Femoral Intramedullary Nailing - Maitiro Ekusarudza Iyo Yakanakisa Insertion Poindi?

Nhanganyaya

Magadzirirwo ekutyoka kwechikadzi kurapwa anogona kuteverwa kumashure kuma1940s apo Kuntscher akaunza yakavharwa intramedullary nailing technique. Kushandiswa kwezvipikiri zve intramedullary (IMNs) mukuputsika kwechikadzi kwave kuve chiyero chekutarisira mumakumi mashoma emakore apfuura, uye ikozvino kuvandudzwa mu intramedullary nailing uye kufambira mberi kwemaitiro ekuvhiya kwakabvumira kuwedzera kukuru kwekushandiswa kwe intramedullary nailing yefemur.

Conservative kurapwa kwechikadzi hunde kuputsika kunoshandiswa chete mune vashoma chaizvo nhamba yevarwere vane contraindications anokosha kuti yokutindivadza uye kuvhiyiwa, uye chikuru kurapa anoramba kuvhiya fixation. Nezve kurapwa kwekuvhiya kwezvimedu izvi, pane akati wandei sarudzo dziripo, dzinosanganisira intramedullary nailing, plate screw fixation, uye kunze kwekugadzirisa. Zvichienzaniswa nedzimwe sarudzo dzekuvhiya, intramedullary nailing ndiyo modality ine yakaderera yekukanganisika mwero uye yepamusoro yekutyoka kupora mwero, uye iri kuwedzera kushandiswa zvakanyanya mukurapa kwekudzidzira.

Kunzwisisa kwakanaka kweanatomy yeproximal femur, kugovera ropa kumusoro wemukadzi uye anatomy yemhasuru dzehudyu inogona kuwedzera zvakanyanya kubudirira kweiyo intramedullary nailing yekutyoka kwevakadzi. Kusiyana neizvi, kusarudzwa kwenzvimbo yekupinda kunoenderana nezvinhu zvakawanda, kusanganisira intramedullary nail design, fracture site, fracture comminution, uye murwere zvikonzero (semuenzaniso, polytrauma, pamuviri, uye kufutisa). Pasinei nenzvimbo yekupinda yakasarudzwa, kuwana nzvimbo yekupinda yakakodzera kwakakosha kuti uchengetedze kuderedzwa kwakakwana panguva yekuisa intramedullary chipikiri uchidzikisa njodzi yematambudziko.

Femoral Anatomy

1.Kupa ropa kumusoro wemukadzi

Musoro wemukadzi unogamuchira vascular supply kubva ku3 arteri huru. The lateral rotator femoral artery (ine 3-4 matavi), iyo obturator artery, iyo inopa denderedzwa ligament, uye medial rotator femoral artery (Fig. 1), iyo inopawo chikepe chinokwira chinokwira icho anastomoses ne lateral rotator femoral artery uye inopa nzvimbo huru yetrochanteric.

2.Anatomy Yema Hip Muscles

Paunenge uchiita intramedullary nailing ye femur, kunzwisisa kwakanaka kwemisungo munzvimbo yakapoteredza rotor kunokosha kudzivirira kukuvara kusingakoshi. Iyo gluteus medius muscle inotangira kubva kune ilium uye inoguma pane lateral aspect of the great trochanter, nepo gluteus minimus muscle inobvawo kubva kune ilium uye inopfuura nepamusoro pechikamu chemashure chekubatana kwehudyu kusvika kumagumo ekupedzisira kweiyo trochanter yakakura (Mifananidzo 2 & 3). Zvose izvi zvinyama zvinoshanda se adductors zvehudyu uye mukati rotator yehudyu. Naizvozvo, kukuvadzwa kwemhasuru idzi panguva yekuiswa kweparacentric femoral intramedullary chipikiri kunozokonzera kushaya simba kweadductor uye Trendelenburg gait, iyo ine mhedzisiro yakaipa pakupora kwemurwere uye mhedzisiro.

Mufananidzo 2. Anatomy yemhasuru dzakatenderedza hudyu

Mufananidzo 3. proximal femoral muscle attachment area

Parallel Femoral Intramedullary Nail

Tsvakurudzo dzinoverengeka dzichangoburwa dzakaongorora iyo yakakwana yekupinda nzvimbo yeparacrine femoral nail. Nail yekupinda poindi sarudzo dzinosanganisira yakakura trochanter uye pyriform fossa, imwe neimwe iine zviratidzo zvayo uye zvine chekuita nezvinetso (Tafura 1).

