Femoral Intramedullary Nailing - Pehea e koho ai i ke kiko hoʻokomo maikaʻi loa?

Hoʻolauna

Hiki ke ʻike ʻia ka hoʻomohala ʻana o ka hoʻomaʻamaʻa ʻana i ka haʻihaʻi wahine i ka makahiki 1940 i ka wā i hoʻokomo ai ʻo Kuntscher i ka ʻenehana nailing intramedullary pani. ʻO ka hoʻohana ʻana i nā kui intramedullary (IMNs) i nā haʻihaʻi femoral i lilo i mea maʻamau o ka mālama ʻana i nā makahiki i hala iho nei, a me nā hoʻomaikaʻi ʻana i kēia manawa. ʻO ka nailing intramedullary a me nā holomua i nā ʻano hana ʻokiʻoki ua ʻae i ka hoʻonui nui ʻana i ka hoʻohana ʻana i ke kui intramedullary o ka femur.

Hoʻohana ʻia ka mālama conservative o nā haʻihaʻi femoral stem wale nō i kahi helu liʻiliʻi o nā mea maʻi me nā contraindications koʻikoʻi i ka anesthesia a me ka hōʻoki ʻana, a ʻo ke kumu nui o ka mālama ʻana e hoʻomau i ka hoʻoponopono. E pili ana i ka lapaʻau ʻana i kēia mau haʻihaʻi, he nui nā koho i loaʻa, e like me ke kui intramedullary, ka hoʻopaʻa ʻana i ka pā, a me ka hoʻoponopono ʻana i waho. Ke hoʻohālikelike ʻia me nā koho ʻokoʻa ʻē aʻe, ʻo ka nailing intramedullary ke ʻano me ka haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa a me ka kiʻekiʻe o ka hoʻōla haʻihaʻi kiʻekiʻe, a ke hoʻohana nui ʻia nei i ka hana lapaʻau.

ʻO ka hoʻomaopopo maikaʻi ʻana i ke anatomy o ka femur proximal, ka hāʻawi ʻana i ke koko i ke poʻo femoral a me ke anatomy o nā ʻiʻo o ka ʻūhā hiki ke hoʻonui nui i ka holomua o ka nailing intramedullary no nā haʻihaʻi femoral. ʻO ka ʻokoʻa, ʻo ke koho ʻana i kahi helu komo e pili ana i nā kumu he nui, e like me ka hoʻolālā nail intramedullary, wahi haʻihaʻi, haʻihaʻi comminution, a me nā mea maʻi (e laʻa, polytrauma, hapai, a me ka momona). Ma waho o ke kahua komo i koho ʻia, ʻo ka loaʻa ʻana o ka wahi komo kūpono he mea nui e mālama i ka hoʻemi kūpono i ka wā o ka hoʻokomo ʻana i ke kui intramedullary me ka hōʻemi ʻana i ka pilikia o nā pilikia.

Anatomy Femoral

1. Hoʻolako koko i ke poʻo femoral

Loaʻa i ke poʻo femoral ka lako vascular mai 3 aʻa nui. ʻO ke aʻaʻa femoral rotator lateral (me nā lālā 3-4), ke aʻa obturator, e hoʻolako i ka ligament poepoe, a me ka medial rotator femoral artery (Fig. 1), e hāʻawi pū ana i kahi moku piʻi i luna e anastomoses me ke aʻa femoral rotator lateral a hoʻolako i ka ʻāpana trochanteric nui aʻe.

2. Anatomy o na 'i'o hope

I ka hana ʻana i ke kui intramedullary o ka femur, pono ka ʻike maikaʻi ʻana i nā ʻiʻo ma kahi e hoʻopuni ana i ka rotor e pale ai i ka hōʻeha pono ʻole. ʻO ka gluteus medius muscle mai ka ilium a hoʻopau i kaʻaoʻaoʻaoʻao o ka trochanter nui, aʻo ka gluteus minimus muscle no ka ilium a hele i kaʻaoʻao hope o ka hui pūhaka e hoʻopau i kaʻaoʻao hope o ka trochanter nui (Figures 2 & 3). Ke hana nei kēia mau ʻiʻo ʻelua ma ke ʻano he adductors o ka ʻūhā a me nā rotators kūloko o ka ʻūhā. No laila, ʻo ka hōʻino ʻana i kēia mau ʻiʻo i ka wā e hoʻokomo ʻia ai ka nail paracentric femoral intramedullary e hopena i ka nāwaliwali adductor a me Trendelenburg gait, kahi hopena maikaʻi ʻole i ka hoʻihoʻi ʻana o ka maʻi a me ka hopena.

