Ciddiyeynta Intramedullary Femoral - Sidee Loo Doortaa Meesha Gelida Ugu Wanaagsan?

Hordhac

Horumarinta daaweynta jabka femoral waxaa laga heli karaa 1940-yadii markii Kuntscher uu soo bandhigay farsamada ciddiyaha intramedullary ee xiran. Isticmaalka cidiyaha intramedullary (IMNs) ee jabka femoral waxay noqotay heerka daryeelka dhowrkii sano ee la soo dhaafay, iyo horumarka hadda jira ciddida intramedullary iyo horumarinta farsamooyinka qalliinka ayaa u oggolaaday koror weyn oo ku saabsan isticmaalka ciddiyaha intramedullary ee femur.

Daaweynta muxaafidka ah ee jabka asliga ah ee femoral waxaa loo isticmaalaa kaliya tiro aad u yar oo bukaanno ah oo leh caqabado muhiim ah oo suuxinta iyo qalliinka, iyo udub-dhexaadka daaweynta ayaa weli ah hagaajinta qaliinka. Marka la eego daawaynta qalliin ee jabkan, waxaa jira dhawr ikhtiyaar oo la heli karo, oo ay ku jiraan ciddida intramedullary, hagaajinta saxanka, iyo hagaajinta dibadda. Marka la barbardhigo xulashooyinka kale ee qalliinka, ciddida intramedullary waa habka leh heerka ugu hooseeya ee dhibaatada iyo heerka bogsashada jabka ugu sarreeya, waxayna noqonaysaa mid si ballaaran loo isticmaalo daaweynta bukaan-socodka.

Fahamka wanaagsan ee anatomy ee femur u dhow, bixinta dhiigga madaxa femoral iyo anatomy ee muruqyada sinta waxay si weyn u kordhin kartaa heerka guusha ciddida intramedullary ee jabka femoral. Taas bedelkeeda, doorashada barta gelitaanka waxay ku xiran tahay arrimo badan, oo ay ku jiraan naqshadeynta ciddiyaha intramedullary, goobta jabka, jabka jabka, iyo arrimaha bukaanka (tusaale, polytrauma, uurka, iyo buurnaanta). Iyada oo aan loo eegin goobta laga soo galo ee la doortay, helitaanka barta saxda ah ee gelitaanka waa lama huraan si loo ilaaliyo dhimis ku filan inta lagu jiro gelinta ciddiyaha intramedullary iyada oo la yareynayo khatarta dhibaatooyinka.

Anatomy Femoral

1.Dhiig u keena madaxa femoral

Madaxa femoral ayaa sahayda xididada xididada ka hela 3 halbowle oo waaweyn. Halbowlaha laf-dhabarka ee femoral-ka (oo leh 3-4 laamood), halbowlaha obturator, kaas oo bixiya ligament wareegsan, iyo halbowlaha femoral ee dhexdhexaadka ah (Jaantus. 1), kaas oo sidoo kale siiya weel kor u kaca oo kor u kaca kaas oo ku qulqulaya halbowlaha femoral rotator lateral iyo sahayda gobolka trochanteric weyn.

2. Anatomy ee Muruqyada Sinta

Markaad samaynayso ciddida intramedullary ee femur, faham wanaagsan oo ku saabsan muruqyada aagga ku wareegsan rotor waa lagama maarmaan si looga hortago dhaawac aan loo baahnayn. Muruqyada dhexdhexaadka ah ee gluteus waxay ka soo jeedaan ilium waxayna ku dhammaataa dhinaca dambe ee trochanter weyn, halka muruqa minimus gluteus uu sidoo kale ka soo jeedo ilium oo uu dhaafo dhinaca dambe ee sinta sinta si uu u soo afjaro dhinaca dambe ee trochanter weyn (Jaantus 2 & 3). Labadan muruq waxay u shaqeeyaan sidii kuwa isku xira bowdada iyo wareegga gudaha ee sinta. Sidaa darteed, dhaawaca muruqyadaas inta lagu jiro gelinta ciddiyaha intramedullary femoral paracentric waxay keeni doontaa daciifnimo iyo socodka Trendelenburg, taas oo saameyn xun ku leh soo kabashada bukaanka iyo natiijada.

