5 Intramedullary zvipikiri zvipikiri zvinoshanda uye maitiro ekuvhiya!

Nheyo dzakakosha dzekupindirana kwepamhepo

1. Nhoroondo yeIntramelalary Nailing

Muna 1910, Liliyal Aluminium Intramedullary zvipikiri zvaishandiswa kurapa fegrafs fraft.

Muna 1913, Schon yaishandiswa sirivha intramedullary zvipikiri kurapa forearm fractures. 

Antscher (1900-1972) Akaita mipiro huru kune intramedyary zvipikiri zvechipikiri. 

Ma1960 uye 1970s aimbova nguva yekudzivirirwa nekukurumidza zvehutachiona. 

Nyika yangu yave ichishandisa ivo mune yakakura yakawanda kubva kuma1990.

2. Kuvhura kuderedzwa uye kuderedzwa kudzikiswa

1. Limb Fractures inogona kuderedzwa kuderedzwa pasi pechiratidzo chakananga kana kuvharwa pasi peX-ray yekutarisa.

2. Kuvhura kuderedzwa kupora nguva yekuporesa kwakareba, kupaza kubuda ropa kwakakura, uye kuderedzwa kwakavhurika kunoparadza kugovera kweropa kusvika pakupera kwekupwanya.

3. Inokurudzirwa kushandisa kudzikiswa kwakavharwa zvakanyanya sezvinobvira. Iyo yekudzvinyirira inogona kushandiswa, kana chidiki chidiki chinogona kuitwa pane yekukasira ndege kuenda kuPry uye kuderedza, nekukasira kuderedza kupindira kweropa kusvika pakuputswa kweropa.

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3. Fixiation Mechanism yemukati intramedullary mbambo

1. Iyo nzira ye intramedullary zvipikiri zvemukati zvekugadziriswa ndeye symmetrical central yemukati mepasi splint fixation.

2. Kugadziriswa kwekupwanya neIntramedullary zvipikiri zvekunetseka-kugovera kugadziriswa, kwete kushushikana-kushushikana-kudzikisira kugadzirisa, izvo zvinokonzera kuumbwa kwefirimu.

3. Central gadziriso ndeyekunyararira kune yakakwirira kune cortalay yekunze kugadzirisa, iyo inogona kuderedza ruoko rwemanyoka, kuderedza chiitiko chealgus angation uye kutadza kwemukati.

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4.Rinei nezvipikiri zvemukati

1. Zvishoma zvibodzwa

2. Yakawedzerwa chiyero chezviratidzo zvekuvhiya

3. Kugadziriswa kwakasimba

4. Kutanga basa rekubatana

5. Kurema kwekutanga

6. Inogona kushandiswa mukubatanidzwa pamwe nedzimwe nzvimbo yemukati

Mhando dzekutanga uye maitiro

1. Kuvhara uye kusiri kukiya intramedullary zvipikiri

2. Dynamic uye Static Locking Intramedullary zvipikiri

3. Kuwedzera kwekuwedzera uye kusiri-medullary fixation maitiro

4. Vhura uye yakavharwa magadziriso maitiro

Kubatikana uye kusaterera

Zvipikiri zvakajairika zvemukati zvine midziyo isina kunaka uye simba rakaderera, asi vane humwe hwekuwedzera uye vanogona kupora mushure mekushora, vachikonzera chete huwandu hushoma hwekutsvedza.

Kubatikana intramedullary zvipikiri zvine chekuita neanti-kutenderera uye anti-compression mhedzisiro, yakanaka gadziriso kugadzikana, uye kutevedzera musimboti wekugadziriswa kwezvinhu zvakanaka. Ivo vanoshandiswa zvakanyanya pamapfupa akareba emakumbo. Kunyanya kune yakawanda-chikamu uye yakafambiswa mabraipi, ivo vane zvakagadzikana zviri nani pane zvakajairika zvipikiri.

Dynamization yeiyo static gadziriso

Static Locking Intramedullary zvipikiri zvinogadzira kushoma kushushikana kushamisika uye parizvino inotsigirwa nekuda kwekusatenderwa kuita dynamization.

Kune fractures iyo isina kupora pamakumi matanhatu kusvika kumwedzi inosvika pabasa, mune sitha pfupa rekugadzira kana kutsiva kweanowedzera mukati mekisimasi nechisimba chinowanzoshandiswa.

Dynamization inogona kushandiswa senzira yekusimudzira kupora kupora. Hazvikurudzirwe nguva nenguva nekuti zvinogona kutungamira kuremara kwekupfupisa uye kutenderera.

