Ma intravellal a intravellary amapatuka - momwe mungasankhire malo abwino kwambiri?

Chiyambi

Kukula kwa mankhwalawa kuthyolako kumatha kutumizidwanso ku 1940s pamene ukunturcher anayambitsa njira yotsekedwa intramullal. Kugwiritsa ntchito misomali ya intradellary Intratsodollary amalumikizana ndikuyenda m'maluso opaleshoni yalola kuwonjezeka kwakukulu pakugwiritsa ntchito intravedollary kukalamphuka kwa femur.

Kugwiritsa ntchito mankhwala osokoneza bongo a maluwa ocheperako kumangogwiritsidwa ntchito pokhapokha odwala omwe ali ndi mankhwala osokoneza bongo komanso opaleshoni, ndi chinthu choyambirira cha chithandizocho chimakhala opaleshoni. Ponena za opaleshoni ya zojambulajambula izi, pali njira zingapo zomwe zimapezeka, kuphatikizapo intradellary mitaing sealing, place snurtetion yokhazikika, ndi kukhazikika kwakunja. Poyerekeza ndi zosankha zina za opaleshoni, intravellal mitaing ndikusintha ndi kuchuluka kotsika kwambiri komanso kuchuluka kwa machiritso ozizira kwambiri, ndipo ikugwiritsidwa ntchito kwambiri pamachitidwe azachipatala.

Kumvetsetsa bwino kwa thupi la proximal femur, magazi amapereka mutu wa minofu ya femiyo komanso thupi la minofu ya m'chiuno zitha kuwonjezera kuchuluka kwa intradellary kukatamata. Mosiyana ndi izi, kusankha kolowera kumadalira zinthu zambiri, kuphatikizapo malo a intramillary, a clacluredice, ndi zolimba. Mosasamala za malo olowera, kupeza malo oyenera olowera ndikofunikira kuti muchepetse kuchepetsedwa kokwanira panthawi ya intramibellary mukamachepetsa chiopsezo cha zovuta.

Chimaso cha Femal

1.blood ipezeke pamutu wachikazi

Mutu wachisoni umalandira mphamvu kuchokera ku mitsempha ikuluikulu ya 3. Makina othamanga a Rototor Fengotor (wokhala ndi nthambi 3-4), ma arturator artery, omwe amapereka gawo lamiyala yokwera kwambiri.

2.Anatomy mu minofu ya m'chiuno

Mukamachita uleravedollary misala ya femur, kumvetsetsa kwa minofu m'deralo pozungulira rotor ndikofunikira kuti muletse kuvulala kosafunikira. Matenda a gluteus medius amachokera ku Ilium ndipo amathera pamtundu wa Trochanter wamkulu, pomwe gluteus minofu yoyambira imayambiranso kuchokera kumbali yakumbuyo ya chiuno cha Trochan (Chithunzi 2 & 3). Ma minofu onsewa amagwira ntchito ngati ziwonetsero za ntchafu ya ntchafu. Chifukwa chake, kuwonongeka kwa minofu iyi mukayika misomali ya intramullal ya intudeallation ndi kugwirira ntchito gait, komwe kumakhala ndi zovuta pakubwezeretsa kwa odwala ndi zotsatira zake.

Mkuyu. 2. Mankhwala a minofu kuzungulira cholumikizira m'chiuno

Chithunzi 3. Proximial Fexal Frocle

Intrallel femullallary msomali

Maphunziro angapo aposachedwa asintha njira yoyenera yolowera msomali wamisomali. Zosankha zam'mimba za msomali zimaphatikizaponso Trocha Worchants ndi PRIFOMPECICECICECECETE

