5 ka'idodin aikace-aikacen ƙusa intramedullary da dabarun tiyata!

Ka'idodin asali na intramedullary nailing

1. Tarihin ƙusa intramedullary

A cikin 1910, an yi amfani da kusoshi na intramedullary na Lilienthal aluminium don magance karyewar ramin femoral.

A cikin 1913, Schone ya yi amfani da kusoshi na intramedullary na azurfa don magance karyewar hannu. 

Kuntscher (1900-1972) ya ba da gudummawa mai yawa ga gyaran ƙusa na intramedullary. 

1960s da 1970s wani lokaci ne na saurin haɓakar kusoshi na intramedullary. 

kasata tana amfani da su da yawa tun daga 1990s.

2. Buɗe raguwa da raguwar rufewa

1. Ana iya rage karayar gaɓoɓin hannu ta hanyar tiyata a ƙarƙashin hangen nesa kai tsaye ko kuma a rufe ƙarƙashin sa ido na X-ray.

2. Bude raguwar karaya lokacin warkarwa yana da tsayi sosai, zubar jini na ciki ya fi yawa, kuma raguwar buɗewa yana ƙara lalata samar da jini zuwa ƙarshen karaya.

3. Ana ba da shawarar yin amfani da rufaffiyar raguwa gwargwadon yiwuwa. Za a iya amfani da na'urar rage juzu'i, ko kuma za a iya yin ɗan guntuwa a kan jirgin da ya karye don pryw da ragewa, ta yadda za a rage tsangwama tare da samar da jini zuwa ƙarshen karaya.

4. Domin rufaffiyar raguwar gazawar, jujjuya guntun kashi ko huda kyallen jikin da ke kewaye, da manyan gutsuttsuran karaya, ana iya amfani da raguwar buɗewar tiyata.

3. Tsarin gyarawa na intramedullary ƙusa

1. Hanyar intramedullary ƙusa na ciki na ciki shine daidaitawar tsaka-tsakin tsakiya na tsakiya.

2. Gyaran karaya ta hanyar ƙusa na intramedullary shine ƙaddamarwa mai rarraba damuwa, ba gyarawar garkuwar damuwa ba, wanda ya dace da siffar callus.

3. Ƙaddamarwa ta tsakiya yana da mahimmanci fiye da gyaran gyare-gyare na waje na cortical, wanda zai iya rage karfin karfi, rage yawan abin da ya faru na valgus angulation da rashin daidaituwa na ciki.

4. Intramedullary ƙusa gyarawa yana samar da tushen rufaffiyar raguwa ko raguwa mai iyaka.

4.Amfanin intramedullary kusoshi

1. Ƙananan rikitarwa

2. Fadada girman alamun tiyata

3. Tsayawa mai ƙarfi

4. Horon aikin haɗin gwiwa na farko

5. Hawan nauyi da wuri

6. Ana iya amfani dashi a hade tare da sauran gyara na ciki

Nau'ukan asali da Dabaru

1. Kulle da kusoshi na intramedullary marasa kullewa

2. Dynamic and static locking intramedullary kusoshi

3. Medullary fadadawa da kuma hanyoyin gyaran gyare-gyaren da ba na medullary ba

4. Buɗe da rufaffiyar dabarun gyarawa

Yin cudanya da juna

Kusoshi na intramedullary na yau da kullun suna da ƙarancin kwanciyar hankali da ƙarancin ƙarfi, amma suna da ƙayyadaddun elasticity kuma suna iya murmurewa bayan nakasawa, suna haifar da ɗan ƙaramin zamewar ciki.

Interlocking intramedullary kusoshi suna da mafi kyawun jujjuyawar jujjuyawar juzu'i da tasirin matsawa, kwanciyar hankali mai kyau, da kuma dacewa da ƙa'idar gyaran halittu. Ana amfani da su sosai a cikin dogayen ƙasusuwan gaɓoɓi. Musamman ga Multi-segment da comminuted fractures, suna da mafi kwanciyar hankali fiye da talakawa intramedullary kusoshi.

