Naifiyar Neling - Yadda za a zabi mafi kyawun sa?

Shigowa da

Za'a iya gano ci gaban aikin karaya na Fimoral karaya zuwa 1940s lokacin da Kuntmer ya gabatar da rufe rufewar Intraaddamar da Na'urar da ke rufewarta. Yin amfani da kusoshi mai ban tsoro (IMNNS) a cikin kararwar Fimoral ta zama matsayin kulawa a cikin 'yan shekarun da suka gabata, da haɓaka na yanzu a ciki Nighling nayiling da ci gaba dabarun tiyata sun ba da izinin ƙaruwa mai yawa cikin amfani da femur na femur.

Ana amfani da maganin ra'ayin mazan jiya na ra'ayin mazan jiya kawai a cikin ƙanana marasa lafiya da mahimmancin magani don maganin barci. Game da lura da tiyata, akwai zaɓuɓɓuka da yawa waɗanda aka samu, gami da nazarin wasan kwaikwayo, farantin dunƙule, da gyara na waje. Idan aka kwatanta da sauran zaɓuɓɓukan tiyata, tsinkaye tsintsaye shine daidaito tare da ƙimar rafi mai ƙarancin rauni, kuma yana ƙaruwa sosai a aikin asibiti.

Kyakkyawan fahimta game da ilmin wasan kwaikwayo na Femur, jinin jini ga farar fata da ilmin tsokoki na iya ƙaruwa da nasarar da aka yiwa tsararraki. A bambanta, zaɓi na Shigowar ya dogara da abubuwa da yawa, gami da tsarin ƙira, karfin zuciya, da abubuwan da ke cikin ƙasa (misali, plolytrauma, ciki, da kiba). Ba tare da la'akari da shigar da shigarwar shiga ba, samun madaidaicin shigarwar shima yana da mahimmanci don kula da isasshen raguwa yayin shigarwar ƙusa yayin rage haɗarin rikice-rikice.

Farar fata

1.Blood bayarwa ga shugaban na Femal

Shugaban farar fata yana karɓar wadatar jijiyoyin jini daga manyan arteries 3. Artalal Rotator Artery (tare da rassan 3-4), obturrur Artery, da kuma mai jujjuyawar yankin mai jujjuyawa da kuma samar da babbar yankin mai jujjuyawar.

2.aninatomy na tsokoki na hip

Lokacin aiwatar da tsawan femur, kyakkyawar fahimta game da tsokoki a yankin da ke kewaye da Rotor yana da mahimmanci don hana raunin da ba dole ba. Gaskiyar gluteus ta samo asali ne daga Ilium kuma ta ƙare akan ƙarshen mahaɗan ƙarfin gwiwa don ƙarewa a kan ƙarshen ƙa'idodin (lambobi 2 & 3). Duk waɗannan tsokoki sun yi aiki a matsayin masu karnuka na cinya da masu sanyaya na ciki na hip. Saboda haka, lalacewar waɗannan tsokoki yayin shigar da ƙusa mai ɗaukar hoto na Adiit da Trendelenburg na Adiit da Trendelenburg na Adiit da sakamako na Trendelenburg na warkarwa da sakamako.

Hoto 2. Anatomy na tsokoki a kusa da hadin gwiwar hip

Hoto na 3. Matsakaicin haɗakar abin da aka makala

Daidaici Fimoral Stredulyulyullary Nail

Nazarin da yawa kwanan nan sun bincika hanya mafi kyau don kyakkyawan ƙusa na ƙusa. Zaɓuɓɓukan Shigar da Nail sun haɗa da mafi yawan kwarewa da kuma Prachiform Fossa, kowannensu yana tare da nasa alamomin da kuma rikice-rikice (Table 1).

