Waxaa jira laba nooc oo hababka qalliinka, boolal saxan iyo biinanka intramedullary, hore waxaa ka mid ah boolal saxan guud iyo AO nidaamka boolal saxan cadaadis, iyo kan dambe waxaa ka mid ah xiran iyo fur retrograde ama biinanka retrograde.Doorashadu waxay ku salaysan tahay goobta gaarka ah iyo nooca jabka.
Qalabaynta pin-intramedullary waxay leedahay faa'iidooyinka soo-gaadhista yar yar, xoqidda yar, hagaajinta xasilloon, looma baahna hagaajin dibadda, iwm.Jajabka hoose ee 1/3, sababtoo ah godka weyn ee medullary iyo lafo badan oo la tirtiro, way adag tahay in la xakameeyo wareegga pin intramedullary, iyo hagaajintu maaha mid ammaan ah, inkastoo lagu xoojin karo boolal, laakiin way ku habboon tahay. loogu talagalay boolal saxan bir ah.
I fur-fure gudaha ah oo loogu talagalay jabka shaft Femur oo leh cidiyaha intramedullary
(1) Jeexitaan: Jeexitaanka xuubka xuubka ama dhabarka dambe ayaa lagu sameeyaa iyada oo udub dhexaad u ah goobta jaban, oo dhererkeedu yahay 10-12 cm, jarjar maqaarka iyo faashad ballaaran oo muujinaya muruqa femoral ee dambe.
Jeexitaanka dambe waxa lagu sameeyaa xariiqda u dhaxaysa trochanter-ka weyn iyo cidhifka dambe ee femur, jeexitaanka maqaarka ee la jeexitaan dambe ee dambe waa isku mid ama wax yar ka dib, iyada oo farqiga ugu weyni uu yahay in jeexitaan dambe uu kala qaybiyo vastus lateral waa muruqa. , halka jeexitaan dambe ee jeexjeexa uu galo barafka dambe ee muruqa lateralis ee muruqa vastus lateralis muruqa.(Sawir 3.5.5.2-1,3.5.5.2-2)
Jeexitaanka anterolateral, dhanka kale, waxaa lagu sameeyaa xariiqa ka soo baxa laf-dhabarka sare ee hore ilaa cidhifka dibedda ee patella, waxaana laga helaa muruqa femoral ee dambe iyo muruqa femoris femoris, kaas oo dhaawici kara muruqa femoral ee dhexdhexaadka ah iyo neerfaha dareemayaasha. laamo ilaa muruqa femoral lateral iyo laamaha rotator femoris externus artery, oo sidaas daraaddeed dhif ah ama aan waligood la isticmaalin (Jaantus 3.5.5.2-3).
(2) Soo-gaadhista: Kala saar oo u soo jiid muruqa femoral ee dambe oo u geli inta u dhaxaysa femoris biceps, ama si toos ah u gooya oo u kala saar muruqa femoral ee dambe, laakiin dhiig-baxa ayaa ka badan.Iska yaree periosteum si aad u muujiso darafyada sare iyo hoose ee jaban ee jabka femur, oo muuji baaxadda ilaa xadka la arki karo oo dib loo soo celin karo, oo ka siib unugyada jilicsan sida ugu yar ee suurtogalka ah.
(3) Dib-u-hagaajinta hagaajinta gudaha: Ku dar addinka ay saamaysay, soo bandhig dhammaadka jaban ee u dhow, geli ubaxa plum ama irbadda intramedullary ee V-qaabeeya, oo isku day inaad cabbirto haddii dhumucda irbaddu ku habboon tahay.Haddii ay jirto cidhiidhi ah godka medullary, balaadhinta daloolka medullary waxaa loo isticmaali karaa in si habboon loo hagaajiyo loona balaadhiyo godka, si looga hortago in irbadda aysan awoodin inay gasho oo aan la soo bixin karin.Ku hagaaji dhammaadka jaban ee u dhow oo leh lafo-haye, geli irbadda intramedullary si dib-u-noqosho ah, ka gal femur ka taroogantarka weyn, iyo marka dhamaadka irbaddu kor u riixdo maqaarka, samee jeex yar oo ah 3cm meesha, oo sii wad inaad geliso. irbadda intramedullary ilaa ay ka soo baxdo maqaarka ka baxsan.Irbadda intramedullary waa la soo noqdaa, dib loo jiheeyaa, iyada oo la sii maraa foornada laga soo bilaabo trochanter weyn, ka dibna si dhow ayaa loo geliyaa diyaaradda qaybta isgoysyada.Cirbadaha intermedullary ee la hagaajiyay waxay leeyihiin cidhifyo yaryar oo wareegsan oo leh godad soo saarid.Markaa looma baahna in la soo baxo oo jihada la beddelo, irbaddana waa la feeray ka dibna hal mar la feeray.Taas beddelkeeda, irbadda waxaa la gelin karaa dib-u-cusbooneysi leh biin hagaha oo bannaanka la jeexjeexay trochanteric weyn, ka dibna biinka intramedullary ayaa la gelin karaa godka medullary.
