Xov Xwm - Kev Kho Mob Femoral Plate Sab Hauv

Muaj ob hom kev phais mob, xws li cov ntsia hlau phaj thiab cov koob ntsaws rau hauv pob txha caj qaum, thawj hom suav nrog cov ntsia hlau phaj dav dav thiab cov ntsia hlau phaj nias AO system, thiab qhov thib ob suav nrog cov koob ntsaws rov qab kaw thiab qhib lossis cov koob ntsaws rov qab. Kev xaiv yog nyob ntawm qhov chaw tshwj xeeb thiab hom pob txha tawg.
Kev kho tus pin intramedullary muaj qhov zoo ntawm kev raug me me, tsawg dua stripping, ruaj khov kho, tsis tas yuav kho sab nraud, thiab lwm yam. Nws yog qhov tsim nyog rau nruab nrab 1/3, sab saud 1/3 femur tawg, ntau-segmental tawg, pathological tawg. Rau qhov qis 1/3 tawg, vim yog lub qhov loj medullary thiab ntau pob txha cancellous, nws nyuaj rau tswj kev tig ntawm intramedullary pin, thiab kev kho tsis ruaj ntseg, txawm hais tias nws tuaj yeem ua kom muaj zog nrog cov ntsia hlau, tab sis nws yog qhov tsim nyog dua rau cov hlau phaj ntsia hlau.

Kuv Qhib-sab hauv Kho rau Qhov Pob Txha Femur nrog Intramedullary Nail
(1) Kev Txiav: Ib qho kev txiav sab nraud lossis sab nraub qaum ntawm lub pob txha femoral yog ua rau ntawm qhov chaw tawg, nrog qhov ntev ntawm 10-12 cm, txiav los ntawm daim tawv nqaij thiab cov fascia dav thiab qhia cov leeg nqaij femoral sab.
Qhov kev txiav sab nraud yog ua rau ntawm txoj kab ntawm lub pob tw loj dua thiab lub pob tw sab nraud ntawm lub pob tw, thiab qhov kev txiav ntawm daim tawv nqaij ntawm qhov kev txiav sab nraud tom qab yog tib yam lossis me ntsis tom qab, qhov sib txawv tseem ceeb yog tias qhov kev txiav sab nraud faib cov leeg vastus lateralis, thaum qhov kev txiav sab nraud tom qab nkag mus rau hauv qhov nruab nrab tom qab ntawm cov leeg vastus lateralis los ntawm cov leeg vastus lateralis. (Daim duab 3.5.5.2-1, 3.5.5.2-2).

Qhov kev phais anterolateral, ntawm qhov tod tes, yog ua los ntawm txoj kab los ntawm anterior superior iliac spine mus rau ntug sab nraud ntawm patella, thiab nkag mus los ntawm cov leeg nqaij lateral femoral thiab cov leeg nqaij rectus femoris, uas yuav ua rau cov leeg nqaij femoral thiab cov ceg ntawm cov hlab ntsha raug mob rau cov leeg nqaij lateral femoral thiab cov ceg ntawm rotator femoris externus artery, thiab yog li ntawd tsis tshua muaj lossis tsis tau siv (Daim Duab 3.5.5.2-3).