Dynamization na a tsaye gyarawa

A tsaye kulle kusoshi intramedullary kusoshi suna samar da danniya abin rufe fuska kuma a halin yanzu galibi ana ba da shawarar don aikin da ba na yau da kullun na haɓakawa.

Ga karayar da ba ta warke ba a watanni 6 zuwa 8 bayan tiyatar, a wurin gyaran kashi ko maye gurbin faɗaɗa ƙusoshin ciki tare da haɓakawa ana amfani da su.

Za a iya amfani da haɓakawa azaman hanyar haɓaka waraka. Ba a ba da shawarar akai-akai domin yana iya haifar da gajarta gaɓoɓi da nakasar juyawa.

Fadada bargo da bazuwar bargo

Fadada marrow na iya shigar da kusoshi na intramedullary tare da diamita mafi girma da ƙarfi mafi girma, wanda ke dacewa da horon aiki da wuri kuma yana rage ƙimar fashe kusoshi.

Fadada marrow na iya haifar da adadi mai yawa na tarkacen kashi tare da tasirin osteoinductive, wanda ke da tasiri ga waraka.

Fadada marrow zai lalata jinin samar da tasoshin abinci mai gina jiki da membrane na endosteal, amma tasoshin jini na iya sake farfadowa tare da kogon kusoshi na intramedullary. Fadada marrow kuma na iya ƙara yawan zagayawa na jini a kewayen tsokar nama mai laushi, ta haka yana haɓaka warkar da karaya.

Ƙwaƙwalwar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta kamata a yi amfani da shi tare da taka tsantsan don raunin da ya faru, raunuka masu yawa, da kuma raunin da ya faru.

Amfanin fadada medullary

① Bayan fadada medullary, yanki na lamba tsakanin ƙusa intramedullary da kashi yana ƙaruwa, wanda ya inganta kwanciyar hankali na gyarawa. 

② Bayan fadada medullary, ana iya amfani da ƙusa mafi girma diamita, wanda ke ƙara ƙarfin ƙusa na intramedullary kuma yana rage yawan kusoshi masu karya. 

③ tarkacen kasusuwa bayan fadada medullary na iya haifar da sabon samuwar kashi, wanda ke taimakawa wajen waraka karaya.

Idan aka kwatanta da medullary fadada kusoshi na intramedullary, kusoshi marasa fa'ida na intramedullary suna da fa'idodi masu zuwa.

① Gajeren lokacin aiki da ƙarancin jini. 

② Ƙananan tsangwama tare da kwararar jini na endosteal a lokuta tare da raunin nama mai laushi mai tsanani.

Aikace-aikace na intramedullary ƙusa

Humeral interlocking intramedullary ƙusa

Alamomi ga humeral kusoshi

Alamu na kusoshi masu tsaka-tsakin tsaka-tsakin intramedullary na humeral a cikin maganin ɓarkewar ɓarna na humeral sune: karaya tare da lalacewar jijiyoyin jini da jijiyoyi, raunin da yawa, raunin rashin ƙarfi, raunin ƙwayoyin cuta, da raunin humeral na kusa.

Matsakaicin da za'a iya gyarawa shine daga 2cm ƙasa da kan humeral zuwa 3cm sama da fossa olecranon. Kuna iya zaɓar gyara shi daga kafada tare da ƙusa intramedullary antegrade ko daga gwiwar hannu tare da ƙusa na baya.

Halayen kusoshi na humeral

Hanyoyin gyare-gyaren tiyata don karyewar shaft na humeral shine ainihin gyaran farantin karfe da gyaran ƙusa na intramedullary.

Gyaran farantin yana da ƙarfin jujjuyawar jujjuyawa da kaddarorin lankwasawa kuma an daidaita shi sosai, amma raunin tiyata yana da girma, yuwuwar kamuwa da cuta yana da girma, kuma jijiya na radial yana da sauƙin lalacewa.

Modern humeral interlocking da kai kusoshi shawo kan shortcomings na talakawa intramedullary kusoshi irin su axial rashin zaman lafiya, matalauta juyi iko, da kuma bukatar ƙarin gyarawa, sabõda haka, karye ne da tabbaci gyarawa, da jini hasãrar ne kananan, da taushi nama tsiri ne m, da kuma medullary fadada shi ne daidai da na gida kashi dasawa ya bayyana ko da dasa shuki, da za a iya fara aiki da wuri, da kayan aiki da za a iya rarraba da wuri. tiyata.

