I-Femoral Intramedullary Nailing-Ungayikhetha Njani Eyona ndawo iFakayo iGqwesileyo?

Intshayelelo

Uphuhliso lonyango lokwaphuka kobufazi lunokulandwa emva phaya kwiminyaka yoo-1940 xa uKuntscher wazisa indlela evaliweyo yezikhonkwane ze-intramedullary. Ukusetyenziswa kwezikhonkwane ze-intramedullary (IMNs) kwi-femoral fractures ibe ngumgangatho wokunyamekela kwiminyaka embalwa edlulileyo, kunye nokuphuculwa kwangoku ukubethelwa kwe-intramedullary kunye nokuqhubela phambili kubuchule botyando kuye kwavumela ukwanda okukhulu kokusetyenziswa kwe-intramedullary nailing of the femur.

Unyango olulondolozayo lwe-femoral stem fractures lusetyenziswa kuphela kwinani elincinci lezigulane ezine-contraindications ebalulekileyo kwi-anesthesia kunye nokuhlinzwa, kwaye eyona nto ingundoqo yonyango ihlala ukulungiswa kotyando. Ngokubhekiselele kunyango lotyando lwezi fractures, kukho iindlela ezininzi ezikhoyo, kubandakanywa ukubethelwa kwe-intramedullary, ukulungiswa kweplate screw, kunye nokulungiswa kwangaphandle. Xa kuthelekiswa nolunye ukhetho lotyando, ukubethelwa kwe-intramedullary yeyona ndlela inelona zinga liphantsi lengxaki kunye nelona zinga liphezulu lokuphola ngokuphuka kokwaphuka, kwaye lisetyenziswa ngokubanzi kuqheliselo lwezonyango.

Ukuqonda kakuhle i-anatomy ye-proximal femur, ukunikezelwa kwegazi kwintloko ye-femal kunye ne-anatomy ye-hip muscle kunokunyusa kakhulu izinga lokuphumelela kwe-intramedullary nailing for fractures femoral. Ngokwahlukileyo, ukukhethwa kwendawo yokungena kuxhomekeke kwizinto ezininzi, kubandakanywa i-intramedullary nail design, indawo yokuphuka, i-fracture comminution, kunye nezigulane (umzekelo, i-polytrauma, ukukhulelwa kunye nokukhuluphala). Kungakhathaliseki ukuba indawo yokungena ekhethiweyo, ukufumana indawo yokungena echanekileyo kubalulekile ukugcina ukunciphisa okwaneleyo ngexesha lokufakwa kwe-intramedullary nail ngelixa unciphisa umngcipheko weengxaki.

I-Femoral Anatomy

1.Ukubonelelwa ngegazi kwintloko yesifazane

Intloko yesifazane ifumana i-vascular supply from 3 imithambo emikhulu. I-lateral rotator femoral artery (kunye ne-3-4 amasebe), i-obturator ye-obturator, enikezela i-ligament ejikelezayo, kunye ne-medial rotator femoral artery (Fig. 1), enika kwakhona isitya esinyukayo esinyukayo esinaso kunye ne-lateral rotator femoral artery kunye nokubonelela indawo enkulu ye-trochanteric.

2.I-Anatomy yeZihlunu zeHip

Xa usenza i-intramedullary nailing of the femur, ukuqonda kakuhle kwemisipha kwindawo ejikeleze i-rotor kubalulekile ukukhusela ukulimala okungadingekile. I-gluteus medius muscle ivela kwi-ilium kwaye iphelela kwi-lateral ye-trochanter enkulu, ngelixa i-gluteus minimus muscle nayo isuka kwi-ilium kwaye idlula kwi-posterior ye-joint hip ukuze iphele kwi-posterior ye-trochanter enkulu (Amanani 2 & 3). Zomibini ezi zihlunu zisebenza njenge-adductors yethanga kunye ne-rotator yangaphakathi ye-hip. Ngoko ke, umonakalo kule misipha ngexesha lokufakwa kwe-paracentric femoral intramedullary nail kuya kubangela ubuthathaka be-adductor kunye ne-Tendelenburg gait, enempembelelo embi ekubuyiseleni isigulane kunye nesiphumo.

