Intera ya femoramellary imisumari - Nigute wahitamo ingingo nziza yo kwinjiza?

Intangiriro

Gutezimbere kuvura femoral birashobora gukurikiranwa kugeza kuri 1940 mugihe Kuncher yatangije tekinike yimisumari ifunze. Ikoreshwa ryimisumari ya Intramedillary (imns) mugutakamba femoral byahindutse urwego rwitaweho mumyaka mike ishize, hamwe no kunonosora ubu Intramedillary imisumari n'iterambere mu buryo bwo kubaga bwo kubaga bwaremereye kwiyongera gukomeye mu gukoresha intera y'imbere y'isi.

Gufata conservateur clammel steml stemral ikoreshwa gusa mumibare mito cyane yabarwayi bafite itandukaniro ryingenzi kuri anesthesia no kubaga, kandi nyamukuru yo kwivuza bikomeje kubaga. Kubijyanye no kubaga kuri ibyo kuvunika, hari amahitamo menshi ahari, harimo intera imisumari, isahani yashushanyije, no gukosorwa hanze. Ugereranije nubundi buryo bwo kubaga, imisumari yinjira ni uburyo bworoshye kubibazo byo gukiza cyane hamwe nigipimo cyo gukira hejuru, kandi birakoreshwa cyane mubikorwa byubuvuzi.

Gusobanukirwa neza anatomiya ya femur feximi, amazi agenga imitwe yimyenda hamwe na anatomy yimitsi yikibuno irashobora kongera intsinzi yikibazo cyintara yavugije imisumari. Ibinyuranye, guhitamo ibyinjira biterwa nibintu byinshi, birimo intera imisumari, kurubuga, hamwe nibintu byo kwihangana, hamwe nibintu byo kwihangana, hamwe nibintu byo kwihangana, hamwe nibintu byo kwihangana (urugero, gutwita, gutwita, nibyifuzo, nuwitayeho, nuwitwite). Utitaye ku mwanya winjira watoranijwe, kubona aho byinjira neza ni ngombwa kugirango ukomeze kugabanuka bihagije mugihe cyo kwinjiza imizabibu mugihe ugabanya ibyago byo kugorana.

Anatoral anonatomy

1.Byitangajwe kumutwe wintangarugero

Umutwe wa femoral wakiriye imiyoboro ya vascular kuva mu nzego 3 zikomeye. Ahantu ho kuborora femoral ibigo bya femorale (hamwe n'amashami 3-4), imiyoboro ya obturattor, itanga ibyombo bizengurutse ibigo bya Anastose hamwe na bondeator yuzuye imiyoboro ya karoge

2.Atatombe yimitsi ya hip

Mugihe ukora intera imisumari ya femur, gusobanukirwa neza imitsi yo mukarere kizengurutse rotor ni ngombwa kugirango wirinde imvune idakenewe. Umutsima wa Gluteus Medisite ukomoka kuri Ilium ukarangirira kuruhande rwimyororero runini, mugihe imitsi miri ya gluteus ikomoka kuri ishingasiyo kandi igatambuka inyuma yinyuma yinyuma yinyuma yumurongo munini (imibare 2 & 3). Iyi mitsi ikorwa nkabaganga b'ikirebe n'imbere mu kibero. Kubwibyo, kwangirika kuri iyi mitsi mugihe cyo kwinjiza imisumari ya paracegrafiya bizavamo intege nke za Adductor na Gait yo mu gatsiko ka Trendelenburg, bigira ingaruka mbi kugarura no kubisubizo.

Igishushanyo cya 2. Anatomy yimitsi ikikije ikibuno

Igishushanyo cya 3. Ikigereranyo cya femorale

Bangijwe na femoral intera imisumari

Ubushakashatsi bwinshi buherutse bwarasemuye aho yinjira mubyiciro bya paracrine. Amahitamo yinjira mu misumari arimo igituba kinini na Fossar fossa, buri kimwe hamwe nibimenyetso byayo kandi bifite ibibazo (imbonerahamwe ijyanye (imbonerahamwe ijyanye (imbonerahamwe ya 1).

