5 intradellary mitu yogwiritsa ntchito mitu ndi njira zopangira opaleshoni!

Mfundo zoyambira za intradellallary mitaing

1. Mbiri ya intradellallary miyala

Mu 1910, Liloney Aluminiyamu misomali inkagwiritsidwa ntchito pochiza zobota za femasi.

Mu 1913, schone adagwiritsa ntchito siliva intradellary misomali kuti igwirizane ndi mawonekedwe amtsogolo. 

Kunturcher (1900-1972) adapereka zopereka zazikulu kwa intradellary. 

The 1960s ndi 1970s inali nthawi yakutukuka kwa misomali intravelallary. 

Dziko langa lakhala likuwagwiritsa ntchito zochuluka kuyambira 1990s.

2. Kuchepetsa kotseguka ndikuchepetsa

1. Mamiyala amitumbo amatha kuchepetsedwa kuchepetsedwa motsogozedwa ndi mawonekedwe a X-ray.

2. Tsegulani nthawi yochepetsera madzi okwanira ndi yotalikirapo, yotupa imakhala yochulukirapo, ndipo kuchepetsa kutseguka kumawononga magazi kumapeto kwa magazi.

3. Ndikulimbikitsidwa kugwiritsa ntchito kuchepetsedwa kwapafupi momwe mungathere. Kuchepetsa njira kumatha kugwiritsidwa ntchito, kapena kukhazikika pang'ono kumatha kupangidwa pa ndege yopukutira kuti ikhale Pry ndikuchepetsa, poyerekeza ndi magazi mpaka magazi.

4. Pakulephera kotsekemera, chidutswa cha mafupa chimawombera kapena kuboola minofu yozungulira, ndi zidutswa zazikulu zosemphana ndi zowawa, zopepuka zopepuka zimatha kugwiritsidwa ntchito.

3. Njira yamakina a intradellallary msomali

1. Njira ya intradellary yamkati yamkati ndi symmetricacial Central Crunt Squarm Sprited.

2. Kukonzekera kwa Fracture ndi intradellary msomali kumapanikizika, osati kukonzanso kovuta, komwe kumapangitsa kuti callus ikhale yolimba.

3. Kukonzekera pakati ndikopamwamba kwambiri kuposa kukhazikika kwamphamvu, komwe kumachepetsa mkono wa artur, kuchepetsa mphamvu ya valgus kulawula komanso kulephera kwamkati.

4.

Zida za intradellallary misomali

1. Mavuto ochepa

2. Kukula kwa mawonekedwe a opaleshoni

3. Kukhazikika kolimba

4. Kuyambira koyambirira kwa ntchito

5. Kulemera koyambirira

6. Itha kugwiritsidwa ntchito limodzi ndi mawonekedwe ena amkati

Mitundu yoyambira ndi maluso

1. Kutseka komanso kosasunthika misomali

2. Mphamvu ndi Static yotseka misomali ya intradellary

3..

4. Tsegulani njira zotseguka komanso zotsekedwa

Kusokoneza komanso kusayanjanitsa

Misomali wamba ya intradedory ili ndi bata losakhazikika komanso mphamvu yotsika kwambiri, koma amakhala ndi zotupa ndipo amatha kuchira pambuyo poluma, ndikupangitsa kuti ikhale yocheperako.

Misomali ya intradellallary ili ndi maboma komanso zovuta zotsutsana ndi zovuta zina, kukhazikika kwabwino, ndikugwirizana ndi mfundo za kusintha kwachilengedwe. Amagwiritsidwa ntchito kwambiri m'mafupa aang'ono a miyendo. Makamaka kwa gawo lalikulu komanso lolumikizidwa, amakhala ndi bata kuposa misomali wamba.

Kukonzekera kwa Static

Malo otsetsereka a intradellallary amatulutsa kupsinjika pang'ono komwe kumapangitsa kuti pakhale kuchepa kwa zinthu zomwe sizikugwirizana ndi zomwe sizimachita mwadongosolo.

