5 intramedullary Nail kopo melao-motheo le dithekeniki ho buoa!

Melao-motheo ya motheo ya go kokotela ka gare ga medullary

1. Histori ya go kokotela ka gare ga medullary

Ka 1910, manala a aluminiamo a Lilienthal a ka gare ga medullary a ile a dirišetšwa go alafa go robega ga shaft ya letheka.

Ka 1913, Schone o ile a diriša manala a silifera a ka gare ga medullary go alafa go robega ga matsogo a ka pele. 

Kuntscher (1900-1972) o bile le meneelo e megolo go tiišeng manala ka gare ga medullary. 

Bo-1960 le bo-1970 e bile nako ya tlhabollo ya ka pela ya manala a ka gare ga medullary. 

naga ya gešo e be e dutše e di šomiša ka bontši go tloga ka bo-1990.

2. Phokotšo ye e bulegilego le phokotšo ye e tswaletšwego

1. Go robega ga ditho go ka fokotšwa ka go buiwa ka tlase ga pono e lebanyago goba go tswalelwa ka tlase ga go bewa leihlo ka X-ray.

2. Nako ya go fola ya go robega ga phokotšo ye e bulegilego e telele kudu, go tšwa madi ka gare ga go buiwa ke mo gontši, gomme phokotšo ye e bulegilego e senya gape kabo ya madi go fihla mafelelong a go robega.

3. Go kgothaletšwa go šomiša phokotšo ye e tswaletšwego ka mo go kgonegago. Sedirišwa sa go fokotša go goga se ka dirišwa, goba go ka segwa mo gonyenyane sefofaneng sa go robega bakeng sa go phuruphutša le go fokotša, ka go rialo gwa fokotša tšhitišo ya kabo ya madi go ya mafelelong a go robega.

4. Bakeng sa go palelwa ga phokotšo ye e tswaletšwego, go phetla karolwana ya marapo goba go phunya ditlhalenama tše di dikologilego, le dikarolwana tše kgolo tša go robega tšeo di šuthišitšwego, go ka šomišwa phokotšo ye e bulegilego ya go bua.

3. Fixation mokgwa wa lenala la ka gare ga medullary

1. Mokhoa oa intramedullary Nail ka hare fixation ke symmetrical bohareng ka hare splint fixation.

2. Go tsepama ga go robega ka lenala la ka gare ga medullary ke go tiiša mo go abago kgateletšego, e sego go tiiša mo go šireletšago kgateletšego, mo go loketšego go bopa callus.

3. Central fixation ke theoretically phahameng ho cortical ntle fixation, e leng ka fokotsa matla letsoho, fokotsa liketsahalo tsa valgus angulation le ka hare fixation hloleha.

4. Intramedullary manala fixation fana ka motheo bakeng sa koaloa phokotso kapa lekanyelitsoeng bulehileng phokotso.

4.Melemo ya manala intramedullary

1. Mathata a sego kae

2. Atolositsoeng sebaka sa ditshupo ho buoa

3. Go tsepama ka go tia

4. Tlwaetšo ya mathomo ya mošomo wa mohlakanelwa

5. Go rwala boima bja mmele ka pela

6. Ka sebediswa ka kopanyo le tse ling tse ka hare fixation

Mehuta ya Motheo le Dithekniki

1. Locking le bao e seng notlela manala intramedullary

2. Dynamic le static notlela intramedullary manala

3. Medullary katoloso le bao e seng medullary fixation dithekeniki

4. Dithekniki tša go tiiša tše di bulegilego le tše di tswaletšwego

Go kgokagana le go se kgokagane

Manala a tlwaelegilego a ka gare ga medullary a na le go tsepama mo go fokolago ga axial le matla a tlase a go kgokologa, eupša a na le elasticity e itšego gomme a ka fola ka morago ga go senyegelwa ke sebopego, a baka feela tekanyo e nyenyane ya go thelela ka gare ga marapo.