Tafura 1.Kutanga pfungwa uye njodzi dzinogona kuitika dzeparacrine uye retrograde femoral nailing
variant	parallel intramedullary chipikiri		retrograde intramedullary nail
	rotor	pyriform fossa (anatomy)
korona ndege	Vertex yetrochanter yakakura uye inonongedza nechepakati kune medullary cavity	kusangana kweiyo trochanter yakakura uye femoral mutsipa	pakati pe intercondylar fossa (anatomy)
sagittal ndege (math.)	Mutsetse pakati pepakati pehombe trochanter nepakati pemwongo wefemur	pyriform fossa (anatomy)	PCL 1.2 cm anterior kune femoral pokutangira, inongedza ku medullary cavity.
exposures	Hip abductor boka rekumisa nzvimbo kukuvara	Kukanganiswa kweropa rekupa musoro wemukadzi uye muhudyu wekunze rotator tsandanyama	Kubata zvisina kunaka kunogona kutungamirira kuPCL
PCL: posterior cruciate ligament

1.Large rotor tsono yekupinda nzvimbo

Iyo trochanter yakakura yakatsanangurwa seyekunze trapezoidal bony protuberance iri pamucheto wepamusoro wemutsipa wechikadzi, iyo yepamusoro inopa kusungirirwa kune lateral gluteus medius uye anterior gluteus minimus muscles (Mifananidzo 2 uye 3). Kunyangwe ichi chiri chiratidziro chidiki chebhonzo, kuisa nzvimbo chaiyo yekutangira paunenge uchiita IMN yemukadzi ungave mutsauko pakati pekuwana zvinogutsa kana kushata kana uchibata nekutyoka kwedzinde remukadzi.

Tichiongorora zvinyorwa zvazvino zvetsanangudzo dzechikadzi yekupinda, takawana kushaikwa kweanotsanangurwa zvakajeka anatomical landmark yeiyo femoral rotor IMN yekupinda.Bharti et al. yakatsanangura nzvimbo yekupinda kubva kune apical apex ye trochanter yakakura seyepakati kune medullary cavity mu orthostatic position, uye seyo iri pakati peiyo trochanter yakakura maererano nechepakati yefemoral medullary cavity in lateral position (Fig. 4), uye imwe tsanangudzo yenzvimbo huru yekupinda trochanter pane lateral hip maonero ari pakati pe-roerird anterior or thenterior. zvikamu zviviri muzvitatu zve rotor.Georgiadis et al. yakatsanangura pfungwa yekupinda tsono seyakanyanya kuseri kwerutivi rweapical superior margin ye rotor.

MUFANANIDZO 4. Intraoperative orthostatic uye lateral maonero ehudyu anoratidza nzvimbo yakakodzera yekupinda ye femoral paramedian intramedullary nailing ye trochanter yakakura. '*' inoratidza intramedullary chipikiri yekupinda.

Zvidzidzo zvenguva ichangopfuura mumabhuku zvakaratidza kuti iyo yepamusoro ye trochanter yakakura ndiyo yakanaka yekutanga nzvimbo yekuwana mutsara wakakwana wesimba, uye kuti kurongeka kwakashata nekuda kwekuremara kweinversion kunowanzoitika apo pfungwa yekupinda inoshandurwa kupfuura 2 mm lateral kusvika kune trochanter yakakura. Ichi chidzidzo chakasimbisawo kuti imwe nzvimbo yekumashure yekupinda inotungamira kune distal mberi kusimuka, nepo yepakati pekupinda poindi inogona kuita kuti distal fracture block ibviswe kumashure. Kusiyana neizvi, imwe ongororo yakaratidza kuti mu intertrochanteric femur fractures, chiitiko che intramedullary nail impingement chaive chakanyanya kukwirira nepinning point yaive lateral kune anterior side kupfuura nepinning point yaive pedyo nepakati uye kumashure mativi.

Iyo yakakura trochanteric apex pinning point inowanzoshandiswa muvarwere vakafuta, uye maitiro aya haadi zvehunyanzvi, achipa nguva shoma yekushanda uye nenjodzi yakaderera yematambudziko pane pyriform fossa pinning point.

