Femoral Intramedullary Nailing - Aleke Nàwɔ Tia Teƒe Nyuitɔ Kekeake?

Kpɔkplɔyiɖeme

Woate ŋu akpɔ afɔkpodzi ƒe gbagbãdɔdada ƒe ŋgɔyiyi tso ƒe 1940-awo me esime Kuntscher to mɔnu si nye closed intramedullary nailing technique vɛ. Intramedullary nails (IMNs) zazã le afɔkpodzi ƒe gbagbã me va zu beléle na ame ƒe dzidzenu le ƒe bla nane siwo va yi me, eye ŋgɔyiyi siwo wowɔ fifia le... intramedullary nailing kple ŋgɔyiyi siwo wowɔ le amekokomɔnu me na be wodzi afɔkpodzi ƒe intramedullary nailing zazã ɖe edzi ŋutɔ.

Dɔnɔ ʋɛ aɖewo ŋutɔ siwo ƒe dzesiwo tsi tre ɖe alɔ̃dɔdɔ kple amekoko ŋu vevie koe wozãa afɔkpodzi ƒe gbagbãdɔ ƒe atikewɔwɔ si me womezãa nu geɖe le o, eye atikewɔwɔ ƒe nu vevitɔ gakpɔtɔ nye amekoko ƒe nuléle ɖe te. Le amekoko ƒe atikewɔwɔ na ƒunukpeƒetetedɔ siawo gome la, mɔnu vovovowo li woate ŋu awɔ, siwo dometɔ aɖewoe nye be woatsɔ aŋe aƒo ɖe lãkusi me, woatsɔ gaƒoɖokui abla ɖe ʋuka me, eye woatsɔe abla ɖe gota. Ne wotsɔe sɔ kple amekoko ƒe mɔnu bubuwo la, ɖaƒoƒo ɖe lãkusi me nye mɔnu si me kuxiwo ƒe agbɔsɔsɔme le sue wu eye wòdaa gbe le amekoko ƒe gbagbã ŋu wu, eye wole ezãm geɖe wu le atikewɔnyawo me.

Ne wose afɔkpodzi si te ɖe eŋu ƒe ŋutilã ƒe wɔwɔme, ʋu si yia afɔkpodzi ƒe ta kple akɔta ƒe lãmekawo ƒe wɔwɔme gɔme nyuie ate ŋu ana afɔkpodzi ƒe gbagbã ƒe dzidzedzekpɔkpɔ nadzi ɖe edzi ŋutɔ. To vovo na ema la, afisi woato age ɖe eme tiatia nɔ te ɖe nu geɖe dzi, siwo dometɔ aɖewoe nye ɖa si le lãkusi me ƒe wɔwɔme, afisi wògbã le, afisi wògbã, kple dɔnɔwo ƒe nusiwo gbɔ wòtso (le kpɔɖeŋu me, nuveviwɔame geɖe, fufɔfɔ, kple lolo akpa). Teƒe ka kee woɖatia be woage ɖo o, teƒe nyuitɔ si woage ɖo xɔxɔ le vevie be woalé edziɖeɖekpɔtɔ si sɔ me ɖe asi le ɖaa dede lãkusi me esime wole kuxi siwo ate ŋu ado mo ɖa ƒe afɔkua dzi ɖem kpɔtɔ.

Femoral Anatomy (Afɔkpodzi ƒe Dzɔdzɔmeŋusẽŋununya).

1.Ʋu si naa afɔkpodzi ƒe ta

Afɔkpodzi ƒe ta xɔa ʋukawo tso ʋuka gã 3 me. Afɔkpodzi ƒe ʋuka si trɔna le axadzi (si me alɔ 3-4 le), ʋuka si xea mɔ na ʋuka si le goglo la, kple afɔkpodzi ƒe ʋuka si trɔna le titina (Nɔnɔm. 1), si hã ɖea ʋuka si yia dzi yia dzi si wɔa anastomose kple afɔkpodzi ƒe ʋuka si trɔna le axadzi eye wònaa trochanteric nuto gãtɔ.