Kwa zonunkhira zomwe sizinachiritse miyezi 6 mpaka isanu ndi itatu, ku Stoperation Kulumikiza kapena kubwezeretsanso kwa intravedillary misomali ndi madambo omwe amagwiritsidwa ntchito.

Kupanga kumatha kugwiritsidwa ntchito ngati njira yolimbikitsira machiritso ochiritsa. Sikulimbikitsidwa mwachisawawa chifukwa zitha kubweretsa kufupikitsa kwa Limbi Kufupikitsa ndi kufupika.

Kukula kwa Marow ndi Kukula Kwamizere

Kukula kwa marowa kumatha kuyika misomali ya intradellal yokhala ndi mainchesi akuluakulu komanso mphamvu zazikulu, zomwe zimapangitsa kuti maphunziro oyambitsidwa ndi omwe amagwira ntchito ndikuchepetsa misomali yosweka.

Kukula kwa marowa kumatha kutulutsa zinyalala zambiri zamafupa, zomwe zimapangitsa kuti machiritso ochiritsa.

Kukula kwa marowa kudzawononga magazi opezeka ndi michere ndi ma membrane, koma mitsempha yamagazi imatha kubwezeretsanso misomali ya intravedollary misomali. Kukula kwa ma mriko kumathandizanso kufala kwa magazi pozungulira minofu yofewa ya minofu, potero amalimbikitsa kuchiritsa.

Kukula kwa marongo kumawonjezera mwayi wotenga matenda komanso embolism, ndipo kuyenera kugwiritsidwa ntchito mosamala kuti musunthe, kuvulala kwakukulu, komanso kuvulala kovuta.

Ubwino wa Kukula kwa Medillary

① Pambuyo powonjezera mphamvu, malo olumikizana pakati pa msomali wa intramillallary ndi fupa limachuluka, zomwe zimathandiza kukhazikika kwa kukonza. 

② Pambuyo powonjezera mphamvu, interter intravellary msomali imatha kugwiritsidwa ntchito, yomwe imawonjezera mphamvu ya msomali wa intramillallallary ndikuchepetsa kuchuluka kwa misomali yosweka. 

③ Ngongole zamafupa pambuyo powonjezera mphamvu imatha kuyambitsa mapangidwe a mafupa, omwe ali omasuka ku machiritso.

Poyerekeza ndi kuchuluka kwa ma intradullal a intradellary misomali, osadziwika

① Kugwiritsa ntchito nthawi yayitali komanso magazi pang'ono. 

② Kusokonezedwa pang'ono ndi magazi oyenda m'magazi ngati atavulala kwambiri minofu.

Kugwiritsa ntchito msomali wa intradellary

Humeral Interlock

Zizindikiro za Humeral misomali

Zizindikiro za kugona kwa Humerallary misomali pochiza Humeral shaft ndi: zowonongeka ndi mitsempha, kuvulala kosakhazikika, kuwonongeka kosakhazikika, komanso zojambula zamitsempha.

Mitundu yomwe imatha kukhazikitsidwa ndi kuchokera pa 2cm pansi pa mutu mpaka 3cm pamwamba pa olecraranfor. Mutha kusankha kuyikonza kuchokera paphewa ndi interrade intradellary msomali kapena kuchokera ku chisoti ndi ma perrode msomali.

Makhalidwe a misomali ya Humeral

Njira zopangira opaleshoni za matenda a Humeral shaft ndizomwe zimakhazikika ndikukhazikika kwa intradellary.

Kukhazikika kwa Plate kuli ndi mphamvu yotsutsa komanso zotsutsana ndi zovomerezeka ndipo zimakhazikika, koma zoopsa zoyipa ndizokulirapo, kuthekera kwa matenda akomwe kumawonongeka mosavuta.

