I-Femoral Intramedullary Nailing - Ungalikhetha Kanjani Iphuzu Lokufaka Elingcono Kakhulu?

Isingeniso

Ukuthuthukiswa kokwelashwa kokuphuka kwesifazane kungalandelelwa emuva kuma-1940s lapho u-Kuntscher ethula indlela yokubopha izipikili ye-intramedullary evaliwe. Ukusetshenziswa kwezinzipho ze-intramedullary (IMNs) ekuqhekekeni kwabesifazane sekuphenduke indinganiso yokunakekelwa emashumini ambalwa eminyaka adlule, kanye nentuthuko yamanje ukubethelwa kwe-intramedullary kanye nentuthuko kumasu okuhlinza kuye kwavumela ukwanda okukhulu ekusetshenzisweni kwe-intramedullary nailing of the femur.

Ukwelashwa okulondoloziwe kwe-femoral stem fractures kusetshenziswa kuphela kwinani elincane kakhulu leziguli ezine-contraindication ephawulekayo ku-anesthesia nokuhlinzwa, futhi insika yokwelashwa ihlala ukulungiswa kokuhlinzwa. Mayelana nokwelashwa kokuhlinzwa kwalokhu kuphuka, kunezinketho ezimbalwa ezitholakalayo, okuhlanganisa ukubethelwa kwe-intramedullary, ukulungiswa kwesikulufu sepuleti, nokulungiswa kwangaphandle. Uma kuqhathaniswa nezinye izinketho zokuhlinzwa, ukubethelwa kwe-intramedullary kuyindlela enezinga eliphansi lezinkinga kanye nezinga eliphezulu lokuphulukiswa kokuphuka, futhi sekuyasetshenziswa kabanzi emisebenzini yomtholampilo.

Ukuqonda kahle i-anatomy ye-proximal femur, ukunikezwa kwegazi ekhanda lesifazane kanye ne-anatomy yemisipha ye-hip kungakhuphula kakhulu izinga lokuphumelela lokubethelwa kwe-intramedullary ngenxa yokuphuka kwe-femal. Ngokuphambene, ukukhethwa kwendawo yokungena kuncike ezintweni eziningi, okuhlanganisa ukuklama kwezinzipho ze-intramedullary, indawo yokuphuka, ukuphuka kwe-fracture, kanye nezici zesiguli (isb, i-polytrauma, ukukhulelwa, nokukhuluphala). Kungakhathaliseki indawo yokungena ekhethiwe, ukuthola indawo yokungena efanele kubalulekile ukuze kugcinwe ukunciphisa okwanele ngesikhathi sokufakwa kwe-intramedullary nail ngenkathi unciphisa ingozi yezinkinga.

I-Femoral Anatomy

1.Ukunikezwa kwegazi ekhanda lesifazane

Ikhanda lesifazane lithola ukuhlinzekwa kwemithambo emithanjeni emi-3 emikhulu. I-lateral rotator femoral artery (enamagatsha angu-3-4), umthambo we-obturator, ohlinzeka nge-ligament eyindilinga, kanye ne-medial rotator femoral artery (Fig. 1), ephinde inikeze umkhumbi okhuphukayo okhuphukayo okhuphuka nge-lateral rotator femoral artery futhi unikeze indawo enkulu ye-trochanteric.

2.I-Anatomy Yemisipha Ye-Hip

Lapho wenza i-intramedullary nailing of the femur, ukuqonda kahle kwemisipha endaweni ezungeze i-rotor kubalulekile ukuvimbela ukulimala okungadingekile. I-gluteus medius muscle ivela ku-ilium futhi iphetha ku-lateral ye-trochanter enkulu, kuyilapho i-gluteus minimus muscle nayo isuka ku-ilium futhi idlula isici esingemuva se-hip joint ukuze iphele kusici esingemuva se-trochanter enkulu (Izibalo 2 & 3). Zombili lezi zicubu zisebenza njengama-adductors ethangeni kanye nama-rotator angaphakathi e-hip. Ngakho-ke, ukulimala kule misipha ngesikhathi sokufakwa kwe-paracentric femoral intramedullary nail kuzoholela ebuthakathakeni be-adductor kanye ne-Tendelenburg gait, enomthelela omubi ekululameni kwesiguli kanye nomphumela.

