisanga ukukhubazeka okusobala.
Ⅳ Ukuxilongwa kanye nokuxilongwa okuhlukile
Ngokusho komlando wesiguli wokulimala, ubuhlungu be-hip kwesobunxele, ukulinganiselwa komsebenzi, ukuhlolwa ngokomzimba kokukhubazeka kokuzungeza kwangaphandle kwesitho sasekhohlo, ukuzwela kwe-groin kusobala, ubuhlungu be-longitudinal axis kowtow ye-leg engezansi kwesobunxele (+), ukungasebenzi kahle kwe-hip kwesobunxele, kuhlanganiswe nefilimu ye-X-ray kungatholakala ngokucacile. Ukuphuka kwe-trochanter kungaba nobuhlungu be-hip kanye nokulinganiselwa komsebenzi, kodwa ngokuvamile ukuvuvukala kwendawo kusobala, iphuzu lokucindezela litholakala ku-trochanter, kanti i-angle yokujikeleza yangaphandle inkulu, ngakho-ke ingahlukaniswa nayo.
Ⅴ Ukwelashwa
Ukunciphisa okuvaliwe kanye nokubopha kwangaphakathi kwezinzipho okungenalutho kwenziwa ngemuva kokuhlolwa okuphelele.
Ifilimu yangaphambi kokuhlinzwa imi kanje:
Ukuhamba ngokujikeleza kwangaphakathi kanye nokubambelela kwesitho esithintekile ngokuthathwa kancane kwesitho esithintekile ngemva kokubuyiselwa kanye ne-fluoroscopy kubonise ukubuyiselwa okuhle
Iphini likaKirschner labekwa ebusweni bomzimba ngasentanyeni ye-femoral ukuze kuhlolwe i-fluoroscopy, kwathi kwenziwa ukusikwa kwesikhumba okuncane ngokwendawo yokuphela kwephini.
Iphini yokuqondisa ifakwa entanyeni ye-femoral ehambisana nobuso bomzimba ohlangothini lwephini likaKirschner ngenkathi kugcinwa ukuthambekela kwangaphambi cishe kwama-degrees angu-15 futhi kwenziwa i-fluoroscopy
Iphini yesibili yokuqondisa ifakwa nge-femoral spur kusetshenziswa umhlahlandlela ohambisana nengxenye engezansi yesiqondiso sephini yokuqala yokuqondisa.
Inalithi yesithathu ifakwa ngokuhambisana nengemuva lenalithi yokuqala ngesiqondiso.
Kusetshenziswa isithombe se-fluoroscopic se-frog lateral, zonke izikhonkwane ezintathu ze-Kirschner zabonakala zingaphakathi kwentamo ye-femoral
Bopha imigodi ohlangothini lwephini lokuqondisa, ulinganise ukujula bese ukhetha ubude obufanele bephini lokuqondisa eligobile elifakwe ku-phini lokuqondisa, kunconywa ukuthi ubophe umgogodla we-femoral wephini lokuqondisa kuqala, okungavimbela ukulahlekelwa ukusetha kabusha.
Faka ezinye izikulufo ezimbili ezifakwe emathinini ngokulandelana bese ubona ngale
Isimo sokusikwa kwesikhumba
Ifilimu yokubuyekeza ngemva kokuhlinzwa
Kuhlanganiswe nobudala besiguli, uhlobo lokuphuka, kanye nekhwalithi yamathambo, kwakhethwa ukubopha kwangaphakathi kwezinzipho ezingenalutho, okunezinzuzo zokulimala okuncane, umphumela oqinisekile wokubopha, ukusebenza okulula nokulula ukukuqonda, ukucindezela okunamandla, isakhiwo esingenalutho sisiza ekukhululekeni kokucindezeleka ngaphakathi kwekhanda, kanye nezinga lokuphulukiswa kokuphuka liphezulu.
Isifinyezo
1 Ukubekwa kwezinaliti zikaKirschner ebusweni bomzimba nge-fluoroscopy kuyasiza ekunqumeni iphuzu kanye nesiqondiso sokufakwa kwenaliti kanye nobubanzi bokunqunywa kwesikhumba;
2 Amaphini amathathu kaKirschner kufanele abe alinganayo, aguquliwe abe yizigzag, futhi asondele onqenqemeni ngangokunokwenzeka, okusiza ekuqiniseni ukuqhekeka kanye nokucindezela okushelelayo kamuva;
3 Indawo yokungena yephini likaKirschner engezansi kufanele ikhethwe endaweni evelele kakhulu yephini eliseceleni ukuqinisekisa ukuthi iphini liphakathi nentamo yephini, kuyilapho iziqongo zezikhonkwane ezimbili eziphezulu zingashelela phambili nangemuva eceleni kwephini elivelele kakhulu ukuze kube lula ukunamathela;
4 Ungashayi iphini likaKirschner lijule kakhulu ngesikhathi esisodwa ukuze ugweme ukungena ebusweni be-articular, i-drill bit ingabhobozwa ngomugqa wokuqhekeka, enye iwukuvimbela ukubhobozwa ngekhanda le-femoral, kanti enye ivumela ukucindezelwa kwezinzipho okungenalutho;
5 Izikulufo ezingenalutho ezifakwe ngaphakathi cishe bese zidlula kancane, yahlulela ukuthi ubude besikulufo esingenalutho bunembile, uma ubude bungekude kakhulu, zama ukugwema ukushintshwa njalo kwezikulufo, uma i-osteoporosis, ukushintshwa kwezikulufo kuba ukufakwa okungavumelekile kwezikulufo, ukuze isiguli sibikezele ukufakwa kwezikulufo okuphumelelayo, kodwa ubude bezikulufo bube buncane kancane kunobude bokufakwa kwezikulufo okungasebenzi kahle bungcono kakhulu!
Isikhathi sokuthunyelwe: Jan-15-2024
