Ho na le mefuta e 'meli ea mekhoa ea ho buoa, li-plate screws le intramedullary pins, ea pele e kenyelletsa li-screws tse akaretsang le li-screw tsa AO system compression plate,' me ea morao-rao e kenyelletsa li-retrograde tse koetsoeng le tse bulehileng kapa li-retrograde.Khetho e itšetlehile ka sebaka se itseng le mofuta oa fracture.
Intramedullary pin fixation e na le melemo ea ho pepeseha hanyenyane, ho fokotseha ho fokolang, ho tsitsisa ho tsitsitseng, ha ho hlokahale ho lokisa ka ntle, joalo-joalo E loketse bohareng ba 1/3, ka holimo ho 1/3 ea fracture ea femur, fracture ea likarolo tse ngata, fracture ea pathological.Bakeng sa fracture e ka tlaase ea 1/3, ka lebaka la mokokotlo o moholo oa medulla le masapo a mangata a ho hlakola, ho thata ho laola ho potoloha ha pini ea intramedullary, 'me ho lokisoa ha ho sireletseha, le hoja ho ka matlafatsoa ka li-screws, empa ho loketse haholoanyane. bakeng sa li-screw plate tsa tšepe.
Ke Bula-ka hare ho Lokisoa bakeng sa Ho robeha ha Femur Shaft ka Nail ea Intramedullary
(1) Ho phunyeha: Ho phunyeha ka morao kapa ka morao ho ka morao ho etsoa setsing sa ho robeha, se nang le bolelele ba 10-12 cm, ho phunyeletsa letlalo le sekhahla se sephara le ho senola mesifa ea lateral femoral.
The lateral incision e etsoa moleng o pakeng tsa trochanter e kholo le lateral condyle ea femur, 'me ho phunyeha ha letlalo la mokokotlo oa morao ho tšoana kapa hanyenyane hamorao, ka phapang e kholo ke hore lateral incision e arola mesifa ea vastus lateralis. , ha karolo e ka morao ea lateral e kena ka morao ea mesifa ea vastus lateralis ka mesifa ea vastus lateralis. (Setšoantšo sa 3.5.5.2-1, 3.5.5.2-2).
Ka lehlakoreng le leng, ho phunyeha ha anterolateral ho entsoe ka mohala ho tloha mokokotlong oa mokokotlo oa mokokotlo oa mokokotlo ho ea moeling o ka ntle oa patella, 'me o fihlella ka har'a mesifa ea lateral femoral le mesifa ea rectus femoris, e ka' nang ea lematsa mesifa ea botšehali le methapo ea kutlo. makala ho mesifa ea lateral femoral le makala a rotator femoris externus artery, ka hona ha e sebelisoe hangata kapa ha ho mohla e sebelisoang (Fig 3.5.5.2-3).
(2) Ho pepeseha: Arola 'me u hule mesifa ea lateral ea botšehali ka pele' me u e kene ka nako ea eona le biceps femoris, kapa ka ho toba khaola le ho arola mesifa ea lateral ea botšehali, empa ho tsoa mali ho feta.Seha periosteum ho senola lipheletsong tse ka holimo le tse ka tlaase tse robehileng tsa ho robeha ha botšehali, 'me u senole sebaka seo se ka bonoang le ho tsosolosoa,' me u hlobolise lisele tse bonolo ka hohle kamoo ho ka khonehang.
(3) Ho lokisa ho lokisa ka hare: Kenya leoto le amehileng, pepesetsa pheletso e robehileng e haufi, kenya palesa ea plum kapa nale ea intramedullary e bōpehileng joaloka V, 'me u leke ho lekanya hore na botenya ba nale bo loketse.Haeba ho e-na le sekhahla sa medullary cavity, "medullary cavity expander" e ka sebelisoa ho lokisa le ho atolosa sekoti hantle, e le ho thibela nale hore e se ke ea khona ho kena le ho se khone ho ntšoa.Lokisa karolo e ka pele e robehileng e nang le lesapo la lesapo, kenya nale ea intramedullary ka morao, u kene ka har'a femur ho tloha ho trochanter e kholo, 'me ha qetello ea nale e phunyeletsa letlalo, etsa sekhahla se senyenyane sa 3cm sebakeng seo, 'me u tsoele pele ho kenya. nale e ka hare ho mmele ho fihlela e hlahella kantle ho letlalo.Nale ea intramedullary e tlosoa, e fetisetsoa hape, e fetisetsoa ka foramen ho tloha ho trochanter e kholoanyane, ebe e kenngoa haufi le sefofane sa karolo ea sefapano.Linale tse ntlafalitsoeng tsa intramedullary li na le lipheletso tse nyane tse chitja tse nang le masoba a ho ntšoa.Joale ha ho hlokahale ho ntša le ho fetola tsela, 'me nale e ka hlajoa ebe e phunyeletsoa hang.Ntle le moo, nalete e ka kenngoa ka morao ka pinana ea tataiso 'me ea pepeseha ka ntle ho trochanteric e kholoanyane, ebe phini ea intramedullary e ka kenngoa ka har'a metso ea medulla.