Table 1. Midsting maki da yiwuwar haɗarin haɗarin haɗarin Paracrine da Retrograde Fattal
ƙjici	Daidaila intreduly ƙusa		Retrogredulllary Nail
	rotor	PrismImP Fossa (Anatomy)
jirgin saman Crown	Vertex na mafi girman magunguna kuma yana nuna a cikin rami na Meduly	Junction na mafi yawan kwarewa da kuma feral wuya	Median na IntercondyyyyyyyyyyyyyyyY (Anatomy)
jirgin sama na sagittal (lissafi.)	Layi tsakanin tsakiyar mafi girman magungunan da tsakiyar rami mara nauyi na femur	PrismImP Fossa (Anatomy)	PLCL 1.2 cm ciki ne ga farkon farkon farawa, yana nuna kogon Meduly.
Fadada	Hip na kungiyar Hip na dakatar da rauni	Rashin wadatar da jini ga mai bikin hali da kuma tsoka ta waje	Rashin jituwa na iya haifar da pcl
PLCL: LIGIGHT CRECIGATE

1. Prighage Rotor Motoma Shiga

Babban Trochert an bayyana shi a matsayin mai ban sha'awa trapezoidal bony frupebeance wanda yake a gefe-gonar da ke kusa da gluteus na Medius da na sama da 3). Kodayake wannan karamin yanki ne Byan Landmark, yana karkatar da matakin farawa lokacin aiwatar da wani bambanci tsakanin samun ingantaccen tushe mai gamsarwa.

Yin bita da littattafan shiga na yanzu saboda kwatancin fasalin shigarwa, mun sami rashin cikakken bayanin yanayin jigon jigon mai shigowa na Mint.bharti et al. aka bayyana wurin shigarwar daga Apical Apical na mafi girman kwararru da kasancewa tsakiya bayanin hanyar da aka gabatar a cikin karkara tsakaninta tsakaninta da kashi ɗaya cikin uku da na gaba kashi biyu bisa uku na rotor.gejidagis et al. aka bayyana ma'anar shigarwar allon kamar yadda mafi yawan bangaren na baya na mafi girman gefe na Rotor.

Hoto na 4. Abubuwan da ke cikin Hip suna nuna ingantaccen shigarwa don shiga cikin manyan magungunan. '* ' yana nuna alamar shigarwar injiniya.

Nazarin kwanan nan a cikin wallafe-wallafen sun nuna cewa kofin mafi girma shine farkon farawa yayin da aka gabatar da hanyar shigowa sama da 2 mm ga mafi girman kwarewari. Wannan nazarin ya kuma jaddada cewa wani matakin shigar da baya na baya yana haifar da gudun hijira mai tsoratarwa, yayin da batun shigarwar zai iya haifar da toshewar karaya da za a magance shi daga baya. Ya bambanta, wani binciken ya nuna cewa a cikin hanzarin femur cenmur na hanji, abin da ke haifar da ƙwararrun ƙwararraki mai mahimmanci tare da ɓangaren pinning wanda ya kasance kusa da ɓangarorin pinning da na baya.

Mafi girma trichansic Pinning Point ne na musamman a cikin marayu na kifaye, kuma wannan hanyar ba ta da bukatar fasaha, samar da lokaci mai rauni na rikice-rikice fiye da Prismform fossa Pinning Point.

Cikakkun rikice-rikice: rikicewar rikice-rikicen da ke haifar da Fimoryulyullyullyuly tare da aka tattauna mafi girman batun Tasoshin a cikin wallafe-wallafen da yawa. Ofayan waɗannan, yawanci suna da alaƙa da dabarun ƙirar, a cikin karya ne ya haifar da rauni. A cikin karuwar hanji na hanji, lokacin shigarwar wuri a gefe da kuma yanayin shiga cikin manyan magunguna shine mafi kusantar haifar da karfin shiga sama da saitin shigowa da gefen.

Wata rikice-rikice ya faru ne saboda raunin da ya dace da nama, musamman ga rassan da ke tattare da kayan maye gurbi na Medifory da kuma tsokoki na ƙara ba shi da wata doka. Bugu da kari, abin da ya faru da necrosis necrosis necrosis tare da kopex na mafi girma takara yayin da ake tunanin shi da muhimmanci sosai, tare da binciken ya ba da rahoto kamar kashi 0.3%.

La'akari da lokacin da ake ciki da wasan kwaikwayo na motsa jiki, lokacin aikin ya kasance 90.7 na farko don manyan Taken Points, idan aka kwatanta shi da Pear-fossa.