Umfanekiso 2. I-Anatomy yemisipha ezungeze ilunga le-hip

Umfanekiso 3. indawo yokunamathisela yemisipha ye-femoral eseduze

I-Parallel Femoral Intramedullary Nail

Ucwaningo oluningi lwakamuva luhlole indawo efanelekile yokungena ye-paracrine femoral nail. Izinketho zamaphuzu okungena ezinzipho zihlanganisa i-trochanter enkulu kanye ne-pyriform fossa, ngayinye enezinkomba zayo kanye nezinkinga ezihambisanayo (Ithebula 1).

Ithebula 1.Amaphuzu okuqala kanye nezingozi ezingaba khona ze-paracrine kanye ne-retrograde femoral nailing
okuhlukile	i-parallel intramedullary nail		buyisela kabusha isipikili se-intramedullary
	i-rotor	i-pyriform fossa (i-anatomy)
indiza yomqhele	I-Vertex ye-trochanter enkulu futhi ekhomba ngokuphakathi emgodini we-medullary	ukuhlangana kwe-trochanter enkulu nentamo yesifazane	i-median ye- intercondylar fossa (i-anatomy)
indiza ye-sagittal (math.)	Umugqa phakathi kwesikhungo se-trochanter enkulu kanye nendawo ephakathi komnkantsha we-femur	i-pyriform fossa (i-anatomy)	I-PCL ingu-1.2 cm ngaphambili endaweni yokuqala yesifazane, ekhomba emgodini we-medullary.
ukuchayeka	Iqembu le-Hip abductor ukulimala kwendawo yokuma	Ukuphazamiseka kokunikezwa kwegazi ekhanda lesifazane kanye ne-hip yangaphandle ye-rotator muscle	Ukuphatha okungalungile kungaholela ku-PCL
I-PCL: i-posterior cruciate ligament

1.Iphuzu lokungena lenaliti ye-rotor enkulu

I-trochanter enkulu iye yachazwa ngokuthi i-trapezoidal bony protuberance yangaphandle etholakala engxenyeni ye-lateral yentamo ye-femoral, ubuso obuhlinzeka ngokunamathiselwe kwi-lateral gluteus medius kanye ne-anterior gluteus minimus muscles (Izibalo 2 kanye ne-3). Nakuba lokhu kuwuphawu lwendawo olungamathambo amancane, ukwenza kwasendaweni indawo okuyiyonayona yokuqala lapho kwenziwa i-IMN yesifazane kungase kube umehluko phakathi kokuthola umphumela owanelisayo noma omubi lapho ubhekana nokuphuka kwesiqu sesifazane.

Ukubuyekeza izincwadi zamanje zezincazelo zephoyinti lokungena wesifazane, sithole ukuntuleka kophawu oluchazwe ngokucacile lwe-anatomical yendawo yokungena ye-femoral rotor IMN.Bharti et al. ichaze iphuzu lokungena elisuka ku-apical apex ye-trochanter enkulu njengento ephakathi nendawo ye-medullary endaweni ye-orthostatic, futhi njengesikhungo se-trochanter enkulu ngokuhambisana nesikhungo se-femoral medullary cavity endaweni ye-lateral (Fig. 4), kanye nencazelo ehlukile yephuzu elikhulu lokungena le-trochanter kumbono we-lateral hip phakathi kwe-router-yangaphakathi ye-router phakathi kwe-router yangaphakathi noma i-router yangaphakathi. izingxenye ezimbili kwezintathu ze-rotor.Georgiadis et al. ichaze iphuzu lokungena kwenaliti njengengxenye engemuva kakhulu ye-apical superior margin ye-rotor.

UMFANEKISO 4. Ukubukwa kwe-intraoperative orthostatic kanye ne-lateral ye-hip kubonisa indawo efanelekile yokungena ye-femoral paramedian intramedullary nailing ye-trochanter enkulu. '*' ikhombisa indawo yokungena ye-intramedullary nail.

