Femoral Intramedullary Nailing - Ɔkwan bɛn so na wobɛpaw baabi a eye sen biara a wɔde hyɛ mu?

Nnianimu

Yebetumi ahu sɛnea asen mu akisikuru ayaresa no nyaa nkɔso fi 1940 mfe no mu bere a Kuntscher de nnadewa a wɔde to asen mu a wɔatoto mu bae no. Nnadewa a ɛwɔ asen mu (IMN) a wɔde di dwuma wɔ asen mu akisikuru mu no abɛyɛ ɔhwɛ gyinapɛn wɔ mfe du du kakraa a atwam no mu, ne mprempren nkɔso a aba wɔ nnadewa a wɔde hyɛ asen mu ne nkɔso a aba wɔ oprehyɛn akwan mu no ama wɔde nnadewa a wɔde hyɛ asen no mu a wɔde di dwuma no akɔ soro kɛse.

Wɔde aduru a wɔde sa asen ntini a abubu no di dwuma wɔ ayarefo kakraa bi pɛ mu a wɔkasa tia nnuru a wɔde kum nipadua no ne oprehyɛn titiriw, na ayaresa titiriw da so ara yɛ oprehyɛn a wɔde si hɔ. Ɛdefa oprehyɛn a wɔde sa saa akisikuru yi ho no, akwan horow pii wɔ hɔ a wobetumi afa so, a nea ɛka ho ne nnadewa a wɔde bɛhyɛ medullary mu, plate screw a wɔde bɛhyɛ mu, ne abɔnten a wɔde hyɛ mu. Sɛ wɔde toto oprehyɛn afoforo a wobetumi apaw ho a, nnadewa a wɔde hyɛ nipadua no mu ne ɔkwan a nsɛnnennen no sua sen biara na ɛma akisikuru no sa yare kɛse, na wɔde redi dwuma kɛse wɔ ayaresabea adwumayɛ mu.

Ntease pa a wobenya wɔ asen a ɛbɛn no nipadua, mogya a ɛkɔ asen no ti ne asen mu ntini ahorow no nipadua ho no betumi ama nkonimdi a ɛba wɔ nnadewa a wɔde hyɛ asen no mu ma asen mu akisikuru no akɔ soro kɛse. Nea ɛne eyi bɔ abira no, baabi a wɔbɛpaw sɛ wɔbɛkɔ mu no gyina nneɛma pii so, a nea ɛka ho ne sɛnea wɔyɛ nnadewa a ɛwɔ medullary mu, baabi a abubu, abubuw no a wɔabubu, ne nneɛma a ɛfa ɔyarefo ho (sɛ nhwɛso no, polytrauma, nyinsɛn, ne kɛseyɛ mmoroso). Ɛmfa ho beae a wɔpaw sɛ wɔbɛkɔ no, beae a ɛfata a wobenya no ho hia na ama wɔakɔ so atew so sɛnea ɛsɛ bere a wɔde nnadewa bɛhyɛ medullary mu bere a ɛtew asiane a ɛwɔ hɔ sɛ ɔhaw ahorow bɛba no so no.

Femoral Anatomy a Wɔde Yɛ Asen

1.Mogya a ɛkɔ femoral ti no mu

Femoral ti no nya ntini ahorow fi ntini atitiriw 3 mu. Afã a ɛkyinkyini asen mu ntini (a ɛwɔ nkorabata 3-4), obturator ntini a ɛma ntini kurukuruwa no, ne mfinimfini a ɛkyinkyini asen mu ntini (Mfonini 1), a ɛno nso ma ntini a ɛforo kɔ soro a ɛne akyi a ɛkyinkyini asen mu ntini no yɛ anastomose na ɛma trochanteric mpɔtam kɛse no.

