Iifractures zengingqi ye-intertrochanteric ye-akhawunti ye-femur ye-50% ye-hip fractures kwaye luhlobo oluqhelekileyo lokuphuka kwizigulane ezisebekhulile.Ukulungiswa kwe-Intramedullary nail ngumgangatho wegolide wonyango lotyando lwe-intertrochanteric fractures.Kukho ukuvumelana phakathi koogqirha bamathambo ukuphepha "impembelelo emfutshane" ngokusebenzisa izikhonkwane ezide okanye ezimfutshane, kodwa okwangoku akukho mvumelwano ekukhetheni phakathi kwezipikili ezide nezifutshane.
Kwithiyori, izikhonkwane ezimfutshane zinokunciphisa ixesha lotyando, zinciphise ukulahleka kwegazi, kwaye zigweme ukuphinda zibuyele, ngelixa izikhonkwane ezinde zinika uzinzo olungcono.Ngethuba lenkqubo yokufaka izikhonkwane, indlela eqhelekileyo yokulinganisa ubude bezikhonkwane ezide kukulinganisa ubunzulu bepini yesikhokelo esifakiwe.Nangona kunjalo, le ndlela idla ngokungachanekanga kakhulu, kwaye ukuba kukho ukutenxa ngobude, ukutshintshwa kwesikhonkwane se-intramedullary kunokukhokelela ekulahlekelweni kwegazi elikhulu, ukwandisa ukwenzakala kotyando, kunye nokwandisa ixesha lotyando.Ngoko ke, ukuba ubude obufunekayo besikhonkwane se-intramedullary bunokuhlolwa kwangaphambili, injongo yokufakwa kwesikhonkwane inokufezekiswa kwimizamo enye, ukuphepha ingozi ye-intraoperative.
Ukujongana nalo mngeni wekliniki, abaphengululi bamazwe angaphandle basebenzise ibhokisi yokupakisha ye-intramedullary (Ibhokisi) ukuvavanya kwangaphambili ubude besikhonkwane se-intramedullary phantsi kwe-fluoroscopy, ebizwa ngokuba yi "Box technique".Isiphumo sesicelo seklinikhi silungile, njengoko kwabelwana ngaso ngezantsi:
Okokuqala, beka isigulane kwibhedi ye-traction kwaye wenze isiqhelo sokunciphisa ukuvala phantsi kwe-traction.Emva kokufezekisa ukunciphisa okwanelisayo, thabatha isikhonkwane se-intramedullary esingavulwanga (kubandakanywa nebhokisi yokupakisha) kwaye ubeke ibhokisi yokupakisha ngaphezu kwe-femur yelungu elichaphazelekayo:
Ngoncedo lomatshini we-C-arm fluoroscopy, ireferensi yendawo esondeleyo kukulungelelanisa isiphelo esiphezulu sesikhonkwane se-intramedullary kunye ne-cortex ngaphezu kwentamo ye-femoral kwaye uyibeke kwintelekelelo yendawo yokungena ye-intramedullary nail.
Emva kokuba i-proximal position yanelisayo, gcina indawo esondeleneyo, emva koko utyhale i-C-arm ukuya ekupheleni kwe-distal kwaye wenze i-fluoroscopy ukuze ufumane umbono ochanekileyo wecala ledolo elihlangeneyo.Isalathiso sendawo ekude yinotshi ye-intercondylar ye-femur.Buyisela isikhonkwane se-intramedullary ngobude obahlukeneyo, sijolise ekufikeleleni umgama phakathi kwesiphelo esikude se-femoral intramedullary nail kunye nenotshi ye-intercondylar ye-femur ngaphakathi kwe-1-3 ye-diameter ye-intramedullary nail.Oku kubonisa ubude obufanelekileyo besikhonkwane se-intramedullary.
Ukongeza, ababhali bachaza iimpawu ezimbini zokucinga ezinokubonisa ukuba isikhonkwane se-intramedullary side kakhulu:
1. Isiphelo esikude sesikhonkwane se-intramedullary sifakwe kwindawo ekude ye-1/3 ye-patellofemoral surface joint (ngaphakathi komgca omhlophe kumfanekiso ongezantsi).
2. Isiphelo esikude sesikhonkwane se-intramedullary sifakwe kunxantathu owenziwe ngumgca we-Blumensaat.
Ababhali basebenzise le ndlela yokulinganisa ubude bezikhonkwane ze-intramedullary kwizigulane ze-21 kwaye bafumana izinga lokuchaneka kwe-95.2%.Nangona kunjalo, kunokubakho umcimbi onokuthi ube khona ngale ndlela: xa isikhonkwane se-intramedullary sifakwe kwizicubu ezithambileyo, kunokubakho umphumo wokukhulisa ngexesha le-fluoroscopy.Oku kuthetha ukuba ubude bokwenene besikhonkwane se-intramedullary esisetyenzisiweyo sinokufuna ukuba bufutshane kancinane kunomlinganiselo wangaphambili.Ababhali baqaphele le nto kwizigulane ezigqithiseleyo kwaye bacetyisa ukuba izigulane ezigqithiseleyo, ubude besikhonkwane se-intramedullary kufuneka buncitshiswe ngokulinganisela ngexesha lokulinganisa okanye uqinisekise ukuba umgama phakathi kokuphela kwesiphelo se-intramedullary kunye ne-intercondylar notch ye-femur ingaphakathi. 2-3 ububanzi besikhonkwane se-intramedullary.
Kwamanye amazwe, izikhonkwane ze-intramedullary zinokupakishwa ngokwazo kwaye zifakwe inzala kwangaphambili, kodwa kwiimeko ezininzi, ubude obahlukeneyo bezikhonkwane ze-intramedullary zidityaniswe kunye kwaye zibulawa inzala ngokudibeneyo ngabavelisi.Ngenxa yoko, akunakukwazi ukuvavanya ubude besikhonkwane se-intramedullary ngaphambi kokuvalwa inzala.Nangona kunjalo, le nkqubo inokugqitywa emva kokuba kufakwe i-drapes yokuvala inzala.
Ixesha lokuposa: Apr-09-2024
