Misinya ya milawu ya xisekelo ya ku belela endzeni ka medullary
1. Matimu ya ku beleriwa ka intramedullary
Hi 1910, ku tirhisiwile swipikiri swa Lilienthal aluminium intramedullary ku tshungula ku tshoveka ka femoral shaft.
Hi 1913, Schone u tirhise swipikiri swa silivhere leswi nga endzeni ka medullary ku tshungula ku tshoveka ka mavoko ya le mahlweni.
Kuntscher (1900-1972) u hoxe xandla swinene eka ku khomiwa ka swipikiri endzeni ka medullary.
Malembe ya va 1960 na va 1970 a ku ri nkarhi wa ku kula hi xihatla ka swipikiri swa intramedullary.
tiko ra mina ri ti tirhisa hi xitalo ku sukela hi va 1990s.
2. Ku hunguta loku pfulekeke na ku hunguta loku pfalekeke
1. Ku tshoveka ka swirho ku nga hungutiwa hi vuhandzuri ehansi ka ku vona hi ku kongoma kumbe ku pfala ehansi ka ku vekiwa tihlo ka X-rheyi.
2. Nkarhi wo hola ka ku tshoveka ka ku hunguta loku pfulekeke wu lehe swinene, ku huma ngati loko ku endliwa vuhandzuri ku tele naswona ku hunguta loku pfulekeke ku ya emahlweni ku onha mphakelo wa ngati ku ya emakumu ka ku tshoveka.
3. Swi hlohleteriwa ku tirhisa ku hunguta loku pfalekeke hi laha swi kotekaka ha kona. Ku nga tirhisiwa xihunguti xa ku koka, kutani ku tsemiwa lokutsongo ku nga endliwa eka xiphemu xa ku tshoveka leswaku ku ta pry ni ku hunguta, xisweswo ku hunguta ku kavanyeteka ka mphakelo wa ngati emakumu ka ku tshoveka.
4. Eka ku tsandzeka ka ku hunguta loku pfalekeke, ku rhendzeleka ka swiphemu swa marhambu kumbe ku tlhava tinyama leti rhendzeleke, na swiphemu leswikulu swa ku tshoveka leswi rhurheriweke, ku hunguta ku pfuleka hi vuhandzuri ku nga tirhisiwa.
1. Ndlela yo khoma swipikiri endzeni ka medullary i ku khoma ka xipikiri xa le xikarhi hi ndlela ya symmetrical.
2. Ku khomiwa ka ku tshoveka hi xipikiri xa intramedullary i ku khomiwa loku hangalasaka ntshikilelo, ku nga ri ku khomiwa loku sirhelelaka ntshikilelo, leswi pfunaka eka ku vumbiwa ka callus.
3. Central fixation hi theoretically yi tlakukile kutlula cortical external fixation, leswinga hungutaka voko ra matimba, swihunguta ku humelela ka valgus angulation xikan’we naku tsandzeka ka internal fixation.
4. Ku khomiwa ka swipikiri endzeni ka medullary swi nyika xisekelo xa ku hunguta loku pfalekeke kumbe ku hunguta loku pfulekeke loku nga nyawuriki.
4.Swipfuno swa swipikiri swa intramedullary
1. Swiphiqo switsongo
2. Ku andlariwa ka mpimo wa swikombiso swa vuhandzuri
3. Ku tiya loku tiyeke
4. Vuleteri bya ntirho wa mahlangano bya le ku sunguleni
5. Ku rhwala ntiko ka ha ri emahlweni
6. Yinga tirhisiwa xikan’we na swin’wana swo khoma endzeni
Tinxaka ta Masungulo na Tithekiniki
1. Ku pfala na ku nga pfali swipikiri swa intramedullary
2. Dynamic na static ku pfala swipikiri swa intramedullary
3. Tithekiniki ta ku ndlandlamuxa medullary na non-medullary fixation
4. Tithekiniki to khoma leti pfulekeke na leti pfalekeke
Ku hlanganisa na ku nga hlanganisiwi
Swipikiri leswi tolovelekeke swa intramedullary swina axial stability yokahle xikan’we na matimba yale hansi ya torsional, kambe swina elasticity yokarhi naswona swinga hola endzhaku ka deformation, leswi vangaka ntsena nhlayo yintsongo ya intrabone sliding.
