Akwai nau'ikan hanyoyin tiyata iri biyu, faranti sukurori da intramedullary fil, na farko ya haɗa da farantin farantin gabaɗaya da na'urorin matsawa na tsarin AO, kuma na ƙarshe ya haɗa da rufaffiyar da buɗe retrograde ko retrograde fil.Zaɓin ya dogara ne akan takamaiman shafin da nau'in karaya.
Ƙwararren fil ɗin intramedullary yana da fa'idodi na ƙananan ƙwanƙwasa, ƙananan raguwa, ƙayyadaddun ƙayyadaddun gyare-gyare, babu buƙatar gyaran waje, da dai sauransu Ya dace da tsakiyar 1/3, babba 1/3 femur fracture, Multi-segmental fracture, pathological fracture.Don ƙananan 1/3 karaya, saboda babban medullary cavity da kuma yawancin soket kashi, yana da wuya a sarrafa juyawa na intramedullary fil, kuma gyarawa ba shi da tsaro, ko da yake ana iya ƙarfafa shi da sukurori, amma ya fi dacewa. ga karfe farantin sukurori.
Na Buɗe Gyaran Ciki don Karyewar Shaft ɗin Femur tare da Ƙaƙƙarfan Intramedullary
(1) ciki na gaba: an sanya shi a gefe guda ko na ƙarshe na ɓangare a gefe, tare da tsawon 10-12 cm, yankan ta fata da kuma bayyana ta hanyar ƙwayar ƙyama.
Ana yin katsewar gefe akan layin da ke tsakanin mafi girma trochanter da ƙwanƙwasa na gefe na femur, kuma ƙaddamarwar fata na gefen gefen baya ɗaya ne ko kadan daga baya, tare da babban bambanci shi ne cewa ƙaddamarwa ta gefe ta raba vastus lateralis tsoka. , yayin da ƙaddamarwa ta baya ta shiga tsaka-tsakin tazara na tsokar ƙwayar tsoka ta hanyar ƙwayar tsoka.(Fig 3.5.5.2-1,3.5.5.2-2)
Ƙwaƙwalwar gaba, a gefe guda, an yi ta hanyar layi daga kashin baya na iliac na gaba zuwa gefen waje na patella, kuma ana samun dama ta hanyar tsokar mace ta gefe da kuma tsokar mata na mata, wanda zai iya cutar da tsokoki na mata da kuma jijiya. rassan zuwa tsokar mace ta gefe da kuma rassan rotator femoris externus artery, sabili da haka da wuya ko ba a taɓa amfani da su ba (Fig 3.5.5.2-3).
(2) Bayyanawa: Ware kuma a ja tsokar mace ta gefe gaba a shigar da ita a tazarar ta tare da femoris biceps, ko kuma a yanke kai tsaye a raba tsokar femoral na gefe, amma zubar jini ya fi yawa.Yanke periosteum don bayyana karaya na sama da na ƙasa na karayar femur, kuma a bayyana iyakar iyakar yadda za a iya lura da shi kuma a maido da shi, kuma a cire kyallen takarda mai laushi kadan kadan.
(3) Gyara gyare-gyaren ciki: Ƙara gaɓoɓin da abin ya shafa, fallasa ƙarshen karyewar kusa, saka furen plum ko allurar intramedullary mai siffar V, sannan a gwada ko kaurin allurar ya dace.Idan an sami raguwar rami mai zurfi, za a iya amfani da na'urar faɗaɗa kogon don gyara rami da kyau da faɗaɗawa, ta yadda za a hana allurar ta kasa shiga kuma ba za a iya fitar da ita ba.Gyara ƙarshen ƙarshen da ya karye tare da mariƙin kashi, saka allurar intramedullary ta koma baya, ku shiga cikin femur daga mafi girma, kuma lokacin da ƙarshen allurar ya motsa fata, yi ɗan ƙaramin yanki na 3cm a wurin, sannan a ci gaba da sakawa. allurar intramedullary har sai ta fito a waje da fata.Ana cire allurar intramedullary, a jujjuya shi, ta wuce ta cikin mazugi daga mafi girma trochanter, sa'an nan kuma an saka shi kusa da jirgin saman sashin giciye.Ingantattun alluran intramedullary suna da ƙananan ƙarshen zagaye tare da ramukan cirewa.Sa'an nan kuma babu buƙatar cirewa a canza hanya, kuma za a iya buga allurar sannan a buga sau ɗaya.A madadin, za a iya shigar da allurar a baya tare da fil ɗin jagora kuma a fallasa su a waje da babban yanki na trochanteric, sa'an nan kuma za a iya shigar da fil ɗin intramedullary a cikin rami na medullary.