(2) Kev Raug: Cais thiab rub cov leeg nqaij femoral sab nraud mus tom ntej thiab nkag mus rau hauv nws lub sijhawm nrog cov biceps femoris, lossis txiav thiab cais cov leeg nqaij femoral sab nraud ncaj qha, tab sis los ntshav ntau dua. Txiav lub periosteum kom pom qhov kawg tawg sab saud thiab qis ntawm qhov tawg ntawm femur, thiab qhia qhov dav kom txog thaum nws tuaj yeem pom thiab rov qab los, thiab tshem cov ntaub so ntswg mos mos kom tsawg li tsawg tau.
(3) Kho qhov kho sab hauv: Muab cov ceg uas raug mob tso rau hauv, qhib qhov kawg uas tawg lawm, ntxig lub paj plum lossis koob intramedullary zoo li V, thiab sim ntsuas seb qhov tuab ntawm koob puas tsim nyog. Yog tias muaj qhov nqaim ntawm lub qhov medullary, lub medullary cavity expander tuaj yeem siv los kho thiab nthuav lub qhov kom zoo, kom tiv thaiv lub koob kom tsis txhob nkag mus thiab tsis tuaj yeem rub tawm. Kho qhov kawg uas tawg lawm nrog lub pob txha, ntxig lub koob intramedullary rov qab, nkag mus rau hauv lub pob txha ntawm lub pob txha loj dua, thiab thaum kawg ntawm lub koob thawb mus rau ntawm daim tawv nqaij, ua ib qho me me ntawm 3cm ntawm qhov chaw, thiab txuas ntxiv ntxig lub koob intramedullary kom txog thaum nws raug nthuav tawm sab nraud daim tawv nqaij. Lub koob intramedullary raug rho tawm, rov qab mus, dhau los ntawm lub qhov rooj los ntawm lub pob txha loj dua, thiab tom qab ntawd ntxig rau ntawm lub dav hlau ntawm qhov seem. Cov koob intramedullary zoo dua muaj cov qhov me me nrog cov qhov rho tawm. Ces tsis tas yuav rub tawm thiab hloov qhov kev taw qhia, thiab lub koob tuaj yeem raug punched tawm thiab tom qab ntawd punched rau hauv ib zaug xwb. Los yog, lub koob tuaj yeem raug ntxig rov qab nrog lub pin qhia thiab nthuav tawm sab nraud ntawm qhov phais loj dua trochanteric, thiab tom qab ntawd lub pin intramedullary tuaj yeem raug ntxig rau hauv qhov medullary cavity.
Kev kho dua tshiab ntawm qhov tawg. Kev sib dhos ntawm lub cev tuaj yeem ua tiav los ntawm kev siv lub zog ntawm tus pin intramedullary proximal ua ke nrog kev sib tsoo ntawm pob txha, kev rub, thiab kev sib tsoo saum toj. Kev kho tiav nrog lub pob txha tuav, thiab tom qab ntawd tus pin intramedullary raug tsav kom lub qhov rho tawm ntawm tus pin raug taw qhia tom qab kom haum rau qhov nkhaus ntawm lub femoral. Qhov kawg ntawm rab koob yuav tsum mus txog qhov tsim nyog ntawm qhov kawg ntawm qhov tawg, tab sis tsis txhob hla cov txheej cartilage, thiab qhov kawg ntawm rab koob yuav tsum tso 2cm sab nraud ntawm trochanter, kom nws tuaj yeem tshem tawm tom qab. (Daim duab 3.5.5.2-4).

Tom qab kho tas, sim ua kom ceg tsis txav thiab saib seb puas muaj qhov tsis ruaj khov. Yog tias yuav tsum tau hloov lub koob txhaj tshuaj uas tuab dua, nws tuaj yeem raug tshem tawm thiab hloov pauv. Yog tias muaj qhov xoob me ntsis thiab tsis ruaj khov, koj tuaj yeem ntxiv ib lub hau ntswj kom txhawb nqa qhov kho. (Daim Duab 3.5.5.2-4).
Thaum kawg qhov txhab tau ntxuav thiab kaw ua ntau txheej. Muab khau looj plab hlaub tiv thaiv kev tig sab nraud rau.
II Phaj Ntsia Hlau Kho Sab Hauv
Kev kho sab hauv nrog cov ntsia hlau phaj hlau tuaj yeem siv rau txhua qhov ntawm cov qia femoral, tab sis qis dua 1/3 yog qhov tsim nyog dua rau hom kev kho no vim yog qhov dav medullary qhov. Cov phaj hlau dav dav lossis AO compression hlau phaj tuaj yeem siv. Qhov kawg yog khov kho dua thiab ruaj khov yam tsis muaj kev kho sab nraud. Txawm li cas los xij, tsis muaj ib qho ntawm lawv tuaj yeem zam lub luag haujlwm ntawm kev ntxhov siab masking thiab ua raws li lub hauv paus ntsiab lus ntawm lub zog sib npaug, uas yuav tsum tau txhim kho.
Txoj kev no muaj ntau qhov kev tev tawv loj dua, kho kom ruaj khov dua sab hauv, cuam tshuam rau kev kho mob, thiab kuj muaj qhov tsis zoo.
Thaum tsis muaj cov mob intramedullary pin, qhov qub fracture medullary curvature lossis ib feem loj ntawm qhov tsis tuaj yeem hla tau thiab qis dua 1/3 ntawm qhov fracture yog adaptable dua.
(1) Txiav sab pob txha caj qaum los yog sab nraub qaum.
(2)(2) Kev nthuav tawm ntawm qhov tawg, thiab nyob ntawm qhov xwm txheej, nws yuav tsum tau kho thiab kho sab hauv nrog cov ntsia hlau phaj. Lub phaj yuav tsum tau muab tso rau ntawm sab nruj, cov ntsia hlau yuav tsum hla dhau lub cortex ntawm ob sab, thiab qhov ntev ntawm lub phaj yuav tsum yog 4-5 npaug ntawm txoj kab uas hla ntawm pob txha ntawm qhov chaw tawg. Qhov ntev ntawm lub phaj yog 4 txog 8 npaug ntawm txoj kab uas hla ntawm pob txha tawg. 6 txog 8 lub phaj qhov feem ntau siv rau hauv lub femur. Cov pob txha loj loj uas tau sib xyaw ua ke tuaj yeem kho nrog cov ntsia hlau ntxiv, thiab ntau cov pob txha grafts tuaj yeem tso rau tib lub sijhawm ntawm sab medial ntawm qhov tawg uas tau sib xyaw ua ke. (Daim duab 3.5.5.2-5).