2.Anatomy Of The Hip Lãmetsiwo

Ne wole afɔkpodzi ƒe atiwo ƒom 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 dzɔna tso ilium me eye wòwua enu ɖe ​​trochanter gãtɔ ƒe axadzi, gake gluteus minimus lãmeka hã dzɔna tso ilium me eye wòtoa akɔta ƒe ƒunukpeƒe ƒe megbe gome va wu enu ɖe ​​trochanter gãtɔ ƒe megbe gome (Nɔnɔmetata 2 & 3). Lãmetsi siawo evea siaa wɔa dɔ abe ata ƒe adductors kple akɔta ƒe ememe rotators ene. Eyata ne wogblẽ nu le lãmeka siawo ŋu le paracentric femoral intramedullary nail dede eme me ana adductor ƒe gbɔdzɔgbɔdzɔ kple Trendelenburg ƒe azɔlizɔzɔ, si kpɔa ŋusẽ gbegblẽ ɖe dɔnɔa ƒe hayahaya kple emetsonuwo dzi.

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

Figure 3. proximal femoral lãmeka ƒe attachment teƒe

Parallel Afɔkpodzi ƒe Intramedullary Nail

Numekuku geɖe siwo wowɔ nyitsɔ laa ku ɖe teƒe nyuitɔ si paracrine femoral nail ate ŋu age ɖo ŋu. Tiatia siwo woate ŋu age ɖe ɖaa me dometɔ aɖewoe nye trochanter gãtɔ kple pyriform fossa, siwo dometɔ ɖesiaɖe kple eƒe dzesiwo kple kuxi siwo do ƒome kplii (Tabla 1).

Table 1.Gɔmedzedze kple afɔku siwo ate ŋu anɔ paracrine kple retrograde femoral nailing me
vovototodedeameme	parallel intramedullary nail si sɔ kple wo nɔewo		megbedede si le lãkusi me
	rotor si woyɔna be rotor	pyriform fossa (ŋutilã ƒe wɔwɔme) .
fiakuku yameʋu	Trochanter gãtɔ ƒe ta eye wòfia asi medullary cavity le titina	trochanter gãtɔ kple afɔkpodzi ƒe kɔ ƒe ƒoƒo ɖekae	titina si le intercondylar fossa (ŋutilã ƒe wɔwɔme) .
sagittal yameʋu (akɔntabubu.) .	Fli si le trochanter gãtɔ ƒe titina kple afɔkpodzi ƒe lãkusi ƒe titina dome	pyriform fossa (ŋutilã ƒe wɔwɔme) .	PCL 1.2 cm do ŋgɔ na afɔkpodzi ƒe gɔmedzedze, si fia asi medullary cavity.
nusiwo woɖena fiana	Hip abductor ƒuƒoƒo ƒe tɔtrɔƒe ƒe abixɔxɔ	Ʋu si yia afɔkpodzi ƒe ta kple akɔta ƒe gotagome rotator lãmeka me ƒe gbegblẽ	Ne womewɔ nu ɖe ​​eŋu nyuie o ate ŋu ana woawɔ PCL
PCL: megbe atitsoga ƒe lãkusi

1.Gã rotor aŋe gege ɖe teƒe

Wogblɔ tso trochanter gãtɔ ŋu be enye ƒu si le gota wu si le trapezoidal ƒu si le afɔkpodzi ƒe kɔ ƒe axadzi, si ƒe anyime nana wòléna ɖe axadzi gluteus medius kple anterior gluteus minimus lãmekawo ŋu (Nɔnɔmetata 2 kple 3). Togbɔ be esia nye ƒu ƒe dzesi sue aɖe hã la, teƒe nyuitɔ si woadze egɔme tsoe ne wole afɔkpodzi ƒe IMN wɔm ate ŋu anye vovototo si le emetsonu si dzea ame ŋu alo esi menyo o kpɔkpɔ ne wole akɔta ƒe ke ƒe gbagbã gbɔ kpɔm dome.