Matsakaicin ƙusa na intramedullary na mata

Alamu don kusoshi masu haɗakar mata na femoral

Duk nau'ikan karaya mai nisan 2cm a ƙasa da kashin jijiyoyi da fiye da 9cm daga haɗin gwiwa.

Tsohuwar karaya na tsakiyar ɓangaren sashin mata.

Marasa lafiya tare da gazawar faranti na ciki.

Siffofin ƙusa haɗakar mata

Amfanin injiniyoyi

Ƙarfin ƙarfin femoral interlocking intramedullary ƙusa don gyara karaya ya fi tsayi fiye da na faranti na karfe, kuma an rarraba karfi a ko'ina a tsakiyar axis na dukan kashi, wanda ba shi da sauƙi don lankwasa da lalacewa.

Kusoshi masu kullewa a duka ƙarshen ƙusa na intramedullary suna sa kashi ya zama gaba ɗaya daga sama zuwa ƙasa, kuma kusoshi masu kullewa a ƙarshen ƙarshen zai iya rage karfin jujjuyawar ƙusa na intramedullary a cikin kashi, hana raguwa da juyawa, da samun matsakaicin kwanciyar hankali da tsayin daka don gyaran karaya.

Gamma Interlocking Intramedullary Nail

Alamun ƙusa gamma

Ana amfani da nau'ikan karaya na peritrochanteric daban-daban, musamman karaya na subtrochanteric.

Alamun ƙusa Gamma (ƙusa sake ginawa).

high subtrochanteric fractures, trochanteric hade tare da femoral shaft fractures.

Amfanin farcen Gamma

Haɓaka ta hanyar haɗa dunƙule hip ɗin ƙusa tare da fasahar ƙusa intramedullary, babban ƙusa yana kusa da cikin rami na medullary fiye da farantin hip mai tsauri, don haka ƙusa Gamma yana gudanar da nauyin majiyyaci kusa da kalandar femoral fiye da farantin hip mai tsauri, yana haɓaka ƙarfin injin da aka saka. Don karaya na subtrochanteric da ke tattare da tsaka-tsaki na cortical comminution, ƙusa Gamma yana guje wa buƙatun sake gina jiki na karaya, don haka yana da fa'ida ga ɓarnawar intertrochanteric ko raunin subtrochanteric.

Retrograde intramedullary femoral nailing

Alamun retrograde femoral kusoshi

An fi amfani da shi don karaya na mata na supracondylar, gami da raunin raunin da ya faru na supracondylar da intercondylar 'T' da 'Y' da aka samu karaya masu dauke da saman articular.

Hakanan za'a iya amfani dashi don karyewar mata a ƙarƙashin isthmus na femur.

Shaft na mata, supracondylar femoral, da intercondylar fractures tsakanin 20CM daga haɗin gwiwa.

Wadanda suka kasa gyara faranti.

Halayen retrograde femoral nailing

Supracondylar femoral fracture shine mummunan karaya tare da wahala a farkon, raguwa kuma na biyu, ƙaƙƙarfan gyaran ciki. Akwai babban abin da ya faru na rikice-rikice kamar karyewar rashin haɗin gwiwa da jinkirin warkarwa.

Retrograde interlocking intramedullary nailing shine hanyar da aka saba amfani dashi don magance raunin femur a cikin 'yan shekarun nan, wanda ke da kwanciyar hankali na injiniya mai kyau, zai iya sarrafa matsuguni na baya da jujjuyawar juzu'i na ƙarshen fashe, kuma yana taimakawa a farkon motsin haɗin gwiwa.

Supracondylar hade karaya karayar mata yana gyarawa tare da tsayin supracondylar intramedullary nailing, wanda ke magance matsalar da ke da wahalar warwarewa ta hanyar ƙusa intramedullary na femur. Kayan aiki yana da sauƙi don aiki, daidai a matsayi, abin dogara a gyarawa, kuma mai haƙuri zai iya yin aikin motsa jiki na farko bayan tiyata.

