Imigaqo ye-5 ye-intramedullary yesicelo kunye nobuchule botyando!

Imigaqo esisiseko ye-intramedullary nailing

1. Imbali ye-intramedullary nailing

Ngomnyaka we-1910, izikhonkwane ze-aluminiyam ye-Lilienthal ze-intramedullary zazisetyenziselwa ukunyanga i-femoral shaft fractures.

Ngo-1913, uSchone wasebenzisa izikhonkwane zesilivere ze-intramedullary ukunyanga iifractures ze-forearm. 

I-Kuntscher (1900-1972) yenza igalelo elikhulu kwi-intramedullary nail fixation. 

I-1960 kunye ne-1970 yayiyixesha lokuphuhliswa ngokukhawuleza kwezipikili ze-intramedullary. 

ilizwe lam belizisebenzisa ngobuninzi ukusukela ngeminyaka yoo-1990.

2. Ukunciphisa okuvulekileyo kunye nokunciphisa okuvaliweyo

1. Ukuphuka kwemilenze kungancitshiswa ngotyando phantsi kombono othe ngqo okanye kuvalwe phantsi kwe-X-ray esweni.

2. Ukuvula ukuncipha kwexesha lokuphulukisa i-fracture lide kakhulu, ukopha kwe-intraoperative kuninzi, kunye nokunciphisa okuvulekileyo kutshabalalisa ngakumbi ukunikezelwa kwegazi ukuya ekupheleni kokuphuka.

3. Kucetyiswa ukuba kusetyenziswe ukunciphisa okuvaliweyo kangangoko kunokwenzeka. I-traction reducer ingasetyenziswa, okanye i-incision encinci ingenziwa kwi-plane fracture ukuze i-pry kwaye inciphise, ngaloo ndlela inciphisa ukuphazamiseka kwegazi ukuya ekupheleni kokuphuka.

4. Ukungaphumeleli kokunciphisa okuvaliweyo, i-bone fragment flipping okanye ukubhoboza izicubu ezijikelezileyo, kunye neziqhekeza ezinkulu ezifudukayo, ukunciphisa utyando oluvulekileyo lunokusetyenziswa.

3. Indlela yokulungisa ye isikhonkwane se-intramedullary

1. Indlela ye-intramedullary nail fixation yangaphakathi i-symmetrical central internal splint fixation.

2. Ukulungiswa kweqhekeza nge-intramedullary nail kukulungiswa kokusabalalisa uxinzelelo, kungekhona ukulungiswa koxinzelelo-ukukhusela, okulungele ukubunjwa kwe-callus.

3. Ukulungiswa okuphakathi kuphezulu ngokwethiyori kwi-cortical yangaphandle yokulungiswa, enokunciphisa ingalo yamandla, ukunciphisa iziganeko ze-valgus angulation kunye nokungaphumeleli kokulungiswa kwangaphakathi.

4. Ukulungiswa kwe-Intramedullary nail kunika isiseko sokunciphisa okuvaliweyo okanye ukunciphisa okuvulekileyo okuncinci.

4.Izinto eziluncedo zezikhonkwane ze-intramedullary

1. Iingxaki ezimbalwa

2. Umda owandisiweyo wezalathisi zotyando

3. Ukulungiswa okuqinileyo

4. Uqeqesho lwangaphambili lomsebenzi odibeneyo

5. Ukuthwala ubunzima kwangoko

6. Ingasetyenziselwa ukudibanisa kunye nokunye ukulungiswa kwangaphakathi

Iintlobo ezisisiseko kunye nobuGcisa

1. Ukutshixa kunye nokungatshixi izikhonkwane ze-intramedullary

2. Izikhonkwane ze-intramedullary zokutshixa ezinamandla kunye ne-static

3. Ukwandiswa kwe-Medullary kunye neendlela zokulungiswa kwe-non-medullary

4. Iindlela zokulungisa ezivulekileyo nezivaliweyo

Ukudibanisa kunye nokungadibanisi

Izikhonkwane eziqhelekileyo ze-intramedullary zinozinzo olulambathayo lwe-axial kunye namandla aphantsi okuguqa, kodwa ano-elasticity ethile kwaye anokubuyisela emva kokuguqulwa, okubangela kuphela inani elincinci le-intrabone sliding.