Dipekere tša ka gare ga medullary tšeo di kgokaganego di na le ditlamorago tše kaone tša go lwantšha go dikološa le tša go lwantšha kgatelelo, go tsepama mo go botse ga go tiiša, gomme di dumelelana le molao wa motheo wa go tiiša ga diphedi. Di šomišwa kudu ka marapong a matelele a ditho. Kudu-kudu bakeng sa go robega ga dikarolo tše dintši le tše di kgaotšwego, di na le go tsepama mo go kaone go feta manala a tlwaelegilego a ka gare ga medullary.

Dynamization ya fixation e sa fetoheng

Static notlela intramedullary manala hlahisa hanyenyane haholo khatello ea kelello masking le hona joale boholo bueletsoa bakeng sa bao e seng kamehla ketso ea dynamization.

Bakeng sa go robega mo go sego gwa fola ka dikgwedi tše 6 go ya go tše 8 ka morago ga go buiwa, go hlomesetšwa ga marapo ka lefelong goba go tšeelwa legato ga manala a katološitšwego a ka gare ga medullary ka dynamization go šomišwa ka tlwaelo.

Dynamization e ka šomišwa bjalo ka mokgwa wa go kgothaletša phodišo ya go robega. Ga e kgothaletšwe ka mehla ka gobane e ka lebiša go khutsofatšeng ga ditho le go golofala ga go dikološa.

Katološo ya moko le katološo yeo e sego ya moko

Katološo ya moko e ka tsenya manala a ka gare ga medullary ka bophara bjo bogolo le maatla a magolo, e lego seo se loketšego go tlwaetšo ya mathomo ya mošomo gomme e fokotša seelo sa manala a robegilego.

Katološo ya moko e ka tšweletša palo e kgolo ya ditlakala tša marapo ka mafelelo a osteoinductive, ao a loketšego phodišo ya go robega.

Katološo ya moko e tla senya kabo ya madi ya ditšhika tša phepo le lera la endosteal, eupša methapo ya madi e ka tsošološwa go bapa le lešoba la manala a ka gare ga medullary. Go katološwa ga moko le gona go ka oketša go elela ga madi mešifeng e boleta yeo e dikologilego, ka go rialo gwa kgothaletša phodišo ya go robega.

Katološo ya moko e oketša ka tekanyo e itšego kgonagalo ya tshwaetšo le embolism, gomme e swanetše go dirišwa ka kelohloko bakeng sa go robega mo go bulegilego, dikgobalo tše dintši le dikgobalo tše di raraganego.

Melemo ya katoloso ya medullary

1 Ka morago ga go katološwa ga medullary, lefelo la kgokagano magareng ga lenala la ka gare ga medullary le lesapo le a oketšega, e lego seo se kaonefatšago go tsepama ga go tsepama. 

2 Ka morago ga go katološwa ga medullary, go ka dirišwa sepekere sa ka gare ga medullary sa bophara bjo bogolo, seo se oketšago matla a sepekere sa ka gare ga medullary gomme se fokotša tekanyo ya manala a robegilego. 

3 Ditlakala tša marapo ka morago ga katološo ya medullary di ka hlohleletša go bopega ga marapo a mafsa, yeo e loketšego phodišo ya go robega.

Ge go bapetšwa le manala a ka gare ga medullary a katološo ya medullary, manala a ka gare ga medullary ao a sa atološwago a na le mehola ye e latelago

1 Nako e kopana ya go bua le go tšwa madi mo gonyenyane. 

2 Tšhišinyo ye nnyane ya go elela ga madi a endosteal maemong ao a nago le dikgobalo tše šoro tša dinama tše boleta.

Tirišo ya lenala la ka gare ga medullary

Humeral loketseng intramedullary sepekere

Ditšhupetšo tša manala a humeral

Ditšhupetšo tša manala a ka gare ga medullary a kgokaganego a humeral kalafong ya go robega ga shaft ya humeral ke: go robega mo go nago le tshenyo ya methapo le ya methapo, dikgobalo tše dintši, go robega mo go sa tsepamago, go robega ga bolwetši le go robega ga humeral ya kgauswi.

