5 intramedullary ntsia thawv daim ntawv thov cov hauv paus ntsiab lus thiab cov txheej txheem phais!

Lub hauv paus ntsiab lus ntawm intramedullary nailing

1. Keeb kwm ntawm intramedullary nailing

Hauv xyoo 1910, Lilienthal aluminium intramedullary rau tes tau siv los kho femoral ncej tawg.

Xyoo 1913, Schone tau siv nyiaj rau cov ntsia hlau los kho pob txha pob txha. 

Kuntscher (1900-1972) tau txais txiaj ntsig zoo rau kev kho cov ntsia hlau intramedullary. 

Xyoo 1960 thiab 1970s yog lub sijhawm ntawm kev loj hlob sai ntawm cov ntsia hlau intramedullary. 

kuv lub teb chaws tau siv ntau heev txij li xyoo 1990.

2. Qhib txo thiab kaw qhov txo qis

1. Cov pob txha pob txha tuaj yeem raug txo qis hauv kev pom kev ncaj qha lossis kaw hauv kev soj ntsuam X-ray.

2. Lub sij hawm qhib kev txo pob txha kho yog qhov ntev, cov ntshav tawm hauv lub cev ntau dua, thiab qhib qhov txo qis ntxiv ua rau cov ntshav txaus rau qhov kawg ntawm pob txha.

3. Nws raug nquahu kom siv kaw qhov txo kom ntau li ntau tau. Lub traction reducer tuaj yeem siv tau, lossis ib qho kev txiav me me tuaj yeem ua rau ntawm lub dav hlau tawg kom rub thiab txo qis, yog li txo qis kev cuam tshuam nrog cov ntshav mus rau qhov kawg ntawm pob txha.

4. Rau kev kaw qhov txo tsis ua haujlwm, cov pob txha fragment flipping los yog tho ib puag ncig cov ntaub so ntswg, thiab loj tawg tawg tawg tawg, kev phais qhib yuav siv tau.

3. Fixation mechanism ntawm intramedullary ntsia thawv

1. Cov txheej txheem ntawm intramedullary ntsia thawv sab hauv fixation yog symmetrical central internal splint fixation.

2. Lub fixation ntawm pob txha los ntawm intramedullary ntsia thawv yog kev ntxhov siab-distributing fixation, tsis stress-shielding fixation, uas yog conducive rau lub shaping ntawm callus.

3. Central fixation yog theoretically superior rau cortical sab nrauv fixation, uas yuav txo tau lub quab yuam caj npab, txo qhov tshwm sim ntawm valgus angulation thiab internal fixation tsis ua hauj lwm.

4. Intramedullary ntsia thawv fixation muab lub hauv paus rau kev kaw qhov txo qis lossis txo qis qhib.

4.Qhov zoo ntawm cov ntsia hlau intramedullary

1. Muaj teeb meem tsawg dua

2. Kev nthuav dav ntawm kev phais mob

3. Kev ruaj khov

4. Kev cob qhia ua haujlwm thaum ntxov

5. Cov kabmob thaum ntxov

6. tuaj yeem siv ua ke nrog lwm yam kev kho sab hauv

Basic hom thiab cov txheej txheem

1. Xauv thiab tsis-locking intramedullary rau tes

2. Dynamic thiab static locking intramedullary rau tes

3. Medullary expansion thiab non-medullary fixation cov txheej txheem

4. Qhib thiab kaw cov txheej txheem fixation

Kev sib tshuam thiab tsis sib cuam tshuam

Ordinary intramedullary rau tes muaj qhov tsis zoo axial stability thiab tsis tshua muaj torsional lub zog, tab sis lawv muaj qee yam elasticity thiab tuaj yeem rov qab tau tom qab deformation, ua rau tsuas yog me me ntawm intrabone zawv zawg.

