Indaba yokukhetha ubukhulu bezipikili ze-intramedullary zamathambo ama-tubular amade wemilenze engezansi.

I-Intramedullary nailing indinganiso yegolide yokwelashwa kokuhlinzwa kokuphuka kwe-diaphyseal kwamathambo amade amashubhu ezithweni ezingezansi. Inikeza izinzuzo ezifana nokuhlukumezeka okuncane kokuhlinzwa namandla aphezulu e-biomechanical, okwenza kusetshenziswe kakhulu ekuqhekekeni kwe-tibial, femoral, kanye ne-humeral shaft. Ngokomtholampilo, ukukhethwa kobubanzi bezinzipho ze-intramedullary ngokuvamile kuthanda uzipho olukhulu kakhulu olungafakwa ngokuvuselelwa kabusha okulingene, ukuze kuqinisekiswe ukuzinza okukhulu. Kodwa-ke, kungakhathaliseki ukuthi ubukhulu be-nail ye-intramedullary buthinta ngokuqondile ukubikezelwa kwe-fracture kuhlala kungacacile.

Esihlokweni esandulele, sixoxe ngocwaningo oluhlola umthelela we-intramedullary nail ububanzi ekuphulukiseni amathambo ezigulini ezingaphezu kwe-50 ezine-intertrochanteric fractures. Imiphumela ayizange ibonise umehluko wezibalo kumazinga okuphulukiswa kokuphuka kanye namazinga okusebenza kabusha phakathi kweqembu elingu-10mm neqembu elinezinzipho eziwugqinsi kuno-10mm.

Iphepha elashicilelwa ngo-2022 yizazi zaseSifundazweni saseTaiwan nalo lafinyelela esiphethweni esifanayo:

Ucwaningo olubandakanya iziguli ezingama-257, ezalungiswa ngezinzipho ze-intramedullary ezinobubanzi obungu-10mm, 11mm, 12mm, no-13mm, lwahlukanisa iziguli ngamaqembu amane ngokusekelwe kububanzi bezinzipho. Kutholakale ukuthi awukho umehluko wezibalo emazingeni okuphulukisa ukuphuka phakathi kwamaqembu amane.

Ngakho-ke, ingabe lokhu kubuye kube yi-tibial shaft fractures elula?

Ocwaningweni olulindelekile lokulawula amacala olubandakanya iziguli ezingama-60, abacwaningi bahlukanise iziguli ezingama-60 ngokulinganayo zaba ngamaqembu amabili angama-30 lilinye. Iqembu A lalungiswa ngezinzipho ezincane ze-intramedullary (9mm kwabesifazane no-10mm kwabesilisa), kuyilapho iQembu B lalungiswa ngezinzipho eziwugqinsi ze-intramedullary (11mm kwabesifazane no-12mm kwabesilisa):

Imiphumela yabonisa ukuthi kwakungekho umehluko ophawulekayo emiphumeleni yomtholampilo noma izithombe phakathi kwezinzipho ezincane neziwugqinsi ze-intramedullary. Ukwengeza, izinzipho ezincane ze-intramedullary zazihlotshaniswa nezikhathi ezimfushane zokuhlinzwa kanye ne-fluoroscopy. Kungakhathaliseki ukuthi kusetshenziswe isikhonkwane esiwugqinsi noma esincane, ukuphinda kwenziwe kabusha okusesilinganisweni kwenziwa ngaphambi kokufakwa kwezinzipho. Abalobi basikisela ukuthi ukuze kube lula ukuphuka kwe-tibial shaft, izipikili ze-intramedullary ezinobubanzi obuncane zingasetshenziselwa ukulungiswa.