Femoral Intramedullary Nailing - Yuav Ua Li Cas Xaiv Qhov Zoo Tshaj Qhov Taw Qhia?

Taw qhia

Kev txhim kho ntawm kev kho mob pob txha femoral tuaj yeem rov qab mus rau xyoo 1940s thaum Kuntscher tau qhia txog cov txheej txheem kaw intramedullary nailing. Kev siv cov ntsia hlau intramedullary (IMNs) hauv femoral fractures tau dhau los ua tus qauv kev saib xyuas nyob rau ob peb lub xyoo dhau los, thiab tam sim no kev txhim kho hauv intramedullary nailing thiab kev nce qib hauv cov txheej txheem phais tau tso cai rau kev siv cov intramedullary nailing ntawm femur.

Conservative kev kho mob ntawm femoral qia fractures tsuas yog siv nyob rau hauv ib tug tsawg tsawg ntawm cov neeg mob uas tseem ceeb contraindications rau tshuaj loog thiab phais, thiab lub mainstay ntawm kev kho mob tseem phais fixation. Hais txog kev kho mob ntawm cov pob txha no, muaj ntau yam kev xaiv muaj, suav nrog intramedullary nailing, phaj ntsia hlau fixation, thiab sab nraud fixation. Piv nrog rau lwm cov kev xaiv phais, intramedullary nailing yog qhov kev hloov kho nrog tus nqi qis tshaj plaws thiab qhov kev kho pob txha zoo tshaj plaws, thiab nws tau dhau los siv dav hauv kev kho mob.

Kev nkag siab zoo ntawm lub cev nqaij daim tawv ntawm tus proximal femur, cov ntshav muab rau lub taub hau femoral thiab lub cev nqaij daim tawv ntawm lub duav tuaj yeem ua rau muaj kev vam meej ntawm intramedullary nailing rau femoral fractures. Nyob rau hauv sib piv, qhov kev xaiv ntawm nkag point nyob ntawm ntau yam, xws li intramedullary ntsia thawv tsim, tawg qhov chaw, pob txha comminution, thiab cov neeg mob yam (xws li, polytrauma, cev xeeb tub, thiab rog). Txawm hais tias qhov chaw nkag tau raug xaiv, tau txais qhov tseeb nkag yog qhov tseem ceeb kom muaj kev txo qis txaus thaum lub sij hawm intramedullary ntsia thawv ntxig thaum txo qhov kev pheej hmoo ntawm cov teeb meem.

Femoral Anatomy

1. Cov ntshav muab rau lub taub hau femoral

Lub taub hau femoral tau txais vascular los ntawm 3 cov hlab ntsha loj. Lub lateral rotator femoral artery (nrog rau 3-4 ceg), obturator hlab ntsha, uas muab lub round ligament, thiab cov medial rotator femoral artery (Fig. 1), uas kuj muab tawm ib tug upward ascending hlab ntsha uas anastomoses nrog rau sab rotator femoral artery thiab muab chanteric cheeb tsam.

2.Tsev cev nqaij daim tawv

Thaum ua haujlwm intramedullary nailing ntawm lub femur, kev nkag siab zoo ntawm cov leeg hauv cheeb tsam ib puag ncig lub rotor yog qhov tseem ceeb los tiv thaiv kev raug mob tsis tsim nyog. Cov leeg gluteus medius pib los ntawm ilium thiab xaus rau sab nraud ntawm qhov loj dua trochanter, thaum cov leeg gluteus minimus kuj tshwm sim los ntawm ilium thiab dhau mus rau tom qab ntawm lub duav sib koom ua ke mus rau qhov kawg ntawm qhov trochanter loj dua (Figures 2 & 3). Ob leeg ntawm cov leeg no ua haujlwm ua adductors ntawm tus ncej puab thiab sab hauv rotators ntawm lub duav. Yog li ntawd, kev puas tsuaj rau cov leeg no thaum lub sij hawm tso rau ntawm paracentric femoral intramedullary ntsia thawv yuav ua rau adductor tsis muaj zog thiab Trendelenburg gait, uas muaj kev cuam tshuam tsis zoo rau cov neeg mob rov qab los thiab cov txiaj ntsig.

