E nwere ụdị ụzọ ịwa ahụ abụọ, skru efere na ntụtụ intramedullary, nke mbụ gụnyere skru efere izugbe na skru efere mkpakọ sistemụ AO, nke ikpeazụ gụnyekwara ntụtụ retrograde mechiri emechi na nke mepere emepe ma ọ bụ retrograde. Nhọrọ a dabere na ebe akọwapụtara na ụdị mgbawa ahụ.
Ịdọnye ntụtụ n'ime ahụ nwere uru dị na obere ikpughe, obere ịpụpụ ihe, ịkwụsi ike, enweghị mkpa maka ndọpụ mpụga, wdg. Ọ dabara adaba maka 1/3 etiti, 1/3 nke ọkpụkpụ femur elu, 1/3 nke ọkpụkpụ dị iche iche, 1/3 nke ọkpụkpụ na-adịghị mma. Maka 1/3 nke ọkpụkpụ dị ala, n'ihi nnukwu oghere medullary na ọtụtụ ọkpụkpụ cancellous, ọ na-esiri ike ijikwa ntụgharị nke pin intramedullary, 1/3 nke ahụ adịghịkwa mma, ọ bụ ezie na enwere ike iji skru mee ka ọ sie ike, mana ọ ka mma maka skru ígwè.
Mkpuchi ime-emeghe maka mgbawa nke ogwe femur site na mbọ intramedullary
(1) Mbepụ: A na-eme mbepụ n'akụkụ ma ọ bụ n'azụ n'etiti ebe mgbawa ahụ dị, ogologo ya bụ 10-12 cm, na-egbutu akpụkpọ ahụ na fascia sara mbara ma na-ekpughe akwara femoral n'akụkụ.
A na-eme mbepụ ahụ n'akụkụ dị n'etiti trochanter ukwu na condyle nke femur, mbepụ akpụkpọ ahụ nke mbepụ azụ bụ otu ihe ahụ ma ọ bụ obere oge ka e mesịrị, isi ihe dị iche bụ na mbepụ azụ na-ekewa akwara vastus lateralis, ebe mbepụ azụ na-abanye n'etiti azụ nke akwara vastus lateralis site na akwara vastus lateralis. (Foto 3.5.5.2-1,3.5.5.2-2)
N'aka nke ọzọ, a na-eme mbepụ anterolateral site na ahịrị site na azụ azụ elu iliac nke dị n'ihu ruo na nsọtụ mpụta nke patella, a na-enwetakwa ya site na akwara femoral na akwara femoris nke dị n'akụkụ, nke nwere ike imerụ akwara femoral na alaka akwara dị n'etiti ruo na akwara femoral na alaka nke akwara femoral nke rotator femoris externus, ya mere a naghị eji ya eme ihe mgbe niile ma ọ bụ na-ejighị ya eme ihe (Foto 3.5.5.2-3).
(2) Ikpughe: Kewapụ ma dọpụta akwara femoral n'akụkụ gaa n'ihu wee banye na ya n'oge ya na biceps femoris, ma ọ bụ bee ma kewaa akwara femoral n'akụkụ ozugbo, mana ọbara ọgbụgba karịrị. Bee periosteum iji gosipụta nsọtụ elu na ala nke mgbawa femur gbajiri agbaji, ma kpughee oke ya ruo n'ókè enwere ike ịhụ ya ma weghachi ya, ma wepụ anụ ahụ dị nro obere oge o kwere mee.
(3) Ịrụzi ihe dị n'ime: Mee ka akụkụ ahụ metụtara, kpughee nsọtụ gbawara agbawa nke dị nso, tinye okooko osisi plum ma ọ bụ agịga intramedullary dị ka V, ma gbalịa tụọ ma ọkpụrụkpụ nke agịga ahụ kwesịrị ekwesị. Ọ bụrụ na e nwere mbelata nke oghere medullary, enwere ike iji ihe na-agbasa oghere medullary rụzie ma gbasaa oghere ahụ nke ọma, ka o wee gbochie agịga ahụ ịbanye na enweghị ike ịdọpụta ya. Jiri ihe na-ejide ọkpụkpụ dozie nsọtụ gbawara agbawa nke dị nso, tinye agịga intramedullary n'azụ, banye n'ime femur site na trochanter ka ukwuu, mgbe njedebe nke agịga ahụ kpaliri akpụkpọ ahụ, mee obere mbepụ nke 3cm n'ebe ahụ, ma nọgide na-etinye agịga intramedullary ruo mgbe ọ pụtara ìhè n'èzí akpụkpọ ahụ. A na-ewepụ agịga intramedullary, na-atụgharị ya, gafere site na foramen site na trochanter ka ukwuu, wee tinye ya nso na mbara nke akụkụ obe. Agịga intramedullary ka mma nwere obere nsọtụ gbara gburugburu nwere oghere mwepụ. Mgbe ahụ ọ dịghị mkpa ịdọpụta ma gbanwee ntụziaka ahụ, a pụkwara ịkụ agịga ahụ ma kụọ ya otu ugboro. Ma ọ bụghị ya, a pụrụ itinye agịga ahụ azụ site na iji ntụtụ nduzi wee kpughee ya n'èzí nnukwu mbepụ trochanteric, wee tinye ntụtụ intramedullary n'ime oghere medullary.
