Femoral intramedullary nailing - Sɛnea wobɛpaw insertion point a eye sen biara?

Nnianimu

Wobetumi ahu asen mu akisikuru ayaresa a ɛbae no wɔ 1940 mfe no mu bere a Kuntscher de nnade a wɔde nnadewa ayɛ a wɔatoto mu no bae no. Nnadewa a ɛwɔ nipadua no mu (IMN) a wɔde di dwuma wɔ asen mu abubu mu no abɛyɛ ɔhwɛ gyinapɛn wɔ mfe du du kakraa a atwam no mu, ne mprempren nkɔso a aba wɔ . Nnadewa a wɔde hyɛ nipadua no mu ne nkɔso a aba wɔ oprehyɛn ho akwan horow mu no ama wɔanya nkɔanim kɛse wɔ asen no mu nnadewa a wɔde di dwuma no mu.

Wɔde asen mu ntini a ɛpaapae no ayaresa a wɔde siw ano di dwuma wɔ ayarefo kakraa bi pɛ a wɔwɔ nnuru a wɔde kum akisikuru ne oprehyɛn a wɔde siw ano kɛse mu nkutoo, na ade titiriw a wɔde sa yare no da so ara yɛ oprehyɛn a wɔde hyɛ nipadua no mu. Ɛdefa oprehyɛn a wɔde sa saa akisikuru yi ho no, akwan horow pii wɔ hɔ a wobetumi afa so, a nea ɛka ho ne intramedullary nailing, mprɛte screw fixation, ne akyi a wɔde hyɛ mu. Sɛ wɔde toto oprehyɛn afoforo a wobetumi apaw ho a, nnadewa a wɔde hyɛ nipadua no mu no yɛ ɔkwan a wɔfa so yɛ ade a ɛyɛ den sen biara na ɛyɛ nea ɛsen biara wɔ abubuw mu, na ɛreyɛ nea wɔde di dwuma kɛse wɔ ayaresabea dwumadi mu.

Ntease pa a ɛfa nipadua no nipadua a ɛbɛn no ho, mogya a ɛkɔ asen no ti ne asen mu ntini no nipadua mu nkwaadɔm no betumi ama nkonimdi a ɛba wɔ intramedullary nailing mu no ayɛ kɛse ama asen mu akisikuru. Nea ɛne eyi bɔ abira no, baabi a wɔpaw sɛ wɔbɛkɔ mu no gyina nneɛma pii so, a nea ɛka ho ne nnadewa a wɔde hyɛ nipadua no mu, baabi a abubu, akisikuru a ɛma obi bubu, ne nneɛma a ɛma ɔyarefo no yɛ adwuma (sɛ nhwɛso no, polytrauma, nyinsɛn, ne kɛseyɛ mmoroso). Ɛmfa ho sɛnea wɔpaw no no, beae a ɛfata a wobenya no ho hia na ama wɔatew so sɛnea ɛsɛ bere a wɔde nnadewa a ɛwɔ akyi no hyɛ mu bere a ɛtew asiane a ɛwɔ hɔ sɛ wobenya ɔhaw ahorow no so no.

Afã a ɛwɔ nipadua no mu .

1.mogya a ɛkɔ asen no ti so .

Asen mu ti no nya ntini mu nneɛma fi ntini akɛse 3 mu. Lateral rotator femoral artery (a ɛwɔ nkorabata 3-4), obturator artery, a ɛma round ligament no, ne medial rotator femoral artery (Mfonini 1), a ɛsan nso ma anwenne a ɛkɔ soro a ɛforo kɔ soro a ɛne lateral rotator femoral artery no yɛ anastomoses na ɛma trochanteric region kɛse no.

2.Asen mu ntini ahorow .

