5 Melao-motheo ea ts'ebeliso ea lipekere tsa intramedullary le mekhoa ea ho buoa!

Melao-motheo ea mantlha ea lipekere tsa intramedullary

1. Histori ea ho kokota ka intramedullary

Ka 1910, lipekere tsa Lilienthal aluminium intramedullary li ne li sebelisetsoa ho phekola ho robeha ha shaft ea botšehali.

Ka 1913, Schone o ile a sebelisa lipekere tsa silevera tsa intramedullary ho phekola ho robeha ha forearm. 

Kuntscher (1900-1972) o ile a kenya letsoho haholo ho lokisa lipekere tsa intramedullary. 

Lilemong tsa bo-1960 le bo-1970 e ne e le nako ea tsoelo-pele e potlakileng ea lipekere tsa intramedullary. 

naha ea heso esale e li sebelisa ka bongata ho tloha lilemong tsa bo-1990.

2. Phokotso e bulehileng le phokotso e koetsoeng

1. Ho robeha ha maoto le matsoho ho ka fokotsoa ka ho buuoa tlas'a pono e tobileng kapa ho koaloa tlas'a tlhahlobo ea X-ray.

2. Nako ea pholiso ea fracture e bulehileng e batla e le telele, mali a tsoang ka har'a opereishene a ntse a eketseha, 'me phokotso e bulehileng e senya phepelo ea mali ho isa pheletsong ea fracture.

3. Ho kgothaletswa ho sebelisa phokotso e koetsoeng ka hohle kamoo ho ka khonehang. Ho ka sebelisoa traction reducer, kapa ho ka etsoa sekhahla se senyenyane sefofaneng sa fracture ho pry le ho fokotsa, kahoo ho fokotsa ho kena-kenana le phepelo ea mali ho fihlela qetellong ea fracture.

4. Bakeng sa ho hloleha ha phokotso e koetsoeng, sekhechana sa lesapo se phetholang kapa ho phunya lisele tse potolohileng, le likhechana tse kholo tse robehileng, ho ka sebelisoa ho fokotsa ho buoa.

3. Mokhoa oa ho lokisa oa sepekere sa intramedullary

1. Mokhoa oa ho lokisa ka hare ho lipekere tsa intramedullary ke symmetrical central central splint fixation.

2. Ho lokisoa ha fracture ka lipekere tsa intramedullary ke ho lokisa khatello ea kelello, eseng ho lokisa khatello ea kelello, e leng se loketseng ho bōptjoa ha callus.

3. Bohareng ba ho lokisa ke theory e phahameng ho feta ho lokisa ka ntle ho cortical, e ka fokotsang letsoho la matla, ho fokotsa ts'oaetso ea valgus angulation le ho hlōleha ho lokisa ka hare.

4. Ho lokisa lipekere tsa Intramedullary ho fana ka motheo oa ho fokotsa ho koaloa kapa ho fokotseha ho fokolang ho bulehileng.

4.Melemo ea lipekere tsa intramedullary

1. Mathata a fokolang

2. Sebaka se atolositsoeng sa matšoao a ho buuoa

3. Tokiso e tiileng

4. Koetliso ea mosebetsi oa pele oa kopanelo

5. Ho jara boima ba pele

6. E ka sebelisoa hammoho le ho lokisa tse ling tsa ka hare

Mefuta le Mekhoa ea Motheo

1. Ho koala le ho se notlele lipekere tsa intramedullary

2. Matla a matla le a tsitsitseng a ho notlela lipekere tsa intramedullary

3. Katoloso ea Medullary le mekhoa ea ho lokisa e seng ea medullary

4. Mekhoa ea ho lokisa e bulehileng le e koetsoeng

Tse kotana le tse sa koalloang

Lipekere tse tloaelehileng tsa intramedullary li na le botsitso bo fokolang ba axial le matla a batlang a le tlaase, empa li na le elasticity e itseng 'me li khona ho hlaphoheloa ka mor'a ho senyeha, e leng se bakang palo e nyenyane feela ea ho thella ha intrabone.