Abincin mai haƙuri shi ne mai mahimmanci lokacin yanke shawara akan hanyar shigarwar ƙusa, amma wannan bambanci ba shi da mahimmanci a cikin watanni 6 da aka kiyasta watanni 12. Kodayake mafi girman batun samun damar Tasiri yana da alaƙa da ƙarancin nama mai laushi saboda wurin da take ciki, kamar yadda Ergi el elgi et al. Sun gano cewa mai daidaita daidaito da ƙarfin tsarin aiki na hip a cikin marassa lafiya tare da mafi girman kwayar cutar ta musamman idan aka kwatanta da kula lafiya. Bugu da kari, bincikensu ya ba da rahoton wani raguwa na mahimmancin hip na hip, masu jujjuyawa da kuma juyawa ciki / waje idan aka kwatanta da opered gefen.

2. Points Inda

Fossa na prosformis tsoka muhimmin yanki ne na Anatommica a matsayin daya daga cikin wuraren da aka shigo da na Paropylic Nail.in Autopsy Cadaveric nazarinsu na Autopsy, Lakhwani et al al. Sanarwa cewa fossa na pyanƙanci tsoka ba shine a 'pear ' pear 'orfforform tsoka abin da aka makala. Ruwan tsoka ya halarci karamin yanki a bakin mafi girman magungunan, yayin da Pracim Plorform Fowsa ne mai ban sha'awa a kan mafi girman ƙungiyar kila da kariyar ƙwayar cuta. Marubutan sun kammala da cewa alamuran tsoka da muryar dandam da kuma abin da ake kira PrismImformnIms Fossiformas ya kamata a kira shi kamar yadda ya kamata 'ko ' mocual 'fossa don tsabta da daidaito daidai. Sun ba da shawarar cewa bayan nazarin CIS-Fikanar da suka ba da shawarar cewa asali 'Rotor Fosssa ' a sake yin nazarin kalmomin shiga na parafemal. Kodayake ana ɗaukar nauyin waɗannan nazarin guda biyu, ana ɗaukarsa sau da sauƙi kuma don hana rikicewa tare da batun shigarwar da aka gabatar da shi, har yanzu za mu koma zuwa inda shigarwar Pricimn formassa.

Bincike da yawa a cikin littattafan yanzu daidai suna bayyana ainihin abin da shigarwar Fasta don Intraadiks Et al. Ka bayyana batun shigar da Pearly Fossa a matsayin fannin abin da aka makala na Carpi Radialis Brevis Carpi Radialis Brevis a cikin bacin rai a cikin bacin rai a gindi daga cikin wuyar cin zarafi (Fig. 5). The marubutan sun kuma gabatar da cewa batun shigarwa wanda ya yi nisa ko kuma lokacin da batun shigarwa ya yi nisa, wanda ya kasance mai girma a cikin marassa karfi.

Hoto na 5. Abun Cikin Cinikin hip yana nuna kyakkyawan shigarwar da aka yiwa alama ta PrismIms Fossa Retrogredullary Nail Nail. The '*' yana nuna ƙusa na iya farawa.

Harcom et al. Aka buga karatun kungiyoyi 14 na kungiyoyi 14 na 'yan Adam a shekarar 1987 da suka kimanta wurin Pin da mafita na tsararrakin ƙwararru daga mai tsaron cikin wasan kwaikwayon. Sun ƙarasa da cewa batun shigarwa na Pyrippis na ƙusa na mafi girman ƙaho tare da wuyancin da GoborPhl et al. A wani binciken Cadaveric, sun kirkiro wurin shigarwar da aka yiwa Fimorarfafa Tsararren ƙusa tare da ƙwararren masaniya mafi girma a cikin jijiyoyin Parini. Bugu da ƙari, a cikin binciken Cadaveric ta Labronici et al. An bayyana Fossa na prisformis tsoka a matsayin yankin mai-zaki wanda ya zo daidai da tsakiyar rami na Centeral Centredully a cikin jirgin ruwan da yake kusa.