Umfanekiso 2. I-Anatomy yemisipha ejikeleze i-hip joint

Umzobo 3. i-proximal femoral muscle attachment area

I-Parallel Femoral Intramedullary Nail

Izifundo ezininzi zakutsha nje ziye zaphonononga eyona ndawo ifanelekileyo yokungena kwi-paracrine femoral nail. Izinketho zokungena ezikhonkwane ziquka i-trochanter enkulu kunye ne-pyriform fossa, nganye inezibonakaliso zayo kunye neengxaki ezinxulumene nazo (Itheyibhile 1).

Itheyibhile 1.Amanqaku okuqalisa kunye nobungozi obunokubakho be-paracrine kunye ne-retrograde femoral nailing
ukwahluka	i-parallel intramedullary nail		retrograde intramedullary nail
	i-rotor	ipyriform fossa (i-anatomy)
inqwelomoya yesithsaba	I-Vertex ye-trochanter enkulu kunye nokukhomba ngaphakathi kwi-medullary cavity	ukuhlangana kwe-trochanter enkulu kunye nentamo ye-femoral	i-median ye- intercondylar fossa (i-anatomy)
Indiza yesagittal (izibalo.)	Umgca phakathi kombindi we-trochanter enkulu kunye nombindi womongo we-femur	ipyriform fossa (i-anatomy)	I-PCL yi-1.2 cm ngaphambili ukuya kwindawo yokuqala ye-femoral, ekhomba kwi-medullary cavity.
utyhileko	Iqela le-Hip abductor lokumisa indawo yokulimala	Ukuphazamiseka kokunikezelwa kwegazi kwintloko ye-femal kunye ne-hip yangaphandle ye-rotator muscle	Ukuphathwa ngendlela engafanelekanga kunokukhokelela kwi-PCL
I-PCL: i-posterior cruciate ligament

1.Indawo yokungena inaliti ye-rotor enkulu

I-trochanter enkulu ichazwe njenge-outermost trapezoidal bony protuberance ebekwe kwicala elisecaleni lentamo ye-femoral, ubuso obubonelela ngokuqhotyoshelweyo kwi-lateral gluteus medius kunye ne-anterior gluteus minimus muscles (Amanani 2 kunye ne-3). Nangona le iyindawo encinci yamathambo, ukubeka kwindawo echanekileyo indawo yokuqala xa usenza i-IMN yowesifazane kunokuba ngumahluko phakathi kokufumana isiphumo esanelisayo okanye esibi xa ujongene nokwaphuka kwesiqu se-femoral.

Ukuphonononga uncwadi lwangoku lweenkcazo ze-femoral entry point, sifumene ukungabikho kwendawo echazwe ngokucacileyo ye-anatomical ye-femoral rotor IMN entry point.Bharti et al. ichaze indawo yokungena ukusuka kwi-apical apex ye-trochanter enkulu njenge-medial ngokubhekiselele kwi-medullary cavity kwindawo ye-orthostatic, kwaye njengendawo ye-trochanter enkulu ngokuhambelana neziko le-femoral medullary cavity kwindawo esecaleni (umzobo 4), kunye nenye inkcazo yendawo enkulu yokungena kwi-trochanter kwi-lateral hip view phakathi kwe-router yangaphambili kunye ne-posterior yangaphakathi kwi-postor yangaphakathi okanye i-posterior. isibini kwisithathu se-rotor.Georgiadis et al. ichaze indawo yokungena inaliti njengelona cala lingasemva lomda ophakamileyo we-apical we-rotor.

I-FIGURE 4. Iimbono ze-intraoperative orthostatic kunye ne-lateral ze-hip zibonisa indawo efanelekileyo yokungena kwi-femoral paramedian intramedullary nailing ye-trochanter enkulu. '*' ibonisa indawo yokungena ye-intramedullary nail.