Izikhonkwane ze-intramedullary ezidibeneyo zineempembelelo ezingcono zokuchasana kunye ne-anti-compression, ukuzinza okulungileyo, kunye nokuhambelana nomgaqo wokulungiswa kwezinto eziphilayo. Zisetyenziswa kakhulu kumathambo amade emilenze. Ngokukodwa kwi-multi-segment kunye ne-fractures comminuted, banokuzinza okungcono kunezikhonkwane eziqhelekileyo ze-intramedullary.

Ukwenziwa kwe-static fixation

Izikhonkwane zokutshixa eziqinileyo ze-intramedullary zivelisa imaski encinci yoxinzelelo kwaye okwangoku zikhuthazwa kakhulu isenzo esingesosiqhelo sokwenza amandla.

Ukuqhekeka okungakhange kuphole kwiinyanga ezi-6 ukuya kwii-8 emva kokusebenza, kwi-situ bone ukuxutywa okanye ukutshintshwa kwezikhonkwane ezandisiweyo ze-intramedullary kunye ne-dynamization isetyenziswa ngokuqhelekileyo.

I-Dynamization ingasetyenziselwa njengendlela yokukhuthaza ukuphiliswa kwe-fracture. Ayikhuthazwa ngokuqhelekileyo kuba inokukhokelela ekunciphiseni amalungu kunye nokukhubazeka okujikelezayo.

Ukwandiswa komongo kunye nokwandiswa okungewona umongo

Ukwandiswa komongo kunokufaka izikhonkwane ze-intramedullary ezinobubanzi obukhulu kunye namandla amakhulu, okuhambelana nokuqeqeshwa kwangaphambili kokusebenza kunye nokunciphisa izinga lezipikili eziphukileyo.

Ukwandiswa komongo kunokuvelisa inani elikhulu leemfucumfucu zethambo kunye ne-osteoinductive effect, ehambelana nokuphulukiswa kwe-fracture.

Ukwandiswa komongo kuya konakalisa unikezelo lwegazi lwemithambo yezondlo kunye ne-endosteal membrane, kodwa imithambo yegazi inokuvuselela ecaleni komngxuma wezikhonkwane ze-intramedullary. Ukwandiswa komongo kunokonyusa ukujikeleza kwegazi kwizihlunu ezithambileyo ezijikelezayo, ngaloo ndlela kukhuthaze ukuphiliswa kokwaphuka.

Ukwandiswa komongo kwandisa amathuba okusuleleka kunye ne-embolism, kwaye kufuneka kusetyenziswe ngononophelo kwiindawo ezivulekileyo, ukwenzakala okuphindaphindiweyo, kunye nokulimala okuyinkimbinkimbi.

Izinto ezilungileyo zokwandiswa kwe-medullary

① Emva kokwandiswa kwe-medullary, indawo yoqhagamshelwano phakathi kwesikhonkwane se-intramedullary kunye nethambo iyanda, ephucula ukuzinza kokulungiswa. 

② Emva kokwandiswa kwe-medullary, i-diameter enkulu ye-intramedullary nail ingasetyenziswa, eyandisa amandla e-intramedullary nail kunye nokunciphisa izinga lezipikili eziphukileyo. 

③ Inkunkuma yamathambo emva kokwandiswa kwe-medullary inokubangela ukubunjwa kwamathambo amatsha, okubangela ukuphiliswa kokwaphuka.

Xa kuthelekiswa nokwandiswa kwe-medullary iinzipho ze-intramedullary, iinzipho ze-intramedullary ezingandiswanga zinezi nzuzo zilandelayo

① Ixesha elifutshane lokusebenza kunye nokopha okuncinci. 

② Ukuphazamiseka okuncinci kwi-endosteal blood flow kwiimeko ezinokulimala okukhulu kwezicubu ezithambileyo.

Ukusetyenziswa kwe isikhonkwane se-intramedullary

I-humeral edibeneyo yesikhonkwane se-intramedullary

Iimpawu ze-humeral iinzipho

Iimpawu ze-humeral interlocking intramedullary nails kunyango lwe-humeral shaft fractures zezi: iifractures kunye nomonakalo we-vascular and nerve, ukulimala okuphindaphindiweyo, ukuphuka okungazinzanga, i-pathological fractures, kunye ne-proximal humeral fractures.