ZVINOGONESA: Intraoperative uye postoperative matambudziko echikadzi intramedullary nailing ine yakakura trochanteric approach point yakakurukurwa mune akati wandei mabhuku. Imwe yeiyi, inowanzoenderana nehunyanzvi hwekurovera zvipikiri, ndeyekutyoka kwemishonga. Mu intertrochanteric femoral fractures, nzvimbo yekupinda iri lateral uye anterior kune yakakura trochanter inowanzoita kuti pave nekuputsika kwepakati pane nzvimbo yekupinda iri pedyo nechepakati.

Imwe dambudziko rakakodzera rinokonzerwa nekukuvadzwa kwezvinyoro-zvinyoro, kunyanya kumatavi emukati rotator femoral artery uye misumbu ye-adductor, asi kukuvadzwa uku kuduku kunofananidzwa ne pyriform fossa entry nail. Mukuwedzera, chiitiko che ischemic necrosis yemusoro wevakadzi nepamusoro peiyo trochanter yakakura sezvo nzvimbo yekupinda inofungidzirwa kuti yakanyanya kuderera, uye zvidzidzo zvinozvitaura zvakaderera se0.3%.

Tichifunga nezve intraoperative nguva uye fluoroscopic exposure, iyo inorehwa nguva yekushanda yaive 90.7 maminetsi eiyo yakakura trochanteric yekupinda poindi kana ichienzaniswa ne112.7 maminetsi eiyo pear-shaped fossa yekupinda boka, nepo fluoroscopic nguva yaive 5.88 masekonzi kune yakakura trochanteric yekupinda poindi boka uye 10. pear-shaped fossa entry point.

Kufungidzira kwevarwere kwaivawo chinhu chinokosha pakusarudza pamusoro peiyo intramedullary nail entry point, sekutanga kushanda kwekugadzirisa (sekuongororwa nechigaro-chigaro chekuongorora uye nguva yekusimudza muedzo) yakanga iri nani zvikuru kune varwere pamwedzi 6 mushure mekushanda kune imwe nzvimbo yekupinda trochanteric kana ichienzaniswa nepyriform fossa yekupinda mbambo, asi mutsauko uyu wakanga usina kukosha mushure mekushanda kwe12. Kunyange zvazvo nzvimbo huru yekuwana trochanteric inowanzobatanidzwa nekubviswa kwenyama shoma shoma nekuda kwenzvimbo yayo, inogona kutungamirira kukukuvara kune boka remuscle abductor, sezvakaratidzwa naErgiş et al. Vakaona kuti simba rekuita uye hip abductor simba rakadzikira muvarwere vane hombe yekupinda trochanteric kana ichienzaniswa nekutonga kwakanaka. Mukuwedzera, chidzidzo chavo chakarondedzera kuderera kukuru kwesimba rezvidyu abductors, flexors uye mukati / kunze rotators zvichienzaniswa nerutivi rusina kushandiswa.

2. Pearly fossa yekupinda nzvimbo

Iyo fossa yemhasuru yepyriformis inzvimbo yakakosha yeanatomical inozivikanwa seimwe yenzvimbo dzekupinda dzeparacentesis femoral intramedullary chipikiri.Muchidzidzo chavo cheautopsy cadaveric, Lakhwani et al. akacherechedza kuti fossa yepiriformis muscle yakanga isiri 'pear' yakaumbwa kana pyriformis muscle attachment. Iyo mhasuru inonamatira kune diki diki pamucheto weiyo trochanter yakakura, nepo pyriform fossa iri kuora mwoyo padivi repakati peiyo trochanter yakakura uye inonamatira ye extensor carpi radialis brevis muscle. Vanyori vakagumisa kuti pyriform muscle uye pyriform fossa zvinhu zviviri zvakasiyana uye iyo inonzi pyriform fossa inofanira kunzi 'rotor' kana 'occlusal' fossa yekujekesa uye kururamisa kweanatomical. Vakataura kuti mushure mekudzidza cis-femoral Vakakurudzira kuti izwi rekutanga 'rotor fossa' ridzokororwe muzvinyorwa panzvimbo ye 'pyriform fossa' mushure mekudzidza mazwi echirevo cheparafemoral entry point. Kunyangwe mapoinzi ezvidzidzo zviviri izvi achitariswa zvakanyanya, kuitira nyore kutsanangura uye kudzivirira kuvhiringidzika nenzvimbo huru yekupinda yetrochanteric, isu ticharamba tichitaura kune ino yekupinda seye pyriform fossa yekupinda.

