I-Temoral Intramellary saising-Ungayikhetha njani eyona ndawo yokufakelwa?

Intshayelelo

Ukuphuhliswa kwendlela yokuqhekeka kwe-femoral inokuthi ilandelwe nge-1940s xa i-Kiscist yazisa ubuchule bokuthintela i-Intramedul. Ukusetyenziswa kwezipikili ze-intramellary (i-Inens) kwi-femoral quares iye yaba ngumgangatho wononophelo kwezi nyaka zimbalwa zidlulileyo, kunye nokuphuculwa okwangoku kwi I-Intramellary saising kunye nenkqubela phambili kwiindlela zokuhlinzwa zivumelekile ukuba zinyukele ekusebenziseni intramidlary yabenga i-femur.

Unyango lolondolozo lwezinto ze-stemral fectures zisetyenziswa kuphela kwinani elincinci lezigulana ezichasene ne-anesthesia notyando, kwaye eyona nto iphambili kunyango ihleli kunyango. Ngokuphathelele unyango lonyango lwala maqhekeza, zininzi iindlela onokukhetha kuzo, kubandakanywa i-Inramellary yabethe, ukulungiswa kwe-plates, kunye nokulungiswa kwangaphandle. Xa kuthelekiswa nolunye ukhetho lonyango, i-Intramellary yabekisi yindlela ephantsi kwenqanaba lokwenzakala eliphantsi kunye nenqanaba eliphezulu lokuphilisa, kwaye iya lisetyenziswa kakhulu kwikhondo leklinikhi.

Ukuqonda okuhle kwe-anatomy yommeli we-femur, igazi kwintloko yenyama kwaye i-anatomy yemisipha ye-Hip inokunyusa umgangatho wempumelelo ye-Intramellary. In contrast, the choice of entry point depends on many factors, including intramedullary nail design, fracture site, fracture comminution, and patient factors (eg, polytrauma, pregnancy, and obesity). Nokuba yeyiphi na indawo yokungena ekhethiweyo, ukufumana indawo efanelekileyo yokungena kubalulekile ukugcina ukuncitshiswa okwaneleyo ngexesha lokufakwa kwe-intramellary ngelixa kuncitshiswa umngcipheko wezipikili.

I-anatomy ye-anatomy

I-1.Blood isibonelelo kwintloko ye-themoral

Intloko yenyama ifumana ubonelelo lwe-vascular ukusuka kwimithambo emi-3 enkulu. I-Laterator ye-gotator ye-gogoral (ene-3-4 amasebe), umthambo we-Obtorator, onikezela i-ligament enyukayo enyukayo i-ofisi ye-gotator ye-gotatoral kwaye ibonelela ngendawo enkulu yeRotarteric.

I-2.natomy yemisipha ye-hip

Xa usenza i-Intramellary yabenga i-femur, ukuqonda okuhle kwezihlunu kule ndawo ijikeleze i-rotor kubalulekile ukuthintela ukwenzakala okungafunekiyo. I-Gluteus Medius umsipha ivela kwi-ILIIM kwaye iphela kwinxalenye ye-Treatter enkulu, ngelixa i-thouts ye-Gluteus ivela kwi-ilutium kwaye idlula kwi-Postenu ye-Posterity iphela kwi-Posterity ye-PROPTER (amanani 2 & 3). Zombini ezi zihlunu zisebenza njengabadukishi belitha kunye neendebe zangaphakathi ze-hip. Ke ngoko, ukonakaliswa kwezi zihlunu ngexesha lokufakelwa kwe-paracerallip ye-paraceralland kuya kukhokelela kubuthathaka bobuthathaka be-addheckis kunye ne-trandelenburg, eneempembelelo ezimbi kwi-GAIT, kunye nesiphumo sokubuyela kwimeko yesigulana kunye nesiphumo.

Umzobo 2. I-anatomy yemisipha ejikeleze i-hip edibeneyo

Umzobo 3

Pharallel feramel

Izifundo ezininzi zakutshanje ziye zavavanya inqaku elifanelekileyo lokungena kwi-paracraral sail. Ukhetho lwePosi lokuNgena kweZikitho lubandakanya i-trochanaster enkulu kunye ne-Pyriform Foma, nganye ineempawu zayo kunye neengxaki ezinxulumene noko (iTheyibhile 1).