Esi míeto agbalẽ siwo li fifia me hena afɔkpodzi ƒe gegeɖeƒe ƒe nuŋlɔɖiwo me la, míekpɔe be ŋutilã ƒe dzesi si woɖɔ nyuie na afɔkpodzi ƒe rotor IMN ƒe gegeɖeƒe ƒe anyimanɔmanɔ.Bharti et al. ɖɔ afisi gege ɖe eme tso trochanter gãtɔ ƒe ta ƒe ta be ele titina ɖo ta medullary cavity gbɔ le orthostatic nɔnɔme me, eye be enye trochanter gãtɔ ƒe titina le ɖekawɔwɔ me kple femoral medullary cavity ƒe titina le axadzinɔnɔme (Fig. 4), eye trochanter gãtɔ ƒe gegeɖeƒe ŋuti numeɖeɖe bubu le axadzi akɔtakpɔkpɔ me le rotor la me le ŋgɔgbe le anterior dome rotor la ƒe akpa etɔ̃lia ɖeka kple megbe eve le etɔ̃ me.Georgiadis et al. ɖɔ afisi aŋea gena ɖo be enye rotor la ƒe axa si le etame ƒe akpa si le megbe wu.

FIGURE 4. Intraoperative orthostatic kple lateral views of the hip ɖea teƒe nyuitɔ si woate ŋu age ɖo na femoral paramedian intramedullary nailing of the greater trochanter fia. '*' fia afisi wotsɔa ɖa le lãkusi me gena ɖe eme.

Numekuku siwo wowɔ nyitsɔ laa le agbalẽwo me ɖee fia be trochanter gãtɔ ƒe ta ye nye gɔmedzeƒe nyuitɔ si woate ŋu akpɔ ŋusẽ ƒe fli nyuitɔ, eye be alesi womewɔa ɖeka nyuie o le inversion deformity ta la dzɔna zi geɖe ne woɖe teƒe si woge ɖo wu milimeta 2 ɖe axadzi yi trochanter gãtɔ gbɔ. Numekuku sia te gbe ɖe edzi hã be afisi woge ɖo le megbe wu la hea ʋuʋu yi ŋgɔ le didiƒe vɛ, evɔ gegeƒe si le domedome ate ŋu ana be ʋuʋudedi ƒe mɔxenu si le didiƒe naʋu le megbe. To vovo na ema la, numekuku bubu ɖee fia be le akɔta ƒe gbagbã siwo le lãkusiwo dome me la, ɖa ƒe ƒoƒo ɖe lãkusi me ƒe dzɔdzɔ sɔ gbɔ ŋutɔ ne wotsɔ lãgbalẽgoe si le axadzi le ŋgɔgbe gome wu esi wotsɔ gaƒoɖokui si te ɖe titina kple megbe axa ŋu wu.

Wozãa trochanteric apex pinning point si lolo wu la zi geɖe le dɔnɔ siwo lolo akpa me, eye dɔ sia mebiaa mɔ̃ɖaŋununya boo o, si wɔnɛ be ɣeyiɣi si woatsɔ awɔ dɔe la mesɔ gbɔ o eye kuxiwo ƒe afɔku nɔa eme wu pyriform fossa pinning point.

KUXIWO: Woƒo nu tso kuxi siwo dona tso afɔkpodzi ƒe lãkusi me ƒoƒo si me trochanteric approach point lolo wu le dɔwɔwɔ me kple dɔwɔwɔ vɔ megbe ŋu le agbalẽ geɖe me. Esiawo dometɔ ɖeka, si do ƒome kple atitsotso ƒe mɔnu zi geɖe la, enye lãmekawo ƒe gbagbã le atikewɔwɔ me. Le akɔta ƒe gbagbã siwo le lãkusiwo dome me la, teƒe si gege ɖe eme si le axadzi kple ŋgɔgbe na akɔta si lolo wu la ate ŋu ana woagbã titina wu teƒe si te ɖe titina ƒe akpa ŋu.

Kuxi bubu si sɔ la tso abi siwo woxɔna le lãmeka falɛfalɛwo ŋu gbɔ, vevietɔ le alɔdze siwo le medial rotator femoral artery kple adductor muscles me, gake abi siawo mebɔ boo o ne wotsɔe sɔ kple pyriform fossa entry nail. Gakpe ɖe eŋu la, wosusu be ischemic necrosis si le afɔkpodzi ƒe ta si ƒe ta nye trochanter gãtɔ ƒe ta abe afisi wòge ɖo ene la le ʋɛ ŋutɔ, eye numekukuwo gblɔ be ebɔbɔ va ɖo 0.3%.