Interlocking intramedullary rau tes muaj zoo dua los tiv thaiv kev sib hloov thiab los tiv thaiv compression, zoo fixation stability, thiab ua raws li lub hauv paus ntsiab lus ntawm lom fixation. Lawv tau siv dav hauv cov pob txha ntev ntawm cov ceg. Tshwj xeeb tshaj yog rau ntau ntu thiab comminuted fractures, lawv muaj kev ruaj ntseg zoo dua li cov rau tes intramedullary.

Dynamization ntawm static fixation

Static locking intramedullary rau tes ua rau muaj kev ntxhov siab me ntsis npog ntsej muag thiab tam sim no feem ntau tau tawm tswv yim rau kev ua haujlwm tsis tu ncua ntawm dynamization.

Rau cov pob txha uas tsis tau kho ntawm 6 mus rau 8 lub hlis tom qab kev phais, nyob rau hauv situ pob txha grafting los yog hloov ntawm nthuav intramedullary rau tes nrog dynamization feem ntau yog siv.

Dynamization tuaj yeem siv los ua ib txoj hauv kev los txhawb kev kho pob txha. Nws tsis raug pom zoo niaj hnub vim tias nws tuaj yeem ua rau limb shortening thiab rotational deformity.

Marrow expansion thiab non-marrow expansion

Marrow expansion tuaj yeem ntxig rau cov rau tes nrog txoj kab uas hla loj dua thiab muaj zog dua, uas yog qhov tsim nyog rau kev cob qhia ua haujlwm thaum ntxov thiab txo tus nqi ntawm cov ntsia hlau tawg.

Marrow expansion tuaj yeem tsim cov pob txha pob txha loj nrog cov nyhuv osteoinductive, uas yog qhov zoo rau kev kho pob txha.

Marrow expansion yuav ua rau cov ntshav txaus ntawm cov hlab ntsha thiab cov hlab ntsha endosteal, tab sis cov hlab ntsha tuaj yeem rov tsim dua nyob rau hauv cov kab noj hniav ntawm cov rau tes intramedullary. Marrow expansion kuj tuaj yeem ua rau cov ntshav ncig nyob ib puag ncig cov nqaij mos mos, yog li txhawb kev kho pob txha.

Marrow expansion kuj ua rau muaj kev kis kab mob thiab embolism, thiab yuav tsum tau siv nrog ceev faj rau kev qhib pob txha, ntau yam kev raug mob, thiab kev raug mob nyuaj.

Qhov zoo ntawm medullary expansion

① Tom qab medullary expansion, qhov chaw sib cuag ntawm cov ntsia hlau intramedullary thiab cov pob txha nce, uas txhim kho kev ruaj ntseg ntawm fixation. 

② Tom qab medullary expansion, ib txoj kab uas hla loj intramedullary ntsia hlau yuav siv tau, uas ua rau kom lub zog ntawm intramedullary ntsia thawv thiab txo tus nqi ntawm cov ntsia hlau tawg. 

③ Cov pob txha pob txha tom qab nthuav dav medullary tuaj yeem tsim cov pob txha tshiab, uas yog qhov zoo rau kev kho pob txha.

Piv nrog rau medullary expansion intramedullary rau tes, cov ntsia hlau tsis nthuav dav muaj qhov zoo hauv qab no

① Lub sijhawm ua haujlwm luv dua thiab los ntshav tsawg. 

② Tsawg cuam tshuam nrog cov ntshav endosteal ntws hauv cov neeg mob uas raug mob cov nqaij mos hnyav.

Daim ntawv thov ntawm intramedullary ntsia thawv

Humeral interlocking intramedullary ntsia thawv

Indications rau humeral rau tes

Cov lus qhia rau humeral interlocking intramedullary rau tes nyob rau hauv kev kho mob ntawm humeral ncej fractures yog: fractures nrog vascular thiab paj hlwb puas, ntau yam kev raug mob, unstable fractures, pathological fractures, thiab proximal humeral fractures.

Qhov ntau yam uas tuaj yeem kho tau yog los ntawm 2cm hauv qab lub taub hau humeral mus rau 3cm saum olecranon fossa. Koj tuaj yeem xaiv kho nws los ntawm lub xub pwg nyom nrog tus ntsia thawv antegrade intramedullary lossis los ntawm lub luj tshib nrog tus ntsia thawv retrograde.