Ti interlocking intramedullary nails tina switandzhaku swo antswa swa anti-rotation na anti-compression, kutshamiseka kahle ka fixation, naswona ti fambisana na principle ya biological fixation. Ti tirhisiwa ngopfu eka marhambu yo leha ya swirho. Ngopfu ngopfu eka ti multi-segment na comminuted fractures, tina ku tshamiseka ko antswa kutlula ti intramedullary nails leti tolovelekeke.
Dynamization ya ku khomiwa ka static
Static locking intramedullary nails yi humesa stress masking yitsongo swinene naswona sweswi ngopfu ngopfu yi seketeriwa eka xiendlo lexi nga riki xa ntolovelo xa dynamization.
Eka ku tshoveka loku nga holangiki eka 6 kuya eka 8 wa tinhweti endzhaku ka vuhandzuri, in situ bone grafting kumbe ku siviwa ka expanded intramedullary nails hi dynamization switala kutirhisiwa.
Dynamization yinga tirhisiwa tani hi ndlela yo hlohletela ku hola ka fracture. A swi bumabumeriwi hi ntolovelo hikuva swi nga endla leswaku swirho swi koma ni ku onhaka ka ku rhendzeleka.
Ku andzisiwa ka marhambu na ku andzisiwa loku nga riki ka marhambu
Ku andzisiwa ka marrow swinga nghenisa swipikiri swa intramedullary leswingana diameter leyikulu xikan’we na matimba swinene, leswi pfunaka eka ndzetelo wa ntirho wosungula naswona swihunguta mpimo wa swipikiri leswi tshovekeke.
Ku andza ka marrow swinga humesa nhlayo leyikulu ya marhambu lawa yanga na osteoinductive effect, leswi pfunaka eka ku hola ka fracture.
Ku andza ka marhambu swita onha mphakelo wa ngati ya misiha ya swakudya na endosteal membrane, kambe misiha ya ngati yinga pfuxeta kuya hi cavity ya intramedullary nails. Ku ndlandlamuxiwa ka marhambu swi nga tlhela swi engetela ku famba-famba ka ngati eka misiha ya tinyama to olova leyi rhendzeleke, xisweswo swi hlohlotela ku hola ka ku tshoveka.
Ku anama ka marrow swi engetela swinene nkarhi wa ku tluleriwa na embolism, naswona swifanele kutirhisiwa hi vukheta eka ku tshoveka loku pfulekeke, ku vaviseka ko tala, na ku vaviseka loku rharhanganeke.
Swipfuno swa ku andzisiwa ka medullary
1 Endzhaku ka ku andzisiwa ka medullary, ndhawu leyi ku hlanganaka exikarhi ka xipikiri xa le ndzeni ka medullary ni marhambu ya engeteleka, leswi antswisaka ku tiya ka ku khomiwa.
2 Endzhaku ka ku andzisiwa ka medullary, ku nga tirhisiwa xipikiri xa intramedullary xa diameter leyikulu, leswi engetelaka matimba ya xipikiri xa intramedullary naswona swi hunguta mpimo wa swipikiri leswi tshovekeke.
3 Ku tshoveka ka marhambu endzhaku ka ku andzisiwa ka medullary swi nga hlohlotela ku vumbiwa ka marhambu lamantshwa, leswi pfunaka eka ku hola ka ku tshoveka.
Loko ku pimanyisiwa na swipikiri swa medullary expansion intramedullary, swipikiri leswinga andlariwangiki swa intramedullary swina swipfuno leswi landzelaka
1 Nkarhi wo koma wa vuhandzuri na ku huma ngati kutsongo.
2 Ku kavanyetiwa kutsongo eka ku khuluka ka ngati ya endosteal eka swiyimo leswi nga na ku vaviseka lokukulu ka tinyama to olova.
