5 intramedullary nnadewa a wɔde di dwuma nnyinasosɛm ne oprehyɛn akwan!

Nnyinasosɛm atitiriw a ɛfa nnadewa a wɔde hyɛ nipadua no mu ho

1. Abakɔsɛm a ɛfa nnadewa a wɔde hyɛ nipadua no mu ho

Wɔ 1910 mu no, wɔde Lilienthal aluminium nnadewa a ɛwɔ medullary mu dii dwuma de saa asen mu ntini a abubu.

Wɔ 1913 mu no, Schone de dwetɛ nnadewa a ɛwɔ medullary mu dii dwuma de saa nsateaa a abubu. 

Kuntscher (1900-1972) boaa kɛse wɔ nnadewa a wɔde hyɛ ntini mu no mu. 

Na 1960 ne 1970 mfe no mu no, nnadewa a ɛwɔ medullary mu no nyaa nkɔso ntɛmntɛm. 

me man no de adi dwuma pii fi 1990 mfe no mu.

2. Open reduction ne closed reduction

1. Wobetumi ayɛ oprehyɛn atew akwaa a abubu so wɔ anisoadehu tẽẽ ase anaasɛ wɔato mu wɔ X-ray a wɔde hwɛ so.

2. Open reduction fracture healing time kyɛ kakra, mogya a ɛba wɔ oprehyɛn mu no dɔɔso, na open reduction sɛe mogya a ɛkɔ fracture awiei no bio.

3. Wɔkamfo kyerɛ sɛ wɔmfa closed reduction nni dwuma sɛnea wubetumi biara. Wobetumi de afiri a ɛtew twetwe so adi dwuma, anaasɛ wobetumi atwitwa ketewaa bi wɔ wimhyɛn a ɛma abubu no so de ahwehwɛ mu na atew so, na wɔnam saayɛ so amma mogya a ɛkɔ baabi a abubu no awiei no ntwitware so.

4. Wɔ closed reduction huammɔdi, dompe asinasin a ɛdannan anaasɛ ɛbɔ ntini a atwa ho ahyia, ne abubu asinasin akɛse a wɔatu a, wobetumi de oprehyɛn open reduction adi dwuma.

3. Fixation adwinnade a ɛfa nnadewa a ɛwɔ medullary mu

1. Ɔkwan a wɔfa so de intramedullary nnadewa mu fixation ne symmetrical mfinimfini mu splint fixation.

.

3. Central fixation yɛ nsusuwii mu korɔn sen cortical abɔnten fixation, a ebetumi atew tumi basa no so, atew valgus angulation ne emu fixation huammɔdi a ɛba no so.

4. Intramedullary nnadewa fixation ma nnyinaso ma closed reduction anaasɛ anohyeto bue reduction.

4.Mfaso a ɛwɔ nnadewa a ɛwɔ medullary mu so

1. Nsɛnnennen kakraa bi

2. Oprehyɛn ho nsɛnkyerɛnne a wɔatrɛw mu

3. Nneɛma a wɔde si hɔ pintinn

4. Ntetee a wɔde ma nkwaa dwumadi ntɛm

5. Mu duru a wɔsoa ntɛm

6. Wobetumi de adi dwuma de afrafra mu fixation afoforo

Mfitiaseɛ Ahodoɔ ne Nneɛma a Wɔde Yɛ Adwuma

1. Nnadewa a ɛwɔ medullary a ɛtow mu na ɛnyɛ nea ɛtow

2. Dynamic ne static locking intramedullary nnadewa

3. Medullary ntrɛwmu ne non-medullary fixation akwan

4. Nneɛma a wɔde si hɔ a wɔabue ne nea wɔato mu

Nneɛma a ɛka bom ne nea ɛnyɛ nea ɛka bom

Nnadewa a ɛwɔ medullary mu a ɛyɛ mmerɛw no ntumi nnyina wɔ axial no mu yiye na ahoɔden a ɛtwetwe no sua koraa, nanso ɛwɔ elasticity bi na ebetumi asan ayɛ yiye bere a asɛe akyi, na ɛma intrabone sliding kakraa bi pɛ.