Izifundo zamva nje kwiincwadi zibonise ukuba i-apex ye-trochanter enkulu yindawo efanelekileyo yokuqala yokufumana umgca ochanekileyo wamandla, kwaye ukulungelelaniswa okungahambi kakuhle ngenxa yokuguqulwa kwe-inversion kwenzeka rhoqo xa indawo yokungena iguqulwa ngaphezu kwe-2 mm lateral ukuya kwi-trochanter enkulu. Olu pho nonongo lukwagxininise ukuba indawo yokungena ngasemva ikhokelela kwi-distal forward displacement, kanti indawo yokungena ephakathi inokubangela ukuba i-distal fracture block ihanjiswe ngasemva. Ngokwahlukileyo koko, olunye uphononongo lubonise ukuba kwi-intertrochanteric femur fractures, iziganeko ze-intramedullary nail impingement zaziphezulu kakhulu kunye ne-pinning point eyayisecaleni ukuya kwicala langaphambili kune-pinning point eyayikufutshane kumacala aphakathi kunye nasemva.

I-trochanteric apex pinning point enkulu idla ngokusetyenziswa kwizigulana ezityebileyo, kwaye le nkqubo ayifuni kakhulu ngokobuchwephesha, inika ixesha elingaphantsi lokusebenza kunye nomngcipheko ophantsi weengxaki kune-pyriform fossa pinning point.

IINGXAKI: Iingxaki ze-intraoperative kunye ne-postoperative ye-femoral intramedullary nailing kunye ne-trochanteric approach point enkulu ziye zaxoxwa kwiimpapasho ezininzi. Enye yezi, edla ngokunxulumene nendlela yokubethelela, kukuqhekeka okubangelwa ngamayeza. Kwi-intertrochanteric femoral fractures, indawo yokungena esecaleni kunye nephambili kwi-trochanter enkulu inokuthi ibangele ukuphuka kwe-medial kunokungena kwindawo yokungena kufuphi necala eliphakathi.

Enye ingxaki echaphazelekayo ngenxa yokulimala kwezicubu ezithambileyo, ngakumbi kumasebe e-medial rotator femoral artery kunye nezihlunu ze-adductor, kodwa ezi nzakala aziqhelekanga xa kuthelekiswa ne-pyriform fossa entry nail. Ukongezelela, iziganeko ze-ischemic necrosis yentloko ye-femoral kunye ne-apex ye-trochanter enkulu njengoko indawo yokungena icingelwa ukuba iphantsi kakhulu, kunye nezifundo ezibika ukuba ziphantsi kwe-0.3%.

Ukuqwalasela ixesha le-intraoperative kunye nokuvezwa kwe-fluoroscopic, ixesha eliqhelekileyo lokusebenza laliyimizuzu engama-90.7 kwindawo yokungena enkulu yetrochanteric xa kuthelekiswa nemizuzu ye-112.7 yeqela lokungena le-fossa elinemilo yepere, ngelixa ixesha le-fluoroscopic yayiyi-5.88 imizuzwana ye-trochanteric enkulu yokungena kunye neqela le-10. indawo yokungena ye-fossa emile okwepere.

I-prognosis yesigulane yayiyeyona nto ibalulekileyo xa uthatha isigqibo malunga ne-intramedullary nail entry point, njengoko ukubuyisela ukusebenza kwangaphambili (njengoko kuhlolwe nguvavanyo lwesihlalo-sihlalo kunye novavanyo lokuphakama kwexesha) kwakungcono kakhulu kwizigulane kwiinyanga ze-6 emva kokusebenza kwendawo yokungena ye-trochanteric xa kuthelekiswa ne-pyriform fossa yokungena kwinqanaba le-pyriform, kodwa lo mahluko wawungabalulekanga emva kweenyanga ze-12. Nangona indawo enkulu yokufikelela kwi-trochanteric idla ngokudityaniswa nokukhutshwa kwezicubu ezithambileyo ezincinci ngenxa yendawo yayo, isenokubangela ukulimala kwiqela le-abductor muscle, njengoko kuboniswe ngu-Ergiş et al. Bafumanise ukuba ibhalansi eguquguqukayo kunye namandla e-hip abductor aye ancipha kwizigulana ezine-trochanteric enkulu yokungena isikhonkwane xa kuthelekiswa nolawulo olusempilweni. Ukongezelela, uphononongo lwabo luchaze ukwehla okukhulu kwamandla e-hip abductors, i-flexors kunye ne-rotator yangaphakathi / yangaphandle xa kuthelekiswa necala elingasebenziyo.

