Xov xwm - Femoral Plate Internal Fixation Procedure

Muaj ob hom kev phais, phaj screws thiab intramedullary pins, yav tas los suav nrog cov phaj dav dav thiab AO system compression phaj screws, thiab tom kawg suav nrog kaw thiab qhib retrograde lossis retrograde pins.Qhov kev xaiv yog nyob ntawm qhov chaw tshwj xeeb thiab hom kev tawg.
Intramedullary pin fixation muaj qhov zoo ntawm qhov raug me me, tsis tshua muaj stripping, ruaj khov kho, tsis xav tau kev kho sab nraud, thiab lwm yam. Nws yog tsim rau nruab nrab 1/3, sab sauv 1/3 femur tawg, ntau segmental puas, pathological puas.Rau qhov qis dua 1/3 pob txha, vim qhov loj medullary kab noj hniav thiab ntau cov pob txha tshem tawm, nws yog ib qho nyuaj rau kev tswj cov kev sib hloov ntawm intramedullary tus pin, thiab fixation tsis ruaj ntseg, txawm hais tias nws muaj peev xwm ntxiv dag zog nrog screws, tab sis nws yog tsim nyog. rau steel phaj screws.

Kuv Qhib-Internal Fixation rau Facture ntawm Femur Ncej nrog Intramedullary Nail
(1) Kev phais: Ib qho kev phais sab nraud lossis posterior lateral femoral incision yog ua nyob rau ntawm qhov chaw tawg, nrog qhov ntev ntawm 10-12 cm, txiav los ntawm daim tawv nqaij thiab cov fascia dav thiab nthuav tawm cov leeg femoral.
Lub lateral incision yog ua nyob rau ntawm txoj kab nruab nrab ntawm lub trochanter ntau dua thiab lateral condyle ntawm lub femur, thiab daim tawv nqaij incision ntawm lub posterior lateral incision yog tib yam los yog me ntsis tom qab, nrog rau lub ntsiab sib txawv yog hais tias lub lateral incision splits lub vastus lateralis nqaij. , thaum lub posterior lateral incision nkag mus rau lub posterior lub sij hawm ntawm lub vastus lateralis nqaij los ntawm lub vastus lateralis nqaij. (Fig 3.5.5.2-1, 3.5.5.2-2).

Lub anterolateral incision, ntawm qhov tod tes, yog ua los ntawm txoj kab los ntawm cov anterior superior iliac qaum mus rau sab ntug ntawm lub patella, thiab nkag mus los ntawm lub lateral femoral nqaij thiab rectus femoris nqaij, uas tej zaum yuav raug mob lub intermediary femoral nqaij thiab paj hlwb. cov ceg mus rau lateral femoral leeg thiab ceg ntawm rotator femoris externus hlab ntsha, thiab yog li tsis tshua muaj los yog tsis siv (Fig 3.5.5.2-3).

(2) Tawm: Sib cais thiab rub cov leeg nqaij femoral rau pem hauv ntej thiab nkag mus rau hauv nws lub sijhawm nrog biceps femoris, los yog txiav ncaj qha thiab cais cov leeg femoral, tab sis los ntshav ntau dua.Txiav lub periosteum kom nthuav tawm lub sab sauv thiab sab qis kawg ntawm lub femur tawg, thiab nthuav tawm qhov kev ua kom pom tau thiab rov qab los, thiab strip cov ntaub so ntswg kom tsawg li sai tau.
(3) Kho qhov kho sab hauv: Ntxiv cov ceg ntoo cuam tshuam, nthuav tawm qhov kawg ntawm qhov tawg, ntxig lub paj paj lossis V-shaped intramedullary koob, thiab sim ntsuas seb lub thickness ntawm rab koob puas tsim nyog.Yog hais tias muaj qhov nqaim ntawm lub medullary kab noj hniav, lub medullary kab noj hniav expander yuav siv tau los kho thiab nthuav cov kab noj hniav kom zoo, thiaj li tiv thaiv cov koob tsis tuaj yeem nkag mus thiab tsis tuaj yeem rub tawm.Txhim kho qhov sib txawv ntawm qhov kawg nrog cov pob txha tuav, ntxig lub koob intramedullary retrogradely, nkag mus rau lub femur los ntawm ntau dua trochanter, thiab thaum kawg ntawm rab koob thawb rau ntawm daim tawv nqaij, ua ib qho me me ntawm 3cm ntawm qhov chaw, thiab txuas ntxiv mus. koob intramedullary kom txog thaum nws tawm sab nraud ntawm daim tawv nqaij.Lub koob intramedullary yog rho tawm, xa rov qab, dhau los ntawm lub foramen los ntawm ntau dua trochanter, thiab tom qab ntawd muab tso rau ze rau lub dav hlau ntawm ntu ntu.Txhim kho intramedullary koob muaj me me sib npaug xaus nrog cov qhov rho tawm.Tom qab ntawd tsis tas yuav rub tawm thiab hloov cov kev taw qhia, thiab rab koob tuaj yeem raug punched tawm thiab tom qab ntawd xuas nrig ntaus ib zaug.Xwb, rab koob tuaj yeem muab tso rau hauv retrograde nrog cov lus qhia tus pin thiab nthuav tawm sab nraud ntau dua trochanteric incision, thiab tom qab ntawd tus pin intramedullary tuaj yeem muab tso rau hauv kab noj hniav medullary.
Kev kho dua tshiab ntawm qhov tawg.Anatomical alignment tuaj yeem ua tiav los ntawm kev siv lub zog ntawm qhov sib thooj intramedullary tus pin ua ke nrog cov pob txha pry pivoting, traction, thiab tawg topping.Kev kho yog ua tiav nrog cov pob txha tuav, thiab tus pin intramedullary ces tau tsav kom tus pin lub qhov rho tawm yog qhia tom qab kom ua raws li femoral curvature.Qhov kawg ntawm rab koob yuav tsum ncav cuag qhov tsim nyog ntawm qhov kawg ntawm qhov tawg, tab sis tsis yog los ntawm cov pob txha mos, thiab qhov kawg ntawm rab koob yuav tsum tau tso 2cm sab nraum lub trochanter, kom nws thiaj li tshem tau tom qab. 3.5.5.2-4).

