Femoral Intramedullary Nailing - Aleke woatia nu nyuitɔ kekeake si woatsɔ ade eme?

Kpɔkplɔyiɖeme

Woate ŋu akpɔ afɔkpodzi ƒe gbagbã ƒe atikewɔwɔ ƒe ŋgɔyiyi tso ƒe 1940-awo me esime Kuntscher to ʋuka me ɖaƒoƒo ƒe mɔnu si wotu la vɛ. lãkusi si le lãkusi me zazã (IMNS) zazã le afɔkpodzi ƒe gbagbã me va zu beléle na ame le ƒe bla nane siwo va yi me, kple ŋgɔyiyi siwo wowɔ fifia le . Ame ƒe lãkusi me ƒoƒo kple amekokomɔnu ƒe ŋgɔyiyi na be akɔta ƒe lãkusi zazã dzi ɖe edzi ŋutɔ.

Wozãa afɔkpodzi ƒe lãkusi ƒe gbagbã si me womezãa atike si wozãna le mɔ si sɔ nu o la le dɔnɔ ʋɛ aɖewo ŋutɔ siwo ƒe atikewɔwɔ kple amekoko si me womedea atike si wua ame o vevie le la ko me, eye atikewɔwɔ vevitɔa gakpɔtɔ nye amekoko ƒe nuléle. Le amekoko ƒe atikewɔwɔ na gbagbã siawo gome la, tiatia geɖe li woate ŋu awɔ, siwo dometɔ aɖewoe nye lãkusi me ƒoƒo, plate screw fixation, kple external fixation. Ne wotsɔe sɔ kple amekoko ƒe tiatia bubuwo la, intramedullary nailing nye mɔnu si me kuxiwo ƒe agbɔsɔsɔ si bɔbɔ wu le eye wòdaa gbe le ame ŋu ƒe agbɔsɔsɔ si lolo wu, eye wole ezãm geɖe wu le atikewɔnyawo me.

Gɔmesese nyui le akɔta ƒe akpa si te ɖe eŋu ƒe ŋutilã ƒe wɔwɔme ŋu, ʋu ƒe tsɔtsɔ yi afɔkpodzi ƒe ta kple akɔta ƒe lãkusiwo ƒe wɔwɔme ate ŋu ana afɔkpodzi ƒe gbagbã ƒe dzidzedzekpɔkpɔ nadzi ɖe edzi ŋutɔ. To vovo na esia la, teƒe si woatia la nɔ te ɖe nu geɖe dzi, siwo dometɔ aɖewoe nye ɖa ƒe wɔwɔme si le lãkusi me, teƒe si wogbã, ƒu gbagbã ƒe comminution, kple dɔnɔa ƒe nɔnɔmewo (le kpɔɖeŋu me, polytrauma, fufɔfɔ, kple lolo akpa). Eɖanye teƒe ka kee wotia o, teƒe si sɔ la xɔxɔ le vevie be woalé edzi ɖeɖe kpɔtɔ nyuie me ɖe asi le ɖa ƒe lãkusi dede eme me esime woaɖe kuxiwo ƒe afɔkua dzi akpɔtɔ.

Afɔkpodzi ƒe wɔwɔme .

1.Ʋu ƒe tsɔtsɔ yi afɔkpodzi ƒe ta .

Afɔkpodzi ƒe ta xɔa ʋukawo tso ʋuka gã 3 me. Lateral rotator femoral artery (si me alɔdze 3-4 le), obturator artery, si naa lãkusi si le gogloe la, kple medial rotator femoral artery (Fig. 1), si hã ɖea ʋuka si le dzi yim si le dzi yim kple lateral rotator femol areg.

2.Anatomy of the hip muscles .