Lipekere tse kopantsoeng tsa intramedullary li na le liphello tse molemo tsa ho thibela ho potoloha le ho thibela khatello ea maikutlo, botsitso bo botle ba ho lokisa, le ho lumellana le molao-motheo oa ho lokisa likokoana-hloko. Li sebelisoa haholo masapong a malelele a maoto le matsoho. Haholo-holo bakeng sa fractures ea likarolo tse ngata le tse fokolang, li na le botsitso bo molemo ho feta lipekere tse tloaelehileng tsa intramedullary.

Matlafatso ea static fixation

Lipekere tse notlellang ka hare ho intramedullary li hlahisa masking e fokolang haholo 'me hajoale li buelloa haholo bakeng sa ketso e sa tloaelehang ea matla.

Bakeng sa fractures e sa foleng ka mor'a likhoeli tse 6 ho isa ho tse 8 ka mor'a ho buuoa, ho sebelisoa ha masapo a situ kapa ho nkela lipekere tse atolositsoeng tsa intramedullary ka dynamization hangata.

Dynamization e ka sebelisoa e le mokhoa oa ho khothaletsa pholiso ea fracture. Ha e khothalletsoe ka tloaelo hobane e ka lebisa ho khutsufatsoa ha maoto le ho holofala ha potoloho.

Ho atolosoa ha moko le ho atolosoa ho se nang moko

Ho atolosoa ha marrow ho ka kenya lipekere tsa intramedullary tse nang le bophara bo boholo le matla a maholo, e leng se loketseng koetliso ea pele ea ts'ebetso le ho fokotsa sekhahla sa lipekere tse robehileng.

Ho atolosoa ha 'mongo ho ka hlahisa palo e kholo ea maloanlahla a masapo a nang le phello ea osteoinductive, e thusang ho folisa ho robeha.

Ho atolosoa ha 'mongo ho tla senya phepelo ea mali ea lijana tsa limatlafatsi le lera la endosteal, empa methapo ea mali e ka inchafatsa haufi le lesoba la lipekere tsa intramedullary. Ho atolosoa ha 'mongo ho ka boela ha eketsa phallo ea mali meleng e bonolo e potolohileng mesifa, ka hona ho khothalletsa pholiso ea ho robeha.

Ho atolosoa ha 'mongo ho eketsa menyetla ea tšoaetso le embolism,' me e lokela ho sebelisoa ka hloko bakeng sa ho robeha ho bulehileng, likotsi tse ngata, le likotsi tse rarahaneng.

Melemo ea ho atolosoa ha medulla

① Ka mor'a ho atolosoa ha medullary, sebaka sa ho kopana pakeng tsa sepekere sa intramedullary le lesapo lea eketseha, e leng se ntlafatsang botsitso ba ho lokisa. 

② Ka mor'a ho atolosoa ha medullary, ho ka sebelisoa sepekere se seholo sa bophara ba intramedullary, se eketsang matla a lesela la intramedullary le ho fokotsa sekhahla sa lipekere tse robehileng. 

③ Litšila tsa lesapo ka mor'a ho atolosoa ha medulla li ka baka sebopeho se secha sa masapo, se thusang ho folisa ho robeha.

Ha ho bapisoa le manala a intramedullary katoloso ea medulla, manala a sa atolositsoeng a na le melemo e latelang.

① Nako e khuts'oane ea opereishene le mali a fokolang. 

② Ho fokotsa ho kena-kenana le phallo ea mali ea endosteal maemong a nang le likotsi tse matla tsa lisele tse bonolo.

Kopo ea sepekere sa intramedullary

Nail ea intramedullary e kopanyang humeral

Lipontšo tsa lipekere tsa humeral

Lipontšo tsa lipekere tsa intramedullary tse nang le li-humeral ha li phekoloa ho robeha ha lithapo tsa humeral ke: ho robeha ha methapo le methapo ea methapo, likotsi tse ngata, ho robeha ho sa tsitsang, fractures ea pathological, le proximal humeral fractures.