2.Anatomy A Ɛwɔ Hip Ntini Mu

Sɛ wɔreyɛ nnadewa a wɔde hyɛ asen no mu a, ɛho hia sɛ wonya ntini a ɛwɔ baabi a atwa rotor no ho ahyia no ase yiye na wɔasiw opira a ɛho nhia ano. Gluteus medius ntini no fi ase fi ilium na ɛba awiei wɔ trochanter kɛse no akyi fã, bere a gluteus minimus ntini no nso fi ilium no mu na ɛfa asen nkwaa no akyi fã no so kɔ awiei wɔ trochanter kɛse no akyi fã no so (Mfonini 2 & 3). Saa ntini abien yi nyinaa yɛ adwuma sɛ adductors a ɛwɔ asen no mu ne asen no mu rotators. Enti, sɛ ntini ahorow yi sɛe bere a wɔde paracentric femoral intramedullary nail hyehyɛ mu a, ɛbɛma adductor no ayɛ mmerɛw na Trendelenburg nantew aba, na ɛno nya nkɛntɛnso bɔne wɔ ɔyarefo no ho a ɔsan nya ne nea ebefi mu aba no so.

Mfonini 2. Ntini a atwa asen no ho ahyia no nipadua

Mfonini 3. proximal femoral ntini a ɛbata ho no

Parallel Femoral Intramedullary nnadewa a ɛwɔ akyi

Nnansa yi nhwehwɛmu pii ahwehwɛ baabi a eye sen biara a paracrine femoral nail no betumi akɔ mu. Nneɛma a wobetumi apaw sɛ nnadewa hyɛn mu no bi ne trochanter kɛse ne pyriform fossa, a emu biara wɔ n’ankasa nsɛnkyerɛnne ne nsɛnnennen a ɛbata ho (Table 1).

Table 1.Nneɛma a wɔde fi ase ne asiane ahorow a ebetumi aba wɔ paracrine ne retrograde femoral nailing mu
variant	nnadewa a ɛwɔ medullary mu a ɛne ne ho di nsɛ		nnadewa a ɛkɔ akyi wɔ medullary mu
	rotor a wɔde yɛ adwuma	pyriform fossa (akwaa ho nhyehyɛe) .
abotiri wimhyɛn	Vertex of the greater trochanter na ɛkyerɛ mfinimfini kɔ medullary cavity no so	trochanter kɛse no ne femoral neck no nhyiam	mfinimfini a ɛwɔ intercondylar fossa (anatomy) no mu .
sagittal plane (akontaabu.) .	Ntrɛwmu a ɛda trochanter kɛse no mfinimfini ne asen no mu ntini a ɛwɔ akyi no mfinimfini ntam	pyriform fossa (akwaa ho nhyehyɛe) .	PCL 1.2 cm wɔ anim wɔ asen no mfiase, na ɛkyerɛ medullary cavity no.
nneɛma a wɔda no adi	Hip abductor kuw gyinabea a opira	Mogya a ɛkɔ asen ti ne asen akyi ntini a ɛkyinkyini no mu a ɛyɛ mmerɛw	Sɛ wɔmfa nni dwuma yiye a, ebetumi ama wɔanya PCL
PCL: akyi ntini a ɛyɛ mmeamudua

1.Large rotor needle kwan a wɔfa so hyɛn mu

Wɔaka trochanter kɛse no ho asɛm sɛ ɛyɛ trapezoidal bony protuberance a ɛwɔ akyi pɛɛ a ɛwɔ asen kɔn no akyi fã, a ne soro ma ɛbata akyi gluteus medius ne anterior gluteus minimus ntini no ho (Mfonini 2 ne 3). Ɛwom sɛ eyi yɛ nnompe agyiraehyɛde ketewaa bi de, nanso beae a ɛfata a wobefi ase bere a wɔreyɛ asen mu IMN no betumi ayɛ nsonsonoe a ɛda nea ɛma abotɔyam anaasɛ nea enye a wobenya bere a woredi asen dua a abubu ho dwuma no ntam.

Bere a yɛsan hwɛɛ mprempren nhoma ahorow a ɛfa asen mu entry point nkyerɛkyerɛmu ho no, yehuu sɛ enni nipadua mu agyiraehyɛde a wɔakyerɛkyerɛ mu pefee a ɛfa femoral rotor IMN entry point ho.Bharti et al. kaa baabi a ɛhyɛn mu fi trochanter kɛse no atifi no ho asɛm sɛ ɛwɔ mfinimfini kɔ medullary cavity no mu wɔ orthostatic gyinabea, na ɛyɛ trochanter kɛse no mfinimfini a ɛne femoral medullary cavity no mfinimfini hyia wɔ afã gyinabea (Mfonini 4), na nkyerɛkyerɛmu foforo a ɛfa trochanter kɛse no mu kwan a wɔfa so hyɛn mu wɔ lateral hip view no so no wɔ rotor no mu wɔ anim a ɛda anterior ntam no ntam rotor no nkyem abiɛsa mu biako ne akyi nkyem abiɛsa mu abien.Georgiadis et al. kaa baabi a ade a wɔde hyɛn mu no ho asɛm sɛ ɛyɛ rotor no apical superior margin no akyi fã kɛse.

