Pankhani ya zomangira zamutu ndi khosi, zimatengera kapangidwe kawiri kopangira zomangira ndi zomangira.Kuphatikizana kophatikizana kwa 2 zomangira kumawonjezera kukana kwa kasinthasintha wa mutu wachikazi.
Munthawi yoyika zomangira zopondereza, kusuntha kwa axial kwa screw screw kumayendetsedwa ndi ulusi wa occlusal pakati pa screw screw ndi lag screw, ndipo kupsinjika kwa anti-rotation kumasinthidwa kukhala kupsinjika kwa mzere kumapeto kwa fracture, motero kumakulitsa kwambiri. mphamvu ya anti-rotational ya screw.Dulani ntchito.Zomangira ziwirizi zimalumikizidwa kuti zipewe "Z".
Mapangidwe a mapeto oyandikira a msomali waukulu wofanana ndi wa prosthesis ophatikizana amachititsa kuti thupi la msomali likhale logwirizana ndi medullary cavity, komanso zogwirizana ndi zizindikiro za biomechanical za proximal femur.
Masitepe Opaleshoni
Udindo: Wodwala amatha kusankha lateral kapena supine malo.Wodwala ali pampando wapamwamba, patebulo lopangira ma radiolucent kapena tebulo la mafupa.Mbali yathanzi ya wodwalayo imalowetsedwa ndikukhazikika pa bulaketi, ndipo mbali yokhudzidwayo imayikidwa 10 ° -15 ° kuti ikhale yogwirizana ndi medullary cavity.
Kukhazikitsanso molondola: Gwirani mwendo womwe wakhudzidwa ndi bedi lokoka musanagwire ntchito, ndikusintha momwe mumakokera pansi pa fluoroscopy kuti mwendo womwe wakhudzidwawo ukhale wozungulira pang'ono mkati ndi malo owonjezera.Zosweka zambiri zimatha kukhazikitsidwa bwino.Kukonzanso koyambirira ndikofunikira kwambiri ndipo Mfundo ndi yakuti, musadule mosavuta ngati palibe kuchepetsa kokwanira.Izi zitha kupulumutsa nthawi yogwira ntchito ndikuchepetsa zovuta panthawi ya opaleshoniyo.Ngati kuchepetsako kuli kovuta, mukhoza kupanga kachipangizo kakang'ono panthawi ya opaleshoni ndikugwiritsa ntchito ndodo yokankhira, retractor, reduction forceps, etc. kuti muchepetse.Kuphulika kwazing'ono Mbali zamkati ndi zakunja zimalekanitsidwa, ndipo palibe chifukwa chosinthira mobwerezabwereza.Mapeto othyoka amatha kukhazikitsidwanso pokhapokha pamene phula loponderezedwa likugwiritsidwa ntchito.
Kuchepetsa kwa trochanter yaying'ono: Mapangidwe a msomali wa intramedullary safuna kupitiriza kwa medial cortex.Nthawi zambiri, palibe chifukwa chochepetsera chidutswa chocheperako cha trochanter fracture, chifukwa opareshoni yocheperako yotsekeka yotseka imakhala ndi zotsatira zochepa pakuyenda kwa magazi kumapeto kwa fracture, ndipo kupasuka ndikosavuta kuchiza.Komabe, coxa varus iyenera kukonzedwa musanayike wononga, ndipo nthawi yopita pansi ndi nthawi yolemetsa yolemetsa iyenera kuchedwetsedwa moyenera.
Malo odulidwa: Kutalika kwa 3-5 masentimita kumapangidwira kumapeto kwa chigawo chachikulu cha trochanter pafupifupi pamtunda wa msana wapamwamba kwambiri wa iliac.Waya wa Kirschner ukhoza kuikidwa kumbali yakunja ya proximal femur, ndi kusinthidwa kuti ikhale yogwirizana ndi kutalika kwa khosi lachikazi pansi pa C-arm fluoroscopy, kotero kuti malo a incision ndi olondola kwambiri.