Soo kabashada dheeraadka ah ee jabka.Is-waafajinta anatomical waxaa lagu gaari karaa iyadoo la isticmaalayo leverage of pin intramedullary u dhow oo ay la socoto jeexan lafta, jiidashada, iyo korka jabka.Hagaajinta waxaa lagu gaaraa xajiye lafo, ka dibna biinka intramedullary ayaa la wadaa si godka soo saarista biinku gadaal loogu hago si uu u waafajiyo qalooca femoral.Dhamaadka cirbadda waa in ay gaaraan qaybta ku habboon ee cirifka fog ee jabka, laakiin ma aha iyada oo loo marayo lakabka carjawda, iyo dhamaadka cirbadda waa in looga tagaa 2cm meel ka baxsan trochanter, si markaa looga saaro. 3.5.5.2-4)
hagaajinta ka dib, isku day dhaqdhaqaaq aan toos ahayn ee addinka oo u fiirso xasilooni darro kasta.Haddii ay lagama maarmaan tahay in la beddelo cirbadda intramedullary dhumuc weyn, waa laga saari karaa oo la bedeli karaa.Haddii ay jirto dabacsanaan yar iyo xasillooni darro, fur ayaa lagu dari karaa si loo xoojiyo hagaajinta. (Jaantus 3.5.5.2-4)
Dhaawaca ayaa ugu dambayntii la nadiifiyey oo lakabyo la xidhay.Kabo balastar wareeg ah oo ka-hortagga dibadda ah ayaa la gashanayaa.
II Plate Screw Internal Fixing
Qalabaynta gudaha ee leh birta birta ah ee birta ah ayaa loo isticmaali karaa dhammaan qaybaha jirridda femoral, laakiin 1/3 hoose ayaa ku habboon hagaajinta noocan oo kale ah sababtoo ah daloolka ballaaran ee medullary.Saxan guud oo bir ah ama saxan bir cadaadis AO ah ayaa la isticmaali karaa.Midda dambe waa mid aad u adag oo si adag u go'an iyada oo aan la hagaajin dibadda.Si kastaba ha ahaatee, midkoodna kama fogaan karo doorka waji-xidhka walbahaarka oo waafaqsan mabda'a awood siman, kaas oo u baahan in la hagaajiyo.
Habkani wuxuu leeyahay kala duwanaansho diirran oo weyn, hagaajin gudaha ah, saameynaya bogsashada, sidoo kale wuxuu leeyahay cillado.
Marka ay jirto maqnaanshaha xaaladaha biinka intramedullary, curvature medullary ee jaban ama qayb weyn oo ka mid ah kuwa aan la gudbi karin iyo 1/3 hoose ee jabka ayaa la qabsan kara.
(1) Jeexitaan dambe ee femoral ama dambe.
(2) (2) Soo-gaadhista jabka, oo ku xidhan duruufaha, waa in la hagaajiyo oo gudaha lagu hagaajiyaa boolal saxan ah.Saxanka waa in lagu dhejiyaa dhinaca cidhiidhiga lateral, boolalku waa inay dhex maraan kortex labada dhinacba, dhererka saxanka waa inuu ahaadaa 4-5 jeer dhexroorka lafta goobta jaban.Dhererka saxanku waa 4 ilaa 8 jeer dhexroorka lafta jaban.6 ilaa 8 taariko dalool ah ayaa caadi ahaan loo isticmaalaa femur.Jajabyada lafaha waaweyn ee la jarjaray ayaa lagu hagaajin karaa boolal dheeri ah, tiro badan oo lafaha lafaha ah ayaa lagu dhejin karaa isla mar ahaantaana dhinaca dhexe ee jabka la gooyey. (Jaantus 3.5.5.2-5).
Biyo raaci oo xidh lakabyada.Iyada oo ku xidhan nooca boolal saxan ah oo la isticmaalay, waxaa la go'aamiyay in lagu dhejiyo dhejis dibadda ah iyo in kale.
Waqtiga boostada: Mar-27-2024