MFONINI 4. Intraoperative orthostatic ne lateral views of the hip kyerɛ ɔkwan pa a wɔfa so hyɛn mu ma femoral paramedian intramedullary nailing of the greater trochanter. '*' kyerɛ baabi a nnadewa a ɛwɔ medullary mu no hyɛn mu.

Nnansa yi nhwehwɛmu ahorow a wɔayɛ wɔ nhoma ahorow mu ada no adi sɛ trochanter kɛse no atifi ne mfiase a eye a wobetumi anya ahoɔden kwan a eye sen biara, na sɛ ɛnhyia yiye esiane inversion deformity nti no taa ba bere a wɔdan baabi a ɛkɔ mu no bɛboro mm 2 kɔ akyi kɔ trochanter kɛse no so no. Saa nhwehwɛmu yi nso sii so dua sɛ baabi a ɛkɔ akyi kɛse no ma ɛkɔ anim kɔ akyirikyiri, bere a baabi a ɛkɔ mfinimfini no betumi ama akyirikyiri abubuw no atu akɔ akyi. Nea ɛne eyi bɔ abira no, nhwehwɛmu foforo kyerɛe sɛ wɔ intertrochanteric femur fractures mu no, na nnadewa a ɛwɔ medullary mu a ɛbɔ no dɔɔso kɛse bere a wɔde pin a ɛwɔ akyi no kɔ anim fã no sen nea ɛbɛn mfinimfini ne akyi fã no.

Wɔtaa de trochanteric apex pinning point kɛse no di dwuma wɔ ayarefo a wɔayɛ kɛse mmoroso mu, na saa adeyɛ yi nyɛ nea ɛho nhia pii wɔ mfiridwuma mu, na ɛma oprehyɛn bere sua na asiane a ɛwɔ hɔ sɛ wobenya nsɛnnennen no sua sen pyriform fossa pinning point no.

NKYERƐKYERƐMU: Wɔaka ɔhaw ahorow a ɛba wɔ oprehyɛn mu ne oprehyɛn akyi a ɛba bere a wɔde nnadewa a wɔde bɔ asen mu a ɛwɔ trochanteric kwan kɛse so ho asɛm wɔ nhoma ahorow pii mu. Eyinom mu biako a mpɛn pii no ɛfa ɔkwan a wɔfa so bɔ nnadewa ho ne akisikuru a aduruyɛ de ma. Wɔ intertrochanteric femoral fractures mu no, ɛda adi sɛ baabi a wɔhyɛn mu a ɛwɔ akyi ne anim wɔ trochanter kɛse no mu no bɛma mfinimfini abubu sen baabi a ɛbɛn mfinimfini fã no.

Ɔhaw foforo a ɛfa ho ne ntini a ɛyɛ mmerɛw a opira, titiriw wɔ medial rotator femoral artery no nkorabata ne adductor ntini ahorow no mu, nanso sɛ wɔde toto pyriform fossa entry nail no ho a, saa opira ahorow yi ntaa mma. Bio nso, wosusuw sɛ ischemic necrosis a ɛba asen ti a ɛwɔ trochanter kɛse no atifi sɛ baabi a ɛhyɛn mu no sua koraa, na nhwehwɛmu ahorow bɔɔ amanneɛ sɛ ɛba fam te sɛ 0.3%.

Sɛ yesusuw bere a wɔde yɛɛ oprehyɛn no mu ne fluoroscopic a wɔde wɔn ho hyɛɛ mu no ho a, na oprehyɛn bere no yɛ simma 90.7 ma trochanteric entry point kɛse no bere a wɔde toto simma 112.7 ma pear-shaped fossa entry point kuw no ho no, bere a fluoroscopic bere no yɛ sikɔne 5.88 ma trochanteric entry point kuw kɛse no ne sikani 10.08 ma pear-shaped kuw no fossa entry point kuw, sɛ wɔde toto pear-shaped fossa entry point ho a.