Ne míebu ɣeyiɣi si wozã le dɔwɔwɔ nɛ me kple fluoroscopic zazã ŋu la, dɔwɔwɔ ƒe ɣeyiɣi si wozãna le mama dedie nu nye miniti 90.7 na trochanteric ƒe gege ɖe teƒe si lolo wu ne wotsɔe sɔ kple miniti 112.7 na fossa ƒe gegeƒe si le abe pear ene ƒe ƒuƒoƒoa, gake fluoroscopic ɣeyiɣi ya nye sɛkɛnd 5.88 na trochanteric ƒe gege ɖe eme ƒe ƒuƒoƒo si lolo wu eye sɛkɛnd 10.08 na pear-nɔnɔme ƒe ƒuƒoƒoa fossa ƒe gegeƒe ƒe ƒuƒoƒo, ne wotsɔe sɔ kple fossa ƒe gegeƒe si le abe pear ene.

Dɔnɔwo ƒe nyagblɔɖi hã nye nu vevi aɖe ne wole nya me tsom le ɖa si le lãkusi me ƒe gege ɖe eme ŋu, elabena dɔwɔwɔ ƒe hayahaya kaba (abe alesi wodae kpɔ to zikpui-zikpui dodokpɔ kple ɣeyiɣi ƒe kɔkɔme dodokpɔ me ene) nyo ɖe edzi ŋutɔ le dɔnɔwo me le ɣleti 6 le dɔwɔwɔ vɔ megbe na trochanteric ƒe gege ɖe teƒe si lolo wu ne wotsɔe sɔ kple pyriform fossa ƒe gege ɖe eme ƒe ɖa, gake vovototo sia meɖe dzesi le ɣleti 12 le dɔwɔwɔ vɔ megbe o. Togbɔ be zi geɖe la. Wokpɔe be dynamic balance kple hip abductor strength dzi ɖe kpɔtɔ le dɔnɔ siwo ƒe trochanteric entry peg lolo wu me ne wotsɔe sɔ kple amesiwo le lãmesẽ me. Gakpe ɖe eŋu la, woƒe numekukua ka nya ta be ŋusẽ si le akɔta ƒe amelélawo, akɔtaƒuwo kple esiwo trɔna le ememe/gota gome dzi ɖe kpɔtɔ ŋutɔ ne wotsɔe sɔ kple akpa si womewɔ dɔ na o.

2. Pearly fossa ƒe gege ɖe eme

Pyriformis lãmeka ƒe fossa nye ŋutilã ƒe dzesi vevi aɖe si wode dzesii be enye teƒe siwo woage ɖo na paracentesis femoral intramedullary nail.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 kadodo hã o. Lãmetsia léna ɖe teƒe sue aɖe ŋu le lãkusi gãtɔ ƒe nugbɔ, gake pyriform fossa ya nyea ʋuʋudedi si le lãkusi gã la ƒe titina eye wònye lãmeka si kekena ɖe enu ƒe akpa si nye extensor carpi radialis brevis ƒe lãkusi. Agbalẽa ŋlɔlawo 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 eye ŋutilã ƒe wɔwɔme nasɔ. Wodo susua ɖa be le cis-femoral sɔsrɔ̃ vɔ megbe Wodo susua ɖa be woagbugbɔ nya gbãtɔ 'rotor fossa' ade agbalẽwo me ɖe 'pyriform fossa' teƒe le parafemoral ƒe gegeɖeƒe ƒe nyagbɔgblɔ sɔsrɔ̃ vɔ megbe. Togbɔ be wodea bubu numekuku eve siawo ƒe nyawo ŋu ŋutɔ hã la, be woaɖɔ wo bɔbɔe eye woaxe mɔ ɖe tɔtɔ kple trochanteric ƒe gegeɖeƒe gãtɔ nu la, míagayɔ gegeƒe sia kokoko be pyriform fossa ƒe gegeƒe.