Tibial interlocking intramedullary kusoshi

Alamomi don ƙusa tibial

Karya mai tsayayye a tsakiyar 1/3 na tibia: karaya mai jujjuyawa, gajeriyar karayar da ba ta dace ba, pseudarthrosis.

Karya mara ƙarfi a cikin 60% na tsayin tibia na tsakiya: karaya kusa da metaphysis, ɓarkewar karkace mai tsayi, ɓarna ɓarna, ɓarnawar ɓarna, ɓarna tare da lahani na kashi.

Halayen ƙusa tibial

Matsakaicin kusoshi na intramedullary na tibia galibi ana amfani dashi don karyewar tibia ta tsakiya.

Ko da yake ana iya amfani da shi don raunin tibia na kusa da nisa, ƙimar rikitarwa ya fi girma, malunion yana faruwa sau da yawa, ƙarshen karayar yana da ≧1cm na motsi a cikin 1/2 na lokuta, kuma 1/4 na gyarawa ya kasa.

Littattafai sun ba da rahoton kyakkyawan sakamako na karayar tibia mai nisa fiye da karayar tibia na kusa bayan gyaran fibula na yau da kullun.

Dabarun tiyata

Preoperative shiri na musamman kayan aiki

Kwancen gado na Orthopedic (gado mai raɗaɗi) ko daidaitaccen gadon tiyata na fluoroscopic; retractor; hoton intensifier.

Daidaitaccen zaɓi na tsayin ƙusa na intramedullary don endoprostheses na farko

Gidan rediyo

ma'aunin tsayin gaɓoɓin hannu

Intramedullary ƙusa diamita

x-ray isthmus nisa

Intramedullary ƙusa tsawon awo

1.Translucent yanke hukunci a karkashin C-arm inji

Ƙarshen nesa da kusa da ƙasusuwan sun kasance a kan tsakiya na hasken; mai mulki ya yi daidai da diaphysis.

2.Length ma'auni bisa ga alamar saman jiki

Femur: tip na mafi girma trochanter → sararin gwiwa gwiwa ko mafi girman sandar patella; tibia: sarari gwiwa na tsaka-tsaki → bangaren gaba na hadin gwiwar idon kafa a dorsiflexion na ƙafa.

Dabarun Shigar Ƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙirar Shiga

Dogayen axis na kogon medullary a madaidaiciyar layi

Ba kusa da wurin shigarwa ba

Tsawon da ya dace: dilated - tsayi; undilated - gajere

(Tabbacin kai tsaye na wurin shigarwa; babu dilation na ɓangaren litattafan almara, babu kariya mai laushi da ake buƙata)

Daidaitaccen wurin shigar ƙusa intramedullary na mata

Shirye-shiryen hanyar shigarwa don ƙusa na intramedullary na mata na layi daya

Juyawar hips da tsotsa

Tsayin tsayin daka kusa da mafi girma trochanter

Bai yi nisa ba

Sanya fil ɗin jagora

Sanya garkuwar nama mai laushi

Retrograde femoral intramedullary ƙusa wurin shiga

30° jujjuyawar gwiwa

Dogon axis na fil ɗin jagora a hanya ɗaya da ramin medullary na gindin femoral mai nisa.

Shigar da fil ɗin Kirschner a cikin femur mai nisa ta hanyar ligament na patellar ta hannun rigar kariya: orthogonal - tsakiyar tsakiya na intercondylar fossa na femur; na gefe - layin Blumensaat

Farawa na PCL ba tare da rauni ba

Daidaitacce tibial intramedullary ƙusa wurin shiga

A tsakiyar layin medullary

Gefen gaba na tibial plateau

Mai girma gwargwadon yuwuwa ba tare da lalata tudun mun tsira ba

Matsakaicin jujjuyawar gwiwa

Ciwon tibial tuberosity-ƙananan sandar patella tare da kogon medullary

Bude rami na medullary: fil ɗin jagora a 15 ° zuwa jirgin sama na sagittal na axis na tsayin tibial

