He whara noa te whati o te kaki o te femur, ā, he whara kino pea mō ngā taote pokanga orthopedic, nā te ngoikore o te rere o te toto, he nui ake te maha o ngā whati kāore i honoa me te osteonecrosis, he tautohenga tonu te maimoatanga pai mō te whati o te kaki o te femur, e whakapono ana te nuinga o ngā tohunga ka taea te whakaaro ki ngā tūroro neke atu i te 65 tau te pakeke mō te arthroplasty, ā, ka taea te whiriwhiri i ngā tūroro kei raro iho i te 65 tau te pakeke mō te pokanga whakapiri ā-roto, ā, ko te pānga tino kino ki te rere o te toto ko te whati momo subcapsular o te kaki o te femur. Ko te whati subhead o te kaki o te femur te mea tino kino te pānga haemodynamic, ā, ko te whakaiti kati me te whakapiri ā-roto tonu te tikanga maimoatanga noa mō te whati subhead o te kaki o te femur. He pai te whakaiti pai ki te whakaū i te whati, te whakatairanga i te whakaora whati me te aukati i te necrosis o te upoko o te femur.
Koinei te take noa o te whati o te kaki o te femur hei matapaki i te mahi o te whakapiri ā-roto nekehanga-katia me te tīwiri cannulated.
Ⅰ Ngā mōhiohio taketake mō te take
Ngā mōhiohio tūroro: tāne 45 tau te pakeke
Amuamu: mamae te hope maui me te herenga o ngā mahi mō ngā hāora e 6.
Hītori: I hinga te tūroro i a ia e kaukau ana, ā, ka mamae te hope maui, ka whakawhāitihia hoki te mahi, kāore i taea te whakaora mā te okioki, ā, i whakaurua ki tō mātou hōhipera me te whati o te kaki o te femur maui i runga i ngā whakaahua X-ray, ā, i whakaurua ki te hōhipera me te hinengaro mārama me te wairua ngoikore, e amuamu ana mō te mamae o te hope maui me te whakawhāitihia o te mahi, ā, kāore i kai, ā, kāore anō kia horoi i tana puku tuarua i muri i te whara.
Ⅱ Whakamātautau Tinana (Tinana Katoa me te Tirotiro Tohunga)
T 36.8°C P87 ngā pao/min R20 ngā pao/min BP135/85mmHg
Te whanaketanga noa, te kai pai, te tūnga noho puku, te hinengaro mārama, te mahi tahi i roto i te tirotiro. He noa te tae o te kiri, he pīataata, kāore he pupuhi, he ponana rānei, kāore he whānui o ngā pona lymph o waho o te tinana katoa, o te rohe rānei. Te rahi o te upoko, he āhua noa, kāore he mamae pēhanga, he puranga, he kanapa te makawe. He rite te rahi o ngā kamo e rua, he porotaka hoki, me te aro ki te hihi o te mārama. He ngawari te kaki, he pokapū te trachea, kāore i nui te repe thyroid, he ōrite te uma, he poto te manawa, kāore he rerekētanga i te whakarongo manawa-pūkahukahu, he noa ngā rohe o te ngakau i te patupatu, ko te tere o te ngakau he 87 ngā pao/meneti, ko te manawa o te ngakau he Qi, he papatahi, he ngawari te puku, kāore he mamae pēhanga, he mamae hoki. Kāore i kitea te ate me te whēkau, ā, kāore he ngawari o ngā whatukuhu. Kāore i tirohia ngā diaphragm o mua me muri, ā, kāore he rerekētanga o te tuaiwi, ngā waewae o runga me ngā waewae o raro matau, me te nekehanga noa. I kitea ngā hihi ā-tinana i roto i te whakamātautau neurological, ā, kāore i puta ngā hihi pathological.
Kāore i kitea he pupuhi mārama o te hope maui, he mamae pēhanga mārama i waenganui o te hope maui, he poto te hurihanga o waho o te waewae maui o raro, he ngawari ki te tuaka roa o te waewae maui o raro (+), he ngoikore te mahi a te hope maui, he pai te kare me te ngohe o ngā maihao e rima o te waewae maui, ā, he noa te pā o te uaua dorsal o te waewae.
Ngā whakamātautau āwhina Ⅲ
I whakaatuhia e te kiriata hihi-X: he whati o te pito o raro o te kaki o te femur maui, he nekehanga o te pito whati.
Kāore i kitea he rerekētanga i roto i te toenga o ngā whakamātautau matū koiora, te hihi-X o te uma, te ine i te densitometry o te wheua, me te ultrasound tae o ngā uaua hohonu o ngā peka o raro.