Ne wole akɔta ƒe akpa si le lãkusi me wɔm la, lãmeka siwo le teƒe si ƒo xlã rotor la gɔmesese nyuie le vevie be woaxe mɔ ɖe abi si mehiã o nu. Gluteus medius lãmeka la dzɔ tso ilium la me eye wòwu enu ɖe ​​axadzi ƒe akpa si le trochanter gãtɔ me, esime gluteus minimus lãmeka hã dzɔ tso ilium la me eye wòtoa akɔta ƒe akpa si le megbe ƒe akpa si nye trochanter gãtɔ ƒe megbe gome (nɔnɔmetata 2 & 3). Lãmetsi siawo evea siaa wɔa dɔ abe akɔta ƒe adductorwo kple akɔta ƒe akpa si le eme ene. Eyata lãmeka siawo ƒe gbegblẽ le paracentric femoral intramedullary nail dodo me ana adductor ƒe gbɔdzɔgbɔdzɔ kple trendelenburg azɔlizɔzɔ, si kpɔa ŋusẽ gbegblẽ ɖe dɔnɔwo ƒe hayahaya kple emetsonu dzi.

Fig. 2. Lãmetsi siwo ƒo xlã akɔta ƒe ƒunukpeƒea ƒe wɔwɔme .

Figure 3. Proximal femoral muscle attachment area .

Parallel femoral intramedullary nail .

Numekuku geɖe siwo wowɔ nyitsɔ laa ku ɖe afisi sɔ nyuie na paracrine ƒe afɔkpodzi ƒe ɖa ŋu. Nail entry point tiatiaawo dometɔ aɖewoe nye trochanter gãtɔ kple Pyriform fossa, ɖesiaɖe kple eƒe dzesiwo kple kuxi siwo do ƒome kplii (Tabla 1).

Table 1.Dzeɖoɖo teƒewo kple afɔku siwo ate ŋu anɔ paracrine kple retrograde femoral nailing .
Variant .	Parallel intramedullary nail .		Retrograde Intramedullary Nail .
	Rotor .	Pyriform fossa (anatomy) .
Fiakuku ƒe yameʋu .	Trochanter gãtɔ ƒe ta kple asifiafia le titina na medullary cavity .	gãtɔ ƒe ƒoƒo . Trochanter kple afɔkpodzi ƒe kɔ	ƒe titina . Intercondylar fossa (anatomy)
Sagittal Plane (Akɔntabubu.) .	Fli si le trochanter gãtɔ ƒe titina kple afɔkpodzi ƒe lãkusi ƒe titina dome .	Pyriform fossa (anatomy) .	PCL 1.2 cm anterior na afɔkpodzi ƒe gɔmedzedze, si fia asi medullary cavity.
Nusiwo woɖena fiana .	Hip abductor ƒuƒoƒo ƒe tɔtrɔƒe ƒe abixɔxɔ .	Ʋu ƒe sisi le afɔkpodzi ƒe ta kple akɔta ƒe gotagome rotator lãmeka ŋu ƒe gbegblẽ .	Ne wowɔ nu ɖe ​​ame ŋu nyuie o la, ate ŋu ana PCL nava .
PCL: megbeƒuƒu ƒe lãkusi .

1.Large rotor needle ƒe gege ɖe teƒe .

Wogblɔ tso trochanter si lolo wu ŋu be enye ƒumeŋuɖui si le gota wu si le gota gome si le afɔkpodzi ƒe kɔ ƒe axadzi ƒe akpa dzi, si ƒe akpa si le eƒe anyime naa lateral gluteus medius kple anterior gluteus minimus muscles (Nɔnɔmetata 2 kple 3). Togbɔ be esia nye ƒu ƒe dzesi sue aɖe hã la, teƒe si woadze egɔme tsoe nyuie ne wole afɔkpodzi ƒe IMN wɔm ate ŋu anye vovototo si le emetsonu si naa dzidzeme ame alo esi menyo o xɔxɔ ne wole nu wɔm kple afɔkpodzi ƒe lãkusi ƒe gbagbã.

Esi míeto agbalẽ siwo li fifia na afɔkpodzi ƒe gege ɖe teƒewo me ŋuti numeɖeɖewo me la, míekpɔe be ŋutilã ƒe wɔwɔme ƒe dzesi si ŋu woƒo nu tsoe nyuie la ƒe anyimanɔmanɔ na afɔkpodzi ƒe rotor IMN ƒe gege ɖe eme.Bharti et al. ɖɔ afisi woage ɖo tso apical apex si le Greater Trochanter me be enye titina na medullary cavity le orthostatic position me, eye be enye trochanter gã la ƒe titina le fli me kple afɔkpodzi ƒe medullary cavity le axadzi ƒe nɔnɔme me le rotor la dome le rotor la dome le rotor la dome la nye le The Greater trotor me le rotor la dome), eye wònye nusi le megbe le rotol la ƒe titina, eye wònye nusi le ŋgɔgbekpa dzi la dome (Fig. Rotor ƒe megbe eve le etɔ̃ me.Georgiadis et al. ɖɔ afisi aŋea ge ɖo be enye megbe ƒe akpa si le megbe wu le apical superior margin of the rotor.