Tom qab fixation, sim passive txav ntawm limb thiab saib tej instability.Yog hais tias nws yog tsim nyog los hloov lub thicker intramedullary koob, nws yuav raug tshem tawm thiab hloov.Yog tias muaj me ntsis loosening thiab instability, ib tug ntsia hlau yuav ntxiv dag zog rau fixation. (Fig 3.5.5.2-4).
Lub qhov txhab thaum kawg tau yaug thiab kaw hauv cov khaubncaws sab nraud povtseg.Ib qho kev tiv thaiv sab nraud tig plaster khau raj yog muab tso rau.
II Plate Screw Internal Fixation
Internal fixation nrog steel phaj screws yuav siv tau nyob rau hauv tag nrho cov qhov chaw ntawm lub femoral qia, tab sis lub qis 1/3 yog ntau haum rau no hom ntawm fixation vim lub dav medullary kab noj hniav.General steel phaj lossis AO compression steel phaj tuaj yeem siv.Cov tom kawg yog ntau ruaj thiab ruaj khov yam tsis muaj kev kho sab nraud.Txawm li cas los xij, tsis muaj leej twg tuaj yeem zam lub luag haujlwm ntawm kev ntxhov siab npog thiab ua raws li lub hauv paus ntsiab lus ntawm lub zog sib npaug, uas yuav tsum tau txhim kho.
Txoj kev no muaj qhov loj dua tev ntau, ntau sab hauv kho, cuam tshuam rau kev kho, thiab kuj muaj qhov tsis zoo.
Thaum tsis muaj intramedullary tus pin tej yam kev mob, qub pob txha medullary curvature los yog ib tug loj ib feem ntawm lub impassable thiab qis dua 1/3 ntawm cov pob txha yog ntau adaptable.
(1) Sab femoral lossis posterior lateral incision.
(2) (2) Tshem tawm ntawm qhov tawg, thiab nyob ntawm qhov xwm txheej, nws yuav tsum tau kho thiab kho sab hauv nrog phaj screws.Lub phaj yuav tsum tau muab tso rau ntawm qhov nro sab nraud, cov ntsia hlau yuav tsum dhau ntawm lub cortex ntawm ob sab, thiab qhov ntev ntawm lub phaj yuav tsum yog 4-5 npaug ntawm txoj kab uas hla ntawm cov pob txha ntawm qhov chaw tawg.Qhov ntev ntawm lub phaj yog 4 mus rau 8 npaug ntawm txoj kab uas hla ntawm cov pob txha tawg.6 mus rau 8 lub qhov phaj feem ntau yog siv rau hauv femur.Cov pob txha loj loj tuaj yeem kho nrog cov ntsia hlau ntxiv, thiab cov pob txha loj tuaj yeem muab tso rau tib lub sijhawm ntawm qhov nruab nrab ntawm cov pob txha comminuted. (Fig 3.5.5.2-5).