Sɛ woreyɛ intramedullary nnadewa a ɛwɔ asen no mu a, ntini a ɛwɔ beae a atwa rotor no ho ahyia no ho ntease pa ho hia na amma obi anpira a ɛho nhia. Gluteus medius ntini no fi ilium no mu na ɛba awiei wɔ trochanter kɛse no afã a ɛwɔ akyi no so, bere a gluteus minimus ntini no nso fi ilium no mu na ɛtwam fa asen nkwaa no akyi fã no so kosi awiei fã a ɛwɔ Greater Trochanter no so (Mfonini 2 & 3). Saa ntini abien yi nyinaa yɛ adwuma sɛ asen ne asen no mu ntini a ɛkyinkyini no adductors. Enti, saa ntini ahorow yi a ɛsɛe bere a wɔde paracentric femoral intramedullary nnadewa hyɛ mu no bɛma adductor ayɛ mmerɛw na Trendelenburg nantew, a ɛwɔ nkɛntɛnso bɔne wɔ ayarefo a wɔn ho tɔ wɔn ne nea efi mu ba no so.

Fig. 2. Ntini a atwa asen nkwaa no ho ahyia no nipadua .

Mfonini 3. Proximal femoral muscle attachment area .

Parallel femoral intramedullary nnadewa .

Nnansa yi nhwehwɛmu ahorow pii ahwehwɛ baabi a eye sen biara a paracrine asen mu nnadewa no bɛkɔ mu no mu. Nail entry point options no bi ne trochanter kɛse ne pyriform fossa, a emu biara wɔ n’ankasa nsɛnkyerɛnne ne nsɛnnennen a ɛbata ho (Table 1).

Table 1.Nsɛntitiriw a efi ase ne asiane ahorow a ebetumi aba sɛ paracrine ne asen mu nnadewa a ɛkɔ akyi no yɛ .
Nsakraeɛ .	Parallel intramedullary nnadewa .		Retrograde intramedullary nnadewa .
	rotor .	Pyriform fossa (Anatomy) .
Crown Plane .	vertex a ɛwɔ trochanter kɛse no mu na ɛkyerɛ medullary cavity no mfinimfini .	hyia . Trochanter kɛse ne asen kɔn no	Median a ɛwɔ Intercondylar Fossa (Anatomy) no mu .
Sagittal wimhyɛn (Akontaabu.) .	Ntrɛwmu a ɛda trochanter kɛse no mfinimfini ne asen no mu ntini no mfinimfini .	Pyriform fossa (Anatomy) .	PCL 1.2 cm anterior to the femoral starting point, a ɛkyerɛ medullary cavity no.
Nneɛma a ɛda adi .	Hip abductor kuw a wogyae point opira .	Mogya a ɛkɔ asen no ti ne asen akyi rotator ntini no mu no asɛe .	Sɛ wɔde di dwuma yiye a, ebetumi ama PCL aba .
PCL: akyi berɛmo no akyi berɛmo .

1.Large rotor needle a ɛkɔ mu .

Wɔaka trochanter kɛse no ho asɛm sɛ ɛyɛ trapezoidal nnompe a ɛwɔ akyi sen biara a ɛwɔ asen kɔn no afã a ɛwɔ akyi no so, a n’atifi no ma ɛbata gluteus medius ne anim gluteus minimus ntini no ho (Mfonini 2 ne 3). Ɛwom sɛ eyi yɛ nnompe agyiraehyɛde ketewaa bi de, nanso sɛ woreyɛ asen mu IMN a ɛfata a, ebetumi ayɛ nsonsonoe a ɛda nea efi mu ba a ɛma abotɔyam anaasɛ ɛnyɛ papa ntam bere a woredi asen mu ntini a ɛpaapae ho dwuma no.

Bere a yɛresan ahwɛ mprempren nhoma ahorow no mu ama asen mu nsɛm a wɔde hyɛ mu ho nkyerɛkyerɛmu no, yehui sɛ enni nipadua no agyiraehyɛde a wɔaka ho asɛm pefee ma femoral rotor IMN entry point.Bharti et al. kaa kwan a ɛkɔ apical apex a ɛwɔ trochanter kɛse no mu no ho asɛm sɛ ɛyɛ medial a ɛkɔ medullary cavity no mu wɔ orthostatic gyinabea, na ɛyɛ trochanter kɛse no mfinimfini a ɛne femoral medullary cavity no mfinimfini hyia wɔ lateral position (Mfonini 4), ne nkyerɛkyerɛmu foforo a ɛfa Greater trochanter entry point on the lateral hip view is inther iner view is anern iniror Rotor no nkyem abiɛsa mu abien.Georgiadis ne afoforo. Ɔkyerɛkyerɛɛ point of needle entry no mu sɛ ɛyɛ akyi fã a ɛwɔ apical superior margin a ɛwɔ rotor no mu.

