5 izimiso intramedullary nail kanye namasu okuhlinza!

Izimiso eziyisisekelo zokubethelwa kwe-intramedullary

1. Umlando wokubethelwa kwe-intramedullary

Ngo-1910, izinzipho ze-Lilienthal aluminium intramedullary zasetshenziselwa ukwelapha ukuphuka kwe-shaft yesifazane.

Ngo-1913, uSchone wasebenzisa izipikili ze-intramedullary zesiliva ukwelapha ukuphuka kwengalo yengalo. 

U-Kuntscher (1900-1972) wenza iminikelo emihle ekulungiseni izipikili ze-intramedullary. 

I-1960 kanye ne-1970 yayiyinkathi yokuthuthukiswa okusheshayo kwezipikili ze-intramedullary. 

izwe lami belizisebenzisa ngobuningi kusukela ngeminyaka yawo-1990.

2. Ukuncishiswa okuvulekile nokwehliswa okuvaliwe

1. Ukuphuka kwezitho kungancishiswa ngokuhlinzwa ngaphansi kokubonwa okuqondile noma kuvalwe ngaphansi kokuqapha kwe-X-ray.

2. Isikhathi sokuphulukisa ukuphuka kokuncipha okuvulekile side kakhulu, ukopha kwangaphakathi kokuhlinzwa kuningi, futhi ukuncishiswa okuvulekile kuphinde kubhubhise ukunikezwa kwegazi ekugcineni kokuphuka.

3. Kunconywa ukusebenzisa ukunciphisa okuvaliwe ngangokunokwenzeka. Isinciphisi sokudonsa singasetshenziswa, noma kungenziwa ukusika okuncane endizeni yokuphuka ukuze kuhlolwe futhi kuncishiswe, ngaleyo ndlela kuncishiswe ukuphazamiseka kokunikezwa kwegazi kuze kube sekugcineni kokuphuka.

4. Ngokwehluleka ukuncishiswa okuvalekile, ukuphephuka kwengxenye yethambo noma ukubhoboza izicubu ezizungezile, nezingcezu ezinkulu zokuphuka ezisusiwe, ukuncishiswa okuvulekile kokuhlinzwa kungasetshenziswa.

3. Indlela yokulungisa ye i-intramedullary nail

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

2. Ukulungiswa kwe-fracture nge-intramedullary nail ukulungiswa kokusabalalisa ukucindezeleka, hhayi ukulungiswa kokuvikela ukucindezeleka, okuhambisana nokubunjwa kwe-callus.

3. Ukulungiswa okuphakathi kuphakeme ngokwengqondo kunokulungiswa kwangaphandle kwe-cortical, okunganciphisa ingalo yamandla, ukunciphisa isigameko se-valgus angulation kanye nokuhluleka kwangaphakathi kokulungiswa.

4. Ukulungiswa kwe-Intramedullary nail kunikeza isisekelo sokunciphisa okuvaliwe noma ukunciphisa okuvulekile okulinganiselwe.

4.Izinzuzo zezinzipho ze-intramedullary

1. Izinkinga ezimbalwa

2. Ububanzi obunwetshiwe bezinkomba zokuhlinzwa

3. Ukulungiswa okuqinile

4. Ukuqeqeshwa komsebenzi ohlanganyelwe kusenesikhathi

5. Ukuthwala isisindo kusenesikhathi

6. Ingasetshenziswa ngokuhambisana nokunye ukulungiswa kwangaphakathi

Izinhlobo Eziyisisekelo Namasu

1. Ukukhiya nokungakhiyi izinzipho ze-intramedullary

2. Izinzipho ze-intramedullary zokukhiya ezinamandla nezimile

3. Ukunwetshwa kwe-Medullary kanye namasu okulungisa okungewona ama-medullary

4. Amasu okulungisa avuliwe navaliwe

Ukuhlangana nokungahlangani

Izinzipho ezivamile ze-intramedullary zinokungaqini kahle kwe-axial namandla aphansi okugwedla, kodwa zinokunwebeka okuthile futhi zingalulama ngemva kokuguquka, okubangela ukushelela okuncane kwe-intrabone.