Xipikiri xa le ndzeni ka medullary lexi hlanganisiweke xa humeral
![5 misinya ya milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri]( "5 intramedullary nail application principles and surgical techniques")
Swikombiso swa swipikiri swa humeral
Swikombiso swa swipikiri swa humeral interlocking intramedullary eka vutshunguri bya ku tshoveka ka humeral shaft i: ku tshoveka loku nga na ku onhaka ka misiha na misiha, ku vaviseka ko tala, ku tshoveka loku nga tshamisekangiki, ku tshoveka ka pathological, na ku tshoveka ka proximal humeral.
Ndzhawu leyinga lulamisiwaka yisuka eka 2cm ehansi ka nhloko ya humeral kuya eka 3cm e henhla ka olecranon fossa. Unga hlawula ku yi lulamisa kusuka eka makatla hi antegrade intramedullary nail kumbe kusuka eka elbow hi retrograde nail.
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-1]( "5 intramedullary nail application principles and surgical techniques-1")
Swihlawulekisi swa swipikiri swa humeral
Maendlelo ya vuhandzuri yo khoma ku tshoveka ka humeral shaft kahlekahle i ku khoma ti plate na ku khoma swipikiri endzeni ka medullary.
Ku khomiwa ka ti plate swina swivumbeko swo tiya swa anti-rotation na anti-bending naswona switshamisekile swinene, kambe trauma ya vuhandzuri yikulu, ku koteka ka ku tluleriwa swile henhla, naswona radial nerve yi onhaka hiku olova.
Swipikiri swa manguva lawa leswi hlanganisaka na ku tipfalela swa humeral swi hlula swihoxo swa swipikiri leswi tolovelekeke swa le ndzeni ka medullary swo fana na ku nga tshamiseki ka axial, ku lawula ku rhendzeleka loku nga riki kahle, na xilaveko xa ku khomiwa loku engetelekeke, leswaku ku tshoveka ku tiya ku tiya, ku lahlekeriwa hi ngati ku va kutsongo, ku hluvula ka tinyama to olova ku va kutsongo, naswona ku andza ka medullary ku ringana na ku rhumeriwa ka marhambu ya ndhawu, ndzhwalo wu ringana yi hangalasiwa, callus yi humelela ka ha ri na nkarhi, naswona ku endla vutiolori lebyi tirhaka byi nga sunguriwa endzhaku ka vuhandzuri.
Xipikiri xa le ndzeni ka medullary lexi hlanganisiweke xa femoral
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-2]( "5 intramedullary nail application principles and surgical techniques-2")
Swikombiso swa swipikiri leswi hlanganisiweke swa femoral
Tinxaka hinkwato ta ku tshoveka 2cm ehansi ka trochanteric vertebra naswona kutlula 9cm kusuka eka nhlonge ya matsolo.
Ku tshoveka ka khale ka xiphemu xa le xikarhi xa femoral shaft.
Vavabyi lava nga na ku tsandzeka ka ku khomiwa ka le ndzeni ka pulati.
Swihlawulekisi swa xipikiri lexi hlanganisiweke xa femoral
Swipfuno swa michini
Voko ra matimba ra femoral interlocking intramedullary nail ro lulamisa ku tshoveka ri lehe ku tlula ra ti steel plates, naswona matimba ya hangalasiwa hi ku ringana eka axis ya le xikarhi ya marhambu hinkwawo, leyi nga oloviki ku yi gombonyoka no yi onha.
Swipikiri leswi pfala eka makumu hamambirhi ya xipikiri xa intramedullary swi endla leswaku marhambu ya vumba hinkwawo kusuka ehenhla kuya ehansi, naswona swipikiri swo pfala eka makumu yale kule swinga hunguta voko ra torque ra xipikiri xa intramedullary eka marhambu, swisivela ku koma na ku rhendzeleka, naswona swifikelela ku tiya lokukulu na ku tiya eka ku tiya ka ku tshoveka.
Gamma Interlocking Xipikiri xa le ndzeni ka medullary
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-3]( "5 intramedullary nail application principles and surgical techniques-3")
Swikombiso swa swipikiri swa gamma
Swi tirha eka tinxaka to hambana ta ku tshoveka ka peritrochanteric, ngopfu ngopfu ku tshoveka ka subtrochanteric.