Ucwaningo lwakamuva ezincwadini lubonise ukuthi i-apex ye-trochanter enkulu iyindawo ekahle yokuqala yokuthola umugqa ophelele wamandla, nokuthi ukuqondanisa okungalungile ngenxa yokuguqulwa kokuguqulwa kuvame ukwenzeka lapho iphuzu lokungena lishintshwa ngaphezu kwe-2 mm lateral kuya ku-trochanter enkulu. Lolu cwaningo luphinde lwagcizelela ukuthi indawo yokungena engemuva kakhulu iholela ekuthuthweni kwe-distal phambili, kanti indawo yokungena ephakathi ingabangela ukuthi i-distal fracture block isuswe ngemuva. Ngokuphambene, olunye ucwaningo lwabonisa ukuthi ekuqhekekeni kwe-femur intertrochanteric, isigameko sokungena kwe-intramedullary nail sasiphakeme kakhulu ngephuzu lokuphina elalibheke eceleni kohlangothi lwangaphambili kunephuzu lokuphina elaliseduze nezinhlangothi ezimaphakathi nezangemuva.

Iphoyinti elikhulu le-trochanteric apex pinning livame ukusetshenziswa ezigulini ezikhuluphele, futhi le nqubo ayifuni kakhulu ngokobuchwepheshe, ihlinzeka isikhathi esincane sokusebenza kanye nengozi ephansi yezinkinga kunephoyinti lokuphina le-pyriform fossa.

IZINKINGA: Izinkinga ze-intraoperative kanye ne-postoperative ye-femoral intramedullary nailing ene-trochanteric approach point enkulu kuxoxwe ngayo ezincwadini ezimbalwa. Enye yalezi, ngokuvamile ehlobene nendlela yokubethela, iwukuphuka okubangelwa ukwelashwa. Ekuqhekekeni kwe-intertrochanteric femoral, indawo yokungena etholakala eceleni nangaphambili kwe-trochanter enkulu kungenzeka ukuthi ibangele ukuphuka okuphakathi kunephuzu lokungena eliseduze nohlangothi oluphakathi.

Enye inkinga efanelekile ingenxa yokulimala kwezicubu ezithambile, ikakhulukazi emagatsheni e-medial rotator femoral artery kanye nemisipha ye-adductor, kodwa lokhu kulimala akuvamile uma kuqhathaniswa ne-pyriform fossa nail yokungena. Ukwengeza, isigameko se-ischemic necrosis yekhanda lesifazane ne-apex ye-trochanter enkulu njengoba indawo yokungena icatshangwa ukuthi iphansi kakhulu, ngezifundo ezibika ukuthi iphansi njenge-0.3%.

Uma kucatshangelwa isikhathi se-intraoperative kanye nokuchayeka kwe-fluoroscopic, isikhathi esimaphakathi sokusebenza sasiyimizuzu engama-90.7 yendawo yokungena enkulu ye-trochanteric uma kuqhathaniswa nemizuzu engu-112.7 yeqembu lephoyinti lokungena elimise okwepheya, kuyilapho isikhathi se-fluoroscopic sasiyimizuzwana engu-5.88 yeqembu elikhulu lokungena le-trochanteric kanye neqembu lephoyinti lokungena le-trochanteric eliqhathaniswa neqembu lesibili le-fossaar eliqhathaniswe ne-fossaar-yesibili engu-10.08. indawo yokungena ye-fossa emise okwepheya.

I-prognosis yesiguli nayo yayiyisici esibalulekile lapho kunqunywa indawo yokungena ye-intramedullary, njengoba ukutakula kokuqala kokusebenza (njengoba kuhlolwe ukuhlolwa kwesihlalo-sesihlalo kanye nokuhlolwa kokuphakama okulinganiselwe) kwakungcono kakhulu ezigulini ezinyangeni ze-6 emva kokuhlinzwa ukuze uthole iphuzu elikhulu lokungena le-trochanteric uma kuqhathaniswa ne-pyriform fossa yokungena iphuzu le-nail, kodwa lo mehluko wawungabalulekile ngemva kwezinyanga ze-12. Nakuba indawo enkulu yokufinyelela ye-trochanteric ngokuvamile ihlotshaniswa nokukhumula izicubu ezithambile kancane ngenxa yendawo yayo, isengaholela ekulimaleni kweqembu lemisipha ye-abductor, njengoba kuboniswe ngu-Ergiş et al. Bathole ukuthi ibhalansi eguquguqukayo namandla e-hip abductor ancipha ezigulini ezinezikhonkwane zokungena ezinkulu ze-trochanteric uma kuqhathaniswa nezilawuli ezinempilo. Ngaphezu kwalokho, ucwaningo lwabo lubike ukwehla okuphawulekayo kwamandla ama-hip abductors, ama-flexible kanye nama-rotator angaphakathi / angaphandle uma kuqhathaniswa nohlangothi olungasebenzi.