Cov yam ntxwv ntawm cov ntsia hlau humeral

Cov txheej txheem phais kho rau humeral ncej tawg yog qhov yooj yim phaj fixation thiab intramedullary ntsia thawv fixation.

Phaj fixation muaj zog tiv thaiv kev sib hloov thiab kev tiv thaiv kev khoov thiab ruaj khov, tab sis kev phais mob loj, qhov tshwm sim ntawm kev kis kab mob yog siab, thiab cov hlab ntsha radial tau yooj yim puas.

Niaj hnub nimno humeral interlocking thiab tus kheej-locking rau tes kov yeej qhov tsis zoo ntawm cov tes zoo tib yam intramedullary xws li axial instability, tsis zoo kev sib hloov, thiab xav tau kev txhim kho thaum ntxov, kom cov pob txha ruaj khov, cov ntshav poob me me, cov nqaij mos stripping tsawg dua, thiab cov medullary expansion yog qhov sib npaug ntawm cov pob txha, sib npaug hauv zos. thiab kev ua haujlwm zoo tuaj yeem pib tom qab kev phais.

Femoral interlocking intramedullary ntsia thawv

Indications rau femoral interlocking rau tes

Txhua hom pob txha 2cm hauv qab trochanteric vertebra thiab ntau tshaj 9cm ntawm lub hauv caug sib koom.

Cov pob txha qub ntawm qhov nruab nrab ntawm lub femoral ncej.

Cov neeg mob uas ua tsis tau tejyam phaj sab hauv fixation.

Nta ntawm femoral interlocking ntsia thawv

Mechanical zoo

Lub caj npab quab yuam ntawm femoral interlocking intramedullary ntsia thawv rau kho cov pob txha yog ntev dua li ntawm cov hlau phaj, thiab lub zog sib npaug sib npaug ntawm lub hauv paus axis ntawm tag nrho cov pob txha, uas tsis yooj yim rau khoov thiab deform.

Cov ntsia hlau xauv ntawm ob qho kawg ntawm cov ntsia hlau intramedullary ua rau cov pob txha tsim tag nrho los ntawm sab saum toj mus rau hauv qab, thiab cov ntsia hlau xauv ntawm qhov kawg ntawm qhov kawg tuaj yeem txo cov torque caj npab ntawm cov ntsia hlau intramedullary hauv cov pob txha, tiv thaiv kom luv thiab tig, thiab ua tiav qhov siab tshaj plaws thiab ruaj khov rau kev txhim kho pob txha.

Gamma Interlocking Intramedullary Nail

Gamma ntsia thawv indications

Muaj feem xyuam rau ntau hom kab mob peritrochanteric fractures, tshwj xeeb tshaj yog subtrochanteric fractures.

Extended Gamma ntsia thawv (reconstruction nail) indications

siab subtrochanteric fractures, trochanteric ua ke nrog femoral ncej tawg.

Qhov zoo ntawm Gamma ntsia thawv

Tsim los ntawm kev sib txuas zawv zawg hip ntsia hlau nrog intramedullary ntsia thawv thev naus laus zis, cov ntsia hlau tseem ceeb yog ze rau sab hauv ntawm lub medullary kab noj hniav ntau dua li cov dynamic hip phaj, yog li tus ntsia thawv Gamma ua rau tus neeg mob qhov hnyav los ze zog rau femoral calcar dua li lub phaj siab dynamic, ua rau lub zog ntawm cov khoom cog. Rau subtrochanteric fractures uas muaj kev sib txuas ntawm nruab nrab cortical comminution, Gamma tus ntsia thawv zam qhov kev xav tau ntawm cov pob txha tawg ntawm lub cev, yog li nws muaj txiaj ntsig zoo rau cov pob txha intertrochanteric lossis subtrochanteric fractures.

