femoral intramedullary nailing - Olonda otya ekifo ekisinga okuyingiza?

Okwanjula

Enkulaakulana y’obujjanjabi bw’okumenya ekisambi esobola okuddirira okutuuka mu myaka gya 1940 nga Kuntscher yaleeta enkola y’okukuba emisumaali mu mubiri enzigale. Okukozesa emisumaali egy’omu lubuto (IMNS) mu kumenya kw’ekisambi kifuuse omutindo gw’okulabirira mu myaka egiyise, n’okulongoosa mu kiseera kino mu . Okukuba emisumaali egy’omu lubuto n’okukulaakulana mu bukodyo bw’okulongoosa kisobozesezza okweyongera okw’amaanyi mu kukozesa emisumaali egy’omu kisambi mu kisambi.

Obujjanjabi obw’okukuuma okumenya kw’ekikolo ky’ekisambi bukozesebwa mu balwadde batono nnyo abalina obuzibu obw’amaanyi eri okubudamya n’okulongoosa, era omusingi omukulu ogw’obujjanjabi gusigala nga gulongoosebwa. Ku bikwata ku kulongoosa okumenya kuno, waliwo engeri eziwerako ezisobola okukozesebwa, omuli okukuba emisumaali mu mubiri, okunyweza sikulaapu y’epulaati, n’okunyweza ebweru. Bw’ogeraageranya n’engeri endala ez’okulongoosa, okukuba emisumaali mu mubiri (intramedullary nailing) kye kikyusa (modality) ekisinga okuzibuwalirwa n’omuwendo gw’okuwona okumenya okumenya, era kifuuka kikozesebwa nnyo mu nkola y’obujjanjabi.

Okutegeera obulungi ensengekera y’omubiri gw’omugongo ogw’okumpi, omusaayi oguweebwa omutwe gw’ekisambi n’ensengekera y’omubiri gw’ebinywa by’omu kiwato bisobola okwongera nnyo ku buwanguzi bw’okukuba emisumaali egy’omu lubuto olw’okumenya ekisambi. Okwawukana ku ekyo, okulonda ekifo ekiyingira kisinziira ku bintu bingi, omuli okukola omusumaali mu mubiri, ekifo awamenyese, okumenya okufuga, n’ensonga z’abalwadde (okugeza, polytrauma, embuto, n’omugejjo). Ka kibeere kifo kya kuyingira kirondeddwa, okufuna ekifo ekituufu eky’okuyingira kyetaagisa okukuuma okukendeera okumala mu kiseera ky’okuyingiza omusumaali ogw’omu lubuto ate nga kikendeeza ku bulabe bw’ebizibu.

Ensengekera y’omubiri (femoral anatomy) .

1.Okugaba omusaayi ku mutwe gw'ekisambi .

Omutwe gw’ekisambi gufuna emisuwa okuva mu misuwa eminene 3. Omusuwa gw’ekisambi ogw’ebbali (nga guliko amatabi 3-4), omusuwa gwa obturator, ogugaba omusuwa ogw’enkulungo, n’omusuwa gw’ekisambi ogw’omu makkati (Fig. 1), era nga gufulumya n’eryato eririnnya waggulu erikwata ekitundu kya lateral rotator femoral artery era ne liwa ekitundu ekinene eky’okulinnya.

2.Anatomy y'ebinywa by'ekisambi .

Bw’oba ​​okola emisumaali egy’omu lubuto mu kisambi, okutegeera obulungi ebinywa mu kitundu ekyetoolodde ekiwujjo kyetaagisa okuziyiza obuvune obuteetaagisa. Ekinywa kya gluteus medius kisibuka mu Ilium ne kikoma ku ludda olw’ebbali olwa trochanter ekinene, ate ekinywa kya gluteus minimus nakyo kisibuka mu Ilium ne kiyita ku ludda olw’emabega olw’ekiwanga ky’omu kiwato okuggwa ku ludda olw’emabega olwa greater trocherter (Figures 2 & 3). Ebinywa bino byombi bikola nga ebiwunyiriza akabina n’ebiwujjo eby’omunda eby’ekisambi. Nolwekyo, okwonooneka kw’ebinywa bino mu kiseera ky’okuyingiza omusumaali ogw’omu kifuba oguyitibwa paracentric femoral intramedullary nail kijja kuvaamu adductor obunafu n’okutambula kwa trendilenburg, ekirina akakwate akabi ku kuwona kw’omulwadde n’ebivaamu.

