Nhau - Femoral Plate Internal Fixation Procedure

Kune marudzi maviri enzira dzekuvhiya, maplate screws uye intramedullary pini, yekutanga inosanganisira general plate screws uye AO system compression plate screws, uye yekupedzisira inosanganisira yakavharwa uye yakavhurika retrograde kana retrograde pini.Sarudzo inobva pane chaiyo saiti uye rudzi rwekutsemuka.
Intramedullary pin fixation ine zvakanakira kusvibiswa kuduku, kubviswa zvishoma, kugadziriswa kwakagadzikana, hapana chikonzero chekugadzirisa kunze, nezvimwewo. Inokodzera pakati 1/3, yepamusoro 1/3 femur fracture, multi-segmental fracture, pathological fracture.Kune yakaderera 1/3 kuputsika, nekuda kwehombe medullary cavity uye akawanda cancellous bone, zvakaoma kudzora kutenderera kwepini intramedullary, uye kugadzirisa hakuna kuchengetedzeka, kunyangwe inogona kusimbiswa ne screws, asi inonyanya kukodzera. zvesimbi ndiro screws.

Ini Kuvhura-yemukati Kugadziriswa kweKutsemuka kweFemur Shaft neIntramedullary Nail
(1) Incision: A lateral kana posterior lateral femoral incision inoitwa pakati penzvimbo yakaputsika, ine urefu hwe 10-12 cm, ichicheka neganda uye yakafara fascia uye kuratidza lateral femoral muscle.
The lateral incision inoitwa pamutsara pakati pe trochanter yakakura uye lateral condyle yefemur, uye ganda rekucheka kwemashure ekupedzisira kwemashure kwakafanana kana zvishoma gare gare, nemusiyano mukuru ndewekuti lateral incision inoparadzanisa vastus lateralis muscle. , nepo posterior lateral incision inopinda mukati memashure e-vastus lateralis muscle kuburikidza ne-vastus lateralis muscle. (Mufananidzo 3.5.5.2-1, 3.5.5.2-2).

Iyo anterolateral incision, kune rumwe rutivi, inogadzirwa kuburikidza nemutsara kubva kune anterior superior iliac spine kusvika kumucheto wekunze wepatella, uye inowanikwa kuburikidza ne lateral femoral muscle uye rectus femoris muscle, iyo inogona kukuvadza pakati pechikadzi chemuviri uye nerve. matavi kune lateral femoral tsandanyama uye matavi e rotator femoris externus artery, uye saka haawanzo shandiswa kana kusamboshandiswa (Fig 3.5.5.2-3).

（2） Kuratidzwa: Kupatsanura uye kudhonza lateral yefemoral tsandanyama kumberi uye kupinda mairi panguva yayo nebiceps femoris, kana kucheka zvakananga nekuparadzanisa lateral yefemoral tsandanyama, asi kubuda ropa kunowedzera.Cheka iyo periosteum kuratidza iyo yepamusoro uye yepasi yakatyoka magumo ekutyoka kwefemu, uye ratidza chiyero kusvika pamwero wekuti unogona kucherechedzwa nekudzoreredzwa, uye bvisa matishu akapfava zvishoma sezvinobvira.
(3) Kugadzirisa kugadzirisa kwemukati: Wedzera nhengo yakakanganiswa, ratidza iyo yakaputsika kupera, isa maruva eplamu kana V-yakaita intramedullary tsono, uye edza kuyera kana ukobvu hwetsono hwakakodzera.Kana paine kutetepa kwemedullary cavity, iyo medullary cavity expander inogona kushandiswa kugadzirisa zvakanaka uye kuwedzera mhango, kuitira kudzivirira tsono kuti isakwanise kupinda uye isingakwanisi kubudiswa.Gadzirisa magumo akatyoka neanobata bhonzo, isa intramedullary tsono retrogradely, pinda mufemur kubva kune yakakura trochanter, uye kana kuguma kwetsono kuchisundira kumusoro kweganda, ita diki diki ye3cm panzvimbo, uye ramba uchipinza. tsono ye intramedullary kusvika yabuda kunze kweganda.Iyo intramedullary tsono inobviswa, inodzoserwa, yakapfuura nepakati peforamen kubva kune yakakura trochanter, yobva yaiswa pedyo nendege yemuchinjiko-chikamu.Yakanatsiridzwa intramedullary tsono dzine diki dzakatenderedzwa magumo ane maburi ekubvisa.Ipapo hapana chikonzero chekudhonza kunze nekuchinja kwakananga, uye tsono inogona kubaiwa kunze uye yobva yaroverwa kamwe chete.Neimwe nzira, tsono inogona kuiswa retrograde nepini yekutungamira uye yakafumurwa kunze kweiyo trochanteric incision yakakura, uyezve intramedullary pin inogona kuiswa mu medullary cavity.
Kuwedzera kudzorerwa kwekuputsika.Anatomical alignment inogona kuwanikwa nekushandisa kuwanda kweiyo proximal intramedullary pini pamwe chete nebhonzo pry pivoting, traction, uye kutyoka topping.Kugadziriswa kunowanikwa nemubati webhonzo, uye pini ye intramedullary inobva yafambiswa kuitira kuti gomba rekubvisa kwepini rinotungamirirwa nechekumashure kuti rienderane nekuputika kwechikadzi.Kuguma kwetsono kunofanira kusvika kune chikamu chakakodzera chekupedzisira kwekuputsika, asi kwete kuburikidza nemucheka we cartilage, uye kuguma kwetsono kunofanira kusara 2cm kunze kwe trochanter, kuitira kuti inogona kubviswa gare gare. 3.5.5.2-4.