Zvidzidzo zvakawanda muzvinyorwa zvemazuva ano zvinonyatsotsanangura nzvimbo chaiyo yekupinda pearly fossa ye intramedullary femoral nails.Georgiadis et al. tsanangura pearly fossa yekupinda nzvimbo senzvimbo yekunamatira ye extensor carpi radialis brevis muscle mukuora mwoyo kumucheto wemutsipa wemukadzi (Fig. 5). Vanyori vakasimbisawo kuti nzvimbo yekupinda iyo yakanyanyisa mberi kana kure kure mukati inogona kuwedzera njodzi yekuputsika kwemutsipa wevakadzi, uye kana nzvimbo yekupinda iri kure zvakanyanya kumashure, panogona kunge kune ngozi yakawanda ye ischemic necrosis, iyo yakakwirira muvarwere vechidiki.

Mufananidzo 5. Intraoperative frontolateral maonero ehudyu inoratidza yakakodzera yekupinda nzvimbo yepyriform fossa retrograde femoral intramedullary nail. Iyo '*' inoratidza panotangira chipikiri.

Harper et al. yakabudisa chidzidzo chemapoka gumi nemana evanhukadzi cadaveric femurs muna 1987 umo vakaongorora nzvimbo yepini ye intramedullary guide uye nzvimbo yekubuda ye intramedullary mbambo yakaunzwa disally uye proximally mune retrograde fashoni kubva intercondylar notch yefemur. Vakagumisa kuti pfungwa yekupinda ye pyriformis paramedian intramedullary nail yakanga iri pamusangano we trochanter yakakura nemutsipa wechikadzi, zvishoma zvishoma kune pyriformis occulta.Nzvimbo yekuisa yakasimbiswa zvakare naGausepohl et al. Mune imwe cadaveric chidzidzo, vakaisa nzvimbo yakakodzera yekupinda yemukadzi intramedullary mbambo pamwe nepakati pepakati peiyo trochanter yakakura pamusoro pe pyriformis tendon. Uyezve, mune cadaveric kudzidza naLabronici et al. iyo fossa ye pyriformis muscle yakatsanangurwa seye pear-shaped luminal region iyo yakabatana nechepakati axis ye femoral intramedullary cavity mu coronal plane.

Iyo pyriform fossa yekuwana nzvimbo ine zvimwe zvakaipira nekuti inyanzvi yakanyanya kunetsa kana ichienzaniswa neiyo yakakura trochanter yekuwana nzvimbo, kunyanya muvarwere vakafuta. Pamusoro pezvo, iyo yakakwana yekupinda saiti yepear-shaped fossa tsono yekupinda nzvimbo inzvimbo nhete, zvichiita kuti zvinyanye kunetsa kugarisana. Semuenzaniso, kunyanyisa kwekutanga kwekutanga pamutsipa wechikadzi kuchaita kuti kuwedzere kutenderera kushushikana uye kuwedzera njodzi yeanterior cortical kuputika, kunyanya kana nzvimbo yekutanga inopfuura 6 mm anterior kune fossa. Mukuwedzera, morphologic kusiyana kunogona kukanganisa nzvimbo yakarurama yekupinda, kunyanya kana iyo pfupi yekunze rotator yakakura kana kuti rotor iri kubuda, inotungamirira kune imwe nzvimbo yekupinda iyo yakanyanyisa uye ine ngozi yekuputsika kwemutsipa wemukadzi.

ZVINOKOSHA: Nekuenzanisa 38 yakakura yekupinda trochanteric nzvimbo ne 53 pearly fossa nzvimbo dzekupinda dzechikadzi intramedullary nailing, Ricci et al akawana kuti pearly fossa boka raive ne30% yakareba nguva yekuvhiya uye 73% yakareba fluoroscopy nguva. Izvi zvakawanikwa zvakasimbiswa naBhatti et al. kana uchienzanisa 2 tsono dzekupinda nzvimbo.

Nezvekukuvara kwezvinyoro zvinyoro, pakanga paine njodzi yakakura yekukuvara kwezvinyoro-nyoro pane pyriformis inlet kana ichienzaniswa neiyo interosseous neuromuscular pane yakakura trochanteric tsono yekupinda point. Dora et al. yakaongororwa 16 vanhu vakuru vecadaveric femurs yekukuvara kwetishu dzakapfava kune pyriformis tsandanyama uye rotor yekupinda pini. Vakaona kuti kunyange zvazvo pyriformis fossa yaiva geometrically optimal, yakakonzera kukuvadza kwakanyanya kune vascular kupa mumusoro wevakadzi uye yakakomberedza tsandanyama nematendon. Izvi zvakawanikwa zvakasimbiswazve necadaveric zvidzidzo naAnsari Moin et al. WHO yakafananidzawo mapoinzi maviri ekupinda. Vakacherekedza kuti kugadziriswa kwemukati kwembambo kunotanga pamusumbu wepyriformis kwainyanya kukuvadza vapfuri vehudyu uye vanotenderera kunze. Mukuwedzera, kukuvadzwa kwepakati rotator femoral artery yakawanikwa mumatambudziko ose (Table 2).