Nnadewa a ɛwɔ medullary a ɛka bom no wɔ tumi a eye sen biara a ɛko tia ɛkyinkyini ne nea ɛko tia nhyɛso, ɛgyina pintinn yiye, na ɛne nnyinasosɛm a ɛne sɛ wɔde abɔde a nkwa wom hyɛ mu no hyia. Wɔde di dwuma kɛse wɔ akwaa nnompe atenten mu. Titiriw wɔ akisikuru a ɛwɔ afã horow pii ne nea wɔabubu no ho no, wotumi gyina pintinn yiye sen nnadewa a ɛwɔ ntini mu a ɛyɛ mmerɛw.

Dynamization a ɛwɔ static fixation mu

Static locking intramedullary nails mma stress masking kakraa bi pɛ na mprempren wɔkamfo kyerɛ kɛse sɛ wɔnyɛ adeyɛ a ɛnyɛ daa a ɛne dynamization.

Wɔ akisikuru a ennyaa ayaresa wɔ asram 6 kosi 8 wɔ oprehyɛn no akyi ho no, wɔtaa de nnompe a wɔde hyɛ mu wɔ beae hɔ anaasɛ wɔde dynamization si nnadewa a wɔatrɛw mu a ɛwɔ medullary mu ananmu.

Wobetumi de ahoɔden adi dwuma sɛ ɔkwan a wɔbɛfa so ahyɛ akisikuru ayaresa ho nkuran. Wɔnkamfo nkyerɛ sɛ wɔnyɛ no daa efisɛ ebetumi ama nipadua no akwaa ayɛ tiaa na ayɛ mmerɛw sɛ ɔbɛdannan ne ho.

Ntini mu ntrɛwmu ne nea ɛnyɛ ntini mu ntrɛwmu

Ntini mu ntrɛwmu betumi de nnadewa a ɛwɔ ntini mu a ne kɛse yɛ kɛse na ahoɔden kɛse ahyɛ mu, na ɛno ma ɛfata ma ntetee a wɔde yɛ adwuma ntɛm na ɛtew nnadewa a abubu no so.

Nnompe mu ntrɛwmu betumi ama nnompe mu nneɛma pii asɛe a ɛwɔ osteoinductive tumi, a ɛma nnompe a abubu no sa.

Ntini a ɛtrɛw no bɛsɛe mogya a ɛwɔ aduannuru ntini ne endosteal membrane no mu, nanso mogya ntini no betumi asan ayɛ foforo wɔ nnadewa a ɛwɔ medullary no mu no mu. Ntini a ɛtrɛw nso betumi ama mogya a ɛkɔ ntini a ɛyɛ mmerɛw a atwa ho ahyia no mu ayɛ kɛse, na ɛnam so ama akisikuru no asa.

Ntini mu ntrɛwmu ma hokwan a ɛwɔ hɔ sɛ obi benya ɔyare mmoawa ne embolism no yɛ kɛse kakra, na ɛsɛ sɛ wɔde ahwɛyiye di dwuma wɔ akisikuru a ɛda adi pefee, opira pii, ne opira a emu yɛ den ho.

Mfaso a ɛwɔ medullary ntrɛwmu so

1 Bere a medullary trɛw akyi no, baabi a ɛda intramedullary nail ne dompe no ntam no kɔ soro, na ɛma fixation no gyina pintinn. 

2 Sɛ wɔtrɛw medullary mu wie a, wobetumi de nnadewa a ɛwɔ medullary mu a ne kɛse yɛ kɛse adi dwuma, na ɛma nnadewa a ɛwɔ medullary no mu ahoɔden yɛ kɛse na ɛtew nnadewa a abubu no so. 