Figure 4. Akɔta ƒe orthostatic orthostatic kple lateral views fia teƒe si sɔ nyuie na afɔkpodzi ƒe paramedian intramedullary nailing of the greater trochanter. '*' fiaa lãkusi si le eme ƒe gege ɖe eme.

Numekuku siwo wowɔ nyitsɔ laa le agbalẽwo me ɖee fia be trochanter gãtɔ ƒe ta nye gɔmedzeƒe nyuitɔ kekeake si woatsɔ akpɔ ŋusẽ ƒe fli nyuitɔ kekeake, eye be ɖekawɔwɔ nyui si le tɔtrɔ ɖe megbe ƒe nɔnɔme madeamedziwo ta la dzɔna zi geɖe ne woɖe teƒe si woge ɖo la wu 2 mm lateral ɖe trochanter gã la ŋu. Numekuku sia te gbe ɖe edzi hã be megbe ƒe teƒe si woate ŋu age ɖo wu la hea distal forward displacement vɛ, gake dometsotso si le domedome ate ŋu ana be distal fracture block la naʋu le megbe. To vovo na esia la, numekuku bubu ɖee fia be le intertrochanteric femur fractures me la, intramedullary nail impingement ƒe dzɔdzɔ sɔ gbɔ ŋutɔ kple pinning point si nye axadzi na anterior see wu pinning point si te ɖe medial kple posterior axawo ŋu.

Wozãa trochanteric apex pinning point gãtɔ zi geɖe le dɔnɔ siwo lolo akpa me, eye dɔdamɔnu sia mebiaa mɔ̃ɖaŋununya boo o, si wɔnɛ be ɣeyiɣi si me womewɔa dɔ le o kple kuxiwo ƒe afɔku si bɔbɔ ɖe anyi wu pyriform fossa pinning point.

Kuxiwo: Woƒo nu tso afɔkpodzi ƒe lãkusi me ƒoƒo ƒe kuxi siwo le dɔwɔwɔ me kple dɔwɔwɔ vɔ megbe ŋu eye woƒo nu tso trochanteric mɔnu si lolo wu ŋu le agbalẽ geɖe me. Esiawo dometɔ ɖeka, si do ƒome kple atitsotso ƒe mɔnu zi geɖe lae nye gbagbãƒe siwo le atikewɔwɔ me. Le intertrochanteric femoral fractures me la, afisi wogena ɖo si le lateral kple anterior to the greater trochanter la ate ŋu ana titina nagbã wu afisi woate ŋu age ɖe titina le titina ƒe akpaa gbɔ.

Kuxi bubu si sɔ la tso abi siwo woxɔna le lãkusi falɛfalɛwo me gbɔ, vevietɔ le medial rotator femoral artery kple adductor muscles ƒe alɔdzewo ŋu, gake abi siawo mebɔ o ne wotsɔe sɔ kple pyriform fossa entry nail. Tsɔ kpe ɖe eŋu la, afɔkpodzi ƒe ta ƒe ischemic necrosis ƒe dzɔdzɔ kple trochanter gãtɔ ƒe ta abe alesi wosusu be eƒe gege ɖe eme le sue ŋutɔ ene, eye numekukuwo gblɔ be eɖiɖi abe 0.3% ene.

Ne míebu dɔwɔwɔ me ɣeyiɣi kple fluoroscopic exposure ŋu la, dɔwɔwɔ ƒe ɣeyiɣi le mama dedie nu nye miniti 90.7 na trochanteric ƒe gege ɖe teƒe gãtɔ ne wotsɔe sɔ kple miniti 112.7 na fossa ƒe gege ɖe eme ƒe ƒuƒoƒo si le abe pear ene, gake fluoroscopic ɣeyiɣi nye 5.88 sɛkɛnd ƒe nɔnɔme ƒe ƒuƒoƒo kple 10.