Ekifaananyi 2. Ensengeka y’ebinywa ebyetoolodde ekiwanga ky’omu kiwato .

Ekifaananyi 3. Ekitundu eky’okukwatagana n’ebinywa by’ekisambi eky’okumpi .

Omusumaali ogw’omu kifuba ogw’enjawulo ogw’omu kifuba .

Okunoonyereza okuwerako okwakakolebwa kunoonyerezza ekifo ekisinga obulungi eky’okuyingira mu musumaali gw’ekisambi ekya Paracrine. Enkola z’okuyingira n’emisumaali mulimu Greater Trochanter ne pyriform fossa, buli emu ng’erina ebiraga n’ebizibu ebikwatagana nabyo (Table 1).

Omulongooti 1.Ebifo ebitandikirawo n’obulabe obuyinza okubaawo mu paracrine ne retrograde femoral nailing .
Enkyukakyuka .	Omusumaali ogw’omu lubuto ogukwatagana .		Omusumaali ogw’omu lubuto ogw’okudda emabega .
	Rotor .	Fyriform fossa (Ekifaananyi) .
Ennyonyi ya Crown .	Vertex of the Greater Trochanter n'okusonga wakati w'ekituli kya medullary .	Enkulungo y’omuti gwa trochanter omukulu n’ensingo y’ekisambi .	Median ya intercondylar fossa (anatomy) .
Ennyonyi ya Sagittal (Okubala.)	layini wakati w’amasekkati ga Greater Trochanter n’amasekkati g’ekituli ky’obusigo mu kisambi .	Fyriform fossa (Ekifaananyi) .	PCL 1.2 cm anterior to the femoral starting point, nga kisonga ku medullary cavity.
Okubikkulwa .	Ekibinja ky'okuwamba ekisambi Okuyimirira obuvune .	okukosa omusaayi okutuuka ku mutwe gw’ekisambi n’ekinywa ky’ekisambi eky’ebweru ekizimbulukusa .	Okukwata obubi kuyinza okuvaako PCL .
PCL: Omusumaali ogw’emabega ogw’omusalaba .

1.Ekifo ekiyingira mu mpiso ya rotor ennene .

Ekirungo ekinene (Greater Trochanter) kibadde kyogerwako nga ekisengejja ky’amagumba ekiyitibwa trapezoidal bony protuberance ekisangibwa ku ludda olw’ebbali olw’ensingo y’ekisambi, kungulu kwayo kuwa okwegatta ku binywa bya lateral gluteus medius ne anterior gluteus minimus (Figures 2 and 3). Wadde nga kino kifo kya magumba kitono, okugabanya ekifo ekituufu nga okola IMN y’ekisambi kiyinza okuba enjawulo wakati w’okufuna ekivaamu ekimatiza oba ekibi nga tukola ku kikolo ky’ekisambi ekimenya.

Nga twekenneenya ebiwandiiko ebiriwo kati olw’ennyonnyola z’ebifo ebiyingira mu kisambi, twazuula obutaba na kabonero ka anatomical landmark akannyonnyoddwa obulungi ku femoral rotor imn entry point.Bharti et al. described the entry point from the apical apex of the greater trochanter as being medial toward the medullary cavity in orthostatic position, and as being the center of the greater trochanter in line with the center of the femoral medullary cavity in lateral position (Fig. 4), and an alternative description of the greater trochanter entry point on the lateral hip view is in the rotor between the anterior between the anterior one-third and Ebitundu bibiri ku bisatu eby’emabega ebya rotor.Georgidis et al. yannyonnyola ensonga y’okuyingira empiso ng’oludda olusinga okuba emabega olw’omumwa ogw’oku ntikko ogw’oku ntikko ogw’ekiwujjo.

