Femoral neck fracture inowanzoitika uye inogona kuparadza kukuvadzwa kune vanachiremba vemapfupa, nekuda kweropa risina simba, chiitiko chekuputsika kusina kubatana uye osteonecrosis yakakwirira, kurapwa kwakakwana kwekuputsika kwemutsipa wevakadzi kuchiri kukakavara, nyanzvi dzakawanda dzinofunga kuti varwere vanopfuura 65 yemakore ezera inogona kutariswa se arthroplasty, uye varwere vari pasi pezera remakore makumi matanhatu nemashanu vanogona kusarudzwa kuti vagadzirise kugadziriswa kwemukati, uye iyo yakanyanya kukanganisa pakuyerera kweropa inokonzerwa 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 kuderedza basa, izvo zvisingagoni kusunungurwa nekuzorora, uye akaendeswa kuchipatara chedu nekuputsika kwemutsipa weruboshwe rwechikadzi pane radiographs, uye akagamuchirwa kuchipatara mumamiriro ezvinhu akajeka epfungwa uye mweya wakashata, achigunun'una nekurwadziwa muhudyu yekuruboshwe uye kuderedza basa, uye akanga asina kudya uye akanga asina kuzvisunungura pachechipiri chechipiri mushure mekukuvara.
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 beats / min, rhythm yemoyo yaive Qi, dumbu rakanga rakati sandara uye rakapfava, pakanga pasina marwadzo ekumanikidzwa kana kurwadziwa kwekudzoka.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 yaivepo mukuongorora kwetsinga uye pathological reflexes haina kubvunzwa.
Pakanga pasina kuzvimba kuri pachena kwehudyu yekuruboshwe, kurwadziwa kuri pachena kwepakati pakati pegomba rekuruboshwe, kupfupikiswa kwekunze kutenderera kuremara kwegumbo rezasi rekuruboshwe, kuruboshwe rezasi ruoko longitudinal axis hunyoro (+), kusashanda kwehudyu yekuruboshwe, kunzwa uye kuita kwe zvigunwe zvishanu zvetsoka yekuruboshwe zvakanga ZVAKANAKA, uye kurovera kwetsinga kwetsoka kwetsoka kwakanga kwakajairika.
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
Zvinoenderana nenhoroondo yemurwere yekushungurudzika, kurwadziwa kwechiuno chekuruboshwe, kuita kushomeka, kuongororwa kwemuviri wegumbo rekuruboshwe rezasi kupfupisa kutenderera kwekunze, kunyorova kwegodzi zviri pachena, marwadzo eruboshwe rezasi rengitudinal axis kowtow kurwadziwa (+), kusashanda kwehudyu yekuruboshwe, kusanganiswa ne iyo X-ray firimu 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 firimu yepreoperative ndeyotevera
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.
Dhonza maburi kwakanangana nepini yegwaro, yera kudzika uye wobva wasarudza kureba kwakakodzera kwembambo yakavharwa padivi pepini yegwara, zvinokurudzirwa kuti urove mumusana wemukadzi wepini ine buri kutanga, izvo zvinogona kudzivirira kurasikirwa kwe reset.
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 yekugadzika kwemukati kwaidiwa, iyo ine zvakanakira diki kukuvadzwa, chokwadi kugadzirisa mhedzisiro, kushanda kuri nyore uye kuri nyore kugona, kunogona kuve nemagetsi kudzvanya, buri rakagadzirwa rinoita. kune intracranial decompression, uye chiyero chekuporesa kwekutyoka kwakakwira.
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 Yepazasi Kirschner pini yekupinda inofanira kusarudzwa pane yakakurumbira lateral femoral crest kuti ive nechokwadi chekuti pini iri pakati pehuro yemukadzi, ukuwo matipi emapini maviri epamusoro achigona kutsvedzerwa kumberi nekumashure pamwe neakanyanya kusimba crest. kufambisa kutevedza;
4 Usatyaire pini yeKirschner yakadzika panguva imwe chete kudzivirira kupinda mukati meiyo articular surface, iyo yekubooresa inogona kudhiriwa nemutsetse wekutyoka, imwe ndeyekudzivirira kubhowa nemumusoro wemukadzi, uye imwe inokodzera chipikiri chine mhango. compression;
5 Maburi maburi akaiswa mukati meanenge uye nepakati zvishoma, tonga kuti kureba kwegoro sikuruu ndeyechokwadi, kana kureba kusiri kure zvakanyanya, edza kudzivirira kazhinji kutsiva screws, kana osteoporosis, kutsiviwa kwe screws kunenge kusingaite kugadzirisa. ye screws, kune kufungidzira kwemurwere kwekugadzirisa kunobudirira kwescrews, asi kureba kwehurefu hwemasvikiro kwakangoipa zvishoma kudarika kureba kusingabatsiri kugadzirisa kwezviputi zviri nani zvikuru!
Nguva yekutumira: Jan-15-2024