2. Indawo yokungena yePearly fossa

I-fossa ye-pyriformis muscle luphawu olubalulekileyo lwe-anatomical echongiweyo njengenye yeendawo zokungena kwi-paracentesis femoral intramedullary nail.Kuphononongo lwabo lwe-autopsy cadaveric, uLakhwani et al. yaqaphela ukuba i-fossa yesihlunu se-pyriformis yayingeyo 'pear' emileyo okanye i-attachment muscle ye-pyriformis. I-muscle inamathele kwindawo encinci kwi-tip ye-trochanter enkulu, kanti i-pyriform fossa i-depression kwi-medial side ye-trochanter enkulu kwaye i-attachment ye-extensor carpi radialis brevis muscle. Ababhali baphetha ngokuthi i-pyriform muscle kunye ne-pyriform fossa zizinto ezimbini ezahlukeneyo kwaye into ebizwa ngokuba yi-pyriform fossa kufuneka ibhengezwe njenge 'rotor' okanye 'occlusal' fossa ukucaca kunye nokuchaneka kwe-anatomical. Bacebisa ukuba emva kokufunda i-cis-femoral Bacebisa ukuba igama lokuqala 'rotor fossa' liphinde lifakwe kwiincwadi endaweni 'ye-pyriform fossa' emva kokufunda isigama se-parafemoral entry point. Nangona amanqaku ezi zifundo zimbini zithathwa kakhulu, ngenxa yokulula kwenkcazo kunye nokuthintela ukudideka kunye nendawo enkulu yokungena ye-trochanteric, siya kubhekisela kule ndawo yokungena njengendawo yokungena ye-pyriform fossa.

Izifundo ezininzi kuncwadi lwangoku zichaza ngokuchanekileyo indawo yokungena yepearly fossa ye-intramedullary femoral nails.Georgiadis et al. chaza i-pearly fossa entry point njengendawo eqhotyoshelweyo ye-extensor carpi radialis brevis muscle ekudakaleni kwisiseko sentamo ye-femal (umzobo 5). Ababhali baphinde bagxininise ukuba indawo yokungena ehamba phambili okanye ekude kakhulu ngaphakathi inokunyusa umngcipheko wokuphulwa kwentamo ye-femal, kwaye xa indawo yokungena ikude kakhulu, kunokubakho umngcipheko omkhulu we-ischemic necrosis, ephakamileyo kwizigulane ezifikisayo.

Umzobo 5. Umbono we-intraoperative frontolateral we-hip obonisa indawo efanelekileyo yokungena kwi-pyriform fossa retrograde femoral intramedullary nail. I-'*' ibonisa indawo ekuqalwa kuyo ngezikhonkwane ze-intramedullary.

Harper et al. yapapasha uphononongo lwamaqela e-14 ye-cadaveric femurs yabantu kwi-1987 apho bavavanya indawo ye-intramedullary guide pin kunye nendawo yokuphuma ye-intramedullary nail yaziswa nge-distally and proximally kwi-retrograde fashion from the intercondylar notch of the femur. Baye bagqiba ukuba indawo yokungena kwi-pyriformis paramedian intramedullary nail ibekwe kwindawo yokuhlangana kwe-trochanter enkulu kunye nentamo ye-femoral, ngaphambili kancinci kwi-pyriformis occulta.Indawo yokufakela yaqinisekiswa kwakhona nguGausepohl et al. Kwesinye isifundo se-cadaveric, babeka indawo efanelekileyo yokungena kwi-femoral intramedullary nail ecaleni kwe-medial edge ye-trochanter enkulu ephezu kwe-pyriformis tendon. Ngapha koko, kuphononongo lwe-cadaveric nguLabronici et al. i-fossa ye-pyriformis muscle yachazwa njengommandla we-luminal owenziwe ngepereya ehambelana ne-axis ephakathi ye-femoral intramedullary cavity kwi-coronal plane.