Mefuta e ka lokisoang e tloha ho 2cm ka tlase ho hlooho ea humeral ho ea ho 3cm ka holim'a olecranon fossa. U ka khetha ho e lokisa ho tloha lehetleng ka sepekere sa antegrade intramedullary kapa ho tloha setsoe ka sepekere sa retrograde.

Litšobotsi tsa lipekere tsa humeral

Mekhoa ea ho lokisa ea ho buoa bakeng sa fractures ea humeral shaft ha e le hantle ke ho lokisa poleiti le ho lokisa lipekere tsa intramedullary.

Plate fixation e na le matla a ho thibela ho potoloha le ho thibela ho kobeha 'me e tsitsitse ka thata, empa ts'oaetso ea ho buuoa e kholo, monyetla oa tšoaetso o phahame,' me methapo ea radial e senyeha habonolo.

Lipekere tsa morao-rao tsa li-humeral le tsa ho itšireletsa li hlōla mefokolo ea lipekere tse tloaelehileng tsa intramedullary tse kang ho se tsitse ha axial, taolo e fokolang ea ho potoloha, le tlhokahalo ea ho lokisoa ho eketsehileng, e le hore fracture e be e tsitsitseng ka thata, ho lahleheloa ke mali ho nyenyane, ho hlobola ha lisele tse bonolo ho fokotsehile, 'me ho atolosoa ha medulla ho lekana le moroalo oa sebaka sa heno, ho tsamaisa lesapo la pele, le ho tsamaisa lesapo la pele, ho fetisoa ho ka etsahala. ho qala ka mor'a ho buuoa.

Nala e kenang ka har'a botšehali ba botšehali

Lipontšo tsa lipekere tse hokahaneng tsa botšehali

Mefuta eohle ea fractures 2cm ka tlase ho vertebra ea trochanteric le ho feta 9cm ho tloha mokokotlong oa lengole.

Maqhetsoana a khale a karolo e bohareng ea molamu oa botšehali.

Bakuli ba hlolehileng ho lokisa poleiti ka hare.

Likarolo tsa Nail e kopanyang ea botšehali

Melemo ea mechine

Letsoho la matla la femoral interlocking intramedullary Nail bakeng sa ho lokisa fractures ke nako e telele ho feta ea lipoleiti tsa tšepe, 'me matla a aroloa ka mokhoa o lekanang karolong e bohareng ea lesapo lohle, leo ho seng bonolo ho koba le ho senyeha.

Lipekere tse notlellang lipheletsong tse peli tsa lesapo la intramedullary li etsa hore lesapo le thehoe ka botlalo ho tloha holimo ho ea tlase, 'me lipekere tse notlellang pheletsong ea distal li ka fokotsa letsoho la torque ea lesapo la intramedullary lesapong, le thibela ho khutsufatsa le ho potoloha, le ho fihlela botsitso bo boholo le ho tiea bakeng sa ho lokisa fracture.

Gamma Interlocking Intramedullary Nail

Lipontšo tsa lipekere tsa Gamma

E sebetsa ho mefuta e fapaneng ea fractures ea peritrochanteric, haholo-holo fractures ea subtrochanteric.

Lipontšo tse atolositsoeng tsa Nail (nail ea kaho).

fractures e phahameng ea subtrochanteric, trochanteric e kopantsoeng le fractures ea femoral shaft.

Melemo ea Gamma Nail

E thehiloe ka ho kopanya sliding hip screw le thekenoloji ea intramedullary, Nail e kholo e haufi le ka hare ho medullary cavity ho feta hip plate e matla, kahoo Gamma Nail e tsamaisa boima ba mokuli haufi le calcar ea botšehali ho feta hip plate e matla, ho eketsa matla a mochine oa ho kenngoa. Bakeng sa fractures ea subtrochanteric e kenyelletsang ho tsamaisana ha cortical medial, Gamma Nail e qoba tlhokahalo ea ho tsosolosoa ha fracture anatomy, kahoo e molemo bakeng sa fractures ea intertrochanteric kapa subtrochanteric fractures.

