Chikadzi Intramedullary Nailing - Maitiro Ekusarudza Yakanyanya Kuisa Pfungwa?

Nhanganyaya

Iko kuvandudzwa kwekurapwa kwechikadzi kunogona kudzoserwa kumashure kuma1940 apo ntscher yakaunza iyo yakavharwa intramedullary nyanzvi yedzidziso. Kushandiswa kweiyo intramedullary zvipikiri (erns) muzvikamu zvechikadzi zvave mwero wekutarisira mumakumi mashoma apfuura, uye kuvandudzwa kwazvino mukati Intramuterllary nemusoro uye kufambira mberi mune zvekuvhiya maitiro kwakabvumira kuwedzera kwakakosha mukushandiswa kwemukati memuromo wemuremu.

Kuchengetedza kurwiswa kweiyo frcustomerts fraystem inoshandiswa chete muhuwandu hushoma hwevarwere nekukasira kupesana neanesthesia uye kuvhiyiwa, uye mushonga wekurapa anoramba achifemerwa. Nezve kurapwa kwekuvhiya kweaya mafaro, pane zvakati wandei sarudzo dziripo, kusanganisira intramedullary zvipikiri, plate screw kugadzirisa, uye yekugadzirisa ekunze. Kuenzaniswa nedzimwe sarudzo dzekuvhiya, nyanzvi yekuvhenekera ndeyekudzikisira pamwe neakaderera complication mwero uye yakanyanya kupora kupora chiyero, uye zviri kuwedzera kushandiswa zvakanyanya mukuita kwekiriniki.

Kunzwisisa kwakanaka kweAnatomy weiyo Proimal Femur, iyo Ropa Kupa Musoro wechikadzi uye Anatomy yeHip tsandanyama dzinogona kuwedzera zvakanyanya kuwanda kwemukati memuromo merning for fractures. Mukupesana, sarudzo yekupinda nzvimbo inoenderana nezvinhu zvakawanda, kusanganisira intramedullary chombo dhizaini, kupwanya nzvimbo, kukanganisika, uye zvinhu zvine mutsindo (semuenzaniso, polytauma, nhumbu, uye kufutisa. Pasinei neiyo nzvimbo yekupinda yakasarudzwa, kuwana iyo chaiyo yekupinda nzvimbo yakakosha kuti urambe wakakwana kuderedzwa panguva yemukati yekuisa chipikiri painenge ichidzora njodzi yekunetseka.

Mukadzi Anatomy

1.Blood inogovera kune iyo femori musoro

Musoro wechikadzi unogamuchira Vascular Supply kubva ku3 Major Arteries. Iyo inotevera rotator femore artery (ine matavi e3-3), iyo inopa artery yedenga, uye iyo inopa zvakare mudziyo unokwira neAnatori echikadzi

2.anatomy yehudyu tsandanyama

Paunenge uchiita mitsipa intramoutular Iyo Gluteus medus muswe unobva kuIlium uye inopera pane yakazotevera trochanter, nepo gluteus mincle kubva kuhukura yechigungano yeiyo humhandara Ose maviri emusuru anobata seanodirana nezve chidya uye kutenderera kwemukati kwehudyu. Naizvozvo, kukuvadza kune aya tsandanyama panguva yekuisa yekamuri yemunhukadzi yekamuri inoguma neAdductor kushaya simba uye Trdenlenburg gait, iyo ine kukanganisa kwekupora kwemurwere uye mhedzisiro.

Fig. 2. Anatomy yemasuru akatenderedza muhudyu mubatanidzwa

Mufananidzo 3. Proximal fembol tsandira nzvimbo yekubatanidza

Zvakafanana feoral intramedullary mbambo

Zvikamu zvakati wandei zvidzidzo zvakati wandei zvakachenesa nzvimbo yekupinda yeParcine Femore Mbiri. Nail Nail Speep Sarudzo dzinosanganisira iyo yakakura trochantter uye pyriform fossa, imwe neimwe ine zvayo zviratidzo uye zvakabatana zvakatarisana (tafura 1).