Tafura 2. Pfupiso yekukuvara kwetishu dzakapfava panzvimbo dzakasiyana dzekupinda tsono
variant	Pyriform fossa yekupinda nzvimbo (n=5)	Hombe rotor feed point (n=5)
zvinyoro zvinyoro
gluteus medius muscle (anatomy)	5	1
gluteus medius tendon	0	4
tendon kukuvara
gluteus minimus (anatomy)	3	0
pyriformis muscle (pamusoro pemusana)	3	3
obturator internus (anatomy)	1	0
latissimus dorsi muscle (anatomy)	3	0
Mitsipa yeropa uye majoini capsules
MFCA Mapazi Akadzika	4	0
MFCA Shallow Branch	4	0
articular capsule (yekubatana senge ibvi mune anatomy)	1	0
MFCA: medial circumflex femoral artery.

Munguva pfupi yapfuura, Bharti et al. akadzidza njodzi yekuomeserwa kwechikadzi intramedullary kuroverera pane yakakura trochanteric yekupinda poindi uye pearly fossa yekupinda uye yakawana njodzi dzakaomesesa dzakadai seyekutyoka kuporesa mwero uye akapfupisa iwo anotevera (Tafura 3).

Tafura 3. Pyriform fossa yekupinda nzvimbo uye yakakura trochanter yekupinda nzvimbo yechikadzi bone mwongo
complication	Piriformis sinus tsono point	Greater trochanter insertion point
Infect	6.7	3.3
Malunion	20	13.3
Kunonoka kupora	20	13.3
Kufamba kwehudyu shoma	20	33.3
Kufamba kwemabvi mashoma	6.7	6.7
Kusiyana kwehurefu hwemakumbo	13.3	20
Chivharo chemuswe chinobuda pamusoro pebhonzo cortex	13.3	20
Intraoperative femoral neck fracture	10	0
Kuputsika kukuru kwetrochanter	0	3.4
Femoral head necrosis	6.7	0

Retrograde femoral intramedullary nailing

Kusarudza nzvimbo yakakodzera yekupinda yekudzoreredza femoral intramedullary nailing ichabatsira kuwana kudzoreredzwa kweakaputsika kurongeka, kureba, uye kutenderera uku uchideredza articular cartilage kukuvara, anterior cruciate ligament (ACL), posterior cruciate ligament (ACL), uye nyoro kukuvara kwetishu (Table 1). Munguva pfupi yapfuura, pave nekuwedzera kufarira mukudzorera femoral intramedullary nailing nechinangwa chekuderedza matambudziko anosangana neparacromial nailing, kusanganisira kurwadziwa kwechiuno, heterotopic ossification, kushaya simba kweadductor, uye pudendal nerve palsy, iyo inoonekwa seisina simba kana ichienzaniswa nekuderedza kuderedza uye kuvhara mukati mekuputika kwechikadzi-kunyanya kugadziriswa kwechikadzi. yedzinde remukadzi. Mukuwedzera, uchapupu huchangobva kuitika hunoratidza kuti kana idzi retrograde intramedullary mbambo dzakakura zvakakodzera, proximal locking misumari inogona kunge isingadikanwi.Pakanga pasina misiyano muhutano hwekuporesa, nguva yekuporesa, kana migumisiro yemurwere-inoshumwa pakati peMeccariello et al. uye Bisaccia et al. mukurapa distal chimwe chetatu femoral stem fractures uchishandisa kukiya uye kusakiya retrograde intramedullary zvipikiri. Saka, kushandiswa kweretrograde femoral nailing kwave kwakakurumbira uye kwakagamuchirwa zvakanyanya.

Tsananguro dzakawanda dzeiyo yakakwana yekupinda nzvimbo yekudzoreredza femoral intramedullary nailing inogona kuwanikwa mumabhuku. Zvidzidzo zvizhinji zvinoratidza nzvimbo yakakodzera yekupinda ye retrograde femoral nail se 1.2 anterior kune femoral mavambo e posterior cruciate ligament.

cm (mumutsara ne medullary cavity) uye pakati pe intercondylar fossa (Mufananidzo 6).