Jaantuska 2. Anatomy ee murqaha agagaarka wadajirka sinta

Jaantuska 3. aagga ku dheggan muruqa femoral ee u dhow

Isbarbar yaacaya Cidiyaha Intramedullary Femoral Femoral

Daraasado dhowr ah oo dhowaan la sameeyay ayaa sahamiyay meesha ugu fiican ee laga galo ciddiyaha femoral paracrine. Ikhtiyaarada cidiiyaha waxaa ka mid ah trochanter-ka weyn iyo pyriform fossa, mid walbana wuxuu leeyahay calaamado u gaar ah iyo dhibaatooyinka la xiriira (Shaxda 1).

Shaxda 1.Dhibcaha bilawga ah iyo khataraha iman kara ee paracrine iyo ciddida femoral dib-u-noqoshada
kala duwanaansho	ciddiyaha intramedullary is barbar socda		dib-u-soo-noqoshada ciddiyaha intramedullary
	rotor	pyriform fossa (anatomy)
diyaarad taaj	Vertex of trochanter weyn oo si dhexdhexaad ah u tilmaamaya daloolka medullary	isku xidhka trochanter weyn iyo qoorta femoral	dhexe ee fossa intercondylar (anatomy)
diyaarad sagittal (xisaab)	Xariiqda u dhaxaysa bartamaha trochanter-ka weyn iyo bartamaha godka dhuuxa ee femur	pyriform fossa (anatomy)	PCL 1.2 cm xaga hore ee barta bilawga femoral, oo tilmaamaysa daloolka medullary.
soo bandhigid	Kooxda afduubayaasha miskaha ee joogsiga dhaawaca	Naafo ku ah bixinta dhiigga madaxa femoral iyo muruqa wareegga dibadda ee sinta	Maaraynta khaldan waxay u horseedi kartaa PCL
PCL: ligament cruciate dambe

1.Irbada rotor weyn ee gelitaanka

Trochanter-ka weyn ayaa lagu tilmaamay inuu yahay laf-dhabarta lafaha trapezoidal-ka baxsan ee ku yaala dhinaca dambe ee qoorta femoral, oogada kaas oo bixiya ku dhejinta gluteus medius lateral iyo gluteus minimus minimus (Jaantus 2 iyo 3). Inkasta oo tani ay tahay calaamad yar oo lafaha lafaha ah, dejinta meesha saxda ah ee bilawga ah marka la samaynayo IMN femoral waxay noqon kartaa farqiga u dhexeeya helitaanka natiijo lagu qanco ama liidato marka wax laga qabanayo jabka stem femoral.

Dib u eegista suugaanta hadda ee sharaxaadaha dhibcaha gelitaanka femoral, waxaan helnay la'aanta calaamad si cad loo qeexay anatomical ee barta gelitaanka femoral rotor IMN.Bharti et al. ayaa ku tilmaamay barta laga soo galo cirifka sare ee trochanter weyn sida mid dhexdhexaad ah oo ku wajahan godka medullary ee booska orthostatic, iyo inuu yahay xarunta dhexe ee trochanter weyn oo la socota xarunta dhexe ee medullary medullary ee booska lateral (Jaantus. 4), iyo sharaxaad kale oo ka mid ah trochanter weyn ee trochanter ee dhexda u dhexeeya aragtida rotor-ka ee u dhexeeya aragtida rotor-rd. iyo gadaal saddex-meelood laba meelood ee rotor.Georgiadis et al. ku tilmaamay barta irbadda laga galo inay tahay dhinaca dambe ee cirifka sare ee wareegga.

Jaantuska 4. Aragtida lafaha qalliinka ee lafaha iyo lateral ee sinta waxay muujineysaa meesha ugu habboon ee laga soo galo femoral paramedian intramedullary ciddida trochanter weyn. '*' waxay tusinaysaa barta ciddiyaha intramedullary.