Fig. 2. Anatomy o nā ʻiʻo a puni ka ʻūhā

Kiʻi 3. wahi pili i ka ʻiʻo femoral pili

Nail Intramedullary Parallel Femoral

Ua ʻimi kekahi mau haʻawina hou i ka helu komo maikaʻi loa no ka nail femoral paracrine. ʻO nā koho helu komo nail me ka trochanter nui aʻe a me ka pyriform fossa, kēlā me kēia me kona mau hōʻailona ponoʻī a me nā pilikia pili (Papa 1).

Papa 1. Nā helu hoʻomaka a me nā pilikia o ka paracrine a me ka retrograde nailing femoral
ʻokoʻa	nail intramedullary parallel		retrograde intramedullary nail
	rotor	pyriform fossa (anatomy)
mokulele lei	ʻO ka piko o ka trochanter nui a me ke kuhikuhi pololei ʻana i ka lua medullary	ka hui o ka nui a me ka ʻāʻī femoral trochanter	median o ka fossa intercondylar (anatomy)
sagittal plane (math.)	Ka laina ma waena o ke kikowaena o ka trochanter nui a me ke kikowaena o ka ʻāʻī o ka femur	pyriform fossa (anatomy)	PCL 1.2 knm mua i ka wahi hoʻomaka femoral, e kuhikuhi ana i ka lua medullary.
hōʻike	ʻEha wahi hoʻomaha o ka hui ʻaihue hip	ʻO ka hōʻino ʻana o ka hāʻawi koko i ke poʻo femoral a me ka ʻiʻo rotator waho waho	Hiki ke alakaʻi i ka PCL i ka lawelawe pono ʻole
PCL: hope cruciate ligament

1. Large rotor needle wahi komo

ʻO ka trochanter nui aʻe i wehewehe ʻia e like me ka ʻaoʻao o waho trapezoidal bony protuberance aia ma ka ʻaoʻao ʻaoʻao o ka ʻāʻī femoral, ka ʻili o ia mea e hoʻopili ai i ka lateral gluteus medius a me anterior gluteus minimus muscles (Figures 2 a me 3). ʻOiai he wahi ʻāina iwi liʻiliʻi kēia, ʻo ka hoʻokaʻawale ʻana i ka wahi hoʻomaka pololei i ka wā e hana ai i ka IMN femoral paha ka ʻokoʻa ma waena o ka loaʻa ʻana o kahi hopena ʻoluʻolu a maikaʻi ʻole paha i ka wā e pili ana i ka haʻi ʻana o ke kumu femoral.

I ka nānā ʻana i nā palapala i kēia manawa no nā wehewehe kikoʻī o ka wahine, ʻike mākou i ka nele o kahi hōʻailona anatomical i wehewehe pono ʻia no ka femoral rotor IMN entry point.Bharti et al. ua wehewehe i ka helu komo mai ka piko o ka trochanter nui e like me ka medial e pili ana i ka lua medullary ma ke kūlana orthostatic, a ʻo ia ke kikowaena o ka trochanter nui ma ka laina me ke kikowaena o ka lua medullary femoral ma ke kūlana ʻaoʻao (Fig. o ka rotor.Georgiadis et al. ua wehewehe ʻo ia i ke kiko o ke komo ʻana i ka nila ma ka ʻaoʻao hope loa o ka ʻaoʻao kiʻekiʻe apical o ka rotor.

HE 4. Hōʻike ʻia nā hiʻohiʻona intraoperative orthostatic a me ka ʻaoʻao o ka ʻūhā i ke kumu komo kūpono no ka nailing intramedullary femoral paramedian o ka trochanter nui. '*' hōʻike i ka helu komo kui intramedullary.