3 Nnompe a asɛe wɔ medullary ntrɛwmu akyi no betumi ama nnompe foforo ayɛ, a ɛma nnompe a abubu no sa yare.

Sɛ wɔde toto medullary expansion intramedullary nails ho a, nnadewa a ɛntrɛw wɔ medullary mu no wɔ mfaso horow a edidi so yi

1 Oprehyɛn bere tiaa na mogya a ɛba no sua. 

2 Mogya a ɛkɔ nipadua no mu no ntwitware pii wɔ nsɛm a ntini a ɛyɛ mmerɛw apirapira kɛse mu.

Dwumadi a wɔde di dwuma nnadewa a ɛwɔ medullary mu

Humeral interlocking intramedullary nnadewa

Nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde nnadewa a ɛwɔ ahurututu mu ayɛ

Nneɛma a ɛkyerɛ sɛ wɔde nnadewa a ɛka bom wɔ akisikuru mu wɔ akisikuru a wɔde sa akisikuru mu ne: akisikuru a ntini ne ntini a asɛe, apirakuru pii, akisikuru a entumi nnyina, akisikuru a ɛyɛ ɔyare, ne akisikuru a ɛbɛn.

Nsonsonoeɛ a wɔbɛtumi asiesie no firi 2cm wɔ humeral ti ase kɔsi 3cm wɔ olecranon fossa no atifi. Wubetumi apaw sɛ wode nnadewa a ɛwɔ akyi a ɛwɔ akyi no besiesie afi wo mmati so anaasɛ wode nnadewa a ɛkɔ akyi no besiesie afi wo nsateaa so.

Su ahorow a ɛwɔ humeral nnadewa mu

Akwan a wɔfa so de oprehyɛn si hɔ ma humeral shaft a ɛpaapae no titiriw ne plate fixation ne intramedullary nail fixation.

Mprɛte a wɔde si hɔ no wɔ tumi a emu yɛ den a ɛko tia ɛkyinkyini ne nea ɛko tia na wɔde asi hɔ denneennen, nanso oprehyɛn mu ahodwiriw no sõ, nea ebetumi aba sɛ ɔyare mmoawa no dɔɔso, na ɛnyɛ den sɛ radial nerve no sɛe.

Nnɛyi nnadewa a ɛka bom na ɛkyekyere ne ho no di sintɔ ahorow a ɛwɔ nnadewa a ɛwɔ medullary mu a ɛyɛ mpapahwekwa te sɛ axial instability, rotation control a enye, ne hia a ehia sɛ wɔde fixation foforo si hɔ no so nkonim, ma enti abubu no besi hɔ pintinn, mogya a ɛyera no sua, ntini a ɛyɛ mmerɛw a wɔayi afi hɔ no sua, na medullary no ntrɛwmu ne local bone transplantation yɛ pɛ, adesoa no bɛyɛ pɛ a wɔkyekyɛ no, callus no pue ntɛm, na wobetumi afi apɔw-mu-teɛteɛ a ɛyɛ adwuma ase wɔ oprehyɛn akyi.

Femoral interlocking intramedullary nnadewa

Nsɛnkyerɛnne a ɛkyerɛ sɛ nnadewa a ɛka bom wɔ asen mu

Abubuo ahodoɔ nyinaa 2cm wɔ trochanteric vertebra ase na ɛboro 9cm firi kotodwe nkwaa no so.

Asen no mfinimfini fã a abubu dedaw.

Ayarefo a wɔde prɛte no mu fixation a entumi nyɛ adwuma yiye.

Nneɛma a ɛwɔ nnadewa a ɛka bom wɔ asen mu no ho

Mfaso a ɛwɔ mfiridwuma mu

Ahoɔden basa a ɛwɔ asen mu nnadewa a ɛka bom a wɔde siesie akisikuru no ware sen dade mprɛte de no, na ahoɔden no kyekyɛ pɛpɛɛpɛ wɔ dompe no nyinaa mfinimfini kwan no so, a ɛnyɛ mmerɛw sɛ wɔbɛkotow na wɔasɛe no.

Nnadewa a ɛtow dompe no ano abien no nyinaa ma dompe no yɛ mũ fi soro kosi ase, na nnadewa a ɛtow wɔ dompe no mu a ɛwɔ akyirikyiri no betumi atew nnadewa a ɛwɔ dompe no mu no nsa a ɛyɛ den no so, asiw tiawa ne ɛkyinkyini ano, na ama dompe no agyina pintinn na ayɛ den kɛse ama abubuw no asisi.