2. Indawo yokungena eyiPearly fossa

I-fossa ye-pyriformis muscle iwuphawu olubalulekile lwe-anatomical olukhonjwe njengenye yezindawo zokungena ze-paracentesis femoral intramedullary nail.Ocwaningweni lwabo lwe-autopsy cadaveric, u-Lakhwani et al. waphawula ukuthi i-fossa ye-pyriformis muscle yayingeyona 'ipheya' emile noma i-pyriformis muscle attachment. Umsipha unamathela endaweni encane esihlokweni se-trochanter enkulu, kuyilapho i-pyriform fossa iwukucindezeleka ohlangothini oluphakathi lwe-trochanter enkulu futhi iyisinamathiselo se-extensor carpi radialis brevis muscle. Ababhali baphethe ngokuthi i-pyriform muscle kanye ne-pyriform fossa yizinto ezimbili ezihlukene nokuthi okuthiwa i-pyriform fossa kufanele kubizwe ngokuthi 'i-rotor' noma 'i-occlusal' fossa ukuze kucace kanye nokunemba kwe-anatomical. Baphakamisa ukuthi ngemva kokutadisha i-cis-femoral Baphakamisa ukuthi igama langempela elithi 'rotor fossa' liphinde lifakwe ezincwadini esikhundleni sethi 'pyriform fossa' ngemva kokutadisha amagama e-parafemoral entry point. Nakuba amaphuzu alezi zifundo ezimbili ahlonishwa kakhulu, ukuze kube lula ukuchaza nokuvimbela ukudideka nendawo enkulu yokungena ye-trochanteric, sisazobhekisela kuleli phuzu lokungena njengendawo yokungena ye-pyriform fossa.

Izifundo eziningana ezincwadini zamanje zichaza ngokunembile indawo yokungena ye-pearly fossa yezinzipho ze-intramedullary femoral.Georgiadis et al. chaza indawo yokungena ye-pearly fossa njengendawo yokunamathiselwe kwe-extensor carpi radialis brevis muscle ekucindezelekeni phansi kwentamo ye-femoral (Fig. 5). Ababhali baphinde bagcizelele ukuthi indawo yokungena ekude kakhulu noma ekude kakhulu ngaphakathi ingase ikhulise ingozi yokuphuka kwentamo yesifazane, futhi lapho indawo yokungena ikude kakhulu emuva, kungase kube nengozi enkulu ye-ischemic necrosis, ephakeme kakhulu ezigulini zentsha.

Umfanekiso 5. Ukubuka kwe-intraoperative frontolateral of the hip okubonisa indawo ekahle yokungena ye-pyriform fossa retrograde femoral intramedullary nail. I-'*' ikhombisa indawo yokuqala yezipikili ze-intramedullary.

Harper et al. ishicilele ucwaningo lwamaqembu angu-14 e-human cadaveric femurs ngo-1987 lapho ahlola khona indawo yephinikhodi ye-intramedullary guide kanye nendawo yokuphuma ye-intramedullary nail yethulwa ngokude futhi ngokuseduze ngendlela yokubuyisela emuva kusukela kunotshi ye-intercondylar ye-femur. Baphetha ngokuthi iphuzu lokungena kwe-pyriformis paramedian intramedullary nail lalitholakala ekuhlanganiseni kwe-trochanter enkulu nentamo yesifazane, kancane kancane ngaphambi kwe-pyriformis occulta.Indawo yokufaka yaqinisekiswa kabusha nguGausepohl et al. Kolunye ucwaningo lwe-cadaveric, babeka indawo efanelekile yokungena ye-femoral intramedullary nail eduze konqenqema oluphakathi lwe-trochanter enkulu phezu kwethenda ye-pyriformis. Ngaphezu kwalokho, ocwaningweni lwe-cadaveric olwenziwe nguLabronici et al. i-fossa ye-pyriformis muscle yachazwa njengesifunda se-luminal esimise okwepheya esihambisana ne-axis emaphakathi ye-femoral intramedullary cavity endizeni ye-coronal.