Numekuku geɖe siwo le agbalẽ siwo li fifia me ɖɔ afisi tututu pearly fossa gena ɖo na intramedullary femoral nails nyuie.Georgiadis et al. ɖɔ pearly fossa ƒe gege ɖe eme be enye teƒe si extensor carpi radialis brevis lãmeka la léna ɖe eŋu le depression si le femoral neck ƒe gɔme (Fig. 5). Agbalẽa ŋlɔlawo te gbe ɖe edzi hã be afisi woge ɖo si yi ŋgɔ akpa alo yi ememe akpa ate ŋu ana afɔkpodzi ƒe kɔ ƒe gbagbã ƒe afɔkua nadzi ɖe edzi, eye ne afisi woge ɖo la yi megbe akpa la, afɔku gã aɖe ate ŋu anɔ ʋu ƒe sisi me, si sɔ gbɔ wu le dɔnɔ siwo nye ƒewuiviwo gome.

Figure 5. Intraoperative frontolateral view of the hip si ɖe teƒe nyuitɔ si woate ŋu age ɖo na pyriform fossa retrograde femoral intramedullary nail fia. '*' fia afisi ɖaa dze egɔme tsoe.

Harper kple exɔlɔ̃wo. ta numekuku aɖe si wowɔ le amegbetɔ ƒe akɔtaƒu ƒe hatsotso 14 ŋu le ƒe 1987 me si me woda afisi intramedullary guide pin le kple afisi intramedullary nail si wotsɔ de distally kple proximally le mɔ si trɔna ɖe megbe tso intercondylar notch of the femur la do le la kpɔ le. Woƒo nya ta be afisi pyriformis paramedian intramedullary nail la gena ɖo la le afisi trochanter gãtɔ kple afɔkpodzi ƒe kɔ do go le, le ŋgɔgbe vie na pyriformis occulta.Gausepohl et al. Le ame kuku ŋuti numekuku bubu me la, woɖo teƒe nyuitɔ si afɔkpodzi ƒe ɖa si le lãkusi me la ge ɖo le trochanter gãtɔ si le pyriformis lãkusia tame ƒe titina. Gawu la, le ame kuku ŋuti numekuku si Labronici et al. woɖɔ pyriformis lãmeka ƒe fossa be enye luminal nuto si le abe pear ene si sɔ kple titina axis si le femoral intramedullary cavity le coronal plane me.

Nusiwo gblẽ le pyriform fossa ƒe gege ɖe teƒea ŋu koŋ elabena le mɔ̃ɖaŋununya gome la, esesẽna wu ne wotsɔe sɔ kple trochanter ƒe gege ɖe teƒe si lolo wu, vevietɔ le dɔnɔ siwo lolo akpa gome. Tsɔ kpe ɖe eŋu la, teƒe nyuitɔ si woate ŋu age ɖo na fossa needle si le abe pear ene ƒe gege ɖe eme la nye teƒe si le gbadzaa, si wɔe be wòsesẽna wu be woanɔ teƒe ɖeka. Le kpɔɖeŋu me, gɔmedzedze si le ŋgɔgbe akpa le afɔkpodzi ƒe kɔ dzi ana gotagome ƒe nuteɖeamedzi nagbɔ eme eye wòana ŋgɔgbe lãkusi ƒe gbagbã ƒe afɔkua nadzi ɖe edzi, vevietɔ ne gɔmedzedzea wu milimeta 6 le ŋgɔgbe na afɔkpodzia. Tsɔ kpe ɖe eŋu la, nɔnɔme ƒe vovototo ate ŋu axe mɔ na afisi woage ɖo nyuie, vevietɔ ne gotagome ʋuƒo kpui si trɔna la lolo alo ʋuƒoa do go, si ana gegeƒe si le titina akpa eye wòate ŋu adzɔ be afɔkpodzi ƒe kɔ nagbã.

KUXIWO: Esi wotsɔ trochanteric gege ɖe teƒe gã 38 sɔ kple teƒe 53 siwo gena ɖe pearly fossa me hena femoral intramedullary nailing la, Ricci et al kpɔe be pearly fossa ƒuƒoƒoa ƒe dɔwɔwɔ ƒe ɣeyiɣi didi wu 30% eye fluoroscopy ƒe ɣeyiɣi didi wu 73%. Bhatti kple exɔlɔ̃wo ɖo kpe nusiwo ŋu woke ɖo siawo dzi. ne wotsɔ aŋea ƒe gegeƒe 2 sɔ kple wo nɔewo.

