Ukubethela nge-intramedullaryyindlela yokulungisa amathambo yangaphakathi esetyenziswa kakhulu ukususela kwiminyaka yoo-1940. Isetyenziswa kakhulu ekunyangeni ukwaphuka kwamathambo amade, ukungadibani, kunye nezinye iingozi ezinxulumene noko. Le ndlela ibandakanya ukufaka isikhonkwane se-intramedullary kumjelo ophakathi wethambo ukuze kuzinziswe indawo yokuqhekeka. Ngamazwi alula, isikhonkwane se-intramedullary sisakhiwo eside esinezinto ezininziisikrufu sokutshixaimingxunya kuzo zombini iziphelo, ezisetyenziselwa ukulungisa iziphelo ezikufutshane nezikude zokwaphuka. Ngokuxhomekeke kwisakhiwo sazo, izipikili ze-intramedullary zingahlulwahlulwa zibe ziqinileyo, zityhubhu, okanye zivuleke, kwaye zisetyenziselwa ukunyanga iintlobo ezahlukeneyo zezigulana. Umzekelo, izipikili ze-intramedullary eziqinileyo zinokumelana ngcono nosulelo ngenxa yokungabikho kwendawo efileyo yangaphakathi.
Zeziphi iintlobo zezaphuko ezifanelekileyo kwizinzipho ze-intramedullary?
Inzipho ze-intramedullarysisixhobo esifanelekileyo sokunyanga ukwaphuka kwe-diaphyseal, ingakumbi kwi-femur kunye ne-tibia. Ngokusebenzisa iindlela ezingaphantsi kakhulu, izipikili ze-intramedullary zinokubonelela ngozinzo oluhle ngelixa zinciphisa umonakalo wezicubu ezithambileyo kwindawo yokuqhekeka.
Utyando lokunciphisa izipikili oluvaliweyo kunye nokufakelwa kwezipikili ngaphakathi kwe-medullary lunezibonelelo ezilandelayo:
Ukunciphisa okuvaliweyo kunye nokubethelela ngaphakathi kwe-medullary nail (CRIN) kuneengenelo zokuphepha ukunqunyulwa kwendawo yokuqhekeka kunye nokunciphisa umngcipheko wosulelo. Ngokunqunyulwa okuncinci, kuthintela ukuqhekeka okukhulu kwezicubu ezithambileyo kunye nomonakalo wokunikezelwa kwegazi kwindawo yokuqhekeka, ngaloo ndlela kuphucula izinga lokuphiliswa kokuqhekeka. Kwiintlobo ezithile zeukwaphuka kwamathambo akufutshane, i-CRIN inokubonelela ngozinzo olwaneleyo lokuqala, ivumela izigulana ukuba ziqale intshukumo yamalungu kwangethuba; ikwaluncedo ngakumbi ngokubhekiselele ekuthwaleni uxinzelelo lwe-axial xa kuthelekiswa nezinye iindlela zokulungisa ezingaqhelekanga ngokubhekiselele kwi-biomechanics. Ingathintela ngcono ukukhululeka kokulungisa kwangaphakathi emva kotyando ngokwandisa indawo yoqhagamshelwano phakathi kwe-implant kunye nethambo, okwenza ifaneleke ngakumbi kwizigulana ezine-osteoporosis.
Isetyenziswa kwi-tibia:
Njengoko kubonisiwe kumfanekiso, inkqubo yotyando ibandakanya ukwenza ukusika okuncinci kwe-3-5 cm kuphela ngaphezulu kwe-tibial tubercle, kunye nokufaka izikrufu ezi-2-3 zokutshixa ngokusebenzisa ukusika okungaphantsi kwe-1 cm kwiziphelo ezikufutshane nezikude zomlenze ongezantsi. Xa kuthelekiswa nokunciphisa okuvulekileyo kwendabuko kunye nokufakelwa kwangaphakathi ngepleyiti yentsimbi, oku kungabizwa ngokuba yindlela yokungenelela kancinci.
Isetyenziswa kwi-femur:
1. Umsebenzi wokudibanisa uzipho lwe-intramedullary oluvaliweyo lwe-femoral:
Ibhekisa kubuchule bayo bokumelana nokujikeleza ngendlela yokutshixa kweenzipho zangaphakathi.
2. Ukwahlulahlula isikhonkwane esingaphakathi kwe-medullary esitshixiweyo:
Ngokwemisebenzi: uzipho oluqhelekileyo oluvaliweyo ngaphakathi kwe-medullary kunye nolwakhiwo lwezipikili ezivaliweyo ngaphakathi kwe-medullary; ikakhulu kumiselwa kukudluliselwa koxinzelelo ukusuka kwilungu lesinqe ukuya kwilungu ledolo, kunye nokuba iindawo eziphezulu nezisezantsi phakathi kwee-rotators (ngaphakathi kwe-5cm) zizinzile na. Ukuba azizinzanga, kufuneka ukwakhiwa kwakhona kokudluliselwa koxinzelelo lwe-hip.
Ngokuphathelele ubude: iintlobo ezimfutshane, ezikufutshane, nezinde, ezikhethwa kakhulu ngokusekelwe kubude bendawo yokuqhekeka xa kukhethwa ubude beenzipho zangaphakathi.
2.1 Izipikili ezinxibelelanayo zangaphakathi ezinxibelelanayo
Umsebenzi oyintloko: ukuzinzisa uxinzelelo lwe-axial.
Iimpawu: Ukuqhekeka kwe-femoral shaft (akusebenzi kwii-subtrochanteric fractures)
2.2 Ukwakhiwa ngokutsha kweenzipho ezinxibelelanayo ngaphakathi kwe-medullary
Umsebenzi ophambili: Ukudluliselwa koxinzelelo ukusuka esinqeni ukuya kwi-femoral shaft akuzinzanga, kwaye uzinzo lokudluliselwa koxinzelelo kweli candelo lufuna ukwakhiwa ngokutsha.
Iimpawu: 1. Ukuqhekeka kwentamo ye-femoral kunye nokuqhekeka kwe-femoral shaft kwicala elinye (ukuqhekeka kwe-bilateral kwicala elinye).
I-PFNA ikwaluhlobo lwesikhonkwane sangaphakathi esifana nokwakhiwa kwakhona!
2.3 Indlela yokutshixa ekude yeenzipho zangaphakathi kwe-medullary
Indlela yokutshixa ekude yezipikili ze-intramedullary iyahluka ngokuxhomekeke kumenzi. Ngokuqhelekileyo, kusetyenziswa isikrufu esinye sokutshixa esingashukumiyo kwizipikili ze-proximal femoral intramedullary, kodwa kwiinkcenkcesho ze-femoral shaft okanye izipikili ze-intramedullary ezinde, izikrufu ezimbini okanye ezintathu zokutshixa ezingashukumiyo ezine-dynamic locking zihlala zisetyenziswa ukuphucula uzinzo lokujikeleza. Zombini izipikili ze-femoral kunye ne-tibial ezinde zangaphakathi ziqiniswe ngezikrufu ezimbini zokutshixa.
Ixesha lokuthumela: Matshi-29-2023