Marongo ekuwedzera uye asiri-emarrow kuwedzera

Kuwedzerwa kwemuzonga kunogona kuisa mukati meyamende yakakomba uye kwakakura simba, iyo inokodzera kune yekutanga yekurovedza kudzidziswa uye inoderedza huwandu hwezvipikiri zvakaputsika.

Kuwedzerwa kwemuzonga kunogona kuburitsa huwandu hwakawanda hwemapfupa emapfupa ane osteoindductive mhedzisiro, iyo inokodzera kupenya kupora.

Kuwedzera kwemuzonga kuchakuvadza neropa kune ngarava dzinotyisa uye endsteal membrane, asi mitsipa yeropa inogona kuunganidza padhuze nepakati yezvipikiri zvemukati. Kuwedzerwa kwemuzonga kunogona zvakare kuwedzera kutenderera kweropa mumapundu akapfava ematehwe, nokudaro anokurudzira kupora.

Kuwedzera kwemuzonga kunowedzera mukana wekutapukira uye embolism, uye kunofanirwa kushandiswa nekuchenjerera kwekuzviviriro pachena, kukuvara kwakawanda, uye kukuvara kwakaoma.

Kubatsira kwekuwedzera kwekuwedzera

Mushure mekuwedzera kwekuwedzera, nzvimbo yekuonana pakati pechipikiri chemukati uye pfupa rinowedzera, rinovandudza kusimba kwekugadziriswa. 

② Mushure mekuwedzera kwekuwanda, madiki madiki emukati metiramendely 

③ madhiri mapfupi mushure mekuwedzera kwekuwedzera kunogona kukonzera kugadzirwa kwehuwandu hwepafupa idzva, iyo inokodzera kupora kupora.

Kuenzaniswa neMidllary Explary Intramedullary zvipikiri, zvisina kugadzirwa mukati memukati zvipikiri zvine zvese zvakanakira

① Nguva pfupi yekuvhiya nguva uye kushoma kubuda ropa. 

Kukanganiswa zvishoma neyekupedzisira ropa kuyerera mune zviitiko zvine mukurumbira zvakanyorova zvizhinji.

Kushandiswa kweiyo intramedullary mbambo

Humizvok Interlocking intramedullary mbambo

Zviratidzo zvezvipikiri zvehurumende

Zviratidzo zvehukama hwekuvhiringidza nhengo dzepfungwa dziri mukurapa kwehukama hwekuvhunduka kwehukama.

Iyo huwandu iyo inogona kugadziriswa ndeye kubva ku2CM pazasi pemusoro wehuwandu kusvika ku3CM pamusoro peOlecanon fossa. Iwe unogona kusarudza kuigadzirisa kubva pamapfudzi ane antegrade intramedullary chipikiri kana kubva kune yehupfumi neyekudzosera mbambo.

Hunhu hwezvipikiri zvehurumende

Nzira dzekuvhiya dzekuvhiya dzehukadzi dzimba dzekupwanya dzakateedzana dzakanyatsogadziriswa uye intramedullary zvipikiri zvipikiri.

Kugadziriswa kweplate kunorwisa kurwisa-kutenderera uye zvinokotama-zvinokotama uye zvakarongedzwa zvakasimba, asi kushaya hope kwakakura, mukana weutachiona wakakwira, uye nerve nerve rakakuvadzwa zviri nyore.

Zvipikiri zvemazuva ano Kurovedza muviri kunogona kutangwa mushure mekuvhiyiwa.

Chikadzi Kubvunzurudza Intramedullary Chikamambo

Zviratidzo zvechikadzi zvipikiri zvipikiri

Mhando dzose dzezvikamu 2cm pazasi pe trochanthec vertebra uye inopfuura 9cm kubva kubvi kubva pabvi.

Zvidimbu zvekare zvepakati chikamu chechikadzi shaft.

Varwere vane vakakundikana ndiro yemukati yekugadziriswa.

Zvimiro zvechikadzi kupindira zvipikiri

Michina yezvakanaka

Ruoko rwemanzvimbo rwechisimba chekupinda kwechikadzi intramedullary

Mpombi yekuvhara pamigumo miviri yeyakagadziriswa inogadzira pfupa rese kusvika pasi, uye zvipikiri zvinokonzeresa kusimuka uye kutenderera uye kutenderera kwakakura uye kusimba kwekutenderera kwekutsvagisa.

Gamma Interlocking intramedullary mbambo

Gamma zvipikiri zvezvinyorwa

Inoshanda kune dzakasiyana-siyana mhando dzePeritrochanttic Fractures, kunyanya subtrochanttic mafungidziro.