Daraasadihii ugu dambeeyay ee suugaanta ayaa muujiyay in meesha ugu sarreysa ee trochanter-ka weyn ay tahay meesha ugu habboon ee lagu heli karo xariiqda ugu fiican ee xoogga, iyo in isku-dhafka liidata ay sabab u tahay qalloocinta leexinta inta badan waxay dhacdaa marka barta laga soo galo la beddelo in ka badan 2 mm dhinaca trochanter weyn. Daraasadani waxay sidoo kale ku nuuxnuuxsatay in barta dambe ee laga soo galo ay horseeddo barakicin hore, halka barta dhexdhexaadka ah ay sababi karto in jeexjeexyada fog ay u barokacaan gadaal. Taas bedelkeeda, daraasad kale ayaa muujisay in jabka femur intertrochanteric, dhacdooyinka ciddiyaha intramedullary ay si aad ah u sarreeyaan iyada oo la raacayo dhibcaha cirifka ah ee dhinaca hore ee dhinaca hore marka loo eego barta dhejiska ee u dhow dhinacyada dhexe iyo dambe.

Meesha ugu weyn ee trochanteric apex pinning point waxaa caadi ahaan loo isticmaalaa bukaanada buuran, habkanina farsamo ahaan aad buu u baahan yahay, oo bixisa waqti yar oo qalliin ah iyo khatar hoose oo dhibaatooyin ah marka loo eego barta pyriform fossa.

DHIBAATOOYINKA: Dhibaatooyinka qalliinka iyo qalliinka ka dib ee ciddida intramedullary femoral oo leh barta habka trochanteric weyn ayaa looga hadlay dhowr daabacaad. Mid ka mid ah kuwan, oo inta badan la xidhiidha farsamada ciddiyaha, ayaa ah jabka caafimaad ahaan. Jajabka femoral intertrochanteric, barta laga soo galo ee ku taal lateral iyo hore ee trochanter weyn waxay u badan tahay inay keento jajab dhexdhexaad ah marka loo eego barta gelitaanka ee u dhow dhinaca dhexe.

Dhibaato kale oo la xiriirta ayaa sabab u ah dhaawacyada jilicsan ee jilicsan, gaar ahaan laamaha lafdhabarta dhexdhexaadka ah ee xididdada femoral iyo murqaha murqaha, laakiin dhaawacyadani waa kuwo aan caadi ahayn marka la barbardhigo ciddiyaha gelitaanka pyriform fossa. Intaa waxaa dheer, dhacdooyinka ischaemic necrosis ee madaxa femoral oo leh cirifka weyn ee trochanter sida barta gelitaanka ayaa loo maleynayaa inay aad u hooseyso, iyada oo daraasaduhu ay soo sheegaan sida ugu hooseeya 0.3%.

Iyadoo la tixgelinayo wakhtiga qalliinka iyo soo-gaadhista fluoroscopic, celceliska wakhtiga qalliinka wuxuu ahaa 90.7 daqiiqo barta gelitaanka weyn ee trochanteric marka la barbar dhigo 112.7 daqiiqo ee kooxda gelitaanka fossa-qaabeeya, halka wakhtiga fluoroscopic uu ahaa 5.88 ilbiriqsi ee kooxda gelitaanka trochanteric weyn iyo 10.08 ilbiriqsi ee gelitaanka koox-qaabeeya

Saadaasha bukaanku waxay sidoo kale ahayd arrin muhiim ah marka la go'aaminayo barta gelitaanka ciddiyaha intramedullary, sida soo kabashada hore ee shaqeynta (sida lagu qiimeeyay imtixaanka kursi-kursiga iyo imtixaanka sare ee waqtiga) ayaa si aad ah ugu fiicnaaday bukaanada 6 bilood ka dib marka la barbardhigo barta gelitaanka trochanteric ee weyn marka la barbardhigo ciddida pyriform fossa gelitaanka, laakiin farqigaani ma ahayn mid muhiim ah bilaha 12. Inkasta oo barta gelitaanka trochanteric ee weyn ay caadi ahaan la xiriirto nudaha jilicsan ee jilicsan sababtoo ah meesha ay ku taal, waxay weli u horseedi kartaa dhaawaca kooxda muruqa afduubka, sida lagu muujiyay Ergiş et al. Waxay ogaadeen in dheellitirka firfircoon iyo xoogga afduubka miskaha ay hoos u dhaceen bukaanada leh galka trochanteric weyn marka loo eego kontaroolada caafimaadka leh. Intaa waxaa dheer, daraasaddoodu waxay soo warisay hoos u dhac weyn oo ku yimid xoogga afduubayaasha miskaha, dabacsanaan iyo rotors gudaha / dibadda ah marka loo eego dhinaca aan shaqaynayn.