Mfonini 4. Intraoperative orthostatic ne lateral views of the hip kyerɛ beae a eye a wobetumi akɔ asen mu paramedian intramedullary nail a ɛwɔ Greater Trochanter no mu. '*' kyerɛ intramedullary nail entry point.

Nnansa yi nhwehwɛmu ahorow a wɔayɛ wɔ nhoma ahorow mu no ada no adi sɛ trochanter kɛse no atifi ne mfiase a eye ma ahoɔden kwan a eye sen biara, na sɛ wɔdannan no yiye esiane inversion deformity nti a, ɛtaa ba bere a wɔdan beae a wɔhyɛn mu no boro mm 2 wɔ trochanter kɛse no akyi no. Saa nhwehwɛmu yi nso sii so dua sɛ akyi kwan a ɛkɔ anim kɛse no ma distal forward displacement, bere a mfinimfini kwan a ɛkɔ mu no betumi ama distal fracture block no akɔ akyi. Nea ɛne eyi bɔ abira no, nhwehwɛmu foforo kyerɛe sɛ wɔ intertrochanteric femur fractures mu no, intramedullary nail impingement a ɛbae no kɔɔ soro kɛse wɔ pinning point a na ɛwɔ afã wɔ anim fã no ho sen pinning point a 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 den wɔ mfiridwuma mu, na ɛma wonya bere a ɛnyɛ adwuma pii na asiane a ɛwɔ hɔ sɛ wobenya ɔhaw ahorow no sua sen pyriform fossa pinning point no.

Nsɛnnennen: Wɔaka oprehyɛn mu ne oprehyɛn akyi nsɛnnennen a ɛfa asen mu nnadewa a ɛwɔ trochanteric kwan so kɛse ho asɛm wɔ nhoma ahorow pii mu. Eyinom mu biako, a mpɛn pii no ɛfa ɔkwan a wɔfa so yɛ nnadewa ho no yɛ nea ɛma obi bubu wɔ aduruyɛ mu wɔ aduruyɛ mu. Wɔ intertrochanteric femoral fractures mu no, ɛda adi sɛ baabi a ɛkɔ trochanter kɛse no akyi ne n’anim no bɛma mfinimfini abubu sen sɛ ɛbɛhyɛn baabi a ɛbɛn mfinimfini fã no.

Ɔhaw foforo a ɛfa ho ne ntini a ɛyɛ mmerɛw a wɔapirapira, titiriw no, mfinimfini rotator asen mu ntini ne adductor ntini no nkorabata, nanso saa apirakuru yi ntaa mma sɛ wɔde toto pyriform fossa entry nnadewa no ho a. Bio nso, wɔsusu sɛ ischemic necrosis a ɛba asen no ti a ɛwɔ trochanter kɛseɛ no atifi no yɛ nea ɛba fam koraa, a nhwehwɛmu ahorow no bɔ amanneɛ sɛ ɛba fam te sɛ 0.3%.

Sɛ yesusuw bere a wɔde yɛ oprehyɛn ne fluoroscopic a wɔde di dwuma ho a, bere a wɔde yɛ oprehyɛn no yɛ simma 90.7 ma trochanteric a ɛkɔ mu kɛse no sɛ wɔde toto simma 112.7 ho ma kuw a ɛte sɛ pear a wɔde hyɛ mu no, bere a fluoroscopic bere yɛ simma 5.88 ma trochanteric a wɔde hyɛn mu kɛse no mu 10. kyerɛ so.