Retrograde intramedullary femoral nailing

Lipontšo tsa ho khutlisa lipekere tsa botšehali

Haholo-holo e sebelisoa bakeng sa fractures ea supracondylar femoral, ho akarelletsa le supracondylar comminuted fractures le intercondylar 'T' le 'Y' comminuted fractures e amang holim'a articular.

E ka boela ea sebelisoa bakeng sa ho robeha ha botšehali ka tlas'a sekoti sa femur.

Femoral shaft, supracondylar femoral, le intercondylar fractures ka hare ho 20CM ho tloha mokokotlong oa lengole.

Ba hlolehileng ho lokisa poleiti.

Litšobotsi tsa retrograde femoral nailing

Supracondylar femoral fracture ke ho robeha ho tebileng ka bothata ba pele, ho fokotsa 'me ka bobeli, ho lokisa ka hare ho matla. Ho na le ts'oaetso e kholo ea mathata a kang fracture non-union le ho lieha ho fola.

Retrograde interlocking interlocking intramedullary nailing ke mokhoa o atisang ho sebelisoa ho phekola distal femur fracture lilemong tsa morao tjena, e nang le botsitso bo botle ba mechine, e ka laola ka katleho ho falla ha morao le ho potoloha ha karolo ea ho qetela ea ho robeha, 'me e thusa mokhatlong oa pele o kopanetsoeng.

Supracondylar e kopantseng femoral stem fracture e tsitsitse ka nako e telele ea supracondylar intramedullary nailing, e rarollang bothata boo ho leng thata ho rarolloa ka ho koala likheo tsa intramedullary tsa femur. Sesebelisoa sena se bonolo ho sebetsa, se nepahetse ka boemo, se ka tšeptjoa ho lokisa, 'me mokuli a ka etsa boikoetliso ba pele ba lengole ka mor'a ho buuoa.

Tibial interlocking lipekere tsa intramedullary

Lipontšo tsa lipekere tsa tibial

Ho robeha ho tsitsitseng bohareng ba 1/3 ea tibia: fractures transverse, short oblique fractures, pseudarthrosis.

Ho robeha ho sa tsitsang ka hare ho 60% ea bolelele ba tibia e bohareng: fractures haufi le metaphysis, nako e telele ea spiral fractures, segmental fractures, fractures fractures, fractures e nang le bokooa ba masapo.

Litšobotsi tsa tibial nailing

Nailing intramedullary nailing ea tibia hangata e sebelisoa bakeng sa fractures ea bohareng ba tibia.

Le hoja e ka boela ea sebelisoa bakeng sa fractures ea proximal le distal tibia, tekanyo ea complication e phahame, malunion e hlaha hangata, qetello ea fracture e na le ≧1cm ea ho tsamaea ho 1/2 ea linyeoe, 'me 1/4 ea ho lokisa e hlōleha.

Lingoliloeng li tlalehile sephetho se betere sa fracture ea distal tibia ho feta ho robeha ha tibia ka mor'a ho lokisoa ha fibula.

Mekhoa ea ho buoa

Tokisetso ea pele ea ts'ebetso ea lisebelisoa tse khethehileng

Bethe ea masapo (bethe ea traction) kapa bethe e tloaelehileng ea ho buoa ea fluoroscopic; retractor; se tiisa setšoantšo.

Khetho e nepahetseng ea bolelele ba lipekere tsa intramedullary bakeng sa li-endoprostheses tsa pele ho ts'ebetso

Radiograph

tekanyo ea bolelele ba setho sa lehlakore

Intramedullary Nail bophara

x-ray bophara ba isthmus

Tekanyo ea bolelele ba manala ka intramedullary

1.Translucent rulara boikemisetso tlas'a C-arm mochine

Lipheletso tsa distal le proximal tsa lesapo li ne li le bohareng ba lehlaseli; 'musi o ne a bapile le diaphysis.