Iphoyinti lokufinyelela le-pyriform fossa linobubi obuthile obuthile ngoba ngokobuchwepheshe linenselele enkulu uma liqhathaniswa nendawo enkulu yokufinyelela ye-trochanter, ikakhulukazi ezigulini ezikhuluphele. Ngaphezu kwalokho, indawo efanelekile yokungena yendawo yokungena enaliti emise okwepheya iyindawo ewumngcingo, okwenza kube inselele kakhulu ukwenza okwasendaweni. Isibonelo, iphoyinti lokuqala elingaphambili kakhulu entanyeni yesifazane lizoholela ekucindezelekeni okukhulu kwe-circumferential futhi kwandise ingozi yokuqhuma kwe-cortical yangaphambili, ikakhulukazi uma indawo yokuqala ingaphezu kuka-6 mm ngaphambili kwe-fossa. Ukwengeza, ukungafani kwe-morphologic kungase kuvimbele indawo yokungena efanele, ikakhulukazi uma i-rotator yangaphandle emfushane inkulu noma i-rotor iphumele ngaphandle, okuholela endaweni yokungena ephakathi kakhulu kanye nengozi yokuphuka kwentamo yesifazane.

IZINKINGA: Ngokuqhathanisa izindawo zokungena ze-trochanteric ezinkulu ezingu-38 ezinezindawo zokungena ze-pearly fossa ezingu-53 zokubethelwa kwe-femoral intramedullary, u-Ricci et al uthole ukuthi iqembu le-pearly fossa linesikhathi eside sokusebenza esingu-30% kanye nesikhathi eside se-fluoroscopy esingu-73%. Lokhu okutholakele kuqinisekiswe nguBhatti et al. lapho uqhathanisa amaphuzu e-2 enaliti yokungena.

Ngokuphathelene nokulimala kwezicubu ezithambile, kwakunengozi enkulu yokulimala kwezicubu ezithambile endaweni yokungena ye-pyriformis uma kuqhathaniswa ne-neuromuscular ye-interterosseous endaweni yokungena inaliti enkulu ye-trochanteric. UDora et al. kuhlolwe ama-cadaveric femurs amadala ayi-16 ngokulimala kwezicubu ezithambile kumsipha we-pyriformis kanye nephinikhodi yokungena ye-rotor. Bathola ukuthi nakuba i-pyriformis fossa yayiyi-geometrically optimally, yabangela umonakalo omkhulu ekuhlinzekeni kwemithambo ekhanda lesifazane kanye nemisipha ezungezile kanye nemisipha. Lokhu okutholakele kuphinde kwaqinisekiswa izifundo ze-cadaveric ngu-Ansari Moin et al. I-WHO iphinde yaqhathanisa amaphuzu amabili okungenela. Baqaphele ukuthi ukulungiswa kwangaphakathi kwe-nail kusukela emsipha we-pyriformis kwakungase kulimaze abathumbi be-hip kanye nama-rotator angaphandle. Ngaphezu kwalokho, ukulimala komthambo we-femoral we-rotator ophakathi kutholwe kuzo zonke izimo (Ithebula 2).

Ithebula 2. Isifinyezo sokulimala kwezicubu ezithambile ezindaweni zokungena yenaliti ezihlukene
okuhlukile	Indawo yokungena ye-Pyriform fossa (n=5)	Indawo yokuphakelayo yerotha enkulu (n=5)
izicubu ezithambile
i-gluteus medius muscle (i-anatomy)	5	1
i-gluteus medius tendon	0	4
ukulimala kwethoni
i-gluteus minimus (i-anatomy)	3	0
i-pyriformis muscle (ngaphezulu komgogodla)	3	3
obturator internus (anatomy)	1	0
i-latissimus dorsi muscle (i-anatomy)	3	0
Imithambo yegazi kanye nama-capsules ahlangene
I-MFCA Deep Branches	4	0
I-MFCA Shallow Branch	4	0
i-articular capsule (ye-joint efana nedolo ku-anatomy)	1	0
I-MFCA: i-medial circumflex femoral artery.