Gamma Interlocking Nnadewa a Ɛwɔ Ntini Mu

Gamma nnadewa ho nsɛnkyerɛnne

Ɛfa peritrochanteric akisikuru ahorow ho, titiriw subtrochanteric akisikuru.

Gamma nnadewa a wɔatrɛw mu (nade a wɔsan yɛ) ho nsɛnkyerɛnne

subtrochanteric a ɛpaapae kɛse, trochanteric a wɔaka abom ne femoral shaft abubu.

Mfaso a ɛwɔ Gamma nnadewa so

Wɔnam asen mu skru a ɛtwetwe ne intramedullary nail mfiridwuma a wɔde ka bom so na ɛyɛɛ nnadewa titiriw no, na ɛbɛn medullary cavity no mu sen asen mprɛte a ɛyɛ nnam no, enti Gamma nnadewa no ma ɔyarefo no mu duru bɛn asen mu calcar sen asen mprɛte a ɛyɛ nnam no, na ɛma mfiri ahoɔden a ɛwɔ nea wɔde ahyɛ mu no mu no yɛ kɛse. Wɔ subtrochanteric fractures a ɛfa medial cortical comminution ho no, Gamma nnadewa no kwati hia a ehia sɛ wɔsan yɛ fracture anatomy, enti mfaso wɔ so ma intertrochanteric fractures anaa subtrochanteric fractures.

Retrograde intramedullary asen mu nnadewa a wɔde hyɛ nipadua no mu

Nneɛma a ɛkyerɛ sɛ asen mu nnadewa a ɛkɔ akyi

Wɔde di dwuma titiriw ma supracondylar femoral fractures, a supracondylar comminuted fractures ne intercondylar 'T' ne 'Y' comminuted fractures a ɛfa articular surface ho ka ho.

Wobetumi de adi dwuma nso ama asen a abubu wɔ asen no isthmus ase.

Femoral shaft, supracondylar femoral, ne intercondylar a ɛpaapae wɔ 20CM mu fi kotodwe nkwaa no mu.

Wɔn a wɔadi nkogu wɔ plate fixation mu.

Su ahorow a ɛwɔ akyi berɛmo mu nnadewa

Supracondylar femoral fracture yɛ akisikuru a emu yɛ den a ɛyɛ den sɛ nea edi kan no, ɛtew so na nea ɛto so abien no, emu fixation a emu yɛ den. Nsɛnnennen te sɛ akisikuru a ɛnyɛ nkabom ne ayaresa a ɛkyɛ ba no dɔɔso.

Retrograde interlocking intramedullary nailing yɛ ɔkwan a wɔtaa fa so sa distal femur fracture wɔ nnansa yi mfe mu, a ɛwɔ mfiridwuma mu ahoɔden pa, ebetumi adi akyi a ɛtwetwe ne rotational displacement a ɛwɔ distal end of the fracture no so yiye, na ɛboa ma nkwaa no tu ntɛm.

Wɔde supracondylar combined femoral stem fracture siesie denam supracondylar intramedullary nailing a wɔatrɛw so, na ɛno na edi ɔhaw a ɛyɛ den sɛ wobedi ho dwuma denam nnadewa a wɔde hyɛ asen no mu a ɛka bom so no ho dwuma. Adwinnade no yɛ mmerɛw sɛ wɔde bedi dwuma, ɛyɛ nea wɔde si hɔ pɛpɛɛpɛ, wotumi de ho to so wɔ sɛnea wɔde si hɔ mu, na ɔyarefo no betumi ayɛ kotodwe apɔw-mu-teɛteɛ a ɛyɛ adwuma ntɛm wɔ oprehyɛn no akyi.

Tibial interlocking nnadewa a ɛwɔ medullary mu

Nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde nnadewa bɛbɔ tibial

Akisikuru a ɛyɛ pintinn wɔ tibia no mfinimfini 1/3: akisikuru a ɛtrɛw, akisikuru ntiantiaa a ɛyɛ oblique, pseudarthrosis.