Mokgwa wo o ka lokišwago ke go tloga go 2cm ka fase ga hlogo ya humeral go ya go 3cm ka godimo ga olecranon fossa. O ka kgetha go e lokiša go tšwa legetleng ka sepekere sa antegrade intramedullary goba go tšwa sekonokono ka sepekere sa go boela morago.

Dika tša manala a humeral

Mekgwa ya go tiiša ka go bua bakeng sa go robega ga shaft ya humeral ge e le gabotse ke go tiiša poleiti le go tiiša manala ka gare ga medullary.

Go tsepama ga poleiti go na le dithoto tše maatla tša go lwantšha go dikološa le go koba gomme go tsepame ka go tia, eupša masetla-pelo a go bua ke a magolo, kgonagalo ya tshwaetšo e phagame, gomme methapo ya radial e senyegile gabonolo.

Manala a mehleng yeno ao a kgokaganego le ao a ithatlelago a humeral a fenya mafokodi a manala a tlwaelegilego a ka gare ga medullary a bjalo ka go se tsepame ga axial, taolo e fokolago ya go dikološa le go nyakega ga go tsepama mo go oketšegilego, e le gore go robega go tsepame ka go tia, tahlegelo ya madi e be e nyenyane, go hlobolwa ga dinama tše boleta e be mo gonyenyane gomme go katološwa ga medullary go lekana le go bjalwa ga marapo a lefelong leo, morwalo o lekana e abja, callus e tšwelela ka pela, gomme go itšhidulla mo go šomago go ka thongwa ka morago ga go buiwa.

Femoral interlocking intramedullary sepekere

Ditšhupetšo tša manala a go kgokagana ga femoral

Mehuta ka moka ya go robega 2cm ka fase ga trochanteric vertebra le go feta 9cm go tšwa go lelokololo la lengwele.

Old fractures ya karolo e bohareng ya shaft femoral.

Balwetši bao ba paletšwego ke poleiti ka gare fixation.

Features ya femoral interlocking sepekere

Melemo ya metšhene

Letsogo la matla la sepekere sa femoral interlocking intramedullary bakeng sa go lokiša go robega ke se setelele go feta sa dipoleiti tša tšhipi, gomme matla a phatlalatšwa ka go lekana sele ya bogareng ya lerapo ka moka, yeo go sego bonolo go e koba le go e senya.

Dipekere tša go notlela mafelelong ka bobedi a sepekere sa ka gare ga medullary di dira gore lesapo le bope ka moka go tloga godimo go ya fase, gomme manala a go notlela mafelelong a kgole a ka fokotša letsogo la torque la sepekere sa ka gare ga medullary ka lesapong, a thibela go khutsufatšwa le go dikološa, gomme a fihlelela go tsepama mo gogolo le go tia bakeng sa go tiiša go robega.

Gamma Interlocking Sepekere sa ka gare ga medullary

Gamma Nail ditshupo

E šoma go mehuta ye e fapanego ya go robega ga peritrochanteric, kudukudu go robega ga subtrochanteric.

Atoloswa Gamma sepekere (reconstruction sepekere) ditshupo

phahameng subtrochanteric fractures, trochanteric kopantswe le femoral shaft fractures.

Melemo ya Gamma Nail

E hlamilwe ka go kopanya sekurufu sa letheka se se thelelago le theknolotši ya manala a ka gare ga medullary, sepekere se segolo se kgauswi le ka gare ga lešoba la medullary go feta poleiti ya letheka ye e fetogago, ka fao sepekere sa Gamma se sepetša boima bja molwetši kgauswi le calcar ya letheka go feta poleiti ya letheka ye e fetogago, e oketša maatla a motšhene a selo seo se tsentšwego. Bakeng sa go robega ga subtrochanteric mo go akaretšago go robega ga cortical ya magareng, lenala la Gamma le efoga go nyakega ga go agwa lefsa ga anatomy ya go robega, ka fao le hola bakeng sa go robega ga intertrochanteric goba go robega ga subtrochanteric.