Na ayarefo nkɔmhyɛ nso yɛ ade titiriw bere a wɔresi nnadewa a wɔde hyɛn mu no ho gyinae no, efisɛ na dwumadi mu ahoɔden a wonya ntɛm (sɛnea wɔde nkongua-akongua sɔhwɛ ne bere a wɔde ma wɔ soro sɔhwɛ) yɛɛ yiye kɛse wɔ ayarefo mu wɔ asram 6 akyi wɔ oprehyɛn no akyi ma trochanteric entry point kɛse no bere a wɔde toto pyriform fossa entry point nnadewa no ho no, nanso nsonsonoe yi nyɛ kɛse wɔ asram 12 akyi wɔ oprehyɛn no akyi. Ɛwom sɛ mpɛn pii no, trochanteric access point kɛse no ne ntini a ɛyɛ mmerɛw a ɛnyɛ den pii esiane beae a ɛwɔ nti no wɔ abusuabɔ de, nanso ɛda so ara betumi ama abductor muscle kuw no apirapira, sɛnea Ergiş ne ne mfɛfo ada no adi no. Wohui sɛ dynamic balance ne hip abductor ahoɔden so tew wɔ ayarefo a na wɔwɔ trochanteric entry peg kɛse no mu bere a wɔde toto wɔn a wɔhwɛ wɔn a wɔwɔ apɔwmuden ho no. Bio nso, wɔn nhwehwɛmu no bɔɔ amanneɛ sɛ ahoɔden a ɛwɔ hip abductors, flexors ne internal/external rotators mu no so tew kɛse bere a wɔde toto ɔfã a wɔanyɛ oprehyɛn no ho no.

2. Pearly fossa a ɛhyɛn mu

Pyriformis ntini no fossa yɛ nipadua mu agyiraehyɛde a ɛho hia a wɔahu sɛ ɛyɛ mmeae a wɔde paracentesis femoral intramedullary nail hyɛn mu no mu biako.Wɔ wɔn funu nhwehwɛmu mu no, Lakhwani ne ne mfɛfo. hyɛɛ no ​​nsow sɛ na pyriformis ntini no fossa no nyɛ 'pear' nsɛso anaasɛ pyriformis ntini a ɛbata ho. Ntini no bata beae ketewaa bi a ɛwɔ trochanter kɛse no ano, bere a pyriform fossa no yɛ ade a ɛda fam wɔ trochanter kɛse no mfinimfini fã na ɛyɛ extensor carpi radialis brevis ntini no a ɛbata ho. Akyerɛwfo no de baa awiei sɛ pyriform ntini ne pyriform fossa yɛ nneɛma abien a ɛsono emu biara na ɛsɛ sɛ wɔfrɛ nea wɔfrɛ no pyriform fossa no 'rotor' anaa 'occlusal' fossa ma emu da hɔ na ɛteɛ wɔ nipadua mu. Wɔhyɛɛ nyansa sɛ bere a wɔasua cis-femoral no awie no Wɔhyɛɛ nyansa sɛ wɔmfa mfitiase asɛmfua 'rotor fossa' no nsan mmra nhoma ahorow mu sen sɛ wɔde 'pyriform fossa' bedi dwuma bere a wɔasua nsɛmfua a wɔde di dwuma wɔ parafemoral entry point no mu awie no. Ɛwom sɛ wobu nsɛntitiriw a ɛwɔ nhwehwɛmu abien yi mu kɛse de, sɛnea ɛbɛyɛ a ɛbɛyɛ mmerɛw sɛ wɔbɛkyerɛkyerɛ mu na wɔasiw adwene a ɛyɛ basaa wɔ trochanteric entry point kɛse no ano no, yɛbɛda so ara afrɛ saa kwan a wɔfa so hyɛn mu yi sɛ pyriform fossa entry point.