Mushure mekugadzirisa, edza passive kufamba kwegumbo uye ona chero kusagadzikana.Kana zvichidikanwa kutsiva iyo gobvu intramedullary tsono, inogona kubviswa uye kutsiviwa.Kana pane zvishoma kusunungura uye kusagadzikana, screw inogona kuwedzerwa kusimbisa kugadzirisa. (Fig 3.5.5.2-4).
Ronda racho rakazonyungudutswa rikavharwa.Anti-external rotation plaster boot inoiswa.
II Plate Screw Internal Fixation
Kugadziriswa kwemukati nesimbi yeplate screws inogona kushandiswa munzvimbo dzose dzechikadzi chechikadzi, asi yakaderera 1/3 inonyanya kukodzera kune rudzi urwu rwekugadzirisa nekuda kwehupamhi medullary cavity.General simbi ndiro kana AO compression simbi ndiro inogona kushandiswa.Iyo yekupedzisira yakanyanya kusimba uye yakasimba yakagadziriswa pasina kunze kwekugadzirisa.Zvisinei, hapana mumwe wavo anogona kudzivisa basa rekumanikidzika masking uye kuenderana nemusimboti wesimba rakaenzana, rinoda kuvandudzwa.
Iyi nzira ine yakakura peeling renji, yakawanda yemukati kugadzirisa, inokanganisa kupora, uye zvakare ine zvikanganiso.
Kana paine kushaikwa kwepini ye intramedullary, yakare fracture medullary curvature kana chikamu chikuru chezvisingafambiki uye yakaderera 1/3 yekutyoka inonyanya kuchinjika. 
(1)Lateral femoral kana posterior lateral incision.
(2) (2) Kuratidzwa kwekuputsika, uye zvichienderana nemamiriro ezvinhu, inofanira kugadziriswa uye yakagadziriswa mukati neplate screws.Iyo ndiro inofanira kuiswa kune lateral tension side, screws inofanira kupfuura nekortex kumativi ose maviri, uye kureba kweplate kunofanira kuva 4-5 nguva yehupamhi hwepfupa panzvimbo yekuputsika.Kureba kweplate ndeye 4 kusvika ku8 nguva yehupamhi hwepfupa rakaputsika.6 kusvika 8 hole mahwendefa anowanzoshandiswa mufemur.Zvimedu zvakakura zvakagadziriswa pfupa zvinogona kugadziriswa nemamwe screws, uye nhamba huru yemapfupa ekubatanidza inogona kuiswa panguva imwechete padivi repakati pekuputsika kwakagadziriswa. (Fig 3.5.5.2-5).