Retrograde intramedullary femoral kokotela

Ditšhupetšo tša manala a femoral a go boela morago

Haholo-holo e sebediswa bakeng sa supracondylar femoral fractures, ho akarelletsa le supracondylar comminuted fractures le intercondylar 'T ' le 'Y ' comminuted fractures akarelletsang bokagodimo bja articular.

E ka šomišwa gape go robega ga femoral ka fase ga isthmus ya femur.

Shaft ya femoral, femoral ya supracondylar, le go robega ga intercondylar ka gare ga 20CM go tšwa go lelokololo la lengwele.

Bao ba paletšwego ke go lokiša poleiti.

Litšobotsi tsa retrograde femoral kokotela

Supracondylar femoral fracture ke fracture e tebileng le bothata ka pele, phokotso le sa bobeli, matla ka hare fixation. Go na le ditiragalo tše di phagamego tša mathata a go swana le go robega ga go se kopane le go diega ga go fola.

Retrograde interlocking intramedullary nailing ke mokgwa wo o tlwaelegilego wo o šomišwago go alafa go robega ga femur ya kgole nywageng ya morago bjale, yeo e nago le go tsepama mo go botse ga motšhene, e ka laola ka mo go atlegilego go šuthišwa ga ka morago le go šuthišwa ga go dikološa ga mafelelong a kgole a go robega, gomme o thuša ka motšhene wa mathomo wa mohlakanelwa.

Go robega ga kutu ya femoral mo go kopantšwego ga supracondylar go tsepame ka go kokotela ga supracondylar intramedullary mo go lelefaditšwego, mo go rarollago bothata bjo go lego thata go bo rarolla ka go kokotela ka gare ga medullary ga femur mo go kgokaganyago. Sedirišwa se se bonolo go se šomiša, se nepagetše ka go bea, se ka botwa ka go tsepama, gomme molwetši a ka dira ditšhišinyo tša pele tše di šomago tša lengwele ka morago ga go buiwa.

Tibial interlocking manala a ka gare ga medullary

Ditšhupetšo tša go kokotela ka tibial

Diphapano tše di tsepamego bogareng bja 1/3 ya tibia: go robega ga go selaganya, go robega mo go kopana ga oblique, pseudarthrosis.

Diphapano tše di sa tsepamago ka gare ga 60% ya botelele bja tibia ya bogareng: go robega kgauswi le metaphysis, go robega ga spiral ye telele, go robega ga segmental, go robega ga comminuted, go robega mo go nago le diphošo tša marapo.

Litšobotsi tsa tibial kokotela

Interlocking intramedullary nailing ya tibia e šomišwa kudu bakeng sa go robega ga tibia ya bogareng.

Le ge e ka šomišwa gape bakeng sa go robega ga tibia ya proximal le distal, seelo sa mathata se godimo, malunion e direga gantši, mafelelo a go robega a na le ≧1cm ya go sepela go 1/2 ya ditiragalo, gomme 1/4 ya fixation e a palelwa.

Dingwalo di begile sephetho se sekaone sa go robega ga tibia ya kgole go feta go robega ga tibia ya kgauswi ka morago ga go tsepama ga fibula ka mehla.

Dithekniki tša go bua

Preoperative ho lokisetsa ya thepa khethehileng

Bethe ya marapo (bethe ya go goga) goba bethe ya go bua ya fluoroscopic ya maemo; retractor ya go gogela morago; setshwantsho intensifier.

Kgetho e nepahetseng ya intramedullary Nail bolelele bakeng sa preoperative endoprostheses

Radiograph

contralateral setho bolelele tekanyo

Bophara bja lenala la ka gare ga medullary

x-ray isthmus bophara

Intramedullary manala bolelele tekanyo

1.Translucent mmusi boikemisetso tlas'a C-letsoho mochine

Mafelelo a kgole le a kgauswi a lerapo a be a le mothalong wa bogareng bja mahlasedi; mmuši o be a bapelana le diaphysis.