2. Meesha laga soo galo Pearly fossa

Fossa ee muruqa pyriformis waa calaamad muhiim ah oo anatomical ah oo lagu aqoonsaday mid ka mid ah meelaha laga soo galo ee cidiraha femoral femoral intramedullary paracentesis. wuxuu xusay in fossa ee muruqa pyriformis aanu ahayn 'pear' qaabaysan ama muruqa pyriformis midna. Muruqa ayaa ku dheggan meel yar oo ku taal cidhifka trochanter-ka weyn, halka pyriform fossa uu yahay niyad-jab dhinaca dhexdhexaadka ah ee trochanter weyn waana isku-xirnaanta muruqa carpi radialis brevis muruqa. Qorayaashu waxay soo gabagabeeyeen in muruqa pyriform-ka iyo pyriform fossa ay yihiin laba qaybood oo kala duwan iyo in waxa loogu yeero pyriform fossa waa in loo tixraacaa sida 'rotor' ama 'occlusal' fossa si loo caddeeyo iyo saxnaanta anatomical. Waxay soo jeediyeen in ka dib markii ay daraasad ku sameeyeen cis-femoral Waxay soo jeediyeen in ereyga asalka ah ee 'rotor fossa' dib loogu soo celiyo suugaanta halkii laga heli lahaa 'pyriform fossa' ka dib markii ay baranayaan ereyada gelitaanka parafemoral. Inkasta oo qodobbada labadan daraasadood ay yihiin kuwo aad loo tixgeliyo, si ay u fududaato sharraxaadda iyo si looga hortago jaahwareerka barta gelitaanka weyn ee trochanteric, waxaan weli tixraaci doonaa barta gelitaanka sida barta gelitaanka pyriform fossa.

Daraasado dhowr ah oo suugaanta hadda jira ayaa si sax ah u qeexaya meesha saxda ah ee laga soo galo fossa pearly ee ciddiyaha femoral intramedullary.Georgiadis et al. ku qeex barta gelitaanka pearly fossa sida aagga ku dheggan muruqa carpi radialis brevis extensor ee niyad-jabka ee salka qoorta femoral (Jaantus. 5). Qorayaashu waxay sidoo kale ku nuuxnuuxsadeen in barta laga soo galo oo aad u fog ama aad u fog gudaha ay kordhin karto khatarta jabka qoorta femoral, iyo marka meesha laga soo galo ay aad uga fogaato, waxaa laga yaabaa inay jirto khatar sare oo ah necrosis ischaemic, taas oo ka sareysa bukaanada qaangaarka ah.

Jaantus 5. Aragtida dhinaca hore ee qalliinka ee sinta oo muujinaysa meesha ugu habboon ee laga soo galo pyriform fossa ciddiyaha intramedullary femoral femoral. The '*' waxay tusinaysaa meesha cidiyahu ka bilaabmayaan.

Harper iyo al. daabacay daraasad ku saabsan kooxaha 14 ee femurs cadaveric aadanaha ee 1987 taas oo ay ku qiimeeyeen meesha pin hagaha intramedullary iyo barta ka bixida ciddiyaha intramedullary soo bandhigay distally iyo proximally in fashion dib-u-nooc ka intercondylar ee femur. Waxay ku soo gabagabeeyeen in barta laga soo galo pyriformis paramedian intramedullary ciddiyaha ayaa ku yaala isgoyska trochanter weyn ee qoorta femoral, wax yar ka hor pyriformis occult. Goobta gelinta ayaa dib loo xaqiijiyay Gausepohl et al. Daraasad kale oo cadcad ah, waxay dejiyeen meesha ugu habboon ee laga soo galo ciddiyaha intramedullary femoral ee cidhifka dhexe ee trochanter weyn oo kor u kaca jilibka pyriformis. Intaa waxaa dheer, in daraasadda cadaveric ee Labronici et al. Fossa ee muruqa pyriformis waxaa lagu tilmaamay inuu yahay gobolka luminal-qaabeeya oo ku beegan dhidibka dhexe ee daloolka intramedullary femoral ee diyaaradda coronal.

