Akụkọ - Usoro ndozi ime efere femoral

Enwere ụdị ụzọ ịwa ahụ abụọ, kposara efere na ntụtụ intramedullary, nke mbụ gụnyere kposara efere izugbe na skru sistemụ mkpakọ AO, nke ikpeazụ gụnyere emechi ma mepee retrograde ma ọ bụ retrograde atụdo.Nhọrọ ahụ dabere na saịtị ahụ akọwapụtara na ụdị mgbawa.
Intramedullary pin fixation nwere uru nke obere ikpughe, obere nkwụsịtụ, nkwụsi ike kwụsiri ike, ọ dịghị mkpa maka nhazi nke mpụga, wdg. Ọ dị mma maka etiti 1/3, elu 1/3 femur fracture, multi-segmental fracture, pathological fracture.Maka mgbaji 1/3 dị ala, n'ihi nnukwu oghere medullary na ọtụtụ ọkpụkpụ kagbuo, ọ na-esiri ike ịchịkwa ntụgharị nke intramedullary pin, na nhazi ahụ adịghị echekwa, ọ bụ ezie na enwere ike iji kposara mee ka ọ dịkwuo ike, ma ọ ka mma karịa. maka kposara efere ígwè.

M ndozi ime ime maka mgbaji nke Femur Shaft nwere ntu intramedullary
(1) Mkpebi: A na-eme ka ọkpụkpụ femoral nke dị n'akụkụ ma ọ bụ nke dị n'azụ na-adabere na saịtị mgbawa, na ogologo nke 10-12 cm, na-egbutu akpụkpọ ahụ na fascia sara mbara ma na-ekpughe ahụ ike femoral.
A na-eme mbepụ n'akụkụ n'ahịrị dị n'etiti trochanter ka ukwuu na condyle mpụta nke femur, na mbepụ akpụkpọ ahụ nke n'azụ mpụta bụ otu ma ọ bụ ntakịrị ka e mesịrị, nke bụ isi ihe dị iche bụ na mbepụ mpụta na-ekewa vastus lateralis muscle. , ebe mbepụ azụ azụ na-abanye n'azụ azụ nke akwara lateralis site na akwara vastus lateralis (Fig 3.5.5.2-1, 3.5.5.2-2).

N'aka nke ọzọ, a na-eme mbepụ nke anterolateral site n'ahịrị site na azụ azụ azụ azụ nke elu elu ruo n'akụkụ mpụta nke patella, a na-enweta ya site na akwara femoral mpụta na akwara femoris rectus, nke nwere ike imerụ ahụ nke etiti femoral na irighiri akwara. alaka ruo na mpụta femoral muscle na alaka nke rotator femoris externus artery, ya mere, ọ na-adịkarịghị ma ọ bụ mgbe eji ya (Fig 3.5.5.2-3).

(2) Ngosipụta: Kewapụ ma dọpụta akwara femoral dị n'akụkụ wee banye n'oge etiti ya na femoris biceps, ma ọ bụ bee ozugbo ma kewaa ahụ ike femoral mpụta, mana ọbara ọgbụgba ka ukwuu.Bee periosteum iji kpughee nsọtụ elu na ala gbajiri agbaji nke femur, ma kpughee oke ya ruo n'ókè enwere ike ịhụ ya ma weghachi ya, ma yipụ anụ ahụ dị nro dị ka o kwere mee.
(3) Imezi mmezi nke ime ime: Tinye akụkụ akụkụ ahụ emetụtara, kpughee njedebe gbajiri nso, fanye ifuru plum ma ọ bụ agịga intramedullary nke nwere V, wee nwaa tụọ ma ọkpụrụkpụ nke agịga ọ dabara.Ọ bụrụ na enwere mbelata nke oghere medullary, enwere ike iji ihe na-eme ka oghere medullary rụọ ọrụ nke ọma ma gbasaa oghere ahụ, ka ọ ghara igbochi agịga ka ọ ghara ịbanye na enweghị ike ịdọpụ ya.Dozie njedebe nke gbajiri agbaji na njide ọkpụkpụ, tinye agịga intramedullary retrogradely, banye femur site na nnukwu trochanter, na mgbe njedebe nke agịga ahụ na-akwali akpụkpọ ahụ, mee obere mbepụ nke 3cm n'ebe ahụ, ma nọgide na-etinye ya. agịga intramedullary ruo mgbe ọ pụtara n'èzí akpụkpọ ahụ.A na-ewepụ agịga intramedullary, na-atụgharị ya, gafere site na foramen site na nnukwu trochanter, wee tinye ya nso na ụgbọ elu nke akụkụ obe.Agịga intramedullary emelitere nwere obere ngwụcha nwere oghere mmịpụta.Mgbe ahụ, ọ dịghị mkpa ịdọpụ ma gbanwee ntụziaka ahụ, a pụkwara ịkụnye agịga ahụ wee pịa ya otu ugboro.N'aka nke ọzọ, enwere ike ịtinye agịga retrograde na ntụtụ nduzi ma kpughee n'èzí n'èzí trochanteric ka ukwuu, mgbe ahụ enwere ike itinye pin intramedullary n'ime oghere medullary.
Mweghachi ọzọ nke mgbaji ahụ.Enwere ike nweta nhazi nke anatomical site na iji ike nke pin intramedullary dị nso na njikọ ọkpụkpụ pry pivoting, traction, na mgbaji topping.A na-eji ihe njide ọkpụkpụ na-enweta ndozi, a na-akpụzi pin intramedullary ka a na-eduzi oghere mịpụta nke ahụ n'azụ ka ọ kwekọọ na curvature femoral.Ọgwụgwụ nke agịga kwesịrị iru akụkụ kwesịrị ekwesị nke njedebe dị anya nke mgbawa, ma ọ bụghị site na oyi akwa cartilage, na njedebe nke agịga kwesịrị ịhapụ 2cm n'èzí nke trochanter, ka e wee wepụ ya mgbe e mesịrị. 3.5.5.2-4).