Retrograde intramedullary femoral nailing

Indications ntawm retrograde femoral rau tes

Feem ntau siv rau supracondylar femoral fractures, suav nrog supracondylar comminuted fractures thiab intercondylar 'T' thiab 'Y' comminuted fractures uas muaj cov pob txha pob txha.

Nws kuj tseem siv tau rau cov pob txha femoral hauv qab lub isthmus ntawm femur.

Femoral ncej, supracondylar femoral, thiab intercondylar puas nyob rau hauv 20CM ntawm lub hauv caug sib koom.

Cov neeg uas ua tsis tau tejyam phaj fixation.

Cov yam ntxwv ntawm retrograde femoral nailing

Supracondylar femoral fracture yog ib qho kev puas tsuaj loj nrog kev nyuaj hauv thawj zaug, txo qis thiab qhov thib ob, muaj zog sab hauv kho. Muaj qhov tshwm sim ntau ntawm cov teeb meem xws li pob txha tsis sib koom ua ke thiab kev kho mob qeeb.

Retrograde interlocking intramedullary nailing yog ib txoj hauv kev uas feem ntau siv los kho distal femur fracture nyob rau xyoo tas los no, uas muaj kev ruaj ntseg zoo, tuaj yeem tswj tau qhov kev hloov pauv tom qab thiab kev hloov pauv ntawm qhov kawg ntawm qhov tawg, thiab pab thaum ntxov sib koom ua ke.

Supracondylar ua ke femoral qia pob txha yog tsau nrog lengthened supracondylar intramedullary nailing, uas daws tau qhov teeb meem uas nyuaj yuav daws tau los ntawm interlocking intramedullary nailing ntawm lub femur. Cov cuab yeej siv tau yooj yim rau kev khiav lag luam, qhov tseeb ntawm qhov chaw, txhim khu kev qha, thiab tus neeg mob tuaj yeem ua haujlwm thaum ntxov hauv caug tom qab kev phais.

Tibial interlocking intramedullary rau tes

Indications rau tibial nailing

Cov pob txha ruaj khov hauv nruab nrab 1/3 ntawm tibia: cov pob txha tawg, luv oblique pob txha, pseudarthrosis.

Cov pob txha tsis ruaj khov nyob rau hauv 60% ntawm qhov ntev ntawm qhov nruab nrab tibia: pob txha nyob ze ntawm lub metaphysis, ntev kauv fractures, segmental fractures, comminuted fractures, fractures nrog cov pob txha tsis xws luag.

Cov yam ntxwv ntawm tibial nailing

Interlocking intramedullary nailing ntawm tibia feem ntau yog siv rau nruab nrab tibia pob txha.

Txawm hais tias nws tseem tuaj yeem siv rau qhov sib thooj thiab qhov sib luag ntawm tibia pob txha, qhov teeb meem tus nqi siab dua, malunion tshwm sim ntau zaus, qhov kawg ntawm pob txha muaj ≧1cm ntawm kev txav mus los hauv 1/2 ntawm cov xwm txheej, thiab 1/4 ntawm kev kho tsis tiav.

Cov ntaub ntawv tau tshaj tawm cov txiaj ntsig zoo ntawm cov pob txha pob txha pob txha zoo dua li qhov sib thooj tibia pob txha tom qab niaj hnub kho ntawm fibula.

Cov txheej txheem phais

Kev npaj ua ntej ntawm cov cuab yeej tshwj xeeb

Orthopedic txaj (traction txaj) lossis tus qauv fluoroscopic phais txaj; retractor; duab intensifier.

Kev xaiv ntawm intramedullary ntsia thawv ntev rau preoperative endoprostheses

Xov tooj cua

contralateral limb length ntsuas

Intramedullary ntsia thawv txoj kab uas hla

x-ray isthmus dav

Intramedullary ntsia thawv ntev ntsuas

1.Translucent kav txiav txim nyob rau hauv C-arm tshuab

Lub distal thiab proximal kawg ntawm cov pob txha yog nyob rau hauv nruab nrab ntawm lub rays; tus kav yog parallel rau lub diaphysis.