Swikombiso swa xipikiri xa Gamma lexi andlariweke (xipikiri xo pfuxeta).
ku tshoveka ka subtrochanteric lokukulu, trochanteric loku hlanganisiweke na ku tshoveka ka femoral shaft.
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-4]( "5 intramedullary nail application principles and surgical techniques-4")
Swipfuno swa xipikiri xa Gamma
Yi endliwe hi ku hlanganisa sliding hip screw na thekinoloji ya intramedullary nail, xipikiri lexikulu xi le kusuhi na le ndzeni ka medullary cavity ku tlula dynamic hip plate, hikwalaho xipikiri xa Gamma xi fambisa ntiko wa muvabyi ekusuhi na femoral calcar ku tlula dynamic hip plate, leswi engetelaka matimba ya michini ya implant. Eka ku tshoveka ka subtrochanteric loku katsaka ku tshoveka ka medial cortical, xipikiri xa Gamma xi papalata xilaveko xa ku pfuxetiwa ka anatomy ya ku tshoveka, hikwalaho swa pfuna eka ku tshoveka ka intertrochanteric kumbe ku tshoveka ka subtrochanteric.
Ku beleriwa ka xirhendzevutani ka le ndzhaku ka intramedullary
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-5]( "5 intramedullary nail application principles and surgical techniques-5")
Swikombiso swa swipikiri swa femoral leswi tlhelelaka endzhaku
Ngopfu ngopfu yi tirhisiwa eka ku tshoveka ka supracondylar femoral, ku katsa na ku tshoveka ka supracondylar comminuted na ku tshoveka ka intercondylar 'T' na 'Y' loku katsaka vuandlalo bya articular.
Yinga tlhela yitirhisiwa eka ku tshoveka ka femoral ehansi ka isthmus ya femur.
Ku tshoveka ka femoral shaft, supracondylar femoral, na intercondylar endzeni ka 20CM kusuka eka nhlonge ya matsolo.
Lava va tsandzekeke ku vekiwa ka tipuleti.
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-6]( "5 intramedullary nail application principles and surgical techniques-6")
Swihlawulekisi swa retrograde femoral nailing
Supracondylar femoral fracture i ku tshoveka lokukulu loku nga na ku nonoka eka xo sungula, ku hunguta na xa vumbirhi, ku tiya ka le ndzeni loku tiyeke. Kuna ku humelela lokukulu ka swiphiqo swofana na fracture non-union na ku hlwela ku hola.
Retrograde interlocking intramedullary nailing i ndlela leyi tirhisiwaka ngopfu ku tshungula ku tshoveka ka distal femur eka malembe ya sweswinyana, leyi nga na ku tshamiseka lokunene ka michini, yi nga lawula kahle ku rhurha ka le ndzhaku na ku rhurha ka ku rhendzeleka ka makumu ya le kule ya ku tshoveka, naswona yi pfuneta eka ku famba ka mahlangano yo sungula.
Supracondylar combined femoral stem fracture yi lulamisiwile hi ku leha ka supracondylar intramedullary nailing, leswi tlhantlhaka xiphiqo lexi swi tikaka ku xi tlhantlha hi ku hlanganisa intramedullary nailing ya femur. Xitirhisiwa lexi xa olova ku xi tirhisa, xi pakanisa eku vekeni ka xona, xa tshembeka eka ku xi khoma naswona muvabyi a nga endla vutiolori bya matsolo lebyi tirhaka ka ha ri emahlweni endzhaku ka vuhandzuri.
Tibial interlocking swipikiri swa le ndzeni ka medullary
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-7]( "5 intramedullary nail application principles and surgical techniques-7")
Swikombiso swa ku beleriwa ka tibial
Ku tshoveka loku tiyeke exikarhi ka 1/3 wa tibia: ku tshoveka loku tsemakanyaka, ku tshoveka ko koma ka oblique, pseudarthrosis.
