Ponena za zomangira za mutu ndi khosi, imagwiritsa ntchito kapangidwe ka zomangira ziwiri za zomangira zotsalira ndi zomangira zokakamiza. Kuphatikizana kwa zomangira ziwiri kumawonjezera kukana kuzungulira kwa mutu wa femoral.
Pakuyika screw yokakamiza, kuyenda kwa axial kwa screw yokakamiza kumayendetsedwa ndi ulusi wa occlusal pakati pa screw yokakamiza ndi screw yokakamiza, ndipo mphamvu yotsutsana ndi kuzungulira imasinthidwa kukhala kukakamiza kolunjika kumapeto kwa fracture, motero kumawonjezera kwambiri mphamvu yotsutsana ndi kuzungulira kwa screw. Dulani magwiridwe antchito. Ma screw awiriwa amalumikizidwa pamodzi kuti apewe zotsatira za "Z".
Kapangidwe ka mbali ya msomali yaikulu yofanana ndi ya chiwalo cholumikizirana kumapangitsa kuti thupi la msomali ligwirizane kwambiri ndi malo olumikizirana mafupa, komanso kuti ligwirizane ndi mawonekedwe a biomechanical a proximal femur.
Njira Zopangira Opaleshoni
UdindoWodwalayo angasankhe malo ogona kapena agone. Wodwalayo ali m'malo ogona, patebulo lochitira opaleshoni lokhala ndi ma radiolucent kapena patebulo lothandizira mafupa. Mbali yathanzi ya wodwalayo imachotsedwa ndikukhazikika pa bulaketi, ndipo mbali yokhudzidwayo imachotsedwa 10°-15° kuti igwirizane ndi medullary cavity.
Kubwezeretsa kolondola: Kokani mwendo wokhudzidwa ndi bedi logwirira ntchito musanachite opaleshoni, ndipo sinthani njira yogwirira ntchito pogwiritsa ntchito fluoroscopy kuti mwendo wokhudzidwawo ukhale wozungulira pang'ono mkati ndi pamalo olowetsa. Mafupa ambiri amatha kubwezeretsedwanso bwino. Kubwezeretsa mwendo musanachite opaleshoni ndikofunikira kwambiri ndipo mfundo ndi yakuti, musadule mosavuta ngati palibe kuchepetsa kokwanira. Izi zitha kusunga nthawi yogwirira ntchito ndikuchepetsa zovuta panthawi ya opaleshoni. Ngati kuchepetsa kuli kovuta, mutha kupanga kudula pang'ono panthawi ya opaleshoni ndikugwiritsa ntchito ndodo yokakamiza, retractor, reduction forceps, ndi zina zotero kuti muthandize kuchepetsa. Mafupa ang'onoang'ono Mbali zamkati ndi zakunja zimalekanitsidwa, ndipo palibe chifukwa chosinthira mobwerezabwereza. Mapeto a fracture amatha kubwezeretsedwanso okha pamene screw yokakamiza imalowetsedwa mkati panthawi ya opaleshoni.
Kuchepetsa trochanter yaing'ono: Kapangidwe ka msomali wa intramedullary sikutanthauza kuti mbali yamkati ya cortex ikhale yolimba. Kawirikawiri, palibe chifukwa chochepetsera chidutswa cha fracture cha trochanter chochepa, chifukwa ntchito yochepetsera closed reduction yomwe siigwira ntchito kwambiri imakhudza kuyenda kwa magazi kumapeto kwa fracture, ndipo fractureyo ndi yosavuta kuchira. Komabe, coxa varus iyenera kukonzedwa musanayike screw, ndipo nthawi yopita pansi ndi nthawi yonyamula zolemera pambuyo pa opaleshoni iyenera kuchedwa moyenera.
Malo odulira: Kuduladula kwa kutalika kwa 3-5 cm kumapangidwa kumapeto kwa proximal kwa greater trochanter apex pafupifupi pamlingo wa anterior superior iliac spine. Waya wa Kirschner ukhoza kuyikidwa mbali yakunja ya proximal femur, ndikusinthidwa kuti ugwirizane ndi mzere wautali wa femur pansi pa C-arm fluoroscopy, kuti malo a kudulako akhale olondola kwambiri.