Mgbe emezichara, nwaa mmegharị ahụ nke akụkụ ahụ ma hụ enweghị ntụkwasị obi ọ bụla.Ọ bụrụ na ọ dị mkpa iji dochie agịga intramedullary dị arọ, enwere ike wepụ ya ma dochie ya.Ọ bụrụ na enwere ntakịrị ịtọpụ na enweghị ntụkwasị obi, enwere ike ịgbakwunye nkedo iji mee ka ndozi ahụ sie ike. (Fig 3.5.5.2-4).
Emechapụrụ ọnya ahụ wee mechie ya n'ígwé.A na-etinye akpụkpọ ụkwụ plasta ntụgharị mgbochi mpụga.
II Plate Screw Internal Fixation
Enwere ike iji ihe ndozi dị n'ime ya na nkedo efere ígwè mee ihe n'akụkụ niile nke femoral stem, ma 1/3 dị ala dị mma maka ụdị nhazi a n'ihi oghere medullary sara mbara.Enwere ike iji efere ígwè General ma ọ bụ AO mkpakọ ígwè efere.Nke ikpeazụ bụ ihe siri ike na nke siri ike na-enweghị nhazi nke mpụga.Otú ọ dị, ọ dịghị onye n'ime ha nwere ike izere ọrụ nke mkpuchi nchekasị ma kwekọọ n'ụkpụrụ nke ike nha anya, nke kwesịrị imeziwanye.
Usoro a nwere oke peeling ka ukwuu, nhazi nke ime ya, na-emetụta ọgwụgwọ, ma nweekwa adịghị ike.
Mgbe enweghi ọnọdụ ntụtụ intramedullary, mgbaji medullary curvature ochie ma ọ bụ akụkụ buru ibu nke enweghị ike ịgafe na 1/3 nke mgbaji ahụ na-enwe ike ime mgbanwe.
(1) Mwapụ akụkụ femoral ma ọ bụ n'azụ.
(2) (2) Ngosipụta nke mgbaji ahụ, na dabere n'ọnọdụ ndị ahụ, a ga-edozi ya ma tinye ya n'ime ya na kposara efere.Ekwesịrị itinye efere ahụ n'akụkụ esemokwu n'akụkụ, ihe nkedo ahụ kwesịrị ịgafe na cortex n'akụkụ abụọ, na ogologo nke efere ahụ kwesịrị ịbụ oge 4-5 nke dayameta nke ọkpụkpụ na ebe mgbawa.Ogologo efere ahụ dị okpukpu 4 ruo 8 n'obosara nke ọkpụkpụ gbajiri agbaji.A na-ejikarị efere oghere 6 ruo 8 na femur.Enwere ike idozi iberibe ọkpụkpụ buru ibu na nkedo ndị ọzọ, a pụkwara itinye ọnụ ọgụgụ dị ukwuu nke ọkpụkpụ ọkpụkpụ n'otu oge ahụ n'akụkụ etiti nke mgbaji ahụ. (Fig 3.5.5.2-5).