Ama-Proximal Femoral Fractures ajwayele ukubonwa ukulimala kwemitholampilo okuvela ekuhlukunyezweni kwamandla aphezulu. Ngenxa yezimpawu ze-anatomical ze-femur ye-proximal, umugqa we-fracture uvame ukuvala indawo enobungqabavu futhi unganwebeka ekuhlanganiseni, okwenza kungalungele ukulungiswa kwezipikili. Ngenxa yalokho, ingxenye ebalulekile yamacala isancike ekuhlelweni kusetshenziswa ipuleti nohlelo lwesikulufa. Kodwa-ke, izici ze-biomechanical zamapuleti ahlelwe ngokuhlelekile zibeka engcupheni enkulu yezinkinga ezinjengokuhluleka kokulungiswa kwepuleti yamuva, ukuqhuma kwangaphakathi kokulungiswa, nokukhipha isikulufa. Ukusetshenziswa kosizo lwepuleti ye-Medial Plate ngokulungile, yize kusebenza ngempumelelo, kuza nezingqinamba zenhlekelele ekhuphukile, isikhathi eside sokuhlinza, ubungozi obukhulayo bokutheleleka kwezokuxhumana, futhi wengeza umthwalo wezezimali ezigulini.
Ngokuchazwa lokhu kucatshangelwa, ukuze kufinyelelwe ukulinganisela okunengqondo phakathi kwezingqinamba ze-biomechanical zamapuleti angashadile kanye nokuhlungwa okuhlangene okuhambisana nokusetshenziswa kwezindawo zokuhlelwa kwepuleti ezilandelanayo ngohlangothi lwe-percutaneous ohlangothini lwe-medial. Le ndlela ikhombise imiphumela ethandekayo yemitholampilo.
Ngemuva kwe-anesthesia, isiguli sibekwa endaweni ephakeme.
Isinyathelo 1: Ukuncishiswa kwe-Fracture. Faka inaliti yeKopher engu-2.0mm ku-TIBIAL TULUBOGE, TREACTACTUS ukusetha kabusha ubude be-LINB, bese usebenzisa i-Knee Pad ukulungisa indawo efudumele yendiza yakwaSagittal.
Isinyathelo 2: Ukubekwa kwepuleti lensimbi elemuva. Ngemuva kokuncishiswa okuyisisekelo nge-traction, khuluma ngqo ne-femur ye-distal lateral, khetha ubude bokukhiya obukhulu ukuze ulondoloze ukuncishiswa, bese ufaka izikulufo ezimbili ezindaweni zokuqhekeka ezikude nokude nokuphumelelwa. Ngalesi sikhathi, kubalulekile ukuqaphela ukuthi izikulufo ezimbili ezihlanekezelwe kufanele zibekwe eduze nangaphambi ngangokunokwenzeka ukugwema ukuthinta ukubekwa kwezikulufo ezingcolile.
Isinyathelo 3: Ukubekwa kwezikulufa zekholomu ye-Medial. Ngemuva kokuzinza ukwaphuka ngeplate yensimbi elemuva, sebenzisa i-2.8mm isikulumo esiqondiswa ngokuqondisa ukuze ungene kwi-Medial Collowle, ne-Point Point etholakala endaweni ephakathi noma ngemuva kokuya phezulu kwebhulokhi. Ngemuva kokuncishiswa kwe-fluoroscopy egculisayo, sebenzisa i-5.0mm drill ukudala umgodi bese ufaka isikulufa sethambo le-7.3mm akhanyiselwe.
Umdwebo obonisa inqubo yokuncipha nokulungiswa. Owesifazane oneminyaka engama-74 ubudala onokwehla kwabesifazane kwangemuva kwe-Intra-articular (AO 33C1). . . (D) isithombe se-fluoroscopy esibonisa isikhundla esigculisayo socingo lomhlahlandlela we-medial; .
Ngesikhathi senqubo yokuncipha, kubalulekile ukubheka amaphuzu alandelayo:
(1) Sebenzisa ucingo lomhlahlandlela ngesikulufa. Ukufakwa kwezikulufo zekholamu ye-Medial Compulan kuyanda kakhulu, futhi usebenzisa ucingo lomhlahlandlela ngaphandle kwesikulufa kungaholela ekhoneni eliphakeme ngesikhathi sokumba ngomculo, okwenza kuthambekele ekusheleleni.
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(3) Ezigulini ezinama-osteoporosis, zifaka i-washer ngesikulufa sekholamu ye-Medial zingavimba isikulufa ekusikeni.
. Uma ukunqanyulwa kwesikulufu kuhlangane phakathi nesikhathi sokufakwa kwekholamu ye-Medial Screw, cabanga ukuhoxa noma ukubuyisela izikulufo ezihlanekezelwa ipuleti laterali, kunikeza kuqala ukubekwa kwezikulufo zekholamu ye-Medical.
Icala 2 . . .
Icala 3. Isiguli sowesifazane, oneminyaka engama-70 ubudala, ngokuqhekeka kwe-periprosthetic ezungeze ukufakwa kwabesifazane. . . .
Isikhathi sePosi: Jan-10-2024