Ua hōʻike ʻia nā haʻawina hou i loko o ka puke moʻolelo ʻo ka piko o ka trochanter nui ka wahi hoʻomaka kūpono no ka loaʻa ʻana o kahi laina o ka ikaika, a ʻo ka alignment maikaʻi ʻole ma muli o ka deformity inversion ke hana pinepine ʻia ke hoʻololi ʻia ka helu o ke komo ʻana ma mua o 2 mm lateral i ka trochanter nui. Ua hoʻoikaika pū kēia haʻawina e alakaʻi ana kahi wahi komo hope i ka neʻe ʻana i mua, akā hiki i kahi wahi komo waena ke hoʻoneʻe i ka poloka haʻihaʻi ma hope. I ka hoʻokaʻawale ʻana, ua hōʻike ʻia kahi haʻawina ʻē aʻe i loko o nā haʻihaʻi femur intertrochanteric, ʻoi aku ka kiʻekiʻe o ka ulu ʻana o ka nail intramedullary impingement me kahi kiko pinning ma ka ʻaoʻao o ka ʻaoʻao mua ma mua o kahi pine pine e pili kokoke ana i ka ʻaoʻao medial a me hope.

Hoʻohana maʻamau ʻia ka piko o ka trochanteric apex pinning point i nā maʻi obese, a ʻoi aku ka liʻiliʻi o kēia kaʻina hana, e hāʻawi ana i ka manawa hana ʻoi aku ka liʻiliʻi o nā pilikia ma mua o ka pyriform fossa pinning point.

NĀ HOʻOPIʻI: Ua kūkākūkā ʻia nā pilikia intraoperative a me ka postoperative o ka nailing intramedullary femoral me kahi wahi hoʻokokoke trochanteric nui aʻe i kekahi mau puke. ʻO kekahi o ia mau mea, pili maʻamau i ka ʻenehana nailing, ʻo ia nā haki i hoʻokomo ʻia i ka lāʻau lapaʻau. I loko o nā haʻihaʻi femoral intertrochanteric, ʻoi aku ka hopena o kahi wahi komo ma ka ʻaoʻao a ma mua o ka trochanter nui aʻe i ka haʻihaʻi waena ma mua o kahi wahi komo kokoke i ka ʻaoʻao waena.

ʻO kekahi pilikia e pili ana ma muli o nā ʻeha ʻili palupalu, ʻoi aku hoʻi i nā lālā o ka medial rotator femoral artery a me nā ʻiʻo adductor, akā ʻoi aku ka liʻiliʻi o kēia mau ʻeha i ka hoʻohālikelike ʻia me ka pyriform fossa entry nail. Eia kekahi, ʻo ka maʻi o ka ischemic necrosis o ke poʻo femoral me ka apex o ka trochanter nui aʻe e like me ka manaʻo o ka helu komo e haʻahaʻa loa, me nā haʻawina e hōʻike ana he haʻahaʻa e like me 0.3%.

I ka noʻonoʻo ʻana i ka manawa intraoperative a me ka hoʻolaha fluoroscopic, ʻo ka manawa hana he 90.7 mau minuke no ka helu komo trochanteric nui aʻe i hoʻohālikelike ʻia me 112.7 mau minuke no ka pūʻulu helu helu fossa ʻano pear, ʻoiai ʻo ka manawa fluoroscopic he 5.88 kekona no ka hui helu trochanteric nui aʻe a me 10.08 kekona no ka helu komo fossa-shaped fossa.

He mea koʻikoʻi ka wānana maʻi i ka wā e hoʻoholo ai i ka helu komo nail intramedullary, ʻoiai ʻoi aku ka maikaʻi o ka hoʻihoʻi ʻana i ka hana mua (e like me ka loiloi ʻia e ka hoʻāʻo noho noho a me ka hoʻāʻo kiʻekiʻe manawa) i nā maʻi ma 6 mau mahina ma hope o ka hoʻopaʻa ʻana no ka nui o ka trochanteric entry point i hoʻohālikelike ʻia me ka pyriform fossa entry point nail, akā ʻaʻole i koʻikoʻi kēia ʻokoʻa ma 12 mau mahina ma hope o ka hana. ʻOiai ʻo ka nui o ka trochanteric access point e pili pinepine ʻia me ka liʻiliʻi o ka wehe ʻana i nā ʻiʻo palupalu ma muli o kona wahi, hiki nō ke alakaʻi i ka hōʻeha i ka pūʻulu ʻiʻo abductor, e like me ka mea i hōʻike ʻia e Ergiş et al. Ua ʻike lākou ua hoʻemi ʻia ke koena ikaika a me ka ikaika abductor hip i nā poʻe maʻi me ka nui o ka trochanteric peg i hoʻohālikelike ʻia i nā mana olakino. Eia kekahi, ua hōʻike kā lākou haʻawina i ka emi nui o ka ikaika o nā mea ʻaihue hip, flexors a me nā rotators i loko / waho i hoʻohālikelike ʻia me ka ʻaoʻao i hana ʻole ʻia.