Ku tshoveka loku nga tshamisekangiki endzeni ka 60% wa ku leha ka tibia ya le xikarhi: ku tshoveka ekusuhi na metaphysis, ku tshoveka ko leha ka spiral, ku tshoveka ka segmental, ku tshoveka loku tshovekeke, ku tshoveka loku nga na swihoxo swa marhambu.
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-8]( "5 intramedullary nail application principles and surgical techniques-8")
Swihlawulekisi swa tibial nailing
Interlocking intramedullary nailing ya tibia yitirhisiwa ngopfu eka ku tshoveka ka mid tibia.
Hambi leswi yinga tlhelaka yitirhisiwa eka ku tshoveka ka tibia yale kusuhi nale kule, mpimo wa swiphiqo wule henhla, malunion yihumelela ngopfu, makumu ya fracture yana ≧1cm ya ku famba eka 1/2 wa timhangu, naswona 1/4 wa fixation ya tsandzeka.
Matsalwa ya vikile mbuyelo wo antswa wa ku tshoveka ka tibia ya le kule ku tlula ku tshoveka ka tibia ya le kusuhi endzhaku ka ku khomiwa ka fibula ka ntolovelo.
Maendlelo ya vuhandzuri
Ku lunghiselela switirhisiwa swo hlawuleka emahlweni ka vuhandzuri
Mubedo wa marhambu (mubedo wo koka) kumbe mubedo wa vuhandzuri wa fluoroscopic wa ntolovelo; xitirhisiwa xo tlherisela endzhaku; xitiyisekiso xa swifaniso.
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-9]( "5 intramedullary nail application principles and surgical techniques-9")
Ku hlawuriwa lokunene ka ku leha ka swipikiri swa intramedullary eka ti endoprostheses ta le mahlweni ka vuhandzuri
Radiograph
ku pima ku leha ka swirho swa le tlhelo
Diameter ya xipikiri xa le ndzeni ka medullary
ku anama ka isthmus ya x-rheyi
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-10]( "5 intramedullary nail application principles and surgical techniques-10")
Ku pima ku leha ka swipikiri swa le ndzeni ka medullary
1.Translucent ruler ku tiyimisela ehansi ka C-voko muchini
Makumu ya le kule ni ya le kusuhi ya marhambu a ma ri exikarhi ka miseve; mufumi a a fambisana ni diaphysis.
2.Ku pima ku leha kuya hi swikoweto swa le henhla ka miri
Femur: nhloko ya trochanter leyikulu → ndzhawu ya matsolo yale tlhelo kumbe pole yale henhla ya patella; tibia: ndhawu ya matsolo ya le xikarhi-le tlhelo → xiphemu xa le mahlweni xa nhlangano wa mavoko eka dorsiflexion ya nenge.
Thekiniki yo Nghenisa Swipikiri Intramedullary - Ndlela yo Nghena
Longitudinal axis ya medullary cavity eka layini yo kongoma
A yi nga ri ekusuhi ngopfu ni ndhawu yo nghena eka yona
Ku leha loku faneleke: dilated - long; undilated - yo koma
(Ku tiyisisiwa loku nga kongomangiki ka ndhawu yo nghena; ku hava ku anama ka pulp, ku hava nsirhelelo wa tinyama to olova lowu lavekaka)
Ndhawu yo nghena ya xipikiri ya le ndzeni ka medullary ya femoral leyi fambelanaka
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-11]( "5 intramedullary nail application principles and surgical techniques-11")
Ku lulamisiwa ka ndhawu yo nghena eka xipikiri xa parallel femoral intramedullary
Ku olovisiwa ka xirhendze na adduction
Ku tsemiwa ka longitudinal proximal eka trochanter leyikulu
A hi kule ngopfu endzhaku
Ku vekiwa ka pini ya nkongomiso
Ku vekiwa ka xisirhelelo xa tinyama to olova
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-12]( "5 intramedullary nail application principles and surgical techniques-12")
Ndhawu yo nghena ya xipikiri xa le ndzhaku xa femoral intramedullary