Uluhlu olunokulungiswa luvela kwi-2cm ngaphantsi kwentloko ye-humeral ukuya kwi-3cm ngaphezu kwe-olecranon fossa. Unokukhetha ukuyilungisa ukusuka ehlombe nge-antegrade intramedullary nail okanye kwi-elbow nge-retrograde nail.

Iimpawu zezikhonkwane ze-humeral

Iindlela zokulungisa utyando lwe-humeral shaft fractures zisisiseko sokulungiswa kwepleyiti kunye nokulungiswa kwe-intramedullary nail.

Ukulungiswa kweplate kunamandla okuchasa ukujikeleza kunye nokuchasa ukugoba kwaye kuqiniswe ngokuqinileyo, kodwa ukuxhatshazwa kokuhlinzwa kukhulu, amathuba okuba usulelo luphezulu, kwaye i-nerve ye-radial yonakaliswa lula.

Izikhonkwane zanamhlanje ze-humeral ezidibeneyo kunye ne-self-locking zinqoba iintsilelo zezikhonkwane eziqhelekileyo ze-intramedullary ezifana nokungazinzi kwe-axial, ukulawulwa okujikelezayo okungahambi kakuhle, kunye nesidingo sokulungiswa okongeziweyo, ukwenzela ukuba i-fracture igxininiswe ngokuqinileyo, ukulahleka kwegazi kuncinci, ukuhluthwa kwezicubu ezithambileyo kuncinci, kunye nokwandiswa kwe-medullary kufana nomthwalo owenziweyo wendawo, i-transplantation esebenzayo ibonakala ngokukhawuleza. kuqalwe emva kotyando.

I-Femoral interlocking intramedullary nail

Izibonakaliso zezikhonkwane ezidibeneyo ze-femoral

Zonke iintlobo zeefractures 2cm ngaphantsi kwe-trochanteric vertebra kwaye ngaphezu kwe-9cm ukusuka kwidolo elihlangeneyo.

Iifractures ezindala zenxalenye ephakathi ye-femoral shaft.

Izigulane ezinepleyiti engaphumelelanga ukulungiswa kwangaphakathi.

Iimpawu zesikhonkwane esidibeneyo se-femoral

Iinzuzo zoomatshini

Ingalo yamandla ye-femoral interlocking intramedullary nail yokulungisa i-fractures ide kuneepleyiti zensimbi, kwaye amandla asasazwa ngokulinganayo kwi-axis ephakathi kwethambo lonke, elingelula ukugoba kunye nokukhubazeka.

Izikhonkwane zokuvala eziphelweni zombini zesikhonkwane se-intramedullary zenza ukuba ithambo libe yinto yonke ukusuka phezulu ukuya ngasezantsi, kwaye izikhonkwane zokutshixa ekupheleni kwe-distal zinganciphisa ingalo ye-torque yesikhonkwane se-intramedullary kwithambo, ukuthintela ukunciphisa kunye nokujikeleza, kunye nokufezekisa ukuzinza okuphezulu kunye nokuqina kokulungiswa kwe-fracture.

Isikhonkwane seGamma esinxibelelanayo se-Intramedullary

Izikhonkwane zeGamma izibonakaliso

Isebenza kwiintlobo ezahlukeneyo ze-peritrochanteric fractures, ngakumbi i-subtrochanteric fractures.

Ukwandiswa kwesikhonkwane se-Gamma (isikhonkwane sokwakha kwakhona) izibonakaliso

iifractures eziphezulu ze-subtrochanteric, i-trochanteric edibeneyo kunye ne-femoral shaft fractures.

Izinto ezilungileyo zeGamma isikhonkwane

Iphuhliswe ngokudibanisa i-sliding hip screw kunye ne-intramedullary nail technology, isikhonkwane esiphambili sisondele ngaphakathi kwi-medullary cavity kune-plate ye-hip eguquguqukayo, ngoko i-Gamma nail iqhuba ubunzima besigulane kufuphi ne-calcar ye-femoral kune-plate ye-hip eguqukayo, ukwandisa amandla omatshini wokufakelwa. Ngokwaphuka kwe-subtrochanteric ebandakanya ukuhamba kwe-cortical ye-medial, isikhonkwane se-Gamma sinqanda isidingo sokwakhiwa ngokutsha kwe-anatomy ye-fracture, ngoko kunenzuzo kwi-intertrochanteric fractures okanye i-subtrochanteric fractures.

