Ukuqhekeka kwesifunda se-intertrochanteric ye-akhawunti ye-femur ye-50% ye-hip fractures futhi uhlobo oluvame kakhulu lokuphuka ezigulini esezikhulile.Ukulungiswa kwe-Intramedullary nail kuyindinganiso yegolide yokwelashwa kokuhlinzwa kokuphuka kwe-intertrochanteric.Kukhona ukuvumelana phakathi kodokotela abahlinzayo bamathambo ukuze bagweme "umphumela omfushane" ngokusebenzisa izipikili ezinde noma ezimfushane, kodwa okwamanje akukho ukuvumelana ekukhetheni phakathi kwezipikili ezinde nezifushane.
Ngokombono, izipikili ezimfushane zinganciphisa isikhathi sokuhlinzwa, zinciphise ukulahlekelwa igazi, futhi zigweme ukubuyisela kabusha, kuyilapho izipikili ezinde zinikeza ukuzinza okungcono.Phakathi nenqubo yokufaka izinzipho, indlela evamile yokulinganisa ubude bezinzipho ezinde ukukala ukujula kwephinikhodi yomhlahlandlela efakiwe.Kodwa-ke, le ndlela ngokuvamile ayinembile kakhulu, futhi uma kukhona ukuchezuka kobude, ukufaka esikhundleni sozipho lwe-intramedullary kungaholela ekulahlekelweni okukhulu kwegazi, ukwandisa ukuhlukumezeka kokuhlinzwa, nokwandisa isikhathi sokuhlinzwa.Ngakho-ke, uma ubude obudingekayo be-intramedullary nail bungahlolwa ngaphambi kokuhlinzwa, umgomo wokufakwa kwezipikili ungafinyelelwa ngomzamo owodwa, ugweme izingozi ze-intraoperative.
Ukuze kubhekwane nale nselele yomtholampilo, izazi zakwamanye amazwe zisebenzise ibhokisi lokupakisha lezinzipho (Ibhokisi) ukuhlola ngaphambi kokuhlinzwa ubude bezipikili ze-intramedullary ngaphansi kwe-fluoroscopy, ebizwa ngokuthi "isu lebhokisi".Umphumela wesicelo somtholampilo muhle, njengoba kwabelwane ngawo ngezansi:
Okokuqala, beka isiguli embhedeni wokudonsa futhi wenze ukunciphisa okuvaliwe okujwayelekile ngaphansi kokudonsa.Ngemva kokuzuza ukuncishiswa okugculisayo, thatha isipikili se-intramedullary esingavulwa (kuhlanganise nebhokisi lokupakisha) bese ubeka ibhokisi lokupakisha ngaphezu kwefemur yesitho esithintekile:
Ngosizo lomshini we-C-arm fluoroscopy, ireferensi yesimo esiseduze iwukuqondisa isiphetho esiseduze sesipikili se-intramedullary ne-cortex ngaphezu kwentamo yesifazane bese usibeka ekubonisweni kwendawo yokungena ye-intramedullary nail.
Uma isikhundla esiseduze sesanelisayo, gcina indawo eseduze, bese ucindezela i-C-arm ngasekugcineni okukude futhi wenze i-fluoroscopy ukuze uthole umbono wangempela we-lateral we-joint joint.Ireferensi yendawo ekude iyinothi ye-intercondylar ye-femur.Faka esikhundleni isikhonkwane se-intramedullary ngobude obuhlukene, uhlose ukuzuza ibanga phakathi kokuphela kwe-distal ye-femoral intramedullary nail kanye ne-intercondylar notch ye-femur ngaphakathi kwamadiamitha angu-1-3 we-intramedullary nail.Lokhu kubonisa ubude obufanelekile bezipho ze-intramedullary.
Ngaphezu kwalokho, ababhali bachaze izici ezimbili ze-imaging ezingase zibonise ukuthi i-intramedullary nail yinde kakhulu:
1. Isiphetho esikude se-intramedullary nail sifakwe engxenyeni ekude ye-1/3 yendawo ehlangene ye-patellofemoral (ngaphakathi komugqa omhlophe esithombeni esingezansi).
2. Ukuphela kwe-distal ye-intramedullary nail ifakwe kunxantathu owenziwe umugqa we-Blumensaat.
Ababhali basebenzise le ndlela ukukala ubude bezinzipho ze-intramedullary ezigulini ezingama-21 futhi bathola izinga lokunemba lika-95.2%.Kodwa-ke, kungase kube nenkinga engase ibe khona ngale ndlela: lapho isipikili se-intramedullary sifakwa esicutshini esithambile, kungase kube nomphumela wokukhulisa ngesikhathi se-fluoroscopy.Lokhu kusho ukuthi ubude bangempela bezipikili ze-intramedullary ezisetshenzisiwe kungase kudingeke bube bufushane kunokulinganisa kwangaphambilini.Ababhali baqaphele lesi simo ezigulini ezikhuluphele futhi baphakamisa ukuthi ezigulini ezikhuluphele kakhulu, ubude be-nail ye-intramedullary kufanele bufinyezwe ngokulinganayo ngesikhathi sokulinganisa noma kuqinisekiswe ukuthi ibanga eliphakathi kokuphela kokuphela kwe-intramedullary nail kanye ne-intercondylar notch ye-femur ingaphakathi. 2-3 ububanzi be-intramedullary nail.
Kwamanye amazwe, izinzipho ze-intramedullary zingase zipakishwe ngazinye futhi zifakwe inzalo ngaphambili, kodwa ezimweni eziningi, ubude obuhlukahlukene bezinzipho ze-intramedullary buyaxutshwa ndawonye futhi buvalwe inzalo ngokuhlangene ngabakhiqizi.Ngenxa yalokho, kungase kungenzeki ukuhlola ubude besipikili se-intramedullary ngaphambi kokuvala inzalo.Kodwa-ke, le nqubo ingaqedwa ngemva kokufakwa kwe-sterilization drapes.
Isikhathi sokuthumela: Apr-09-2024