2.Length tekanyo ho ea ka 'mele holim matšoao

Femur: ntlha ya trochanter ye kgolo → sebaka sa lengwele la ka mahlakoreng goba pole ya godimo ya patella; tibia: sebaka sa lengole la medial-lateral → lehlakore la ka pele la leqaqailaneng lelokololo ka dorsiflexion ya leoto.

Thekniki ya go Tsenya Manala ka gare ga medullary - Mokgwa wa go Tsena

Longitudinal selekane sa medullary cavity ka mola o otlolohileng

E sego kgauswi kudu le ntlha ya go tsena

Bolelele ba maleba: dilated - telele; undilated - e khutšoanyane

(Tiišetšo ye e sa lebanyego ya ntlha ya go tsena; ga go na go katološwa ga makhura, ga go nyakege tšhireletšo ya dinama tše boleta)

Parallel femoral intramedullary sepekere ntlha ya go tsena

Go lokišetša ntlha ya go tsena bakeng sa sepekere sa intramedullary sa femoral se se bapilego

Hip koba le adduction

Longitudinal incision proximal ho trochanter e khōlō

E sego kgole kudu morago

Go bewa ga pini ya tlhahlo

Go bewa ga thebe ya dinama tše bonolo

Retrograde femoral intramedullary sepekere ntlha ya go tsena

30 ° lengole koba

Long axis ya tataiso Pin ka tsela e tšoanang le medullary cavity ya distal femoral kutu

Go tsenywa ga pini ya Kirschner ka gare ga femur ya kgole ka ligament ya patellar ka sleeve ya tšhireletšo: orthogonal - bogareng bja fossa ya intercondylar ya femur; lateral - Mola wa Blumensaat

Ntlha ya mathomo ya PCL ntle le go gobala

Parallel tibial intramedullary sepekere ntlha ya go tsena

Ka centerline ya medullary cavity

Mošito wa ka pele wa selete sa tibial

Godimo ka mo go kgonegago ntle le go senya selete se se phagamego

Palo e kahodimodimo lengole flexion

Incision tibial tuberosity-ka tlase pole ya patella hammoho medullary cavity

Bula lešoba la medullary: pini ya tlhahlo ka 15° go sefofane sa sagittal sa sele ya longitudinal ya kutu ya tibial

Boemo ba intensifier setšoantšo

Dithekniki tša go dira moko

Motlakase matla phokotso

diphapano tše foreše

Phokotšo ya seatla

go robega ga kgale ka pseudoarthrosis, sclerosis ka gare ga lešoba la medullary

Ga go na tourniquet ka tlase ga infleišene

go elela ga madi ke setšidifatši se sebotse kudu

Dithekniki tša go beakanya gape

Parallel femoral intramedullary kokotela

Mabaka a bothata bja go tsošološa go robega ga letheka

Go phuthela dinama tše boleta tše koto ga go dumelele phihlelelo ya thwii lerapong

Ntlha ya go tsena ya nalete e ka se bonwe ka leihlo la kgopolo ka go lebanya

Hip kopanetsoeng adduction → iliac fascia tsitsipano → robeha khutšoanyane

Phokotšo ya go robega ga tibial

Go dirišwa gampe

Boholo ba subcutaneous le bonolo ho palpate

Go robega mo go tsepamego - go robega ga mofuta wa A le B wa bogareng goba wa kgole

Oblique fractures - go bolaya ka mo go feteletšego

Intramedullary nailing→displacement disebediswa

Magato a phokotšo ya thušo

Ntlha phokotso forceps

tibia ya go swara; percutaneous kapa leqeba tshebediso ya

Di-retractor tše kgolo (di-brace) .

phokotšo ye e diegilego; go khutsufatšwa ga setho

Dikurufu tša Schanz tša nakwana

1 Femur, letheka la letheka

2 Kgauswi le mola wa go robega ka mo go kgonegago

3 Tšhomišo ya cortical e tee ya go robega ga kgauswi

4Šomiša chuck ya bokahohleng yeo e nago le T-handle bakeng sa go laola gabonolo

Sepekere sa Poller

1Metaphyseal fracture (ho lokisa mola oa matla, tsitsisa tsosoloso, tsosolosa tshebetso)

2 go robega mo go sekamego ga tibia ya kgole goba femur (kgateletšego ya go kuta → kgatelelo) .