Tafura 1.Starting mapoinzi uye njodzi dzinogona kuitika dzeParacrine uye Retrograde Femorel Mberi
mutsauko	Parallel intramedullary zvipikiri		Retrograde intramedullary mbambo
	rotor	pyriform fosssa (anatomy)
ndege yakasviba	Vertex yeakakura trochantter uye pointing maully kune medullary cavity	Junction yeiyo yakakura trochantter uye yekadzi mutsipa	Pakati peiyo Intercondylar Fossa (Anatomy)
Sagittal ndege (Math.)	Mutsara pakati penzvimbo yakakura trochantter uye pakati pegomba remarara re femur	pyriform fosssa (anatomy)	PCL 1.2 cm anterior kune yechikadzi kutanga nzvimbo, kunongedzera kune iyo medullary cavity.
kufumurwa	Hip Abductor Boka rinomira kukuvara kwekukuvara	Kukanganisika kweropa kugovera kumusoro wechikadzi uye hip kunze kwekunze rotator muswe	Kubata zvisina kunaka kunogona kutungamira pcl
PCL: Posterior Cruciate Ligament

1.large Rotor Wadyo Kupinda Pfungwa

Iyo yakakura trochanter yakatsanangurwa seyekunze trapezoidal by protuberance inowanikwa pane imwe chete yechikadzi mutsipa. Kunyangwe ichi chiri chidiki chidiki cheblemark

Kuongorora mabhuku azvino ekupinda echikadzi yakarondedzera yekupinda nzvimbo kubva kune apical Apex yeiyo trochantter seyakafanana neyekupedzisira trochanter nzvimbo yekupinda muThe Roteral. Posterior maviri-matatu eiyo rotor.georgadis et al. yakatsanangura iyo poindi yekupinda sindira seyakanyanya posterior side yeiyo apical superior margin yeiyo rotor.

Mufananidzo 4. Intraoperative maonero uye anotevera maonero ehudyu airatidza iyo yakakodzera yekupinda nzvimbo yeiyo famentury intramoutular '* ' Inoratidza iyo Intramealy Nail Nail yekupinda Pfungwa.

Zvidzidzo zvichangobva kuitika mumabhuku zvakaratidza kuti Apex yeiyo trochantter ndiyo yekutanga nzvimbo yekuwana mutsara wekutora, uye izvo zvakarongeka zvakakonzerwa nekupinda zvinopfuura 2 mm gare gare kune yakakura trochantter. Iyi fundo yakasimbisawo kuti imwe nzvimbo yekupinda Posterior inotungamira ku distal yekudzikama, nepo yepakati yekupinda nzvimbo inogona kukonzera iyo distal block kuti isunungurwe posteriorly. Mukupesana, kumwe kwekudzidza kwakaratidza kuti multratanticem frour fracts, chiitiko cheMukati cheMukati Chakanyanya Kukwira Nepinongedzo kune iyo Interior Side Per Interior People iyo yaive pedyo neyepiniti yaive pedyo neyekupedzisira uye posterior mativi.

Iyo Yakakura TrochantEric Apex Pinning Point inowanzoshandiswa mune vanorwara vane hunyanzvi, uye maitiro aya haishandisirwe zvakanyanya uye nenjodzi yepazasi pane iyo pyriform fosssa pinning point point.

Zvinetso: Intraoperative matambudziko ezvekumisikidza echikadzi intramoutulary neakakura nzira yeTrochanttic nzira yakakurukurwa mumabhuku akati wandei. Chimwe cheizvi, kazhinji zvine chekuita nehunyanzvi hwekuvhiringidza, hunotsamwiswa. Muchivharo chembere fral fralures, nzvimbo yekupinda iri kuwanda uye anterior kune yakakura trochanter inokwanisika kuti inokonzeresa kupwanywa pane iyo yekupinda pfambi padyo nepakati peidi.

Chimwezve chinongedzo chakakodzera chinokonzerwa nekukuvara kwakapfava, kunyanya kumapazi ezvemukati mezvemukati mechikadzi Uye zvakare, chiitiko cheIschemic necrosis yemusoro neApex yeiyo yakakura trochanter sezvo iyo yekupinda iyo pfungwa inofungidzirwa kuve yakaderera, nezvidzidzo ichizivisa yakaderera se 0.3%.