Nhwehwɛmu pii a ɛwɔ mprempren nhoma ahorow mu no kyerɛkyerɛ baabi pɔtee a pearly fossa no hyɛn mu ma intramedullary femoral nails no mu pɛpɛɛpɛ.Georgiadis et al. kyerɛkyerɛ baabi a pearly fossa hyɛn mu no mu sɛ beae a extensor carpi radialis brevis ntini no bata ho wɔ adwenemhaw a ɛwɔ asen kɔn no ase no mu (Mfonini 5). Nhoma akyerɛwfo no sii so dua nso sɛ baabi a wɔhyɛn mu a ɛkɔ n’anim dodo anaasɛ ɛkɔ akyiri dodo no betumi ama asiane a ɛwɔ hɔ sɛ asen kɔn bɛpaapae no ayɛ kɛse, na sɛ baabi a wɔhyɛn mu no kɔ akyi dodo a, asiane kɛse betumi aba sɛ wobenya ischemic necrosis, a ɛkɔ soro wɔ ayarefo a wɔrebɛn mpanyin afe so no mu.

Mfonini 5. Intraoperative frontolateral view of the hip a ɛkyerɛ beae a eye a wobetumi akɔ mu ama pyriform fossa retrograde femoral intramedullary nail. '*' no kyerɛ baabi a nnadewa a ɛwɔ medullary no fi ase.

Harper ne afoforo. tintim nhwehwɛmu bi a wɔyɛe wɔ nnipa afunu akuw 14 ho wɔ 1987 mu a wɔhwehwɛɛ faako a intramedullary guide pin no wɔ ne baabi a intramedullary nail a wɔde baa akyirikyiri ne bɛn no fi mu wɔ ɔkwan a ɛkɔ akyi fi intercondylar notch a ɛwɔ femur no mu no mu. Wɔde baa awiei sɛ baabi a pyriformis paramedian intramedullary nnadewa no hyɛn mu no wɔ baabi a trochanter kɛse no ne asen kɔn no hyia, wɔ pyriformis occulta no anim kakra.Gausepohl ne ne mfɛfo san sii beae a wɔde hyɛɛ mu no so dua. Wɔ amu ho nhwehwɛmu foforo mu no, wɔde beae a eye sen biara a asen mu nnadewa a ɛwɔ asen no mu no betumi akɔ mu wɔ trochanter kɛse a ɛkata pyriformis ntini no so no mfinimfini ano. Bio nso, wɔ afunu ho nhwehwɛmu a Labronici ne ne mfɛfo yɛe no mu no, wɔde wɔn ho hyɛɛ mu no. wɔkaa pyriformis ntini no fossa ho asɛm sɛ ɛyɛ luminal region a ɛte sɛ pear a ɛne asen no mu ntini a ɛwɔ coronal plane no mfinimfini axis no hyia.

Pyriform fossa access point no wɔ ɔhaw pɔtee bi efisɛ ɛyɛ mfiridwuma mu asɛnnennen kɛse sɛ wɔde toto trochanter access point kɛse no ho a, titiriw wɔ ayarefo a wɔayɛ kɛse mmoroso mu. Bio nso, beae a eye sen biara a wobetumi akɔ mu ama fossa needle a ɛte sɛ pear no hyɛn mu no yɛ beae teateaa, na ɛma ɛyɛ den kɛse sɛ wobɛkɔ baabiara. Sɛ nhwɛso no, sɛ wofi ase wɔ anim dodo wɔ asen kɔn no so a, ɛbɛma adwennwen a ɛboro so aba atwa ho ahyia na asiane a ɛwɔ hɔ sɛ anim cortical bɛpae no ayɛ kɛse, titiriw sɛ beae a wofi ase no boro mm 6 wɔ fossa no anim a. Afei nso, nsonsonoe a ɛwɔ nipadua no mu no betumi asiw beae a ɛfata a wɔde hyɛn mu no kwan, titiriw sɛ abɔnten so rotator tiawa no yɛ kɛse anaasɛ rotor no puei a, ɛde beae a ɛhyɛn mu a ɛyɛ mfinimfini dodo na asiane wɔ hɔ sɛ asen kɔn mu bɛpaapae aba.

NKYERƐKYERƐMU: Ɛdenam mmeae akɛse 38 a wɔde trochanteric hyɛn mu ne mmeae 53 a wɔde pearly fossa hyɛn mu ma femoral intramedullary nailing totoo ho so no, Ricci ne ne mfɛfo hui sɛ pearly fossa kuw no nyaa oprehyɛn bere tenten 30% ne fluoroscopy bere tenten 73%. Saa nsɛm yi na Bhatti ne ne mfɛfo sii so dua. bere a wɔde toto mmeae 2 a wɔde nnade no hyɛn mu no ho no.