Mpaapaemu a entumi nnyina wɔ mfinimfini tibia no tenten mu 60%: mpaapaemu a ɛbɛn metaphysis, akisikuru atenten a ɛyɛ spiral, mpaapaemu a ɛwɔ afã horow, abubu a wɔabubu, abubu a nnompe mu sintɔ wɔ mu.

Su ahorow a ɛwɔ tibial nailing mu

Wɔde interlocking intramedullary nailing of tibia di dwuma kɛse ma mid tibia a ɛpaapae.

Ɛwom sɛ wobetumi de adi dwuma nso ama proximal ne distal tibia fractures de, nanso nsɛnnennen dodow no dɔɔso, malunion taa ba, abubu awiei no wɔ ≧1cm a ɛkanyan wɔ nsɛm no mu 1/2 mu, na fixation no 1/4 di nkogu.

Nhoma ahorow bɔɔ amanneɛ sɛ nea efii distal tibia fracture mu ba no ye sen proximal tibia fracture bere a wɔde fibula ahyɛ mu daa akyi.

Oprehyɛn ho akwan horow

Nnwinnade titiriw a wosiesie ansa na wɔayɛ oprehyɛn

Nnompe mpa (traction bed) anaasɛ mpa a wɔde yɛ oprehyɛn a wɔde fluoroscopic yɛ a wɔtaa de di dwuma; nea ɛtwetwe nneɛma; mfonini a ɛma mfonini no mu yɛ den.

Intramedullary nnadewa tenten a wɔpaw no yiye ma endoprostheses ansa na wɔayɛ oprehyɛn

Radiograph a wɔde twa mfonini

contralateral limb tenten susuw

Intramedullary nnadewa no kɛse

x-ray isthmus no trɛw

Intramedullary nnadewa tenten susuw

1.Translucent sodifo gyinaesi wɔ C-basa afiri ase

Ná dompe no awiei a ɛwɔ akyirikyiri ne nea ɛbɛn no wɔ ray no mfinimfini; na sodifo no ne diaphysis no di nsɛ.

2.Length susuw sɛnea nipadua no ani agyiraehyɛde te

Femur: trochanter kɛse no ano → kotodwe a ɛwɔ akyi anaasɛ patella no atifi dua; tibia: mfinimfini-afã kotodwe ahunmu → anim fã a ɛwɔ ankle nkwaa mu wɔ dorsiflexion of foot mu.

Intramedullary Nail Insertion Technique - Ɔkwan a wɔfa so hyɛn mu

Longitudinal axis a ɛwɔ medullary cavity no mu wɔ tẽẽ

Ɛnyɛ nea ɛbɛn baabi a wɔbɛhyɛn mu no dodo

Ne tenten a ɛfata: dilated - tenten; undilated - tiawa

(Wɔasi so dua wɔ ɔkwan a ɛnteɛ so wɔ baabi a wɔbɛhyɛn mu; enhia sɛ wɔtrɛw pulp mu, ɛho nhia sɛ wɔbɔ ntini a ɛyɛ mmerɛw ho ban)

Parallel femoral intramedullary nnadewa a ɛkɔ mu

Ahosiesie a wɔyɛ wɔ baabi a wɔbɛhyɛn mu ama nnadewa a ɛwɔ asen mu a ɛne ne ho di nsɛ

Hip flexion ne adduction a wɔde hyɛ nipadua no mu

Ntwitwiridii tenten a ɛbɛn trochanter kɛse no

Ɛnyɛ akyirikyiri dodo

Akwankyerɛ pin no a wɔde besisi hɔ

Ntini a ɛyɛ mmerɛw kyɛm no a wɔde besi hɔ

Retrograde femoral intramedullary nnadewa a ɛkɔ mu

30° kotodwe a wɔde bɛbɔ

Akwankyerɛ pin no axis tenten a ɛkɔ ɔkwan koro no ara so ne medullary cavity a ɛwɔ distal femoral stem no