Misomali yamakono ya Humeral ndikudzitchinjiriza ya zolakwa wamba za intradedollary, kuwongolera kosinthika, ndipo kuwonongeka kwa minofu kumawonjezedwa, ndipo kuchita masewera olimbitsa thupi kungayambike atachitidwa opaleshoni.

Chipinda chogwirira ntchito intradellallary msomali

Zizindikiro zolumikizirana

Mitundu yonse ya fraction 2cm pansi pa trochantic vertebra ndi oposa 9cm kuchokera ku bondo.

Makina okalamba a pakati pa gawo la femingu.

Odwala omwe ali ndi vuto la kulephera.

Mawonekedwe a msomali wolowera

Ubwino Wake

Mkono wamphamvu wa kulowera kwa intradellallary msomali wokhazikika ndi kutalika kwa mbale, ndipo mphamvu imagawidwanso pantral axis fupa lonse la mafupa, zomwe sizophweka kuzimiririka.

Misomali yotseka kumapeto onse a intradellallary amapanga fupa lonse kuchokera pamwamba mpaka pansi, ndipo misomali yotseka yotsika mtengo imatha kuchepetsa chiwongola dzanja cham'madzi.

Gamma amalumikiza nsomba zamkati

Gail

Zogwiritsidwa ntchito pamitundu yosiyanasiyana ya peritrochantic fracratives, makamaka burrochentic ma fracrate.

Kukulitsa msomali wa gamma (heail yomanganso)

Suble ntchombela fractions, trochantic yophatikizidwa ndi femlu ya femas.

Ubwino wa gama msomali

Yopangidwa ndi kuphatikiza scrocked scress ndi urradellary Technology, msomali waukulu umayandikira mkati mwa mphaka wa HAMMARY CICTE, ndikuwonjezera mphamvu yamagetsi yolowera. Pamitundu yopumira yokhudza ma medial contraction, yemwe garam Healsi amapewa kufunika kwa anatonda kwa anatom matope, kotero ndizopindulitsa kwa ma metricantic matraction kapena borrochantic fractures kapena borrochantic.

Retrograde intradellary

Zisonyezo za kubweza misomali

Amagwiritsidwa ntchito makamaka ku Supracondylar Femaral, kuphatikizapo Supracondylar yolumikizidwa ndi intcondslar \

Itha kugwiritsidwanso ntchito ngati festicutor pansi pa isthmo ya femur.

Femal shat, Supravondylar Femaral Fraluyal, ndi ma incundslar fractures mkati mwa 20cm kuyambira bondo.

Iwo omwe asinthidwa kwambiri.

Makhalidwe a retrog

Supracondylar Femaral Fracreur ndi kuvuta kwambiri movutikira, kuchepetsa ndi kwachiwiri, kukonza kwamkati mwamphamvu. Pali zovuta zambiri monga zovuta monga kuwonongeka osakhala mgwirizano ndikuchiritsa.

Kubwezeretsanso kugwirira ntchito mkati mwa intradellary ndi njira yomwe imagwiritsidwa ntchito pochiza matenda a Frur mu Zaka zaposachedwa, omwe ali ndi mawonekedwe abwino othana ndi kutha kwa njirayi, ndikuthandizira kuyenda koyambirira kwa kusokonekera.

Supracondylar kuphatikiza kugwedezeka kwa chibwibwi kumakhazikika ndi topracondyrola dorramullar intravellary mitambotion, yomwe imathetsa vutoli lomwe limavuta kusungunuka ndikugwiritsira ntchito intravellary misampha ya femur. Chidacho ndi chosavuta kugwira ntchito, molondola pokhazikitsa, chodalirika pakukhazikika, ndipo wodwalayo amatha kugwira ntchito momasuka pochita masewera olimbitsa thupi atachitidwa opaleshoni.

TIBAL TILLY TILSENDURELY Misomali

Zizindikiro za tibial

Zokhazikika zokhazikika mu pakati 1/3 za tibia: zotchinga zotchinga, zotchinga zazifupi, pseudarthrosis.