Ɛdefa ntini a ɛyɛ mmerɛw a opira ho no, na asiane kɛse wɔ hɔ sɛ ntini a ɛyɛ mmerɛw bepira wɔ pyriformis inlet no mu bere a wɔde toto interosseous neuromuscular a ɛwɔ trochanteric needle kɛse no mu no ho no. Dora ne afoforo. yɛɛ mpanyimfo 16 afunu asen mu nhwehwɛmu sɛ ebia ntini a ɛyɛ mmerɛw apirapira wɔ pyriformis ntini ne rotor entry pin no mu anaa. Wohui sɛ ɛwom sɛ na pyriformis fossa no yɛ nea eye sen biara wɔ geometric mu de, nanso ɛsɛee ntini a ɛkɔ asen no ti ne ntini ne ntini a atwa ho ahyia no mu kɛse. Wɔsan sii saa nsɛm yi so dua denam afunu ho nhwehwɛmu a Ansari Moin ne ne mfɛfo yɛe so. WHO nso de mmeae abien a wɔde hyɛn mu totoo ho. Wɔhyɛɛ no ​​nsow sɛ nnadewa no a wɔde hyɛ mu a efi ase wɔ pyriformis ntini no so no betumi asɛe asen no mu nneɛma a ɛkyere ne akyi a ɛkyinkyini no kɛse. Bio nso, wohuu sɛnea medial rotator femoral artery no asɛe wɔ nsɛm no nyinaa mu (Table 2).

Table 2. Ntini a ɛyɛ mmerɛw a opira wɔ mmeae ahorow a wɔde ade hyɛn mu no ho nsɛm tiawa
variant	Pyriform fossa a ɛkɔ mu (n=5) .	Rotor feed point kɛse (n=5) .
ntini a ɛyɛ mmerɛw
gluteus medius ntini (anatomy) .	5	1
gluteus medius ntini a ɛwɔ nipadua no mu	0	4
ntini a wɔapirapira
gluteus minimus (akwaa ho nhyehyɛe) .	3	0
pyriformis ntini (a ɛwɔ akyi berɛmo no atifi) .	3	3
obturator internus (akwaa ho nhwehwɛmu) .	1	0
latissimus dorsi ntini (apɔw-mu-teɛteɛ) .	3	0
Mogya ntini ne nkwaa mu ntini a ɛwɔ nipadua no mu
MFCA Nkorabata a Ɛmu Dɔ	4	0
MFCA Baa Dwumadibea a Ɛnyɛ Den	4	0
articular capsule (a ɛfa nkwaa te sɛ kotodwe wɔ nipadua mu) .	1	0
MFCA: asen mu ntini a ɛwɔ mfinimfini a ɛtwa ho hyia.

Nnansa yi ara, Bharti ne afoforo. yɛɛ nsɛnnennen a ɛwɔ asen mu nnadewa a wɔde bɔ asen mu wɔ trochanteric entry point kɛse ne pearly fossa entry point no ho nhwehwɛmu na wohuu nsɛnnennen ho asiane te sɛ fracture healing rate na wɔbɔɔ no mua sɛnea edidi so yi (Table 3).

Table 3. Pyriform fossa hyɛn mu ne trochanter kɛse a ɛhyɛn mu asen nnompe mu ntini
nsɛnnennen a ɛba	Piriformis sinus afiri a wɔde yɛ ade	Trochanter a wɔde hyɛ mu kɛse
Nya ɔyare mmoawa	6.7	3.3
Malunion na ɛyɛ	20	13.3
Ayaresa a ɛkyɛ	20	13.3
Hip motion a anohyeto wom	20	33.3
Nkotodwe a ɛkɔ baabiara a anohyeto wom	6.7	6.7
Nsonsonoe a ɛda akwaa tenten ntam	13.3	20
Dua no ano no puepue wɔ nnompe no atifi	13.3	20
Asen kɔn mu a ɛpaapae wɔ oprehyɛn mu	10	0
Trochanter a ɛpaapae kɛse	0	3.4
Femoral ti a ɛyɛ mmerɛw	6.7	0