Gome 1.Sarting mfundo ndi zoopsa za paracila imodzi ndikubwezera
zosiyana	intradell intradellary msomali		Bweretsani Introdellalery msomali
	ratator	PRIFORGE fossa (Anatomy)
ndege yapa korona	Vertex ya trochanter wamkulu ndi kuloza mkati mwa medullary patsekeke	Kuyamba kwa Trocharst Brochan ndi Tsisi	Wokhala wa pakati pa ma sycondylar fossa (Anatomy)
Ndege ya Sagittal (masamu))	Mzere pakati pa pakatikati pa trocharsint yayikulu ndi pakatikati pa mitsinje ya femur	PRIFORGE fossa (Anatomy)	PCL 1.2 cmmioior kupita ku poyambira kuvina, akulozera ku Medillary patsekeke.
kufinya	Kuvulala kwa m'chiuno	Kuwonongeka kwa magazi kupita ku mitu yokazinga ndi minyewa yakunja	Kugwira molakwika kumatha kutsogolera ku PCL
PCL: Vuto Lokhazikika

1.large rosor singano yolowera

Wofalitsa wamkulu wa Trochant wafotokozedwera kunja kwa ma trapezoidal ponny protuberance yomwe ili pamphuno ya femal, yomwe imapereka minofu yopanda tanthauzo ya gluteus (Chithunzi 2 ndi 3). Ngakhale ili ndi ma bony ang'onoang'ono a Bony

Kubwereza Mabuku a Zinthu Zolongosola Zolowerera, Tidapeza kusowa kwa chizindikiro cholongosoledwa momveka bwino kwa romical rosor stor. anafotokozera zolowera kuchokera ku Trux ya Trochan yayikulu ngati malo osungirako zinthu zakale, komanso ngati malo osungirako zinthu zapamwamba kwambiri. magawo awiri mwa atatu a Rotor.Gorgiadis et al. anafotokozera mfundo ya singano ngati mbali yolowera kwambiri ya mapiri apamwamba a rotor.

Chithunzi 4. Zovuta za Orthostatic ndi zofananira za m'chiuno zimawonetsa malo abwino olowera kwa intradel a intradellary ilrocharm yayikulu. ''

Kafukufuku waposachedwa m'mabuku awonetsa kuti pali gawo lalikulu la Trochantry Trochan ndiye malo oyenera kuti muchepetse mphamvu yamphamvu nthawi zambiri ikasinthira kwambiri. Kafukufukuyu adatsimikizanso kuti malo ofikira kwambiri amatsogolera kuyika kutsogolo, pomwe gawo lolowera pakatikati limatha kuyambitsa chipika chowongolera kuti muchepetse kunja. Mosiyana ndi zimenezo, kafukufuku wina adawonetsa kuti ku incronchantic Fremur Fracraurs

Malo okulirapo a Trox Trox Trox amagwiritsidwa ntchito pazodwala zonenepa, ndipo njirayi siyikufunika kwambiri, ndikugwiritsa ntchito nthawi yochepa komanso chiopsezo chochepa kwambiri posyer.

Zovuta: Zovuta komanso zotsogola zovuta za intravelary zimapatuka ndi vuto lalikulu la Trochantic lomwe lakambidwa m'mabuku angapo. Chimodzi mwa izi, nthawi zambiri zimakhudzana ndi njira yokhotakhota, ndi kuphatikizidwa. Mu ma inctrochantic fromicurity

Kuphatikiza kwina koyenera kumachitika chifukwa cha kuvulala kwa minofu yofewa, makamaka ku nthambi za ma rotota yam'madzi amtundu wa vuta ndi minofu, koma kuvulala kumeneku sikuli kofala poyerekeza ndi Prifirorm fossa kulowa msomali msomali msomali. Kuphatikiza apo, kuchuluka kwa ischemic necrosis ya mutu wa femichesi wa Trochantry Trochantry monga momwe amafunira kuti andichepetse kwambiri, ndi maphunziro omwe amafotokoza kuti ndi 0.3%.

Poganizira za kuwonekera kwa nthawi yovuta komanso kuwonekera kwa nthawi yayitali, mphindi 10.7 kwa mphindi 90.