Makina osakhazikika mkati mwa 60% ya kutalika kwa tibia: Zovala zam'matambo, zotupa zazitali, zotupa, zopangidwa ndi mafupa, zowonongeka ndi mafupa.

Makhalidwe a Tibraal

Kulankhulirana kwa intradellary kukalampha kwa Tibia kumagwiritsidwa ntchito makamaka kwa mkati wa Tibia.

Ngakhale itha kugwiritsidwanso ntchito poyerekeza ndi kuchepa kwa tatia, kuchuluka kwa zovuta, kupweteka kumapezeka nthawi zambiri, kutha kwa chipongwe.

Zolemba zidanenedwa zotsatira zabwino za kusokonekera kwa tibia fractured kuposa proximal tibia fracreur pambuyo pokhazikika kwa fibula.

Njira Zopaleshoni

Kukonzekera kwa zida zapadera

Bedi la Orthopdic (pabedi thirakiti) kapena quooroscopic opaleshoni yoopsa; retarator; chipilala cha chithunzi.

Kusankha Koyenera kwa Milandu Yapakatikati Kwa Tsopi Yothandizira Endoprosts

Ma radiograph

kuchuluka kwa miyendo ya ku Contb

Intradellallary misomali

X-ray isthmus m'lifupi

Intradellallary miyeso yamkati

1.Translucent muyezo wotsimikiza ndi makina am'mlengalenga

Mapeto a fupa ndi ofatsa a fupa anali pamtundu wa ray; Wolamulirayo anali wofanana ndi diaphiys.

Mankhwala a 2.Length molingana ndi zojambula zamthupi

Femur: MPHAMVU YA TROCHATER TROCHATE OFTELE → Malo Omera a Bowal kapena Torm Coler of Patella; Tibia: Malo osaimira-a Medial-bondo-anterour in nkle cholumikizira cha phazi.

Intradellallary minofu yolowera - njira yolowera

Chitali cha axidal cha medullary catsekizi yolunjika

Osati pafupi kwambiri ndi malo olowera

Kutalika koyenera: Kutalikirana - kutalika; otetezedwa - achidule

(Chitsimikizo cholowera) cholowera; palibe pulp dilation, popanda kuteteza minofu yofewa)

Intrallel femravellallary misomali yolowera

Kukonzekera kwa malo olowera kwa intravellallal

Chifuwa cha m'chiuno ndi kusinthidwa

Kutalika kwakutali kwambiri ku Trochanter wamkulu

Osati kutali kwambiri

Kuyika kwa pini yowongolera

Kuyika kwa chishango chofewa

Retrogrange intravellary misomali

30 ° Bondo

Axis wamtali wa pini yowongolera mbali yomweyo monga medillary imakhazikika pa tsinde la femul

Ikani ma pini a Kirschner mu dials femur kudzera pa Patellar Fomu yoteteza: Orthogonal - mkati mwa ma intcondylar fossa ya femur; Mzere wa Blumensyaat

Kuyambira polemba PCL popanda kuvulala

Ibial Cibial intradellallary mitu yolowera

Pakatikati pa Medillary Camulury

Malire oyenda a Tibial Plateau

Zokwera kwambiri popanda kuwononga chipongwe

Bwino Kwambiri Bondo

Kusunthira kwa TIBLEMECECECECECE-Polefer Pole of Patella m'mbali mwa medillary

Tsegulani Cadullary Camulury: Pin yowongolera pa 15 ° kupita ku geagittal ndege yayitali

