Akwai nau'ikan hanyoyin tiyata guda biyu, sukurori na faranti da fil ɗin intramedullary, na farko ya haɗa da sukurori na faranti na gabaɗaya da sukurori na faranti na matsewa na tsarin AO, na biyu kuma ya haɗa da fil ɗin retrograde ko retrograde a rufe da buɗe. Zaɓin ya dogara ne akan takamaiman wurin da kuma nau'in karyewar.
Gyaran fil ɗin intramedullary yana da fa'idodin ƙananan fallasa, ƙarancin cirewa, gyarawa mai ƙarfi, babu buƙatar gyarawa ta waje, da sauransu. Ya dace da 1/3 na tsakiya, karyewar ƙafa ta sama 1/3, karyewar sassa da yawa, karyewar cututtuka. Ga karyewar ƙasa 1/3, saboda babban ramin medullary da kuma ƙashi mai yawa, yana da wuya a sarrafa juyawar fil ɗin intramedullary, kuma gyarawar ba ta da aminci, kodayake ana iya ƙarfafa ta da sukurori, amma ya fi dacewa da sukurori na farantin ƙarfe.
Ƙunshin ciki na Buɗaɗɗen wuri don Karyewar Shaft na Femur tare da ƙusa ta Intramedullary
(1) Yankewa: Ana yin yankan gefe ko na baya a kan wurin da karayar ta faru, tsawonsa ya kai santimita 10-12, yana yanke fata da kuma fascia mai faɗi sannan ya bayyana tsokar gefen cinyar.
An yi yankewar gefe a kan layin da ke tsakanin babban trochanter da kuma lateral condyle na femur, kuma yankewar fata na yankewar gefe na baya iri ɗaya ne ko kuma ɗan lokaci kaɗan, babban bambanci shine cewa yankewar gefe yana raba tsokar vastus lateralis, yayin da yankewar gefe na baya ke shiga tazara ta baya ta tsokar vastus lateralis ta cikin tsokar vastus lateralis. (Hoto na 3.5.5.2-1,3.5.5.2-2)
A gefe guda kuma, ana yin yankewar anterolateral ta layin daga kashin baya na gaba zuwa gefen waje na patella, kuma ana shiga ta cikin tsokar femoral ta gefe da tsokar femoris ta rectus, wanda zai iya cutar da tsokar femoral da rassan jijiyoyi na tsakiya zuwa ga tsokar femoral ta gefe da rassan jijiyar femoris ta waje, don haka ba a taɓa amfani da shi ba ko kuma ba a taɓa amfani da shi ba (Hoto na 3.5.5.2-3).
(2) Bayyanawa: Raba tsokar cinyar a gefe gaba sannan a shigar da ita a lokacin da take tare da biceps femoris, ko kuma a yanke kai tsaye a raba tsokar cinyar a gefe, amma zubar jini ya fi yawa. A yanke periosteum don bayyana ƙarshen karyewar cinyar sama da ƙasa, sannan a bayyana girman da za a iya gani da kuma gyara ta, sannan a cire kyallen da ke da laushi gwargwadon iyawa.
(3) Gyaran wurin da aka gyara na ciki: Sanya gaɓɓan da abin ya shafa, buɗe ƙarshen da ya karye kusa, saka furen plum ko allurar intramedullary mai siffar V, sannan a yi ƙoƙarin auna ko kauri na allurar ya dace. Idan akwai kunkuntar ramin medullary, ana iya amfani da mai faɗaɗa ramin medullary don gyara da faɗaɗa ramin yadda ya kamata, don hana allurar shiga da rashin iya cirewa. Gyara ƙarshen da ya karye kusa da shi da abin riƙe ƙashi, saka allurar intramedullary a baya, shiga cikin femur daga babban trochanter, kuma lokacin da ƙarshen allurar ya tura fata, yi ƙaramin yankewa na 3cm a wurin, sannan a ci gaba da saka allurar intramedullary har sai ta bayyana a wajen fata. Ana cire allurar intramedullary, a juya ta, a ratsa ta cikin foramen daga babban trochanter, sannan a saka ta kusa da saman sashin giciye. Ingancin allurar intramedullary suna da ƙananan ƙarshen zagaye tare da ramukan cirewa. Sannan babu buƙatar a ja a canza alkibla, kuma ana iya fitar da allurar sannan a huda ta sau ɗaya. A madadin haka, ana iya saka allurar a baya da fil ɗin jagora sannan a fallasa ta a wajen babban yankewar trochanteric, sannan a saka fil ɗin intramedullary a cikin ramin medullary.