Dɔnɔwo ƒe nyagblɔɖi hã nye nu vevi aɖe ne wole nya me tsom le ɖa ƒe gege ɖe lãkusi me ŋu, elabena dɔwɔwɔ ƒe hayahaya kaba (abe alesi wodae kpɔ to zikpui-zikpui dodokpɔ kple ɣeyiɣi ƒe kɔkɔme dodokpɔ si woɖo ɣeyiɣi na me ene) nyo ŋutɔ le dɔnɔ siwo le ɣleti 6 me le dɔwɔwɔ vɔ megbe na trochanteric ƒe gege ɖe teƒe 12 ƒe fossa fossa me, gake menye pyriform fossa o. Togbɔ be zi geɖe la, trochanteric access point si lolo wu la do ƒome kple tissue stripping si mebɔ o le afisi wòle ta hã la, ate ŋu ana woaxɔ abi kokoko le abductor muscle group la ŋu, abe alesi Ergiş et al. Wokpɔe be dynamic balance kple hip abductor strength dzi ɖe kpɔtɔ le dɔnɔ siwo ŋu trochanteric entry peg si lolo wu le ne wotsɔe sɔ kple lãmesẽ me tɔwo. Tsɔ kpe ɖe eŋu la, woƒe numekukua ka nya ta be ŋusẽ dzi ɖe kpɔtɔ ŋutɔ le akɔta ƒe ʋuʋudediwo, flexors kple ememe/gotagome rotators ƒe akpa si womewɔ dɔ le o ŋu.

2. Pearly fossa ƒe gege ɖe eme ƒe teƒe .

Pyriformis lãmeka ƒe fossa nye ŋutilã ƒe wɔwɔme ƒe dzesi vevi aɖe si woɖe fia be enye teƒe siwo wogena ɖo na Paracentesis ƒe afɔkpodzi ƒe lãkusi ƒe ɖa.Le woƒe amekuku ŋuti numekuku me la, Lakhwani et al. de dzesii be pyriformis lãmeka ƒe fossa menye 'pear' ƒe nɔnɔme alo pyriformis lãmeka ƒe kpeɖeŋutɔ o. Lãmetsi la léa ɖe teƒe sue aɖe le trochanter gãtɔ ƒe nugbɔ, gake pyriform fossa ya nye blanuiléle le trochanter gãtɔ ƒe titina ƒe akpa dzi eye wònye extensor carpi radialis brevis lãmeka ƒe kpeɖeŋutɔ. Agbalẽŋlɔlawo ƒo nya ta be pyriform lãmeka kple pyriform fossa nye nu vovovo eve eye be ele be woayɔ nusi woyɔna be pyriform fossa be 'rotor' alo 'occlusal' fossa hena eme kɔ kple anatomical correctness. Wodo susua ɖa be le cis-femoral sɔsrɔ̃ megbe la wodo susu ɖa be woagaɖe nya gbãtɔ 'rotor fossa' ɖe go le agbalẽwo me ɖe 'Pyriform Fossa' teƒe le nusɔsrɔ̃ tso parafemoral entry point ƒe nyagbɔgblɔ ŋu vɔ megbe. Togbɔ be wodea bubu numekuku eve siawo ƒe teƒewo ŋu ŋutɔ hã la, be woate ŋu aɖɔ wo bɔbɔe eye be woaxe mɔ ɖe tɔtɔ kple trochanteric ƒe gege ɖe teƒe si lolo wu nu hã la, míagayɔ teƒe sia si wogena ɖo be Pyriform Fossa ƒe gege ɖe eme.

Numekuku geɖe siwo wowɔ le agbalẽ siwo li fifia me la ƒo nu tso alesi tututu pearly fossa gena ɖe emee ŋu pɛpɛpɛ na intramedullary femoral nails.Georgiadis et al. Ðe pearly fossa ƒe gege ɖe teƒe si nye extensor carpi radialis brevis lãmeka le blanuiléle me le afɔkpodzi ƒe kɔ gɔme (Fig. 5) ƒe akpa si wotsɔ kpe ɖe eŋu. Agbalẽa ŋlɔlawo te gbe ɖe edzi hã be afisi wogena ɖo si didi akpa alo yi didiƒe akpa ate ŋu ana afɔkpodzi ƒe kɔ nagbã ƒe afɔkua nadzi ɖe edzi, eye ne afisi wogena ɖo la didi akpa la, afɔku gã aɖe ate ŋu anɔ eme be ʋu si me ʋu sina tona le ʋu me, si sɔ gbɔ wu le ƒewuiviwo me.