Fig. 2. Anatomy ntawm cov leeg nyob ib ncig ntawm lub duav pob qij txha

Daim duab 3. proximal femoral nqaij Symptoms cheeb tsam

Parallel Femoral Intramedullary Nail

Ntau qhov kev tshawb fawb tsis ntev los no tau tshawb nrhiav qhov zoo tshaj plaws nkag mus rau paracrine femoral ntsia thawv. Cov kev xaiv rau ntsia thawv nkag muaj xws li cov trochanter ntau dua thiab cov pyriform fossa, txhua tus muaj nws tus kheej qhia thiab cov teeb meem cuam tshuam (Table 1).

Table 1.Pib cov ntsiab lus thiab muaj peev xwm txaus ntshai ntawm paracrine thiab retrograde femoral nailing
txawv	parallel intramedullary ntsia thawv		retrograde intramedullary ntsia thawv
	lub rotor	pyriform fossa (anatomy)
crown dav hlau	Vertex ntawm ntau dua trochanter thiab taw qhia medially mus rau medullary kab noj hniav	Kev sib tshuam ntawm ntau dua trochanter thiab femoral caj dab	Qhov nruab nrab ntawm qhov intercondylar fossa (anatomy)
sagittal plane (math.)	Kab nruab nrab ntawm qhov nruab nrab ntawm qhov loj dua trochanter thiab qhov nruab nrab ntawm lub plab kab noj hniav ntawm lub femur	pyriform fossa (anatomy)	PCL 1.2 cm anterior mus rau femoral pib taw tes, taw tes rau medullary kab noj hniav.
raug	Hip abductor pawg stopping point raug mob	Kev puas tsuaj ntawm cov ntshav muab rau lub taub hau femoral thiab lub duav sab nraud rotator leeg	Kev tuav tsis raug yuav ua rau PCL
PCL: posterior cruciate ligament

1.Large rotor koob nkag point

Qhov ntau dua trochanter tau piav qhia tias yog sab nraud ntawm cov pob txha trapezoidal protuberance nyob rau sab nraud ntawm lub caj dab femoral, qhov saum npoo uas muab txuas rau sab nraud gluteus medius thiab anterior gluteus minimus nqaij (Figures 2 thiab 3). Txawm hais tias qhov no yog qhov chaw me me, qhov chaw pib qhov tseeb thaum ua qhov IMN femoral yuav yog qhov txawv ntawm qhov tau txais txiaj ntsig zoo lossis tsis zoo thaum cuam tshuam nrog femoral qia tawg.

Kev tshuaj xyuas cov ntaub ntawv tam sim no rau femoral nkag point piav qhia, peb pom tias tsis muaj ib qho kev piav qhia meej anatomical landmark rau femoral rotor IMN nkag point.Bharti li al. piav qhia txog qhov chaw nkag los ntawm lub apical apex ntawm ntau dua trochanter raws li qhov nruab nrab mus rau medullary kab noj hniav nyob rau hauv orthostatic txoj hauj lwm, thiab raws li yog qhov chaw ntawm lub trochanter ntau dua nyob rau hauv txoj kab nrog rau qhov chaw ntawm lub femoral medullary kab noj hniav nyob rau hauv lateral txoj hauj lwm (Fig. 4), thiab lwm yam kev piav qhia ntawm qhov ntau dua trochanter nyob rau hauv lub trochantery taw tes ntawm view. anterior ntawm lub anterior ib feem peb thiab posterior ob feem peb ntawm lub rotor.Georgiadis li al. piav qhia lub ntsiab lus ntawm rab koob nkag yog feem ntau tom qab ntawm lub apical superior margin ntawm lub rotor.

Daim duab 4. Intraoperative orthostatic thiab lateral views ntawm lub duav qhia qhov zoo tagnrho nkag point rau femoral paramedian intramedullary nailing ntawm lub trochanter ntau dua. '*' qhia txog tus ntsia thawv intramedullary.

