Intramedullary nailingbubuchule obuqhelekileyo bokulungisa amathambo wangaphakathi obusukela emva koo-1940.Isetyenziswa ngokubanzi kunyango lwamathambo amade, ama-non-union, kunye nezinye iingozi ezinxulumene nazo.Ubuchwephesha bubandakanya ukufaka isikhonkwane se-intramedullary kumjelo osembindini wethambo ukuzinzisa indawo yokuphuka.Ngamagama alula, isikhonkwane se-intramedullary sisakhiwo eside esine-multipleisikrufu sokutshixaimingxuma kwiziphelo zombini, ezisetyenziselwa ukulungisa i-proximal kunye ne-distal end of fracture.Ngokuxhomekeke kwisakhiwo sabo, izikhonkwane ze-intramedullary zingahlelwa njengento eqinile, i-tubular, okanye i-open-section, kwaye isetyenziselwa ukuphatha iintlobo ezahlukeneyo zezigulane.Umzekelo, izikhonkwane eziqinileyo ze-intramedullary zinokuxhathisa okungcono kusulelo ngenxa yokunqongophala kwendawo efileyo yangaphakathi.
Ziziphi iintlobo zeefractures ezifanelekileyo kwizikhonkwane ze-intramedullary?
Isikhonkwane se-Intramedullarysisifakelo esifanelekileyo sokunyanga i-diaphyseal fractures, ngakumbi kwi-femur kunye ne-tibia.Ngokusebenzisa ubuchule obuncinci, isikhonkwane se-intramedullary sinokubonelela ngokuzinza kakuhle ngelixa unciphisa umonakalo wezicubu ezithambileyo kwindawo yokuphuka.
Ukucuthwa okuvaliweyo kunye notyando lwe-intramedullary nailing fixation lunezi zibonelelo zilandelayo:
Ukunciphisa okuvaliweyo kunye ne-intramedullary nailing (CRIN) ineenzuzo zokuphepha ukuchithwa kwendawo yokuphuka kunye nokunciphisa umngcipheko wokusuleleka.Nge-incision encinci, igwema ukuchithwa kwezicubu ezithambileyo ngokubanzi kunye nomonakalo wokunikezelwa kwegazi kwindawo yokuphuka, ngaloo ndlela kuphuculwe izinga lokuphulukisa ukuphuka.Kwiintlobo ezithile zeukwaphuka kwamathambo okusondele, I-CRIN inokubonelela ngokuzinza okwaneleyo kokuqala, ukuvumela izigulane ukuba ziqale ukunyakaza ngokubambisana kwangaphambili;Kwakhona kunenzuzo ngakumbi malunga nokuthwala uxinzelelo lwe-axial xa kuthelekiswa nezinye iindlela zokulungiswa kwe-eccentric ngokwemigaqo ye-biomechanics.Inokuthintela ngcono ukukhulula ukulungiswa kwangaphakathi emva kokuhlinzwa ngokunyusa indawo yoqhagamshelwano phakathi kokufakelwa kunye nethambo, okwenza kube lula ngakumbi kwizigulane ezine-osteoporosis.
Isetyenziswa kwi-tibia:
Njengoko kubonisiwe kulo mfanekiso, inkqubo yotyando ibandakanya ukwenza i-3-5 cm encinci ngaphezu kwe-tubercle ye-tibial, kunye nokufaka i-screws ye-2-3 yokutshixa ngokusebenzisa izibonda ezingaphantsi kwe-1 cm kwi-proximal kunye ne-distal ends of the low leg.Xa kuthelekiswa nokunciphisa okuvulekileyo kwendabuko kunye nokulungiswa kwangaphakathi kunye nepleyiti yensimbi, oku kunokubizwa ngokuba bubuchule obuncinci obuncinci.
Isetyenziswa kwi-femur:
1. Umsebenzi wokudibanisa wesikhonkwane se-femoral esitshixiwe kwi-intramedullary:
Ibhekisa kumandla ayo okumelana nokujikeleza ngendlela yokutshixa yesikhonkwane se-intramedullary.
2.Ukuhlelwa kwesikhonkwane esitshixiweyo se-intramedullary:
Ngokwemiqathango yomsebenzi: isikhonkwane se-intramedullary esitshixiweyo kunye nokwakhiwa kwakhona kwe-intramedullary nail;ikakhulu igqitywe ngokugqithiswa koxinzelelo olusuka kwi-hip joint ukuya emadolweni, nokuba iindawo eziphezulu kunye nezantsi phakathi kwee-rotators (ngaphakathi kwe-5cm) zizinzile.Ukuba ingazinzile, ukwakhiwa kwakhona kokuhanjiswa koxinzelelo lwe-hip kuyadingeka.
Ngokumalunga nobude: iintlobo ezimfutshane, ezikufutshane, kunye nezandisiweyo, ngokukodwa ezikhethiweyo ngokusekelwe ekuphakameni kwendawo yokuphuka xa ukhetha ubude besikhonkwane se-intramedullary.
2.1 Isikhonkwane se-intramedullary esidityanisiweyo
Umsebenzi ophambili: ukuzinzisa uxinzelelo lwe-axial.
Iimpawu: Ukuqhekeka kwe-femoral shaft (engasebenziyo kwi-subtrochanteric fractures)
2.2 Ukwakhiwa kwakhona kwesikhonkwane se-intramedullary
Umsebenzi oyintloko: Ukuhanjiswa kwengcinezelo ukusuka kwi-hip ukuya kwi-shaft ye-femoral ayizinzile, kwaye ukuzinza kokuhanjiswa kwengcinezelo kule nxalenye kufuneka kuhlaziywe.
Izibonakaliso: 1. I-Subtrochanteric fractures;2. Ukuphulwa kwentamo ye-femoral kudibaniswa ne-femoral shaft fractures kwicala elifanayo (i-bilateral fractures kwicala elifanayo).
I-PFNA ikwaluhlobo lolwakhiwo-uhlobo lwesikhonkwane se-intramedullary!
2.3 Indlela yokutshixa ekude yesikhonkwane se-intramedullary
Indlela yokutshixa i-distal yezikhonkwane ze-intramedullary iyahluka ngokuxhomekeke kumenzi.Ngokubanzi, isikrufu esinye sokutshixa esimileyo sisetyenziselwa iinzipho ezisondele kwi-femoral intramedullary, kodwa ukophuka kwe-femoral shaft okanye izikhonkwane ezinde ze-intramedullary, izikrufu ezimbini okanye ezintathu zokutshixa ezimileyo ezinokutshixwa okuguquguqukayo zihlala zisetyenziselwa ukomeleza uzinzo olujikelezayo.Zombini izikhonkwane ze-femoral kunye ne-tibial zobude be-intramedullary ziqiniswe ngezikrufu ezimbini zokutshixa.
Ixesha lokuposa: Mar-29-2023