2.Length ntsuas raws li lub cev nto cim

Femur: ntsis ntawm ntau dua trochanter → lateral hauv caug qhov chaw los yog superior ncej ntawm patella; tibia: medial-lateral hauv caug qhov chaw → anterior nam ntawm pob taws sib koom hauv dorsiflexion ntawm ko taw.

Intramedullary Nail Insertion Technique - Kev Nkag Mus Nkag

Longitudinal axis ntawm medullary kab noj hniav nyob rau hauv ib txoj kab ncaj nraim

Tsis dhau ze rau qhov chaw nkag

Tsim nyog ntev: dilated - ntev; undiated - luv

(Kev lees paub tsis ncaj ntawm qhov chaw nkag; tsis muaj cov paj dilation, tsis muaj cov ntaub so ntswg tiv thaiv yuav tsum tau)

Parallel femoral intramedullary ntsia thawv nkag nkag

Kev npaj ntawm qhov nkag mus rau qhov sib npaug femoral intramedullary ntsia thawv

Hip flexion thiab adduction

Longitudinal incision proximal rau ntau dua trochanter

Tsis deb dhau rov qab

Qhov chaw ntawm tus taw qhia tus pin

Qhov chaw ntawm cov ntaub thaiv npog mos

Retrograde femoral intramedullary ntsia thawv nkag nkag

30 ° lub hauv caug flexion

Ntev axis ntawm tus taw qhia tus pin nyob rau hauv tib txoj kev raws li lub medullary kab noj hniav ntawm lub distal femoral qia

Ntxig ntawm Kirschner tus pin rau hauv qhov distal femur ntawm patellar ligament los ntawm lub tes tsho tiv thaiv: orthogonal - nruab nrab ntawm intercondylar fossa ntawm femur; lateral - Blumensaat's kab

Pib taw tes ntawm PCL yam tsis muaj kev raug mob

Parallel tibial intramedullary ntsia thawv nkag

Nyob rau hauv lub centerline ntawm medullary kab noj hniav

Sab saum toj margin ntawm tibial toj siab

Siab npaum li qhov ua tau yam tsis muaj kev puas tsuaj rau lub toj siab

Lub hauv caug flexion siab tshaj plaws

Incision tibial tuberosity-cov ncej ntawm patella raws medullary kab noj hniav

Qhib lub medullary kab noj hniav: qhia tus pin ntawm 15 ° rau lub dav hlau sagittal ntawm longitudinal axis ntawm tibial qia

Txoj hauj lwm ntawm cov duab intensifier

Marrowing cov txheej txheem

Hluav taws xob txo qis

cov pob txha tshiab

Kev ceev txo

qub pob txha nrog pseudoarthrosis, sclerosis nyob rau hauv medullary kab noj hniav

Tsis muaj tourniquet nyob rau hauv kev nce nqi

ntshav khiav yog qhov zoo tshaj plaws coolant

Repositioning cov txheej txheem

Parallel femoral intramedullary nailing

Yog vim li cas rau kev nyuaj hauv kev kho femoral fractures

Cov ntaub so ntswg tuab tsis tso cai rau cov pob txha ncaj qha

Koob nkag point tsis tuaj yeem pom ncaj qha

Hip ob leeg adduction → iliac fascia nro → pob txha shortening

Tibial fracture txo

Manipulation

Feem ntau yog subcutaneous thiab yooj yim rau palpate

Stabilized puas - nruab nrab lossis distal A thiab B hom pob txha

Oblique fractures - overkill

Intramedullary nailing → tshem tawm cov cuab yeej

Kev ntsuas txo qis

Point txo forceps

tibia; percutaneous los yog qhov txhab siv

Loj retractors (braces)

ncua kev txo qis; limb shortening

Temporary Schanz screws

① Femur, tibia

② Raws li ze rau txoj kab tawg li sai tau

③ Proximal tawg ib leeg siv cortical

④Siv lub chuck universal nrog T-kuav kom yooj yim maneuvering

Poller ntsia thawv

①Metaphyseal tawg (kho txoj kab ntawm quab yuam, ruaj khov kho, rov ua haujlwm)

