Ukubethela nge-intramedullarykuyindlela yokubopha yangaphakathi yamathambo esetshenziswa kakhulu kusukela ngawo-1940. Isetshenziswa kabanzi ekwelapheni ukuphuka kwamathambo amade, ukungahlangani, kanye nokunye ukulimala okuhlobene. Le ndlela ihilela ukufaka isipikili sangaphakathi emseleni ophakathi wethambo ukuze kuzinziswe indawo yokuphuka. Ngamazwi alula, isipikili sangaphakathi sisakhiwo eside esinezinto eziningiisikulufu sokukhiyaIzimbobo kuzo zombili izinhlangothi, ezisetshenziselwa ukulungisa izinhlangothi eziseduze nezikude zokuphuka. Kuye ngesakhiwo sazo, izinzipho zangaphakathi kwe-medullary zingahlukaniswa njengezingxenye eziqinile, ezishubhu, noma ezivulekile, futhi zisetshenziselwa ukwelapha izinhlobo ezahlukene zeziguli. Isibonelo, izinzipho zangaphakathi kwe-medullary eziqinile zinokumelana okungcono nokutheleleka ngenxa yokuntuleka kwesikhala sangaphakathi esifile.
Yiziphi izinhlobo zokuphuka ezifanelekela izinzipho zangaphakathi kwe-medullary?
Uzipho lwe-intramedullaryiyindlela efanelekile yokwelapha ukwaphuka kwe-diaphyseal, ikakhulukazi ku-femur kanye ne-tibia. Ngokusebenzisa amasu angangenisi kakhulu, izinzipho ze-intramedullary zinganikeza ukuzinza okuhle ngenkathi kunciphisa ukulimala kwezicubu ezithambile endaweni yokuqhekeka.
Ukuhlinzwa kokunciphisa okuvaliwe kanye nokulungisa izinzipho ngaphakathi kwe-medullary kunezinzuzo ezilandelayo:
Ukunciphisa okuvaliwe kanye nokuhlaba izinzipho ngaphakathi kwe-medullary (i-CRIN) kunezinzuzo zokugwema ukusikwa kwendawo yokuqhekeka nokunciphisa ingozi yokutheleleka. Ngokusikwa okuncane, kugwema ukuqhekeka okukhulu kwezicubu ezithambile kanye nomonakalo ekuhlinzekweni kwegazi endaweni yokuqhekeka, ngaleyo ndlela kuthuthukiswe izinga lokuphulukiswa kokuqhekeka. Ngezinhlobo ezithile zeukuphuka kwamathambo aseduze, i-CRIN inganikeza ukuzinza okwanele kokuqala, okuvumela iziguli ukuthi ziqale ukunyakaza kwamalunga kusenesikhathi; futhi kunenzuzo enkulu maqondana nokuthwala ukucindezeleka kwe-axial uma kuqhathaniswa nezinye izindlela zokubopha ezingavamile maqondana ne-biomechanics. Kungavimbela kangcono ukukhululeka kokubopha kwangaphakathi ngemva kokuhlinzwa ngokwandisa indawo yokuxhumana phakathi kwe-implant nethambo, okwenza ifaneleke kakhulu iziguli ezine-osteoporosis.
Kusetshenziswa ku-tibia:
Njengoba kuboniswe esithombeni, inqubo yokuhlinzwa ihilela ukwenza ukusika okuncane okungu-3-5 cm kuphela ngaphezu kwe-tibial tubercle, nokufaka izikulufo ezikhiyayo ezingu-2-3 ngokusebenzisa ukusika okungaphansi kwe-1 cm emaphethelweni aseduze nakude omlenze ongezansi. Uma kuqhathaniswa nokunciphisa okuvulekile kwendabuko kanye nokufakwa kwangaphakathi ngepuleti lensimbi, lokhu kungabizwa ngokuthi inqubo engeyinhle kangako.
Kusetshenziswa ku-femur:
1. Umsebenzi wokuxhumanisa we-femoral locked intramedullary nail:
Ibhekisela ekhonweni layo lokumelana nokujikeleza ngokusebenzisa indlela yokukhiya ye-intramedullary nail.
2. Ukuhlukaniswa kwezinzipho zangaphakathi ezikhiyiwe:
Ngokuphathelene nomsebenzi: uzipho olujwayelekile oluvalekile ngaphakathi kwe-medullary kanye nokwakhiwa kabusha kozipho oluvalekile ngaphakathi kwe-medullary; ikakhulukazi kunqunywa ukudluliselwa kokucindezeleka kusuka esihlanganyelweni sesinqe kuya esihlanganyelweni sedolo, kanye nokuthi izingxenye eziphezulu nezingezansi phakathi kwama-rotator (ngaphakathi kwama-5cm) zizinzile yini. Uma zingazinzile, ukwakhiwa kabusha kokudluliselwa kokucindezeleka kwesinqe kuyadingeka.
Ngokuphathelene nobude: izinhlobo ezimfushane, eziseduze, kanye nezinde, ezikhethwa kakhulu ngokusekelwe ekuphakameni kwendawo yokuqhekeka lapho kukhethwa ubude bezinzipho zangaphakathi.
2.1 Izipikili ezijwayelekile ezixhumene ngaphakathi kwe-medullary
Umsebenzi oyinhloko: ukuzinza kokucindezeleka kwe-axial.
Izinkomba: Ukuphuka komgodi we-femoral (akusebenzi ekuqhekekeni kwe-subtrochanteric)
2.2 Ukwakhiwa kabusha kwezipikili zangaphakathi ezixhumeneyo
Umsebenzi oyinhloko: Ukudluliselwa kokucindezeleka kusuka esinqeni kuya emshaftini we-femoral akuzinzile, futhi ukuzinza kokudluliselwa kokucindezeleka kulesi sigaba kudinga ukwakhiwa kabusha.
Izinkomba: 1. Ukuphuka kwentamo ye-femoral okuhlanganiswe nokuphuka kwe-femoral shaft ohlangothini olufanayo (ukuphuka kwezinhlangothi zombili ohlangothini olufanayo).
I-PFNA futhi uhlobo lwezipikili zangaphakathi ezisebenza kabusha!
2.3 Indlela yokukhiya ekude yezinzipho zangaphakathi kwe-medullary
Indlela yokukhiya ekude yezinzipho ze-intramedullary iyahlukahluka kuye ngomkhiqizi. Ngokuvamile, isikulufu esisodwa sokukhiya esingaguquki sisetshenziselwa izinzipho ze-proximal femoral intramedullary, kodwa ezinkingeni zokuphuka kwe-femoral shaft noma ezinzingweni ze-intramedullary ezinde, izikulufu ezimbili noma ezintathu zokukhiya ezingaguquki ezine-dynamic locking zivame ukusetshenziswa ukuthuthukisa ukuzinza kokujikeleza. Zombili izinzipho ze-femoral neze-tibial ezinde ziqiniswe ngezikulufo ezimbili zokukhiya.
Isikhathi sokuthunyelwe: Mashi-29-2023