Plaurform Fossion is Isaidaicin yana da wasu takamaiman rashi saboda yana matukar wahala idan aka ƙawata ga mafi girman damar amfani da Trochan, musamman a cikin marasa lafiya. Bugu da kari, da ingantaccen shafin yanar gizo na Pear-mai fasalin Fossa allle shigarwa shine kunkuntar yanki, yana sanya shi ya fi fuskantar kalubale. Misali, fara farawa a kan wuyanta mai ban sha'awa zai haifar da matsanancin kashin baya ya fashe da yawa, musamman idan farawar kwari ya wuce 6 mm na sama da fossa. Bugu da kari, bambancin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin ilimin halittarsa ​​na iya hana shi a daidai shafin saukarwa, musamman idan gajeriyar hanyar Roty, yana haifar da hanyar shiga da ke daɗaɗɗen karaya.

Cikakkun rikice-rikice: Ta hanyar kwatanta shafukan shigar 38 mafi girma Trochanation da ke haifar da Fossan wasan Foses, RicciTi lokacin da ke da tsayi na Fosescycopy lokacin. Waɗannan binciken sun tabbatar da waɗannan binciken da Bhatti et al. Lokacin kwatanta maki na shigowa 2.

Game da raunin nama, akwai haɗarin rauni mai laushi a cikin pristormist inlet idan aka kwatanta shi da keɓaɓɓiyar hanyar isarwa. Dora et al. kimanta 9 manya cadveric femurs ga taushi nama rauni zuwa ga priliformis tsoka da kuma juyawa shigarwa. Sun gano cewa duk da cewa Prilpormims Fossa ya kasance mafi ƙarancin gaske, ya haifar da gagaramar da gagarumar mafi mahimmancin wadatar da jijiyoyin jiki da tsokoki kewaye da ƙuruciya. Wadannan binciken sun yi sulhu daga karatun Cadaveric daga Ansari moin et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et al et et al q et al q. Wanda ya kuma kwatanta maki biyu shigarwa. Sun lura cewa gyaran na cikin gida ya fara a kan gwagun tsoka ya fi lalata masu satar kayan hip da masu maye. Bugu da kari, lalacewar m Realator Artery an samu a duk lokuta (Table 2).

Tebur 2
ƙjici	Protiform fossa shigarwa (n = 5)	Manyan Biyyayyaki na Rotor (n = 5)
nama mai taushi
Glutus medius tsoka (antatomy)	5	1
Glutus Medius jijiya	0	4
Raunin jijiya
Glutus Minimus (Anatomy)	3	0
prisrifis tsoka (sama da saman kashin baya)	3	3
obtuurfa wavida (anatomy)	1	0
Latissimus Drssi tsoka (Anatya)	3	0
Jijiyoyin jini da haɗin gwiwa
Mfca zurfin rassan	4	0
Mfca mafita reshe	4	0
Capsulewararren masanan (na haɗin gwiwa kamar gwiwa a gwiwa a cikin antatomy)	1	0
MFCA: Medalsx mai kaciya mai ban sha'awa.

Kwanan nan, BhARTI et al. Nazarin hadarin hadarin da ke haifar da gabatarwar da ke haifar da gabatarwar da aka gabatar a cikin matakin shigar da fata na fata da taƙaitawar su kamar haka (Table 3).

Tebur 3
wahala	PiriformIfist sinus allura ma'ana	Mafi girman shigarwar Trocher
Harba	6.7	3.3
Mikinta	20	13.3
Jinkirta waraka	20	13.3
Limitar Hip	20	33.3
Limitedungu na gwiwa	6.7	6.7
Hukumar LimB	13.3	20
Da wutsiya hula pretrudes sama da kashi cortex	13.3	20
Cikakken matsalar wuya	10	0
Mafi girma Trocharter karaya	0	3.4
Feral shugaban necrosis	6.7	0

Retrograde Fimoreduly na niyyar

Eterayyade wurin shigarwa da ya dace don retrograde na farkawa zai taimaka wajen samar da ci gaba da lalacewar gakin gari, tsawon ACL), da raunin fata mai taushi (Table 1). Kwanan nan, an sami ƙarin sha'awar retrograde na tsinkaye tare da manufar rage da lalata, wanda aka ɗauka da rauni na ciki, musamman a cikin rushewar na cikin uku bisa uku na babban kara. Bugu da kari, shaidar kwanan nan ta nuna cewa lokacin da wadannan retrograde na retredull quzed ne, lokacin da aka ba da rahoton sakamako tsakanin Meccariello et al. kuma Bisaccia et al. A cikin lura da na nesa-na uku na qarancin ƙwararru ta amfani da kullewa da nolocking retrogredull qils. Don haka, amfani da nazarin hawaye na retrograde ya zama sananne kuma an karɓa shi sosai.