Itheyibhile 1.Ukunyusa amanqaku kunye nomngcipheko onokubakho weParacrine kunye nokubuyisa i-fetroral
yahluka	pharamel ye-intramellary		Phinda ubuye kwi-Intramellary Nail
	rotor	I-Pyriform Fossa (Anatomy)
Indiza yesithsaba	I-vertex ye-trouchar enkulu kunye ne-poinctong medity cavity cavity cavity	Ukudibana kwe-trochanater enkulu kunye nentamo ye-femoral	I-Median ye- Concondylar fossa (anatomy)
Inqwelomoya ye-Sagittal (Math.)	Umgca phakathi kweziko le-rocharte enkulu kunye neziko le-femur	I-Pyriform Fossa (Anatomy)	I-PCL 1.2 CM yangaphakathi kwindawo yokuqalisa inqaku, likhomba kwi-cavity cavity.
ukuvezwa	I-hip atchertor ye-otportor yendawo yokulimala	Ukonakaliswa kwegazi kwintloko ye-femoral kunye ne-hip roust rosts	Ukuphatha okungafanelekanga kunokukhokelela kwi-PCL
I-PCL: Posteries Cruntelated Ligamente

1.Ukusebenza kwendawo yokungena ye-Bector

I-trouchar enkulu ichazwe njengeyona nto iphambili ye-trapezoidal bomny ye-protuberance ekhoyo kwi-Latelit yentanyeni, umphezulu onikezela ukunamathela kwi-Gluteus Medius Medius Medis Medius Medius Medis Medis Medis Medis Medis Medis Medius (amanani 2 no-3). Nangona le yi-Bicmark encinci yeBony, ukuba inqaku elichanekileyo lokuqalisa xa usenza umahluko phakathi kokufumana isiphumo esifanelekileyo okanye esibi xa usenza iqhekeza le-femm.

Ukuphononongwa koncwadi lwangoku lweenkcazo zenqanaba lokungena kwendawo, sifumana ukunqongophala kwe-anatomical yomhlaba echazwe ngokucacileyo kwi-thectoral rooting proo.barti et al. ichaze indawo yokungena kwi-Apex ye-APEX ye-APEX enkulu njenge-medial kwindawo yokungena kwi-trochastatic kwindawo engaphandle ye-theateral kwi-One-hip ye-Ontertal kwi-ANTATEN Isibini kwisithathu seRotor.gegisadis et al. ichaze inqaku lokungena kwenaliti njengeyona ndawo ingasentla ye-posterical ye-apical margin ye-rotor.

Umzobo 4. Imibono ye-Orthhostatic ye-Orthostatic kunye ne-HEATRAL ye-HIP ibonisa indawo yokungena ye-Pramoral ye-Pramomea kwi-Tradiser enkulu. '* ' ibonisa indawo yokungena kwi-intramellary.

Izifundo zamva nje kuncwadi zibonakalise ukuba i-apex ye-trochan enkulu yesona sithuba sifanelekileyo sokufumana umgca wokuziphatha, kwaye ukulungelelaniswa okungalunganga kokuphela kwexeshana ngaphezulu kwe-2 mm. Esi sifundo sigxininise ukuba indawo engasentla yokungena ikhokelela ekuqhubeni phambili kwi-discuntral yokuphuma, ngelixa inqaku lokungenela eliPhakathi linokubangela ibhloko ye-distal ye-discal. Ngokwahlukileyo koko, olunye uphononongo lubonise ukuba kwi-femur ye-ferrocancric fecture, imvakalelo ye-Inramellary ye-Inramellary yayingaphezulu kwendawo engaphandle kunendawo enamachaphaza akwenzeka kwi-medial kunye nendawo engasemva.

Indawo enkulu ye-Apenchteric Apexteric Apex isetyenziswa rhoqo kwizigulana ezityebileyo, kwaye le nkqubo ayifunwanga inyani, ibonelela ngexesha lokusebenza elincinci kunye nomngcipheko ophantsi we-Pyriform Fossa Prossa Prossa Prossa Prossa iPossa iPination.