Mweghachi ọzọ nke mgbawa ahụ. Enwere ike ime ka nhazi ahụ dị n'ime ahụ site na iji ike nke ntụtụ intramedullary proximal yana njikọ nke ntụgharị ọkpụkpụ, traction, na fracture topping. A na-eji ihe njide ọkpụkpụ eme ihe, a na-akwalikwa ntụtụ intramedullary ka oghere mwepụta nke ntụtụ ahụ wee kwekọọ na mgbagọ femoral. Ọgwụgwụ agịga ahụ kwesịrị iru akụkụ kwesịrị ekwesị nke njedebe dịpụrụ adịpụ nke mgbawa ahụ, mana ọ bụghị site na akwa cartilage, a ga-ahapụkwa njedebe agịga ahụ 2cm n'èzí trochanter, ka e wee wepụ ya ma emechaa. (Foto 3.5.5.2-4).
Mgbe etinyere ya, gbalịa imegharị aka ahụ ma hụ na ọ dịghịzi ike. Ọ bụrụ na ọ dị mkpa iji dochie agịga intramedullary dị arọ, enwere ike iwepụ ya ma dochie ya. Ọ bụrụ na enwere ntakịrị mbelata na enweghị ntụkwasị obi, enwere ike itinye skru iji mee ka ntọala ahụ sie ike. (Foto 3.5.5.2-4)
E mechara sachaa ọnyá ahụ ma mechie ya n'ime akwa. E tinyere akpụkpọ ụkwụ plasta na-emegide mpụga.
Mgbakwunye nke efere II
Enwere ike iji skru efere ígwè mee ihe n'akụkụ niile nke ogwe femoral, mana 1/3 dị ala dabara adaba maka ụdị ndozi a n'ihi oghere medullary sara mbara. Enwere ike iji efere ígwè nkịtị ma ọ bụ efere ígwè mkpakọ AO. Nke ikpeazụ siri ike ma sie ike na-enweghị ndozi mpụga. Agbanyeghị, ọ dịghị nke ọ bụla n'ime ha nwere ike izere ọrụ nke ikpuchi nrụgide ma kwekọọ na ụkpụrụ nke ike nhata, nke kwesịrị ka eme ka ọ ka mma.
Usoro a nwere oke mkpụcha akpụkpọ ahụ, ihe ndị dị n'ime ya na-eme ka ọ dị mma, na-emetụta ọgwụgwọ, ma nweekwa adịghị ike.
Mgbe enweghị ọnọdụ pin intramedullary, ọkpụkpụ gbajiri agbaji ochie ma ọ bụ akụkụ buru ibu nke ihe a na-apụghị ịgafe na obere 1/3 nke ọkpụkpụ gbajiri agbaji na-agbanwe agbanwe karịa.
(1) Mbepụ akụkụ azụ ma ọ bụ akụkụ azụ nke femoral.
(2)(2) Mkpughe nke mgbawa ahụ, dabere na ọnọdụ ya, a ga-edozi ya ma tinye skru efere n'ime ya. A ga-etinye efere ahụ n'akụkụ nrụgide dị n'akụkụ, skru ahụ kwesịrị ịgafe cortex n'akụkụ abụọ ahụ, ogologo efere ahụ kwesịrị ịdị okpukpu 4-5 nke dayameta ọkpụkpụ ahụ n'ebe mgbawa ahụ dị. Ogologo efere ahụ bụ okpukpu 4 ruo 8 nke dayameta ọkpụkpụ ahụ gbawara agbawa. A na-ejikarị efere oghere 6 ruo 8 eme ihe na femur. Enwere ike iji skru ndị ọzọ dozie nnukwu iberibe ọkpụkpụ comminuted, enwere ike itinye ọtụtụ ihe ndọpụta ọkpụkpụ n'otu oge n'akụkụ etiti nke mgbawa comminuted. (Foto 3.5.5.2-5).
Sachaa ma mechie ya n'ime akwa. Dabere n'ụdị skru efere ejiri mee ihe, a kpebiri ma a ga-etinye ihe mkpuchi mpụga na plasta ma ọ bụ na a gaghị etinye ya.
Oge ozi: Maachị-27-2024