30° ku olovisiwa ka matsolo
Long axis ya guide pin eka tlhelo rin’we na medullary cavity ya distal femoral stem
Ku nghenisiwa ka pini ya Kirschner eka distal femur hiku tirhisa patellar ligament hiku tirhisa sleeve yo sirhelela: orthogonal - exikarhi ka intercondylar fossa ya femur; lateral - Layini ya Blumensaat
Ndhawu yo sungula ya PCL handle ko vaviseka
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-13]( "5 intramedullary nail application principles and surgical techniques-13")
Ndhawu yo nghena ya swipikiri ya tibial intramedullary leyi fambelanaka
Eka layini ya le xikarhi ya xirhendzevutana xa medullary
Margin yale mahlweni ya tibial plateau
Hi laha swi kotekaka ha kona handle ko onha ndhawu ya le henhla
Ku olovisiwa ka matsolo lokukulu
Ku tsemiwa ka tibial tuberosity-inferior pole ya patella kuya hi medullary cavity
Pfula medullary cavity: guide pin eka 15° kuya eka sagittal plane ya longitudinal axis ya tibial stem
Xiyimo xa xitiyisekiso xa xifaniso
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-14]( "5 intramedullary nail application principles and surgical techniques-14")
Maendlelo yo endla marrowing
Ku hunguta loku tirhisaka gezi
ku tshoveka lokuntshwa
Ku hungutiwa ka mavoko
ku tshoveka ka khale loku nga na pseudoarthrosis, sclerosis eka medullary cavity
Ku hava tourniquet ehansi ka inflexini
ku famba-famba ka ngati i xitofu lexinene ngopfu
Tithekiniki to tlhela ti veka ndhawu
Ku beleriwa ka le ndzeni ka medullary ka femoral loku fambisanaka
Swivangelo swa ku nonoka ku vuyisela ku tshoveka ka femoral
Ku phutsela ka tinyama to olova to tiya a swi pfumeleli ku nghena hi ku kongoma eka marhambu
Ndhawu yo nghena hi naliti a yi nge voniwi hi ku kongoma
Ku nghenisiwa ka mahlangano ya xirhendze → ku tsana ka iliac fascia → ku koma ka ku tshoveka
Ku hungutiwa ka ku tshoveka ka tibial
Ku tirhisiwa ka vukanganyisi
Ngopfu ngopfu yiva ehansi ka nhlonge naswona swa olova ku yi khoma
Ku tshoveka loku tiyeke - ku tshoveka ka muxaka wa A na B exikarhi kumbe ekule
Ku tshoveka ka oblique - ku dlaya ku tlula mpimo
Intramedullary nailing→switirhisiwa swo rhurhela
Magoza ya ku hunguta lama pfunetaka
Ti forceps to hunguta tinhla
tibia; ku tirhisiwa ka percutaneous kumbe swilondza
Switirhisiwa leswikulu swo tlherisela endzhaku (swisirhelelo) .
ku hungutiwa loku hlweleke; ku koma ka swirho
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-15]( "5 intramedullary nail application principles and surgical techniques-15")
Swikwirikiri swa Schanz swa nkarhinyana
1 Xirhendzevutani, tibia
2 Kusuhi na layini yo tshoveka hilaha swinga kotekaka hakona
3 Ku tshoveka ka le kusuhi ku tirhisiwa ka cortical yin’we
4Tirhisa chuck ya universal leyingana T-handle kuva yi olova ku manoeuver
Xipikiri xa poller
1Ku tshoveka ka metaphyseal (ku lulamisa layini ya matimba, ku tiyisisa ku vuyiseriwa, ku vuyisela ntirho) .
2 ku tshoveka loku oblique ka tibia ya le kule kumbe femur (ntshikelelo wa ku tsemeta → ntshikelelo) .
3 Swipikiri swa le ndzeni ka medullary leswi nga vekiwangiki kahle swi nghena eka xiteji xa khale xa medullary hi nkarhi wa vuhandzuri bya vumbirhi
4 Ndhawu yo nghena yo biha, ku nga ringani kahle ka ku tshoveka ka le kusuhi (xikurufu lexi vekiweke hi ku kongoma eka ku rhurha loku nga kotekaka ka endoplant) .