Indawo yofikelelo ye-pyriform fossa ineziphene ezithile kuba ingumceli mngeni othe kratya xa kuthelekiswa nendawo yofikelelo ye-trochanter enkulu, ngakumbi kwizigulana ezityebileyo. Ukongeza, eyona ndawo ifanelekileyo yokungena kwindawo yokungena enaliti emile okwepere yindawo emxinwa, nto leyo eyenza kube nzima kakhulu ukubekwa kwindawo. Ngokomzekelo, indawo yokuqala yangaphambili kwintamo ye-femoral iya kubangela uxinzelelo olugqithisileyo olujikelezayo kunye nokwandisa umngcipheko wokuqhuma kwe-cortical yangaphambili, ngakumbi ukuba indawo yokuqala ingaphezulu kwe-6 mm ngaphambili kwi-fossa. Ukongezelela, ukungafani kwe-morphologic kunokuthintela indawo yokungena echanekileyo, ngakumbi ukuba i-rotator yangaphandle emfutshane ininzi okanye i-rotor iphuma, ikhokelela kwindawo yokungena ephakathi kakhulu kunye nomngcipheko wokuphuka kwentamo ye-femal.

IINGXAKI: Ngokuthelekisa iisayithi ze-38 ezinkulu zokungena ze-trochanteric kunye neendawo ze-53 ze-pearly fossa zokungena kwi-femoral intramedullary nailing, u-Ricci et al wafumanisa ukuba iqela le-pearly fossa linexesha elide le-30% kunye ne-73% yexesha elide le-fluoroscopy. Ezi ziphumo ziqinisekisiwe nguBhatti et al. xa uthelekisa iindawo zokungena inaliti ezi-2.

Ngokumalunga nokulimala kwezicubu ezithambileyo, kwakukho umngcipheko ophezulu wokulimala kwezicubu ezithambileyo kwi-pyriformis inlet xa kuthelekiswa ne-interosseous neuromuscular kwindawo enkulu yokungena inaliti ye-trochanteric. UDora et al. ivavanywe i-16 yabantu abadala i-cadaveric femurs yokulimala kwezicubu ezithambileyo kwi-pyriformis muscle kunye ne-rotor entry pin. Baye bafumanisa ukuba nangona i-pyriformis fossa yayiyi-geometrically optimally, ibangele umonakalo omkhulu kwi-vascular supply kwintloko ye-femoral kunye nemisipha ejikelezayo kunye neetoni. Ezi ziphumo zaphinda zaqinisekiswa ngezifundo ze-cadaveric ngu-Ansari Moin et al. I-WHO iphinde yathelekisa iindawo ezimbini zokungena. Baye baqaphela ukuba ukulungiswa kwangaphakathi kwesikhonkwane esiqala kwi-pyriformis muscle kwakunokonakalisa i-hip abductors kunye ne-rotator yangaphandle. Ukongezelela, umonakalo kwi-rotator ye-femoral artery yafunyanwa kuzo zonke iimeko (iThebhile 2).

Itheyibhile 2. Isishwankathelo sokulimala kwezicubu ezithambileyo kwiindawo ezahlukeneyo zokungena kwiinaliti
ukwahluka	Indawo yokungena yePyriform fossa (n=5)	Indawo enkulu yokutya yerotha (n=5)
inyama ethambileyo
i-gluteus medius muscle (i-anatomy)	5	1
i-gluteus medius tendon	0	4
ukwenzakala komthambo
igluteus minimus (i-anatomy)	3	0
imisipha yepyriformis (ngaphezulu komnqonqo)	3	3
obturator internus (anatomy)	1	0
i-latissimus dorsi muscle (i-anatomy)	3	0
Imithambo yegazi kunye ne-capsules edibeneyo
MFCA Amasebe anzulu	4	0
Isebe leMFCA elingenzulu	4	0
i-articular capsule (yedibeneyo efana nedolo kwi-anatomy)	1	0
I-MFCA: umthambo we-femoral we-circumflex ophakathi.

Kutshanje, Bharti et al. wafunda umngcipheko wengxaki yokubethelwa kwe-femoral intramedullary kwindawo yokungena enkulu yetrochanteric kunye nepearly fossa entry point kwaye wafumanisa iingozi ezinxunguphalisayo ezifana nezinga lokuphiliswa kokwaphuka kwaye wazishwankathela ngolu hlobo lulandelayo (Itheyibhile 3).