② oblique pob txha ntawm lub pob txha pob txha los yog femur (shear stress → siab)

③ Cov ntsia hlau tsis zoo nkag mus rau hauv qhov qub medullary channel thaum lub sijhawm phais thib ob

④ Cov ntsiab lus tsis zoo ntawm kev nkag, qhov tsis zoo ntawm cov pob txha pob txha sib raug zoo (ntsuas ntsia hlau muab tso rau ntawm qhov ua tau hloov pauv ntawm qhov endoplant)

Ntxiv dav tourniquet

① tibia

② ntxiv los ntawm traction lossis retractor

③ Siv ceev faj hauv cov nqaij mos raug mob hnyav

④ Cia nws luv

⑤ Txwv tsis pub medullary expansion hauv lub xeev inflated

Ntsia locking sequence: distal ces proximal

Qhov zoo

yooj yim ntawm knockback, compression ntawm tawg tawg; tshem tawm kev sib cais; txo kev ua haujlwm.

Txo cov txheej txheem rau ncua sij hawm & kev phais kev phais

Cov teeb meem uas yuav ntsib nrog kev phais ncua

Axial deformity (shortening, angulation thiab hloov chaw)

Kev loj hlob ntawm cov ntaub so ntswg granulation

Cov pob txha thaum ntxov

Sclerosis ntawm pob txha tawg nrog kaw ntawm medullary kab noj hniav

Osteoporosis

Muaj teeb meem intraoperative

Deflection ntawm tus expander thiab tus ntsia thawv intramedullary → intramedullary ntsia thawv nkag ntawm lub cortex

Angular deformity → retractor

Dislocation ntawm qhov xaus → Poller tus ntsia thawv, phaj fixation

Cov txheej txheem los tiv thaiv cov kab txawv txav

Proximal - qhov tseeb nkag nkag

Distal - intramedullary ntsia thawv nyob rau hauv nruab nrab ntawm lub medullary kab noj hniav

Cov teeb meem ntawm Intramedullary Nailing

★ Kab mob

★ Kev puas tsuaj rau paj hlwb

★ Distorted kho ntawm pob txha

★ Kev Kho Mob Fractures

Sab nraud rotation, torsion, valgus, internal rotation, angulation

★ mob pob qij txha

★ Rog embolism

★ Heterotopic ossification

★ Pulmonary embolism

★ Rov ua dua

★ Thrombosis

★ Joint nruj

★ Tsis yog kev sib koom ua ke ntawm pob txha pob txha, pob txha nonunion

★ Internal fixation tsis ua hauj lwm

★Limb shortening

★ Lwm yam

Teeb meem-- Kab mob

1. Thaum ntxov, qhib pob txha raug suav hais tias yog ib qho contraindication rau intramedullary nailing.

2.Qhov tshwm sim ntawm tus kab mob tom qab phais hauv qhov qhib pob txha yog nyob ntawm qhov xwm txheej ntawm cov nqaij mos raug mob thiab kis kab mob.

Qhov tshwm sim ntawm kev kis kab mob tom qab qhib pob txha yog nyob ntawm lub xeev ntawm cov nqaij mos raug mob thiab kev kis kab mob nrog rau kev tswj cov ntaub so ntswg.

3.Thinner intramedullary rau tes ua rau muaj feem kis tau tus mob; non-expanded locking intramedullary nails fixation yog qhov tsis zoo, thiab cov pob txha xaus muaj

Qhov tsis-expanded locking intramedullary ntsia thawv fixation yog tus tsis zoo, nrog rau microscopic txav ntawm qhov kawg ntawm cov pob txha thiab cov seem seem, uas yog ib qho yooj yim rau cov kab mob loj hlob.