Ekifaananyi 4. Okulabira mu kulongoosebwa okulaba n’okulaba okw’ebbali okw’ekisambi kulaga ekifo ekituufu eky’okuyingira mu kifuba paramedian intramedullary nailing of the greater trochanter. '*' kiraga ekifo eky'okuyingiza omusumaali mu mubiri.

Okunoonyereza okwakakolebwa mu biwandiiko kulaga nti entikko y’ekitundu ekinene (Greater Trochanter) y’entandikwa ennungi ey’okufuna layini y’amaanyi esinga obulungi, era nti okukwatagana okubi olw’okulema kw’okukyusakyusa kutera okubaawo ng’ensonga y’okuyingira ekyusiddwa okusukka mm 2 ku mabbali okutuuka ku trochanter omunene. Okunoonyereza kuno era kwaggumiza nti ekifo ekisinga okuba eky’emabega kivaako okusengulwa mu maaso okw’ewala, so ng’ate ekifo eky’okuyingira eky’omu makkati kiyinza okuvaako ekitundu ky’okumenya eky’ewala okusengulwa emabega. Okwawukana ku ekyo, okunoonyereza okulala kwalaga nti mu intertrochanteric femur fractures, incidence of intramedullary nail impingement yali significantly n'ekifo eky'okunyiga ekyali lateral ku anterior side okusinga ku pinning point eyali okumpi ne medial ne posterior sides.

The Greater Trochanteric apex pinning point etera okukozesebwa mu balwadde abagejjulukuka, era enkola eno tesaba nnyo mu by’ekikugu, egaba obudde obutono obw’okulongoosa n’obulabe obutono obw’okuzibuwalirwa okusinga pyriform fossa pinning point.

Ebizibu: Ebizibu ebiva mu kulongoosebwa n’oluvannyuma lw’okulongoosebwa eby’okukuba emisumaali egy’omu kifuba n’ensonga enkulu ey’enkola ya trochanteric byogerwako mu bitabo ebiwerako. Ekimu ku bino, ebiseera ebisinga ekikwatagana n’enkola y’okukuba emisumaali, kwe kumenyaamenya okuleetebwa mu by’obujjanjabi. Mu kumenya kw’ekisambi eky’omu makkati (intertrochanteric femoral fractures), ekifo ekiyingira ekisangibwa ku mabbali n’eky’omu maaso ku kitundu ekinene (Greater Trochanter) kitera okuvaamu okumenya okw’omu makkati okusinga ekifo eky’okuyingira okumpi n’oludda olw’omu makkati.

Ekizibu ekirala ekikwatagana kiva ku buvune obw’ebitundu ebigonvu, naddala ku matabi g’omusuwa gw’ekisambi eky’omu makkati n’ebinywa by’addukita, naye obuvune buno tebutera kutera kugeraageranya n’omusumaali oguyingira mu fossa ogwa pyriform. Okugatta ku ekyo, obungi bw’obulwadde bwa ischemic necrosis of the femoral head with the apex of the greater trochanter nga entry point bwe kirowoozebwa okuba wansi nnyo, nga okunoonyereza kukitegeeza nti kitono nga 0.3%.

Considering intraoperative time and fluoroscopic exposure, the mean operative time was 90.7 minutes for the greater trochanteric entry point compared with 112.7 minutes for the pear-shaped fossa entry point group, whereas fluoroscopic time was 5.88 seconds for the greater trochanteric entry point group and 10.08 seconds for the pear-shaped fossa entry point group, compared with the pear-shaped fossa entry okusonga.

