Ngokuphathelene nezikulufo zekhanda nentamo, isebenzisa umklamo wezikulufo ezimbili zezikulufo ezigobile kanye nezikulufo zokucindezela. Ukuhlanganiswa okuhlangene kwezikulufo ezimbili kuthuthukisa ukumelana nokujikeleza kwekhanda le-femoral.
Ngesikhathi senqubo yokufaka isikulufu sokucindezela, ukunyakaza kwe-axial kwesikulufu sokuvala kuqhutshwa yintambo ye-occlusal phakathi kwesikulufu sokucindezela nesikulufu sokuvala, futhi ukucindezeleka kokulwa nokujikeleza kuguqulwa kube ukucindezela okuqondile ekugcineni kokuqhekeka, ngaleyo ndlela kuthuthukisa kakhulu amandla okulwa nokujikeleza kwesikulufu. Sika ukusebenza. Izikulufu ezimbili zixhumene ndawonye ukuze kugwenywe umphumela we-"Z".
Ukwakheka kwesiphetho esiseduze nesipikili esiyinhloko kufana nokwe-prosthesis ehlangene kwenza umzimba wezipikili uvumelane kakhulu nomgodi ophakathi, futhi uvumelane kakhulu nezici ze-biomechanical ze-proximal femur.
Izinyathelo Zokuhlinzwa
Isikhundla: Isiguli singakhetha ukuma eceleni noma phansi. Isiguli sisesimweni sokulala phansi, etafuleni lokuhlinza elinemisebe noma etafuleni lokudonsa amathambo. Uhlangothi oluphilile lwesiguli luyadonswa futhi luqiniswe esibayeni, kanti uhlangothi oluthintekile luyadonswa ku-10°-15° ukuze kube lula ukuhambisana nomgodi we-medullary.
Ukusetha kabusha okunembile: Hlunga isitho esithintekile ngombhede wokudonsa ngaphambi kokuhlinzwa, bese ulungisa indlela yokudonsa ngaphansi kwe-fluoroscopy ukuze isitho esithintekile sibe sesimweni sokujika kancane kwangaphakathi kanye nokudonsa. Iningi lamathambo aphukile lingasethwa kabusha kahle. Ukusetha kabusha ngaphambi kokuhlinzwa kubaluleke kakhulu futhi Iphuzu liwukuthi, ungalisiki kalula uma kungekho ukunciphisa okwanelisayo. Lokhu kungonga isikhathi sokusebenza futhi kunciphise ubunzima ngesikhathi sokuhlinzwa. Uma ukunciphisa kunzima, ungenza i-incision encane ngesikhathi sokuhlinzwa bese usebenzisa i-push rod, i-retractor, i-reduction forceps, njll. ukusiza ekunciphiseni. Amanxeba amancane Izinhlangothi zangaphakathi nezangaphandle ziyahlukaniswa, futhi asikho isidingo sokulungisa ngokuphindaphindiwe. Isiphelo sokuphuka singasethwa kabusha ngokuzenzakalelayo lapho isikulufu sokucindezela sifakwe ngaphakathi ngesikhathi sokuhlinzwa.
Ukunciphisa i-trochanter encane: Ukwakheka kozipho lwe-intramedullary akudingi ukuqhubeka kwe-medial cortex. Ngokuvamile, asikho isidingo sokunciphisa i-lesser trochanter fracture fracture, ngoba ukusebenza kokunciphisa okuvaliwe okuncane kakhulu kunethonya elincane ekujikelezeni kwegazi kwengxenye yokuqhekeka, futhi ukuqhekeka kulula ukukwelapha. Kodwa-ke, i-coxa varus kufanele ilungiswe ngaphambi kokuba kubekwe isikulufu, futhi isikhathi sokuya phansi kanye nesikhathi sokuthwala isisindo ngemva kokuhlinzwa kufanele sibambezeleke ngokufanele.
Indawo yokusikwa: Kwenziwa ukusika okude okungu-3-5 cm ekugcineni kwe-proximal kwe-greater trochanter apex cishe ezingeni lomgogodla we-anterior superior iliac. Intambo ye-Kirschner ingafakwa ohlangothini lwangaphandle lwe-proximal femur, futhi ilungiswe ukuze ihambisane ne-axis ende ye-femur ngaphansi kwe-C-arm fluoroscopy, ukuze indawo yokusika ibe nembe kakhudlwana.