Ƙarin gyara karyewar. Ana iya cimma daidaiton yanayin jiki ta hanyar amfani da ƙarfin fil ɗin intramedullary na proximal tare da juyawar ƙashi, jan hankali, da saman karyewar. Ana samun daidaiton da abin riƙe ƙashi, sannan ana tura fil ɗin intramedullary ta yadda ramin cire fil ɗin zai yi daidai da lanƙwasa na femoral. Ƙarshen allurar ya kamata ya isa ga ɓangaren da ya dace na ƙarshen karyewar, amma ba ta hanyar layin cartilage ba, kuma ƙarshen allurar ya kamata a bar shi 2cm a wajen trochanter, don a iya cire shi daga baya. (Hoto na 3.5.5.2-4)
Bayan an gyara, a gwada motsi na gaɓɓai a jiki sannan a lura da duk wani rashin daidaito. Idan ya zama dole a maye gurbin allurar intramedullary mai kauri, ana iya cire ta a maye gurbinta. Idan akwai ɗan sassautawa da rashin daidaito, ana iya ƙara sukurori don ƙarfafa gyaran. (Hoto na 3.5.5.2-4).
An wanke raunin a ƙarshe kuma an rufe shi da yadudduka. An saka takalmin filastik mai hana juyawa na waje.
Gyaran Ciki na Faranti na II
Ana iya amfani da sukurori na ƙarfe a dukkan sassan jikin femoral, amma ƙananan 1/3 ya fi dacewa da wannan nau'in gyara saboda faɗin ramin medullary. Ana iya amfani da farantin ƙarfe na gaba ɗaya ko farantin ƙarfe mai matsawa na AO. Na ƙarshen ya fi ƙarfi kuma an gyara shi sosai ba tare da gyara na waje ba. Duk da haka, babu ɗayansu da zai iya guje wa rawar da ke ɓoye damuwa kuma ya bi ƙa'idar ƙarfi iri ɗaya, wanda ke buƙatar a inganta shi.
Wannan hanyar tana da babban yanayin barewa, ƙarin gyarawa na ciki, yana shafar warkarwa, kuma yana da rauni.
Idan akwai rashin yanayin fin ɗin intramedullary, tsohon lanƙwasa na medullary ko babban ɓangare na abin da ba za a iya wucewa ba da kuma ƙasa da 1/3 na karyewar sun fi dacewa.
(1)Yankewar gefe a gefe ko a gefe a bayan cinya.
(2)(2) Bayyanar karyewar, kuma dangane da yanayin, ya kamata a daidaita shi kuma a haɗa shi da sukurori na faranti a ciki. Ya kamata a sanya faranti a gefen tashin hankali na gefe, sukurori ya kamata su ratsa ta cikin cortex a ɓangarorin biyu, kuma tsawon faranti ya kamata ya zama sau 4-5 na diamita na ƙashin a wurin karyewar. Tsawon faranti ya ninka diamita na ƙashin da ya karye sau 4 zuwa 8. Ana amfani da faranti 6 zuwa 8 na rami a cikin cinya. Ana iya gyara manyan gutsuttsuran ƙashi da ƙarin sukurori, kuma ana iya sanya adadi mai yawa na dashen ƙashi a lokaci guda a gefen tsakiya na karyewar da aka karye. (Hoto na 3.5.5.2-5).
Kurkura a rufe shi da yadudduka. Dangane da nau'in sukurori na faranti da aka yi amfani da su, an yanke shawarar ko za a shafa abin da aka gyara a waje da filasta ko a'a.
Lokacin Saƙo: Maris-27-2024