2.Tekanyo ea bolelele ho latela matšoao a holim'a 'mele

Femur: ntlha ea trochanter e kholo → sebaka sa lengole sa lateral kapa palo e phahameng ea patella; tibia: sebaka se bohareng ba lengole → karolo e ka pele ea lenonyeletso la maqaqailana ka dorsiflexion ea leoto.

Mokhoa oa ho Kenya Manala ka Intramedullary - Mokhoa oa ho Kena

Longitudinal axis ea medulla cavity ka mola o otlolohileng

Ha e haufi haholo le moo ho kenang teng

Bolelele bo loketseng: e atolositsoeng - e telele; e sa hlakang - e khutšoanyane

(Tiiso e sa tobang ea sebaka sa ho kena; ha ho phallo ea pulp, ha ho na tšireletso ea lisele tse bonolo tse hlokahalang)

Sebaka se ts'oanang sa ho kena ha Nail intramedullary femoral

Tokisetso ea sebaka sa ho kena bakeng sa nail e tšoanang ea femoral intramedullary

Ho pharalla ha letheka le ho eketsa

Longitudinal incision proximal ho trochanter e kholoanyane

E seng hole haholo morao

Ho behoa ha phini ea tataiso

Ho behoa ha thebe ea linama tse bonolo

Retrograde femoral intramedullary Nail entry point

30 ° ho phunya lengole

Sebaka se selelele sa phini ea tataiso ka lehlakoreng le le leng la medulari ea kutu ea distal femoral

Ho kenngoa ha phini ea Kirschner ka har'a femur ea distal ka patellar ligament ka letsoho le sireletsang: orthogonal - bohareng ba intercondylar fossa ea femur; lateral - mohala oa Blumensaat

Ho qala ha PCL ntle le kotsi

Sebaka se ts'oanang sa tibial intramedullary Nail entry point

Moleng o bohareng oa mokoti oa medulla

Karolo e ka pele ea sehlaba sa tibial

E phahame ka hohle kamoo ho ka khonehang ntle le ho senya sehlaba

Bolelele ba ho phunya lengole

Incision tibial tuberosity-tlase pole ea patella haufi le metso ea medulla

Bula mokokotlo oa medulla: pin ea tataiso ho 15 ° ho ea sefofaneng sa sagittal sa axis ea longitudinal ea tibial stem.

Boemo ba setšoantšo se matlafatsang

Mekhoa ea marrowing

Phokotso ea motlakase

fractures tse ncha

Phokotso ea letsoho

ho robeha ha khale ka pseudoarthrosis, sclerosis ka har'a metso ea medulla

Ha ho na tourniquet tlas'a inflation

phallo ea mali ke ntho e pholileng ka ho fetisisa

Mekhoa ea ho khutlisetsa maemo

Nailing e tšoanang ea femoral intramedullary

Mabaka a bothata ba ho khutlisa ho robeha ha botšehali

Ho phuthela ha lisele tse bonolo ha ho lumelle ho kena ka ho toba lesapong

Sebaka sa ho kenya nale ha se khone ho bonoa ka ho toba

Ho kenyelletsa lenonyeletso la hip → tsitsipano ea iliac fascia → ho khutsufatsoa ha fracture

Ho fokotseha ha Tibial fracture

Ho qhekella

Haholo-holo subcutaneous le bonolo ho palpate

Ho robeha ho tsitsitseng - ho robeha ha bohareng kapa distal mofuta oa A le B

Oblique fractures - overkill

Intramedullary nailing→ lisebelisoa tsa ho falla

Mehato e thusang ea ho fokotsa

Li-forceps tsa ho fokotsa lintlha

tibia; tshebediso ya percutaneous kapa leqeba

Li-retractors tse kholo (li-braces)

ho lieha ho fokotseha; ho khutsufatsa setho

Li-screws tsa nakoana tsa Schanz

① Femur, tibia

② Haufi le mohala oa fracture ka hohle kamoo ho ka khonehang

③ Ts'ebeliso e potlakileng ea fracture e le 'ngoe ea cortical

④Sebelisa chuck ea bokahohle e nang le T-handle bakeng sa ho tsamaisa habonolo

Lenala la poller

① Ho robeha ha Metaphyseal (ho lokisa moeli oa matla, ho tsitsisa tsosoloso, ho tsosolosa ts'ebetso)