Iingxaki: Iingxaki zokungena ngaphakathi kunye nendawo ezingezwe kwi-intstoperative kunye ne-Inraral Deramellary yokwahlulahlula inqaku eliphezulu le-rounsancricic lixoxwe kwiimpapasho ezininzi. Enye yazo, ihlala inxulumene nendlela yokufaka i-Nating, i-upractured forpes. Kwi-interacracharanricty themoral thesmoral, indawo yokungena efikelelweyo kwaye i-ANTER kwiRouchar enkulu inokwenzeka ukuba ichaphazele iqhekeza leMedial kunendlela yokungena.

Enye ingxaki efanelekileyo kukubakho ngenxa yokulimala kwe-tiss-tiss, ngakumbi kumasebe omnyama we-Medical Armoratol kunye ne-Addles, kodwa ezi ndlela zokulimala ziqhelekile xa kuthelekiswa nesipikili se-Pyriform Fossa. Ukongeza, izehlo ze-ischemic Necrosis yentloko yenyama ene-apex ye-trochan enkulu njengendawo yokungena icingisise iphantsi kakhulu, kunye ne-0.3%.

Ukujonga ixesha lokungena kunye nokuvezwa kwe-fluoroscopic, ixesha lokuphumelela lingama-90,7 imizuzu yokungena kwi-trongernic yendawo yokungena kwi-rossa yendawo yokungena kwi-rossa yendawo yokungena kwe-rossa. inqaku.

I-progunosis yesigulana yayiyinto ebalulekileyo xa usenza isigqibo kwindawo yokungena kwi-Intramerelary, njengoko uvavanyo lwexesha lokungena kwi-Pyriform kunye novavanyo lwexesha lokungena kwi-Pyriform kunye novavanyo lwexesha lokungena kwiPyriform. Nangona indawo enkulu yokufikelela eqinileyo ihlala idityaniswa ne-tity yezicubu ezithambileyo ngenxa yendawo yayo, isenokungakhokelela ekulimaleni iqela le-ABDIT, njengoko kubonisiwe yi-ERGIş et. Bafumanisa ukuba ibhalansi eguqukayo kunye namandla e-hip ancitshiswa kwizigulana ezine-rounsancric yokungena kwi-rounchancricic xa kuthelekiswa nolawulo olusempilweni. Ukongeza, ufundisiso lwabo luxele ukuncipha okufanelekileyo kwamandla amaqhekeza ee-Hip, i-flaxesors kunye neeropares zangaphakathi / zangaphandle zithelekiswa necala elingasebenziyo.

I-2. I-Peary Forsa yokungena

Ifossa yemisipha yePyriforis yindawo ebalulekileyo yomhlaba obalulekileyo ochongiweyo njengenye yeendawo zokungena kwi-paraceltis ye-paraceltes Iqaphele ukuba i-fossa ye-Pyriforis Muscle yayingayi 'ipere ' i-Pear 'okanye i-Pyriforis yemisipha. Umsipha unamathela kwindawo encinci kwi-trotherte enkulu, ngelixa i-Pyriform Fossa yindlela yokudakumba kwicala le-trouchar enkulu kwaye kukuncamathisela kwi-CarPrial Ridaisis Ridaisis Muradis Ridaisis Ridais mscle. Ababhali baqukumbela ukuba isihlunu sePyriform kunye ne-Pyriform Fossa ngamacandelo amabini ahlukeneyo kwaye ebizwa ngokuba yi-Pyriform Fossa kufuneka ibhekiswe kwi 'foslussal ' ukuchaneka kwe-anatomical ' Bacebisa ukuba emva kokufunda kwi-fis-ferals bacebisa ukuba igama lantlandlolo 'iRotor Fossa ' iphinde iphinde ivelise uncwadi endaweni ye- i-faminology yendawo yokungena. Nangona amanqaku kwezi zifundo zibini ejongwa kakhulu, ukuba akhululwe yinkcazo kunye nokuthintela ukudideka nendawo yokungena eqinileyo yetrothetisi, siza kubhekisa kule ndawo yokungenela i-Pyriform Fossa.