Izinzipho ezixhumene ze-intramedullary zinemiphumela engcono yokunqanda ukujikeleza kanye ne-anti-compression, ukuzinza okuhle kokulungisa, futhi zihambisana nesimiso sokulungiswa kwezinto eziphilayo. Asetshenziswa kakhulu emathanjeni amade ezitho. Ikakhulukazi ama-multi-segment kanye nama-fractures ahamba phambili, banokusimama okungcono kunezinzipho ezijwayelekile ze-intramedullary.

Ukuguqulwa kokulungiswa okumile

Izinzipho ze-intramedullary zokukhiya ezimile zikhiqiza ukuvala ingcindezi okuncane kakhulu futhi okwamanje zigqugquzelwa kakhulu isenzo esingajwayelekile sokwenza amandla.

Ngokuphuka okungakapholi ezinyangeni eziyisi-6 kuya kweziyisi-8 ngemuva kokuhlinzwa, ukuxhunyelelwa kwethambo le-situ noma ukushintshwa kwezinzipho ezinwetshiwe ze-intramedullary nge-dynamization kuvame ukusetshenziswa.

I-Dynamization ingasetshenziswa njengendlela yokukhuthaza ukuphulukiswa kokuphuka. Akunconyiwe njengokujwayelekile ngoba kungaholela ekufinyezweni kwezitho kanye nokukhubazeka kokujikeleza.

Ukunwetshwa komnkantsha kanye nokunwetshwa okungewona umnkantsha

Ukwandiswa komnkantsha kungafaka izinzipho ze-intramedullary ezinobubanzi obukhudlwana namandla amakhulu, okuhambisana nokuqeqeshwa kokusebenza kwangaphambi kwesikhathi futhi kunciphisa izinga lezipikili eziphukile.

Ukwandiswa komnkantsha kungaveza inani elikhulu lemfucumfucu yamathambo ngomphumela we-osteoinductive, osiza ukuphulukiswa kokuphuka.

Ukunwetshwa komnkantsha kuzolimaza ukunikezwa kwegazi kwemithambo yezakhi kanye nolwelwesi lwe-endosteal, kodwa imithambo yegazi ingakwazi ukuvuselela eduze komgodi wezinzipho ze-intramedullary. Ukunwetshwa komnkantsha kungandisa futhi ukujikeleza kwegazi emisipha ezungezile yezicubu ezithambile, ngaleyo ndlela kukhuthaze ukuphulukiswa kokuphuka.

Ukunwetshwa komnkantsha kwandisa amathuba okutheleleka kanye ne-embolism, futhi kufanele kusetshenziswe ngokuqapha ekwephukeni okuvulekile, ukulimala okuningi, nokulimala okuyinkimbinkimbi.

Izinzuzo zokunwetshwa kwe-medullary

① Ngemva kokunwetshwa kwe-medullary, indawo yokuxhumana phakathi kwe-intramedullary nail nethambo iyakhula, okuthuthukisa ukuzinza kokulungisa. 

② Ngemva kokunwetshwa kwe-medullary, kungasetshenziswa isikhonkwane esikhulu se-intramedullary esiwububanzi obukhulu, okwandisa amandla esipikili se-intramedullary futhi sinciphise izinga lezipikili eziphukile. 

③ Imfucumfucu yamathambo ngemva kokunwetshwa kwe-medullary ingadala ukwakheka kwamathambo okusha, okusiza ekwelapheni kokuphuka.

Uma kuqhathaniswa nokunwetshwa kwe-medullary izinzipho ze-intramedullary, izinzipho ze-intramedullary ezinganwetshiwe zinezinzuzo ezilandelayo

① Isikhathi esifushane sokusebenza nokopha okuncane. 

② Ukuphazamiseka okuncane kokugeleza kwegazi kwe-endosteal ezimeni ezinokulimala okukhulu kwezicubu ezithambile.

Isicelo se i-intramedullary nail

I-Humeral interlocking intramedullary nail

Izinkomba zezinzipho ze-humeral

Izinkomba ze-humeral interlocking intramedullary izinzipho ekwelapheni ukuphuka kwe-humeral shaft yilezi: ukuphuka ngokulimala kwe-vascular and nerve, ukulimala okuningi, ukuphuka okungazinzile, ukuhlukana kwe-pathological, kanye nokuphuka kwe-humeral proximal.

