Femoral neck fracture inowanzoitika uye inogona kuparadza kukuvadza kune vanachiremba vemapfupa, nekuda kweropa risina simba, chiitiko chekuputsika chisingaiti-union uye osteonecrosis yakakwirira, kurapwa kwakanakisisa kwekuputsika kwemutsipa wevakadzi kuchiri kukakavara, nyanzvi dzakawanda dzinotenda kuti varwere vanopfuura makore 65 ezera rezera re65 rinogona kuonekwa se65 yezera re65 yezera. yakasarudzwa nokuda kwekuvhiyiwa kwemukati, uye kukanganisa kwakanyanya pakuyerera kweropa kunokonzerwa ne subcapsular type fracture ye femoral neck. Subcapital fracture yemutsipa wevakadzi ine yakanyanya kuoma haemodynamic kukanganisa, uye kuvharwa kuderedzwa uye kugadziriswa kwemukati ichiri nzira yekurapa yenguva dzose ye subcapital fracture ye femoral neck. Kuderedza kwakanaka kunobatsira kudzikamisa kuputsika, kukurudzira kuporeswa kwekutyoka uye kudzivirira femoral head necrosis.
Izvi zvinotevera zvinowanzoitika zvemukadzi wemutsipa subcapital fracture kukurukura maitiro ekuita yakavharwa-displacement mukati mekugadzirisa ne cannulated screw.
Ⅰ Ruzivo rwekutanga rwenyaya
Ruzivo rwemurwere: murume ane makore makumi mana nemashanu
Chichemo: kurwadziwa kwehudyu kwekuruboshwe uye kumisa basa kwemaawa matanhatu.
Nhoroondo: Murwere akawira pasi paaigeza, achikonzera marwadzo muhudyu yekuruboshwe uye kuderedzwa kwebasa, izvo zvisingagoni kusunungurwa nekuzorora, uye akagamuchirwa kuchipatara chedu nekuputsika kwemutsipa weruboshwe rwechikadzi pamaradiographs, uye akaendeswa kuchipatara mumamiriro ezvinhu akajeka epfungwa uye mweya wakashata, achinyunyuta nemarwadzo muhudyu yekuruboshwe uye kuderedzwa kwebasa, uye akanga asina kuzvisunungura mushure mekukuvara kwechipiri uye asina kuzvisunungura mushure mekukuvara kwake kwechipiri.
Ⅱ Kuongororwa Kwemuviri (Kutarisa Muviri Wese & Kutarisa Nyanzvi)
T 36.8°C P87 kurova/miniti R20 kurova/miniti BP135/85mmHg
Kukura kwakajairika, kudya kwakanaka, nzvimbo yekungoita, mafungiro akajeka, kushandira pamwe mukuongororwa. Rudzi rweganda rakajairika, elastic, hapana edema kana rash, hapana kuwedzera kwepamusoro lymph nodes mumuviri wese kana munharaunda. Saizi yemusoro, yakajairwa morphology, hapana marwadzo ekumanikidza, kuwanda, bvudzi rinopenya. Vese vadzidzi vakaenzana muhukuru uye denderedzwa, vane sensitive light reflex. Mutsipa waive wakapfava, trachea yaive pakati, thyroid gland haina kukura, chifuva chaive chakaenzana, kufema kwakapfupikiswa zvishoma, pakanga pasina kusarudzika pa cardiopulmonary auscultation, miganhu yemoyo yaive yakajairika pakurova, kurova kwemoyo kwaive 87 kurova / min, rhythm yemoyo yaive Qido pakanga pasina marwadzo kana marwadzo ab. Chiropa nechirungu hazvina kuonekwa, uye makanga musina kunyorova muitsvo. Iyo anterior uye posterior diaphragms haina kuongororwa, uye pakanga pasina kuremara kwemusana, makumbo epamusoro nemakumbo ezasi ezasi, nekufamba kwakajairika. Physiological reflexes yakanga iripo mukuongorora kwetsinga uye pathological reflexes haina kubvunzwa.
Pakanga pasina kuzvimba kuri pachena kwehudyu yekuruboshwe, kurwadza kuri pachena kwekumanikidzwa pakati pechidya chekuruboshwe, kupfupikiswa kwekunze kutenderera kuremara kwegumbo rezasi rezasi, kuruboshwe rezasi rengitudinal axis kunyorova (+), kusashanda kwehudyu yekuruboshwe, kunzwa uye kuita kwezvigunwe zvishanu zvegumbo rekuruboshwe zvaive OK, uye dorsal arterial pulsation yetsoka yaive yakajairika.
Ⅲ bvunzo dzebetsero
X-ray firimu yakaratidza: kuruboshwe femoral mutsipa subcapital fracture, dislocation yekuputsika kupera.
Imwe yakasara yekuongorora kwebiochemical, chifuva X-ray, bone densitometry, uye ruvara rwe ultrasound rwematsinga akadzika emakumbo ezasi haana kuratidza kukanganisa kuri pachena.