Tsosoloso e eketsehileng ea ho robeha.Ho lumellana ha anatomical ho ka finyelloa ka ho sebelisa matla a "proximal intramedullary pin" hammoho le lesapo pry pivoting, traction, le fracture topping.Ho lokisoa ho finyelloa ka sets'oants'o sa lesapo, 'me pini ea intramedullary e ntan'o khannoa e le hore lesoba la ho ntša pin le lebisetsoe ka morao ho lumellana le ho kobeha ha botšehali.Qetello ea nale e lokela ho fihla karolong e loketseng ea karolo e ka thōko ea ho robeha, empa eseng ka lesela la lefufuru, 'me qetellong ea nale e lokela ho sala 2cm ka ntle ho trochanter, e le hore e ka tlosoa hamorao. 3.5.5.2-4).
Ka mor'a ho lokisa, leka ho sisinyeha ha setho sa letsoho 'me u hlokomele ho se tsitse leha e le hofe.Haeba ho hlokahala ho nkela nale e teteaneng ea intramedullary, e ka tlosoa ebe e nkeloa sebaka.Haeba ho na le ho lokoloha hanyenyane le ho hloka botsitso, screw e ka eketsoa ho matlafatsa ho lokisa. (Fig 3.5.5.2-4).
Qetellong leqeba le ile la hlatsuoa 'me la koaloa ka mekhahlelo.Boots ea samente e thibelang ho potoloha kantle e kenngoa.
II Plate Screw Internal Fixation
Ho lokisa ka hare ka li-screws tsa tšepe tsa tšepe ho ka sebelisoa likarolong tsohle tsa kutu ea botšehali, empa karolo e ka tlaase ea 1/3 e loketse haholoanyane bakeng sa mofuta ona oa ho lokisa ka lebaka la mokokotlo o pharaletseng oa medullary.Ho ka sebelisoa poleiti e akaretsang ea tšepe kapa poleiti ea tšepe ea AO.Ea ho qetela e tiile haholoanyane 'me e tsitsitse ka thata ntle le ho lokisa ka ntle.Leha ho le joalo, ha ho le ea mong oa bona ea ka qobang karolo ea ho pata khatello ea maikutlo le ho lumellana le molao-motheo oa matla a lekanang, a lokelang ho ntlafatsoa.
Mokhoa ona o na le mefuta e mengata ea ho peeling, ho lokisa ka hare ho feta, e amang pholiso, hape e na le mefokolo.
Ha ho na le khaello ea maemo a intramedullary pin, khale fracture medullary curvature kapa karolo e kholo ea ntho e ke keng ea tsamaea le karolo e ka tlase ea 1/3 ea fracture e fetoha haholoanyane.
(1) Ho chesoa ka morao ho basali kapa ka morao.
(2) (2) Ho pepeseha ha ho robeha, 'me ho itšetlehile ka maemo, ho lokela ho lokisoa le ho kenngoa ka hare ka li-screws tsa poleiti.Letlapa le lokela ho behoa ka lehlakoreng la tsitsipano ea lateral, li-screws li lokela ho feta ka har'a cortex mahlakoreng ka bobeli, 'me bolelele ba poleiti e lokela ho ba makhetlo a 4-5 a bophara ba lesapo sebakeng sa ho robeha.Bolelele ba poleiti ke makhetlo a 4 ho isa ho a 8 bophara ba lesapo le robehileng.Lipoleiti tse 6 ho isa ho tse 8 li sebelisoa hangata ka har'a femur.Likaroloana tse kholo tsa masapo tse entsoeng ka letsoho li ka lokisoa ka li-screws tse eketsehileng, 'me palo e kholo ea masapo e ka behoa ka nako e le' ngoe ka lehlakoreng le ka hare la fracture e entsoeng. (Fig 3.5.5.2-5).
Hlatsoa 'me u koale ka mekhahlelo.Ho itšetlehile ka mofuta oa li-screw tsa poleiti tse sebelisitsoeng, ho ile ha etsoa qeto ea hore na ho tla sebelisoa ho lokisa ka ntle ka plaster kapa che.
Nako ea poso: Mar-27-2024