Retrograde femoral intramedullary nnadewa a wɔde hyɛ nipadua no mu

Sɛ wɔkyerɛ baabi a ɛfata a wɔde nnadewa a wɔde hyɛ akyi a ɛwɔ akyi no bɛboa ma wɔasan anya akisikuru no a ɛne ne ho hyia, ne tenten, ne nea ɛkyinkyini yiye bere a ɛtew ntini mu ntini a ɛsɛe, anim ntini a ɛwɔ akyi (ACL), akyi ntini a ɛwɔ akyi (ACL), ne ntini a ɛyɛ mmerɛw a opira (Table 1). Nnansa yi, wɔanya anigye kɛse wɔ retrograde femoral intramedullary nailing ho a botae no ne sɛ wɔbɛtew nsɛnnennen a ɛbata paracromial nailing ho, a nea ɛka ho ne asen mu yaw, heterotopic ossification, adductor mmerɛwyɛ, ne pudendal nerve palsy, a wobu no sɛ ɛnyɛ nea ɛyɛ hu kɛse bere a wɔde toto incisional reduction ne locking femoral plating ma internal ho no fixation, titiriw wɔ asen dua no nkyem abiɛsa mu biako a ɛwɔ akyirikyiri a abubu mu. Bio nso, adanse a wɔanya nnansa yi kyerɛ sɛ, sɛ wɔde nnadewa a ɛwɔ akyi a ɛkɔ akyi yi kɛse yɛ nea ɛfata a, ebia ɛho renhia sɛ wɔde nnadewa a ɛtow proximal locking.Nsonsonoe biara nni ayaresa dodow, bere a wɔde sa yare, anaa nea efii mu bae a ayarefo bɔɔ ho amanneɛ no mu wɔ Meccariello ne ne mfɛfo ntam. ne Bisaccia ne afoforo. wɔ asen ntini a ɛpaapae a ɛwɔ akyirikyiri no mu nkyem abiɛsa mu biako a wɔde nnadewa a ɛwɔ akyi a ɛkɔ akyi a ɛtow ne nea ɛntoto mu di dwuma mu. Enti, nnadewa a wɔde hyɛ akyi a wɔde di dwuma no abɛyɛ nea agye din na wɔagye atom kɛse.

Wobetumi ahu nkyerɛkyerɛmu pii a ɛfa baabi a eye sen biara a wobetumi akɔ mu ama retrograde femoral intramedullary nailing wɔ nhoma ahorow mu. Nhwehwɛmu dodow no ara kyerɛ sɛ baabi a eye a asen mu nnadewa a ɛkɔ akyi no betumi akɔ mu no yɛ 1.2 anim wɔ asen mu mfiase a ɛwɔ akyi asɛndua mu ntini no mu

cm (a ɛne medullary cavity no hyia) ne intercondylar fossa no mfinimfini (Mfonini 6).

MFONINI 6. Intraoperative orthostatic ne lateral views of the knee a ɛkyerɛ beae a eye a wobetumi akɔ mu ama retrograde femoral intramedullary nail. '*' kyerɛ baabi a nnadewa a ɛwɔ medullary no fi ase.

Ɛwom sɛ biribiara nni hɔ a ɛkyerɛ koraa sɛ wɔde nnadewa a ɛwɔ asen mu a ɛkɔ akyi no bɛba de, nanso wɔaka nsɛnkyerɛnne pii a ɛfa ho ho asɛm. Eyinom bi ne ayarefo a wɔanya polytrauma, ayarefo a wɔayɛ kɛse mmoroso kɛse, ayarefo a wɔyem, asen dua a abubu wɔ afã abien, asen dua ne acetabular/pelvic a ɛpaapae wɔ ipsilateral anaasɛ asen kɔn a abubu, ne asen dua ne tibial a abubu. Saa nsɛnkyerɛnne yi mu dodow no ara fa sɛnea ɛnyɛ den sɛ wɔde ɔyarefo no besi baabi ne oprehyɛn akuru pii a ɛbɛn hɔ a wosiw ano no ho.