Ububanzi obungalungiswa busuka ku-2cm ngaphansi kwekhanda elinomswakama ukuya ku-3cm ngaphezu kwe-olecranon fossa. Ungakhetha ukuyilungisa kusuka ehlombe nge-antegrade intramedullary nail noma kusukela endololwaneni nge-nail retrograde.

Izici zezinzipho ze-humeral

Izindlela zokulungisa zokuhlinza zokuphuka kwe-humeral shaft ngokuyisisekelo ziyi-plate fixation kanye nokulungiswa kwe-intramedullary nail.

Ukulungiswa kwe-plate kunezindawo eziqinile zokulwa nokujikeleza kanye ne-anti-gonding futhi kugxilwe ngokuqinile, kodwa ukuhlukumezeka kokuhlinzwa kukhulu, amathuba okutheleleka aphezulu, futhi i-radial nerve ilimala kalula.

Izipikili zesimanje ze-humeral interlocking kanye ne-self-locking zinqoba ukushiyeka kwezipikili ezijwayelekile ze-intramedullary ezifana nokungazinzi kwe-axial, ukulawulwa okungahambi kahle kokujikeleza, nesidingo sokulungiswa okwengeziwe, ukuze ukuphuka kuqiniswe ngokuqinile, ukulahlekelwa kwegazi kuncane, ukukhishwa kwezicubu ezithambile kuncane, futhi ukunwetshwa kwe-medullary kufana nomthwalo we-medullary olingana nomthwalo wendawo, i-transplantation yasekuqaleni ibonakala, i-transplantation yasekuqaleni ingakwazi ukusabalalisa i-transplantation. kuqalwe ngemva kokuhlinzwa.

I-Femoral interlocking intramedullary nail

Izinkomba zezinzipho ezihlanganayo zesifazane

Zonke izinhlobo zokuphuka kwe-2cm ngaphansi kwe-vertebra ye-trochanteric futhi ngaphezu kwe-9cm kusukela ekuhlanganyeleni kwamadolo.

Ukuphuka okudala kwengxenye ephakathi ye-femoral shaft.

Iziguli ezinepuleti elihlulekile ukulungiswa kwangaphakathi.

Izici ze-femoral interlocking nail

Izinzuzo Mechanical

Ingalo yamandla ye-femoral interlocking intramedullary nail yokulungisa ukuphuka yinde kunaleyo yamapuleti ensimbi, futhi amandla asabalaliswa ngokulinganayo ku-axis emaphakathi yethambo lonke, okungelula ukugoba nokuwohloka.

Izipikili zokukhiya emikhawulweni yomibili yezipikili ze-intramedullary zenza ithambo libe lilonke ukusuka phezulu kuya phansi, futhi izipikili zokukhiya ekugcineni zinganciphisa ingalo ye-torque ye-intramedullary nail ethanjeni, ivimbele ukufinyeza nokujikeleza, futhi ifinyelele ukuzinza okukhulu nokuqina kokulungiswa kwe-fracture.

I-Gamma Interlocking Intramedullary Nail

Izinkomba ze-Gamma nail

Kusebenza ezinhlotsheni ezahlukahlukene zokuphuka kwe-peritrochanteric, ikakhulukazi ama-subtrochanteric fractures.

Izinkomba ezinwetshiwe ze-Gamma (nail yokwakha kabusha).

ukuphulwa okuphezulu kwe-subtrochanteric, i-trochanteric ehlangene nokuphulwa kwe-femoral shaft.

Izinzuzo ze-Gamma nail

Ithuthukiswe ngokuhlanganisa isikulufu se-hip esishelelayo nobuchwepheshe bezinzipho ze-intramedullary, isikhonkwane esiyinhloko siseduze nengaphakathi le-medullary cavity kune-dynamic hip plate, ngakho-ke i-Gamma nail iqhuba isisindo sesiguli eduze ne-calcar yesifazane kune-hip plate enamandla, okwandisa amandla omshini wokufakelwa. Ngokuphuka kwe-subtrochanteric okubandakanya ukuqhutshwa kwekholarikhi emaphakathi, isipikili se-Gamma sigwema isidingo sokwakhiwa kabusha kwe-anatomy yokuphuka, ngakho-ke kunenzuzo ekuqhekekeni kwe-intertrochanteric noma ukuphuka kwe-subtrochanteric.