Figure 5. Intraoperative frontolateral view of the hip si ɖea afisi sɔ nyuie na pyriform fossa retrograde femoral intramedullary nail afia. '*' la fiaa lãkusi ƒe gɔmedzedze ƒe gɔmedzedze.

Harper kple exɔlɔ̃wo. Wota numekuku aɖe tso amegbetɔ ƒe ame kuku ƒe afɔkpodzi ƒe ƒuƒoƒo 14 ŋu le ƒe 1987 me si me woda afisi ʋuka me mɔfianu ƒe pin le kple afisi wodo ɖa le ɖe lãkusi me si woto vɛ le didiƒe kple teƒe si te ɖe eŋu le akɔta ƒe notch si le lãkusia dome la me. Woƒo nya ta be teƒe si Pyriformis Paramedian Intramedullary Nail la gena ɖo la le trochanter gãtɔ si ŋu afɔkpodzi ƒe kɔ le la ƒe ƒoƒoƒe, si do ŋgɔ vie na pyriformis occulta.Woda asi ɖe teƒe si wotsɔ de eme la dzi to Gausepohl et al. Le ame kuku ŋuti numekuku bubu me la, wova nɔ teƒe nyuitɔ si wogena ɖo na afɔkpodzi ƒe lãkusi si le lãkusi me le trochanter gãtɔ si le pyriformis ƒe lãkusia tame la ƒe titina. Gakpe ɖe eŋu la, le ame kuku ƒe numekuku si Labronici et al. Wogblɔ tso pyriformis lãmeka ƒe fossa ŋu be enye luminal-nuto si le abe pear ene si sɔ kple afɔkpodzi ƒe lãkusi ƒe titina ƒe titina le coronal plane me.

Nu aɖewo koŋ le Pyriform Fossa ƒe mɔ̃ si wotsɔna ɖea nu me la ŋu elabena le mɔ̃ɖaŋununya gome la, esesẽna wu ne wotsɔe sɔ kple trochanter ƒe mɔ̃ si lolo wu, vevietɔ le dɔnɔ siwo lolo akpa me. Tsɔ kpe ɖe eŋu la, teƒe nyuitɔ si woate ŋu age ɖo na fossa-aŋe si le abe pear ene la nye teƒe si le gbadzaa, si wɔnɛ be wònyea teƒe si wòle be woawɔe le. Le kpɔɖeŋu me, gɔmedzedze ƒe gɔmedzedze si gbɔ eme le afɔkpodzi ƒe kɔ dzi ana nutome ƒe nuteɖeamedzi si gbɔ eme nava eye wòadzi afɔku si le ŋgɔgbekpa ƒe gbagbã me ɖe edzi, vevietɔ ne gɔmedzedzea wu 6 mm ŋgɔgbe na fossa. Tsɔ kpe ɖe eŋu la, nɔnɔme ƒe vovototo ate ŋu axe mɔ ɖe teƒe si sɔ si me woage ɖo la nu, vevietɔ ne gotagome rotator kpui la lolo alo rotor la do ɖe gota, si na be woate ŋu age ɖe eme si le titina akpa eye wònye afɔku be afɔkpodzi ƒe kɔ nagbã.

Kuxiwo: To 38 gãtɔ trochanteric gege ɖe teƒe 53 pearly fossa gege ɖe teƒewo na femoral intramedullary nailing, Ricci et al kpɔe be pearly fossa ƒuƒoƒoa ƒe 30% didi wu dɔwɔwɔ ɣeyiɣi kple 73% didi fluoroscopy ɣeyiɣi. Woɖo kpe nusiwo ŋu woke ɖo siawo dzi to Bhatti et al. Ne èle 2 Needle ƒe gegeɖe teƒewo sɔm kple wo nɔewo.

