Ukuphuka kwentamo ye-Femoral kuwukulimala okuvamile futhi okungase kube yingozi kodokotela abahlinzayo bamathambo, ngenxa yokunikezwa kwegazi elibuthakathaka, izehlakalo zokuphuka okungeyona inyunyana kanye ne-osteonecrosis ziphakeme, ukwelashwa okuphelele kokuphuka kwentamo yesifazane kuseyimpikiswano, izazi eziningi zikholelwa ukuthi iziguli zingaphezu kwamandla. Iminyaka engu-65 ubudala ingacatshangelwa i-arthroplasty, futhi iziguli ezingaphansi kweminyaka engu-65 ubudala zingakhethwa ukuhlinzwa kwangaphakathi ukulungiswa, futhi umthelela omkhulu kakhulu ekugelezeni kwegazi kubangelwa ukuphulwa kohlobo lwe-subcapsular lwentamo ye-femoral.Ukuphuka kwe-subcapital yentamo ye-femoral kunomthelela omubi kakhulu we-haemodynamic, futhi ukunciphisa okuvaliwe nokulungiswa kwangaphakathi kuseyindlela yokwelapha evamile yokuphuka kwe-subcapital yentamo yesifazane.Ukuncishiswa 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 e-hip kwesokunxele kanye nokulinganiselwa komsebenzi, okwakungenakukhululeka ngokuphumula, futhi sangeniswa esibhedlela sethu ngokuphuka kwentamo ye-femur kwesokunxele kuma-radiographs, futhi wangeniswa esibhedlela esesimweni esicacile sengqondo nomoya ompofu, ekhononda ngobuhlungu be-hip kwesokunxele kanye nokulinganiselwa komsebenzi, futhi akazange adle futhi akazange azikhulule ekuthunjweni kwakhe kwesibili ngemva kokulimala.
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, akukho buhlungu bengcindezi, isisindo, izinwele ezicwebezelayo.Bobabili abafundi bayalingana ngosayizi futhi bayindilinga, bane-reflex yokukhanya ebucayi.Intamo yayithambile, uqhoqhoqho lwaluphakathi nendawo, indlala yegilo ayizange ikhuliswe, isifuba sasinokulinganisa, ukuphefumula kwaba mfushane kancane, kwakungekho okungavamile ku-cardiopulmonary auscultation, imingcele yenhliziyo yayivamile lapho kushaywa, ukushaya kwenhliziyo kwakungama-87 beats / min, isigqi senhliziyo kwakungu-Qi, isisu sasiyisicaba futhi sithambile, abukho ubuhlungu bengcindezi noma ubuhlungu obuphindelelayo.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 yesokunxele, ubuhlungu bengcindezi obusobala phakathi nendawo ye-groin yesokunxele, ukukhubazeka kokujikeleza kwangaphandle kwesitho esingaphansi kwesokunxele, ukuthamba kwe-axis ye-longitudinal yomlenze wesobunxele (+), ukungasebenzi kahle kwe-hip kwesokunxele, ukuzwa kanye nomsebenzi izinzwane ezinhlanu zonyawo lwesokunxele zazilungile, futhi ukushayeka komthambo ongemuva wonyawo 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, ukuthamba kwe-groin kusobala, ubuhlungu be-lengitudinal longitudinal longitudinal axis kowtow ubuhlungu (+), ukungasebenzi kahle kwe-hip kwesokunxele, kuhlangene ifilimu ye-X-ray ingatholakala 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 ukubuyiselwa 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 besipikili esingenalutho esikulufiwe eduze kwephinikhodi, kunconywa ukuthi kufakwe isikulufu emgogodleni wesipikili esingenalutho kuqala, okungavimbela ukulahlekelwa setha kabusha.
Jikela kwesinye isikulufu esifakwe ngamathini amabili ngemva kwesinye bese ubona nge
Isimo sesikhumba sokusikwa
Ifilimu yokubuyekeza ye-postoperative
Kuhlanganiswe neminyaka yesiguli, uhlobo lokuphuka, kanye nekhwalithi yamathambo, ukulungiswa kwangaphakathi kwe-nail okuvaliwe okuvaliwe okuvaliwe, okunezinzuzo zokuhlukumezeka okuncane, umphumela wokulungisa oqinisekile, ukusebenza okulula nokulula ukukwazi, kungenziwa ukucindezela okunamandla, isakhiwo esingenalutho sifanelekile. ekuwohlokeni kwe-intracranial, futhi izinga lokuphulukiswa kokuphuka 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 ukuqinisekisa ukuthi iphini liphakathi nentamo yesifazane, kuyilapho amathiphu amaphini amabili aphezulu angasheleleka aye phambili nangemuva eduze kwe-crest evelele kakhulu. ukwenza lula ukubambelela;
4 Ungashayeli iphinikhodi ye-Kirschner ijule kakhulu ngesikhathi esisodwa ukuze ugweme ukungena endaweni eyi-articular, i-drill bit ingabholwa ngomugqa wokuphuka, enye iwukuvikela ukubhoboza ekhanda lesifazane, kanti enye ivumela uzipho olungenalutho. ukucindezela;
5 Izikulufu ezingenalutho ezikulufiwe cishe bese zidlula kancane, hlulela ubude besikulufu esingenalutho bunembile, uma ubude bude bungekho kude kakhulu, zama ukugwema ukushintshwa njalo kwezikulufu, uma i-osteoporosis, ukushintshwa kwezikulufu ngokuyisisekelo kuba okungavumelekile. yezikulufo, ukuze kubikezelwe isiguli ukuqina okusebenzayo kwezikulufu, kodwa ubude bobude bezikulufi bubi kakhulu kunobude bokulungisa okungasebenzi kwezikulufu kungcono kakhulu!
Isikhathi sokuthumela: Jan-15-2024