Retrograde intramedullary femoral nailing

Izinkomba ze-retrograde femoral izinzipho

Isetshenziselwa kakhulu ukuphuka kwe-femoral supracondylar, okuhlanganisa ukuphuka kwe-supracondylar comminuted kanye ne-intercondylar 'T' kanye 'Y' nokuphuka okuhlanganisiwe okubandakanya i-articular surface.

Ingase futhi isetshenziselwe ukuphuka kwe-femal ngezansi kwe-isthmus ye-femur.

I-Femoral shaft, i-supracondylar femoral, kanye ne-intercondylar fractures ngaphakathi kwe-20CM ukusuka ekuhlanganyeleni kwamadolo.

Labo abahlulekile ukulungisa amapuleti.

Izici ze-retrograde femoral nailing

I-Supracondylar femoral fracture iwukuphuka okukhulu nobunzima okokuqala, ukunciphisa futhi okwesibili, ukulungiswa okuqinile kwangaphakathi. Kukhona izehlakalo eziphezulu zezinkinga ezinjengokuphuka okungahlangani kanye nokubambezeleka kokuphola.

I-Retrograde interlocking interlocking intramedullary nailing iyindlela evame ukusetshenziswa yokwelapha i-distal femur fracture eminyakeni yamuva, enokuqina okuhle kwemishini, ingakwazi ukulawula ngokuphumelelayo ukufuduka kwangemuva kanye nokuhamba okujikelezayo kokuphela kwe-distal ye-fracture, futhi kusiza ekunyakazeni kwamalunga okuqala.

I-Supracondylar ehlanganisiwe ye-femoral stem fracture ilungiswa nge-supracondylar intramedullary nailing emide, exazulula inkinga okunzima ukuyixazulula ngokufaka izipikili ze-intramedullary ze-femur. Ithuluzi lilula ukusebenza, linembile ekumiseni, lithembekile ekulungiseni, futhi isiguli singakwazi ukwenza ukuzivocavoca kwamadolo kusenesikhathi ngemuva kokuhlinzwa.

I-Tibial interlocking intramedullary izinzipho

Izinkomba zokubethelwa kwe-tibial

Ukuphuka okuzinzile phakathi kwe-1/3 ye-tibia: ukuhlukana okuphambene, ukuhlukana okufushane kwe-oblique, i-pseudarthrosis.

Ukuqhekeka okungazinzile ngaphakathi kwe-60% yobude be-tibia ephakathi: ukuphuka eduze kwe-metaphysis, ukuphuka okuvunguzayo okude, ukuhlukana kwezigaba, ukuhlukana okuhlangene, ukuphuka ngokukhubazeka kwamathambo.

Izimpawu ze-tibial nailing

I-interlocking intramedullary nailing of tibia isetshenziswa kakhulu ekuqhekekeni kwe-tibia.

Nakuba ingasetshenziswa futhi ekuqhekekeni kwe-tibia eseduze ne-distal, izinga lezinkinga liphakeme, i-malunion yenzeka kaningi, ukuphela kwe-fracture kune-≧1cm yokunyakaza ku-1/2 yamacala, futhi i-1/4 yokulungiswa ihluleka.

Izincwadi zibike umphumela ongcono wokuphuka kwe-distal tibia kunokuhlukana kwe-tibia okuseduze ngemva kokulungiswa kwe-fibula okujwayelekile.

Amasu okuhlinza

Ukulungiswa kwangaphambi kokuhlinzwa kwemishini ekhethekile

Umbhede wamathambo (umbhede wokudonsa) noma umbhede ojwayelekile wokuhlinza we-fluoroscopic; i-retractor; isiqinisi isithombe.