Itheyibhile 3. Indawo yokungena yePyriform fossa kunye nendawo yokungena enkulu ye-trochanter ye-femoral bone umongo
ingxaki	Inqaku lenaliti yePiriformis sinus	Indawo yokufaka i-trochanter enkulu
Yosulela	6.7	3.3
Malunion	20	13.3
Ukulibaziseka ukuphiliswa	20	13.3
Intshukumo yehip encinci	20	33.3
Ukuhamba kwamadolo okulinganiselwe	6.7	6.7
Umahluko wobude belungu	13.3	20
Umnqwazi womsila uphumela ngaphezulu kwekhokoreksi yethambo	13.3	20
Ukwaphuka kwentamo ye-femoral ye-Intraoperative	10	0
Ukwaphuka kwetrochanter enkulu	0	3.4
I-necrosis yentloko ye-Femoral	6.7	0

Retrograde femoral intramedullary nailing

Ukumisela indawo efanelekileyo yokungena kwi-retrograde femoral intramedullary nailing kuya kunceda ukubuyisela ukulungelelaniswa kwe-fracture efanelekileyo, ubude, kunye nokujikeleza ngelixa unciphisa umonakalo we-articular cartilage, i-anterior cruciate ligament (ACL), i-posterior cruciate ligament (ACL), kunye nokulimala kwezicubu ezithambileyo (Itheyibhile 1). Kungekudala, kukho umdla okhulayo wokubuyisela i-femoral intramedullary nailing ngenjongo yokunciphisa iingxaki ezinxulumene ne-paracromial nailing, kubandakanywa intlungu ye-hip, i-heterotopic ossification, ubuthathaka be-adductor, kunye ne-pudendal ye-nerve palsy, ethathwa njengeyona nto inqabileyo xa ithelekiswa nokunciphisa i-incisional kunye nokuvala i-femoral fixing, ngokukodwa i-femoral infrared-platform. yesiqu sowesifazane. Ukongezelela, ubungqina bakutshanje bubonisa ukuba xa ezi zikhonkwane ze-intramedullary zibuyisela ngokufanelekileyo ubukhulu, izikhonkwane zokutshixa ezikufutshane zingenakufuneka.Kwakungekho mmahluko kumazinga okuphilisa, ixesha lokuphilisa, okanye iziphumo ezichazwe ngesigulane phakathi kweMeccariello et al. kunye noBisaccia et al. kunyango lwe-distal one-third femoral stem fractures usebenzisa ukutshixa kunye nokungatshixi ukubuyisela iinzipho ze-intramedullary. Ngaloo ndlela, ukusetyenziswa kwe-retrograde femoral nailing iye yathandwa kwaye yamkelwa ngokubanzi.

Iinkcazo ezininzi zeyona ndawo ifanelekileyo yokungena kwi-retrograde femoral intramedullary nailing inokufumaneka kuncwadi. Uninzi lwezifundo zichonga indawo efanelekileyo yokungena kwi-retrograde femoral nail njenge-1.2 yangaphambili kwimvelaphi ye-femoral ye-posterior cruciate ligament.

cm (ngokuhambelana ne-medullary cavity) kunye neziko le-intercondylar fossa (Umfanekiso 6).

I-FIGURE 6. Iimbono ze-intraoperative orthostatic kunye necala lamadolo ebonisa indawo efanelekileyo yokungena kwi-retrograde femoral intramedullary nail. '*' ibonisa indawo ekuqalwa kuyo ngezikhonkwane ze-intramedullary.

Nangona kungekho nkcazo epheleleyo yokubuyisela i-femoral intramedullary nailing, izikhombisi ezininzi ezizalanayo zichaziwe. Ezi zibandakanya izigulane ze-polytrauma, izigulane ezigqithiseleyo, izigulane ezikhulelweyo, i-bilateral femoral stem fractures, i-ipsilateral femoral stem kunye ne-acetabular / i-pelvic fractures okanye i-femoral neck fractures, kunye ne-ipsilateral femoral stem kunye ne-tibial fractures. Uninzi lwezi zibonakaliso zihambelana nokulula kokumiswa kwesigulane kunye nokuthintela amanxeba amaninzi otyando ngokusondeleyo.