Dziwani malo olowera: malo olowera ndi apakati pang'ono mpaka pamwamba pa trochanter yaikulu, yomwe imagwirizana ndi 4 ° lateral kupatuka kwa axis yaitali ya medullary cavity kutsogolo.Poyang'ana kutsogolo, malo olowera msomali ali pamtunda wautali wa medullary cavity;
Malo Olowera Nangano
IlowetsaGuwuPin Fluoroscopy
Zonse Reamed
Popeza kuti kumapeto kwa msomali waukulu wa InterTan ndi wokhuthala, msomaliwo ukhoza kulowetsedwa pambuyo pa kukonzanso kwathunthu panthawi ya opareshoni.Kubwezeretsanso kumayenera kuyimitsidwa pamene choletsa chobowoleranso chikhudza chida cholowera.Kaya shaft ya distal femoral imasinthidwanso zimatengera kukula kwa medullary cavity.Ngati X-ray isanayambike ipeza kuti mtsempha wa medullary wa proximal femoral shaft mwachiwonekere ndi wopapatiza, chowongolera chachikazi chiyenera kukonzedwa musanachite opaleshoni.Ngati kubwezeretsanso sikukwanira, zimakhala zovuta kuyika screw.Panthawi yopukutira, imatha kugwedezeka pang'ono Zigawo zam'mbali za msomali wa intramedullary ziyenera kupewedwa, koma kugogoda mwamphamvu pa mchira wa msomali kuyenera kupewedwa.Kugogoda koopsa koteroko kungayambitse kugawanika kwa mafupa panthawi ya opaleshoni kapena kusuntha kwa fractureyo pambuyo pochepetsa.
Ikani manja oteteza minofu yofewa, kubowolerani motsatira waya wowongolera ndi kubowola, ndikukulitsa njira yachikazi ya msomali wa intramedullary (pamwambapa);ngati pakatikati pa medullary ndi yopapatiza, gwiritsani ntchito kubowola kofewa kuti mukulitse pamedullary mpaka m'lifupi mwake;gwirizanitsani kalozerayo ikani msomali waukulu wa InterTAN muzitsulo za medullary (pansipa);
ProximalLok
Kuyika kwa screw screw
Kuyika kwa screw screw
Mangani msomali wokhoma wa distal
RmaganizoLok
End Cup
Chithandizo cha Postoperative
Mankhwala opha tizilombo ankagwiritsidwa ntchito nthawi zonse kuti ateteze matenda patatha maola 48 atachitidwa opaleshoni;otsika-mamolekyu heparin kashiamu ndi mpweya mapampu anagwiritsidwa ntchito kuteteza deep vein thrombosis (DVT) m'munsi m'munsi, ndipo matenda zofunika zachipatala anapitiriza kuchiritsidwa.Ma radiographs omveka a pelvis ndi anteroposterior ndi lateral radiographs a chiuno chokhudzidwa ndi chiuno ankatengedwa nthawi zonse kuti amvetse kuchepetsa fracture ndi kukonza mkati.
Patsiku loyamba pambuyo pa opaleshoni, wodwalayo adalimbikitsidwa kuti achite chiwopsezo cha isometric cha quadriceps femoris pamalo ocheperako.Pa tsiku lachiwiri, wodwalayo adalangizidwa kuti akhale pabedi.Patsiku lachitatu, wodwalayo anali kuchita masewera olimbitsa thupi m'chiuno ndi mawondo pabedi.Palibe cholemetsa pa mwendo womwe wakhudzidwa.Limbikitsani odwala omwe ali ndi mwayi wonyamula gawo la zolemetsa pa mwendo womwe wakhudzidwa mkati mwazovomerezeka pakatha milungu 4 mutatha opaleshoni.Pang'onopang'ono yendani ndi woyenda ndi kulemera molingana ndi X-ray kutsatira pa 6 kwa masabata a 8.Odwala omwe sangathe kuyenda pawokha komanso kukhala ndi matenda osteoporosis owopsa Kwa odwala omwe amapitilira kukula kwa fupa pa X-ray, amatha kuyenda pang'onopang'ono ndikulemera mothandizidwa.
Contact Munthu: Yoyo (Product Manager)
TEL/Whatsapp: +86 15682071283
Nthawi yotumiza: May-08-2023