Okuteebereza kw’abalwadde nakyo kyali kikulu nnyo nga basalawo ku kifo eky’okuyingira n’omusumaali ogw’omu lubuto, ng’okuwona amangu mu nkola (nga bwe kyakeberebwa mu kukebera entebe-entebe n’okukebera okusitula obudde) kwali kusinga nnyo mu balwadde ku myezi 6 oluvannyuma lw’okulongoosebwa olw’ekifo ekinene eky’okuyingira kw’ekitundu ky’omubiri ekiyitibwa trochanteric bw’ogeraageranya n’omusumaali gw’omusumaali ogw’ekika kya pyriform, enjawulo eno teyali ya makulu mu myezi 12 mu kiseera ky’okulongoosebwa mu ngeri ey’amaanyi. Newankubadde nga ekifo ekinene eky’okutuuka ku trochanteric kitera okukwatagana n’okuggyako ebitundu ebigonvu ebitono olw’ekifo we kiri, kikyayinza okuvaako obuvune mu kibinja ky’ebinywa by’abawamba, nga bwe kibadde kiragibwa Ergiş et al. Baakizuula nti dynamic balance ne hip abductor strength byakendeera mu balwadde abalina trochanteric entry pEG esingawo bw’ogeraageranya n’abalamu abafuga. Okugatta ku ekyo, okunoonyereza kwabwe kwalaga okukendeera okw’amaanyi mu maanyi g’abawamba ekisambi, flexors ne internal/external rotators bw’ogeraageranya n’oludda olutali lwa mirimu.

2. Pearly Fossa Ekifo we bayingira .

Fossa y’ekinywa kya pyriformis kye kifo ekikulu eky’omubiri ekimanyiddwa ng’ekimu ku bifo eby’okuyingira mu musumaali ogw’omu kifuba oguyitibwa paracentesis femoral intramedullary nail.Mu kunoonyereza kwabwe okw’okukebera omulambo, Lakhwani et al. yategeeza nti ekifo ky’ekinywa kya pyriformis tekyali kya 'pear' mu ngeri wadde okugattibwa kw’ebinywa bya pyriformis. Ekinywa kikwata ku kitundu ekitono ku ntikko y’ekitundu ekinene eky’obutiti, so nga ekifo ekiyitibwa pyriform fossa kibeera kiwuubaalo ku ludda olw’omu makkati olw’ekitundu ekinene eky’omutawaana era nga kwegatta kwa kinywa kya extensor carpi radialis brevis. Abawandiisi baamaliriza nti ekinywa kya pyriform ne pyriform fossa bintu bibiri eby’enjawulo era nti ekiyitibwa pyriform fossa kisaana okuyitibwa 'rotor' oba 'occlusal' fossa for clarity and anatomical correctness. Baawa amagezi nti oluvannyuma lw'okusoma cis-femoral baawa amagezi nti ekigambo eky'olubereberye 'Rotor fossa' kiddemu okuyingizibwa mu biwandiiko mu kifo kya 'pyriform fossa' oluvannyuma lw'okusoma ebigambo by'ekifo eky'okuyingira mu parafemoral. Newankubadde nga ensonga z’okunoonyereza kuno ebbiri zitwalibwa nnyo, olw’obwangu bw’okunnyonnyola n’okuziyiza okutabulwa n’ekifo ekinene eky’okuyingira kwa trochanteric, tujja kukyajuliza ekifo kino eky’okuyingira ng’ekifo eky’okuyingira mu fossa ya pyriform.

Okunoonyereza okuwerako mu biwandiiko ebiriwo kati kunnyonnyola bulungi ekifo ekituufu eky’okuyingira mu luulu fossa for intramedullary femoral nails.Georgiadis et al. Nnyonnyola ekifo ekiyingira mu luulu fossa ng’ekitundu ky’okugattibwa kw’ekinywa kya extensor carpi radialis brevis mu kiwuubaalo ku musingi gw’ensingo y’ekisambi (Fig. 5). Abawandiisi era bakikkaatirizza nti ekifo ekiyingira ekigenda ewala ennyo mu maaso oba ewala ennyo munda kiyinza okwongera ku bulabe bw’okumenya ensingo y’ekisambi, era ng’ekifo ekiyingira kiri wala nnyo emabega, wayinza okubaawo akabi ak’amaanyi ak’obulwadde bwa ischemic necrosis, obusinga mu balwadde abato.

