Ukuphuka kwesifunda se-intertrochanteric se-femur kubanga u-50% wokuphuka kwe-hip futhi kuyindlela evame kakhulu yokuphuka kwe-hip ezigulini esezikhulile. Ukufakwa kwezipikili ngaphakathi kwe-intramedullary kuyindinganiso yegolide yokwelapha ukuphuka kwe-intertrochanteric ngokuhlinzwa. Kukhona ukuvumelana phakathi kodokotela abahlinzayo bamathambo ukugwema "umphumela we-shorts" ngokusebenzisa izinzipho ezinde noma ezimfushane, kodwa okwamanje akukho ukuvumelana ngokukhetha phakathi kwezipikili ezinde nezimfushane.
Ngokombono, izinzipho ezimfushane zinganciphisa isikhathi sokuhlinzwa, zinciphise ukulahleka kwegazi, futhi zigweme ukujiya, kuyilapho izinzipho ezinde zinikeza ukuzinza okungcono. Ngesikhathi senqubo yokufaka izinzipho, indlela evamile yokulinganisa ubude bezinzipho ezinde ukukala ukujula kwephini yokuqondisa efakiwe. Kodwa-ke, le ndlela ngokuvamile ayinembile kakhulu, futhi uma kukhona ukuphambuka kobude, ukufaka esikhundleni sezinzipho zangaphakathi kwe-medullary kungaholela ekulahlekelweni kwegazi okukhulu, kwandise ukulimala kokuhlinzwa, futhi kwandise isikhathi sokuhlinzwa. Ngakho-ke, uma ubude obudingekayo bezinzipho zangaphakathi kwe-medullary bungahlolwa ngaphambi kokuhlinzwa, umgomo wokufaka izinzipho ungafinyelelwa ngomzamo owodwa, ukugwema izingozi zangaphakathi kokuhlinzwa.
Ukuze kuxazululwe le nselele yezokwelapha, izazi zakwamanye amazwe zisebenzise ibhokisi lokupakisha izinzipho elingaphakathi kwe-medullary (Ibhokisi) ukuhlola ubude bezinzipho ezingaphakathi kwe-medullary ngaphambi kokuhlinzwa ngaphansi kwe-fluoroscopy, okubizwa ngokuthi "indlela yebhokisi". Umphumela wokusetshenziswa kwezokwelapha muhle, njengoba kwabiwe ngezansi:
Okokuqala, beka isiguli embhedeni wokudonsa bese wenza ukunciphisa okuvalekile njalo ngaphansi kokudonsa. Ngemva kokufinyelela ekunciphiseni okwanelisayo, thatha uzipho lwangaphakathi olungavulwanga (kufaka phakathi ibhokisi lokupakisha) bese ubeka ibhokisi lokupakisha ngaphezu kwe-femur yesitho esithintekile:
Ngosizo lomshini we-C-arm fluoroscopy, inkomba yesikhundla se-proximal iwukuvumelanisa ukuphela kwe-proximal kozipho lwe-intramedullary ne-cortex engaphezulu kwentamo ye-femoral bese uyibeka endaweni yokungena kozipho lwe-intramedullary.
Uma indawo eseduze seyanelisa, gcina indawo eseduze, bese ucindezela ingalo ye-C uye ekugcineni kwedolo bese wenza i-fluoroscopy ukuze uthole umbono wangempela ohlangothini lwedolo. Inkomba yendawo ekude iyisichibi se-intercondylar se-femur. Faka esikhundleni isipikili se-intramedullary ngobude obuhlukene, uhlose ukufeza ibanga phakathi kokuphela kwe-distal kwesipikili se-femoral intramedullary kanye nesichibi se-intercondylar se-femur ngaphakathi kwamadayamitha angu-1-3 esipikili se-intramedullary. Lokhu kubonisa ubude obufanele besipikili se-intramedullary.
Ngaphezu kwalokho, abalobi bachaze izici ezimbili zesithombe ezingase zibonise ukuthi uzipho olungaphakathi kwe-medullary lude kakhulu:
1. Isiphetho esikude se-nail intramedullary sifakwa engxenyeni eyi-1/3 ekude yendawo ehlangene ye-patellofemoral (ngaphakathi komugqa omhlophe esithombeni esingezansi).
2. Isiphetho esikude sesipikili sangaphakathi kwe-medullary sifakwa kunxantathu owakhiwe umugqa we-Blumensaat.
Ababhali basebenzise le ndlela ukukala ubude bezinzipho zangaphakathi kwe-medullary ezigulini ezingu-21 futhi bathola izinga lokunemba elingu-95.2%. Kodwa-ke, kungase kube nenkinga engaba khona ngale ndlela: lapho uzipho lwangaphakathi kwe-medullary lufakwa ezicutshini ezithambile, kungase kube nomphumela wokukhulisa ngesikhathi se-fluoroscopy. Lokhu kusho ukuthi ubude bangempela bezinzipho zangaphakathi kwe-medullary ezisetshenzisiwe kungadingeka bube bufushane kancane kunesilinganiso sangaphambi kokuhlinzwa. Ababhali baqaphele lesi simo ezigulini ezikhuluphele kakhulu futhi basikisela ukuthi ezigulini ezikhuluphele kakhulu, ubude bezinzipho zangaphakathi kwe-medullary kufanele bufinyezwe ngokulinganisela ngesikhathi sokulinganisa noma baqinisekise ukuthi ibanga eliphakathi kokuphela okude kwezinzipho zangaphakathi kwe-medullary kanye ne-intercondylar notch ye-femur lingaphakathi kwamadayamitha angu-2-3 ezinzipho zangaphakathi kwe-medullary.
Kwamanye amazwe, izinzipho ze-intramedullary zingapakishwa ngazinye futhi zihlanzwe kusengaphambili, kodwa ezimweni eziningi, ubude obuhlukahlukene bezinzipho ze-intramedullary buhlanganiswa ndawonye futhi buhlanzwe ndawonye ngabakhiqizi. Ngenxa yalokho, kungase kungenzeki ukuhlola ubude bezinzipho ze-intramedullary ngaphambi kokuhlanza. Kodwa-ke, le nqubo ingaqedwa ngemva kokuba amakhethini okuhlanza esefakiwe.
Isikhathi sokuthunyelwe: Ephreli-09-2024