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Igikombe kinini cyasobanuwe nkurwego rwo hanze rwamabuto rwinshi rwa ENOn Nubwo iyi ari ntoya yamashanyarazi, imenyekanisha ingingo iboneye mugihe ukora imn yakozwe mubitsina bishobora kuba itandukaniro riri hagati yo kubona ibisubizo bishimishije cyangwa bibi mugihe uhuye nigiti cyuzuye.

Twasuzumye ibitabo biriho kubisobanuro bya femoral point, twasanze kubura ikintu cya anatomic por rotor ya rurmor imn kwinjira.bharti et al. yasobanuye aho byinjira muri apex ya apical ya trochantere nini nko kuba umuhuza kugeza ku mwobo ukabije mu mwobo uri hagati yimbere mumwanya wimbere hagati yimbere hamwe na nyuma yinyuma bibiri bya gatatu bya rotor.georgiadis et al. yasobanuye ingingo yinjira nkuruhande rwinyuma rwibipimo bisumba byose bya rotor.

Igishushanyo cya 4. Ibitekerezo bya orttraostative nibice byibibuno byerekana ibyinjira byiza kuri intera ya paragodian ya Intramedian '*' Erekana intera yo kwinjira mu misumari.

Ubushakashatsi buherutse gukorwa mu bitabo bwerekanye ko apex y'ikimyo kinini ari intangiriro yo kubona umurongo mwiza w'ingufu, kandi ko guhuza nabi kubera ubumuga bwo guhinduranya igihe bibamo MM 2 kugeza ku ndunduro zirenga 2. Ubu bushakashatsi kandi bwashimangiye ko ingingo yinjira imbere iganisha ku kwimurwa kwa kure, mugihe ikintu cyinjira hagati gishobora gutera kuvunika kure kwimurwa inyuma. Ibinyuranye n'indi bushakashatsi bwerekanye ko mu kuvunika femur femur femur ari hejuru cyane hamwe nimpano ya pirikingi kuruta hamwe nimpande zumuryango.

Ingingo nini ya Trochanteric Apex ikunze gukoreshwa mubarwayi bafite umubyibuho ukabije, kandi ubu buryo ntibusaba tekiniki, gutanga igihe gito hamwe ningaruka zo hasi zo kugorama pyriform foining point.

Ingorabahizi: Ingorabahizi no gushinga amaposita yo mu misumari ya femorave hamwe na trochantere nini yahagaritswe byaganiriweho mubitabo byinshi. Kimwe muribi, mubisanzwe kijyanye na tekinike mbi, ziterwa nubuvuzi. Mu kuvunika femoral ya serduct, aho byinjira bihari kandi imbere imbere yo guswera gukomeye birashoboka kuva ku kuvunika metal kuruta ingingo yinjira yegereye uruhande rwo hagati.

Ikindi kibazo kijyanye no gukomeretsa byoroshye-tissue, cyane cyane kumashami yumunyamuryango w'agateganyo, ariko ibikomere ntabwo bikunze kugaragara ugereranije na pyriform yinjira mu misumari yinjira muri Pyriform yinjira mu misumari yinjira mu misumari y'inganda z'inganda za fesa. Byongeye kandi, intera ya Ischemic Necrosis yumutwe wumuyoboro hamwe na apex yiki gihe kinini nkuko byinjira bitekerezwa cyane, hamwe no kubigiraho amakuru nka 0.3%.

Urebye igihe cyahiye na flueroscopic, igihe cyakoreshwaga gifite iminota 90.7 kubice byinjira muri Grochanter.