Ⅳ Te tātaritanga me te tātaritanga rerekētanga
E ai ki te hītori o te tūroro mō te whara, te mamae o te hope maui, te whakawhāiti i ngā mahi, te whakamātautau tinana o te waewae maui o raro, te whakapoto i te āhua o te hurihanga o waho, te ngawari o te huha, te mamae o te waewae maui o raro o te tuaka roa (+), ka taea te tautuhi mārama i te ngoikore o te hope maui, me te kiriata hihi-X. Ka taea hoki te mamae o te hope me te whakawhāiti i ngā mahi i te whati o te trochanter, engari i te nuinga o te wā ka kitea te pupuhi o te rohe, kei roto te pūwāhi pēhanga i te trochanter, ā, he nui ake te koki hurihanga o waho, nō reira ka taea te wehewehe i tēnā.
Ⅴ Maimoatanga
I muri i te whakamātautau katoa, i mahia te whakaiti katia me te whakapiri i ngā whao tuwhera ki roto.
Ko te kiriata i mua i te pokanga e whai ake nei
I whakaatuhia he whakaoranga pai i muri i te whakaora me te tirotiro i te waewae e pāngia ana mā te nekenekehanga me te hurihanga ā-roto me te kukume i te peka e pāngia ana me te tango paku i te peka e pāngia ana.
I whakatakotoria he pine Kirschner ki te mata o te tinana i te ahunga o te kaki o te femur hei tirotiro i te fluoroscopy, ā, i mahia he tapahi kiri iti i runga i te wāhi o te pito o te pine.
Ka whakaurua he pine ārahi ki roto i te kaki o te femur kia whakarara ki te mata o te tinana i te ahunga o te pine Kirschner, me te pupuri tonu i te piko o mua o te 15 nekehanga, ā, ka mahia he fluoroscopy.
Ka whakaurua te pine arataki tuarua mā roto i te tītaha o te femur mā te whakamahi i tētahi aratohu e whakarara ana ki te taha raro o te ahunga o te pine arataki tuatahi.
Ka werohia he ngira tuatoru kia rite ki te tuara o te ngira tuatahi mā te aratohu.
Mā te whakamahi i tētahi whakaahua taha o te poroka, i kitea ngā titi Kirschner e toru kei roto i te kaki o te femur.
Wirihia ngā kōhao ki te ahunga o te pine arataki, inehia te hohonu, kātahi ka tīpako i te roa e tika ana o te whao tuwhera kua whaohia ki te pine arataki. E taunakihia ana kia whaohia te tuaiwi femur o te whao tuwhera i te tuatahi, kia kore ai e ngaro te tautuhi anō.
Whakawetohia ngā tīwiri e rua kua whakapūmauhia tetahi i muri i tetahi, ka titiro mā roto i te
Te āhua o te tapahi kiri
Kiriata arotake i muri i te pokanga
I te taha o te tau o te tūroro, te momo whati, me te kounga o te wheua, i pai ake te whakapiripiri ā-roto o te whao kōhao katia, he painga nōna ko te whara iti, he pānga whakapiri pono, he ngāwari te whakahaere me te ngāwari ki te whakahaere, ka taea te pēhi mā te mana hiko, he pai te hanganga kōhao ki te whakaiti i te pēhi o roto o te angaanga, ā, he tere te whakaora whati.
Whakarāpopototanga
1 Mā te whakatakotoranga o ngā ngira a Kirschner ki te mata o te tinana mā te whakamahi i te fluoroscopy ka taea te whakatau i te pūwāhi me te ahunga o te werohanga o te ngira me te whānuitanga o te tapahi kiri;
2 Me whakarara, me huripokitia te porotaka o ngā pine Kirschner e toru, me tata hoki ki te taha e taea ana, he mea tēnei hei whakau i te whati me te pēhitanga reti i muri mai;
3 Me whiriwhiri te wāhi whakauru o te pine Kirschner o raro i te tihi o te femur e tino kitea ana kia noho te pine ki waenganui o te kaki o te femur, ā, ka taea te neke whakamua, te neke whakamuri hoki i ngā pito o ngā pine e rua o runga i te tihi e tino kitea ana kia pai ai te piri;
4 Kaua e werohia te pine Kirschner kia hohonu rawa i te wā kotahi kia kore ai e uru ki te mata hononga, ka taea te wero i te mata wiri mā te rārangi whati, ko tētahi hei ārai i te wero i te pane o te femur, ā, ko tētahi hei āwhina i te pēhanga o te whao tuwhera;
5. Ka whaowhia ngā tīwiri tuwhera ki roto i te tata, kātahi ka whakamātauria kia tika te roa o te tīwiri tuwhera. Ki te kore e roa rawa te roa, ngana kia kaua e whakakapia pinepine ngā tīwiri. Ki te mate wheua, ka kore e tika te whakakapinga o ngā tīwiri, ā, ka kore e whai hua te whakatikatika o ngā tīwiri. He kino rawa te tūroro ki te whai hua o te whakatikatika o ngā tīwiri, engari he kino ake te roa o te whakatikatika o ngā tīwiri i te roa o te whakatikatika kore hua o ngā tīwiri!
Wā tuku: Hanuere-15-2024
