Umba wokukhetha ubukhulu bezikhonkwane ze-intramedullary kumathambo amade e-tubular yamalungu angaphantsi.

I-Intramedullary nailing ngumgangatho wegolide wonyango lotyando lwe-diaphyseal fractures yamathambo amade e-tubular kumalungu asezantsi. Inika izibonelelo ezinje ngokwenzakala okuncinci kotyando kunye namandla aphezulu e-biomechanical, okwenza ukuba isetyenziswe ngokuqhelekileyo kwi-tibial, femoral, kunye ne-humeral shaft fractures. Ngokweklinikhi, ukukhethwa kwe-intramedullary nail diameter kudla ngokuthanda esona sikhonkwane singqingqwa esinokufakwa ngokulungiswa okuphakathi, ukuqinisekisa uzinzo olukhulu. Nangona kunjalo, ingaba ubukhulu besikhonkwane se-intramedullary buchaphazela ngokuthe ngqo i-prognosis ye-fracture ihlala ingabonakali.

Kwinqaku elidlulileyo, sixoxe ngophononongo oluvavanya impembelelo ye-intramedullary nail ububanzi ekuphulukiseni amathambo kwizigulane ezingaphezu kwe-50 kunye ne-intertrochanteric fractures. Iziphumo zibonise ukuba akukho mahluko wezibalo kumazinga okuphulukisa ukuphuka kunye namazinga okusebenza kwakhona phakathi kweqela le-10mm kunye neqela elinezikhonkwane ezingaphezu kwe-10mm.

Iphepha elapapashwa ngo-2022 ngabaphengululi abavela kwiPhondo laseTaiwan nalo lafikelela kwisigqibo esifanayo:

Uphononongo olubandakanya izigulane ze-257, eziye zalungiswa ngezikhonkwane ze-intramedullary ze-diameter 10mm, 11mm, 12mm, kunye ne-13mm, zahlula izigulane zibe ngamaqela amane ngokusekelwe kububanzi bezikhonkwane. Kwafunyaniswa ukuba akukho mmahluko wamanani kumazinga okuphulukisa ukuphuka phakathi kwamaqela amane.

Ke, ngaba oku kukwanjalo kwi-tibial shaft fractures elula?

Kuphononongo olulindelekileyo lokulawula iimeko ezibandakanya izigulane ze-60, abaphandi bahlula izigulane ze-60 ngokulinganayo zibe ngamaqela amabini e-30 nganye. Iqela A lalungiswa ngezikhonkwane ezicekethekileyo ze-intramedullary (9mm kubasetyhini kunye ne-10mm kumadoda), ngelixa iQela B lalungiswa ngezikhonkwane ezishinyeneyo ze-intramedullary (11mm kubasetyhini kunye ne-12mm kumadoda):

Iziphumo zibonise ukuba akukho mahluko ubalulekileyo kwiziphumo zeklinikhi okanye umfanekiso phakathi kwezikhonkwane ezibhityileyo nezityebileyo ze-intramedullary. Ukongeza, izikhonkwane ezincinci ze-intramedullary zadityaniswa namaxesha amafutshane otyando kunye ne-fluoroscopy. Kungakhathaliseki ukuba isikhonkwane esityebileyo okanye esincinci sisetyenzisiwe, ukuhlanjululwa okuphakathi kwenziwa ngaphambi kokufakwa kwezikhonkwane. Ababhali bacebisa ukuba i-tibial shaft fractures elula, izikhonkwane ze-intramedullary ezinobubanzi obuncinci zingasetyenziselwa ukulungiswa.