Indlela yokulungisa yangaphakathi ye-PFNA
I-PFNA (I-Proximal Femoral Nail Antirotation), i-proximal femoral anti-rotation intramedullary nail.Ifanele izinhlobo ezihlukahlukene ze-femoral intertrochanteric fractures;ama-subtrochanteric fractures;femoral intamo base fractures;ukuphuka kwentamo yesifazane kuhlanganiswe nokuphulwa kwe-femoral shaft;i-femoral intertrochanteric fractures ehlanganiswe nokuphuka kwe-femoral shaft.
Izici eziyinhloko zokuklama izinzipho kanye nezinzuzo
(1) Umklamo omkhulu wezinzipho uboniswe amacala angaphezu kuka-200,000 we-PFNA, futhi uzuze ukufana okuhle kakhulu ne-anatomy ye-medullary canal;
(2) I-engeli yokuthumba eyi-6-degree yesipikili esikhulu ukuze ifakwe kalula ukusuka phezulu kwe-trochanter enkulu;
(3) Isipikili esingenalutho, kulula ukusifaka;
(4) I-distal end ye-nail eyinhloko inokunwebeka okuthile, okulula ukufaka isikhonkwane esiyinhloko futhi igweme ukugxila kokucindezeleka.
I-Spiral blade:
(1) Ukulungiswa kwangaphakathi okukodwa kanyekanye kuqeda ukulwa nokujikeleza nokuqiniswa kwe-angular;
(2) I-blade inendawo enkulu kanye nobubanzi obuphakathi obukhula kancane kancane.Ngokushayela futhi ucindezele ithambo elikhansela, amandla okubambelela we-helical blade angathuthukiswa, okulungele ikakhulukazi iziguli ezinezithombo ezixekethile;
(3) I-helical blade ihlanganiswe ngokuqinile nethambo, okuthuthukisa ukuzinza futhi imelana nokujikeleza.Ukuphela kokuphuka kunamandla aqinile okuwa kanye nokukhubazeka kwe-varus ngemva kokumuncwa.
Amaphuzu alandelayo kufanele anakwe ekwelapheni ukuphuka kwezinsikazi ngePFNA ukulungiswa kwangaphakathi:
(1) Iziguli eziningi esezikhulile zihlushwa izifo eziyisisekelo zezokwelapha futhi azikubekezeleli ukuhlinzwa.Ngaphambi kokuhlinzwa, isimo esijwayelekile sesiguli kufanele sihlolwe ngokuphelele.Uma isiguli singakwazi ukubekezelela ukuhlinzwa, ukuhlinzwa kufanele kwenziwe ngokushesha ngangokunokwenzeka, futhi isitho esithintekile kufanele sisetshenziswe ngokushesha ngemva kokuhlinzwa.Ukuvimbela noma ukunciphisa ukuvela kwezinkinga ezihlukahlukene;
(2) Ububanzi bomgodi we-medullary kufanele bulinganiswe kusenesikhathi ngaphambi kokuhlinzwa.Ububanzi be-nail eyinhloko ye-intramedullary yi-1-2 mm encane kune-cavity ye-medullary yangempela, futhi ayifanele ukubekwa okunobudlova ukuze kugwenywe ukuvela kwezinkinga ezifana nokuhlukana kwe-distal femur;
(3) Isiguli siphezulu, isitho esithintekile siqondile, futhi ukujikeleza kwangaphakathi kungu-15 °, okulungele ukufakwa kwenaliti yomhlahlandlela kanye nesipikili esikhulu.Ukudonsa okwanele nokunciphisa okuvaliwe kokuphuka ngaphansi kwe-fluoroscopy yizihluthulelo zokuhlinzwa okuphumelelayo;
(4) Ukusebenza okungalungile kwendawo yokungena yenaliti yomhlahlandlela wesikulufu esikhulu kungase kubangele isikulufu esikhulu se-PFNA ukuthi sivinjwe kumgodi we-medullary noma indawo ye-spiral blade ibe eccentric, okungabangela ukuchezuka kokunciphisa ukuphuka noma ukugunda ingcindezi. intamo yesifazane kanye nekhanda lesifazane nge-spiral blade ngemva kokuhlinzwa, ukunciphisa umphumela wokuhlinzwa;
(5) Umshini we-X-ray we-C-arm kufanele ngaso sonke isikhathi unake ukujula nokugqama kwenaliti yomhlahlandlela we-screw blade lapho ugoqa, futhi ukushona kwekhanda le-screw blade kufanele kube 5-10 mm ngaphansi kwendawo yoqwanga ikhanda lesifazane;
(6) Ngokuhlukana kwe-subtrochanteric ehlanganisiwe noma izingcezu ezinde ze-oblique fracture, kunconywa ukusebenzisa i-PFNA enwetshiwe, futhi isidingo sokunciphisa okuvulekile sincike ekunciphiseni ukuphuka nokuzinza ngemva kokunciphisa.Uma kunesidingo, ikhebula lensimbi lingasetshenziswa ukubopha ibhulokhi yokuphuka, kodwa izothinta ukuphulukiswa kwe-fracture futhi kufanele igwenywe;
(7) Ukuze uthole ukuhlukana okuhlukanisiwe phezulu kwe-trochanter enkulu, ukusebenza kufanele kube mnene ngangokunokwenzeka ukuze kugwenywe ukuhlukana okuqhubekayo kwezingcezu zokuphuka.
Izinzuzo kanye nemikhawulo ye-PFNA
Njengohlobo olusha lweidivayisi yokulungiswa kwe-intramedullary, i-PFNA ingadlulisela umthwalo ngokusebenzisa i-extrusion, ukuze izinhlangothi zangaphakathi nangaphandle ze-femur zikwazi ukuthwala ukucindezeleka okufanayo, ngaleyo ndlela kufezeke injongo yokuthuthukisa ukuzinza nokusebenza kahle kokulungiswa kwangaphakathi kwama-fractures.Umphumela omisiwe muhle njalo njalo.
Ukusetshenziswa kwe-PFNA nakho kunemikhawulo ethile, njengobunzima bokubeka isikulufu sokukhiya esikude, ingozi eyengeziwe yokuphuka eduze kwesikulufu sokukhiya, ukukhubazeka kwe-coxa varus, nobuhlungu endaweni yangaphambili yethanga okubangelwa ukucasuka kwebhande le-aliotibial.I-Osteoporosis, kanjaloukulungiswa kwe-intramedullarykuvame ukuba nokwenzeka kokwehluleka ukulungisa kanye nokuphulwa kwe-fracture nonnunion.
Ngakho-ke, ezigulini esezikhulile ezine-intertrochanteric fractures engazinzile ezine-osteoporosis enzima, ukuthwala isisindo sokuqala akuvunyelwe ngokuphelele ngemva kokuthatha i-PFNA.
Isikhathi sokuthumela: Sep-30-2022