Izifundo ezininzi kuncwadi lwangoku zichaza ngokuchanekileyo indawo yokungena kwi-Peary Forsarallarary ye-Intralimes ye-Intramorary et. Chaza indawo yokungena ye-Pearsa ye-Pearsa njengendawo yokuncamathisela i-Recersor Carprid Ridaisis Brevis kwi-demoral intamo (Fig. 5). Ababhali baphinde bagxininisa ukuba indawo yokungena ephambili kakhulu okanye ngaphakathi ingaphezulu inokunyusa umngcipheko we-submoral tyhake, kwaye kunokubakho umngcipheko omkhulu we-iscrosis, ephakame kakhulu kwizigulana ezikhulayo.

Umzobo we-5 '* ' Ibonisa inqaku le-Inramellary.

I-harper et al. Yapapasha isifundo samaQela ali-14 kwi-Cenadeveric Peminic ngo-1987 apho bavavanya khona indawo ye-Intramellary iPIN kunye nendawo yokuphuma kwefashoni ye-Intramellar eyaziswa kwi-notch ye-femur. Baye bagqiba kwelokuba inqaku lokungena kwe-Pyriformis Paramedian Pramedian I-Inramedian yavela kwi-trocharal ye-trocharmis entanyeni ye-pyriformis ye-thermohl. Kwelinye ixesha lesifundo se-cadanistic, babeka indawo yokungena eyindawo yokungena kwi-Oneralrarary enesipikithi se-medial etroneni ngaphezulu kwe-Pyrifor pheon. Ngaphaya koko, kwisifundo seKadanistic nguLabroniki et al. the fossa of the pyriformis muscle was described as a pear-shaped luminal region that coincided with the central axis of the femoral intramedullary cavity in the coronal plane.

Indawo yePyriform Fossa inolwazi oluthile lwezinto ezithile kuba lucelomngeni ngakumbi lucelomngeni xa kuthelekiswa nenqaku eliphezulu lokufikelela kwi-RONTATE, ngakumbi kwizigulana ezityebileyo. Ukongeza, indawo eyiyo yokungena kwi-Pears ye-Pears ye-Pears ye-Pears ye-Fears ye-Fears yindawo emxinwa, esenza lucelomngeni ukuba lube senza ingeniso. Umzekelo, indawo engaphezulu yangaphandle eqaqambileyo yentamo iya kukhokelela ekunxaxheni kwaye yonyusa umngcipheko we-ANTAREAL TRORT, ngakumbi ukuba indawo yokuqala ingaphezulu kwe-6 mm engaphezulu kwe-6 mm yangaphandle kwifossa. Ukongeza, umahluko we-morphologuc unokuhlawula indawo efanelekileyo yendawo, ngakumbi ukuba i-rototor yangaphandle i-Bulky i-bulky okanye i-rotor iphuma, ekhokelela kwindawo yokungena eyimpikiswano kwaye ingumngcipheko we-submolral yentamo.

Iingxaki: Ngokuthelekisa iisayithi ezingama-38 ezinkulu zokungena nge-53 peary fossa yokungenisa i-fearda ye-feramellary, i-ricci et al ifumane i-30% yexesha elide kunye ne-73% yexesha elide. Ezi zinto zifunyanisiweyo zaqinisekiswa yiBhatti et al. Xa uthelekisa amanqaku a-2 enaliti.

Ngokuphathelele ukulimala okuthambileyo kwezicubu, kwabakho umngcipheko ophezulu wokulimala okuthambileyo kwi-pyriformis inlet xa kuthelekiswa ne-neuromuscular ye-neromussic kwindawo yokungena kwi-rounsanstic. Dora et al. UVAVANYO LWE-16 Dadaventic Peminic ye-Feleurs kwi-Tissue ethambileyo kwi-Pyriforis yemisipha kunye nePIN yokuNgena kweRotor. Bafumanisa ukuba nangona i-Pyriforis FomasA yayiyindlela efanelekileyo kakhulu, yabangela ukonakala okukhulu kwe-vascular kwiNtloko yeNkemo kunye nezihlunu ezijikelezileyo kunye nemisipha. Ezi zinto zifunyanisiweyo ziphinde zaqwalaselwa ngeZifundo zeKadaniveric ngo-Ansari Moin et al. Ngubani owathelekisa amanqaku amabini okungena. Baqwalasele ukuba ukulungiswa kwangaphakathi kwesikhonkwane esiqala kwimisipha ye-Pyrifous kwakungaphezulu kokukonakalisa abasebenzi be-hip kunye neendebe zangaphandle. Ukongeza, ukonakaliswa komntu we-Medical Armoral Arsery wafunyanwa kuzo zonke iimeko (iTheyibhile 2).