② ho robeha ha oblique ea distal tibia kapa femur (khatello ea ho kuta → khatello)

③ Lipekere tsa intramedullary tse boemong bo bobe li kena mocha oa khale oa medulla nakong ea opereishene ea bobeli

④ Sebaka se fosahetseng sa ho kena, ho se tsamaisane hantle ha ho robeha (sekoti se behiloe ka mokhoa o ts'oanang le sebaka se ka bang teng sa endoplant)

Tourniquet e pharaletseng

① tibia

② e tlatselletsoa ke ho hula kapa ho hula

③ Sebelisa ka hloko likotsing tse matla tsa lisele tse bonolo

④ E boloke e le khutšoanyane

⑤ Thibela katoloso ea medulla sebakeng se nang le moea o matla

Tatelano ya ho notlela manala: distal ebe proximal

Melemo

boiketlo ba ho kokota, khatello ea khefu ea fracture; ho felisoa ha karohano; ts'ebetso ea ho fokotsa.

Mekhoa ea ho fokotsa ts'ebetso ea ho buuoa e liehang le e sa sebetseng

Mathata a ka 'nang a kopana le ho lieha ho buuoa

Axial deformity (ho khutsufatsa, ho ferekana kapa ho falla)

Keketseho ea lisele tsa granulation

Likhopo tsa pele tsa masapo

Sclerosis ea fracture e robeha ka ho koaloa ha mokokotlo oa medulla

Osteoporosis

Mathata a ka bang teng intraoperative

Ho kheloha ha 'expander' le manala a intramedullary → ho kenella ha manala a intramedullary ka cortex

Angular deformity → retractor

Ho kheloha ha lipheletso tse khaotsoeng → Lenala la Poller, ho lokisa poleiti

Mekhoa ea ho thibela likhoele tse sa tloaelehang tsa matla

Proximal - sebaka se nepahetseng sa ho kena

Distal - lenala la intramedullary bohareng ba mokokotlo oa medulla

Mathata a Intramedullary Nailing

★Tshwaetso

★Tšenyo ya methapo

★Pholiso e khopameng ea maqeba

★Ho robeha ha Lingaka

Ho potoloha ka ntle, torsion, valgus, ho potoloha ka hare, ho ferekana

★Mahlaba a haufi le manonyeletso

★Embolism ea mafura

★Heterotopic ossification

★Pulmonary embolism

★Ho robeha hape

★Thrombosis

★Ho satalla ha manonyeletso

★Ho se kopane ha fracture, ho se kopane ha lesapo

★Ho hloleha ho lokisa ka hare

★Ho khutsufatsa maoto le matsoho

★Tse ling

Mathata--Tshwaetso

1.Early on, open fractures were taken as contraindication to intramedullary nailing.

2.Tlhahiso ea ts'oaetso ea ka mor'a ts'ebetso ho fractures e bulehileng e itšetlehile ka boemo ba kotsi ea lisele tse bonolo le tšilafalo.

Ketsahalo ea tšoaetso ka mor'a ho robeha ho bulehileng ho itšetlehile ka boemo ba kotsi ea lisele tse bonolo le tšilafalo hammoho le mokhoa oo lesela le bonolo le laoloang ka lona.

3.Thinner lipekere intramedullary eketsa monyetla oa tšoaetso; Ho lokisa lipekere tse sa atolositsoeng tsa intramedullary ho batla ho fokola, 'me lipheletsong tsa lesapo li na le

Ho lokisa lipekere tse sa atolositsoeng tsa intramedullary ho batla ho fokola, ho na le motsamao oa microscopic oa karolo e robehileng ea lesapo hammoho le karolo e setseng, e leng bonolo bakeng sa kholo ea baktheria.