4. Kev siv ntawm kev nthuav dav thiab txwv kev nthuav dav medullary fixation tsis tsuas yog txhim kho qhov ruaj khov ntawm cov pob txha, tab sis kuj zam kev tsim ntawm qhov chaw tuag.

Fat Embolism Syndrome

1.Qhov tshwm sim ntawm FES ntawm qhov ntev tubular pob txha tawg yog 0.5% mus rau 2%.

2. Kev nthuav dav ntawm medulla thiab tsis nthuav dav ntawm medulla tsis muaj qhov cuam tshuam loj rau kev ua pa ntawm lub ntsws.

3.Thaum nthuav cov medulla, cov txheej txheem yuav tsum maj mam kneading, tsis txhob muaj zog ntau dhau thiab ua haujlwm ntxhib.

4. qhov kev kuaj mob tam sim no ntawm FES tseem lees txais cov qauv uas tau hais los ntawm Gurd hauv xyoo 1974, thiab kev kho mob tom qab kuaj mob yuav ncua sij hawm zoo tshaj plaws rau kev kho mob thiab tej zaum yuav muaj teeb meem loj.

Ncua pob txha kho thiab pob txha nonunion

Ntau yam cuam tshuam rau pob txha kho tom qab intramedullary ntsia thawv kho, thiab cov laj thawj yuav raug tshuaj xyuas raws li hauv qab no.

1.soft cov ntaub so ntswg embedded nyob rau hauv lub puas kawg

2. Kev sib cais ntawm kev sib tsoo ntawm qhov kawg

3. Tus neeg mob lub hnub nyoog laus dua

4. Qhib pob txha, mob nqaij mos loj, mob hemodialysis hauv zos lossis kis mob.

5. Tsis zoo intramedullary ntsia thawv fixation

6. Ua ke ntshav qab zib mellitus lossis lwm yam kab mob noj.

Kev Kho Mob Fractures

Kev kho mob pob txha pob txha yog feem ntau cov pob txha tawg uas tshwm sim los ntawm kev siv tsis raug thaum lub sij hawm intramedullary ntsia thawv fixation.

Intraoperative saib xyuas yuav tsum tau them rau

1. Kev xaiv tsis raug ntawm tus ntsia thawv nkag nkag tuaj yeem ua rau muaj kev sib tsoo ze.

2. Tsis txhob quab yuam thawb hauv kev nthuav dav ntawm medulla.

3. Kev nkag ntawm cov ntaub ntawv nthuav tawm yuav tsum nyob rau hauv tib txoj kev raws li cov kev taw qhia ntawm cov ntsia hlau ntxig.

4. Tsis txhob siv quab yuam thaum muab cov ntsia hlau intramedullary rau hauv qhov kawg.

Mob hauv cov pob qij txha nyob sib ze

1. Qhov chaw ntawm tus ntsia thawv intramedullary muaj cov ntaub so ntswg mos thiab txawm tias cov tshuaj ntsiav sib koom ua ke nyob ib ncig ntawm tsawg kawg yog 1 pob qij txha.

2. Lub tibial toj siab txuas nrog rau sab pem hauv ntej ntawm qhov nruab nrab meniscus los ntawm lub hauv caug transverse ligament thiab tsim ib thaj chaw nyab xeeb saum lub tibial tuberosity mus txog qhov no. Yog hais tias lub nailing taw tes nyob ze rau sab saum toj los yog txoj kab uas hla ntawm tus ntsia thawv intramedullary loj dhau lawm, nws tuaj yeem ua rau muaj kev puas tsuaj rau cov txheej txheem intra-articular, uas ua rau mob tom qab lub hauv caug.

3. Proximal protrusion ntawm intramedullary ntsia thawv thiab heterotopic ossification yog lub ntsiab ua rau mob hip tom qab femoral intramedullary ntsia thawv phais.

4. Proximal protrusion ntawm intramedullary rau tes, proximal locking ntsia thawv irritation thiab rotator cuff cuam tshuam yog lub ntsiab ua rau mob lub xub pwg nyom tom qab humeral intramedullary nailing.