Retrograde intramedullary femoral nailing

Izibonakaliso ze-retrograde femoral iinzipho

Isetyenziswa kakhulu kwi-supracondylar femoral fractures, kubandakanywa i-supracondylar comminuted fractures kunye ne-intercondylar 'T' kunye 'Y' kunye neefractures ezibandakanya i-articular surface.

Ingasetyenziselwa ukuphuka kwe-femoral ngezantsi kwe-isthmus ye-femur.

I-Femoral shaft, i-supracondylar femoral, kunye ne-intercondylar fractures ngaphakathi kwe-20CM ukusuka kwidolo elihlangeneyo.

Abo basileleyo ukulungisa ipleyiti.

Iimpawu ze-retrograde femoral nailing

I-Supracondylar femoral fracture yi-fracture enzima kunye nobunzima bokuqala, ukunciphisa kwaye okwesibini, ukulungiswa okunamandla kwangaphakathi. Kukho izehlo eziphezulu zeengxaki ezifana ne-fracture non-union kunye nokulibaziseka ukuphilisa.

I-Retrograde interlocking intramedullary nailing yindlela esetyenziswa ngokuqhelekileyo yokunyanga i-distal femur fracture kwiminyaka yamuva nje, enozinzo oluhle lomatshini, inokulawula ngokufanelekileyo ukufuduka kwangasemva kunye nokujikeleza okujikelezayo kwesiphelo se-distal ye-fracture, kwaye inceda kwintshukumo yokuqala yokubambisana.

I-Supracondylar edibeneyo ye-femoral stem fracture igxininiswe kunye ne-longened supracondylar intramedullary nailing, eyisombulula ingxaki enzima ukuyisombulula ngokudibanisa i-intramedullary nailing of the femur. Isixhobo silula ukusebenza, sichanekile ekumiseni, sithembeke ekulungiseni, kwaye isigulane sinokwenza ukuqeqeshwa kwamadolo kwangaphambili emva kokuhlinzwa.

Izikhonkwane ze-intramedullary ezidibeneyo zeTibial

Iimpawu zokubethelwa kwe-tibial

Iifractures ezizinzileyo phakathi kwe-1/3 ye-tibia: iifractures ezinqamlekileyo, iifractures ezimfutshane ze-oblique, i-pseudarthrosis.

Ukuqhekeka okungazinzanga ngaphakathi kwe-60% yobude be-tibia ephakathi: iifractures kufuphi ne-metaphysis, i-long spiral fractures, i-segmental fractures, i-fractures comminuted, i-fractures eneziphene zamathambo.

Iimpawu ze-tibial nailing

I-interlocking intramedullary nailing of tibia isetyenziswa kakhulu kwi-mid tibia fractures.

Nangona ingasetyenziselwa ukuphulwa kwe-proximal kunye ne-distal tibia fractures, izinga lobunzima liphezulu, i-malunion iyenzeka ngokuphindaphindiweyo, isiphelo se-fracture sine-≧1cm yokunyakaza kwi-1/2 yamatyala, kwaye i-1/4 yokulungiswa ayiphumelelanga.

Uncwadi luchaze iziphumo ezingcono zokuqhekeka kwe-distal tibia kunokwaphuka kwe-tibia esondele emva kokulungiswa kwe-fibula.

Ubuchule botyando

Ukulungiswa kwangaphambili kwezixhobo ezikhethekileyo

Ibhedi ye-Orthopedic (ibhedi yokutsala) okanye ibhedi eqhelekileyo yotyando lwe-fluoroscopic; iretractor umfanekiso wokuqinisa.

Ukhetho oluchanekileyo lwe-intramedullary nail length for preoperative endoprostheses

Radiograph

umlinganiselo wobude belungu eliphambeneyo

I-Intramedullary nail diameter

x-reyi isthmus ububanzi

Umlinganiselo wobude bezikhonkwane ze-Intramedullary

1.Ukuzimisela kwerula e-Translucent phantsi komatshini we-C-arm

Iziphelo ezikude kunye nezisondeleyo zethambo zazisembindini we-ray; umlawuli wayehambelana ne-diaphysis.