MUFANANIDZO 6. Intraoperative orthostatic uye lateral maonero emabvi anoratidza nzvimbo yakakodzera yekupinda ye retrograde femoral intramedullary nail. '*' inoratidza panotangira chipikiri.

Kunyangwe pasina chiratidziro chakakwana chekudzoreredza femoral intramedullary nailing, akawanda ehama zviratidzo akatsanangurwa. Izvi zvinosanganisira varwere vepolytrauma, varwere vanorwara zvakanyanya, varwere vane pamuviri, bilateral femoral stem fractures, ipsilateral femoral stem uye acetabular / pelvic fractures kana femoral mutsipa fractures, uye ipsilateral femoral stem uye tibial fractures. Zvizhinji zvezviratidzo izvi zvine chekuita nekureruka kwekumira kwemurwere nekudzivirira kwemaronda ekuvhiya akawanda ari padyo.

Kune rimwe divi, zvachose contraindications kudzoreredza femoral intramedullary nailing zvinosanganisira kuvharirwa kweiyo retrograde intramedullary chiteshi neyakachengetwa implant uye yakavhurika kuputsika kweiyo distal femur. Relative contraindications ndeye fractures inowanikwa mukati me 5 cm ye trochanter shoma, kuoma kwekuwana iyo yakakwana yekupinda nzvimbo nekuda kwebvi kushanduka kwepasi pasi pe 45 degrees, hutachiona hwemabvi husati hwavapo hunogona kutungamirira kune ngozi yekupararira kune chikadzi chechikadzi, kukuvara kwakanyanya kwezvinyoro-nyoro kumativi emabvi, uye intra-articular fracture uye yakanyanya kuparara kwepole in pole disfetal.

Matambudziko: Matambudziko mazhinji ekudzoreredza femoral nailing ane chekuita nekubata zvisina kunaka, kunyanya kuiswa kwakashata kwenzvimbo yekupinda. Mundege yesagittal, imwe anterior yekupinda poindi ichaita kuti posterior fracture dudziro, articular pamusoro kukuvara, uye pamwe chipikiri kupinza patella kana ibvi richichinjika. Kune rumwe rutivi, kana nzvimbo yekupinda isina kumira zvakanaka mumashure ekutungamirira, izvi zvinogona kukonzera njodzi yakakura yekukuvara kune posterior cruciate ligament origin uye anterior displacement yenzvimbo yekuputsika.

Hutchinson et al. akatsanangura matambudziko anoenderana neasina kukodzera coronal ndege yekupinda nzvimbo. Vakaona kuti kupinda mukati kwakanyanyisa kwakaguma nekuremara kwemashure neshanduro yeposterolateral fracture, nepo yakanyanyisa lateral yakaguma nekuremara kwepakati nekushandura kwemukati.Sanders et al. yakashuma kuti kusarudza nzvimbo yepakati pekutanga iyo yaiva 2 cm kana kupfuura kubva ku-axis yepakati yakaguma nepakati pepakati cortical fracture yakanga yakasvibiswa nekuda kwemashure ekukotamisa isthmic nguva yekutyoka kunokonzera kuderera kwemashure ekuderera.

Mamwe matambudziko ane chekuita neretrograde femoral follower nailing anosanganisira kurwadziwa kwemabvi, kuoma, heterotopic knee ossification, uye intra-articular mabvi asina kuumbwa kwemuviri.

Pedzisa

Kunyangwe nzira yega yega intramedullary yekuroverera zvipikiri ine chiratidzo chinoenderana, sarudzo yekuti ndeipi intramedullary yekurovera zvipikiri yekushandisa mukurapa femoral stem fractures inowanzoenderana nezvinodiwa nachiremba. Paunenge uchiita intramedullary nailing yefemur, kuwana chaiyo yekupinda poindi yerudzi rwembambo inoshandiswa kugadzirisa inodiwa kuti ibudirire. Kuziva kwenzvimbo yeanatomy uye kuita kwekufungidzira kuchabatsira chiremba wekuvhiya kuita maitiro akaringana uku achidzikisa njodzi yekusangana nematambudziko. Uyezve, mu intramedullary nailing procedures, kuchengetedza kwekuderedza chinhu chakakosha mukudzivirira malunion uye malunion kana kusabatanidzwa kwekuputsika.