Nquma indawo yokungena: indawo yokungena iphakathi kancane nesihloko se-trochanter enkulu, okuhambisana nokuphambuka okungu-4° ohlangothini lwe-axis ende ye-medullary cavity ekubukeni kwangaphambili. Ekubukeni ohlangothini lwe-lateral, indawo yokungena kwezinzipho itholakala ku-axis ende ye-medullary cavity;
Indawo Yokungena Yenaliti
Ii-nsertGi-uidePin Fi-luoroscopy
R ngokugcwelei-eamed
Njengoba ingxenye engezansi yesipikili esikhulu se-InterTan iwugqinsi, isipikili singafakwa kuphela ngemva kokusiphinda ngokugcwele ngesikhathi sokusebenza. Ukusiphinda okuseduze kufanele kumiswe lapho idivayisi yokuvimbela ye-drill yokusiphinda ithinta ithuluzi lokungena. Ukuthi i-distal femoral shaft ilungisiwe yini kuncike ekutheni ubukhulu be-medullary cavity bunqunywa. Uma i-X-ray yangaphambi kokuhlinzwa ithola ukuthi i-medullary cavity ye-proximal femoral shaft incane ngokusobala, i-femoral shaft reamer kufanele ilungiswe ngaphambi kokuhlinzwa. Uma ukusiphinda kunganele, kuzokwenza kube nzima ukufaka isikulufu. Ngesikhathi senqubo yokusiphinda, singanyakazisa kancane. Izingxenye eziseceleni zesipikili se-intramedullary kufanele zigwenywe, kodwa ukungqongqoza ngobudlova emsileni wezipikili kufanele kugwenywe. Ukungqongqoza okunjalo okunolaka kungabangela kalula ukuqhekeka kwamathambo ngesikhathi sokusebenza noma ukuphinda kufakwe ukuphuka ngemva kokuncipha.
Faka isivikelo sezicubu ezithambile, bhoboza ngentambo yokuqondisa nge-drill, bese wandisa isiteshi se-proximal femoral sezinzipho zangaphakathi kwe-medullary (ngenhla kwesithombe); uma umgodi we-medullary umncane, sebenzisa i-drill ethambile elungisiwe ukuze wandise umgodi we-medullary ube ububanzi obufanele; xhuma umhlahlandlela faka uzipho oluyinhloko lwe-InterTAN kumgodi we-medullary (ngezansi);
Pi-roximalLi-ock
Ukubekwa kwesikulufu se-Lag
Ukubekwa kwesikulufu sokucindezela
Faka isikulufu esikhiyayo esikude
Ri-emoteLi-ock
Indebe Yokuphela
Ukwelashwa Ngemva Kokuhlinzwa
Ama-antibiotic asetshenziswa njalo ukuvimbela ukutheleleka emahoreni angu-48 ngemva kokuhlinzwa; i-heparin calcium kanye namaphampu omoya anesisindo esincane sama-molecule asetshenziswa ukuvimbela i-deep vein thrombosis (DVT) emaphethelweni angezansi, futhi izifo eziyisisekelo zezokwelapha zaqhubeka nokwelashwa. Ama-radiograph alula e-pelvis kanye nama-radiograph anteroposterior kanye nama-lateral e-hip joint athintekile athathwa njalo ukuze kuqondwe ukunciphisa ukuphuka kanye nokuqina kwangaphakathi.
Ngosuku lokuqala ngemva kokuhlinzwa, isiguli sakhuthazwa ukuba senze ukufinyela kwe-isometric kwe-quadriceps femoris endaweni yokulala kancane. Ngosuku lwesibili, isiguli sayalwa ukuba sihlale embhedeni. Ngosuku lwesithathu, isiguli senziwa ngenkuthalo izivivinyo zokujiya kwe-hip kanye nedolo embhedeni. Akukho ukuthwala isisindo esithweni esithintekile. Khuthaza iziguli ezikwaziyo ukuthwala ingxenye yesisindo esithweni esithintekile ngaphakathi kwebanga elibekezelelekayo emavikini ama-4 ngemva kokuhlinzwa. Hamba kancane kancane nomuntu ohamba ngezinyawo othwala isisindo ngokusho kokulandelwa kwe-X-ray emavikini ayi-6 kuya kwayi-8. Iziguli ezingakwazi ukuhamba ngokuzimela futhi ezine-osteoporosis enzima. Ezigulini ezinokukhula okuqhubekayo kwe-bone callus ku-X-ray, zingahamba kancane kancane zithwele isisindo ngaphansi kokusekelwa.
Umuntu Oxhumana Naye: Yoyo (Umphathi Womkhiqizo)
Ucingo/I-Whatsapp: +86 15682071283
Isikhathi sokuthunyelwe: Meyi-08-2023