Na ayarefo nkɔmhyɛ nso yɛ ade titiriw bere a wosi nnadewa a wɔde hyɛ mu no ho gyinae no, efisɛ na dwumadi mu ahoɔden a wɔde ma ntɛm (sɛnea wɔde nkongua-akongua sɔhwɛ ne bere a wɔde yɛ no so sɔhwɛ no yɛɛ ho nhwehwɛmu no) yɛɛ papa kɛse wɔ ayarefo mu wɔ asram 6 akyi wɔ oprehyɛn no akyi wɔ trochanteric kwan a wɔfa so hyɛn mu kɛse no ho bere a wɔde totoo pyriform a wɔde hyɛn mu no nnadewa no ho no, nanso saa nsonsonoe yi nyɛ nea ɛho hia wɔ asram pii akyi wɔ 12 oprehyɛn mu. Ɛwom sɛ mpɛn pii no, trochanteric access point kɛse no ne ntini a ɛyɛ mmerɛw a woyi fi hɔ esiane sɛ ɛwɔ nti no wɔ abusuabɔ de, nanso ɛda so ara tumi ma obi pira abductor ntini kuw no, sɛnea Ergiş ne ne mfɛfo ada no adi no. Wohui sɛ ahoɔden a ɛkari pɛ ne hip abductor ahoɔden so tew wɔ ayarefo a wɔwɔ trochanteric entry PEG kɛse no mu sɛ wɔde toto controls a ɛte apɔw ho a. Bio nso, wɔn nhwehwɛmu no bɔɔ amanneɛ sɛ ahoɔden a ɛwɔ hip abductors, flexors ne internal/etranal rotators no so tew kɛse bere a wɔde totoo ɔfã a wɔanyɛ no oprehyɛn no ho no.

2. Pearly Fossa Nkɔmmɔbɔ .

Fossa a ɛwɔ pyriformis ntini no mu no yɛ nipadua mu agyiraehyɛde a ɛho hia a wɔakyerɛ sɛ ɛyɛ mmeae a wɔde paracentesis femoral intramedullary nnadewa hyɛ mu no mu biako.Wɔ wɔn afunu mu nhwehwɛmu mu no, Lakhwani et al. no kae sɛ pyriformis ntini no fossa nyɛ 'pear' a wɔayɛ no sɛnea ɛte anaasɛ pyriformis ntini a ɛbata ho. Ntini no bata beae ketewaa bi a ɛwɔ trochanter kɛse no ano ho, bere a pyriform fossa no yɛ adwenemhaw a ɛwɔ trochanter kɛse no mfinimfini fã na ɛyɛ extensor carpi radialis brevis ntini no a ɛbata ho. Akyerɛwfo no de baa awiei sɛ pyriform muscle ne pyriform fossa no yɛ nneɛma ahorow abien na ɛsɛ sɛ wɔfrɛ nea wɔfrɛ no pyriform fossa no sɛ 'rotor' anaasɛ 'occlusal' fossa ma emu da hɔ na ɛma nipadua no yɛ adwuma yiye. Wɔhyɛɛ nyansa sɛ bere a wosuaa cis-femoral no wiei no wɔhyɛɛ nyansa sɛ wɔmfa mfitiase asɛmfua 'rotor fossa' no mmra wɔ nhoma ahorow mu sen sɛ wɔbɛsan de 'pyriform fossa' ahyɛ mu bere a wɔasua nsɛmfua a ɛwɔ parafemoral entry point no mu awie no. Ɛwom sɛ wobu nsɛm a ɛwɔ saa nhwehwɛmu abien yi mu no kɛse, sɛnea ɛbɛyɛ a nkyerɛkyerɛmu no bɛyɛ mmerɛw na yɛasiw adwene a ɛyɛ basaa a ɛne trochanteric a ɛkɔ mu kɛse no ano no, yɛbɛda so ara aka saa kwan a wɔfa so hyɛn mu yi ho asɛm sɛ pyriform fossa entry point.