Ɔkwan foforo so no, nneɛma a ɛsɔre tia koraa sɛ wɔmfa nnadewa a wɔde bɛhyɛ akyi asen no mu no bi ne akyi berɛmo mu kwan a ɛkɔ akyi no a wɔde ahyɛ mu a wɔakora so no siw kwan ne akyi berɛmo a ɛwɔ akyirikyiri no a ɛpaapae. Nneɛma a ɛne no bɔ abira a ɛfa ho ne abubuw a ɛwɔ sɛntimita 5 wɔ trochanter ketewa no ho, ɛyɛ den sɛ wobenya baabi a eye sen biara a wɔde hyɛn mu esiane kotodwe a wɔabɔ no a ennu digrii 45 nti, nkotodwe mu yare a edi kan a ebetumi ama asiane aba sɛ ɛbɛtrɛw akɔ asen no mu, ntini a ɛyɛ mmerɛw a apira kɛse a atwa kotodwe no ho ahyia, ne ntini a ɛwɔ ase no mu a ɛpaapae patella ne dua a ɛwɔ akyirikyiri koraa no.

Nsɛnnennen: Nsɛnnennen dodow no ara a ɛba bere a wɔde nnadewa a wɔde hyɛ akyi no fa sɛnea wɔmfa nni dwuma yiye, titiriw baabi a wɔde hyɛn mu no a wɔmfa nsi hɔ yiye. Wɔ sagittal plane no mu no, baabi a ɛkɔ anim kɛse no bɛma akyi abubu nkyerɛase, articular surface asɛe, na ebia nnadewa bɛbɔ patella no so bere a wɔabɔ kotodwe no. Ɔkwan foforo so no, sɛ wɔmfa baabi a wɔde hyɛn mu no nsi akyi kwan no so yiye a, eyi betumi ama asiane kɛse aba sɛ wobepira akyi asɛndua no mfiase na wɔatu baabi a abubu no wɔ anim no.

Hutchinson ne afoforo. kaa nsɛnnennen a ɛbata mmeae a ɛmfata a wɔde hyɛn coronal plane mu ho asɛm. Wohui sɛ mfinimfini kwan a ɛhyɛn mu dodo no ma akyi fã a ɛyɛ mmerɛw a ɛwɔ akyi a ɛpaapae nkyerɛase, bere a akyi a ɛboro so no de mfinimfini a ɛyɛ mmerɛw ne mfinimfini nkyerɛase ba.Sanders et al. bɔɔ amanneɛ sɛ sɛ wɔpaw mfinimfini mfiase a ɛne mfinimfini kwan no ntam kwan yɛ sɛntimita 2 anaa nea ɛboro saa a, ɛde mfinimfini cortical fracture a na malunited esiane posterior isthmic bending moment a ɛwɔ fracture no mu a ɛde posterolateral reduction a enye bae nti.

Nsɛnnennen afoforo a ɛbata retrograde femoral follower nailing ho ne kotodwe mu yaw, ɛyɛ den, heterotopic knee ossification, ne intra-articular knee free body formation.

Fa wie

Ɛwom sɛ ɔkwan biara a wɔfa so bɔ nnadewa wɔ asen mu no wɔ nea ɛne no hyia de, nanso mpɛn pii no, ɔkwan a wɔbɛfa so de nnadewa a wɔde hyɛ asen mu a wɔbɛpaw de asa asen ntini a abubu no gyina nea oduruyɛfo a ɔyɛ oprehyɛn no pɛ so. Sɛ wɔreyɛ intramedullary nailing of the femur a, ɛho hia sɛ wonya baabi a ɛfata a wɔde hyɛn mu ma nnadewa ko a wɔde si hɔ no na ama nea efi mu ba no ayɛ yiye. Nimdeɛ a ɛwɔ mpɔtam hɔ nipadua ne mfoniniyɛ adwumayɛ ho no bɛboa oduruyɛfo a ɔyɛ oprehyɛn no ma wayɛ oprehyɛn a ɛfata wɔ mfiridwuma mu bere a ɛtew asiane a ɛwɔ hɔ sɛ ɔhaw ahorow a ɛbata ho no so. Bio nso, wɔ nnadewa a wɔde fa medullary mu no, sɛnea wɔbɛkɔ so akura so tew no yɛ ade titiriw a ɛma wosiw nkabom bɔne ne nkabom a enni mu anaasɛ akisikuru a ɛnyɛ biako no ano.