Cov kev tshawb fawb tsis ntev los no hauv cov ntaub ntawv tau pom tias lub apex ntawm ntau dua trochanter yog qhov zoo tshaj plaws pib taw tes kom tau txais kev pom zoo ntawm kev quab yuam, thiab qhov kev sib raug zoo tsis zoo vim qhov kev hloov pauv tsis zoo feem ntau tshwm sim thaum lub ntsiab lus nkag mus rau ntau dua 2 hli lateral mus rau ntau dua trochanter. Txoj kev tshawb no tseem hais ntxiv tias qhov chaw nkag mus tom ntej yuav ua rau muaj kev cuam tshuam rau pem hauv ntej, thaum qhov chaw nkag nruab nrab tuaj yeem ua rau qhov cuam tshuam ntawm qhov cuam tshuam yuav raug tshem tawm tom qab. Nyob rau hauv sib piv, lwm txoj kev tshawb fawb pom tau hais tias nyob rau hauv intertrochanteric femur fractures, qhov tshwm sim ntawm intramedullary ntsia thawv impingement yog loj dua nrog ib tug pinning point uas yog lateral mus rau sab anterior dua nrog ib tug pinning point uas yog ze rau lub nruab nrab thiab posterior sab.

Qhov ntau dua trochanteric apex pinning point feem ntau yog siv rau cov neeg mob rog, thiab cov txheej txheem no tsis tshua muaj kev xav tau, muab sijhawm ua haujlwm tsawg dua thiab muaj kev pheej hmoo tsawg dua li qhov pyriform fossa pinning point.

KEV PAB CUAM: Intraoperative thiab postoperative teeb meem ntawm femoral intramedullary nailing nrog ib tug ntau dua trochanteric mus kom ze point tau tham nyob rau hauv ntau yam kev tshaj tawm. Ib qho ntawm cov no, feem ntau cuam tshuam nrog cov txheej txheem nailing, yog kev kho mob pob txha. Nyob rau hauv intertrochanteric femoral fractures, ib qho chaw nkag nyob rau sab thiab anterior mus rau lub trochanter ntau dua yog feem ntau yuav ua rau ib tug medial fractures tshaj qhov nkag point ze rau sab medial.

Lwm qhov teeb meem tseem ceeb yog vim cov nqaij mos raug mob, tshwj xeeb tshaj yog rau cov ceg ntawm cov hlab ntsha medial rotator femoral artery thiab cov leeg adductor, tab sis cov kev raug mob no tsawg dua piv nrog cov pyriform fossa nkag rau ntsia thawv. Tsis tas li ntawd, qhov tshwm sim ntawm ischemic necrosis ntawm lub taub hau femoral nrog lub apex ntawm ntau dua trochanter raws li qhov nkag nkag tau xav tias yuav qis dua, nrog cov kev tshawb fawb qhia tias nws qis li 0.3%.

Xav txog lub sij hawm intraoperative thiab fluoroscopic raug, lub sij hawm nruab nrab yog 90.7 feeb rau qhov ntau dua trochanteric nkag point piv nrog rau 112.7 feeb rau pear-shaped fossa nkag point pawg, whereas fluoroscopic lub sij hawm yog 5.88 vib nas this rau ntau dua trochanteric nkag point pear-pawg pab pawg 0 vib nas this thiab 1 vib nas this. nrog pear-puab fossa nkag point.

Tus neeg mob prognosis kuj yog ib qho tseem ceeb thaum txiav txim siab ntawm intramedullary ntsia thawv nkag, raws li thaum ntxov ua hauj lwm rov qab (raws li kev soj ntsuam los ntawm lub rooj zaum-lub rooj kuaj thiab timed elevation test) tau zoo dua nyob rau hauv cov neeg mob ntawm 6 lub hlis tom qab phais rau qhov ntau dua trochanteric nkag point piv nrog cov pyriform fossa nkag point 1 lub hlis tsis tseem ceeb, tab sis qhov no yog qhov tseem ceeb ntawm tus ntsia thawv. Txawm hais tias qhov ntau dua trochanteric nkag mus yog feem ntau cuam tshuam nrog cov ntaub so ntswg tsawg dua vim nws qhov chaw, nws tseem tuaj yeem ua rau raug mob rau cov leeg nqaij abductor, raws li tau pom los ntawm Ergiş li al. Lawv pom tias dynamic tshuav nyiaj li cas thiab lub duav abductor lub zog tau txo nyob rau hauv cov neeg mob uas muaj ntau dua trochanteric nkag peg piv rau kev noj qab nyob zoo tswj. Tsis tas li ntawd, lawv txoj kev tshawb fawb tau qhia txog qhov txo qis hauv lub zog ntawm lub duav abductors, flexors thiab sab hauv / sab nraud rotators piv rau sab tsis ua haujlwm.