Ngakolunye uhlangothi, ukuchasana ngokupheleleyo ekubuyiseleni ukubethelwa kwe-femoral intramedullary kubandakanya ukuvinjelwa kwejelo le-intramedullary ye-retrograde yi-implant egciniweyo kunye nokuvuleka okuvulekileyo kwe-distal femur. I-contraindications ehambelanayo i-fractures ebekwe ngaphakathi kwe-5 cm ye-trochanter encinci, ubunzima bokufikelela kwindawo efanelekileyo yokungena ngenxa yokuguqa kwedolo elingaphantsi kwama-degrees angama-45, ukusuleleka kwedolo kwangaphambili okunokuthi kubangele umngcipheko wokusasazeka kwi-femoral stem, ukulimala okunzima kwezicubu ezithambileyo edolweni, kunye nokwaphuka kwe-intra-articular kunye ne-pole disfetal.

Iingxaki: Uninzi lweengxaki zokubethelwa kwe-femoral retrograde zihambelana nokuphathwa ngendlela engafanelekanga, ngakumbi ukubekwa okungalunganga kwendawo yokungena. Kwindiza ye-sagittal, indawo yokungena yangaphambili ngakumbi iya kubangela ukuguqulelwa kwe-fracture yangasemva, umonakalo we-articular surface, kwaye mhlawumbi ukufakwa kwezikhonkwane kwi-patella xa idolo liguquguquka. Ngakolunye uhlangothi, ukuba indawo yokungena ifakwe ngendlela engafanelekanga kwi-posterior direction, oku kunokubangela umngcipheko ophezulu wokulimala kwimvelaphi ye-ligament ye-posterior cruciate kunye nokufuduka kwangaphambili kwendawo yokuphuka.

Hutchinson et al. kuchazwe iingxaki ezinxulumene neendawo ezingafanelekanga zokungena kwinqwelomoya. Baye bafumanisa ukuba indawo yokungena ephakathi ngokugqithisileyo ibangele ukukhubazeka kwe-posterolateral kunye nenguqulelo ye-posterolateral fracture, ngelixa i-lateral engaphezulu ibangele ukukhubazeka kwe-medial kunye ne-medial translation.Sanders et al. ingxelo yokuba ukukhetha indawo yokuqalisa ye-medial eyayiyi-2 cm okanye ngaphezulu kwi-axis ye-medial kubangele ukuphuka kwe-cortical ye-medial eyayiyi-malunited ngenxa ye-posterior isthmic yokugoba umzuzu wokuphuka okubangelwa ukucutha okungahambi kakuhle kwe-posterolateral.

Ezinye iingxaki ezinxulumene ne-retrograde femoral ukubethelwa ngezikhonkwane zibandakanya iintlungu zamadolo, ukuqina, i-heterotopic knee ossification, kunye ne-intra-articular knee free formation.

Qukumbela

Nangona indlela nganye yezikhonkwane ye-intramedullary inesalathiso esihambelanayo, ukhetho lokuba yeyiphi na indlela yokubethelela ye-intramedullary enokusetyenziswa kunyango lwe-femoral stem fractures idla ngokuxhomekeke kukhetho lukagqirha wotyando. Xa usenza i-intramedullary nailing of the femur, ukufumana indawo yokungena echanekileyo yohlobo lwesikhonkwane esisetyenziselwa ukulungiswa kuyadingeka kwisiphumo esiyimpumelelo. Ulwazi lwe-anatomy yendawo kunye nokusebenza kwe-imaging kuya kunceda ugqirha wenza inkqubo yobugcisa eyaneleyo ngelixa unciphisa umngcipheko weengxaki ezinxulumene nazo. Ukongezelela, kwiinkqubo ze-intramedullary nailing, ukugcinwa kokunciphisa kuyingxenye ebalulekileyo ekuthinteleni i-malunion kunye ne-malunion okanye i-nonunion of fractures.