Goobta gelitaanka pyriform fossa waxay leedahay faa'iidooyin gaar ah sababtoo ah farsamo ahaan aad ayay u dhib badan tahay marka loo eego barta marinka trochanter-ka weyn, gaar ahaan bukaanada buuran. Intaa waxaa dheer, goobta ugu fiican ee laga galo irbadda fossa ee qaabka pear-ku waa meel cidhiidhi ah, taas oo ka dhigaysa mid aad u adag in la soo koobo. Tusaale ahaan, bar bilawga hore oo xad dhaaf ah oo ku taal luqunta femoral waxay keenaysaa cadaadis xad dhaaf ah waxayna kordhisaa halista dillaaca kortikal hore, gaar ahaan haddii barta bilawga ah ay ka badan tahay 6 mm hore ee fossa. Intaa waxaa dheer, isbarbardhigga morphologic wuxuu caqabad ku noqon karaa goobta saxda ah ee gelitaanka, gaar ahaan haddii wareegga gaaban ee dibadda uu yahay mid weyn ama rotorku uu soo baxayo, taasoo horseedaysa goobta gelitaanka oo aad u dhexdhexaad ah iyo khatarta jabka qoorta femoral.

DHIBAATOOYINKA: Isbarbardhigga 38 goobood oo trochanteric weyn ah oo leh 53 goobood oo fossa pearly ah oo loogu talagalay ciddiyaha intramedullary femoral, Ricci et al waxay ogaatay in kooxda fossa pearly ay haysteen 30% waqti dheer oo qalliin ah iyo 73% waqti dheer oo fluoroscopy ah. Natiijooyinkan waxaa xaqiijiyay Bhatti et al. marka la is barbar dhigo 2da dhibcood ee irbadda.

Marka la eego dhaawaca jilicsan ee jilicsan, waxaa jiray halis sare oo ah dhaawaca jilicsan ee jilicsan ee marinka pyriformis marka la barbardhigo neuromuscular-ka interosseous ee barta irbadda trochanteric ee weyn. Dora iyo al. lagu qiimeeyay 16 femurs cadaveric ee qaangaarka ah ee dhaawacyada unugyada jilicsan ee muruqa pyriformis iyo pin gelitaanka rotor. Waxay ogaadeen in inkasta oo fossa pyriformis uu ahaa joomatari ahaan ugu fiicnaa, waxay sababtay dhaawac aad u weyn oo ku yimid sahayda xididada madaxa femoral iyo muruqyada ku hareeraysan iyo seedaha. Natiijooyinkan waxaa dib u xaqiijiyay daraasadaha caddaymaha ee Ansari Moin et al. WHO ayaa sidoo kale is barbardhigtay laba meelood oo laga soo galo. Waxay xuseen in hagaajinta gudaha ee ciddiyaha laga bilaabo muruqa pyriformis ay u badan tahay inay waxyeeleeyaan afduubayaasha miskaha iyo rotors dibadda ah. Intaa waxaa dheer, dhaawaca xididdada femoral ee wareegga dhexdhexaadka ah ayaa laga helay dhammaan kiisaska (Shaxda 2).

Shaxda 2. Soo koobida dhaawacyada unugyada jilicsan ee meelaha irbada laga galo ee kala duwan
kala duwanaansho	Pyriform fossa barta laga soo galo (n=5)	Bar quudinta rotor weyn (n=5)
unug jilicsan
muruqa gluteus medius (anatomy)	5	1
Gluteus medius tendon	0	4
dhaawaca seedaha
gluteus minimus (anatomy)	3	0
muruqa pyriformis (korka sare ee lafdhabarta)	3	3
obturator internus (anatomy)	1	0
muruq latissimus dorsi (anatomy)	3	0
Xididdada dhiigga iyo kaabsoosha wadajirka ah
MFCA Laamaha Deep	4	0
Laanta-gacmeedka MCCA	4	0
kaabsal articular (labo-goysyada sida jilibka ee anatomy)	1	0
MFCA: dhexdhexaadinta halbowlaha femoral.