Le lãmeka falɛfalɛwo ƒe abixɔxɔ gome la, afɔku nɔ eme be lãmeka falɛfalɛwo naxɔ abi le pyriformis ƒe gege ɖe eme ne wotsɔe sɔ kple ƒuwo dome ahɔhɔ̃meka siwo le trochanteric needle ƒe gege ɖe teƒe si lolo wu. Dora kple exɔlɔ̃wo. da ame tsitsi 16 ƒe ame kuku ƒe afɔkpodziwo kpɔ be lãmeka falɛfalɛwo xɔ abi le pyriformis lãmeka kple rotor ƒe gege ɖe eme ŋu hã. Wokpɔe be togbɔ be pyriformis fossa la nyo wu le geometri gome hã la, egblẽ nu le ʋuka siwo yia afɔkpodzi ƒe ta kple lãmeka kple lãkusi siwo ƒo xlãe ŋu vevie wu. Wogaɖo kpe nusiwo ŋu woke ɖo siawo dzi to ame kuku ŋuti numekuku siwo Ansari Moin et al. WHO tsɔ teƒe eve siwo wotsɔ ge ɖe eme hã sɔ kple wo nɔewo. Wode dzesii be ɖaa ƒe ememe léle ɖe te si dze egɔme tso pyriformis lãmeka gbɔ ate ŋu agblẽ nu le akɔta ƒe amelénuwo kple gotagome tɔtrɔwo ŋu wu. Tsɔ kpe ɖe eŋu la, wokpɔ nusiwo gblẽ le medial rotator femoral artery ŋu le nɔnɔmeawo katã me (Tabla 2).

Table 2. Lãmetsi falɛfalɛ siwo xɔ abi le aŋe ƒe gege ɖe teƒe vovovowo ƒe kpukpui
vovototodedeameme	Pyriform fossa ƒe gege ɖe eme (n=5) .	Rotor ƒe nuɖuɖu ƒe teƒe gã (n=5) .
lãkusi falɛfalɛwo
gluteus medius lãmeka (ŋutilã ƒe wɔwɔme) .	5	1
gluteus medius ƒe lãkusi	0	4
lãkusi ƒe abixɔxɔ
gluteus minimus (ŋutilã ƒe wɔwɔme) .	3	0
pyriformis lãmeka (si le akɔta ƒe tame) .	3	3
obturator internus (ŋutilã ƒe wɔwɔme) .	1	0
latissimus dorsi lãmeka (ŋutilã ƒe wɔwɔme) .	3	0
Ʋukawo kple ƒunukpeƒewo
MFCA ƒe Alɔdzedɔwɔƒe Goglowo	4	0
MFCA ƒe Alɔdzedɔwɔƒe si me goglo o	4	0
articular capsule (si nye ƒunukpeƒe abe klo ene le ŋutilã ƒe wɔwɔme me) .	1	0
MFCA: medial circumflex afɔkpodzi ƒe ʋuka.

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

Table 3. Pyriform fossa ƒe gegeƒe kple trochanter gãtɔ ƒe gegeƒe afɔkpodzi ƒe ƒumeŋuɖui
kuxi sesẽ aɖe	Piriformis sinus ƒe aŋe ƒe teƒe	Trochanter ƒe nudede teƒe si lolo wu
Dɔlékuiwo xɔxɔ	6.7	3.3
Malunion ƒe ŋkɔ	20	13.3
Dɔyɔyɔ si tsi 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 nugbɔ dona ɖe ƒu ƒe lãkusi tame	13.3	20
Afɔkpodzi ƒe kɔ ƒe gbagbã le dɔwɔwɔ na ame me	10	0
Trochanter ƒe gbagbã gãtɔ	0	3.4
Afɔkpodzi ƒe ta ƒe kuku	6.7	0