Kufunga nezvenguva yekuwedzera uye kuwanda kwehuwandu, iyo nguva yekubatira yaive makumi mapfumbamwe nemashanu emaminitsi ekupinda neyekupinda kweGreat poindi.

PROVELESISE PROGNOSICEI CERISE PECTOR PAMUSORO PENYAYA DZESVONDO DZINOGONESESA MUNYAYA DZESVONDO DZESVONDO DZESVONDO DZESVONDO DZESVONDO DZESVONDO DZESVONDO DZESVONDO DZINOGARA PAMUSORO. Kunyangwe iyo huru trochanttic yekuwana nzvimbo inowanzobatanidzwa neisina kunyoroveswa tissue stisued ichirovera nekuda kwenzvimbo yayo, inogona kuramba ichikuvadzwa kuboka reAbductor mhasuru, sezvakaratidzwa naErgiş et al. Vakawana kuti simba rega simba uye hip Abductor simba rakadzikira mumarwere neakakura trochantEric yekupinda Peg achienzanisirwa nehutano hutano. Uye zvakare, kudzidza kwavo kwakaratidza kuderera kwakakosha musimba rehudyu vabati, vanofamba-famba uye vemukati / vekunze / vekunze vanotenderera vachienzaniswa neasina-isiriyo.

2. Pearly Fossa Kupinda Pfungwa

Fossa yeiyo pyriform mhasuru yakakosha Anatomick Landmark inoonekwa seimwe yeiyo nzvimbo yekupinda yechikadzi yeParacantsis Zerekedza kuti fossa yeiyo pyriformis mhasuru yakanga isina kana '' Peari 'yakaumbwa kana pyriform muswe wekubatanidza muswe. Iyo mhasuru inonamira kunzvimbo diki iri padiki yeTrochanter, nepo pyriform fossa ndeye kushungurudzika pane yakakura trochantter uye iri kubatanidzwa kweiyo Franstor Carpi radialis brevis Vanyori vakagumisa kuti iyo pyriform tsandanyama uye iyo pyriform fosses masangano maviri akasiyana uye ayo anonzi Pyriform Fosssa anofanira kutaurwa se 'Rotor ' kana chifananidzo Vakataura kuti mushure mekufunda iyo cis-chikadzi yavakakurudzira izwi rekutanga 'Rotor FOSSA Kunyangwe iwo mativi ezvidzidzo izvi izvi ari kuratidzwa zvakanyanya, kuti adzivise kurondedzerwa uye nekudzivirira kuvhiringidzwa neiyo huru trochantistic yekupinda pfungwa, isu tichiri kureva kune iyi yekupinda pfungwa sePyriform Fosssa yekupinda.

Zvidzidzo zvakati wandei mumabhuku azvino anorondedzera nenzira kwayo chaiyo yekupinda pfungwa yeiyo pearly fossa yeIntramedullary femori zvipumbidzo. Tsanangura iyo Pearly Fossa yekupinda nzvimbo senzvimbo yekubatanidzwa kweiyo Extensor carpi radialis brevis mumutsipa wechikadzi (Fig. 5). Vanyori vacho vakasimbisawo kuti nzvimbo yekupinda yakanyanya kumberi kana iri kure kwazvo inogona kuwedzera njodzi yemutsipa wechikadzi

Mufananidzo 5. Intraoperative Frontoalisteral maonero eiyo hip inoratidza iyo yakakodzera yekupinda pfungwa yePyriford Iyo '* ' inoratidza iyo intramealy nail kutanga pfungwa.

Harper et al. Rakaburitswa chidzidzo chemapoka gumi nemana ezvemapoka emunhu wecadaver. Ivo vakagumisa kuti pfungwa yekupinda yePyriform Paramedian intramedullary Mune imwezve kudzidza kweCadaveic, vakawona iyo yakakodzera yekupinda nzvimbo yechikadzi intramedudullary mumugwagwa wepamhepo weiyo huru trochanter pamusoro pePyriformis Tendon. Uyezve, muCadiveric kudzidza naLabronici et Al. Fossa yeiyo pyriform tsandanyama yakarondedzerwa sedunhu rine-peari dunhu rakabatana neCentral Axis yeiyo forramedullary cavity mulonal ndege.