Ukukhethwa okulungile kobude bezinzipho ze-intramedullary zama-endoprostheses ngaphambi kokuhlinzwa

I-Radiograph

isilinganiso sobude bezitho eziphambene

I-Intramedullary nail ububanzi

x-ray isthmus ububanzi

Isilinganiso sobude bezinzipho se-Intramedullary

1.Ukuzimisela kwerula ekhanyayo ngaphansi komshini we-C-arm

Iziphetho ezikude neziseduze zethambo zazisemgqeni omaphakathi we-ray; umbusi wayehambisana ne-diaphysis.

2.Isilinganiso sobude ngokuya ngezimpawu zomzimba

I-Femur: ithiphu le-trochanter enkulu → indawo yamadolo engemuva noma isigxobo esiphezulu se-patella; i-tibia: i-medial-lateral knee space → isici sangaphambili se-ankle joint in dorsiflexion of foot.

I-Intramedullary Nail Insertion Technique - Indlela Yokungenela

I-axis ye-longitudinal ye-medullary cavity emgqeni oqondile

Akusondeli kakhulu endaweni yokungena

Ubude obufanele: bunwetshiwe - ubude; okungahlanganisiwe - kufushane

(Ukuqinisekiswa okungaqondile kwendawo yokungena; akukho ukunwetshwa kwe-pulp, akukho ukuvikelwa kwezicubu ezithambile okudingekayo)

Indawo yokungena yezinzipho ye-femoral ye-intramedullary

Ukulungiswa kwendawo yokungena ye-parallel femoral intramedullary nail

I-hip flexion kanye ne-adduction

I-longitudinal incision proximal kuya ku-trochanter enkulu

Hhayi kude kakhulu emuva

Ukubekwa kwephinikhodi yomhlahlandlela

Ukubekwa kwesihlangu sezicubu ezithambile

Retrograde femoral intramedullary nail entry point

30° ukugoba kwamadolo

I-eksisi ende yephinikhodi yomhlahlandlela endaweni efanayo ne-medullary cavity yesiqu se-femoral distal

Ukufakwa kwephinikhodi ye-Kirschner ku-distal femur nge-patellar ligament ngomkhono ovikelayo: i-orthogonal - phakathi kwe-intercondylar fossa ye-femur; i-lateral - umugqa we-Blumensaat

Iphoyinti lokuqala le-PCL ngaphandle kokulimala

Indawo yokungena yezipikili ye-tibial ye-intramedullary ehambisanayo

Emgqeni omaphakathi we-medullary cavity

Umkhawulo wangaphambili we-tibial plateau

Iphakeme ngangokunokwenzeka ngaphandle kokulimaza ithafa

Ukuguquguquka okukhulu kwamadolo

I-incision tibial tuberosity-inferior pole ye-patella eduze kwe-medullary cavity

Vula i-medullary cavity: iphinikhodi engu-15 ° ukuya endizeni ye-sagittal ye-axis longitudinal yesiqu se-tibial

Ukuma kwesiqinisi isithombe

Amasu okuzala

Ukunciphisa amandla kagesi

ama-fractures amasha

Ukuncishiswa mathupha

ukuphuka okudala nge-pseudoarthrosis, i-sclerosis emgodini we-medullary

Ayikho i-tourniquet ngaphansi kokwehla kwamandla emali

ukujikeleza kwegazi kuyisipho esingcono kakhulu

Amasu okubeka kabusha

I-Parallel femoral intramedullary nailing

Izizathu zobunzima ekubuyiseleni ukuphuka kwezinsikazi

Ukusonga kwezicubu ezithambile akukuvumeli ukufinyelela okuqondile ethanjeni

Indawo yokufaka yenaliti ayikwazi ukubonwa ngokuqondile

Ukwengezwa kwelunga le-hip → ukungezwani kwe-iliac fascia → ukufinyezwa kokuphuka