Ekifaananyi 5. Okulaba mu maaso mu maaso g’ekisambi nga kiraga ekifo ekituufu eky’okuyingira ku musumaali ogw’omu kifuba ogw’omu kifuba ogw’ekika kya pyriform fossa. '*' eraga entandikwa y'omusumaali ogw'omu lubuto.

Harper et al. yafulumya okunoonyereza ku bibinja 14 eby’amasanyalaze g’omuntu mu 1987 mwe baakebera ekifo ppini y’omusumaali gw’omu lubuto n’ekifo we bafulumira omusumaali ogw’omu lubuto ogwayingizibwa mu ngeri ey’ewala era ey’okumpi mu ngeri ey’okudda emabega okuva ku ngulu w’omugongo ogw’omu kisenge. Baamaliriza nti ekifo eky’okuyingira kw’omusumaali gwa Pyriformis paramedian intramedullary gwali ku nkulungo ya greater trochanter n’ensingo y’ekisambi, katono mu maaso ku pyriformis occulta.Ekifo eky’okuyingizaamu kyaddamu okukakasibwa Gausepohl et al. Mu kunoonyereza okulala okw’omulambo, baateeka ekifo ekituufu eky’okuyingiramu omusumaali ogw’omu kifuba ogw’omu kifuba okuyita ku ludda olw’omu makkati olw’ekitundu ekinene eky’omutawaana ogusukkulumye ku musinde gwa pyriformis. Ekirala, mu kunoonyereza kw’omulambo okwakolebwa Labronici et al. Fossa y’ekinywa kya pyriformis yayogerwako ng’ekitundu ky’omumwa eky’ekika ky’amapeera ekyali kikwatagana n’ekisenge eky’omu makkati eky’ekisenge ky’omusuwa gw’omu kifuba mu nnyonyi ya coronal.

Ekifo ekiyitibwa pyriform fossa access point kirina ebimu ku bizibu ebitongole kubanga mu by’ekikugu kisoomoozebwa nnyo bw’ogeraageranya n’ekifo ekinene eky’okuyingira mu bitundu bya trochanter naddala mu balwadde abagejjulukuka. Okugatta ku ekyo, ekifo ekisinga obulungi eky’okuyingira ekifo eky’okuyingiza empiso ya Fossa ekiringa amapeera kitundu kifunda, ekifuula okusoomoozebwa okusingawo okubeera mu kifo. Okugeza, entandikwa ennyo ey’omu maaso ku bulago bw’ekisambi ejja kuvaamu okunyigirizibwa okw’okwetooloola okuyitiridde n’okwongera ku bulabe bw’okubutuka kw’omubiri ogw’omu maaso, naddala singa entandikwa esukka mm 6 mu maaso ku fossa. Okugatta ku ekyo, enjawulo ya morphologic eyinza okulemesa ekifo ekituufu eky’okuyingira, naddala singa ekiwujjo ekimpi eky’ebweru kiba kinene oba ekiwujjo kifuluma, ekivaamu ekifo ekiyingira ekisusse okubeera wakati ate nga kirimu akabi k’okumenya ensingo y’ekisambi.

Ebizibu: Nga tugerageranya ebifo 38 ebinene eby’okuyingira mu bitundu by’omubiri ebiyitibwa trochanteric nga biriko ebifo 53 eby’okuyingira mu luulu fossa eby’okusumba emisumaali egy’omu kifuba, Ricci et al baazuula nti ekibinja kya Fossa eky’amayinja ga luulu kyalina ekiseera ekiwanvu ebitundu 30% n’ekiseera ekiwanvu 73% eky’okukebera fluoroscopy. Ebizuuliddwa bino byakakasibwa Bhatti et al. Nga ogeraageranya ebifo 2 ebiyingira empiso.