Retrograde femoral intramedullary nailing

Nyanya afisi sɔ si woatsɔ age ɖe afɔkpodzi ƒe lãkusi me le megbe la akpe ɖe eŋu be woagbugbɔ afɔkpodzi ƒe gbagbã ƒe ɖoɖo nyuitɔ, didime, kple eƒe tɔtrɔ aɖo anyi esime woaɖe ƒunukpeƒe ƒe ƒunukpeƒe ƒe gbegblẽ, ŋgɔgbe ƒe atitsoga ƒe lãkusi (ACL), megbe ƒe atitsoga ƒe lãkusi (ACL), kple lãkusi falɛfalɛwo ƒe abixɔxɔ dzi akpɔtɔ (Tabla 1). Nyitsɔ laa la, amewo va tsɔ ɖe le megbedede ƒe afɔkpodzi ƒe lãkusi me kple taɖodzinu be woaɖe kuxi siwo dona tso paracromial nailing me dzi akpɔtɔ, siwo dometɔ aɖewoe nye akɔtave, heterotopic ossification, adductor ƒe gbɔdzɔgbɔdzɔ, kple pudendal nerve palsy, si wobuna be mexɔa ame boo o ne wotsɔe sɔ kple incisional reduction kple locking femoral plating for internal fixation, vevietɔ le afɔkpodzi ƒe akpa si le didiƒe ƒe akpa etɔ̃lia ƒe gbagbã me. Gakpe ɖe eŋu la, kpeɖodzi siwo wokpɔ nyitsɔ laa ɖee fia be ne ɖa siawo siwo trɔna yia megbe la ƒe lolome sɔ la, ɖewohĩ mahiã be woatsɔ ɖa siwo le proximal locking nails awɔe o. Vovototo aɖeke menɔ dɔyɔyɔ ƒe agbɔsɔsɔme, ɣeyiɣi si woatsɔ ada dɔe, alo emetsonu siwo dɔnɔwo ka nya ta le Meccariello et al. kple Bisaccia kple exɔlɔ̃wo. le afɔkpodzi ƒe ke ƒe akpa etɔ̃lia ƒe gbagbã siwo le didiƒe dada me to ɖa siwo le megbe siwo le megbe si wotu kple esiwo womexe o zazã me. Eyata afɔkpodzi ƒe ɖaƒoƒo si wotsɔna tsia megbe zazã va xɔ ŋkɔ eye wolɔ̃ ɖe edzi le afisiafi.

Woate ŋu akpɔ afisi woate ŋu age ɖo nyuie wu na megbedede ƒe afɔkpodzi ƒe lãkusi me nailing ŋuti numeɖeɖe geɖe le agbalẽwo me. Numekuku akpa gãtɔ ɖee fia be teƒe nyuitɔ si afɔkpodzi ƒe ɖa si trɔna yia megbe la age ɖo be enye 1.2 do ŋgɔ na afɔkpodzi ƒe gɔmedzedze si le megbe atitsoga ƒe lãkusi me

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

NUÐEÐEŊUTI 6. Kloa ƒe orthostatic kple axadzi nukpɔkpɔ siwo wowɔ le dɔwɔwɔ nɛ me si ɖe afisi sɔ nyuie si woate ŋu age ɖo na retrograde femoral intramedullary nail fia. '*' fia afisi ɖaa dze egɔme tsoe.

Togbɔ be naneke meli si fia bliboe be woate ŋu aƒo afɔkpodzi ƒe lãkusi me le megbe o hã la, woƒo nu tso dzesi geɖe siwo fia le wo nɔewo ŋu. Esiawo dometɔ aɖewoe nye dɔnɔ siwo ŋu nuveviwɔame geɖe le, dɔnɔ siwo lolo akpa, dɔnɔ siwo fɔ fu, afɔkpodzi ƒe akpa eve ƒe gbagbã, afɔkpodzi ƒe akpa eve kple acetabular/pelvic ƒe gbagbã alo afɔkpodzi ƒe kɔ ƒe gbagbã, kple afɔkpodzi ƒe axa kple afɔkpodzi ƒe gbagbã. Dzesi siawo ƒe akpa gãtɔ do ƒome kple dɔnɔa ƒe nɔƒe bɔbɔe kple mɔxexe ɖe amekoko ƒe abi geɖe siwo te ɖe wo nɔewo ŋu nu.

Le go bubu me la, nusiwo tsi tre ɖe megbedede ƒe afɔkpodzi intramedullary nailing ŋu keŋkeŋ dometɔ aɖewoe nye be woaxe mɔ na retrograde intramedullary channel to nusi wotsɔ de eme si wolé ɖe te kple afɔkpodzi si le didiƒe ƒe gbagbã. Nusiwo tsi tre ɖe eŋu le mɔ aɖe nue nye gbagbã siwo le sentimeta 5 tso trochanter suetɔ gbɔ, esesẽna be woage ɖe teƒe nyuitɔ si woage ɖo le klo ƒe ƒoƒo si mede dzidzenu 45 o ta, klo ƒe dɔléle do ŋgɔ si ate ŋu ahe afɔku vɛ be wòakaka ɖe afɔkpodzi ƒe ke me, abi sesẽ siwo le lãmeka falɛfalɛwo ŋu ƒo xlã kloa, kple intra-articular fracture of the inferior pole of the patella kple atikpo si le didiƒe ʋĩi.