Itheyibhile 2. Isishwankathelo sezicubu ezithambileyo ze-tiss
yahluka	Inqaku lokungena kwe-Pyriform Fossa (n = 5)	Indawo enkulu yeRotor (n = 5)
izicubu ezithambileyo
I-Gluteus Medius Muscle (Anatomy)	5	1
I-Gluteus Medius tendon	0	4
ukulimala kwe-tendon
I-Gluteus Minis (Anatomy)	3	0
umsipha we-pyrifous (ngaphezulu komqolo)	3	3
I-Obturator I-Internatus (Anatomy)	1	0
I-Latissimimus Dorcle (Anatomy)	3	0
Imithambo yegazi kunye neecaphule ezidibeneyo
I-MFCA ERTS	4	0
I-MFCA i-MFCA	4	0
i-articular capsule (ye-dibanise efana nedolo kwi-anatomy)	1	0
I-MFCA: I-Mecial Alwalflex oryery.

Kutsha nje, i-Bharti et al. ifundwe umngcipheko wobunzima bokungena ngaphakathi kwendawo yokungena kwi-tercharic yendawo yokungena kwi-tercharic kunye nendawo yokungena ye-Pearsa ye-Pearsa kwaye wafumana umngcipheko wokuphilisa amanqanaba okuphilisa kwaye washwankathela ngolu hlobo lulandelayo (iTheyibhile 3).

Itheyibhile 3
uxinzelelo	I-Piriformis Sinus iname	Inqaku lePropanion enkulu
Zosulele	6.7	3.3
I -mm	20	13.3
Ukulibaziseka kwempiliso	20	13.3
I-Hip Motion	20	33.3
Intshukumo yedolo elinomda	6.7	6.7
Ubude bomzimba obungangqinelani	13.3	20
I-PAP PACPUDS ngaphezulu kwe-bone cortex	13.3	20
Intshukumo ye-intraoperal yemfesane	10	0
Ukwaphuka okukhulu	0	3.4
Intloko yentloko yentloko	6.7	0

Phinda ubuyise

Ukuchonga indawo efanelekileyo yokungena kwi-Inrameral Deramoral Shoing iya kunceda ukufezekisa ulungelelwaniso lolungelelwaniso lwe-witland, ubude, i-acl curntilage liigament liigamente (i-ACLR), kunye nokulimala okuthambileyo (iTheyibhile 1). Kutshanje, kuye kwakho umdla okhulayo kwi-Intramgraph ye-Interamoral yangena ngenjongo yokunciphisa iingxaki ezinxulumene nokuncitshiswa kwe-raracromial, kunye ne-biptotopic i-pip yobuthathaka, ingakumbi kwi-distal ye-distal isinye kwisithathu se-stemoral stem. Ukongeza, ubungqina obufutshane babonisa ukuba xa ezi zikhonkwane zokubuyiswa kwe-intramellary zinokulinganiswa ngokufanelekileyo, i-proximal yokutshixa ayinakufuneka. kunye ne-baccia et al. kunyango lwe-dimoral-stemoral stem thestorals isebenzisa i-kipting kunye nokungafakwanga i-intermgrade ye-intramedlary. Ngenxa yoko, ukusetyenziswa kokuthinjelwa kwe-fetroral femoral kuye kwamkelwa kwaye kwamkelwe ngokubanzi.

Iinkcazo ezininzi zenqaku elifanelekileyo lokungena kwi-Pretrograde Intramlarary I-Teramelland ifumaneka kuncwadi. Uninzi lwezifundo luchonga indawo yokungena ye-fetroral ye-fetroral njenge-1.2 i-ANTER kwimvelaphi ye-themoral ye-Posteriment Ligament Lillelo

I-CM (ngokuhambelana ne-cavity cavity) kunye neZiko le-Concondylar fossa (umzobo 6).