Tourniquet yo anama swinene
1 xirho xa le ndzeni xa tibia
2 yi engeteriwa hi traction kumbe retractor
3 Tirhisa hi vukheta eka ku vaviseka lokukulu ka tinyama to olova
4 Yi hlayise yi koma
5 Ku yirisa ku andzisiwa ka medullary eka xiyimo xa inflated
![5 milawu ya ku chela swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri16]( "5 intramedullary nail application principles and surgical techniques16")
Ntlhandlamano wa ku pfala swipikiri: distal then proximal
Swipfuno swa kona
ku olova ka knockback, ku tshikileriwa ka ku tshoveka ka ku tshoveka; ku herisiwa ka ku hambana; matirhelo yo hunguta.
Tithekiniki to hunguta vuhandzuri byo hlwela & lebyi nga hlanganisiwangiki
Swiphiqo leswi nga ha hlanganaka na swona loko vuhandzuri byi hlwela
Ku onhaka ka axial (ku koma, ku angula na kumbe ku rhurha) .
Ku kula eka ka tinyama ta granulation
Swirhumbana swa marhambu swa le ku sunguleni
Sclerosis ya ku tshoveka yi tshoveka hi ku pfala ka medullary cavity
Vuvabyi bya marhambu
Swiphiqo leswi nga ha vaka kona loko ku endliwa vuhandzuri
Ku hambuka ka expander na xipikiri xa le ndzeni ka medullary → ku nghena ka xipikiri xa le ndzeni ka medullary ya cortex
Ku onhaka ka angular → retractor
Ku tshoveka ka makumu lama tsemiweke → Xipikiri xa Poller, ku khomiwa ka pulati
Maendlelo yo sivela milayeni ya matimba leyi nga tolovelekangiki
Proximal - ndhawu yo nghena leyinene
Distal - xipikiri xa intramedullary exikarhi ka medullary cavity
![5 milawu ya ku cheriwa ka swipikiri endzeni ka medullary na tithekiniki ta vuhandzuri-17]( "5 intramedullary nail application principles and surgical techniques-17")
Swiphiqo swa Intramedullary Nailing
★Ku tluleriwa hi vuvabyi
★Ku onhaka ka misiha
★Ku hola loku soholotiweke ka ku tshoveka
★Ku Pfuxetiwa ka Vutshunguri
Ku rhendzeleka ka le handle, torsion, valgus, ku rhendzeleka ka le ndzeni, angulation
★Ku vava ka mahlangano ya le kusuhi
★Ku khomiwa hi vuvabyi bya mafurha
★Ku endliwa ka marhambu hi heterotopic
★Ku va na vuvabyi bya embolism bya mahahu
★Ku tlhela ku tshoveka
★Ku va na thrombosis
★Ku tsana ka mahlangano
★Non-union ya ku tshoveka, marhambu nonunion
★Ku tsandzeka ka ku lulamisiwa ka le ndzeni
★Ku koma ka swirho
★Swin'wana
Swiphiqo--Ku tluleriwa
1.Eku sunguleni, ku tshoveka loku pfulekeke a ku tekiwa tanihi xikombiso lexi lwisanaka ni ku belela endzeni ka medullary.
2.Ku humelela ka ku tluleriwa endzhaku ka vuhandzuri eka ku tshoveka loku pfulekeke swi ya hi xiyimo xa ku vaviseka ka tinyama to olova na ku thyakisa
Ku humelela ka ku tluleriwa endzhaku ka ku tshoveka loku pfulekeke swiya hi xiyimo xa ku vaviseka ka tinyama to olova xikan’we naku thyakisa xikan’we na ndlela leyi tinyama to olova ti lawuriwaka ha yona.
3.Thinner intramedullary nails ti engetela nkarhi wo tluleriwa; non-expanded locking intramedullary nails fixation a yi kahle ngopfu, naswona makumu ya marhambu ya na
Ku khomiwa ka swipikiri leswinga andlariwangiki leswinga pfaleriwa endzeni ka medullary aswi kahle ngopfu, laha kungana ku fambafamba ka microscopic ka makumu lawa ya tshovekeke ya marhambu xikan’we na residual cavity, leswi olovaka eka kukula ka ti bacteria.