2. Puka momi wahi komo

ʻO ka fossa o ka ʻiʻo pyriformis he ʻāina anatomical koʻikoʻi i ʻike ʻia ʻo ia kekahi o nā helu komo no kahi paracentesis femoral intramedullary nail.I kā lākou autopsy cadaveric study, Lakhwani et al. ʻike ʻia ʻo ka fossa o ka ʻiʻo pyriformis ʻaʻole ia he 'pear' a ʻaʻole hoʻi i hoʻopili ʻia i ka ʻiʻo pyriformis. Hoʻopili ka ʻiʻo i kahi wahi liʻiliʻi ma ka piko o ka trochanter nui, ʻoiai ʻo ka pyriform fossa he puʻuwai ma ka ʻaoʻao medial o ka trochanter nui a he mea hoʻopili ia o ka extensor carpi radialis brevis muscle. Ua hoʻoholo nā mea kākau he ʻelua mau mea like ʻole ka ʻiʻo pyriform a me ka fossa pyriform a ʻo ka mea i kapa ʻia ʻo pyriform fossa pono e kapa ʻia ʻo ka 'rotor' a i ʻole ka 'occlusal' fossa no ka akaka a me ka pololei anatomical. Ua manaʻo lākou ma hope o ke aʻo ʻana i ka cis-femoral Ua manaʻo lākou e hoʻokomo hou ʻia ka huaʻōlelo kumu 'rotor fossa' i loko o ka palapala ma mua o ka 'pyriform fossa' ma hope o ke aʻo ʻana i nā huaʻōlelo o ka wahi komo parafemoral. ʻOiai ua manaʻo nui ʻia nā kiko o kēia mau haʻawina ʻelua, no ka maʻalahi o ka wehewehe ʻana a me ka pale ʻana i ka huikau me ka wahi komo trochanteric ʻoi aku ka nui, e kuhikuhi mau mākou i kēia wahi komo ma ke ʻano he pyriform fossa.

ʻO kekahi mau haʻawina i loko o nā puke o kēia manawa e wehewehe pono i ka helu komo pololei o ka fossa momi no nā kui femoral intramedullary.Georgiadis et al. e wehewehe i ke kiko komo momi ma ke ʻano he wahi o ka hoʻopili ʻana o ka ʻiʻo extensor carpi radialis brevis i loko o ke kaumaha ma ke kumu o ka ʻāʻī femoral (Fig. 5). Ua hoʻokūpaʻa pū nā mea kākau e hiki i kahi helu komo i mua a i ʻole i loko ke hoʻonui i ka pilikia o ka haki ʻana o ka ʻāʻī o ka ʻāʻī, a i ka wā e mamao loa ai ka helu komo i hope, hiki ke piʻi nui i ka necrosis ischemic, ʻoi aku ka kiʻekiʻe o nā maʻi ʻōpio.

Kiʻi 5. ʻO ka ʻike mua o ka ʻūhā e hōʻike ana i ka helu komo kūpono no kahi pyriform fossa retrograde femoral intramedullary nail. Hōʻike ka '*' i ka wahi hoʻomaka nail intramedullary.

ʻO Harper et al. i hoʻopuka i kahi noiʻi o 14 pūʻulu o ke kanaka cadaveric femurs ma 1987 a lākou i loiloi ai i kahi o ka intramedullary alakaʻi pine a me ka puka i waho o ka intramedullary nail i hoʻokomo ʻia ma kahi mamao a kokoke i ke ʻano retrograde mai ka intercondylar notch o ka femur. Ua hoʻoholo lākou aia ka helu o ke komo ʻana o ka pyriformis paramedian intramedullary nail ma ka hui ʻana o ka trochanter nui me ka ʻāʻī femoral, i mua iki i ka pyriformis occulta. Ua hōʻoia hou ʻia ka pūnaewele hoʻokomo e Gausepohl et al. Ma kahi noiʻi cadaveric ʻē aʻe, ua ʻike lākou i ka wahi komo kūpono no ka ʻōnaehana nail intramedullary femoral ma ka ʻaoʻao waena o ka trochanter nui ma luna o ka tendon pyriformis. Eia kekahi, i ka haʻawina cadaveric e Labronici et al. ua wehewehe ʻia ka fossa o ka ʻiʻo pyriformis ma ke ʻano he ʻāpana luminal e like me ka pear-like me ke koʻikoʻi waena o ka lua intramedullary femoral i loko o ka mokulele coronal.