2.Umlinganiselo wobude ngokweempawu zomphezulu womzimba

I-Femur: incam ye-trochanter enkulu → isithuba sedolo elisecaleni okanye ipali ephezulu yepatella; i-tibia: i-medial-lateral knee space → inkalo yangaphambili ye-ankle joint in dorsiflexion of foot.

UbuChwepheshe boFakelo lweNzipho kwi-Intramedullary-iNdlela yokuNgena

I-axis ye-longitudinal ye-medullary cavity kumgca othe ngqo

Ayisondele kakhulu kwindawo yokungena

Ubude obufanelekileyo: ukuhlanjululwa - ubude; engafakwanga - mfutshane

(Ukuqinisekiswa okungathanga ngqo kwendawo yokungena; akukho luhlambululo lwepulp, akukho khuseleko lwezicubu ezithambileyo ezifunekayo)

Indawo yokungena yezikhonkwane ye-femoral intramedullary

Ukulungiswa kwendawo yokungena kwi-parallel femoral intramedullary nail

I-hip flexion kunye ne-adduction

I-Longitudinal incision incision proximal ukuya kwi-trochanter enkulu

Hayi kude kakhulu emva

Ukubekwa kwephini lokukhokela

Ukubekwa kwesikhuselo sethishu ethambileyo

Retrograde femoral intramedullary nail point yokungena

30 ° ukuguquguquka kwedolo

I-axis ende ye-pin yesikhokelo kwicala elifanayo ne-medullary cavity ye-distal femoral stem

Ukufakwa kwe-Kirschner pin kwi-distal femur ngokusebenzisa i-patellar ligament ngokusebenzisa umkhono wokukhusela: i-orthogonal - phakathi kwe-intercondylar fossa ye-femur; ecaleni - umgca weBlumensaat

Indawo yokuqala ye-PCL ngaphandle kokulimala

I-Parallel tibial intramedullary nail entry point

Kumgca ophakathi we-medullary cavity

Umda wangaphambili we-tibial plateau

Iphezulu kangangoko ngaphandle kokonakalisa ithafa

Ubuninzi bedolo lokuguqa

I-incision tibial tuberosity-inferior pole yepatella ecaleni kwe-medullary cavity

Vula i-medullary cavity: i-pin yesikhokelo kwi-15 ° ukuya kwi-sagittal plane ye-axis yobude be-tibial stem.

Indawo yokuqinisa umfanekiso

Ubuchule bomongo

Ukunciphisa amandla ombane

iifractures ezintsha

Ukunciphisa ngesandla

ukwaphuka okudala kunye nepseudoarthrosis, i-sclerosis kwi-medullary cavity

Akukho tourniquet phantsi kokunyuka kwamaxabiso

ukujikeleza kwegazi sesona sipholileyo

Iindlela zokubeka ngokutsha

I-Parallel femoral intramedullary nailing

Izizathu zobunzima bokubuyisela ukuphuka kwe-femoral

Ukusonga iithishu ezithambileyo akuvumeli ukufikelela ngokuthe ngqo kwithambo

Indawo yokungena yenaliti ayinakubonwa ngokuthe ngqo

Ukunyuswa kwelungu le-hip → uxinzelelo lwe-iliac fascia → ukucutha ukwaphuka

Ukunciphisa i-Tibial fracture

Ukulawula

Ikakhulu i-subcutaneous kwaye kulula ukuyiphatha

Ukwaphuka okuzinzile - phakathi okanye i-distal A kunye nohlobo lwe-B uhlobo lokwahlukana