Kara maido da karaya.Za a iya samun daidaitawar jiki ta hanyar yin amfani da madaidaicin fil ɗin intramedullary na kusa da haɗin gwiwa tare da pivoting na kashi, jan hankali, da karaya.Ana samun gyarawa tare da mariƙin kashi, sa'an nan kuma ana tura fil ɗin intramedullary ta yadda za a jagoranci ramin cire fil ɗin a baya don dacewa da lanƙwan femoral.Ƙarshen allura ya kamata ya isa ga ɓangaren da ya dace na ƙarshen ɓawon burodi, amma ba ta hanyar ƙwayar guringuntsi ba, kuma ƙarshen allurar ya kamata a bar 2cm a waje da trochanter, don a iya cire shi daga baya. 3.5.5.2-4)
Bayan gyare-gyare, gwada motsi mara kyau na ƙafar ƙafa kuma lura da kowane rashin kwanciyar hankali.Idan ya cancanta don maye gurbin allurar intramedullary mai kauri, ana iya cire shi kuma a maye gurbinsa.Idan akwai ɗan sassautawa da rashin kwanciyar hankali, ana iya ƙara dunƙule don ƙarfafa gyare-gyare. (Fig 3.5.5.2-4)
A karshe an wanke raunin kuma an rufe shi da yadudduka.Ana saka takalmin filastar jujjuyawar waje.
II Plate Screw Internal Fixation
Ana iya amfani da gyare-gyaren ciki tare da ƙwanƙwasa farantin karfe a duk sassan sassan femoral, amma ƙananan 1/3 ya fi dacewa da wannan nau'in gyare-gyaren saboda faɗuwar medullary cavity.Za a iya amfani da farantin karfe na gaba ɗaya ko AO matsawa karfe farantin.Ƙarshen ya fi ƙarfi kuma yana da ƙarfi ba tare da gyarawa na waje ba.Duk da haka, ba ɗayansu ba zai iya guje wa rawar da ake yi na damuwa da damuwa kuma ya dace da ka'idar daidaitattun ƙarfi, wanda ke buƙatar ingantawa.
Wannan hanya tana da mafi girman kewayon peeling, ƙarin gyaran ciki, yana shafar warkarwa, kuma yana da gazawa.
Lokacin da rashin yanayin fil na intramedullary, tsohuwar karaya medullary curvature ko babban ɓangaren maras wucewa da ƙananan 1/3 na karaya sun fi daidaitawa.
(1)Lateral femoral ko ta baya.
(2) (2) Bayyana karaya, kuma dangane da yanayin, ya kamata a gyara shi kuma a gyara shi a ciki tare da skru farantin.Ya kamata a sanya farantin a gefen tashin hankali na gefe, kullun ya kamata ya wuce ta hanyar cortex a bangarorin biyu, kuma tsawon farantin ya kamata ya zama sau 4-5 na diamita na kashi a wurin raguwa.Tsawon farantin yana da sau 4 zuwa 8 diamita na kashin da ya karye.Ana yawan amfani da faranti 6 zuwa 8 a cikin femur.Za'a iya gyara ɓangarorin ƙasusuwan ƙasusuwa masu girma tare da ƙarin sukurori, kuma ana iya sanya adadi mai yawa na ƙasusuwan kasusuwa a lokaci guda a gefen tsakiya na raunin da aka yanke. (Fig 3.5.5.2-5).
Kurkura kuma rufe a cikin yadudduka.Dangane da nau'in screws da aka yi amfani da su, an yanke shawarar ko za a yi amfani da gyaran waje tare da filasta.
Lokacin aikawa: Maris-27-2024