Kudwala kwa vutoli kunalinso kofunika kwambiri posankha malo olowera mkati mwa intradedol, poyeserera pampando wa Prirbirm Propherence. Ngakhale kuti kuchuluka kwakukulu kwa Trochaicfic komwe kumagwirizanitsidwa ndi minofu yochepa yopanda minofu chifukwa cha malo ake, imatha kulepheretsa gulu la Abductor minofu, monga momwe lasonyezedwa ndi Ergiş et al. Anapeza kuti mphamvu yolimba ndi nyonga ya m'chiuno a Abeddukitala idachepa kwa odwala omwe ali ndi vuto lalikulu la Trochantic poyerekeza ndi zowongolera zothetsa thanzi. Kuphatikiza apo, kafukufuku wawo adanenanso kuti amachepetsa mphamvu ya mankhwala a m'chiuno, owombera mkati / kunja / kunja poyerekeza ndi mbali yomwe siyimagwiritsidwe ntchito.

2. Peally fossa kulowa

Phossa wa minofu ya adyrimor ndi chizindikiro chofunikira chomwe chimadziwika kuti ndi chimodzi mwazolowera paracentellary Nail.in Phunziro lawo la Cadaveyy Cadaveric, Lakhwic et al. Anazindikira kuti fossa ya minofu ya pyfirmas sinali peyala 'yopangidwa kapena minofu ya pyyrimor minofu. Minofu imatchera kudera laling'ono kumapeto kwa Trochan wa Troshan, pomwe Pryifrim fossa ndi vuto lalikulu la trochanter wamkulu wa Trochan wa Carpissis Brevis. Olembawo adazindikira kuti minofu ya pakhungu ndi proferm fossa ndi mabungwe awiri osiyanasiyana ndikuti olojekiti 'kapena ' Adanenanso kuti ataphunzira Chis-femuleral omwe amamupangira mawuwo 'Protor fossa Ngakhale mfundo za kafukufukuyu zimawonedwa bwino, kuti muchepetse kusokonezedwa ndi kusokonezeka ndi vuto lalikulu la Trochantic.

Kafukufuku angapo m'zaka zamakono amafotokozera molondola mawuwo a possel fossa yolumikizira misomali wa intramillah.georgiadis et al. Fotokozerani zolowera mu peyala monga malo omwe amaphatikizidwa ndi ma radial a carpis bracles minofu yamiyala yovuta (mkuyu. 5). Olembawo adatsimikiziranso kuti malo olowera kwambiri kapena akutali kwambiri amatha kuwonjezera chiopsezo cha kuwonongeka kwa khosi, ndipo polowera ku Ischemic necrosis, yomwe ndi yapamwamba kwambiri ya odwala achichepere.

Chithunzi 5. Malingaliro okopa a m'chiuno chosonyeza malo abwino olowera ku PRIFORE PROSTARARE KULANDIRA ITRAMEURELY TIL. The '* ' akuwonetsa malo a intradellary.

Harper et al. Adalemba kuti kafukufuku wa magulu 14 a anthu aku Cadarsic a anthu mu 1987 pomwe adawunikira malo omwe amawunikirapo chikhomo cha intradelladellary ndi pang'ono pompopompo. Anazindikira kuti kulowera kwa appriormis paradia intradedlary nail adapezeka pamphuno yayikulu ndi khosi lopanda pake, tsamba locheperako lidayanjananso ndi gasepohl et al. Mu kafukufuku wina wa Cadaveric, adazungulira malo oyenera a intravelallary msomali. Kuphatikiza apo, mu kafukufuku wa Cadaveric ndi Laboronici et al. Phassa ya minofu ya anvirimos idafotokozedwa ngati dera looneka ngati peyala lomwe limagwirizana ndi Axis yapakatikati pa intravedillary ya ndege ya coronal.

Mfundo yofikira zithunzi za PYFORorm Fassa ili ndi zovuta zina chifukwa ndizovuta kwambiri poyerekeza ndi gawo lalikulu la chithokomiro chachikulu, makamaka odwala onenepa kwambiri. Kuphatikiza apo, tsamba lolowera lolowera la Pearda la Pearda singano ndi malo opapatiza, zomwe zimapangitsa kuti zikhale zovuta kwambiri. Mwachitsanzo, malo oyambira kumapeto kwa khosi la femirol chidzatipatsa mphamvu yovuta kwambiri ndikuwonjezera chiopsezo cha chiwopsezo chanthe, makamaka ngati malo oyambira ndi opitilira 6 mm andern to thertea. Kuphatikiza apo, morphologic Convel atha kulepheretsa malo olowera, makamaka ngati nthito yakunja kapena rotor ikuyenda bwino, ndikuwongolera malo olowera ndi chiopsezo cha m'mbuyo.