I-Oblique fractures - i-overkill

Ukubethelwa kwe-Intramedullary→izixhobo zokufuduswa

Amanyathelo okunciphisa ancedisayo

Amandla okunciphisa amanqaku

isifuba ukusebenzisa i-percutaneous okanye inxeba

iiretractor ezinkulu (iibrayisi)

ukulibaziseka ukuncitshiswa; ukunciphisa amalungu

Izikrufu zeSchanz zethutyana

① I-Femur, i-tibia

② Ngokusondeleyo kumgca wokuqhekeka ngokusemandleni

③ Ukuqhekeka okusondele kusetyenziso lwecortical enye

④Sebenzisa i-chuck yendawo yonke ene-T-handle ukuze uyiqhube lula

Isikhonkwane se-poller

① I-Metaphyseal fracture (ukulungisa umgca wamandla, ukuzinzisa ukubuyisela, ukubuyisela ukusebenza)

② ukuphuka kwe-oblique ye-distal tibia okanye i-femur (uxinzelelo lwe-shear → uxinzelelo)

③ Izikhonkwane ze-intramedullary ezibekwe kakubi zingena kumjelo we-medullary endala ngexesha lotyando lwesibini

④ Indawo yokungena engafanelekanga, ulungelelwaniso olubi lwezahlulo (isikruru esibekwe ngokusisigxina kwindawo enokwenzeka yokufuduswa kwe-endoplant)

I-tourniquet ebanzi ngakumbi

① isifuba

② ukuxhaswa ngokutsalwa okanye ukurhoxa

③ Sebenzisa ngononophelo kumonzakalo wezicubu ezithambileyo

④ Yigcine imfutshane

⑤ Ukuthintela ukwandiswa kwe-medullary kwimeko yokunyuka

Ulandelelwano lokutshixa iinzipho: i-distal ke proximal

Iingenelo

ukukhululeka kwe-knockback, ukunyanzeliswa kwekhefu lokuphuka; ukupheliswa kokwahlula; imisebenzi yokunciphisa.

Iindlela zokunciphisa utyando olulibazisekileyo kunye nolungekhoyo

Iingxaki ezinokudibana notyando olulibazisekileyo

I-axial deformity (ukunciphisa, i-angulation kunye okanye ukufuduswa)

Ukukhula kwezicubu zegranulation

Ukhwekhwe lokuqala lwamathambo

I-sclerosis yokwaphuka ikhefu kunye nokuvalwa kwe-medullary cavity

I-Osteoporosis

Iingxaki ze-intraoperative ezinokwenzeka

Ukuphambuka kwe-expander kunye ne-intramedullary nail → intramedullary nail ukungena kwi-cortex

Ukukhubazeka kwe-engular → iretractor

Ukushenxiswa kweziphelo ezicandiweyo → isikhonkwane sikaPoller, ukulungiswa kwepleyiti

Iindlela zokuthintela imigca yamandla engaqhelekanga

Iproximal - indawo yokungena echanekileyo

I-Distal - isikhonkwane se-intramedullary kumbindi we-medullary cavity

Iingxaki ze-Intramedullary Nailing

★Usulelo

★Umonakalo wemithambo-luvo

★Ukuphiliswa okugqwethekileyo kokwaphuka

★Ukwaphuka kwezonyango

Ukujikeleza kwangaphandle, i-torsion, i-valgus, ukujikeleza kwangaphakathi, i-angulation

★Intlungu edibeneyo yamalungu

★Amafutha embolism

★Heterotopic ossification

★I-Pulmonary embolism

★Ukwaphuka kwakhona

★Thrombosis

★Ukuqina kwamalungu

★Non-union of fracture, bone nonunion

★Ukusilela ukulungisa kwangaphakathi

★Ukunciphisa amalungu

★Okunye

Iingxaki--Usulelo

I-1.Early on, i-fractures evulekileyo yayithathwa njengento echasene ne-intramedullary nailing.

I-2.Isiganeko sokusuleleka emva kokuhlinzwa kwiifractures ezivulekileyo kuxhomekeke kwimeko yokulimala kwezicubu ezithambileyo kunye nokungcoliswa.

Isiganeko sokusuleleka emva kokuphuka okuvulekileyo kuxhomekeke kwimeko yokulimala kwezicubu ezithambileyo kunye nokungcoliswa kunye nendlela elawulwa ngayo izicubu ezithambileyo.

3.Izikhonkwane ze-intramedullary ezinqabileyo zonyusa ithuba lokusuleleka; Ukulungiswa kwezikhonkwane ze-intramedullary ezingandiselwanga kukutshixa kumbi kakhulu, kwaye iziphelo zethambo zine

Ukulungiswa kwezikhonkwane ze-intramedullary ezingenakwandiswayo kuncinci, kunye nentshukumo ye-microscopic yesiphelo esaphukileyo sethambo kunye ne-residual cavity, elula ekukhuleni kwebhaktheriya.