Yawancin kwatancin shigarwar shiga wurin shigarwar da ke haifar da tsinkaye na farkawa na iya samu a cikin wallafe-wallafen. Mafi yawan karatun da suka gano kyakkyawan shigarwar don retrograde femal ƙusa kamar 1.2

cm (a layi tare da rami na meduly) da kuma cibiyar IntercondyY Fossa (Hoto na 6).

Hoto 6. Kotun Orthoposative na gwiwa na gwiwa yana nuna ingantaccen shigarwar shigarwar ƙusa na retrogredullary ƙusa. '* ' yana nuna ƙwararrun ƙwararraki na intremyullaly.

Kodayake babu cikakken nuni ga retrograde na farauta, an bayyana alamun da yawa. Waɗannan sun haɗa da marasa lafiya na Polytrauma, marasa lafiya masu juna biyu, marasa lafiyar kasashen biyu, ƙwayoyin cuta na yau da kullun, karar wuya. Yawancin waɗannan alamun suna da alaƙa da sauƙi na haƙuri da haƙuri da kuma rigakafin yawancin raunuka a kusanci.

A gefe guda, cikakken al'adan don retrogedull tsinratedull shoinguly Nigerulladallan na sama da hana retragrary tashar da kuma bude karar na Distal femur. 'Yan ta'addar sunadarai suna cikin cikas a cikin 5 cm mai ƙarfafawa masu ƙarancin ƙarfi, da kuma cututtukan da ke da ƙarfi waɗanda ke iya haifar da haɗarin yada a gwiwa, da kuma cututtukan gwiwa na ɓoyewa a gwiwa, da kuma m-artic-articular maƙera da matsanancin kewayewa.

Cikakkawa: Mafi yawan rikitarwa na masu nuna fikafikan hetrograde suna da alaƙa da rashin daidaituwa, musamman ba daidai ba wuri na wurin. A cikin jirgin ruwa na Sagittal, wani matakin shigar da ke ciki zai haifar da karaya daga cikin fassarar karaya, lalatacciyar hanyar lalacewa, kuma wataƙila ƙusa na lalata a kan patella lokacin da aka daidaita gwiwa. A gefe guda, idan wurin shigarwa ya dace da matsayin da ba daidai ba a cikin shugabanci na baya, wannan na iya haifar da haɗarin rauni ga asalin jijiyoyin ƙasa.

Hutchinson et al. An bayyana rikice-rikice hade da wuraren da ba a shigar da shi ba. Sun gano cewa batun shigarwar da ke faruwa a cikin nakasassu na ciki tare da fassarar karaya, yayin da daya a kaikai ya haifar da nakasar media da kuma fassarar tsakiya. An ba da rahoton cewa zaɓi farkon farawa wanda ya kasance 2 cm ko fiye da axis na medical last lortricy last lortmy sakamakon mummunan raguwar ragi.

Sauran rikice-rikice masu hade da nazarin zanga-zangar mai zanga-zangar da ke cike da raunin gwiwa, taurin kai, heroiknessen gwiwa na gwiwa, da kuma karfin jikin mutum na ciki.

Gama

Kodayake kowace tsakar fata ta tsaka-tsaki tana da nuni mai dacewa, zaɓi wanda ya shafi dabarar kyakkyawan tushe don amfani da fifikon karuwa da yawa ya dogara da fifiko na likitan mata. A lokacin da aiwatar da wasan kwaikwayo na femur, samun madaidaicin shigarwar da aka yi amfani da nau'in ƙusa ana buƙatar gyaran sakamako don samun nasara. Sanin ƙirar ƙirar gida da kuma aikin yi zai taimaka wa likitan tiyata yayin rage haɗarin rikice-rikice-rikice. Ari ga haka, a cikin tsarin Na'urar Nighted, Kulawa na rage shine kayan aiki mai mahimmanci a cikin hana mugunta da ikon karaya.