2. Pearly fossa nkag point

Lub fossa ntawm cov leeg pyriformis yog ib qho tseem ceeb anatomical landmark pom tias yog ib qho ntawm cov ntsiab lus nkag rau paracentesis femoral intramedullary ntsia thawv. tau sau tseg tias cov fossa ntawm cov leeg pyriformis tsis yog 'pear' zoo li lossis cov leeg pyriformis txuas. Cov leeg txuas mus rau ib qho chaw me me ntawm qhov kawg ntawm qhov loj dua trochanter, whereas pyriform fossa yog ib qho kev nyuaj siab nyob rau sab nruab nrab ntawm qhov loj dua trochanter thiab yog ib qho txuas ntawm extensor carpi radialis brevis leeg. Cov kws sau ntawv tau xaus lus tias cov leeg pyriform thiab cov pyriform fossa yog ob qhov sib txawv thiab qhov hu ua pyriform fossa yuav tsum raug hu ua 'rotor' lossis 'occlusal' fossa kom pom tseeb thiab qhov tseeb ntawm lub cev. Lawv tau tawm tswv yim tias tom qab kawm cis-femoral Lawv tau hais tias thawj lo lus 'rotor fossa' yuav tsum tau rov qhia dua hauv cov ntaub ntawv es tsis txhob 'pyriform fossa' tom qab kawm cov ntsiab lus ntawm parafemoral nkag point. Txawm hais tias cov ntsiab lus ntawm ob txoj kev tshawb fawb no tau saib xyuas zoo, kom yooj yim piav qhia thiab tiv thaiv kev tsis sib haum xeeb nrog ntau dua trochanteric nkag point, peb tseem yuav xa mus rau qhov chaw nkag no raws li pyriform fossa nkag point.

Ntau qhov kev tshawb fawb hauv cov ntaub ntawv tam sim no qhia meej txog qhov tseeb nkag ntawm pearly fossa rau intramedullary femoral nails.Georgiadis li al. piav qhia txog pearly fossa nkag point raws li thaj tsam ntawm kev txuas ntawm extensor carpi radialis brevis leeg hauv kev nyuaj siab ntawm lub hauv paus ntawm lub caj dab femoral (Fig. 5). Cov kws sau ntawv kuj tseem hais ntxiv tias qhov nkag mus uas nyob deb dhau mus lossis nyob deb sab hauv tuaj yeem ua rau muaj kev pheej hmoo ntawm femoral caj dab tawg, thiab thaum lub ntsiab lus nkag mus deb dhau mus, tej zaum yuav muaj kev pheej hmoo siab ntawm ischemic necrosis, uas siab dua rau cov neeg hluas.

Daim duab 5. Intraoperative frontolateral saib ntawm lub duav uas qhia qhov zoo tagnrho nkag point rau ib tug pyriform fossa retrograde femoral intramedullary ntsia thawv. Lub '*' qhia txog tus ntsia thawv intramedullary pib taw tes.

Harper et al. luam tawm ib txoj kev tshawb no ntawm 14 pawg ntawm tib neeg cadaveric femurs nyob rau hauv 1987 nyob rau hauv uas lawv ntsuam xyuas qhov chaw ntawm intramedullary phau ntawv qhia tus pin thiab qhov chaw tawm ntawm lub intramedullary ntsia thawv qhia distally thiab proximally nyob rau hauv ib tug retrograde zam los ntawm intercondylar notch ntawm lub femur. Lawv xaus lus tias lub ntsiab lus nkag ntawm pyriformis paramedian intramedullary ntsia thawv yog nyob rau ntawm qhov sib tshuam ntawm ntau dua trochanter nrog lub caj dab femoral, me ntsis anterior mus rau pyriformis occulta.Qhov chaw ntxig tau rov qab los ntawm Gausepohl li al. Hauv lwm txoj kev tshawb fawb cadaveric, lawv tau txheeb xyuas qhov zoo tshaj plaws nkag mus rau tus ntsia thawv femoral intramedullary nyob rau ntawm ntug nruab nrab ntawm qhov loj dua trochanter overlying cov leeg pyriformis. Tsis tas li ntawd, hauv kev kawm cadaveric los ntawm Labronici li al. lub fossa ntawm cov leeg pyriformis tau piav qhia tias yog thaj tsam pear-puab luminal uas tau sib koom nrog lub hauv paus axis ntawm femoral intramedullary kab noj hniav nyob rau hauv lub coronal dav hlau.