Loaʻa i ka pyriform fossa kahi koʻikoʻi koʻikoʻi no ka mea ʻoi aku ka paʻakikī i ka hoʻohālikelike ʻana i ka wahi komo trochanter ʻoi aku ka nui, ʻoi aku ka nui o nā maʻi obese. Eia hou, he wahi haiki ka wahi e komo ai no ka niila fossa kohu pear, i mea paʻakikī loa ka hoʻokaʻawale ʻana. No ka laʻana, ʻo kahi hoʻomaka mua loa ma ka ʻāʻī femoral e hopena i ke koʻikoʻi pōʻai nui a hoʻonui i ka pilikia o ka pohā cortical anterior, ʻoi aku ka nui inā ʻoi aku ka nui o ka hoʻomaka ma mua o 6 mm ma mua o ka fossa. Eia kekahi, hiki ke hoʻopili ʻia ka ʻokoʻa morphologic i ke kahua komo kūpono, ʻoi aku ka nui inā ʻoi aku ka nui o ka rotator waho pōkole a i ʻole ka puka ʻana o ka rotor, e alakaʻi ana i kahi wahi komo i waena a hiki i ka haʻi ʻana o ka ʻāʻī o ka wahine.

NĀ HOʻOPIʻI: Ma ka hoʻohālikelike ʻana i 38 mau wahi komo trochanteric nui aʻe me 53 mau wahi komo ʻana o nā fossa pearly no ka nailing intramedullary femoral, ua ʻike ʻo Ricci et al he 30% ka lōʻihi o ka manawa hana a me ka manawa fluoroscopy he 73%. Ua hōʻoia ʻia kēia mau ʻike e Bhatti et al. i ka hoʻohālikelike ʻana i nā helu komo 2 nila.

E pili ana i ka ʻeha o ka ʻiʻo palupalu, ʻoi aku ka nui o ka hōʻeha ʻana o ka ʻili palupalu ma ka puka pyriformis i hoʻohālikelike ʻia me ka neuromuscular interosseous ma ka wahi komo o ka nila trochanteric nui aʻe. ʻO Dora et al. loiloi ʻia he 16 mau male cadaveric makua no nā ʻeha ʻili palupalu i ka ʻiʻo pyriformis a me ka pine komo rotor. Ua ʻike lākou ʻoiai ʻoi aku ka maikaʻi o ka pyriformis fossa, ua ʻoi aku ka nui o ka pōʻino i ka hāʻawi ʻana i ke kīpē i ke poʻo femoral a me nā ʻiʻo a me nā ʻiʻo a puni. Ua hōʻoia hou ʻia kēia mau ʻike e nā haʻawina cadaveric e Ansari Moin et al. Ua hoʻohālikelike ʻo WHO i ʻelua mau helu komo. Ua ʻike lākou ʻo ka hoʻopaʻa ʻana i loko o ka nail e hoʻomaka ana ma ka puʻupuʻu pyriformis e hōʻino paha i nā ʻaihue hip a me nā rotators waho. Eia hou, ua loaʻa ka pōʻino i ka medial rotator femoral artery i nā hihia a pau (Table 2).

Papa 2. Hōʻuluʻulu manaʻo o nā ʻeha ʻiʻo palupalu ma nā wahi komo o ka nila
ʻokoʻa	Pyriform fossa wahi komo (n=5)	Lae hānai rotor nui (n=5)
mea palupalu
gluteus medius ʻiʻo (anatomy)	5	1
gluteus medius tendon	0	4
ʻeha ʻāʻī
gluteus minimus (anatomy)	3	0
pyriformis muscle (ma luna o ka iwi kuamoʻo)	3	3
obturator internus (anatomy)	1	0
latissimus dorsi ʻiʻo (anatomy)	3	0
Nā kīʻaha koko a me nā capsule hui
MFCA Lala Hohonu	4	0
MFCA Lala Papau	4	0
articular capsule (o ka hui e like me ke kuli ma ke anatomy)	1	0
MFCA: medial circumflex femoral artery.