Ku bikwata ku buvune obw’ebitundu ebigonvu, waaliwo obulabe obw’amaanyi obw’obuvune obw’ebitundu ebigonvu ku mulyango gwa pyriformis bw’ogeraageranya n’obusimu obuyitibwa interosseous neuromuscular ku kifo ekinene eky’okuyingiza empiso z’omu trochanteric. Dora et al. yakebera ebisambi by’omulambo gw’abantu abakulu 16 ku buvune bw’ebitundu ebigonvu ku binywa bya pyriformis ne pin y’okuyingira mu nkulungo. Baakizuula nti wadde nga pyriformis fossa yali ya geometrically optimal, yaleeta obulabe obw’amaanyi eri emisuwa supply ku femoral head n’ebinywa ebikyetoolodde n’emisuwa. Ebizuuliddwa bino byaddamu okukakasibwa okunoonyereza ku mirambo okwakolebwa Ansari Moin et al. eyageraageranya n’ebifo bibiri ebiyingira. Baategeezezza nti okunyweza omusumaali munda mu kinywa kya pyriformis kwali kusinga kwonoona biwamba bya hip ne external rotators. Okugatta ku ekyo, okwonooneka kw’omusuwa gw’ekisambi eky’omu makkati (medial rotator femoral artery) kwasangibwa mu mbeera zonna (Table 2).

Omulongooti 2. Mu bufunze obuvune bw’ebitundu ebigonvu ku bifo eby’enjawulo ebiyingira empiso .
Enkyukakyuka .	Ekifo ekiyingira mu fossa ya pyriform (n=5) .	Ekifo ekinene eky'okuliisaamu rotor (n=5) .
Ebitundu ebigonvu .
Ekinywa kya gluteus medius (anatomy) .	5	1
Omusuwa gwa Gluteus Medius .	0	4
Obuvune bw’omusuwa .
Gluteus Minimus (Ekifaananyi) .	3	0
Pyriformis muscle (okuyita waggulu ku mugongo) .	3	3
Obturator Internus (Ekifaananyi ky’okusengejja) .	1	0
Latissimus dorsi muscle (okusengejja) .	3	0
Emisuwa gy’omusaayi n’enkwaso z’ennyondo .
MFCA amatabi amawanvu .	4	0
MFCA Ettabi eritali ddene .	4	0
articular capsule (ey’ekiwanga nga okugulu mu mubiri) .	1	0
MFCA: Omusuwa gw’ekisambi ogw’omu makkati ogw’omu makkati.

Gye buvuddeko, Bharti et al. yasoma ku bulabe bw’okuzibuwalirwa kw’okusalira emisumaali mu kifuba ku kifo ekinene eky’okuyingira mu bitundu by’omubiri (trochanteric entry point) n’ekifo eky’okuyingira mu luulu fossa era n’azuula obulabe bw’obuzibu ng’omuwendo gw’okuwonya okumenya n’okubifunza bwe biti (Table 3).

Omulongooti 3. Pyriform Fossa Entry Point ne Greater Trochanter Entry Point femoral Bone Marrow .
Okuzibuwalirwa .	Piriformis Sinus Empiso .	Ekifo ekinene eky'okuyingizaamu trochanter .
Obulwadde bwa .	6.7	3.3
Malunion .	20	13.3
okulwawo okuwona .	20	13.3
Entambula y'ekisambi eriko ekkomo .	20	33.3
Entambula y’okugulu eriko ekkomo .	6.7	6.7
Obuwanvu bw’ebitundu by’omubiri obutakwatagana .	13.3	20
Enkoofiira y’omukira efulumira waggulu w’ekitundu ky’amagumba ekiyitibwa bone cortex .	13.3	20
Okumenya ensingo y’ekisambi mu kulongoosebwa .	10	0
Greater Trochanter Okumenya .	0	3.4
femoral omutwe necrosis .	6.7	0

Retrograde femoral intramedullary okukuba emisumaali .