Yakawedzera Gamma Chikiri (Kuvakazve zvipikiri) zviratidzo

Yakakwira subtrochanttic fractures, trochanthec yakasanganiswa neyechikadzi shaft fractures.

Zvakanakira zveGAMMA Nail

Kuvandudzwa nekubatanidza kusimuka kwehukama neIntramedulary Nail tekinoroji, saka iyo gamma zvipikiri zvinoremerwa neyechikadzi calate. Zvekupaza subtrochanttion inosanganisira m medacal customer cortic

Retrograde Intramedullary Femory Mbiri

Zviratidzo zveRetrograde Vechikadzi zvipikiri

Inonyanya kushandiswa for supracondylar feal fracts, kusanganisira supracondlar commined

Inogona zvakare kushandiswa kune fraeral fractures pazasi iyo isthmus ye femur.

Chikadzi shaft, supracondlar femeral, uye intercondylar fractures mukati me20cm kubva kubvi kubva pabvi.

Avo vakatadza plate fixation.

Hunhu hwekudzokorora femory nailing

Supracondylar feal fracture ndeyekupwanya kwakakomba neyakaoma mukutanga, kuderedza uye kwechipiri, kusimba kwemukati. Iko kune chiitiko chakanyanya chiitiko chakadai sekukona kwete-mubatanidzwa uye unononoka kupora.

Retrograde Interlocking Intramedullary Nailing nzira inowanzo shandiswa kubata distal femur bracture, inogona kudzora zvakanyatso kudzikisira kudzikisira uye kutenderera kwekupedzisira kwekupedzisira kwekupwanya, uye zvinobatsira mukutanga kwekufamba.

Supracondylar yakasangana nechikadzi fral cracture yakagadziriswa neLubgenylar intramedullar intramedullar Chiridzwa chiri nyore kushanda, chakarurama mukutsigira, chakavimbika mugadziriro, uye murwere anogona kuita zvekutanga kubuda mabvi kurovedzera mushure mekuvhiyiwa.

Tibial Interlocking Intramedullary zvipikiri

Zviratidzo zveTibial Nailing

Yakamanikidzwa Fractures muiyo yepakati 1/3 yeTibia: Transverse fractures, pfupi oblique fractures, pseudrrrosis.

Zvisingarambidzo pakati pe60% yehurefu hweTibia: Fractures padhuze nedanho rekutangira, dzakareba zvipenyu, zvidimbu zvekupokana, zvakapetwa, zvikanganiso zvine pfupa.

Hunhu hwe tibial mbiri

Kubatanidza intramedullary bailing ye tibia inonyanya kushandiswa kuTibia Fractures.

Kunyangwe zvichikwanisa kushandiswawo kuti proximal uye distal Tibia fractures, iyo complication yakakwira, malunion anoitika kazhinji, kupunzika kwekupedzisira kune ± 1cm yekufamba muna 1/2 yezviitiko, uye 1/4 yeiyo gadziriro ikatadza.

Mabhuku akataurisa mhedzisiro iri nani yeKristal Tibia kupwanya kupfuura proximal ticract tibia mushure mekugadziriswa kwemufaro wechibudiki.

Kuvhiya Maitiro

Kugadzirira Kwazvo Kwemidziyo Inokosha

Orthopedic mubhedha (mubhedha wekutengesa) kana standard fluoroscopic mubhedha; kudzoreredza; mufananidzo unosimbisa.

Kusarudzwa kwakakodzera kweiyo intramedullary chipikiri chehurefu hwekureba kweiyo preoperative endprosties

Radiograph

Contracteral lim blast kuyerwa

Intramedullary zvipikiri zvechikara

X-ray isthmus upamhi

Intramedullary zvipikiri zviyero

1.Translucent Mutongi Ekutsiva pasi peC-AMR Machine

Iyo distal uye proximal mhedzisiro yepfupa yaive pane iyo centerline yeRay; Mutongi aive akaenzana ne diaphysis.

2.Length kuyerwa zvichienderana nemamirimita emuviri

Femur: Tip of Great Trochantter → Litteral bhinzi nzvimbo kana yepamusoro pole ye patella; Tibia: Medial-Litteral Bight Space → anterior chikamu cheAnkle Joint muDorsiflexion yetsoka.