I kēia mau lā, ʻo Bharti et al. ua aʻo i ka pilikia hoʻopiʻi o ka nailing intramedullary femoral ma ka helu komo trochanteric nui a me ka wahi komo momi fossa a loaʻa i nā pilikia hoʻopiʻi e like me ka wikiwiki o ka ho'ōla ʻana a hōʻuluʻulu iā lākou e like me kēia (Papa 3).

Papa 3. Pyriform fossa wahi komo a nui trochanter wahi komo iwi femoral iwi
pilikia	ʻO ke kiko nila o ka nila Piriformis sinus	Kahi hoʻokomo trochanter ʻoi aʻe
Hoʻopili	6.7	3.3
Malunion	20	13.3
Hoʻōla lohi	20	13.3
ʻO ka ʻoni ʻūhā palena	20	33.3
ʻO ka holo ʻana o ke kuli kaupalena	6.7	6.7
Kūlike ʻole ka lōʻihi o nā lālā	13.3	20
Piʻi ka pāpale huelo ma luna o ka iwi iwi	13.3	20
ʻO ka haʻi ʻana o ka ʻāʻī femoral intraoperative	10	0
ʻO ka haʻihaʻi trochanter nui	0	3.4
Femoral poo necrosis	6.7	0

Retrograde femoral nailing intramedullary

ʻO ka hoʻoholo ʻana i ka helu komo kūpono no ka retrograde femoral intramedullary nailing e kōkua i ka hoʻihoʻi ʻana i ka alignment fracture maikaʻi loa, ka lōʻihi, a me ka hoʻololi ʻana i ka wā e hōʻemi ana i ka pōʻino o ka cartilage articular, anterior cruciate ligament (ACL), hope cruciate ligament (ACL), a me ka hōʻeha ʻili palupalu (Table 1). I kēia mau lā, ua hoʻonui nui ʻia ka hoihoi i ka retrograde femoral intramedullary nailing me ka manaʻo e hōʻemi i nā pilikia e pili ana me ka nailing paracromial, me ka ʻeha o ka ʻūhā, ka heterotopic ossification, ka nāwaliwali adductor, a me ka pudendal nerve palsy, i manaʻo ʻia he mea liʻiliʻi loa ke hoʻohālikelike ʻia me ka hoʻohaʻahaʻa insional a me ka laka ʻana o ka femoral plating no ka hoʻopaʻa ʻana i loko o ka femoral. kumu. Eia kekahi, ua hōʻike ʻia nā hōʻike hou i ka wā e hoʻopaʻa ʻia ai kēia mau nails retrograde intramedullary, ʻaʻole pono ke koi ʻia nā kui laka kokoke. a me Bisaccia et al. i ka mālama ʻana i ka hapakolu o ka haʻihaʻi ʻana o ke kumu femoral me ka hoʻohana ʻana i ka laka a me ka nonlocking retrograde intramedullary nails. No laila, ua kaulana a ʻae ʻia ka hoʻohana ʻana i ka retrograde femoral nailing.

Hiki ke loaʻa nā wehewehe he nui o ka helu komo no ka retrograde femoral intramedullary nailing ma ka palapala. ʻO ka hapa nui o nā haʻawina e ʻike i ka helu komo kūpono no ka nail retrograde femoral e like me 1.2 mua i ke kumu femoral o ka ligament cruciate hope.

knm (ma ka laina me ka medullary cavity) a me ke kikowaena o ka intercondylar fossa (Figure 6).

HE 6. Nā hiʻohiʻona o ke kuli a me nā ʻaoʻao o ke kuli e hōʻike ana i ke kahua komo kūpono no ka nail retrograde femoral intramedullary. '*' hōʻike i ka wahi hoʻomaka nail intramedullary.

ʻOiai ʻaʻohe hōʻailona piha no ka retrograde femoral intramedullary nailing, ua wehewehe ʻia nā hōʻailona pili. ʻO kēia nā mea maʻi polytrauma, nā maʻi ʻeha nui loa, nā maʻi hāpai, nā haʻihaʻi o ka femoral bilateral, ka ipsilateral femoral stem a me ka acetabular/pelvic fractures a i ʻole ka ʻāʻī o ka ʻāʻī, a me ka ipsilateral femoral stem a me tibial fractures. ʻO ka hapa nui o kēia mau hōʻailona e pili ana i ka maʻalahi o ka hoʻonohonoho ʻana o ka mea maʻi a me ka pale ʻana i nā ʻeha hōʻeha he nui ma kahi kokoke.