Ibitekerezo by'indwara byagize kandi ikintu cy'ingenzi mugihe ufashe icyemezo cyo kwinjira mu bwinjiriro bw'imirimo, nk'uko bigenzurwa n'itsinda ry'icyiciro cya Crochanter ku mwanya wa Cyrivate. Nubwo ingingo nini yo kugera kuri Trochanternic isanzwe ifitanye isano na tissuse nkeya zoroheje kubera aho ziherereye, irashobora kuganisha ku mutwe w'imitsi y'ibishishwa, nkuko byerekanwe na Ergime er. Basanze aringaniza imbaraga hamwe na Hip Imbaraga za Hip zagabanutse kubarwayi bafite uruganda runini runini ugereranije nubugenzuzi buzima. Byongeye kandi, ubushakashatsi bwabo bwatangaje ko bugabanuka cyane imbaraga za Hip ishishikarizwa, guhinduka no mu gihugu cyangwa indege yimbere / hanze ugereranije nimpande zidakoreshwa.

2. Pearly Fessa yinjira

Fossa ya Pyriforsis yimitsi ya Pyriforsis ni ikintu cyingenzi cya anatorki cyagaragaye nkimwe mu ngingo zinjira muri paracentes interal inter-tedopsique yo kwiga, Lakhwani et al. Yavuze ko Fessa yo mu mitsi ya Pyriforsis yari afite 'pear ' ikozwe cyangwa cyangwa pyriformis imitsi. Imitsi ifata ahantu hato ku isonga rya trochanter nini, mugihe Pyriform Fossa ari uguhungabana kuruhande rwikibazo kinini kandi ni umugereka wa carpi radial brevis imitsi. Abanditsi banzuye ko imitsi ya Pyriform hamwe na Pyriform Fossa ni inzitizi ebyiri zitandukanye kandi ko icyitwa Pyriform Fossa igomba koherezwa nka 'rosto ' fossa kugirango igororokeye. Babisabye nyuma yo kwiga imyenda ya CIS-femoral basabye ko ijambo ry'umwimerere 'REOTO RUBONA mu bitabo aho kuba ' Pyriformat Fessa 'nyuma yo kwiga ijambo ry'ibiparere. Nubwo ingingo zibi kwiga byombi ziyubahwa cyane, kugirango zorohereze ibisobanuro no gukumira urujijo no gukumira urujijo rwinjira, tuzakomeza kwerekeza kuri iyi ngingo nka Pyriform yinjira.

Ubushakashatsi bwinshi mubitabo byubu buryo busobanura neza ibyinjira nyabyo bya FISSA ya Pearsa kumasasu yimivumo ya inkutamvugo. Sobanura ifarashi yinjira mugihe agace k'umugereka wa carpi radial brevis mumitsi yo kwiheba munsi yijosi (Ishusho 5). Abanditsi kandi bashimangiye kandi ko ingingo yinjira kure cyane cyangwa iri kure cyane irashobora kugabanya ibyago byo kuvunika mu ijosi ry'ibinyabuzima, kandi iyo ikintu cyinjijwe ari kure cyane, hashobora kubaho ibyago byinshi byo kwigomeka cyane, hashobora kubaho ibyago byinshi byo gukomera kwa ISICEC.

Igishushanyo cya 5. Imbere yo kubona ibibuno byerekana ikibuno cyerekana icyerekezo cyiza cya Pyriform Fossa retrograde intera imisumari ya femorale. '* ' «' Yerekana intera yinjira mu ntangiriro.

Harper et al. Yasohoye ubushakashatsi bwitsinda 14 ya sensiya yimyaka ya 1987 aho basuzumye aho PIN ya PIN ya Intramedullary yashyizwe ahagaragara na retrograde kumurimo wa retronderlar wo muri femur. Banzuye ko ingingo yo kwinjira muri Pyrimis Pardimedian Intramedian Calsomedian Caldomiary yari iherereye ku ijosi rikomeye n'ijosi ry'umunyamerika, imbere muri Pyriformis, yashyizwe ahagaragara na Gausepohl et al. Mu bundi bushakashatsi bwa Cadavelandic, bahagaritse umwanya mwiza wo kwinjira mu misumari y'umunyabwenge ku nkombe yo hagati ya trochantere nyinshi hejuru ya PyriForsite Tendon. Byongeye kandi, mubyigisho bya Cadaveric na Labronici et al. FASSA ya Pyriforsis yasobanuwe nk'akarere ka Liminal ihindagurika kw'amakarari yahuriye hamwe na axis nkuru y'intangiriro y'inkuta z'umunya femore mu ndege.