Kirschner pin no a wɔde hyɛ distal femur no mu denam patellar ligament no so denam ahobammɔ nsateaa no so: orthogonal - mfinimfini a ɛwɔ intercondylar fossa a ɛwɔ femur no mu; lateral - Blumensaat no nkyerɛwde

PCL mfiase a enni opira

Parallel tibial intramedullary nnadewa a ɛkɔ mu

Wɔ mfinimfini kwan a ɛwɔ medullary cavity no so

Tibial plateau no anim fã

Ɛkɔ soro sɛnea ɛbɛyɛ yiye biara a ɛnsɛe asasetaw no

Nkotodwe a wɔdannan no kɛse

Ntwitwa tibial tuberosity-inferior pole of patella wɔ medullary cavity no ho

Bue medullary cavity no: akwankyerɛ pin wɔ 15° kɔ sagittal plane a ɛwɔ longitudinal axis a ɛwɔ tibial stem no so

Gyinabea a mfonini a ɛma ɛyɛ den no wɔ

Akwan a wɔfa so yɛ marrowing

Ɛlektrik ahoɔden a wɔde tew so

akisikuru a ɛyɛ foforo

Nsaano a wɔde tew so

dedaw a ɛpaapae a pseudoarthrosis, sclerosis wɔ medullary cavity mu

Tourniquet biara nni hɔ wɔ nneɛma bo a ɛkɔ soro ase

mogya a ɛkɔ nipadua no mu ne ade a eye sen biara a ɛma onwini

Akwan a wɔfa so san de si baabi foforo

Parallel femoral intramedullary nnadewa a wɔde hyɛ mu

Nea enti a ɛyɛ den sɛ wɔbɛsan de asen mu abubuw aba

Ntini a ɛyɛ mmerɛw a wɔde kyekyere ho a ɛyɛ den no mma wontumi nkɔ dompe no mu tẽẽ

Wontumi nyɛ baabi a wɔde nnade hyɛn mu no ho mfonini tẽẽ

Hip joint adduction → iliac fascia tension → akisikuru a ɛyɛ tiaa

Tibial a ɛpaapae a wɔtew so

Nneɛma a wɔde di dwuma ɔkwammɔne so

Dodow no ara wɔ honam ani na ɛnyɛ den sɛ wɔde wɔn nsa bɛka

Stabilized fracture - mfinimfini anaa akyirikyiri A ne B type fracture

Oblique fractures - a wokum no dodo

Intramedullary nailing→nnwinnade a wɔde tu kwan

Nneɛma a wɔde boa a wɔde tew nneɛma so

Nsɛntitiriw a wɔtew so forceps

tibia; percutaneous anaa kuru a wɔde di dwuma

Nneɛma akɛse a wɔde twe nneɛma (braces) .

tew a wɔkyɛ; akwaa a ɛyɛ tiaa

Bere tiaa mu Schanz nkɔnsɔnkɔnsɔn

1 Femur, asen, asen

2 Ɛbɛn baabi a abubu no sɛnea ɛbɛyɛ yiye biara

3 Proximal fracture biako cortical a wɔde di dwuma

4Fa amansan chuck a ɛwɔ T-handle di dwuma ma ɛnyɛ den sɛ wobɛfa so ayɛ adwuma

Poller nnadewa

1Metaphyseal fracture (a wɔteɛteɛ ahoɔden nhama no, ɛma sanba no gyina, ɛma oprehyɛn no san ba) .

2 distal tibia anaa femur a ɛpaapae wɔ oblique (shear stress → pressure) .

3 Nnadewa a ɛwɔ medullary mu a enni baabi pa no hyɛn medullary channel dedaw no mu bere a wɔreyɛ oprehyɛn a ɛto so abien no

4 Beae a ɛnyɛ papa a wɔde hyɛn mu, proximal fracture alignment a enye (skru a wɔde si hɔ tẽẽ ma endoplant no betumi atu) .