Nhwehwɛmu pii a ɛwɔ mprempren nhoma ahorow mu no kyerɛkyerɛ beae pɔtee a pearly fossa no hyɛn mu ma intramedullary femoral nails.Georgiadis et al. Kyerɛkyerɛ pearly fossa entry point sɛ beae a extensor carpi radialis brevis muscle no bata ho wɔ adwenemhaw no mu wɔ asen kɔn no ase (Mfonini 5). Nhoma akyerɛwfo no nso sii so dua sɛ baabi a wɔhyɛn mu a ɛkɔ akyiri dodo anaasɛ ɛkɔ akyiri dodo no betumi ama asiane a ɛwɔ hɔ sɛ obi bɛkɔ ne kɔn mu no ayɛ kɛse, na sɛ baabi a ɛkɔ akyiri dodo no kɔ akyiri dodo a, ebia asiane kɛse wɔ hɔ sɛ mogya a ɛtɔ kɔ nipadua no mu no bɛtetew, a ɛdɔɔso 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 pyriform fossa retrograde femoral intramedullary nail. '*' no kyerɛ intramedullary nail a wɔde fi ase.

Harper ne afoforo a wɔyɛ adwuma wɔ hɔ no. Wotintim nhwehwɛmu bi a ɛfa nnipa afunu akuw 14 ho wɔ 1987 mu a wɔhwɛɛ beae a intramedullary guide pin no wɔ ne baabi a wɔde nnadewa a ɛwɔ intramedullary nnadewa no mu no fi hɔ kɔ akyirikyiri ne akyi wɔ ɔkwan a ɛkɔ akyi fi intercondylar notch a ɛwɔ asen no mu no mu. Wɔde baa awiei sɛ beae a pyriformis paramedian intramedullary nail no hyɛn mu no wɔ trochanter kɛse no ne asen kɔn no nhyiam, na ɛwɔ anim kakra wɔ pyriformis occilta no ho.Wɔsan sii beae a wɔde wɔn ho hyɛɛ mu no so dua denam Gausepohl ne afoforo so. Wɔ afunu ho nhwehwɛmu foforo mu no, wɔyɛɛ beae a eye a wobetumi akɔ asen mu ntini mu nnadewa no mu wɔ trochanter kɛse no mfinimfini ano a ɛkata pyriformis ntini no so. Bio nso, wɔ afunu nhwehwɛmu a Labronici ne ne mfɛfo yɛe no mu no. Wɔkaa pyriformis ntini no fossa ho asɛm sɛ ɛyɛ luminal region a ɛte sɛ pear a ɛne asen mu ntini a ɛwɔ akyi berɛmo no mu wɔ coronal plane no mu no hyia.

Pyriform Fossa Access Point no wɔ ɔhaw pɔtee bi efisɛ mfiridwuma mu no ɛyɛ den kɛse sɛ wɔde toto trochanter a wɔde di dwuma kɛse no ho a, titiriw wɔ ayarefo a wɔayɛ kɛse mmoroso no mu. Nea ɛka ho no, beae a eye sen biara a wobetumi akɔ fossa needle a ɛte sɛ pear no mu no yɛ beae ketewaa bi, na ɛma ɛyɛ den kɛse sɛ wobɛtra baabi. Sɛ nhwɛso no, baabi a wofi ase fi anim a ɛboro so wɔ asen kɔn no so no bɛma atwa ho ahyia adwennwen a ɛboro so na ama asiane a ɛwɔ hɔ sɛ anterior cortical no bɛpae no ayɛ kɛse, titiriw sɛ nea wofi ase no boro mm 6 wɔ fossa no anim a. Bio nso, morphologic contrast betumi asiw beae a ɛfata a ɛkɔ mu no kwan, titiriw sɛ abɔnten rotator tiawa no yɛ kɛse anaasɛ rotor no repue, a ɛde kɔ beae a ɛkɔ mu a ɛyɛ mfinimfini dodo na asiane a ɛwɔ hɔ sɛ asen kɔn mu bɛpaapae no.

Nsɛnnennen: Ɛdenam trochanteric a ɛkɔ mmeae akɛse 38 a wɔde totoo mmeae 53 a wɔde pearly fossa kɔ mu ma femoral intramedullary nailing ho so no, Ricci ne afoforo hui sɛ pearly fossa kuw no nyaa bere tenten a wɔde yɛ oprehyɛn no 30% ne 73% bere tenten a wɔde yɛ fluoroscopy. Saa nnoɔma a wɔahu yi, Bhatti ne ne mfɛfoɔ sii so dua. Sɛ wode 2 needle entry points no toto ho a.