Intramedullary nail kusaisa matekiniki - yekupinda nzira nzira

Longitudinal Axis yeiyo medullary cavity mumutsara wakananga

Kwete padyo padyo nenzvimbo yekupinda

Kureba kwakakodzera: dilated - refu; Undated - Pfupi

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Kufanana kwechikadzi intramedullary nail yekupinda nzvimbo

Kugadzirira kwenzvimbo yekupinda yeiyo yakafanana femery intramedudullary mbambo

Hip FrExion uye Adduction

Longitudinal Incisional Proximal kune yakakura Trochantter

Kwete kure zvakanyanya kumashure

Kuiswa kweiyo PIN

Kuiswa kweiyo yakapfava tishu nhoo

Retrograde femorel intramedullary nail yekupinda Point

30 ° ibve flexion

Refu axis yejira rekutungamira mune imwecheteyo nhungamiro yemukati mechikara cheiyo distal femori stem

Kuiswa kweKiriviri Kiriviri Pin mune iyo Distal femur kuburikidza nePatelar lignamende yekudzivirira: Orthogonal - yepakati peIntercondylar fossa yeiyo fosta yeiyo fossa yeiyo fossa ye fosssa ye fosssa ye fossa Litteral - Blumensaat's mutsara

Kutanga point ye pcl isina kukuvara

Parallel tibial intramedullary nail yekupinda Point

Pane iyo centreline yeiyo medullary cavity

Anterior margin ye tiili clateau

Yakakwira sezvinobvira pasina kukuvadza maplateau

Yakakura Knee Flexion

Incision tibial tubosity-isinganyanyama patella pamwe nepakati pepakati

Vhura iyo medullary cavity: Batanidza pini pa15 ° kune iyo Sagittal ndege yeiyo Longitudinal Axis yeTemial stem

Chinzvimbo chechifananidzo chinowedzera

Marwunta Matani

Kuderedzwa kwemagetsi

Zvitsva Zvakawanda

Kuderedzwa kwemanyoro

Chinyakare chakapwanyika ne pseudoarthrosis, sclerosis mumugumo wemugumo

Hapana tireniquet iri pasi peflation

Dunhu reropa ndiyo yakanakisa inotonhorera

Kudzokorora maitiro

Kufanana kwechikadzi intramedudullary mbiri

Zvikonzero zvekuomerwa mukudzoreredza fravel fractures

Gobvu rakapfava tishu rekuputira haritenderi kuwanikwa kwakananga kune pfupa

Sindano yekupinda Point haigone kuvonekwa zvakananga

Hip Mubatanidzwa Mukurukurirana

Tibial fracture kuderedza

Kunyengera

Kazhinji subcutaneous uye zviri nyore kuhukura

STabilized Fracture - Mid kana distal A uye B Type Fracture

Oblique fractures - overkill

Intramedullary kuchera

Ancillary kuderedza matanho

Point kuderedza forceps

tibia; percutaneous kana ronda kushandiswa

Rakakura Resters (Brace)

kuderedza kunonoka; limb kupfupisa

Nguva pfupi SChanz Screws

① femari, tibia

 Pedyo neiyo fracture mutsara sezvinobvira

③ proximal bracture single cortical shandisa

④use a Universal chuck ine t-bata yekuisa nyore kufambisa

Poller mbambo

①metaphyseal bracture (kururamisa mutsara wesimba, kudzikisira kudzoreredzwa, kudzoreredza kuvhiya)

② Oblique kupwanya kwe distal tibia kana femur (Shear kushushikana → kudzvinyirira)

③ isina kunyatsoiswa mukati memukati mipikiri kupinda muzvinyorwa zvekare panguva yechipiri kuvhiya

④ Pfuma isina kunaka yekupinda, varombo proximal bracture alignment (screw yakaiswa perpendicular kune iyo inogona kugadzirwa kwekutamiswa kweiyo endoplant)

Yakawedzera Wideturniquet

① tibia

② inowedzerwa nehurongwa kana kudzoreredzwa

③ Shandisa nekuchenjerera mukukuvara kwakasimba kwematombo

④ chengetedza ipfupi

⑤ Rambidza kuwedzera kwepedyo mukuwedzera mune yakatarwa nyika

Zvipikiri kukiya kutevedzana: distal wobva waita proximal

Zvakanakira

kurerutsa kwekugogodza, kumanikidzwa kwekukanganisa kupaza; kubviswa kwekuparadzaniswa; kuderedza mabasa.