Iyo pyriform Foss Access Pfungwa ine zvimwe zvakashata zvakashata nekuti ndezvehunyanzvi zvakanyanya kuoma kana uchiwedzera kuenzaniswa neakakura trochanter yekuwana nzvimbo, kunyanya mune varwere vanonamira. Uye zvakare, iyo yakakwana yekupinda saiti yePear-yakaumbwa fossa yetso yekupinda nzvimbo inzvimbo yakatetepa, ichiita kuti ienderane nekumunyoro. Semuenzaniso, anonyanya kutangira kutanga pane mutsipa wechikadzi anozoguma nekushushikana kwakanyanya uye kuwedzera njodzi yemanyokisheni yekuputika, kunyanya kana poindi yekutanga inopfuura 6 mm anterior kune fossa. Mukuwedzera, morphologic musiyano unogona kukanganisa nzvimbo yekupinda.

Zvinotaurwa: Nekuenzanisa 38 Great TrochantEric Kupinda Sites ne 53 Pearly Fossa Kupinda Sites yeBoss Intramedullary Group Izvi zvakawanikwa zvakasimbiswa naBhatti et al. Kana uchienzanisa iyo 2 sindano yekupinda mapoinzi.

Pamusoro pekukuvara-kwehunyoro hwekukuvara, pakanga paine njodzi yakanyanya kupfava Dora et al. Yakaongororwa Vakawana kuti kunyangwe iyo pyriformis fossa yaive geometrically yakajeka, yakakonzera kukuvara kwakanyanya kune iyo vascular yekupa kumusoro weshiri uye kutenderera kwemasumbu uye tendon. Izvi zvakawanikwa zvakagadzirwazve neCadaveriki zvidzidzo naAksari moin et al. Uyo akafananidzawo maviri ekupinda mapoinzi. Vacherechedza kuti kugadziriswa kwemukati kwechipikiri kutanga paPyriform Muswe kwaive zvakanyanya kukwanisa kukuvadza mahukadzi uye ekunze ratators. Mukuwedzera, kukuvadzwa kune iyo medial rotator femori artery yakawanikwa mune zvese zviitiko (tafura 2).

Tafura 2
mutsauko	Pyriform fosssa yekupinda nzvimbo (n = 5)	Yakakura rotor yekudyisa point (n = 5)
zvinyoro nyoro
Gluteus Medus Muswe (Anatomy)	5	1
Glutes Medius Tendon	0	4
Tendon kukuvara
Gluteus minimum Simpus (Anatomy)	3	0
Pyriformis tsandanyama (pamusoro pepamusoro pemuzongo)	3	3
Obtiratortertert of of of of (anatomy)	1	0
Latissimus Dorsi Muscle (Anatomy)	3	0
Mitsipa yeropa uye majoini capsules
MFCA yakadzika matavi	4	0
MFCA yakadzika bazi	4	0
Articular Capsule (of Joint Yakadai sebvi muAnatomy)	1	0
MFCA: Medial Dzekuenderera Femorel artery.

Nguva pfupi yadarika, Bharti et al. Akafunda njodzi yekunyanyisa yemukana wechigadzirwa kuimba yepamusoro yekupinda

Tafura 3
complication	Piriformis Sinus Shoni Point	Great Trochantter Kuisa Pfungwa
Kukanganisa	6.7	3.3
Malunion	20	13.3
Kunonoka Kuporesa	20	13.3
LIMITED HIP MOTION	20	33.3
Kushoma ibvi kufamba	6.7	6.7
LimB Kureba Kusiririsa	13.3	20
Iyo muswe cap inodhinda pamusoro pepfupi cortex	13.3	20
Intraoperative femori mutsipa kupwanya	10	0
Great Trochanter Fracture	0	3.4
Chikadzi musoro necrosis	6.7	0

Retrograde femorel intramedullary mbiri

Kufunga nezve yakakodzera yekupinda nzvimbo yekudzoreredza echikadzi Nguva pfupi yadarika, kwave nekuwedzera kuwedzera kwetsvina echikadzi Chikamu chimwe chete muzvitatu chechikadzi tsvimbo. Mukuwedzera, ufakazi hwechangobva kuitika hunoratidza kuti izvi zvipikiri zvakareruka zvakaringana, proximal kukwezva uye bisccia et al. Mukurapa kweiyo distal imwe-yechitatu yechikadzi tsvina inokona ichishandisa kuvhara uye kusatarisa retrograde intramedullary zvipikiri. Saka, kushandiswa kwekudzokorora chikara kwemukati kwakakurumbira uye kugamuchirwa zvakanyanya.