Lub pyriform fossa nkag point muaj qee qhov tsis zoo vim nws yog technically nyuaj dua piv rau qhov ntau dua trochanter access point, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob rog. Tsis tas li ntawd, qhov zoo tshaj plaws nkag qhov chaw rau pear-puab fossa koob nkag point yog ib qho chaw nqaim, ua rau nws nyuaj rau hauv zos. Piv txwv li, qhov pib tshaj plaws ntawm lub caj dab femoral yuav ua rau muaj kev ntxhov siab ntau dhau thiab ua rau muaj kev pheej hmoo ntawm anterior cortical tawg, tshwj xeeb tshaj yog tias qhov pib taw tes yog ntau tshaj 6 hli anterior rau fossa. Tsis tas li ntawd, qhov sib txawv ntawm morphologic tuaj yeem cuam tshuam qhov chaw nkag tau raug, tshwj xeeb tshaj yog tias qhov luv luv sab nraud rotator yog qhov loj lossis lub rotor yog protruding, ua rau qhov chaw nkag uas yog qhov nruab nrab thiab muaj kev pheej hmoo ntawm femoral caj dab tawg.

TSIS TXAUS SIAB: Los ntawm kev sib piv 38 ntau dua trochanteric nkag qhov chaw nrog 53 pearly fossa nkag qhov chaw rau femoral intramedullary nailing, Ricci li al pom tias pawg pearly fossa muaj 30% ntev ua haujlwm thiab 73% ntev fluoroscopy lub sij hawm. Cov kev tshawb pom no tau lees paub los ntawm Bhatti li al. thaum piv cov 2 koob nkag cov ntsiab lus.

Hais txog kev raug mob ntawm cov nqaij mos, muaj kev pheej hmoo siab dua ntawm cov nqaij mos raug mob ntawm cov pyriformis inlet piv nrog cov interosseous neuromuscular ntawm qhov ntau dua trochanteric koob nkag. Dora et al. soj ntsuam 16 tus neeg laus cadaveric femurs rau cov nqaij mos raug mob rau cov leeg pyriformis thiab rotor nkag tus pin. Lawv pom tias txawm hais tias pyriformis fossa yog geometrically pom, nws ua rau muaj kev puas tsuaj ntau rau cov hlab ntsha rau lub taub hau femoral thiab cov leeg nqaij thiab cov leeg. Cov kev tshawb pom no tau lees paub los ntawm kev tshawb fawb cadaveric los ntawm Ansari Moin li al. WHO kuj tau piv ob lub ntsiab lus nkag. Lawv tau sau tseg tias kev kho sab hauv ntawm tus ntsia thawv pib ntawm cov leeg pyriformis feem ntau yuav ua rau lub duav abductors thiab cov rotators sab nraud. Tsis tas li ntawd, kev puas tsuaj rau cov hlab ntsha medial rotator femoral artery tau pom nyob rau hauv txhua rooj plaub (Table 2).

Table 2. Cov ntsiab lus ntawm cov nqaij mos raug mob ntawm qhov sib txawv ntawm cov koob nkag
txawv	Pyriform fossa nkag point (n=5)	Loj rotor pub point (n=5)
cov ntaub so ntswg
gluteus medius nqaij (anatomy)	5	1
gluteus medius leeg	0	4
leeg raug mob
gluteus minimus (anatomy)	3	0
pyriformis nqaij (dhau ntawm sab qaum)	3	3
obturator internus (anatomy)	1	0
latissimus dorsi nqaij (anatomy)	3	0
Cov hlab ntsha thiab cov hlab ntsha sib koom ua ke
MFCA Deep Ceg	4	0
MFCA Shallow Ceg	4	0
articular capsule (ntawm kev sib koom tes xws li hauv caug hauv lub cev)	1	0
MFCA: medial circumflex femoral artery.