Malo owonera chithunzi

Njira Zotchinga

Kuchepetsa kwamagetsi

fracratures zatsopano

Kuchepetsa Manja

Kuwonongeka Kwakale ndi PseudorthRosis, Sclerosis mu Medullary Cadullary

Palibe woyendayenda

Kufalikira kwa Magazi ndiye wozizira kwambiri

Njira zobwezeretsera

Intrallel femial

Zifukwa zophweka pobwezeretsanso madandaulo

Kukulunga kwa minofu yofewa sikukupatsani mwayi wofikira mwachindunji

Malo olowera singano sangawonekere mwachindunji

Hint Joint Adction → Iliac Fascia Snansical → Fracture Kufupikitsa

Kuchepetsa kwa Tibial Fracture

Kupusitsa

Makamaka wotsekemera komanso wosavuta kupereka

Kukhazikika kwa Bracture - Mid kapena Stull A ndi B Mtundu

Zovala Zosachedwa - Kuchulukitsa

Intradellallary mitaing → Zosakaniza zida

Njira Zotsitsa Zoyeserera

Mfundo zochepetsera

tibia; % kapena bala

Zikuluzikulu (braces)

kuchedwa kuchepetsa; Limbi Kufupikitsa

Zomangira zosakhalitsa

① femur, tibia

② Pafupifupi mzere wakuwonongeka momwe mungathere

③ Proximal Fracture Services imodzi yogwiritsa ntchito

④ Gwiritsani Chigawo chadziko lonse ndi chiwongola dzanja chosavuta

Msomali pamoto

①metaphhyseal fractar (kukonza mzere wamphamvu, kukhazikika kubwezeretsa, kubwezeretsa opareshoni)

② Oblique fracture a TIBIA kapena femur (kupsinjika kwa shear → Kupanikizika)

③ Misozi yosalala bwino interradel

④ Malo osayenera olowera, osavomerezeka a proximal osinthika (screw adayikidwa mwapamwamba mpaka kuzolowera endoplant)

Owonjezera owonjezera

① Tibia

Onjezerani ndi tratiction kapena retaractor

③ Gwiritsani ntchito mosamala mu zowawa zofewa minofu

④ Sungani zazifupi

⑤ lekani mawu a Medlarlary mu State

Njira Yokomezera Kwathunthu: Kusakanikirana ndiye Proximal

Ubwino

kuwononga kogogoda, kukakamiza kuswa kwamphamvu; kuchotsedwa kwa kupatukana; Kuchepetsa ntchito.

Kuchepetsa njira zochepetsera & kusachita opareshoni

Mavuto omwe angakumane nawo ndi kuchedwa opaleshoni

Kulema kwa Axial (Kufupikitsa, kukwiya komanso kapena kusamuka)

Kukula mu granulation minofu

Mafupa oyambira

Sclerosis yakuthwa imasweka ndikutsekedwa kwa medullary

Osteoporosis

Mavuto Othekera

Kulongosola kwa wowonjezera ndi msomali wa intradellary → intravellallary mitail kuloweza kwa cortex

Kupunduka kwa angular → Kubwezera

Kusamutsidwa kumatha omaliza → msomali wa pololler, ma plate

Njira zopewera mizere yoyipa

Proxximal - malo olondola olowera

Internal - intradellallary msomali pakati pa medillary

Mavuto a intradellary mitaing

★ matenda

★ kuwonongeka kwa mitsempha

★ Kuchiritsa kolakwika kwa fracrate

★ Makonda azachipatala

Kusintha Kwakunja, Kumata, Valgus, Kusintha Kwamkati Kwa Mkati, Kulaula

★ zolumikizira zolumikizana

★ Mafuta Otsatsa

★ herthotopic

★ Mphamvu yam'mapapo

★ Kubwezeretsanso

★ thrombosis

★ Kukhazikika kolunjika

★ Osakhala Union of Fracture, Mafuta Opanda

★ Kulephera kwamkati kwamkati

★ Limitsani kufupikitsa

★ Zina

Mavuto - Kutengera

Mwa 1.ereirly, otseguka otseguka amadziwika kuti ndi otsutsana ndi intradellary mitaing.

2.Mumitundu ya matenda osokoneza bongo otseguka zimatengera mawonekedwe a kuvulala kofewa kwa minofu ndi kuipitsidwa

Kuchulukana kwa matenda pambuyo potseguka kutseguka kumatengera kuvulaza kwa minofu ndi kuipitsidwa komanso momwe minofu yofewa imayendetsedwa.