4. Ku tirhisiwa ka expanded na limited expanded medullary fixation a swi antswisi ntsena ku tshamiseka ka ku tshoveka, kambe swi tlhela swi papalata ku tumbuluxiwa ka ndhawu leyi feke.
Xiphiqo xa Fat Embolism
1.Ku humelela ka FES ya ku tshoveka ka marhambu yo leha ya ti tubular i 0.5% kuya eka 2%.
2. Ku andzisiwa ka medulla na ku nga andzisi ka medulla a swi na vuyelo lebyikulu eka ku nghenisiwa ka moya wa mahahu.
3.Loko u ndlandlamuxa medulla, thekiniki yifanele kuva yi hlanganisiwa hiku olova, ku papalata matimba yotala swinene xikan’we naku tirha hindlela yoka yingari kahle.
4.ku kumiwa ka sweswi ka FES ka ha amukela swipimelo leswi ringanyetiweke hi Gurd hi 1974, naswona vutshunguri endzhaku ka ku kumiwa byi ta hlwela nkarhi lowunene wa vutshunguri naswona byi nga va na switandzhaku swo tika.
Ku hlwela ku hola ka ku tshoveka na ku nga hlangana ka marhambu
Swilo swohambana hambana swi khumba ku hola ka ku tshoveka endzhaku ka ku khomiwa ka swipikiri endzeni ka medullary, naswona swivangelo swinga kamberiwa hindlela leyi landzelaka.
1.soft tissue leyi nghenisiweke eka makumu ya fracture
2. Ku hambanisiwa ka makumu ya transverse fracture
3. Malembe ya ku dyuhala ya muvabyi
4. Ku tshoveka loku pfulekeke, ku vaviseka lokukulu ka tinyama to olova, hemodialysis ya ndhawu leyikulu kumbe ku tluleriwa.
5. Ku nga khomi kahle ka swipikiri swa intramedullary
6. Vuvabyi bya chukele lebyi hlanganisiweke kumbe mavabyi man’wana lama dyaka.
Ku Pfuxetiwa ka Vutshunguri
Ku tshoveka loku vangiwaka hi vutshunguri ngopfu ngopfu i ku tshoveka ka vumbirhi loku vangiwaka hi ku tirhisiwa loku nga fanelangiki hi nkarhi wa ku khomiwa ka swipikiri endzeni ka medullary.
Ku fanele ku nyikiwa nyingiso wa le ndzeni ka vuhandzuri
1. Ku hlawuriwa loku nga kongomangiki ka ndhawu yo nghena eka xipikiri swi nga endla leswaku ku tshoveka ka le kusuhi.
2. U nga susumeti hi matimba eka ku andzisiwa ka medulla.
3. Ku nghena ka ku andzisiwa ka pulp ku fanele ku va eka tlhelo leri fanaka na tlhelo ra ku nghenisiwa ka swipikiri.
4. U nga tirhisi matimba loko u nghenisa swipikiri swa le ndzeni ka medullary emakumu ya le kule.
Ku vava eka mahlangano lama nga ekusuhi
1. Ku vekiwa ka xipikiri xa le ndzeni ka medullary swi katsa tinyama to olova hambi ku ri capsule ya mahlangano ekusuhi ni nhlonge yin’we.
2. Tibial plateau yihlanganisiwa na anterior edge ya medial meniscus hi transverse knee ligament naswona yi endla ndzhawu leyi hlayisekeke ehenhla ka tibial tuberosity kufikela eka ndzhawu leyi. Loko ndzhawu yo belela yiri ekusuhi swinene nale henhla kumbe diameter ya intramedullary nail yiri yikulu swinene, swinga vanga ku onhaka eka swivumbeko swa intra-articular, leswi endlaka leswaku kuva na ku vava ka matsolo endzhaku ka vuhandzuri.
3. Ku humelela ka le kusuhi ka xipikiri xa le ndzeni ka medullary na heterotopic ossification i swivangelo leswikulu swa ku vava ka xirhendze endzhaku ka vuhandzuri bya xipikiri xa le ndzeni ka medullary ya femoral.
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