Tsis ntev los no, Bharti et al. tau kawm txog qhov teeb meem ntawm femoral intramedullary nailing ntawm qhov chaw nkag trochanteric ntau dua thiab qhov chaw nkag pearly fossa thiab pom cov teeb meem kev pheej hmoo xws li pob txha kho tus nqi thiab sau cov ntsiab lus raws li hauv qab no (Table 3).

Table 3. Pyriform fossa nkag point thiab ntau dua trochanter nkag point femoral pob txha
teeb meem	Piriformis sinus koob point	Greater trochanter insertion point
Kab mob	6.7	3.3
Malunion	20	13.3
Kev kho mob qeeb	20	13.3
Txwv hip motion	20	33.3
Txwv lub hauv caug txav	6.7	6.7
Limb length sib txawv	13.3	20
Tail cap protrudes saum cov pob txha cortex	13.3	20
Intraoperative femoral caj dab tawg	10	0
Loj dua trochanter tawg	0	3.4
Femoral taub hau necrosis	6.7	0

Retrograde femoral intramedullary nailing

Kev txiav txim siab qhov chaw nkag uas tsim nyog rau retrograde femoral intramedullary nailing yuav pab kom ua tiav cov kev kho kom zoo ntawm cov pob txha pob txha, qhov ntev, thiab kev sib hloov thaum txo qis pob txha pob txha puas, anterior cruciate ligament (ACL), posterior cruciate ligament (ACL), thiab cov ntaub so ntswg mos (Table 1). Tsis ntev los no, tau muaj kev txaus siab ntxiv rau hauv retrograde femoral intramedullary nailing nrog lub hom phiaj ntawm kev txo cov teeb meem cuam tshuam nrog paracromial nailing, nrog rau mob hauv siab, heterotopic ossification, adductor tsis muaj zog, thiab pudendal paj hlwb, uas yog suav tias yog qhov tsis tshua muaj tshwm sim thaum piv nrog incisional remorcture thiab plating hauv fractions, tshwj xeeb tshaj yog nyob rau hauv kev kho mob. ib feem peb ntawm femoral qia. Tsis tas li ntawd, cov pov thawj tsis ntev los no qhia tau hais tias thaum cov ntsia hlau retrograde intramedullary yog qhov tsim nyog, tsis tas yuav tsum tau kaw cov ntsia hlau ze ze.Tsis muaj qhov sib txawv ntawm cov nqi kho mob, lub sijhawm kho, lossis cov neeg mob tau tshaj tawm cov txiaj ntsig ntawm Meccariello li al. thiab Bisaccia et al. nyob rau hauv kev kho mob ntawm distal ib feem peb femoral qia fractures siv xauv thiab nonlocking retrograde intramedullary rau tes. Yog li, kev siv retrograde femoral nailing tau ua nrov thiab tau txais dav.

Ntau cov lus piav qhia ntawm qhov pom kev nkag mus rau retrograde femoral intramedullary nailing tuaj yeem pom hauv cov ntawv nyeem. Feem ntau cov kev tshawb fawb txheeb xyuas qhov zoo tshaj plaws nkag mus rau tus ntsia thawv retrograde femoral li 1.2 anterior mus rau femoral keeb kwm ntawm lub posterior cruciate ligament.

cm (nyob rau hauv kab nrog medullary kab noj hniav) thiab qhov chaw ntawm lub intercondylar fossa (Daim duab 6).

Daim duab 6. Intraoperative orthostatic thiab lateral views ntawm lub hauv caug uas qhia qhov zoo tagnrho nkag point rau ib tug retrograde femoral intramedullary ntsia thawv. '*' qhia txog tus ntsia thawv intramedullary pib taw tes.

Txawm hais tias tsis muaj qhov qhia meej meej rau retrograde femoral intramedullary nailing, ntau cov txheeb ze txheeb ze tau piav qhia. Cov no suav nrog cov neeg mob polytrauma, cov neeg mob rog rog, cov neeg mob cev xeeb tub, ob sab femoral qia fractures, ipsilateral femoral qia thiab acetabular / pelvic fractures lossis femoral neck fractures, thiab ipsilateral femoral qia thiab tibial fractures. Feem ntau ntawm cov kev qhia no muaj feem xyuam rau qhov yooj yim ntawm tus neeg mob qhov chaw thiab kev tiv thaiv ntawm ntau qhov kev phais mob nyob ze.

