Kune mhando mbiri dzenzira dzekuvhiya, plate screws nema intramedullary pins, yekutanga inosanganisira general plate screws nema AO system compression plate screws, uye yekupedzisira inosanganisira closed and open retrograde kana retrograde pins. Sarudzo yacho inobva panzvimbo chaiyo uye rudzi rwekutyoka.
Kugadzika kwepini mukati memudumbu kune zvakanakira zvekuonekwa kudiki, kusabvisa zvidimbu, kugadzika kwakasimba, kusada kugadzika kwekunze, nezvimwewo. Yakakodzera kugadzika kwepakati pe1/3, kuputsika kwekumusoro kwe1/3 femur, kuputsika kwezvikamu zvakawanda, kuputsika kwepathological. Kune kuputsika kwepasi kwe1/3, nekuda kwegomba guru remedullary uye mapfupa akawanda anodzima, zvakaoma kudzora kutenderera kwepini mukati memudumbu, uye kugadzika kwacho hakuna kuchengetedzeka, kunyangwe kuchigona kusimbiswa nezvikuruu, asi kwakakodzera zvakanyanya zvikuruu zvesimbi.
Kugadzika kwemukati kweFemur Shaft neIntramedullary Nail
(1) Kuchekwa: Kuchekwa kwechiuno chakatarisana kana chekumashure kunoitirwa pakati penzvimbo yakatyoka, nehurefu hwe10-12 cm, kuchicheka ganda neparutivi rwakafara rwechiuno uye kuchiburitsa tsandanyama dzechiuno chakatarisana.
Kuchekwa kweparutivi kunoitwa pamutsetse uri pakati pe trochanter yakakura ne lateral condyle ye femur, uye kuchekwa kweganda kwe posterior lateral incision kwakafanana kana kuti kwave kunonoka zvishoma, musiyano mukuru uri wekuti lateral incision inoparadzanisa vastus lateralis muscle, nepo posterior lateral incision ichipinda posterior interval ye vastus lateralis muscle kuburikidza ne vastus lateralis muscle. (Mufananidzo 3.5.5.2-1, 3.5.5.2-2).
Kuchekwa kwepashure, kune rumwe rutivi, kunoitwa kuburikidza nemutsara kubva kumusana wepamusoro weiac kusvika kumucheto wekunze wepatella, uye kunowanikwa kuburikidza nemhasuru yefemoral yechipfuva uye muscle yerectus femoris, izvo zvinogona kukuvadza muscle yefemoral yepakati uye matavi etsinga kune muscle yefemoral yechipfuva uye matavi e rotator femoris externus artery, uye nekudaro hazviwanzo shandiswa kana kuti hazvimbo shandiswi (Mufananidzo 3.5.5.2-3).
（2） Kuonekwa: Bvisa uye dhonza tsandanyama yechipfuva yechipfuva mberi woipinza panguva yayo ne biceps femoris, kana kucheka zvakananga nekuparadzanisa tsandanyama yechipfuva yechipfuva yechipfuva, asi kubuda ropa kwakawanda. Cheka periosteum kuti uratidze magumo epamusoro neapasi akatyoka ekutyoka kwechiuno, uye ratidza scope kusvika painogona kuonekwa uye kudzorerwa, uye bvisa nyama dzakapfava zvishoma sezvinobvira.
（3）Kugadzirisa nzvimbo yemukati: Bvisa nhengo yakakuvara, buritsa mugumo wakatyoka weproximal, isa maruva eplum kana tsono yemukati ine chimiro cheV, uye edza kuyera kana ukobvu hwetsono hwakakodzera. Kana paine kutetepa kwenzvimbo yemukati, medullary cavity expander inogona kushandiswa kugadzirisa nekuwedzera nzvimbo yacho nemazvo, kuitira kudzivirira tsono kuti isakwanise kupinda uye isakwanise kuburitswa. Gadzirisa mugumo wakatyoka weproximal nechinhu chinobata mapfupa, isa tsono yemukati medullary kumashure, pinda mufemur kubva kutrochanter huru, uye kana mugumo wetsono ukasundidzira ganda kumusoro, gadzira kachikamu kadiki ke3cm panzvimbo yacho, uye ramba uchiisa tsono yemukati medullary kusvika yabuda pachena kunze kweganda. Tsono yemukati medullary inobviswa, inotungamirwa, inopfuudzwa nepaforamen kubva kutrochanter huru, uye yozoiswa pedyo nepakati pechikamu chemuchinjikwa. Tsono dzemukati medullary dzakavandudzwa dzine mativi madiki akatenderera ane maburi ekuburitsa. Ipapo hapana chikonzero chekuburitsa kunze wochinja nzira, uye tsono inogona kuburitswa yobva yaburitswa kamwe chete. Neimwe nzira, tsono inogona kuiswa kumashure nepini inotungamirwa yoiswa pachena kunze kwechikamu chikuru chetrochanteric, uye ipapo pini yemukati medullary inogona kuiswa mugomba remedullary.