3.Tinner intradellary misomali imawonjezera mwayi wa matenda; Kusaka komwe sikunakulidwe komweko kwa intradellal

Kutseka kosazungulira kwa intradellary misomali kumakhala kosavuta, ndikuyenda kwa microscopic kwa kumapeto kwa fupa komanso kotsalira mkati mwake, zomwe ndizosavuta kukula kwa bakiteriya.

4. Kugwiritsa ntchito kumawonjezera ndipo kuperewera kowonjezereka komwe kumawonjezereka kosakanikirana sikungokhala kukhazikika kwa kukhazikika kwa kuwonongeka kwa kuwonongeka, komanso kupewa chilengedwe cha moyo wakufa.

Mafuta embolism syndrome

1.Mundu wa FES yamafupa zazitali zamafupa ndi 0,5% mpaka 2%.

2. Kukula kwa medulla komanso kusakula kwa medilla sikukhudza kwambiri pa mpweya wa m'mapapo.

3.Pakukulitsa Medulla, njirayo iyenera kugwada pang'ono, kupewa mphamvu kwambiri komanso ntchito yoyipa.

4. DZIKO LAPANSI la FES lipitilizabe kutsata zomwe adafunsidwa mu 1974, ndipo mankhwalawa atazindikira kuti akwanitsa kulandira chithandizo chamankhwala komanso atha kukhala ndi zotsatirapo zoyipa.

Kuchedwa Kuchiritsa ndi Mafuno

Zinthu zosiyanasiyana zimakhudza machiritso olakwika pambuyo pokonza mitambo, ndipo zomwe zimayambitsa zimatha kusanthula motere.

1.Soft minofu yolumikizidwa mu madzi owonongeka

2. Kulekanitsidwa kwa chotchinga chododometsa chimatha

3. Zakale za wodwala

4. Tsegulani kuwonongeka, kuvulala kwambiri kwa minofu ya minofu, kwakukulu ndi matenda a hemodialysis kapena matenda.

5..

6. Anaphatikizira matenda ashuga kapena matenda ena okonda.

Matenda a Zachipatala

Mankhwala owoneka bwino makamaka amakhala achiwiri achabechabe chifukwa cha kupusitsa kosayenera panthawi ya intradellary.

Chidwi chikuyenera kulipidwa

1. Kusankhidwa kolakwika kwa malo olowera msomali kumatha kubweretsa kuwonongeka kwa proximal.

2. Osakankha mwamphamvu pakukula kwa medulla.

3. Kulowa kwa kuchuluka kwa zamkati kuyenera kukhala mbali yomweyo ndikuwongolera kwa misomali.

4. Osagwiritsa ntchito mphamvu poika misomali ya intradellary kulowa kumapeto.

Kupweteka kwa oyandikana nawo

1. Kuyika kwa msomali wa intradellallary kumaphatikizapo minofu yofewa komanso kapisozi kakhomacho mkati mwa gawo limodzi.

2. Tibial Plateau yolumikizidwa ndi matumbo antial a Menicus ya Medial ndi TIPOMOYO YAKUKHUDZANI NDIPONSO KUPANGITSA TIBECY Tsitsi mpaka pano. Ngati malo osaimikapo ali pafupi kwambiri kapena mainchesi a mgodi wa intradellary ndi wamkulu, zimatha kuwononga zida zam'madzi zam'madzi, zomwe zimapangitsa kupweteka kwa bondo.

3. Promximial proser of intradellallary msomali ndi huttotopic ndi zomwe zimayambitsa kupweteka kwa m'chiuno mkati mwazinthu zam'madzi zisanachitike.

4. Promximial proser ya misomali ya intradellallal, yotseka misomali ndi vutotor cuff ndi zomwe zimayambitsa kupweteka kwa mapewa atatu.