Ntawm qhov tod tes, kiag li contraindications rau retrograde femoral intramedullary nailing muaj xws li kev cuam tshuam ntawm retrograde intramedullary channel los ntawm cov khoom cog thiab qhib pob txha ntawm lub distal femur. Cov txheeb ze contraindications yog cov pob txha nyob hauv 5 cm ntawm qhov tsawg dua trochanter, nyuaj rau kev nkag mus rau qhov pom kev nkag siab vim yog lub hauv caug flexion tsawg dua 45 degrees, ua ntej kis kab mob hauv lub hauv caug uas yuav ua rau muaj kev pheej hmoo ntawm kis mus rau femoral qia, mob hnyav heev ntawm cov nqaij mos nyob ib ncig ntawm lub hauv caug, thiab intra-articular pob txha pob txha.

Cov teeb meem: Feem ntau cov teeb meem ntawm retrograde femoral nailing muaj feem xyuam rau kev tuav tsis raug, tshwj xeeb tshaj yog qhov tsis raug ntawm qhov chaw nkag. Nyob rau hauv lub dav hlau sagittal, lub ntsiab lus nkag mus rau sab nrauv yuav ua rau kev puas tsuaj tom qab, kev puas tsuaj ntawm daim tawv nqaij, thiab tej zaum yuav ntsia hlau cuam tshuam ntawm patella thaum lub hauv caug yog flexed. Ntawm qhov tod tes, yog tias lub ntsiab lus nkag tsis raug nyob rau hauv cov kev taw qhia tom qab, qhov no yuav ua rau muaj kev pheej hmoo siab ntawm kev raug mob rau lub hauv paus caj dab tom qab thiab qhov chaw ntawm qhov chaw tawg.

Hutchinson et al. piav qhia cov teeb meem cuam tshuam nrog cov ntsiab lus tsis raug ntawm coronal dav hlau nkag. Lawv pom tias qhov kev nkag mus rau qhov nruab nrab ntau dhau ua rau muaj kev cuam tshuam ntawm posterolateral deformity nrog posterolateral fracture translation, whereas ib tug overly lateral ib tug ua rau ib tug medial deformity thiab medial translation.Sanders li al. tau tshaj tawm tias xaiv qhov chaw pib nruab nrab uas yog 2 cm lossis ntau dua ntawm qhov nruab nrab ntawm qhov nruab nrab ua rau muaj qhov nruab nrab cortical pob txha uas yog malunited vim lub posterior isthmic dabtsi yog khoov lub sijhawm ntawm cov pob txha uas ua rau tsis zoo posterolateral txo.

Lwm yam teeb meem cuam tshuam nrog retrograde femoral follower nailing muaj xws li mob hauv caug, txhav, heterotopic hauv caug ossification, thiab intra-articular hauv caug tsis muaj lub cev tsim.

Xaus

Txawm hais tias txhua tus txheej txheem intramedullary nailing muaj qhov sib piv, qhov kev xaiv ntawm cov txheej txheem intramedullary nailing siv nyob rau hauv kev kho mob ntawm femoral qia fractures feem ntau yog nyob ntawm tus kws phais nyiam. Thaum ua intramedullary nailing ntawm lub femur, tau txais qhov tseeb nkag mus rau hom ntsia thawv siv rau fixation yog yuav tsum tau rau ib tug ua tau zoo. Kev paub txog lub cev nqaij daim tawv hauv zos thiab kev ua yeeb yam hauv zos yuav pab tus kws phais neeg ua tus txheej txheem tsim nyog thaum txo qhov kev pheej hmoo ntawm cov teeb meem cuam tshuam. Tsis tas li ntawd, hauv cov txheej txheem intramedullary nailing, kev saib xyuas ntawm kev txo qis yog ib qho tseem ceeb hauv kev tiv thaiv malunion thiab malunion lossis nonunion ntawm pob txha.