Ukwehliswa kwe-Tibial fracture

Ukukhohlisa

Ikakhulukazi i-subcutaneous futhi kulula ukuyishaya

Ukuphuka okuzinzile - ukuphuka okuphakathi noma okukude kohlobo luka-A no-B

I-Oblique fractures - i-overkill

I-Intramedullary nailing→ amathuluzi okususa

Izinyathelo zokunciphisa ezisizayo

Ama-forceps okunciphisa amaphuzu

i-tibia; ukusetshenziswa kwe-percutaneous noma inxeba

Ama-retractors amakhulu (ama-braces)

ukunciphisa ukubambezeleka; ukufinyezwa kwezitho

Izikulufu ze-Schanz zesikhashana

① I-Femur, i-tibia

② Njengoba kuseduze nomugqa wokuphuka ngangokunokwenzeka

③ Ukusetshenziswa okusondelene kwekhohlo elilodwa lokuphuka

④Sebenzisa i-chuck yendawo yonke nge-T-handle ukuze uqondise kalula

Isipikili se-poller

①Ukuphuka kwe-Metaphyseal (ukulungisa umugqa wamandla, ukuzinzisa ukubuyisela, ukubuyisela ukusebenza)

② ukuphuka kwe-oblique ye-distal tibia noma i-femur (ingcindezi ye-shear → ingcindezi)

③ Izinzipho ze-intramedullary ezimi kahle zingena esiteshini esidala se-medullary phakathi nokuhlinzwa kwesibili

④ Indawo yokungena engalungile, ukuqondanisa okungalungile kokuphuka (isikulufu esibekwe ngendlela eqondile ekugudlukeni okungenzeka kwe-endoplant)

I-tourniquet ebanzi eyengeziwe

① i-tibia

② kulekelelwa ngokudonsa noma i-retractor

③ Sebenzisa ngokuqapha ekulimaleni okukhulu kwezicubu ezithambile

④ Igcine imfushane

⑤ Vimbela ukunwetshwa kwe-medullary esimweni sokukhuphuka kwamandla

Ukulandelana kokukhiya izinzipho: i-distal bese i-proximal

Izinzuzo

ukukhululeka kwe-knockback, ukucindezelwa kwamakhefu okuphuka; ukuqedwa kokuhlukana; imisebenzi yokunciphisa.

Amasu okunciphisa okuhlinzwa okubambezelekile & okungezona inyunyana

Izinkinga ezingase zihlangatshezwe ngokuhlinzwa ukubambezeleka

Ukukhubazeka kwe-Axial (ukufinyeza, ukugudluzwa kanye noma ukugudluzwa)

Ukukhula kwezicubu ze-granulation

Uqweqwe lwamathambo okuqala

I-sclerosis yokuphuka iphuka ngokuvalwa kwe-medullary cavity

I-Osteoporosis

Izinkinga ze-intraoperative ezingenzeka

Ukuchezuka kwe-expander kanye ne-intramedullary nail → ukungena kwe-intramedullary nail ku-cortex

Ukukhubazeka kwe-angular → i-retractor

Ukususwa kweziphetho ezinqanyuliwe → Uzipho luka-Poller, ukulungiswa kwepuleti

Izindlela zokuvimbela imigqa yamandla engavamile

I-Proximal - indawo yokungena elungile

I-Distal - isipikili se-intramedullary phakathi nendawo ye-medullary cavity

Izinkinga ze-Intramedullary Nailing

★Ukutheleleka

★Ukulimala kwemizwa

★Ukuphulukiswa okuhlanekezelwe kokuphuka

★Ukuphuka Kwezokwelapha

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

★Izinhlungu zamalunga aseduze

★I-fat embolism

★Heterotopic ossification

★I-Pulmonary embolism

★Ukuphuka kabusha

★Thrombosis

★Ukuqina kwamalunga

★Non-union of fracture, bone nonnunion

★Ukuhluleka kokulungiswa kwangaphakathi

★Ukunciphisa izitho

★Okunye

Izinkinga--Ukutheleleka

I-1.Early, ukuphuka okuvulekile kwakubhekwa njenge-contraindication ekubetheleni kwe-intramedullary.

I-2. Isigameko sokutheleleka kwangemva kokuhlinzwa ekuqhekekeni okuvulekile kuncike esimweni sokulimala kwezicubu ezithambile kanye nokungcola.

Isigameko sokutheleleka ngemva kokuphuka okuvulekile sincike esimweni sokulimala kwezicubu ezithambile kanye nokungcola kanye nendlela izicubu ezithambile ezilawulwa ngayo.