Okuzuula ekifo ekituufu eky’okuyingira mu kukuba emisumaali mu kifuba ekidda emabega kijja kuyamba okutuuka ku kuzzaawo okukwatagana okulungi okw’okumenya, obuwanvu, n’okuzimbulukuka nga tukendeeza ku kwonooneka kw’eggumba ly’omumwa, ery’omu maaso ery’omu maaso (ACL), oluvannyuma lw’omusuwa gw’omubiri ogw’omu maaso (Acl), n’obuvune mu bitundu ebigonvu (Table 1). Recently, there has been an increasing interest in retrograde femoral intramedullary nailing with the aim of reducing the complications associated with paracromial nailing, including hip pain, heterotopic ossification, adductor weakness, and pudendal nerve palsy, which is considered minimally invasive when compared with incisional reduction and locking femoral plating for internal fixation, especially in fractures of the distal one-third of the ekikolo ky’ekisambi. Okugatta ku ekyo, obujulizi obusembyeyo bulaga nti bwe kiba nti emisumaali gino egy’okudda emabega (retrograde intramedullary nails) giba gya sayizi esaanidde, emisumaali egy’okusiba egy’okumpi giyinza obuteetaagisa.Tewaaliwo njawulo mu miwendo gy’okuwona, obudde okuwona, oba ebivaamu ebiweebwa omulwadde wakati wa Meccariello et al. ne Bisaccia et al. Mu kujjanjaba okumenya kw’ekikolo ky’ekisambi eky’ewala eky’ewala nga tukozesa emisumaali egy’omu lubuto egy’okusibira n’okugisiba. Bwe kityo, okukozesa emisumaali egy’okudda emabega (retrograde femoral nailing) kifuuse eky’ettutumu era ekikkirizibwa ennyo.

Ennyonyola nnyingi ez’ekifo ekisinga obulungi eky’okuyingira mu kukuba emisumaali egy’omu kifuba egy’emabega (retrograde femoral intramedullary nailing) giyinza okusangibwa mu biwandiiko. Okunoonyereza okusinga kuzuula ekifo ekirungi eky’okuyingira mu musumaali gw’ekisambi eky’emabega nga 1.2 anterior to the femoral origin of the posterior cruciate ligament .

CM (mu kukwatagana n’ekisenge ky’omubiri (medullary cavity)) n’amakati g’ekifo ekiyitibwa intercondylar fossa (Ekifaananyi 6).

Ekifaananyi 6. Okulaba mu ngeri ey’okulongoosebwa n’okulaba okw’ebbali okw’okugulu nga kulaga ekifo ekituufu eky’okuyingira ku musumaali ogw’omu kifuba ogw’emabega ogw’omugongo ogw’emabega. '*' kiraga ekifo omusumaali ogutandikira mu lususu.

Wadde nga tewali kiraga kituufu ku kusalira emisumaali egy’omu kifuba egy’okudda emabega (retrograde femoral intramedullary nailing), ebiraga ebikwatagana ebingi bibadde binnyonnyolwa. Mu bino mulimu abalwadde b’olukalala, abalwadde abagejjulukuka ennyo, abalwadde abali embuto, okumenya ekikolo ky’ekisambi eky’enjuyi zombi, ekikolo ky’omu kifuba eky’omu kifuba n’okumenya ekisambi ky’omu kifuba/ekisambi oba okumenya ensingo y’ekisambi, n’ekikolo ky’omu kifuba eky’omu kifuba n’okumenyeka kw’omugongo. Ebisinga ku bino ebiraga bino byekuusa ku kwanguyiza omulwadde okuteeka n’okuziyiza ebiwundu ebingi eby’okulongoosa mu kumpi.