Tourniquet a ɛtrɛw kɛse

1 tibia a ɛwɔ nipadua no mu

2 a wɔde traction anaa retractor ka ho

3 Fa ahwɛyiye di dwuma wɔ ntini a ɛyɛ mmerɛw a wɔapirapira kɛse mu

4 Ma ɛnyɛ tiawa

5 Bara medullary ntrɛwmu wɔ inflated tebea no mu

Nail locking nnidiso nnidiso: distal afei proximal

Mfaso a ɛwɔ so

ɛnyɛ den sɛ wobɛbɔ knockback, compression of fracture breaks; ntetewmu a wobeyi afi hɔ; dwumadi ahorow a wɔtew so.

Reduction akwan a wɔfa so yɛ delayed & nonunion oprehyɛn

Ɔhaw ahorow a ebia wobehyia wɔ oprehyɛn a wɔkyɛ mu

Axial deformity (a ɛyɛ tiaa, ɛyɛ anim ne anaasɛ ɛyɛ nea ɛkɔ baabi foforo) .

Nkɔso wɔ of granulation tissue

Nnompe mu akisikuru a edi kan

Sclerosis a ɛma obi abubu no bubu bere a wɔato medullary cavity no mu no

Nnompe mu yare

Ɔhaw ahorow a ebetumi aba wɔ oprehyɛn mu

Deflection of the expander ne intramedullary nnadewa → intramedullary nnadewa a ɛkɔ cortex no mu

Angular deformity → ade a ɛtwe ade kɔ akyi

N’awiei a wɔatwa no a ɛtwetwe → Poller nnadewa, mprɛte a wɔde si hɔ

Akwan a wɔfa so siw ahoɔden nhama a ɛnteɛ ano

Proximal - a ɛteɛ a wɔde hyɛn mu

Distal - intramedullary nnadewa a ɛwɔ medullary cavity no mfinimfini

Nsɛnnennen a Ɛwɔ Intramedullary Nailing mu

★Ɔyare mmoawa

★Ntini a ɛsɛe

★Ayaresa a wɔakyinkyim wɔ akisikuru ho

★Aduruyɛ mu Akisikuru

Abɔnten so kyinhyia, torsion, valgus, mu kyinhyia, angulation

★Adjacent nkwaa mu ɛyaw

★Srade a ɛma mogya tu

★Nnompe a ɛyɛ heterotopic

★Ahurututu mu ntini a ɛma mogya tu

★Saa abubuw bio

★Thrombosis a ɛma mogya tu

★Nkwaa a ɛyɛ den

★Non-union of fracture, nnompe a ɛnyɛ nkabom

★Mfinimfini fixation huammɔdi

★Akwaa a ɛyɛ tiaa

★Afoforo

Nsɛnnennen--Ɔyare mmoawa

1.Mfiase no, na wobu akisikuru a wɔabue mu sɛ ɛyɛ nea ɛne nnadewa a wɔde hyɛ nipadua no mu no nhyia.

2.Oprehyɛn akyi ɔyare mmoawa a ɛba wɔ akisikuru a wɔabue mu no gyina sɛnea ntini a ɛyɛ mmerɛw apira ne efĩ no te so

Sɛnea ɔyare mmoawa no ba wɔ akisikuru a wɔabue mu akyi no gyina tebea a ntini a ɛyɛ mmerɛw no apira ne efĩ ne ɔkwan a wɔfa so di ntini a ɛyɛ mmerɛw no ho dwuma so.

3.Thinner intramedullary nnadewa ma hokwan a ɛwɔ hɔ sɛ wobenya ɔyare mmoawa no yɛ kɛse; non-expanded locking intramedullary nails fixation nyɛ papa koraa, na nnompe no ano wɔ

Nnadewa a wɔde hyɛ mu a ɛnyɛ nea wɔatrɛw mu a wɔde hyɛ mu no nyɛ papa koraa, na dompe no awiei a abubu no a wɔde hwɛ ade ketewaa bi na ɛkeka ne ho nso wɔ dompe a aka no mu, a ɛnyɛ den sɛ mmoawa nyin.