Zovuta: Poyerekeza 38 zazikulu za Trochagentic zolowera ndi ma 53 a pearda polowetsa misala, ricci et al al al alt al Zopeza izi zidatsimikiziridwa ndi bhatti et al. poyerekeza mfundo ziwiri zolowera.

Ponena za kuvulala kofewa, panali chiopsezo chachikulu cha kuvulala kofewa ku chiweto cholowera poyerekeza ndi mitsempha ya inrosseuscorcr ku Erochantic mfundo yolowera. Dora et al. kuwunika kwa mabanja 16 akuluakulu kwa oyambitsa minofu yofewa ku minofu ya alfirmors ndi pini yolowera. Adapeza kuti ngakhale a PYIFORIS FASSA anali woyenera kwambiri, zidapangitsa kuti pakhale kupweteka kwa mutu wa mitu yolimba ndi minofu yozungulira. Zopeza izi zidayanjananso ndi maphunziro a Cadaveric ndi Ansari Moin et al. Amenenso anayerekezera mfundo ziwiri zolowera. Iwo adanenanso kuti misomali yamkati imayamba ku minyewa ya akhungu nthawi zambiri imatha kuwononga zopukutira m'chiuno ndi zowota zakunja. Kuphatikiza apo, kuwonongeka kwa ma genive a nthiti a vuto ochita masewera olimbitsa thupi omwe amapezeka nthawi zonse (tebulo 2).

Tebulo 2. Chidule cha kuvulala kofewa kwa minofu yolowera ku singano yolowera
zosiyana	Phristom fossa kulowa (n = 5)	Malo akulu oyendetsa rotor roso (n = 5)
minofu yofewa
Gluteus Medius Miscle (Anatomy)	5	1
Gluteus Medius Menton	0	4
chimondo
Gluteus Minimus (Anatomy)	3	0
Minofu ya PYFormis (pamwamba pa msana)	3	3
Obtutor Iduls (Anatomy)	1	0
latissimus dorsi minofu (manatomy)	3	0
Mitsempha yamagazi ndi makapisozi ogwirizana
MFCA Nthambi zakuya	4	0
MFCA Sallow nthambi	4	0
kapisozi kapisozi (wa cholowa ngati bondo mu anatomy)	1	0
MFCA: Mankhwala oyendayenda.

Posachedwa, Bharti et al. Anaphunzira chiopsezo chomata immidellary cholowera ku Trochartic Grount ndi malo olowera pakhungu ndipo adapeza zoopsa zokuchiritsa monga momwe amachiritsira motere (tebulo 3).

Gome 3. Prirform fossa kulowanso polowera kwambiri polowera mawu
chisokonezo	Piriformis sinus singano	Chachikulu chophatikizika cholowera
Patsa matanda	6.7	3.3
Kuwa	20	13.3
Kuchedwa kuchiritsa	20	13.3
Kuyenda kochepa	20	33.3
Kuyenda kocheperako	6.7	6.7
Kutalika kwa miyendo	13.3	20
Mchira up purpers pamwamba pa fupa lamoto	13.3	20
Kusokonekera kwa makosi	10	0
Great Trochaint Worcluve	0	3.4
Nemmiy necrosis	6.7	0

Retrogrode femullallary mitaing

Kuzindikira malo oyenera a Introllation a Introvellary akuthandizira kubwezeretsanso kuwonongeka kwa carticulage, kugwa kwa acter), ndi kuvulala kwa minofu (tebulo 1). Posachedwa, pakhala chiwongola dzanja chowonjezereka pa Introllation Intravellary amapatsirana ndi cholinga chochepetsa misomali, kuphatikizapo kupweteka kwa chisoti gawo limodzi mwa magawo atatu a tsinde. Kuphatikiza apo, umboni waposachedwa ukusonyeza kuti pamene awa abweza misomali ya intradellal, misomali yotseka mwina silingafunikire. ndi bisaccia et al. Mankhwalawa osokoneza gawo limodzi lachitatu loyenda bwino pogwiritsa ntchito kutseka ndi kusatsegula retrograde introvedillary misomali. Chifukwa chake, kugwiritsa ntchito kubwereza zachiwawa kusokonekera kwakhala kotchuka komanso kuvomerezedwa kwambiri.