3 Manala a ka gare ga medullary ao a sa bewago gabotse a tsena ka mokerong wa kgale wa medullary nakong ya go buiwa ga bobedi

4 Ntlha e fokolang ya go tsena, go logaganya ga go robega ga proximal mo go fokolago (sekurufu se beilwe ka go otlologa go go šuthišwa mo go kgonegago ga endoplant)

Tourniquet e sephara e eketsehileng

1 tibia ya go swana le ya

2 go tlaleletšwa ka go goga goba retractor

3 Šomiša ka kelohloko dikgobalong tše šoro tša dinama tše boleta

4 E boloke e le e kopana

5 Thibela katoloso ya medullary boemong ba inflated

Nail notlela tatelano: distal ebe proximal

Mehola

bonolo bja knockback, kgatelelo ya go robega kgaotša; go fedišwa ga karogano; ditiro tša phokotšo.

Dithekniki tša phokotšo bakeng sa go buiwa mo go diegilego & mo go sa kopanego

Mathata ao a ka kopanago le ona ka go diega ga go buiwa

Axial deformity (khutsofatsa, angulation le kapa displacement) .

Kgolo ka ya granulation dinama tse nyenyane tse

Makhopho a pele a marapo

Sclerosis ya go robega e thubega ka go tswalelwa ga lešoba la medullary

Go fokola ga marapo

Mathata a kgonegago a ka gare ga go buiwa

Deflection ya expander le intramedullary sepekere → intramedullary sepekere ho kenella ha cortex

Go golofala ga sekhutlong → retractor

Dislocation ya mafelelo a kgaotšwego → Poller ya lenala, poleiti fixation

Mekgwa ya go thibela mela ya maatla ye e sa tlwaelegago

Kgauswi - ntlha ya go tsena ye e nepagetšego

Distal - intramedullary lenala ka bohareng ba medullary cavity

Mathata a Intramedullary Nailing

★Twatši

★Tshenyo ya methapo

★Phodišo ye e kgopamego ya go robega

★Diphapano tša Bongaka

Potoloho e ka ntle, torsion, valgus, potoloho ka hare, angulation

★Bohloko bja manonyeletšo bjo bo bapilego

★Embolism ya mafura

★Go fetošwa ga marapo ga heterotopic

★Embolism ya maswafo

★Go robega gape

★Thrombosis ya go tšhologa

★Go thatafala ga mohlakanelwa

★Non-kopano ya go robega, marapo nonunion

★Go palelwa ga fixation ya ka gare

★Go khutsufatšwa ga ditho

★Tše dingwe

Mathata--Twatši

1.Mathomong, go robega mo go bulegilego go be go lebelelwa e le contraindication go intramedullary nailing.

2.The ketsahalo ea postoperative tshwaetso ka bulehileng fractures itšetlehile ka boemo ba bonolo dinama tse nyenyane tse gobala le tšilafalo

Tiragalo ya tshwaetšo ka morago ga go robega mo go bulegilego e ithekgile ka boemo bja go gobala ga dinama tše boleta le tšhilafalo gammogo le mokgwa wo dinama tše boleta di laolwago ka wona.

3.Thinner intramedullary manala eketsa monyetla oa tshwaetso; bao e seng atoloswa notlela intramedullary manala fixation ke batlang e fokola, 'me masapo qetellong na

Go tsepama ga manala a ka gare ga medullary a go notlela ao a sa katološwago go fokola kudu, ka motšhene wa maekerosekopo wa mafelelo a robegilego a lerapo gammogo le lešoba la mašaledi, leo le lego bonolo bakeng sa kgolo ya dipaketheria.