Rondedzero dzakawanda dzekupindira kwepakuvenji nzvimbo yekudzokorora echikadzi intramoutulary inogona kuwanikwa mumabhuku. Zvizhinji zvezvidzidzo zvinozivisa iyo yakakodzera yekupinda nzvimbo yeiyo Retrograde femory chipikiri se1,2 anterior kune imwe yechikadzi yakatanga yeiyo posterior crucate ligrament

cm (mumutsara neyekupedzisira cavity) uye pakati peiyo Intercondylar Fossa (Mufananidzo 6).

Mufananidzo 6. Intraoperative ertsthils uye yakazotevera maonero ebvi rinoratidza iyo yakakodzera yekupinda nzvimbo yekudzoreredza femeral '* ' zvinoratidza chipinganidzo chakapindurana kutanga.

Kunyangwe pasina chiratidzo chakazara cheRetrograde echikadzi intramedullary zvipuka, zvakawanda zvehama zviratidzo zvakatotsanangurwa. Izvi zvinosanganisira varwere vePolytrau Zvizhinji zvezviratidzo izvi zvine hukama nekureruka kwemurwere chinzvimbo uye kudzivirira kwemaronda mazhinji ekuvhiya kwepedyo.

Kune rimwe divi, kupokana zvachose kune vanodzora echikadzi pamhepo kunosanganisira kuvharirwa kwekutambanudza kwekutambanudza kwenzira neyekuchengetwa uye yakavhurika mabhureki eiyo femur femur. Kukanganiswa kwekanganani kunowanikwa mukati me5 cm yeMusiniki Trachent

Zvinetso: Zvakawanda zvinongedzo zvechikadzi chevakadzi chinoenderana nekubata zvisina kufanira, kunyanya kusaiswa zvisiri izvo kwenzvimbo yekupinda. Mundege yeSagittal, imwe anterior yekupinda yekupinda inoguma nekumashure kwekushandura, kukuvara kwekunyepedzera, uye pamwe chipikiri chipikiri pane patella kana ibvi rikashandurwa. Kune rimwe divi, kana nzvimbo yekupinda isina kujairika munzira yepashure, izvi zvinogona kuguma nengozi yakanyanya yekukuvara kune iyo yepashure yekudzvinyirira ligament yekuvapo

Hutchinson et al. yakatsanangurwa conflications yakabatana neisina kukodzera ndege yekuisa mapepa ekupinda mapoinzi. Vakaona kuti panyama yepamusoro yekupinda pfungwa yakakonzera kushandurwa kwepashure neyepashure peprocesteral bracture. Zvakataurwa kuti kusarudza medu kutanga nzvimbo yaive 2 cm kana kudarika iyo medial axis yakakonzerwa neyakagadziriswa nekuda kweiyo poster isthinmi inokonzerwa nekukasira mukudzikiswa kwepashure.

Zvimwe zvinetso zvakabatana neRetrograde echikadzi kutevedza zvipikiri zvinosanganisira kupfugama kurwadziwa, kuomarara, hetroptopic ibvi kujekesa, uye intra-leticular ibvi remahara emahara muviri.

Mugumo

Kunyangwe hazvo mamiriro ega ega eltrameduutal Paunenge uchiita intrameduutery yemukati yeiyo femur, kuwana iyo chaiyo yekupinda nzvimbo yemhando yechipikiri inoshandiswa kuti gadziriswe inodiwa kuti uwane mugumo unobudirira. Kuziva kwemunharaunda anatomy uye kufungidzira kuita kuchabatsira kuti chiremba aite maitiro ehunyanzvi akakwana apa achideredza njodzi yemanzwiro ekubatana. Pamusoro pezvo, muIntramealy Nailing Maitiro, kuchengetedza kuderedzwa kwechikamu chakajeka mukudzivirira kushaya simba uye kuonda kana kusaziva kwemapundu.