Ɛdefa soft-tissue opira ho no, na asiane kɛse wɔ hɔ a ɛbɛma ntini a ɛyɛ mmerɛw no apira wɔ pyriformis a ɛkɔ mu no mu bere a wɔde toto interosseous neuromuscular a ɛwɔ trochanteric needle a ɛkɔ mu kɛse no ho no. Dora ne afoforo. Wɔhwɛɛ atiridiinini a ɛyɛ mpanyimfo 16 mu sɛ ebia ntini a ɛyɛ mmerɛw apirapira wɔ pyriformis ntini ne rotor entry pin no ho. Wohui sɛ ɛwom sɛ pyriformis fossa no yɛ nea eye sen biara wɔ geometric kwan so de, nanso ɛde ɔhaw kɛse baa ntini a ɛwɔ asen no ti ne ntini ne ntini a atwa ho ahyia no so. Wɔsan sii saa nsɛm yi so dua denam afunu ho nhwehwɛmu a Ansari Moin ne ne mfɛfo yɛe so. WHO nso de nsɛm abien a wɔde hyɛ mu no totoo ho. Wɔhyɛɛ no ​​nsow sɛ nnadewa no mu a wɔde hyɛ mu fi ase wɔ pyriformis ntini no so no taa sɛe asen mu kyere a wɔkyere wɔn no ne akyi a ɛkyinkyini no. Bio nso, wohuu sɛnea medial rotator femoral artery no sɛe wɔ nsɛm no nyinaa mu (Table 2).

Table 2. Ntini a ɛyɛ mmerɛw a ɛpira wɔ needle entry points ahorow mu no ho nsɛm tiawa .
Nsakraeɛ .	Pyriform Fossa a ɛkɔ mu (n=5) .	Rotor aduan a wɔde ma kɛse (n=5) .
Ntini a ɛyɛ mmerɛw .
Gluteus medius ntini (Anatomy) .	5	1
Gluteus Medius ntini .	0	4
Ntini mu yare .
Gluteus minimus (Anatomy) .	3	0
Pyriformis ntini (wɔ akyi berɛmo no atifi) .	3	3
Obturator Internus (Anatomy) .	1	0
Latissimus dorsi ntini (Anatomy) .	3	0
Mogya ntini ne nkwaa a ɛwɔ nipadua no mu .
MFCA nkorabata a emu dɔ .	4	0
MFCA nkorabata a emu nnɔ .	4	0
articular capsule (a ɛyɛ nkwaa te sɛ kotodwe wɔ nipadua mu) .	1	0
MFCA: medial circumflex asen mu ntini.

Nnansa yi ara, Bharti ne afoforo. yɛɛ ɔhaw a ɛyɛ hu a ɛwɔ asen mu ntini mu nnadewa mu wɔ trochanteric a ɛkɔ mu kɛse no ne pearly fossa entry point no ho nhwehwɛmu na ohui sɛ ɔhaw ahorow no mu asiane te sɛ fracture healing rate na ɔbɔɔ no mua sɛnea edidi so yi (Table 3).

Table 3. Pyriform fossa kwan a ɛkɔ mu ne trochanter a ɛkɔ mu kɛse asen mu nnompe mu ntini .
Nsɛnnennen .	Piriformis Sinus Needle Point .	trochanter a wɔde hyɛ mu kɛse .
ɔyare mmoawa .	6.7	3.3
Malunion .	20	13.3
Ayaresa a ɛkyɛ .	20	13.3
Hip a ɛyɛ kakraa bi .	20	33.3
Nkotodwe a ɛkɔ fam kakraa bi .	6.7	6.7
Ntini no tenten a ɛne ne ho nhyia .	13.3	20
dua no ano a ɛwɔ nnompe no atifi no puei .	13.3	20
Oprehyɛn mu asen mu kɔn mu akisikuru .	10	0
Trochanter a ɛpaapae kɛse .	0	3.4
Asen mu ti necrosis .	6.7	0

Retrograde femoral intramedullary nnadewa .