4. Tshebediso ya atolositsoeng le lekanyelitsoeng atolositsoeng medullary fixation ha feela ntlafatsa botsitso ba robeha, empa hape qoba tlholo ya sebaka se hwilego.

Bolwetši bja Embolism ya Mafura

1.The ditiragalo tša FES ya go robega ga marapo a matelele a tubular ke 0.5% go ya go 2%.

2. Katološo ya medulla le go se atološwe ga medulla ga go na mafelelo a magolo go go tsenywa ga moya ka maswafo.

3.Ge o atološa medulla, thekniki e swanetše go ba ka bonolo go duba, go efoga maatla a mantši kudu le tšhomišo ya makgwakgwa.

4.the bjale tlhahlobo ya FES e sa amogela ditekanyetšo tšeo di šišintšwego ke Gurd ka 1974, gomme kalafo ka morago ga tlhahlobo e tla diegiša nako ye kaone ya kalafo gomme e ka ba le ditlamorago tše šoro.

Diegile go robega phodišo le marapo nonunion

Mabaka a fapa-fapanego a ama phodišo ya go robega ka morago ga go tsepama ga manala ka gare ga medullary, gomme dibaki di ka hlahlobja ka tsela ye e latelago.

1.soft dinama tse nyenyane tse embedded ka ho robeha qetellong

2. Karoganyo ya mafelelo a go robega ka go selaganya

3. Bogolo bja mengwaga ya molwetši

4. Go robega mo go bulegilego, go gobala mo gogolo ga dinama tše boleta, hemodialysis e šoro ya lefelong leo goba tshwaetšo.

5. Poor intramedullary manala fixation

6. Bolwetši bja swikiri bjo bo kopantšwego goba malwetši a mangwe a go ja.

Diphapano tša tša Kalafo

Go robega mo go hlohleletšwago ke tša kalafo kudu-kudu ke go robega ga bobedi mo go bakwago ke go dirišwa mo go sa swanelago nakong ya go tsepama ga manala ka gare ga medullary.

Intraoperative tlhokomelo lokela ho lefa ho

1. Kgetho e sa nepahalang ya ntlha ya go tsena ya manala e ka lebiša go robegeng ga proximal.

2. O se ke wa kgorometša ka kgapeletšo katološong ya medulla.

3. Monyako wa katoloso ya makhura e swanetše go ba ka tsela ye e swanago le ka tsela ya go tsenywa ga manala.

4. O se ke wa diriša matla ge o tsenya manala a ka gare ga medullary mafelelong a kgole.

Bohloko manonyeletšong a kgauswi

1. Go bewa ga lenala la ka gare ga medullary go akaretša dinama tše boleta gaešita le capsule ya manonyeletšo tikologong ya bonyenyane lelokololo le tee.

2. Selete sa tibial se kgokagantšwe le mošito wa ka pele wa meniscus ya magareng ka ligament ya lengwele ya go selaganya gomme se bopa lefelo le le bolokegilego ka godimo ga tuberosity ya tibial go fihla ntlheng ye. Ge e ba ntlha ya go kokotela e le kgaufsi kudu le godimo goba bophara bja sepekere sa ka gare ga medullary e le bjo bogolo kudu, e ka baka tshenyo dibopegong tša ka gare ga ditho tša mmele, e lego seo se feleletšago ka bohloko bja lengwele ka morago ga go buiwa.

3. Proximal protrusion ya intramedullary sepekere le heterotopic ossification ke dibaki ka sehloohong tsa bohloko ba letheka ka mor'a femoral intramedullary sepekere ho buoa.

4. Proximal protrusion ya intramedullary manala, proximal notlela manala teneho le rotator cuff tšitiso ke dibaki ka sehloohong tsa magetla bohloko ka mor'a humeral intramedullary nailing.