Kuxi siwo dona tso eme: Kuxi siwo dona tso afɔkpodzi ƒe ɖaƒoƒo si yi megbe me ƒe akpa gãtɔ do ƒome kple alesi womewɔa nu nyuie o, vevietɔ ne wometsɔ teƒe si woge ɖo la ɖo nyuie o. Le sagittal plane me la, teƒe si woge ɖo le ŋgɔgbe wu ana megbe gbagbã ƒe gɔmeɖeɖe, ƒunukpeƒe ƒe akpa si agblẽ, eye ɖewohĩ ɖa naƒo ɖe akɔta ne wobɔbɔ kloa. Le go bubu me la, ne womeɖo afisi woage ɖo le megbemɔ si mesɔ o la, esia ate ŋu ana afɔku gã aɖe nanɔ anyi be woaxɔ abi le megbe ƒe atitsoga ƒe lãkusi ƒe dzɔtsoƒe ŋu eye teƒe si gbã la naʋuʋu le ŋgɔgbe.

Hutchinson kple exɔlɔ̃wo. ƒo nu tso kuxi siwo dona tso coronal plane ƒe gege ɖe teƒe siwo mesɔ o ŋu. Wokpɔe be titina ƒe gegeɖeƒe si gbɔ eme na megbe ƒe akpa ƒe nɔnɔme madeamedzi kple megbe ƒe gbagbã ƒe gɔmeɖeɖe, gake axadzi ƒe akpa si gbɔ eme ya na titina ƒe nɔnɔme gbegblẽ kple titina ƒe gɔmeɖeɖe.Sanders et al. ka nya ta be titina gɔmedzedze si didi sentimeta 2 alo esi wu nenema tso titina ƒe axadzi tiatia na titina ƒe lãkusi ƒe gbagbã si wowɔ malunited le megbe isthmic bending moment of the fracture si he posterolateral reduction nyuie o vɛ.

Kuxi bubu siwo do ƒome kple afɔkpodzi yomedzelawo ƒe atitsotso le megbe dometɔ aɖewoe nye klo ƒe vevesese, eƒe sesẽ, klo ƒe ƒu ƒe ʋuʋu le mɔ vovovowo nu, kple ŋutilã si me klo mele o ƒe wɔwɔme le ƒunukpeƒe.

Ƒo eta

Togbɔ be dzesi si sɔ ɖe enu le aɖuɖɔtoe me ƒoƒo ƒe mɔnu ɖesiaɖe ŋu hã la, zi geɖe la, amekola ƒe didi dzie wotia be woazã aɖuɖɔtoe me ƒoƒo ƒe mɔnu si woazã le afɔkpodzi ƒe ke ƒe gbagbãwo dada me. Ne wole afɔkpodzi ƒe atitsoga ƒom la, ehiã be woakpɔ afisi woage ɖo nyuie na ɖa ƒomevi si wozãna tsɔ léa ɖae hafi woate ŋu akpɔ dzidzedze. Nutoa me ŋutilã ƒe wɔwɔme kple nɔnɔmetatawo ɖeɖe ƒe dɔwɔwɔ ŋuti sidzedze akpe ɖe amekolaa ŋu wòawɔ dɔ si sɔ le mɔ̃ɖaŋununya nu esime wòaɖe kuxi siwo do ƒome kplii ƒe afɔkua dzi akpɔtɔ. Tsɔ kpe ɖe eŋu la, le aɖuɖɔtoe me ƒoƒo ƒe mɔnuwo me la, edzi ɖeɖe kpɔtɔ me léle ɖe asi nye akpa vevi aɖe le mɔxexe ɖe dɔmawɔmawɔ nyuie kple dɔmawɔmawɔ nyuie alo nonunion of fractures nu me.