Le abi si woxɔna le lãme falɛfalɛwo ŋu gome la, afɔku nɔ eme be woaxɔ abi le lãkusi falɛfalɛwo me le pyriformis ƒe mɔ̃a me ne wotsɔe sɔ kple interosseous neuruscular si le trochanteric needle entry point gãtɔ me. Dora kple exɔlɔ̃wo. Woda ame tsitsiwo ƒe ame tsitsi ƒe afɔti 16 kpɔ be woxɔ abi le lãkusi falɛfalɛwo ŋu le pyriformis lãmeka kple rotor entry pin ŋu. Wokpɔe be togbɔ be pyriformis fossa la sɔ nyuie wu hã la, egblẽ nu le ʋukawo ƒe ta kple lãmeka kple lãkusi siwo ƒo xlãe ŋu vevie wu. Wogaɖo kpe nusiwo ŋu woke ɖo siawo dzi to numekuku siwo Ansari Moin et al. ame siwo hã tsɔ teƒe eve siwo woge ɖe eme la sɔ kple wo nɔewo. Wode dzesii be lãgbalẽa ƒe ememe ƒoƒo si dze egɔme tso pyriformis lãmekaa dzi la ate ŋu agblẽ nu le akɔta ƒe ʋuʋudediwo kple gotagome rotators ŋu wu. Tsɔ kpe ɖe eŋu la, wokpɔ nusiwo gblẽ le medial rotator femoral artery ŋu le nɔnɔmeawo katã me (Tabla 2).

Table 2. Nuveviwɔame le lãkusi falɛfalɛwo me ƒe kpukpuiwo le aŋe siwo wotsɔna gena ɖe eme vovovowo me .
Variant .	Pyriform Fossa ƒe Nyatakakadzraɖoƒe (n=5) .	Rotor ƒe nuɖuɖuƒe gã (n=5) .
Lãmetsi falɛfalɛwo .
Gluteus medius lãmeka (anatomy) .	5	1
Gluteus Medius ƒe lãkusi .	0	4
Nuveviwɔame le lãkusi me .
Gluteus minimus (anatomy) .	3	0
Pyriformis lãmeka (le akɔta ƒe tame) .	3	3
Obturator Internus (anatomy) .	1	0
Latissimus dorsi lãmeka (anatomy) .	3	0
Ʋukawo kple ƒunukpeƒetetedɔ .
MFCA ƒe alɔdze siwo me goglo .	4	0
MFCA ƒe alɔdze si me goglo o .	4	0
articular capsule (si nye ƒunukpeƒe abe klo le ŋutilã ƒe wɔwɔme me ene)	1	0
MFCA: Medial Circumflex ƒe afɔkpodzi ƒe ʋuka.

Nyitsɔ laa la, Bharti kple exɔlɔ̃wo gblɔ be: wosrɔ̃ nu tso kuxi si le afɔkpodzi ƒe lãkusi me ƒoƒo ŋu le trochanteric ƒe gege ɖe teƒe si lolo wu kple pearly fossa ƒe gege ɖe teƒea me eye wokpɔ kuxi ƒe afɔkuwo abe gbagbã ƒe dɔyɔyɔ ƒe agbɔsɔsɔ ene eye woƒo wo nu ƒu abe alesi gbɔna ene (Tabla 3).

Table 3. Pyriform fossa ƒe gege ɖe teƒe kple trochanter gãtɔ ƒe gege ɖe teƒe si wogena ɖo afɔkpodzi ƒe ƒumeŋuɖui .
Kuxiwo .	Piriformis sinus ƒe aŋenu .	Greater trochanter ƒe nudede teƒe .
Dɔlékuiwutikewo .	6.7	3.3
Malunion .	20	13.3
Dɔyɔyɔ si wohe ɖe megbe .	20	13.3
Akɔta ƒe ʋuʋu si seɖoƒe li na .	20	33.3
Klo ƒe ʋuʋu si seɖoƒe li na .	6.7	6.7
abɔ kple afɔ ƒe didime ƒe vovototo .	13.3	20
Asike ƒe nutrenu la dona ɖe ƒumeŋuɖui tame .	13.3	20
Afɔkpodzi ƒe kɔ ƒe gbagbã le dɔwɔwɔ me .	10	0
Greater trochanter fracture .	0	3.4
Afɔkpodzi ƒe ta ƒe kuku .	6.7	0

Retrograde Femoral Intramedullary Nailing .