Ma ka ʻaoʻao ʻē aʻe, ʻo nā contraindications paʻa loa i ka retrograde femoral intramedullary nailing e pili ana i ke keakea ʻana o ke kahawai retrograde intramedullary e ka implant i hoʻopaʻa ʻia a me nā haʻihaʻi hāmama o ka femur distal. ʻO nā contraindications pili nā haki i loaʻa i loko o 5 knm o ka trochanter liʻiliʻi, paʻakikī i ke komo ʻana i ka wahi komo maikaʻi loa ma muli o ke kuʻekuʻe ʻana o ke kuli ma lalo o 45 degere, ma mua o ka maʻi kuli i hiki ke alakaʻi i kahi pilikia o ka hoʻolaha ʻana i ke kumu femoral, nā ʻeha ʻili palupalu koʻikoʻi a puni ka kuli, a me ka haki intra-articular o ka pole haʻahaʻa a me ka pole o waho.

Nā pilikia: ʻO ka hapa nui o nā hoʻopiʻi o ka retrograde nailing femoral e pili ana i ka lawelawe pono ʻole ʻana, ʻoi aku ka hewa o ke kau ʻana o ka wahi komo. Ma ka mokulele sagittal, ʻoi aku ka nui o ke komo ʻana ma mua o ka unuhi ʻana i ka haʻihaʻi hope, ka pōʻino o ka ʻili, a me ka paʻi ʻana paha o ke kui ma ka patella i ka wā e lohi ai ke kuli. Ma kekahiʻaoʻao, inā hoʻonohonoho ponoʻole ka helu komo ma kaʻaoʻao hope, hiki i kēia ke hopena i kaʻoi aku o kaʻeha i ke kumu o ka ligament cruciate hope a me ka neʻe muaʻana o ka wahi haʻihaʻi.

Hutchinson et al. i wehewehe ʻia nā pilikia e pili ana i nā helu komo ʻana o ka mokulele coronal kūpono ʻole. Ua ʻike lākou ua loaʻa i kahi helu komo ma waena o ka hoʻololi ʻana o ka posterolateral me ka unuhi ʻana o ka haʻihaʻi posterolateral, akā ʻo kahi ʻaoʻao nui loa i hopena i ka deformity medial a me ka unuhi medial.Sanders et al. Ua hōʻike ʻia ʻo ke koho ʻana i kahi wahi hoʻomaka ma waena o 2 knm a ʻoi aʻe paha ma waho o ke koʻi medial ka hopena i ka haʻihaʻi cortical medial i malunited ma muli o kahi manawa kuʻi hope o ka haʻi i hopena i ka hōʻemi ʻana o ka posterolateral.

ʻO nā hoʻopiʻi ʻē aʻe e pili ana i ka retrograde femoral follower nailing e pili ana i ka ʻeha kuli, ʻoʻoleʻa, heterotopic knee ossification, a me ka hoʻokumu ʻana o ke kino kuli intra-articular.

Hoʻopau

ʻOiai ʻo kēlā me kēia ʻano hana nailing intramedullary he hōʻailona kūpono, ʻo ke koho ʻana o ke ʻano hana nailing intramedullary e hoʻohana ai i ka mālama ʻana i nā haʻihaʻi o ka femoral stem maʻamau e hilinaʻi ʻia i ka makemake o ke kauka. I ka hana ʻana i ke kui intramedullary o ka femur, pono e loaʻa ka helu komo kūpono no ke ʻano o ke kui i hoʻohana ʻia no ka hoʻoponopono ʻana no ka hopena kūleʻa. ʻO ka ʻike o ka anatomy kūloko a me ka hana kiʻi e kōkua i ke kauka lapaʻau e hana i kahi kaʻina hana kūpono ʻoiai e hōʻemi ana i ka pilikia o nā pilikia pili. Eia kekahi, i nā kaʻina hana nailing intramedullary, ʻo ka mālama ʻana i ka hōʻemi he mea koʻikoʻi ia i ka pale ʻana i ka malunion a me ka malunion a i ʻole nonunion o nā haki.