Ⅳ Kuongororwa uye kusiyanisa kuongororwa
Maererano nenhoroondo yemurwere yekushungurudzika, kurwadziwa kwehudyu kuruboshwe, basa rekuita, kuongororwa kwepanyama kwegumbo rezasi rezasi kupfupisa kunze kutenderera kuremara, kunyorova kwegodzi pachena, kuruboshwe kuzasi kwegumbo longitudinal axis kowtow marwadzo (+), kukanganiswa kwehudyu yekuruboshwe, yakasanganiswa nefirimu yeX-ray inogona kunyatsoongororwa. Kuputsika kwetrochanter kunogonawo kuva nemarwadzo ehudyu uye kuderedza basa, asi kazhinji kuputika kwepanzvimbo kunooneka, nzvimbo yekumanikidza inowanikwa mu trochanter, uye kona yekunze kutenderera yakakura, saka inogona kusiyaniswa nayo.
Ⅴ Kurapa
Yakavharwa kuderedzwa uye hollow mbambo yemukati kugadzirisa yakaitwa mushure mekunyatsoongorora.
Iyo preoperative firimu ndeiyi inotevera
Maneuver nekutenderera kwemukati uye kudhonzwa kwegumbo rakakanganiswa nekutorwa zvishoma kwenhengo yakakanganiswa mushure mekudzoreredzwa uye fluoroscopy yakaratidza kudzoreredza kwakanaka.
Pini yeKirschner yakaiswa pamusoro pemuviri munzira yemutsipa wechikadzi we fluoroscopy, uye ganda diki diki rakagadzirwa maererano nenzvimbo yekuguma kwepini.
Pini yekutungamira inopinzwa muhuro hwechikadzi ichienderana nepamusoro pemuviri munzira yeKirschner pini uku ichichengetedza kurerekera kwepamberi kweanenge madhigirii gumi nemashanu uye fluoroscopy inoitwa.
Pini yegwaro rechipiri inopinzwa kuburikidza nefemoral spur uchishandisa gwara rinoenderana nechepasi pekwakananga kwepini yekutanga.
Tsono yechitatu inoiswa parallel kuseri kwetsono yekutanga kuburikidza negwara.
Kushandisa frog fluoroscopic lateral image, mapini matatu eKirschner akaonekwa ari mukati mehuro yemukadzi.
Dhobora maburi kwakanangana nepini yegwara, yera kudzika uye wobva wasarudza hurefu hwakakodzera hwembambo yakakwidibirwa padivi pepini yegwara, zvinokurudzirwa kuti ukururwe mumusana wechikadzi wembambo yepini kutanga, izvo zvinogona kudzivirira kurasikirwa kwekugadzika patsva.
Nyora mune mamwe maviri cannulated screw imwe mushure meimwe uye ona kuburikidza
Skin incision condition
Postoperative yekuongorora firimu
Yakasanganiswa nezera remurwere, rudzi rwekutyoka, uye bhonzo remhando, yakavharwa kuderedzwa kwembambo mbambo yemukati kugadzirisa kwaidiwa, iyo ine zvakanakira diki kukuvadzwa, chokwadi chekugadzirisa mhedzisiro, kushanda kuri nyore uye nyore kugona, kunogona kuve nemagetsi kudzvanya, maburi magadzirirwo anobatsira kune intracranial decompression, uye iyo yekutyoka kuporesa mwero wakakwira.
Summary
1 Kuiswa kwetsono dzeKirschner pamusoro pemuviri nefluoroscopy kunobatsira pakuona poindi uye kutungamira kwekupinzwa kwetsono uye huwandu hwekucheka kweganda;
2 Mapini matatu eKirschner anofanirwa kunge akafanana, akatenderedzwa zigzag, uye ari padyo nemupendero sezvinobvira, izvo zvinobatsira pakutyoka kudzikamiswa uye gare gare kutsvedza kudzvanywa;
3 Pazasi peKirschner pin yekupinda poindi inofanira kusarudzwa panzvimbo inonyanya kuzivikanwa ye lateral femoral crest kuti ive nechokwadi chekuti pini iri pakati pehuro yemukadzi, ukuwo matipi emapini maviri epamusoro achigona kutsvedzerwa kumberi nekumashure achitevedza crest yakatanhamara kufambisa kunamatira;
4 Usatyaire pini yeKirschner yakadzama panguva imwe chete kudzivirira kupinda mukati meiyo articular surface, chibooreso chinogona kudhonzwa nemutsetse wekutyoka, imwe ndeyekudzivirira kuchera nemusoro wefemoral, uye imwe yacho inonamira pakutsikirirwa kwembambo;
5 Iyo mhango screws yakapindirwa mukati meanenge uye nepakati diki, tonga kureba kwegomba sikururu ndeyechokwadi, kana kureba kusiri kure zvakanyanya, edza kudzivirira kazhinji kutsiva screws, kana osteoporosis, kutsiva kwe screws kunenge kusingaite kugadzirisa kwe screws, nekuda kwekufungidzira kwemurwere kugadzirisa kunoshanda kwe screws, asi kureba kwehurefu hwema screws hurefu hwakaipisisa kupfuura kureba kweiyo screws inongowedzera kureba. zviri nani!
Nguva yekutumira: Jan-15-2024
