Hariho ubwoko bubiri bwuburyo bwo kubaga, amasahani ya plaque na pine intramedullary, iyambere irimo imiyoboro rusange ya plaque na AO sisitemu yo guhagarika plaque, naho iyanyuma ikubiyemo gufunga no gufungura retrograde cyangwa retrograde. Guhitamo gushingiye kurubuga rwihariye nubwoko bwavunitse.
Intramedullary pin fixation ifite ibyiza byo guhura bito, kwiyambura bike, gukosorwa neza, ntibikenewe gukosorwa hanze, nibindi. Birakwiriye hagati ya 1/3, hejuru ya 1/3 kuvunika femur, kuvunika ibice byinshi, kuvunika indwara. Kubuvunike bwo hasi bwa 1/3, bitewe nubuvumo bunini bwa medullary hamwe namagufwa menshi ya kanseri, biragoye kugenzura ukuzenguruka kwa pin intramedullary, kandi gukosorwa ntabwo ari umutekano, nubwo bishobora gushimangirwa ninsinga, ariko birakwiriye cyane kumashanyarazi.
Mfunguye-imbere gukosora kuvunika kwa Femur Shaft hamwe na Nail Intramedullary
.
Gutembereza kuruhande bikozwe kumurongo uri hagati ya trochanter nini na condyle yinyuma yigitereko, kandi uruhu rwuruhu rwinyuma rwuruhande rumwe ni kimwe cyangwa nyuma gato, aho itandukaniro nyamukuru ari uko gutembera kuruhande bigabanya imitsi ya latus latalis, mugihe iyinyuma yinyuma yinjira hagati yinyuma yimitsi nini ya latalis5.2 ， Fig 3.
Ku rundi ruhande, gukomeretsa kwa anterolateral, bikozwe binyuze kumurongo uva imbere yimbere ya iliac umugongo ugana ku nkombe yinyuma ya patella, kandi ukagerwaho unyuze mumitsi yinyuma yumugore hamwe n imitsi ya rectus femoris, ishobora gukomeretsa imitsi ya femorale femorale n amashami ya nervice kumitsi yinyuma yumutwe hamwe namashami ya rotator femoris externus arteri, kandi rero ni gake 3. cyangwa never
. Kata periosteum kugirango ugaragaze impera zo hejuru no hepfo zavunitse zavunitse femur, hanyuma ugaragaze intera kuburyo ishobora kugaragara no kugarurwa, hanyuma wambure imyenda yoroshye nkibishoboka.
（3） Gusana ibyimbere imbere: Ongeraho ingingo yanduye, shyira ahagaragara impera yegeranye, shyiramo ururabyo rwa plum cyangwa urushinge rwa V rufite inshinge, hanyuma ugerageze gupima niba ubunini bwurushinge bukwiye. Niba hari igabanuka ry'imyobo ya medullary, umugari wa medullary waguka urashobora gukoreshwa mugusana neza no kwagura urwobo, kugirango wirinde urushinge kutabasha kwinjira kandi ntirushobora gukururwa. Kosora impera yegeranye ivunitse hamwe nufite igufwa, shyiramo urushinge rwimbere rwisubiramo, winjire mu gitsina gore uhereye kuri trocanter nini, kandi iyo urushinge rwa urushinge rusunitse uruhu, kora uduce duto twa 3cm ahantu, hanyuma ukomeze gushiramo urushinge rwimbere kugeza rugaragaye hanze yuruhu. Urushinge rwimbere rwakuweho, rwerekejwe, runyura kuri foramen ruva muri trocanter nini, hanyuma rwinjizwa hafi yindege yambukiranya. Inshinge zinonosoye zifite inshundura ntoya hamwe nu mwobo wo gukuramo. Noneho nta mpamvu yo gukuramo no guhindura icyerekezo, kandi urushinge rushobora gukubitwa hanyuma rugakubitwa rimwe. Ubundi, urushinge rushobora kwinjizwamo retrograde hamwe na pin ikuyobora hanyuma ikagaragazwa hanze ya troncanteric nini cyane, hanyuma pin yo mumbere irashobora kwinjizwa mumyanya ya medullary.
Kongera kugarura kuvunika. Guhuza Anatomical birashobora kugerwaho ukoresheje uburyo bwa pine ya primaxal intramedullary ifatanije na pivoti yamagufwa, gukurura, no kuvunika hejuru. Gukosora bigerwaho hamwe nufite igufwa, hanyuma pin yimbere igahita itwarwa kugirango umwobo wo gukuramo pin werekeza inyuma kugirango uhuze na curvature femorale. Impera y'urushinge igomba kugera ku gice gikwiye cy’impera ya kure y’imvune, ariko ntunyuze mu gice cya karitsiye, kandi iherezo ry’urushinge rigomba gusigara 2cm hanze ya trocanter, kugirango rishobore gukurwaho nyuma. （Ishusho 3.5.5.2-4 ）。
Nyuma yo gukosorwa, gerageza kugenda byimikorere yingingo hanyuma urebe ihungabana iryo ariryo ryose. Niba ari ngombwa gusimbuza urushinge runini cyane, rushobora gukurwaho no gusimburwa. Niba haribintu byoroheje kandi bidahungabana, hashobora kongerwaho umugozi kugirango ushimangire gukosorwa. （Igishusho 3.5.5.2-4 ）。
Igikomere amaherezo cyahinduwe kandi gifunga ibice. Kurwanya anti-external rotation ya plaster yashyizwe.
II Isahani Ihinduranya Imbere
Gukosora imbere hamwe nibyuma bya plaque birashobora gukoreshwa mubice byose byuruti rwigitsina gore, ariko 1/3 cyo hepfo kirakwiriye kubwubu buryo bwo gukosora bitewe nubuvumo bwagutse bwa medullary. Isahani rusange yicyuma cyangwa plaque ya AO compression irashobora gukoreshwa. Iheruka irakomeye kandi ihamye neza nta gukosorwa hanze. Ariko, ntanumwe muribo ushobora kwirinda uruhare rwo guhisha imihangayiko kandi ahuza nihame ryimbaraga zingana, zigomba kunozwa.
Ubu buryo bufite intera nini yo gukuramo, gukosora imbere, bigira ingaruka ku gukira, kandi bifite n'ibitagenda neza.
Iyo habuze ikibazo cyimiterere ya pin, kuvunika kwa medullary ishaje cyangwa igice kinini cyibidashoboka kandi igice cya 1/3 cyo kuvunika kirahuza cyane.
(1) Kuruhande rw'umugore cyangwa inyuma.
(2). Isahani igomba gushyirwa kuruhande rwuruhande rwimpagarara, imigozi igomba kunyura muri cortex kumpande zombi, kandi uburebure bwisahani bugomba kuba inshuro 4-5 z'umurambararo w'amagufwa ahavunitse. Uburebure bw'isahani ni inshuro 4 kugeza kuri 8 z'umurambararo w'amagufwa yamenetse. Isahani 6 kugeza 8 isanzwe ikoreshwa muri femur. Ibice binini byamagufwa bishobora gukosorwa hifashishijwe imigozi yinyongera, kandi umubare munini wibihimba byamagufwa birashobora gushyirwa icyarimwe kuruhande rwagati rwagati rwacitse. （Ishusho 3.5.5.2-5 ）。
Kwoza no gufunga ibice. Bitewe n'ubwoko bwa plaque yamashanyarazi yakoreshejwe, hafashwe umwanzuro niba udakoresha cyangwa udashyira mugikorwa cyo gukosora hanze hamwe na plaster.
Igihe cyo kohereza: Werurwe-27-2024