4. Ukusetyenziswa kokulungiswa kwe-medullary okwandisiweyo kunye nokulinganiselweyo akugcini nje ukuphucula ukuzinza kwe-fracture, kodwa kunqanda ukudala indawo efile.

I-Fat Embolism Syndrome

I-1.Iziganeko ze-FES zokuphuka kwamathambo e-tubula ende yi-0.5% ukuya kwi-2%.

2. Ukwandiswa kwe-medulla kunye nokunganyuki kwe-medulla akunayo impembelelo ebalulekileyo kwi-ventilation ye-pulmonary.

3.Xa ukhulisa i-medulla, ubuchule kufuneka buxove ngobunono, ukuphepha amandla amaninzi kunye nokusebenza kakubi.

I-4.ukuxilongwa kwangoku kwe-FES kusamkela imigaqo ecetywayo nguGurd kwi-1974, kwaye unyango emva kokuxilongwa luya kulibazisa ixesha elifanelekileyo lonyango kwaye lunokuba nemiphumo emibi.

Ukulibaziseka ukuphiliswa kokwaphuka kunye nokungabikho kwethambo

Izinto ezahlukahlukeneyo zichaphazela ukuphulukiswa kwe-fracture emva kokulungiswa kwe-intramedullary nail, kwaye izizathu zingahlalutywa ngolu hlobo lulandelayo.

I-1.izicubu ezithambileyo ezifakwe kwi-fracture end

2. Ukwahlulwa kweziphelo zokuqhekeka okunqamlezayo

3. Ubudala besigulane

4. Ukuqhekeka okuvulekileyo, ukwenzakala okukhulu kwezicubu ezithambileyo, i-hemodialysis enzulu yendawo okanye usulelo.

5. Ukulungiswa kwesikhonkwane kwi-intramedullary embi

6. I-diabetes mellitus edibeneyo okanye ezinye izifo ezidliwayo.

Ukwaphuka kwezonyango

Iifractures ezibangelwa ngunyango ikakhulu yizahlulo zesibini ezibangelwa ukuguqulwa okungafanelekanga ngexesha lokulungiswa kwe-intramedullary nail.

Ingqwalasela ye-intraoperative kufuneka ihlawulwe

1. Ukukhethwa okungachanekanga kwendawo yokungena yesikhonkwane kunokukhokelela ekuqhekekeni okusondeleyo.

2. Musa ukutyhala ngenkani ekwandiseni i-medulla.

3. Umnyango wokwandiswa kwe-pulp kufuneka ube kwicala elifanayo njengendlela yokufakwa kwezikhonkwane.

4. Musa ukusebenzisa amandla xa ufaka izikhonkwane ze-intramedullary kwi-distal end.

Iintlungu kumalungu angabamelwane

1. Ukubekwa kwesikhonkwane se-intramedullary kubandakanya izicubu ezithambileyo kunye ne-capsule edibeneyo kwindawo edibeneyo ubuncinane ye-1.

2. I-plateau ye-tibial ixhunywe kumda wangaphambili we-meniscus ephakathi nge-knee ligament kwaye yenza indawo ekhuselekileyo ngaphezu kwe-tuberosity ye-tibial ukuya kweli nqanaba. Ukuba indawo yokubethelwa isondele kakhulu phezulu okanye ububanzi besikhonkwane se-intramedullary bukhulu kakhulu, kunokubangela umonakalo kwizakhiwo ze-intra-articular, okubangelwa intlungu emva kokuhlinzwa.

3. I-proximal protrusion ye-intramedullary nail kunye ne-heterotopic ossification zizona zizathu eziphambili zentlungu ye-hip emva kokuhlinzwa kwe-femoral intramedullary nail.

4. I-proximal protrusion of intramedullary intramedullary, i-proximal locking irritation ye-nail irritation kunye nokuphazamiseka kwe-rotator cuff yizona zizathu eziphambili zeentlungu zegxalaba emva kwe-humeral intramedullary nailing.