Umzobo we-6 '* ' ibonisa inqaku le-Inramellary.

Nangona kungekho sibonakaliso esigqibeleleyo sokuphinda-phinda ukuphinda-phinda i-Intramellaral Wailling, izibonakaliso ezizodwa zesalamane zichaziwe. Oku kubandakanya abaguli be-Polytramina, abaguli abatyebileyo, abagulayo, isiqu se-felateral stem, i-ipsilateral stemoral stem kunye ne-acetabral stemoral okanye i-felvic yentshukumo ye-IPSVIL kunye ne-IPSICORAL. Uninzi lwezi zinto zibonisa ukuba zihambelana nokukhululeka kwesigulana kunye nokuthintela amanxeba amaninzi okwenza izinto ezisondeleyo.

Kwelinye icala, ukuphikisana okuphezulu kokuphinda-phinda i-Intramrallaral Saning kubandakanya isithintelo sejelografi ye-Intramellary ngokufakwa kwindawo egciniweyo kunye ne-subral evulekile ye-femur ye-distar. Ukuqhutywa kwezinto ezikhoyo ziqhekezwe ngaphakathi kwe-5 cm ye-trounter encinci, ubunzima ekufikeleleni kwi-datesi yongeso, kunye ne-Intra-Fissure ye-Peellar ye-patella kunye nepali egqithileyo.

Iingxaki: Uninzi lweengxaki zokubuyisa i-fetrograde zihambelana nokuphatha okungafanelekanga, ngakumbi ukubekwa ngokuchanekileyo kwendawo yokungena. In the sagittal plane, a more anterior entry point will result in posterior fracture translation, articular surface damage, and possibly nail impingement on the patella when the knee is flexed. Kwelinye icala, ukuba indawo yokungena ibekwe ngendlela engafanelekanga kwi-Post engasemva, oku kungakhokelela emngciphekweni omkhulu wokulimala kwi-Posteries Cruenery Imvelaphi ye-Ligament Leigameshini ye-LUGREENT kunye nendawo engaphandle kwendawo yokuqhekeka.

I-Hutchinson et al. ichaze iingxaki ezinxulumene neendawo zokungena zenqwelomoya. Bafumanise ukuba inqaku lokungena ngokugqithileyo liye laphumela kwi-Polterporal Distemment ye-Popterpollel Fracture Guqula i-Practroure Gratch, kanti umntu ophunyezwe kakhulu waphumela kwi-ac.ages.anders et al. Inike ingxelo yokuba ukhetha inqaku le-Medial elaliyi-2 cm okanye ngaphezulu kwi-axis ye-mexial kukhokelela ekuqhekekeni kwe-mesterial ehlelwe ngumzuzu wokungenwa kwe-posteric evele.

Ezinye iingxaki ezinxulumene nokubuyiselwa kwe-fetrograde yomlandeli zibandakanya iintlungu zedolo, ukuqina, i-goterotopic ye-goteratopic ye-godes, kunye ne-Intra-Articular I-GEARMICTATION.

Gqiba

Nangona ubuchwephesha ngasinye se-Intelimellary nganye inomqondiso ohambelana nayo, ukhetho lwendlela ye-intramelimerary ye-Intramellary yokusebenzisa kunyango lwezinto ze-Stemqual Practures zihlala zixhomekeke kugqirha wokukhetha ugqirha. Xa usenza i-Intramellary yabethe i-femur, efumana indawo yokungena echanekileyo yohlobo lwesipikili esisetyenziselwa ukulungiswa sifunwa sisiphumo esiphumeleleyo. Ulwazi lwendlela ye-anatomy yendawo kunye nengcinga yokufumanisa kuya kumnceda ugqirha ogqirha wendlela eyaneleyo ngelixa enciphisa umngcipheko weengxaki ezinxulumene noko. Ukongeza, kwiinkqubo zokuhambisa i-Inramelilary, ulondolozo lokuncitshiswa licandelo elibalulekileyo ekuthinteleni i-arhodion kunye nentsuma okanye engasebenziyo.