Pospa yinjira ahantu runaka ifite ibibi byihariye kuko ari tekiniki itoroshye ugereranije na trochantere ikomeye, cyane cyane kubarwayi babishoboye. Byongeye kandi, urubuga rwinjira neza kumashaza ishusho ya FAAR Ingingo ni agace gafunganye, bigatuma bitoroshye kubona. Kurugero, intangiriro yimbere yimbere yijosi izavamo imihangayiko ikabije kandi yongera ibyago byo guturika kwimbere, cyane cyane niba intangiriro yimbere ya mm igera kuri 6 imbere ya mm imbere kuri fossa. Byongeye kandi, itandukaniro rya morphologiya rishobora kubangamira urubuga rwinjira, cyane cyane niba rugufi rwo hanze rwinshi ruringaniye cyangwa rotor ni ugutera imbere, bikatera urubanza rwinjira kandi ruvunika ijosi.

Ingorabahizi: Mugereranije ibibanza 38 binjira muri Crochanter Crochanter hamwe na 53 byinjira mu masaro yo mu mbaraga z'inkuta z'isi zo mu mbaraga za femoral. Itsinda rya Fossa rya Fossa Ibi byagaragaye byemejwe na Bhatti et al. mugihe ugereranya amanota 2 yinjira.

Ku bijyanye n'imvune yoroshye-tissue, habaye ibyago byinshi byo gukomeretsa byoroshye-tissue kuri Pyriforsis Arlet ugereranije na neuromusculas kumwanya muto wo kwinjira. Dora et al. Isuzumabumwe 16 z'Abakuze Cadaveric Cyine zangiza ibikomere byoroshye kuri pyriforsis imitsi na rotor yinjira. Basanze nubwo Pyrifristois Fossa yari afite agaciro geometrically, yateje ibyangiritse cyane kumutwe wumutwe no mumitsi hamwe n'imitsi ikikije. Ibi byagaragaye byasonijwe nubushakashatsi bwa Cadaveric na Ansari Moin et al. Ninde wagereranije amanota abiri yinjira. Bavuze ko gukosora imisumari guhera mu mitsi ya Pyriformis byari bishoboka cyane ko byangiza ibinyomoro by'agateganyo ndetse no hanze. Byongeye kandi, ibyangiritse kuri gari ya motator hagati ya femorale yabonetse mubihe byose (imbonerahamwe 2).

Vuba aha, Bharti et al. Yize ibyago byo kugorana mu mbaraga z'umunya femoravuzi ku ngingo nini yo kwinjira hamwe no ku mwanya wa FAARSA yinjira kandi ugasanga ingorane zizagira ingaruka nkincamake (Imbonerahamwe 3).

Retrograde intera ya femorale imisumari

Kugena aho byinjira muri retragrade intera imisumari ya femorale izafasha kugera kugarura ibintu byiza, uburebure, no kuzunguruka mugihe cyo kugabanya imvugo ya Articular, uburebure Vuba aha, habaye ubushake bwo gusubiramo intera ya femorale, hagamijwe kugabanya ingorane zijyanye no kugabanya imisumari, bifatwa nk'igitsina gake, cyane cyane mu bubabare bwo kugabanya imisumari, cyane cyane mu bice bya kure uruti rw'umunyabwenge. Byongeye kandi, ibimenyetso biheruka byerekana ko iyo iyi retrograde intera imisumari imaze gukinishwa neza, imisumari yo gufunga itarangwamo, igihe cyo gukira, cyangwa kubarwayi-bivugwa hagati ya Meckariello et al. na Bisaccia et al. Mu kuvura ikarito ya kure-ya gatatu ya Femoral Stem Fromral ukoresheje gufunga no kudahagarika retrograde intramedulllary imisumari. Rero, gukoresha gusubiramo imisumari yubugome byakunzwe kandi byemewe cyane.