Ku luuyi olulala, ebiziyiza ebituufu okuzza emisumaali egy’omu kifuba egy’okudda emabega (retrograde femoral intramedullary nailing) mulimu okuzibikira omukutu gw’omu lubuto ogw’okudda emabega (retrograde intramedullary channel) nga gukozesebwa ekintu ekisimbibwa ekisigaddewo n’okumenyaamenya kw’ekisambi eky’ewala. Ebiziyiza ebikwatagana (relative contrandications) bye bimenyeka ebisangibwa mu sentimita 5 okuva ku kitundu ekitono eky’obutiti, obuzibu mu kutuuka ku kifo ekisinga obulungi olw’okufukamira okugulu okutakka wansi wa diguli 45, okukwatibwa okugulu okwasooka ekiyinza okuvaako obulabe bw’okusaasaana ku kikolo ky’ekisambi, obuvune obw’amaanyi obw’omutwe ogw’amaanyi okwetoloola okugulu, n’okugwa kw’omugongo ogw’amaanyi.

Ebizibu: Ebizibu ebisinga eby’okukuba emisumaali egy’okudda emabega (retrograde femoral nailing) byekuusa ku kukwata obubi naddala okuteeka obubi ekifo we bayingira. Mu nnyonyi ya sagittal, ekifo ekisinga okuyingira mu maaso kijja kuvaamu okuvvuunula okumenya okw’emabega, okwonooneka kw’okungulu kw’ebitundu by’omubiri, era nga kiyinzika okuba nti okukuba omusumaali ku patella ng’okugulu kufuukuuse. Ku luuyi olulala, singa ekifo we bayingira kibeera mu kifo ekitali kituufu mu kkubo ery’emabega, kino kiyinza okuvaamu obulabe obw’amaanyi obw’obuvune ku nsibuko y’omusuwa gw’omutwe ogw’emabega n’okusengulwa okw’omu maaso okw’ekifo eky’okumenya.

Hutchinson et al. Ebizibu ebinnyonnyoddwa ebikwatagana n’ebifo ebiyingira mu nnyonyi ya coronal ebitali bituufu. Baakizuula nti ekifo ekisusse eky’okuyingira mu makkati kyavaamu okulema kw’oludda olw’emabega n’okuvvuunula okumenya okw’emabega, so nga okw’ebbali okusukkiridde kwavaamu okulema okw’omu makkati n’okuvvuunula okw’omu makkati.Sanders et al. yategeeza nti okulonda entandikwa ey’omu makkati eyaali sentimita 2 oba okusingawo okuva ku kisenge eky’omu makkati kyavaamu okumenya kw’ekitundu eky’omu makkati okwali okukoleddwa mu ngeri ya malinited olw’ekiseera eky’okubeebalama eky’emabega eky’okumenya ekivaamu okukendeeza obubi okw’emabega.

Ebizibu ebirala ebikwatagana ne retrograde femoral follower nailing mulimu okulumwa okugulu, okukaluba, heterotopic knee ossification, n’okutondebwa kw’omubiri ogutaliimu nkwaso mu bitundu by’omubiri.

okumaliriza .

Newankubadde nga buli nkola y’okukuba emisumaali mu mubiri (intramedullary nailing technique) erina ekiraga ekikwatagana, okulonda kwayo enkola ya intramedullary nailing okukozesa mu kujjanjaba okumenya kw’ekikolo ky’ekisambi kitera okusinziira ku kulongoosa okwettanira. Nga okola emisumaali mu kisambi mu kisambi, okufuna ekifo ekituufu eky’okuyingira mu kika ky’omusumaali ekikozesebwa okunyweza kyetaagisa okusobola okuvaamu obulungi. Okumanya ensengekera y‟omubiri n‟okukola ebifaananyi mu kitundu kijja kuyamba omusawo alongoosa okukola enkola emala mu by‟ekikugu ate nga akendeeza ku bulabe bw‟ebizibu ebikwatagana nabyo. Okugatta ku ekyo, mu nkola z’okukuba emisumaali mu mubiri, okulabirira okukendeeza kitundu kikulu nnyo mu kuziyiza malunion ne malunion oba nonunion of fractures.