Matsayin mai ƙara hoto

Dabarun marrowing

Rage wutar lantarki

sabbin karaya

Rage hannun hannu

tsohuwar karaya tare da pseudoarthrosis, sclerosis a cikin rami na medullary

Babu yawon shakatawa a ƙarƙashin hauhawar farashin kaya

zagawar jini shine mafi kyawun sanyaya

Dabarun sake sanyawa

Daidaici na femoral intramedullary nailing

Dalilan wahala wajen dawo da karaya na femoral

Kundin nama mai kauri baya bada izinin shiga kai tsaye zuwa kashi

Ba za a iya ganin wurin shigar allura kai tsaye ba

Ƙunƙarar haɗin gwiwa na hip → iliac fascia tashin hankali → rage karaya

Rage karayar Tibial

Yin magudi

Mafi yawa subcutaneous da sauki palpate

Karya mai ƙarfi - tsakiyar ko nisa nau'in A da B

Karyar da ba ta dace ba - wuce kima

Intramedullary nailing→ kayan aikin maye gurbin

Matakan rage mataimaka

Ƙaddamar da rage maki

tibia; percutaneous ko rauni amfani

Manyan retractors (kwangin gyaran kafa)

rage jinkiri; rage gabobi

Schanz na ɗan lokaci

① Femur, tibia

② Kusa da layin karaya kamar yadda zai yiwu

③ Matsakaicin karaya guda ɗaya amfani

④ Yi amfani da chuck na duniya tare da T-handle don sauƙin motsa jiki

Poller ƙusa

① Metaphyseal fracture (gyara layin karfi, daidaitawa maidowa, maido da aiki)

② raunin da ya faru na distal tibia ko femur (danniya mai karfi → matsa lamba)

③ Rashin matsayi mara kyau na intramedullary kusoshi suna shiga tsohuwar tashar medullary yayin tiyata na sakandare

④ Matsayi mara kyau na shigarwa, rashin daidaituwa mara kyau na kusanci (dunƙule da aka sanya daidai da yuwuwar ƙaura na endplant)

Yawon shakatawa mai faɗi

① tibia

② an haɗa shi ta hanyar ƙwanƙwasa ko retractor

③ Yi amfani da hankali a cikin raunin nama mai laushi mai tsanani

④ Tsaya shi gajere

⑤ Haramta faɗaɗa medullary a cikin halin kumbura

Jerin kulle ƙusa: distal sannan kusanci

Amfani

sauƙi na ƙwanƙwasa, matsawa karya karya; kawar da rabuwa; ayyukan ragewa.

Dabarun ragewa don jinkiri & tiyatar rashin haɗin kai

Matsalolin da za a iya fuskanta tare da jinkirin tiyata

Nakasar axial (gajewa, angulation ko ƙaura)

Girma a cikin nama na granulation

Kashin farko

Sclerosis na karaya karya tare da rufewa na medullary cavity

Osteoporosis

Matsalolin ciki mai yiwuwa

Juyawar ƙusa da ƙusa na intramedullary → shiga cikin ƙusa na intramedullary na cortex

Nakasa angular → retractor

Rushewar ƙarewar da aka yanke → ƙusar poller, gyaran faranti

Hanyoyi don hana ƙananan layin ƙarfi

Proximal - daidai wurin shigarwa

Distal - ƙusa intramedullary a tsakiyar rami na medullary

Matsalolin Nailing Intramedullary

★kamuwa da cuta

★Lalacewar jijiya

★Gwargwadon waraka daga karaya

★Rashin Lafiya

Juyawa na waje, torsion, valgus, jujjuyawar ciki, angulation

★ Ciwon gabobi na kusa

★Fat embolism

★Heterotopic ossification

★ kumburin huhu

★Sake karaya

★Thombosis

★Taurin hadin gwiwa

★Rashin haduwar karaya, rashin haduwar kashi

★Rashin gyaran ciki

★Gajartar gabobi

★Sauran

Matsalolin--kamuwa da cuta

1. Tun da farko, an yi la'akari da karaya a buɗe a matsayin abin da ya hana intramedullary nailing.

2.Abin da ya faru na kamuwa da cuta bayan tiyata a cikin ɓarna a buɗe ya dogara da matsayi na rauni mai laushi da gurɓatawa.