Kugadziriswazve kwekutyoka. Kurongeka kwemuviri kunogona kuitwa nekushandisa leverage yeproximal intramedullary pin pamwe chete ne bone pry pivoting, traction, uye fracture topping. Kugadziriswa kunoitwa ne bone holder, uye intramedullary pin inofambiswa kuitira kuti buri rekuburitsa pin riendeswe kumashure kuti rienderane ne femoral curvature. Mugumo wetsono unofanira kusvika pachikamu chakakodzera che distal end of the break, asi kwete ne cartilage layer, uye mugumo wetsono unofanira kusiiwa 2cm kunze kwe trochanter, kuitira kuti ikwanise kubviswa gare gare. (Mufananidzo 3.5.5.2-4).
Mushure mekugadzika, edza kufambisa gumbo zvisina kugadzikana uye tarisa kusagadzikana kupi zvako. Kana zvichidikanwa kutsiva tsono yakakora yemukati memudullary, inogona kubviswa yotsiviwa. Kana paine kusunungura kudiki uye kusagadzikana, sikuruu inogona kuwedzerwa kusimbisa kugadzika. (Mufananidzo 3.5.5.2-4).
Ronda racho rakazobviswa jira ndokuvharwa. Bhutsu yeplaster inodzivisa kutenderera kwekunze inopfekwa.
Kugadziriswa Kwemukati kwePlatifomu yeII Screw
Kuisa mukati nesimbi plate screws kunogona kushandiswa muzvikamu zvese zve femoral stem, asi 1/3 yepasi ndiyo yakakodzera mhando iyi yekuisa nekuda kwehupamhi hwe medullary cavity. General steel plate kana AO compression steel plate inogona kushandiswa. Iyo yekupedzisira yakasimba uye yakasimba isina external fixation. Zvisinei, hapana kana imwe yadzo inogona kudzivirira basa rekuvhara stress uye kutevedzera musimboti wesimba rakaenzana, iro rinoda kuvandudzwa.
Nzira iyi ine nzira yakakura yekukwesha mavanga, inogadzirisa zviri mukati, inokanganisa kupora, uye inewo zvikanganiso.
Kana paine kushomeka kwemamiriro emukati memedullary pin, kutenderera kwemedullary medullary yekare kana chikamu chikuru chenzvimbo isingapindiki uye chikamu 1/3 chepazasi chekutyoka zvinochinjika zviri nyore.
(1) Kuchekwa kweparutivi kwefemu kana kwepashure kweparutivi.
(2)(2) Kuonekwa kwekukuvara, uye zvichienderana nemamiriro ezvinhu, kunofanira kugadziriswa uye kugadziriswa mukati ne plate screws. Plate inofanira kuiswa parutivi rwe lateral tension, screws dzinofanira kupfuura nepakati pe cortex kumativi ese, uye kureba kweplate kunofanira kuva ka4-5 kubva padhayamita yepfupa panzvimbo yakatyoka. Kureba kweplate kwakapetwa ka4 kusvika ka8 kupfuura dhayamita yepfupa rakatyoka. Ma plates matanhatu kusvika masere ane maburi anowanzo shandiswa mu femur. Zvidimbu zvikuru zvemapfupa zvakatyoka zvinogona kugadziriswa ne screws dzekuwedzera, uye huwandu hwakawanda hwe mapfupa anogona kuiswa panguva imwe chete padivi repakati rekutyoka kwakatyoka. (Mufananidzo 3.5.5.2-5).
Sukurudza wovhara nematanda. Zvichienderana nerudzi rwema plate screws akashandiswa, zvakasarudzwa kuti zviise plaster yekunamira kunze here kana kuti kwete.
Nguva yekutumira: Kurume-27-2024