Kuderedza maitiro ekunonoka & kusaziva kuvhiyiwa

Matambudziko anogona kusangana nekuvhiyiwa kwakanonoka

Axial deformity (kupfupikisa, ingation uye kana kutamiswa)

Kukura muGranulation Tishu

Mbambo dzepakutanga pfupa

Sclerosis yekukanganisa kupwanya nekuvhara kweiyo medullary cavity

Osteoporosis

Zvinangwa zvinogoneka zvinogoneka

Deflection yeiyo Expander uye Intramedullary Chikamambo

Angurar Kuremara → Retsoka

Dislocation yekubviswa inopera → Poller's mbichana, plate fixation

Nzira dzekudzivirira zvisina kujairika masimba emitsetse

Proximal - Yakarurama yekupinda Point

Distal - intramedullary mbambo pakati peiyo medullary cavity

Zvinetso zveNyramedullary Nailing

★ Utachiona

★ Nerve kukuvara

★ Yakakanganiswa Kuporesa Kwezvakareruka

★ Zvekurapa

Kutenderera kwekunze, tursion, valgus, kutenderera kwemukati, kusimuka

★ ADJACENT YAKABUDA MUKADZI

★ Fat embolism

★ Hetroptopic Onssization

★ Pulmonary embolism

★ Re-fracture

★ Thrombosis

★ Joint kuomarara

★ Non-Union yekukanganisa, pfupa nonunion

★ Yemukati yekugadzirisa kukundikana

★ Limb kupfupisa

★ Zvimwe

Zvinotaurwa - Kutapukirwa

1.Elarly on, yakavhurika fractures yaionekwa sekukanganisa kumisangano yemukati.

2.The zviitiko zvehutachiona hwehutachiona mumakavhuri akavhurika zvinoenderana nechimiro chekukuvara kwakapfava kwetishu uye kusvibiswa

Zvakaitika zvekutapukirwa mushure mekuvhurika kupwanyika zvinoenderana nenyika yekukuvara kwakapfava uye kusvibiswa pamwe nemabatiro akapfava.

3.thhinner intramedullary zvipikiri zvinowedzera mukana wekutapukirwa; isina-yakawedzerwa locking intramedullary zvipikiri zvipikiri zvakaringana, uye mapfupa emapfupa ane

Iyo isiri-yakawedzera kukiya nzvimbo yechipikisi chechipikiri chechipikiri chakashata, ne microscopic kufamba kwemucheto wakaputsika wepfupa pamwe nemarara akasara, zviri nyore kukura kwehutachiona.

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Mafuta embolism syndrome

1.Kuitika kwechiitiko chehurefu hweTubular pfupa dzinobhururuka ndeye 0.5% kusvika ku2%.

2. Kuwedzera kweMedulla uye kusiri-kuwedzera kweMedulla hakuna chakakosha pakubata kwepuremoni.

3.Kunyatsowedzera medulla, maitiro ekutambudza anofanira kunge ari zvinyoronyoro, achidzivisa simba rakawandisa uye kushanda kwakashata.

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Kunonoka kupora kupora uye pfupa nonunion

Zvinhu zvakasiyana-siyana zvinokanganisa kupora kupora mushure mekupokana zvipikiri zvipikiri, uye zvikonzero zvinogona kuongororwa seinotevera.

1.Soft tissu yakanyorwa mumugumo wakaputsika

2. Kuparadzanisa kweTransverser Fracture inopera

3. Kuzvarwa kwezera remurwere

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5. Murombo Intramedullary zvipikiri zvechipikiri

6. Yakasanganiswa chirwere cheshuga mellitus kana zvimwe zvirwere zvinopesana.

Zvekurapa Zvekurapa

Zvepamhepo zvakamhanyirwa zvidimbu zvinonyanya kuvezwa zvidimbu zvinokonzerwa nekusagadzikana kwekunyengera panguva yekugadziriswa kwemukati.

Intranaoperative kutarisisa kunofanirwa kubhadharwa

1. Iko kusarudzwa kweseti yechipikiri yekupinda netiji inogona kutungamira kuProximal kupwanyika.

2. Usasundira zvine simba mukuwedzera kweMedulla.

3. Iyo yekupinda yePulp kuwedzera inofanirwa kunge iri munzira imwechete senzira yekuisa mbambo yekuisa.

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Kurwadziwa mumubatanidzwa

1. Kuiswa kwechipikiri chegomarara kunosanganisira kupfava zvakapfava uye kunyangwe iyo capt capsule munzvimbo yepedyo kweinenge 1 mubatanidzwa.

2. Kana iyo bailing point iri padyo nepamusoro kana dhaya yeiyo intramedullary mbichana yakakura kwazvo, inogona kukonzera kukuvara kwezvivakwa zveIntra-zvinongedzo, zvichikonzera kurwadziwa kwebvi.

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