Ne woɖo afisi sɔ na gege ɖe megbe na megbefɔti ƒe lãkusi ƒe ɖaƒoƒo akpe ɖe ame ŋu be woagbugbɔ aɖo akɔta ƒe ɖoɖo nyuitɔ kekeake, didime, kple tɔtrɔ gbɔ esime woaɖe articular cartilage ƒe gbegblẽ dzi akpɔtɔ, anterior cruciate ligament (ACL), megbe 1). Nyitsɔ laa la, ɖetsɔleme si le dzidzim ɖe edzi ɖe megbefɔti ƒe afɔkpodzi ƒe ƒoƒoe ŋu kple taɖodzinu be woaɖe kuxi siwo do ƒome kple paracromial nailing dzi akpɔtɔ, si me akɔta ƒe vevesese, heterotopic ossification, adductor weakness, kple pudendal nerve palsy, si wobuna be indirely invasive kple incisal of the frac of the internal invasive, Afɔkpodzi ƒe ke. Tsɔ kpe ɖe eŋu la, kpeɖodzi siwo wokpɔ nyitsɔ laa ɖee fia be ne megbeƒuƒu siawo siwo trɔna ɖe megbe la ƒe lolome sɔ la, ɖewohĩ mahiã be woahiã na ɖa siwo te ɖe wo nɔewo ŋu o.Vovototo aɖeke menɔ dɔyɔyɔ ƒe agbɔsɔsɔme, ɣeyiɣi si woatsɔ ada gbe le ame ŋu, alo emetsonu siwo dɔnɔa gblɔ le Meccariello et al. eye Bisaccia kple exɔlɔ̃wo gblɔ be: Le afɔkpodzi ƒe ke ƒe gbagbã akpa etɔ̃lia ƒe akpa etɔ̃lia ƒe dɔwɔwɔ me to ʋuƒo si wotsɔna ƒoa nu kple esiwo me womexea ʋu ɖo o zazã me. Eyata afɔdzidede si trɔna ɖe megbe zazã va xɔ ŋkɔ eye ame geɖe lɔ̃ ɖe edzi.

Woate ŋu akpɔ nu geɖe tso teƒe nyuitɔ si wogena ɖo na megbefɔti ƒe lãkusi me ƒoƒoe ŋu le agbalẽwo me. Numekuku akpa gãtɔ ɖee fia be mɔ nyuitɔ si dzi woato age ɖe afɔkpodzi ƒe ɖaƒoƒo megbe la nye 1.2 anterior na afɔkpodzi ƒe megbeƒuƒu ƒe afɔti ƒe dzɔtsoƒe .

CM (si sɔ kple medullary cavity) kple intercondylar fossa ƒe titina (Nɔnɔmetata 6).

Figure 6. klo ƒe orthostatic orthostatic kple lateral views si ɖee fia be woge ɖe eme nyuie na retrograde femoral intramedullary nail. '*' fiaa lãkusi ƒe gɔmedzedze ƒe gɔmedzedze.

Togbɔ be womeɖe dzesi blibo aɖeke na retrograde femoral intramedullary nailing o hã la, woƒo nu tso nu geɖe siwo ɖee fia le ƒomedodo me ŋu. Esiawo dometɔ aɖewoe nye polytrauma dɔnɔwo, dɔnɔ siwo lolo akpa, dɔnɔ siwo fɔ fu, afɔkpodzi ƒe lãkusi ƒe akpa eve ƒe gbagbã, afɔkpodzi ƒe afɔkpodzi ƒe lãkusi kple acetabular/akɔta ƒe gbagbã alo afɔkpodzi ƒe kɔ ƒe gbagbã, kple ipsilateral femoral stem kple tibial fractures. Dzesi siawo ƒe akpa gãtɔ do ƒome kple dɔnɔwo ƒe nɔƒe bɔbɔe kple mɔxexe ɖe amekoko ƒe abi gbogbo siwo te ɖe wo nɔewo ŋu gbɔ.