Mafotokozedwe ambiri a malo okwanira olowera ku Introllation intravellary miyala imatha kupezeka m'mabuku. Kafukufuku ambiri amazindikira malo oyenera a remoramu msomali ngati 1.2 kumbuyo kwa chilengedwe cha kugwedezeka kwamphamvu

cm (mzere ndi ma medillary patsekelo) ndi pakatikati pa malo osungirako zinthu zakale (Chithunzi 6).

Chithunzi 6. Maonekedwe owoneka bwino a mawondo a bondo akuwonetsa malo oyenera a remoramil carravelary msomali msomali msomali msomali msomali msomali. ' ' akuwonetsa malo a Intradellary.

Ngakhale palibe vuto lililonse kwa Reporramul Cantravellary Intramullary mitaing, zisonyezo zingapo zafotokozedwa. Izi zimaphatikizapo odwala a Polytrauma, odwala onenepa kwambiri, odwala oyembekezera, acetabatir femporal / topractions fracratures kapena ma taxial a ippial. Zambiri mwa zisonyezo izi zimagwirizana kuti musakhale wodwala kusiya komanso kupewa mabala ambiri opaleshoni.

Kumbali inayo, motsutsana kwathunthu ku Entrograd interradellary misomali imaphatikizapo kutsekeka kwa retrodellary njira yokhazikika komanso yotseguka ya femur yagalimoto. Contraindications contraictication ndi mkati mwa masentimita 5 a wocheperako, kuvuta kupeza njira yochepetsetsa ya bondo, ndipo matenda a intra-arturer kuzungulira tourla ndi mtengo wovuta kwambiri.

Zovuta: Mavuto ambiri a retroghange mitu yopweteka amakhudzana ndi kusamalira mosayenera, makamaka kuyika kolakwika kwa malo olowera. Mu ndege ya sagittal, malo olowera mopanda kanthu Komabe, ngati zolowera zikuikidwa molakwika polowera kumene, izi zitha kuvulaza kuvulala kwam'mimba iloise yochokera pansi.

Hutiinson et al. Ananenedwa zovuta zomwe zimagwirizana ndi mfundo zosayenera za coronal. Adapeza kuti malo olowera mosamala omwe adayambitsa kusokonekera kwa zikhomo ndi matembenuzidwe asterance osachedwa, pomwe munthu wofananira naye kwambiri adayambitsa kusokonekera kwamankhwala komanso kumasulira kwa mendulo. Adanenedwa kuti akusankha mfundo yoyambira ya 2 cm kapena kupitilira apo, kuwonongeka kwa mkati mwa chipongwe chochepa cha kuwonongeka kwa Fracraurs chopanda pake.

Zovuta zina zokhudzana ndi Reporrange wotsatsa misomali amaphatikiza kupweteka kwa bondo, kuuma kwa hertotopic fluted, ndi bondo inturtor free thupi lokha.

Tsiliza

Ngakhale njira iliyonse yolowera intramullal ili ndi chisonyezo chofanana, kusankha komwe intravedollary yachisoni kugwiritsa ntchito mankhwalawa ochita masewera olimbitsa thupi nthawi zambiri kumadalira zomwe mukufuna kuchita. Mukamachita uleravedollary misala ya femur, kupeza mfundo yolowera yolowera pamtundu wa msomali wogwiritsidwa ntchito umafunikira kuti zinthu zisinthe bwino. Kudziwa za magwiridwe antchito ndi kulingalira kumathandiza dokotala kuti achitire njira yabwinoyi ndikuchepetsa chiopsezo chogwirizana. Kuphatikiza apo, munthawi ya intradellallary misala, kukonza kuchepa ndi chinthu chovuta popewa kupweteka kwambiri ndikupewa kupweteka.