Ibisobanuro byinshi byinjira muburyo bwo gusubiramo intera ya femoral intera yubutaka burashobora kuboneka mubitabo. Inyigisho nyinshi zerekana ikintu cyiza cyo gusubiramo imisumari ya retrograde nka 1.2 Imbere mu nkomoko yumunyabwenge ya reciate yinyuma

cm (bijyanye na cavity cavity) n'ikigo cya intercondylar fossa (Ishusho 6).

Igishushanyo cya 6. Ibintu bya ortthostive ortthostive hamwe na pical byerekana ibyinjira neza kugirango basubire inyuma intera femoral umusumari. '*' Erekana Intramedillary Intangiriro.

Nubwo nta kimenyetso cyuzuye cyo gusubiramo intera ya femoral, ibimenyetso byinshi ugereranije. Harimo abarwayi ba Polytrauma, abarwayi bafite umubyibuho ukabije, abarwayi batwite, guhagarika femoral ibiti bya iPilaral, kuvunika femorale hamwe na factrale ya acetabular cyangwa ibisebe bya icetabular, hamwe na femoral femoral stemre hamwe na tibial. Byinshi muribi bimenyetso bifitanye isano no koroshya umwanya wihangana no gukumira ibikomere byinshi byo kubaga hafi.

Ku rundi ruhande, bivuza itunganiza mu buryo bwuzuye bwo gusubiramo imisumari ya femorave harimo intera ya retttramediade intramedulllary umuyoboro wagutse hamwe no gukingura femur ya kure. Kumenyekanisha isano iringaniye biri muri cm 5 yigifuniko gito cyo kugera kuri dogere enye, hamwe no kuvuza ibihangano byihuta bya pateri, hamwe ninkingi zikabije za patella na pole ikabije.

Ingorabahizi: Ingorane nyinshi zo gusubiramo imisumari yubugome ijyanye no gufata nabi, cyane cyane gushyira nabi aho byinjira. Mu ndege ya SAGITLAL, ingingo yinjira imbere izavamo ibisobanuro byinyuma, ibyangiritse hejuru, kandi birashoboka ko imisumari kuri patella mugihe ivi ryahindutse. Kurundi ruhande, niba ibyinjira bihagaze neza muburyo bwinyuma, ibi birashobora kuvamo ibyago byinshi byo gukomeretsa inyuma yinyuma yinyuma yinyuma hamwe no kwimurwa imbere.

Hutchinson et al. byasobanuwe ingorane zijyanye nindege idakwiye. Basanze ingingo yo kwinjira hejuru yavuyemo ubumuga bwibitabo hamwe nibisobanuro bya posterolate na gahunda yimyanya yimyanya, mugihe umuntu arengana cyane nubuhinduzi bwo hagati.ndars et al. yatangaje ko guhitamo ingingo yo hagati yari cm 2 cyangwa irenga kuri axis yo hagati yatumye habaho kuvuza imitako yakoreshejwe mu gihe gito cyo kunyerera bikagabanuka kugabanuka kwamavurungano.

Ibindi bigo bifitanye isano na retrograrade umusumari wumunyagihugusiaga imisumari ivi, gukomera, ibyatsi bya heterotopic ivi, na intra-artra-articular ivi ryumubiri.

Kurangiza

Nubwo buri kintu cyimisumari yimisumari gifite icyerekezo gihuye, guhitamo intera imisumari yimisumari kugirango ukoreshe kuvunika imiyoboro yubukerewe mubusanzwe mubisanzwe biterwa nubusabane. Mugihe ukora intera imisumari ya femur, kubona aho byinjira muburyo bwumusumari ukoreshwa mugukosora birasabwa kugirango ibisubizo byiza. Ubumenyi bwimikorere ya anatomiya nibitekerezo bizafasha kubaga gukora muburyo buhagije bwa tekiniki mugihe bigabanya ibyago byo guhura nibibazo. Byongeye kandi, munzira zigenda zitera imisumari, kubungabunga kugabanuka nikintu gikomeye mu gukumira malunion na malunion cyangwa ubusa kubirangagura.