Ukuqhekeka kwengingqi ye-intertrochanteric ye-femur kubangela i-50% yokuqhekeka kwe-hip kwaye lolona hlobo luqhelekileyo lokuqhekeka kwizigulane ezindala. Ukulungiswa kwezipikili ngaphakathi kwe-intramedullary yeyona ndlela ibalaseleyo yokunyanga ukuqhekeka kwe-intertrochanteric. Kukho ukuvumelana phakathi koogqirha bamathambo ukuba baphephe "impembelelo emfutshane" ngokusebenzisa izipikili ezinde okanye ezimfutshane, kodwa okwangoku akukho mvumelwano malunga nokukhetha phakathi kwezipikili ezinde nezimfutshane.
Ngokwethiyori, iinzipho ezimfutshane zinokunciphisa ixesha lotyando, zinciphise ukulahleka kwegazi, kwaye ziphephe ukujijeka, ngelixa iinzipho ezinde zibonelela ngozinzo olungcono. Ngexesha lenkqubo yokufaka iinzipho, indlela eqhelekileyo yokulinganisa ubude bezinzipho ezinde kukulinganisa ubunzulu bephini yesikhokelo efakiweyo. Nangona kunjalo, le ndlela ayisoloko ichanekile kakhulu, kwaye ukuba kukho ukuphambuka kobude, ukutshintsha inzipho ze-intramedullary kunokukhokelela ekulahlekelweni kwegazi okukhulu, kwandise ukwenzakala kotyando, kwaye kwandise ixesha lotyando. Ke ngoko, ukuba ubude obufunekayo beenzipho ze-intramedullary bunokuvavanywa ngaphambi kotyando, injongo yokufaka iinzipho inokufezekiswa ngexesha elinye, kuthintelwe iingozi zangaphakathi kotyando.
Ukujongana nale ngxaki yezonyango, iingcali zamanye amazwe zisebenzise ibhokisi yokupakisha iinzipho ngaphakathi kwe-medullary (Ibhokisi) ukuvavanya ubude bezinzipho ngaphakathi kwe-medullary ngaphambi kotyando phantsi kwe-fluoroscopy, ebizwa ngokuba yi-"Box technique". Isiphumo sokusetyenziswa kwezonyango silungile, njengoko kwabelwana ngaso ngezantsi:
Okokuqala, beka isigulane ebhedini yokutsala uze wenze ukunciphisa okuvaliweyo phantsi kokutsala. Emva kokufezekisa ukunciphisa okwaneleyo, thatha isikhonkwane esingavulwanga ngaphakathi (kuquka nebhokisi yokupakishwa) uze ubeke ibhokisi yokupakishwa ngaphezulu kwe-femur yelungu elichaphazelekayo:
Ngoncedo lomatshini we-C-arm fluoroscopy, isalathiso sendawo ekufutshane kukulungelelanisa isiphelo esikufutshane senzipho zangaphakathi kunye ne-cortex engaphezulu kwentamo ye-femoral kwaye siyibeke kwindawo yokungena kwenzipho zangaphakathi.
Xa indawo ekufutshane ilungile, gcina indawo ekufutshane, uze utyhale ingalo ye-C uye kwisiphelo esikude uze wenze i-fluoroscopy ukuze ufumane umbono ochanekileyo wecala ledolo. Isalathiso sendawo ekude yi-intercondylar notch ye-femur. Buyisela uzipho lwe-intramedullary ngobude obahlukeneyo, ujonge ukufikelela kumgama phakathi kwesiphelo esikude se-femoral intramedullary natch ye-intercondylar ye-femur ngaphakathi kwe-1-3 diameters ye-intramedullary nail. Oku kubonisa ubude obufanelekileyo be-intramedullary nail.
Ukongeza, ababhali bachaze iimpawu ezimbini zomfanekiso ezinokubonisa ukuba uzipho olungaphakathi kwe-medullary lude kakhulu:
1. Isiphelo esikude sesikhonkwane se-intramedullary sifakwe kwinxalenye eyi-1/3 yomphezulu we-patellofemoral joint (ngaphakathi komgca omhlophe kumfanekiso ongezantsi).
2. Isiphelo esikude sesikhonkwane se-intramedullary sifakwe kunxantathu owenziwe ngumgca weBlumensaat.
Ababhali basebenzise le ndlela ukulinganisa ubude bezinzipho ze-intramedullary kwizigulana ezingama-21 kwaye bafumana izinga lokuchaneka kwe-95.2%. Nangona kunjalo, kunokubakho ingxaki enokubakho ngale ndlela: xa isinzipho se-intramedullary sifakwa kwizicubu ezithambileyo, kunokubakho isiphumo sokukhulisa ngexesha le-fluoroscopy. Oku kuthetha ukuba ubude bokwenyani bezinzipho ze-intramedullary ezisetyenzisiweyo bunokufuneka bube bufutshane kancinci kunomlinganiselo wangaphambi kotyando. Ababhali bayibonile le nto kwizigulana ezityebileyo kwaye bacebisa ukuba kwizigulana ezityebileyo kakhulu, ubude bezinzipho ze-intramedullary kufuneka bufutshane ngexesha lokulinganisa okanye baqinisekise ukuba umgama phakathi kwesiphelo esikude sezinzipho ze-intramedullary kunye ne-intercondylar notch ye-femur ungaphakathi kweedayamitha ezi-2-3 zezinzipho ze-intramedullary.
Kwamanye amazwe, iinzipho ze-intramedullary zinokupakishwa ngokwahlukeneyo kwaye zibulawe iintsholongwane, kodwa kwiimeko ezininzi, ubude obahlukeneyo beenzipho ze-intramedullary buxutywa kunye kwaye bubulawe iintsholongwane kunye ngabavelisi. Ngenxa yoko, kusenokungabi lula ukuvavanya ubude beenzipho ze-intramedullary ngaphambi kokubulawa iintsholongwane. Nangona kunjalo, le nkqubo inokugqitywa emva kokuba ii-drapes zokubulala iintsholongwane zifakiwe.
Ixesha lokuthumela: Epreli-09-2024