Sɛ wohu baabi a ɛfata a wobetumi akɔ retrograde femoral intramedullary nailing mu a, ɛbɛboa ma wɔasan ayɛ fracture alignment, tenten, ne rotation bere a wɔtew articular cartilage a asɛe, anterior cruciate ligament (ACL), posterior cruciate ligament (ACL), ne soft tissue injury (Table 1) so. Nnansa yi, anigye a ɛrekɔ soro wɔ retrograde femoral intramedullary nailing ho a wɔn botae ne sɛ wɔbɛtew nsɛnnennen a ɛbata paracromial nnadewa ho no so, a nea ɛka ho ne asen mu yaw, heterotopic ossification, adductor mmerɛwyɛ, ne pudendal ntini palsy, a wobu no sɛ ɛyɛ kakraa bi a wɔde hyɛ wɔn ho mu bere a wɔde wɔn ho a wɔde to wɔn ho so ne wɔn a wɔapaapae mu no gyina hɔ ma wɔn a wɔapirapira no asɛnnua. Afei nso, adanse a nnansa yi ara adanse kyerɛ sɛ bere a saa nnadewa a wɔde kɔ akyi a wɔde kɔ akyi yi kɛse fata no, ebia ɛho nhia sɛ wɔde nnadewa a wɔde to mu no to nkyɛn.Nsonsonoe biara nni ayaresa dodow, bere a wɔde sa yare, anaasɛ nea efi mu ba a ɔyarefo bɔ ho amanneɛ wɔ Meccariello ne ne mfɛfo ntam no mu. ne Bisaccia ne afoforo. Wɔ ayaresa a ɛwɔ akyirikyiri nkyem abiɛsa mu biako femoral stem fractures a wɔde locking ne nonlocking retrograde intramedullary nnadewa di dwuma. Enti, asen mu nnadewa a ɛkɔ akyi a wɔde di dwuma no abɛyɛ nea nkurɔfo ani gye ho na wogye tom kɛse.

Yebetumi ahu nkyerɛkyerɛmu pii a ɛfa baabi a eye sen biara a wɔfa so hyɛn asen mu a ɛwɔ akyi no mu nnadewa a ɛkɔ akyi no mu wɔ nhoma ahorow mu. Nhwehwɛmu dodow no ara kyerɛ beae a eye a wobetumi akɔ akyi a ɛyɛ asen mu nnadewa no sɛ ɛyɛ 1.2 wɔ akyi a ɛyɛ akyi berɛmo no mfiase no ho .

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

Mfonini 6. Intraoperative orthostatic ne lateral views of the kotodwe a ɛkyerɛ beae a eye a wobetumi akɔ mu ama retrograde femoral intramedullary nail. '*' kyerɛ intramedullary nail a wɔde fi ase.

Ɛwom sɛ biribiara nni hɔ a ɛkyerɛ koraa sɛ wɔde nnadewa a ɛwɔ asen mu a ɛkɔ akyi no kɔ akyi de, nanso wɔaka nsɛnkyerɛnne ahorow pii a ɛfa ho ho asɛm. Eyinom bi ne polytrauma ayarefo, ayarefo a wɔayɛ kɛse mmoroso a wɔayɛ kɛse, ayarefo a wɔyem, afã abien asen mu ntini a ɛpaapae, ipsilateral femoral stem ne acetabular/pelvic fractures anaa femoral neck fractures, ne ipsilateral femoral stem ne tibial fractures. Saa nsɛnkyerɛnne yi mu dodow no ara fa sɛnea ɛyɛ mmerɛw sɛ ɔyarefo no besi ne ho na wosiw oprehyɛn akuru pii ano wɔ baabi a ɛbɛn no ho.