3.Izinzipho ezincane ze-intramedullary zandisa amathuba okutheleleka; Ukulungiswa kwezinzipho ze-intramedullary zokukhiya okunganwetshiwe kumpofu kakhulu, futhi iziphetho zethambo zine

Ukulungiswa kwezinzipho ze-intramedullary zokukhiya okunganwetshiwe kumbi kakhulu, kunokunyakaza okubonakalayo kwengxenye ephukile yethambo kanye nendawo eyinsalela, okulula ukukhula kwebhaktheriya.

4. Ukusetshenziswa kokulungiswa kwe-medullary okwandisiwe nokulinganiselwe akuthuthukisi nje kuphela ukuzinza kokuphuka, kodwa futhi kugwema ukudala indawo efile.

I-Fat Embolism Syndrome

I-1.Isigameko se-FES sokuphuka kwamathambo ama-tubula amade yi-0.5% kuya ku-2%.

2. Ukunwetshwa kwe-medulla nokungakhuli kwe-medulla akunawo umthelela omkhulu ekungeneni komoya wamaphaphu.

3.Uma unweba i-medulla, inqubo kufanele ixove kahle, igweme amandla amaningi kanye nokusebenza kanzima.

4.ukuxilongwa kwamanje kwe-FES kusasebenzisa indlela ehlongozwa u-Gurd ngo-1974, futhi ukwelashwa ngemva kokuxilongwa kuzobambezela isikhathi esingcono kakhulu sokwelashwa futhi kungase kube nemiphumela emibi.

Ukuphulukiswa kokuphuka okubambezelekile nokungakhulumi kwethambo

Izici ezihlukahlukene zithinta ukuphulukiswa kokuphuka ngemva kokulungiswa kwe-intramedullary nail, futhi izimbangela zingahlaziywa kanje.

I-1.izicubu ezithambile ezifakwe ekugcineni kokuphuka

2. Ukuhlukaniswa kokuphela kokuphuka okuphambene

3. Iminyaka yobudala yesiguli

4. Ukuphuka okuvulekile, ukulimala okukhulu kwezicubu ezithambile, i-hemodialysis ebucayi yendawo noma ukutheleleka.

5. Ukulungiswa kahle kwezinzipho ze-intramedullary

6. Isifo sikashukela i-mellitus esihlanganisiwe noma ezinye izifo ezidliwayo.

Ukuphuka Kwezokwelapha

Ukuphuka okudalwe ngokwezokwelapha ikakhulukazi ukuphuka kwesibili okubangelwa ukuxhaphazwa okungalungile ngesikhathi sokulungiswa kwe-intramedullary nail.

Ukunakwa kwe-intraoperative kufanele kukhokhwe

1. Ukukhetha okungalungile kwendawo yokungena yezipikili kungase kuholele ekuqhekekeni okuseduze.

2. Ungaphusheli ngamandla ekwandiseni i-medulla.

3. Ukungena kokunwetshwa kwe-pulp kufanele kube ngendlela efanayo nesiqondiso sokufakwa kwezipikili.

4. Ungasebenzisi amandla lapho ufaka izipikili ze-intramedullary ekugcineni kwe-distal.

Ubuhlungu emalungeni angomakhelwane

1. Ukufakwa kwe-intramedullary nail kuhilela izicubu ezithambile ngisho ne-capsule ehlangene eduze kwelunga okungenani elingu-1.

2. I-tibial plateau ixhunywe emaphethelweni angaphambili e-meniscus ephakathi nge-knee ligament futhi yakha indawo ephephile ngaphezu kwe-tuberosity ye-tibial kuze kube kuleli phuzu. Uma iphuzu le-nailing lisondele kakhulu phezulu noma ububanzi be-nail ye-intramedullary likhulu kakhulu, lingabangela ukulimala kwezakhiwo ze-intra-articular, okuholela ebuhlungu bedolo ngemuva kokuhlinzwa.

3. I-proximal protrusion of intramedullary nail kanye ne-heterotopic ossification yizona zimbangela eziyinhloko zobuhlungu be-hip ngemva kokuhlinzwa kwe-femoral intramedullary nail.

4. I-proximal protrusion of intramedullary nail, proximal locking nail irritation kanye nokuphazamiseka kwe-rotator cuff yizimbangela eziyinhloko zobuhlungu behlombe ngemva kwe-humeral intramedullary nailing.