I-Intramedullary nailingiyindlela evame ukusetshenziswa yokulungisa amathambo yangaphakathi eyaqala ngeminyaka yawo-1940s. Isetshenziswa kabanzi ekwelapheni ukuphuka kwamathambo amade, okungezona izinyunyana, nokunye ukulimala okuhlobene. Le nqubo ihlanganisa ukufaka isikhonkwane esingaphakathi kwe-intramedullary kumsele omaphakathi wethambo ukuze kuzinziswe indawo yokuphuka. Ngamagama alula, isikhonkwane se-intramedullary isakhiwo eside esineziningiisikulufu sokukhiyaizimbobo kuzo zombili iziphetho, ezisetshenziselwa ukulungisa iziphetho eziseduze nezikude zokuphuka. Ngokuya ngesakhiwo sazo, izipikili ze-intramedullary zingahlukaniswa njengeziqinile, i-tubular, noma i-open-section, futhi zisetshenziselwa ukwelapha izinhlobo ezahlukene zeziguli. Isibonelo, izinzipho eziqinile ze-intramedullary zikwazi ukumelana kangcono nokutheleleka ngenxa yokuntuleka kwendawo efile yangaphakathi.
Yiziphi izinhlobo zokuphuka ezifanele izipikili ze-intramedullary?
I-Intramedullary nailisitshalo esifanelekile sokwelapha ukuphuka kwe-diaphyseal, ikakhulukazi ku-femur kanye ne-tibia. Ngokusebenzisa amasu okuhlasela kancane, isipikili se-intramedullary singanikeza ukuzinza okuhle kuyilapho sinciphisa ukulimala kwezicubu ezithambile endaweni yokuphuka.
Ukuncishiswa okuvaliwe kanye nokuhlinzwa kokulungiswa kwezipikili ze-intramedullary kunezinzuzo ezilandelayo:
Ukwehliswa okuvaliwe kanye nokubethelwa kwe-intramedullary (CRIN) kunezinzuzo zokugwema ukusika indawo yokuphuka kanye nokunciphisa ingozi yokutheleleka. Nge-incision encane, igwema ukuhlukaniswa kwezicubu ezithambile eziningi kanye nokulimala kokunikezwa kwegazi endaweni yokuphuka, ngaleyo ndlela kuthuthukisa izinga lokuphulukisa lokuphuka. Ngezinhlobo ezithile zei-proximal bone fractures, i-CRIN inganikeza ukuzinza okwanele kokuqala, okuvumela iziguli ukuba ziqale ukunyakaza okuhlangene kusenesikhathi; futhi kunenzuzo eyengeziwe mayelana nokuthwala ukucindezeleka kwe-axial uma kuqhathaniswa nezinye izindlela zokulungiswa kwe-eccentric ngokuya nge-biomechanics. Kungavimbela kangcono ukuxegiswa kokulungiswa kwangaphakathi ngemva kokuhlinzwa ngokwandisa indawo yokuxhumana phakathi kokufakelwa kanye nethambo, okuyenza ifaneleke kakhulu iziguli ezine-osteoporosis.
Kusetshenziswa ku-tibia:
Njengoba kuboniswe emfanekisweni, inqubo yokuhlinzwa ihilela ukwenza ukusika okuncane okungama-3-5 cm ngaphezu kwe-tubercle ye-tibial, nokufaka izikrini zokukhiya ezingu-2-3 ngokusebenzisa i-incision engaphansi kuka-1 cm emikhawulweni eseduze ne-distal yomlenze ophansi. Uma kuqhathaniswa nokuncishiswa okuvulekile okungokwesiko kanye nokulungiswa kwangaphakathi ngepuleti lensimbi, lokhu kungabizwa ngokuthi indlela yokuhlasela kancane ngempela.
Kusetshenziswa ku-femur:
1. Umsebenzi wokuxhuma we-femoral locked intramedullary nail:
Isho ikhono layo lokumelana nokuphenduka ngendlela yokukhiya ye-intramedullary nail.
2.Ukuhlukaniswa kwe-nail ekhiyiwe ye-intramedullary:
Ngokuphathelene nomsebenzi: isipikili se-intramedullary esikhiyiwe esijwayelekile kanye nokwakhiwa kabusha kukhiyiwe isipikili se-intramedullary; ikakhulukazi kunqunywa ukudluliselwa kokucindezeleka kusukela ekuhlanganyeleni kwe-hip kuya edolweni, nokuthi ngabe izingxenye ezingenhla neziphansi phakathi kwama-rotator (ngaphakathi kwe-5cm) zizinzile. Uma ingazinzile, ukwakhiwa kabusha kokudluliselwa kokucindezeleka kwe-hip kuyadingeka.
Ngokuphathelene nobude: izinhlobo ezimfushane, ezisondelene, nezinwetshiwe, ikakhulukazi ezikhethwa ngokusekelwe ekuphakameni kwendawo yokuphuka lapho kukhethwa ubude be-intramedullary nail.
2.1 Uzipho olujwayelekile oluhlanganayo lwe-intramedullary
Umsebenzi oyinhloko: ukuzinza kwe-axial stress.
Izinkomba: Ukuphuka kwe-femoral shaft (akusebenzi ekuqhekekeni kwe-subtrochanteric)
2.2 Ukwakhiwa kabusha kwezipikili ze-intramedullary
Umsebenzi oyinhloko: Ukudluliselwa kokucindezeleka kusukela ku-hip kuya ku-femoral shaft akuzinzile, futhi ukuzinza kokudluliselwa kwengcindezi kule ngxenye kudinga ukwakhiwa kabusha.
Izinkomba: 1. I-Subtrochanteric fractures; 2. Ukuphuka kwentamo yesifazane kuhlanganiswe nokuphuka kwe-femoral shaft ohlangothini olufanayo (ukuphuka kwezinhlangothi zombili ohlangothini olufanayo).
I-PFNA iphinde ibe uhlobo lwe-nail ye-intramedullary yokwakhiwa kabusha!
2.3 Indlela yokukhiya i-distal yezipikili ze-intramedullary
Indlela yokukhiya i-distal yezinzipho ze-intramedullary iyahlukahluka kuye ngomkhiqizi. Ngokuvamile, isikulufu sokukhiya esisodwa esimile sisetshenziselwa izinzipho eziseduze ze-femoral intramedullary, kodwa ngokuphuka kwe-femoral shaft noma izipikili ezinwetshiwe ze-intramedullary, izikulufu zokukhiya ezimile ezimbili noma ezintathu ezinokukhiya okuguquguqukayo zivame ukusetshenziswa ukuze kuthuthukiswe ukuzinza okujikelezayo. Zombili izipikili ze-intramedullary ezinwetshiwe ze-femoral kanye ne-tibial zihlanganiswe nezikulufa zokukhiya ezimbili.
Isikhathi sokuthumela: Mar-29-2023