Dziwani malo olowera: malo olowera ali pakati pang'ono ndi pamwamba pa trochanter yayikulu, zomwe zikugwirizana ndi kupotoka kwa 4° kwa mzere wautali wa medullary cavity pa mawonekedwe akutsogolo. Pa mawonekedwe akumbali, malo olowera msomali ali pa mzere wautali wa medullary cavity;
Malo Olowera Singano
InsertGuidePin Fluoroscopy
R Yokwaniraadamuyika
Popeza mbali yapafupi ya msomali waukulu wa InterTan ndi yokhuthala pang'ono, msomali ukhoza kulowetsedwa pokhapokha mutawukonza bwino panthawi ya opaleshoni. Kuwukonza bwino kuyenera kuyimitsidwa pamene chipangizo choletsa cha chobowolera chogwirira ntchito chikhudza chida cholowera. Kaya shaft ya distal femoral yasinthidwanso kutengera kukula kwa shaft ya medullary kwatsimikiziridwa. Ngati X-ray isanachitidwe opaleshoni ipeza kuti shaft ya medullary ya proximal femoral shaft ndi yopapatiza, chowumitsa shaft ya femoral iyenera kukonzedwa opaleshoni isanayambe. Ngati kuwukonza sikukwanira, zidzapangitsa kuti zikhale zovuta kuyika screw. Panthawi yowumitsa, ikhoza kugwedezeka pang'ono. Zigawo za msomali wa intramedullary ziyenera kupewedwa, koma kugogoda mwamphamvu pamchira wa msomali kuyenera kupewedwa. Kugogoda kotereku kungayambitse kusweka kwa mafupa mosavuta panthawi ya opaleshoni kapena kusunthanso kwa kusweka pambuyo pochepetsa.
Ikani chigoba choteteza minofu yofewa, bowolani pamodzi ndi waya wotsogolera pogwiritsa ntchito chobowola, ndikukulitsa njira yolumikizirana ya msomali wamkati mwa medullary (chithunzi pamwambapa); ngati msomali wa medullary ndi wopapatiza, gwiritsani ntchito chobowola chofewa chokonzedwanso kuti muwonjezere msomali wa medullary m'lifupi mwake; lumikizani chobowolacho lowetsani msomali waukulu wa InterTAN mu msomali wa medullary (pansipa);
ProximalLkhola
Kuyika kwa zomangira zotsalira
Kuyika kwa screw yopondereza
Kokani msomali wotsekeka wakutali
RemoteLkhola
Chikho Chomaliza
Chithandizo Pambuyo pa Opaleshoni
Mankhwala opha tizilombo toyambitsa matenda ankagwiritsidwa ntchito nthawi zonse kuti apewe matenda patatha maola 48 kuchokera pamene opaleshoniyo inachitidwa; heparin calcium ndi mpweya wochepa unagwiritsidwa ntchito kuti apewe matenda a mtsempha wamagazi (DVT) m'miyendo ya m'munsi, ndipo matenda oyamba adapitilizidwa kuchiritsidwa. Ma X-ray osavuta a m'chiuno ndi ma X-ray a anteroposterior ndi lateral a cholumikizira cha m'chiuno chomwe chakhudzidwacho ankatengedwa nthawi zonse kuti amvetsetse kuchepetsa kusweka kwa mafupa ndi kukhazikika kwa mkati.
Pa tsiku loyamba pambuyo pa opaleshoni, wodwalayo analimbikitsidwa kuchita kusinthasintha kwa isometric kwa quadriceps femoris ali pansi pang'ono. Pa tsiku lachiwiri, wodwalayo analangizidwa kuti akhale pabedi. Pa tsiku lachitatu, wodwalayo anachita masewera olimbitsa thupi opindika m'chiuno ndi bondo pabedi. Palibe zolemera pa mwendo wokhudzidwa. Limbikitsani odwala okhoza kunyamula gawo la kulemera pa mwendo wokhudzidwa mkati mwa nthawi yovomerezeka milungu 4 pambuyo pa opaleshoni. Pang'onopang'ono yendani ndi chowongolera chonyamula zolemera malinga ndi kutsatira kwa X-ray pa masabata 6 mpaka 8. Odwala omwe sangathe kuyenda paokha komanso ali ndi matenda oopsa a mafupa. Kwa odwala omwe ali ndi kukula kosalekeza kwa mafupa pa X-ray, amatha kuyenda pang'onopang'ono ndi zolemera pansi pa chithandizo.
Munthu Wolumikizana Naye: Yoyo (Woyang'anira Zamalonda)
TEL/Whatsapp: +86 15682071283
Nthawi yotumizira: Meyi-08-2023