Dhawaan, Bharti et al. wuxuu bartay khatarta dhibka leh ee ciddida intramedullary femoral ee barta trochanteric weyn iyo barta gelitaanka fossa pearly waxayna heleen khataraha dhibka leh sida heerka bogsashada jabka waxayna ku soo koobeen sidan soo socota (Shaxda 3).

Shaxda 3. Pyriform fossa barta laga soo galo iyo barta dhuuxa femoral ee trochanter weyn
dhibka	Barta cirbadda sinuska ee Piriformis	Barta galinta trochanter ka weyn
caabuqa	6.7	3.3
Maluuun	20	13.3
bogsiinta dib u dhaca	20	13.3
Dhaqdhaqaaq sinta xaddidan	20	33.3
Dhaqdhaqaaqa jilibka oo xadidan	6.7	6.7
Farqiga dhererka addimada	13.3	20
Koofiyadda dabada waxay ka soo baxdaa kortexka lafta	13.3	20
Intraoperative qoorta jabniinka femoral	10	0
Jabka weyn ee trochanter	0	3.4
Necrosis madaxa femoral	6.7	0

Dib-u-cusbooneysii ciddiyeynta intramedullary femoral

Go'aaminta barta gelitaanka ku habboon ee ciddida intramedullary femoral ee dib-u-celinta waxay gacan ka geysan doontaa in la gaaro dib-u-soo-celinta jabka ugu fiican, dhererka, iyo wareegga iyada oo la yareynayo dhaawaca carjawda articular, ligament cruciate (ACL), ligament dambe (ACL), iyo dhaawaca unugyada jilicsan (Shaxda 1). Dhawaan, waxaa jiray xiisaha sii kordhaya ee ciddida intramedullary femoral femoral iyada oo ujeedadu tahay in la yareeyo dhibaatooyinka la xidhiidha ciddida paracromial, oo ay ku jiraan xanuunka sinta, heterotopic ossification, daciifnimada xididdada, iyo curyaanka neerfaha pudendal, taas oo loo arko in ay tahay mid aad u yar marka la barbar dhigo jeexjeexyada jeexjeexyada iyo xiritaanka jajabyada femoral ee hoos u dhaca gudaha gudaha gudaha distalc. jiridda femoral. Intaa waxaa dheer, caddaymihii ugu dambeeyay waxay soo jeedinayaan in marka ciddiyaha dib-u-celinta intramedullary ay si habboon u cabbiraan, ciddiyaha qufulka dhow ayaa laga yaabaa in aan loo baahnayn. iyo Bisaccia et al. daawaynta fog ee seddax meelood meel ka mid ah jajabka jirridda femoral iyadoo la isticmaalayo quful iyo aan xirneyn oo dib u habeyn lagu sameeyo cidiyaha intramedullary. Sidaa darteed, isticmaalka ciddiyaha femoral retrograde ayaa noqday mid caan ah oo si ballaaran loo aqbalay.

Sharaxooyin badan oo ku saabsan barta gelitaanka ugu habboon ee ciddida intramedullary femoral femoral ayaa laga heli karaa suugaanta. Daraasadaha intooda badani waxay aqoonsadaan barta gelitaanka ugu habboon ee ciddida femoral dib u soo noqoshada sida 1.2 hore ee asalka femoral ee ligament cruciate dambe

cm (oo la jaan qaadaya godka medullary) iyo bartamaha fossa intercondylar (Jaantuska 6).

Jaantuska 6. Aragtida lafaha qalliinka ee qalliinka iyo dhinaca dambe ee jilibka oo muujinaya meesha ugu habboon ee laga soo galo ciddiyaha intramedullary femoral. '*' waxay tusinaysaa meesha cididhigu ka bilaabmayo.