4. Tšebeliso ea lisebelisoa tse atolositsoeng le tse fokolang tse atolositsoeng tsa medullary ha li ntlafatse feela botsitso ba ho robeha, empa hape li qoba ho thehoa ha sebaka se shoeleng.

Mafura a Embolism Syndrome

1.Tlhahiso ea FES ea ho robeha ha masapo a malelele a tubula ke 0.5% ho 2%.

2. Ho atolosoa ha medulla le ho se atolosoe ha medulla ha ho na phello e kholo ho moea oa pulmonary.

3.Ha o atolosa medulla, mokhoa ona o lokela ho khumama ka bonolo, ho qoba matla a mangata le ho sebetsa ka thata.

4.ho hlahlojoa hona joale ha FES ho ntse ho amohela mekhoa e hlalositsoeng ke Gurd ka 1974, 'me phekolo ka mor'a ho hlahlojoa e tla lieha nako e ntle ea phekolo' me e ka ba le liphello tse tebileng.

Ho lieha ho fola le ho robeha ha lesapo

Lintlha tse fapaneng li ama pholiso ea fracture ka mor'a ho lokisa lipekere tsa intramedullary, 'me lisosa li ka hlahlojoa ka tsela e latelang.

1.lithane tse bonolo tse kentsoeng pheletsong ea fracture

2. Karohano ea ho robeha ho pota-pota ho fela

3. Botsofali ba mokuli

4. Ho robeha ho bulehileng, kotsi e tebileng ea lisele tse bonolo, hemodialysis e tebileng ea lehae kapa tšoaetso.

5. Ho lokisa lipekere tse mpe tsa intramedullary

6. Lefu la tsoekere le kopaneng kapa mafu a mang a jeoang.

Meroho ea Bongaka

Ho robeha ho bakoang ke meriana ke haholo-holo ho robeha ha manala ho bakoang ke ho qhekella ho sa lokelang nakong ea ho lokisa lipekere tsa intramedullary.

Tlhokomelo ea Intraoperative e lokela ho lefshoa ho

1. Khetho e sa nepahalang ea ntlha ea ho kena ha lipekere e ka lebisa ho robeha ha proximal.

2. U se ke ua qobella ka matla katolosong ea medula.

3. Monyako oa ho atolosoa ha pulp o lokela ho ba ka tsela e ts'oanang le tataiso ea ho kenngoa ha lipekere.

4. U se ke ua sebelisa matla ha u kenya lipekere tsa intramedullary karolong ea distal.

Bohloko ba manonyeletso a boahelani

1. Ho behoa ha lenala la intramedullary ho kenyelletsa lisele tse bonolo esita le capsule e kopanetsoeng sebakeng sa bonyane sa 1.

2. Sefate sa tibial se kopantsoe le moeli o ka pele oa meniscus ea bohareng ka mokokotlo oa lengole 'me o etsa sebaka se sireletsehileng ka holimo ho tibial tuberosity ho fihlela ntlheng ena. Haeba ntlha ea lipekere e le haufi haholo le holimo kapa bophara ba sepekere sa intramedullary se le seholo haholo, se ka baka tšenyo ho mehaho ea intra-articular, e leng se bakang bohloko ba mangole ka mor'a ho buuoa.

3. Proximal protrusion ea intramedullary Nail le heterotopic ossification ke lisosa tse ka sehloohong tsa bohloko ba letheka ka mor'a ho buuoa ka botšehali ba intramedullary.

4. Ho phatloha ho hoholo ha lipekere tsa intramedullary, ho halefisoa ha lipekere tsa proximal le ho kena-kenana le rotator cuff ke tsona lisosa tse ka sehloohong tsa bohloko ba mahetla ka mor'a hore humeral intramedullary nailing.