Ɔkwan foforo so no, nea ɛka ho koraa a ɛne asen mu ntini a ɛwɔ akyi no a wɔde si akyi no bɔ abira no bi ne sɛ wɔde aduru a wɔde hyɛ nipadua no mu a wɔakora so no asiw kwan a ɛkɔ akyi no kwan ne asen a ɛwɔ akyirikyiri no mu a ɛpaapae no ano. Nneɛma a wɔde tia no kakra ne mpaapaemu a ɛwɔ trochanter ketewa no mu sɛntimita 5, a ɛyɛ den sɛ wobenya baabi a wobetumi akɔ mu yiye esiane kotodwe a wɔde bɔ wɔn ho a ennu digrii 45 nti, na ebetumi ama asiane a ɛwɔ hɔ sɛ ɛbɛtrɛw akɔ asen no dua no mu, ntini a ɛyɛ mmerɛw a emu yɛ den a ɛfa apirakuru a ɛfa nkotodwe no ho, ne ntini a ɛwɔ ntini a ɛwɔ anim no mu ne wɔn a wɔde wɔn ho hyɛ ntini a ɛwɔ wɔn mu no mu.

Nsɛnnennen: Nsɛnnennen dodow no ara a ɛwɔ retrograde femoral nailing mu no fa sɛnea wɔde di dwuma wɔ ɔkwan a ɛmfata so ho, titiriw no, baabi a wɔde hyɛ mu no a wɔmfa nsi hɔ yiye no. Wɔ sagittal plane no mu no, anim a ɛkɔ anim kɛse no bɛma n’akyi abubu nkyerɛase, articular surface asɛe, na ebia nnadewa a ɛbɛbɔ patella no bere a kotodwe no abɔ no. Ɔkwan foforo so no, sɛ baabi a wɔhyɛn mu no gyina akyi kwan no so wɔ ɔkwan a ɛmfata so a, eyi betumi ama asiane kɛse aba sɛ wobepira wɔ akyi a ɛyɛ kurukuruwa no mfiase ne baabi a ɛwɔ anim no anim a ɛkɔ.

Hutchinson ne afoforo. kaa nsɛnnennen a ɛfa coronal plane entry points a ɛmfata ho no ho asɛm. Wohui sɛ mfinimfini kwan so hyɛn a ɛkɔ mu dodo no maa akyi berɛmo no yɛɛ mmerɛw bere a na akyi abubu akyi no, bere a nea ɛwɔ akyi dodo no maa ntamgyinafo no yɛɛ mmerɛw na wɔkyerɛɛ ase wɔ mfinimfini.Sanders et al. bɔɔ amanneɛ sɛ sɛ wɔpaw medial mfiase a ɛyɛ 2 cm anaa nea ɛboro saa fi medial axis no so a, ɛde medial cortical fracture a ɛyɛ malunited esiane akyi esthmic bending moment a ɛmaa fracture no bae a ɛmaa posterolateral so tew yiye.

Nsɛnnennen afoforo a ɛbata retrograde femoral follower nnadewa ho no bi ne kotodwe mu yaw, stiffness, heterotopic kotodwe ossification, ne intra-articular kotodwe a enni nipadua mu.

Fa ba awiei .

Ɛwom sɛ nnadewa a wɔde hyɛ nipadua no mu biara wɔ sɛnkyerɛnne a ɛne no hyia de, nanso ɔkwan a wɔfa so yɛ nnadewa a wɔde hyɛ nipadua no mu a wɔde bedi dwuma wɔ asen mu ntini a ɛpaapae no ayaresa mu no taa gyina oprehyɛn a wɔyɛ so. Sɛ woreyɛ intramedullary nail a ɛwɔ femur no mu a, ɛho hia sɛ wonya baabi a ɛfata ma nnadewa ko a wɔde di dwuma ma fixation no na ama nea ebefi mu aba no ayɛ yiye. Nimdeɛ a ɛfa mpɔtam hɔ nipadua ne mfoniniyɛ ho no bɛboa oduruyɛfo a ɔyɛ oprehyɛn no ma wayɛ ɔkwan a ɛfata wɔ mfiridwuma mu bere a ɛtew asiane a ɛwɔ ɔhaw ahorow a ɛbata ho no so. Bio nso, wɔ intramedullary nailing nhyehyɛe mu no, sɛ wɔtew so a, ɛyɛ ade titiriw a ɛma wosiw malunion ne malunion anaa nonion of fractures ano.