Inkasta oo aysan jirin calaamad buuxda oo dib-u-cusbooneysiin ah ciddida intramedullary femoral femoral, calaamado badan oo qaraabo ah ayaa lagu sifeeyay. Kuwaas waxaa ka mid ah bukaanada polytrauma, bukaanada jirrada leh ee buuran, bukaanada uurka leh, jabka laba geesoodka ah ee femoral, stem femoral ipsilateral iyo acetabular / miskaha jabka ama jabka qoorta femoral, iyo ipsilateral stem femoral iyo jabka tibial. Inta badan calaamadahani waxay la xiriiraan fududaynta meelaynta bukaan-socodka iyo ka-hortagga nabarro qalliin oo badan oo u dhow.

Dhanka kale, iska-hor-imaadyo dhammaystiran oo dib-u-cusbooneysiin ciddiyeeynta intramedullary femoral waxaa ka mid ah xannibaadda kanaalka intramedullary dib-u-celinta by maqaar-galaha la hayo iyo jabka furan ee femur fog. Caqabadaha qaraabada ah waa jabka ku yaala gudaha 5 cm ee trochanter ka yar, oo ay ku adagtahay helitaanka barta ugu fiican ee gelitaanka sababtoo ah jilibka jilibka ee ka yar 45 darajo, caabuqa jilibka ka hor kaas oo keeni kara khatarta ah in uu ku faafo jirridka femoral, dhaawacyo jilicsan oo jilicsan oo jilicsan oo ku wareegsan jilibka, iyo jabka gudaha gudaha jilibka iyo xuubka hoose ee hoose.

Dhibaatooyinka: Inta badan dhibaatooyinka ciddiyaha femoral retrograde waxay la xiriiraan maaraynta aan habboonayn, gaar ahaan meelaynta khaldan ee barta laga soo galo. Diyaaradda sagittal, barta hore ee laga soo galo waxay keeni doontaa turjumaadda jabka dambe, dhaawaca dusha sare ee articular, iyo suurtogalnimada ciddi cidi ku dheggan patella marka jilibka la leexiyo. Dhanka kale, haddii barta laga soo galo ay si khaldan u dhigto jihada dambe, tani waxay keeni kartaa khatar sare oo dhaawac ah oo ku yimaada asalka lafdhabarta dambe iyo barokaca hore ee goobta jabka.

Hutchinson iyo al. lagu tilmaamay dhibaatooyinka la xidhiidha meelaha laga galo diyaaradda coronal ee aan habboonayn. Waxay ogaadeen in barta gelitaanka dhexdhexaadka ah ee xad-dhaafka ah ay keentay qaab-dhismeedka gadaal-dambeed oo leh tarjumaad jabka dambe, halka mid aad u daran ay keentay cillad dhexdhexaad ah iyo tarjumaad dhexdhexaad ah.Sanders et al. ayaa sheegay in xulashada barta bilawga dhexdhexaadka ah ee 2 cm ama in ka badan oo ka baxsan dhidibka dhexe ay keentay jabka dhexdhexaadka ah ee dhexdhexaadka ah kaas oo xumaaday sababtoo ah foorarsiga dambe ee isthmic ee jabka taasoo keentay hoos u dhac hoose oo dambe.

Dhibaatooyinka kale ee la xidhiidha ciddida raacda femoral dib-u-noqoshada waxaa ka mid ah xanuun jilibka ah, qallafsanaanta, jilibka heterotopic ossification, iyo samaynta jirka oo xor ah oo jilibka ah.

Gabagabo

Inkasta oo farsamada ciddida intramedullary kasta ay leedahay calaamad u dhiganta, doorashada farsamada ciddida intramedullary si loogu isticmaalo daaweynta jabka jirridda femoral sida caadiga ah waxay ku xiran tahay doorbidista dhakhtarka qalliinka. Markaad samaynayso ciddida intramedullary ee femur, helitaanka meesha saxda ah ee laga galo nooca ciddiyaha loo isticmaalo hagaajinta ayaa looga baahan yahay natiijo guul leh. Aqoonta anatomy maxalliga ah iyo waxqabadka sawir-qaadista ayaa ka caawin doona dhakhtarka qalliinka inuu sameeyo nidaam farsamo ahaan ku filan isagoo yareynaya khatarta dhibaatooyinka la xiriira. Intaa waxaa dheer, hababka ciddiyaha intramedullary, dayactirka dhimista ayaa ah qayb muhiim ah oo ka hortagaysa xumaanta iyo xumaanta ama la'aanta jabka.