4. Ɛnyɛ sɛ expanded ne limited expanded medullary fixation a wɔde di dwuma no ma abubuw no gyina pintinn nko, na mmom ɛkwati sɛ wɔbɛbɔ baabi a awu nso.

Fat Embolism Syndrome a Ɛyɛ Fɛ a Ɛyɛ Fɛ

1.FES a ɛba wɔ nnompe atenten a ɛpaapae mu no yɛ 0.5% kosi 2%.

2. Medulla no ntrɛwmu ne medulla no a ɛntrɛw no nni nkɛntɛnso kɛse biara wɔ ahurututu mu mframa a ɛkɔ mu no so.

3.When trɛw medulla, ɛsɛ sɛ ɔkwan no yɛ brɛoo kneading, kwati ahoɔden pii ne rough adwumayɛ.

4.mprempren FES a wohu no da so ara gye gyinapɛn a Gurd de too gua wɔ 1974 mu no tom, na ayaresa a wɔde ma wɔ bere a wɔahu akyi no bɛkyɛ bere a eye sen biara a wɔde bɛsa yare no na ebetumi de nea emu yɛ den aba.

Nnompe a abubu a ɛkyɛ ne nnompe a ɛnyɛ biako

Nneɛma ahorow ka sɛnea akisikuru no sa yare bere a wɔde nnadewa a ɛwɔ medullary no mu awie no, na wobetumi ahwehwɛ nea ɛde ba no mu sɛnea edidi so yi.

1.soft tissue embedded wɔ abubuw awiei

2. Ntetewmu a ɛwɔ transverse fracture awiei

3. Mfe a ɔyarefo no adi anyin

4. Open fracture, soft tissue opira kɛse, mpɔtam hɔ hemodialysis a emu yɛ den anaa ɔyare mmoawa.

5. Intramedullary nnadewa a wɔmfa nsi hɔ yiye

6. Asikreyare anaa nyarewa afoforo a wɔde di dwuma a wɔaka abom.

Aduruyɛ mu Akisikuru

Aduruyɛ mu akisikuru titiriw yɛ akisikuru a ɛto so abien a ɛnam nsakrae a ɛmfata a wɔde di dwuma bere a wɔde nnadewa a ɛwɔ medullary mu no si hɔ nti.

Ɛsɛ sɛ wɔde adwene si so wɔ oprehyɛn no mu

1. Sɛ wɔanpaw baabi a nnadewa no hyɛn mu no yiye a, ebetumi ama nnadewa no abubu.

2. Mfa ahoɔden npia medulla no ntrɛwmu no mu.

3. Ɛsɛ sɛ ɔkwan a wɔfa so kɔ pulp ntrɛwmu no mu no kɔ ɔkwan koro no ara so sɛnea wɔde nnadewa bɛhyɛ mu no.

4. Mfa ahoɔden nni dwuma bere a wode nnadewa a ɛwɔ medullary mu rehyɛ akyirikyiri awiei no.

Ɛyaw a ɛba nkwaa a ɛbemmɛn hɔ no mu

1. Sɛ wɔde nnadewa a ɛwɔ medullary mu si a, ɛfa ntini a ɛyɛ mmerɛw ne nkwaa no mu aduru mpo a anyɛ yiye koraa no ɛbɛn nkwaa 1 ho.

2. Tibial plateau no nam transverse knee ligament no so bata medial meniscus no anim ano na ɛyɛ beae a ahobammɔ wɔ wɔ tibial tuberosity no atifi kosi saa beae yi. Sɛ nnadewa no bɛn soro dodo anaasɛ nnadewa a ɛwɔ ntini no mu no ntwemu yɛ kɛse dodo a, ebetumi asɛe ntini a ɛwɔ ntini no mu no, na ɛde kotodwe mu yaw aba oprehyɛn akyi.

3. Nnadewa a ɛwɔ medullary mu a ɛbɛn a ɛbɛpue ne heterotopic ossification ne nneɛma atitiriw a ɛde asen mu yaw ba bere a wɔayɛ nnadewa a ɛwɔ asen mu oprehyɛn akyi.

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