Le go bubu me la, nusiwo tsi tre ɖe wo nɔewo ŋu keŋkeŋ le megbefɔti ƒe lãkusi me ƒoƒoe ŋu dometɔ aɖewoe nye mɔxexe ɖe megbe ƒe ʋuka si wogbugbɔna ɖe megbe to akɔta ƒe akpa si wotsɔ de eme si wolé ɖe te kple eƒe akpa si le didiƒe ƒe akpa si le ʋuʋu ɖi la gbɔ. Nusiwo woate ŋu awɔ le ƒomedodo me nye gbagbãƒe siwo le trochanter si le sue wu gbɔ sentimeta 5 me, si sesẽna be woage ɖe teƒe nyuitɔ si woage ɖo le klo ƒe ʋuʋu si mede dzidzenu 45 o ta, klo ƒe dɔléle si nɔ anyi do ŋgɔ si ate ŋu ana afɔku nanɔ eme be wòakaka ɖe afɔkpodzi ƒe akpa si le klo ƒe akpa si le ƒoƒom sesĩe la gbɔ, kple infer-tissue si le klo ƒe akpa si le lãme na ame vevie la ŋu.

Kuxiwo: Afɔkpodzi ƒe ɖaƒoƒo megbe ƒe kuxi akpa gãtɔ do ƒome kple asiléle ɖe nu ŋu le mɔ si mesɔ o nu, vevietɔ teƒe si wogena ɖo la ɖoɖo ɖe mɔ si mesɔ o nu. Le sagittal plane me la, teƒe si woate ŋu age ɖo le ŋgɔgbe wu la ana woaɖe megbeƒu gɔme le megbe, aɖukpodzi ƒe anyigba ƒe akpa si le anyime, kple ɖewohĩ ɖa ƒe ʋuʋu le patella la dzi ne wobɔbɔ kloa. Le go bubu me la, ne teƒe si wogena ɖo la le megbe le megbe gome la, esia ate ŋu ana afɔku gã aɖe nasu ame si be wòaxɔ abi le megbeƒu ƒe lãkusi ƒe dzɔtsoƒe kple ŋgɔgbea ƒe ʋuʋu le ŋgɔgbe.

Hutchinson kple exɔlɔ̃wo. ƒo nu tso kuxi siwo do ƒome kple coronal plane entry points siwo mesɔ o ŋu. Wokpɔe be titina ƒe gege ɖe eme ƒe teƒe si gbɔ eme na be megbeƒuƒu ƒe nɔnɔme de megbe kple megbeƒuƒu ƒe gɔmeɖeɖe, gake axadzi si gbɔ eme na be medial deformity kple medial translation.Sander et al. Woka nya ta be tiatia le titina gɔmedzedze si nye 2 cm alo esi wu nenema tso medial axis la na medial cortical fracture si wowɔ malunited le posterior isthmic bending moment of the fracture si na be megbeƒuƒu dzi ɖeɖe kpɔtɔ manyomanyo ta.

Kuxi bubu siwo do ƒome kple afɔdzidela ƒe ƒoƒo ɖe megbe la dometɔ aɖewoe nye klo ƒe vevesese, sesẽ, klo ƒe ʋuʋu si me heterotopic le, kple klo ƒe wɔwɔme si me klonu mele o.

Ƒo eta .

Togbɔ be dzesi si sɔ kple wo nɔewo le lãkusi me ƒoƒo ƒe mɔnu ɖesiaɖe ŋu hã la, zi geɖe la, atike si wozãna le lãkusi me ƒe mɔnu si woazã le afɔkpodzi ƒe lãkusi ƒe gbagbãwo dada me nɔa te ɖe amekola ƒe didi dzi. Ne wole akɔta ƒe akpa si le lãkusia me wɔm la, ehiã be woakpɔ afisi sɔ na ɖa ƒomevi si wozãna tsɔ léa nu ɖe ​​te hena emetsonu dzidzedzetɔe. Nutoa me ƒe ŋutilã ƒe wɔwɔme kple nɔnɔmetatawo ɖeɖe ƒe dɔwɔwɔ ŋuti sidzedze akpe ɖe amekolaa ŋu wòawɔ dɔ si sɔ le mɔ̃ɖaŋununya gome esime wòaɖe kuxi siwo do ƒome kplii ƒe afɔkua dzi akpɔtɔ. Tsɔ kpe ɖe eŋu la, le intramedullary nailing procedures me la, edzi ɖeɖe kpɔtɔ nye nu vevi aɖe le mɔxexe ɖe malunion kple malunion alo nonunion of fractures nu me.