Abubuwan da ke faruwa na kamuwa da cuta bayan fashewar budewa ya dogara ne akan yanayin raunin nama mai laushi da gurɓatawa da kuma yadda ake sarrafa nama mai laushi.

3.Thinner intramedullary kusoshi ƙara da damar kamuwa da cuta; ba-faɗi na kulle intramedullary kusoshi gyarawa ne in mun gwada da matalauta, da kashi iyakar da

Gyaran ƙusa na intramedullary wanda ba a faɗaɗa shi ba yana da ƙarancin ƙarancin ƙarfi, tare da motsi na microscopic na karyewar ƙarshen kasusuwa da ragowar rami, wanda ke da sauƙin haɓakar ƙwayoyin cuta.

4. The use of expanded and limited expanded medullary fixation not only improves the stability of the fracture, but also avoids the creation of a dead space.

Fat Embolism Syndrome

1.Abin da ya faru na FES na dogon tubular kashi karaya shine 0.5% zuwa 2%.

2. Fadada medulla da rashin fadada medulla ba shi da wani tasiri mai mahimmanci akan iskar huhu.

3.Lokacin da fadada medulla, dabarar ya kamata a durƙusa a hankali, guje wa ƙarfi da ƙarfi da aiki mai ƙarfi.

4.A halin yanzu ganewar asali na FES har yanzu rungumi ka'idojin da Gurd ya gabatar a cikin 1974, kuma magani bayan ganewar asali zai jinkirta mafi kyawun lokaci don magani kuma yana iya samun sakamako mai tsanani.

Jinkirin warkar da karaya da rashin haɗin kashi

Abubuwa daban-daban suna shafar warkar da karaya bayan gyaran ƙusa na intramedullary, kuma ana iya bincikar musabbabin kamar haka.

1.taushi mai laushi da aka saka a ƙarshen karaya

2. Rabewar karaya ta ƙare

3. Yawan tsufa na majiyyaci

4. Bude karaya, mummunan rauni mai laushi, mummunan hemodialysis na gida ko kamuwa da cuta.

5. Rashin gyaran ƙusa na intramedullary

6. Hadaddiyar ciwon suga ko wasu cututtuka masu amfani da su.

Karyawar Likita

Karayar da ke haifar da likitanci galibi karaya ce ta biyu sakamakon magudin da bai dace ba yayin gyaran farce ta intramedullary.

Ya kamata a biya kulawar intraoperative

1. Zaɓin da ba daidai ba na wurin shigar ƙusa zai iya haifar da karaya kusa.

2. Kada a tura da karfi a cikin fadada medulla.

3. Ƙofar faɗaɗa ɓangaren litattafan almara ya kamata ya kasance a cikin hanya ɗaya da hanyar shigar da ƙusa.

4. Kada a yi amfani da karfi lokacin shigar da kusoshi na intramedullary zuwa ƙarshen nesa.

Jin zafi a cikin haɗin gwiwa

1. Sanya ƙusa na intramedullary ya ƙunshi nama mai laushi har ma da capsule na haɗin gwiwa a kusa da akalla 1 haɗin gwiwa.

2. An haɗu da farantin tibial zuwa gefen gaba na meniscus na tsakiya ta hanyar haɗin gwiwar gwiwa kuma ya samar da wani yanki mai aminci a sama da tuberosity na tibial har zuwa wannan batu. Idan wurin ƙusa ya yi kusa da sama ko diamita na ƙusa na intramedullary ya yi girma sosai, zai iya haifar da lalacewa ga tsarin intra-articular, wanda zai haifar da ciwon gwiwa bayan tiyata.

3. Proximal protrusion na intramedullary ƙusa da heterotopic ossification sune manyan abubuwan da ke haifar da ciwon hip bayan tiyata na intramedullary na mata.

4. Proximal protrusion na intramedullary kusoshi, kusanci kulle ƙusa hangula da kuma rotator cuff tsangwama su ne manyan dalilan ciwon kafada bayan humeral intramedullary nailing.