Muva nje, u-Bharti et al. wafunda ubungozi benkinga yokubethelwa kwe-femoral intramedullary endaweni yokungena ye-trochanteric kanye nendawo yokungena ye-pearly fossa futhi wathola ubungozi bezinkinga ezifana nezinga lokuphulukiswa kokuphuka futhi wazifingqa ngale ndlela elandelayo (Ithebula 3).

Ithebula 3. Iphuzu lokungena le-Pyriform fossa kanye nendawo yokungena ye-trochanter enkulu yethambo lomnkantsha
inkinga	Iphuzu lenaliti ye-Piriformis sinus	Indawo yokufaka i-trochanter enkulu
Thelela	6.7	3.3
I-Malunion	20	13.3
Ukuphulukiswa okubambezelekile	20	13.3
Ukunyakaza kwe-hip okulinganiselwe	20	33.3
Ukunyakaza kwamadolo okulinganiselwe	6.7	6.7
Umehluko wobude bezitho	13.3	20
Isivalo somsila siphumela ngaphezu kwe-bone cortex	13.3	20
I-intraoperative femoral neck fracture	10	0
Ukuphuka kwe-trochanter enkulu	0	3.4
I-necrosis yekhanda labesifazane	6.7	0

Retrograde femoral intramedullary nailing

Ukunquma indawo efanelekile yokungena yokubuyisela emuva i-femoral intramedullary nailing kuzosiza ekufinyeleleni ukubuyiselwa kokuqondisa kahle kwe-fracture, ubude, nokujikeleza ngenkathi kunciphisa ukulimala kwe-articular cartilage, i-anterior cruciate ligament (ACL), i-posterior cruciate ligament (ACL), nokulimala kwezicubu ezithambile (Ithebula 1). Muva nje, kuye kwaba nesithakazelo esikhulayo ekubuyiseleni i-femoral intramedullary nailing ngenhloso yokunciphisa izinkinga ezihlobene ne-paracromial nailing, kuhlanganise nobuhlungu be-hip, i-heterotopic ossification, ubuthakathaka be-adductor, kanye ne-pudendal nerve palsy, ebhekwa njengento encane kakhulu uma iqhathaniswa nokunciphisa i-incisional kanye nokuvala i-femoral fixing plating yangaphakathi, ikakhulukazi i-femoral. yesiqu sesifazane. Ukwengeza, ubufakazi bamuva bubonisa ukuthi lapho lezi zinzipho ze-intramedullary ezibuyisela emuva zilingana ngokufanelekile, izipikili zokukhiya eziseduze zingase zingadingeki.Kwakungekho mehluko emazingeni okuphulukisa, isikhathi sokuphulukiswa, noma imiphumela embikwe ngesiguli phakathi kweMeccariello et al. kanye noBisaccia et al. ekwelapheni i-distal one-third femoral stem fractures kusetshenziswa ukukhiya nokungakhiyi izinzipho ze-intramedullary. Ngakho-ke, ukusetshenziswa kwe-retrograde femoral nailing sekuye kwaduma futhi kwamukelwa kabanzi.

Izincazelo eziningi zephoyinti elilungile lokungena le-retrograde femoral intramedullary nailing zingatholakala emibhalweni. Ucwaningo oluningi lukhomba indawo efanelekile yokungena ye-retrograde femoral nail njenge-1.2 yangaphambili kumsuka wesifazane we-posterior cruciate ligament.

cm (ngokuhambisana ne-medullary cavity) kanye nendawo ephakathi ye-intercondylar fossa (Umfanekiso 6).

UMFANEKISO 6. Ukubukwa kwe-intraoperative orthostatic kanye neceleni kwedolo okubonisa indawo efanelekile yokungena ye-retrograde femoral intramedullary nail. '*' ikhombisa indawo yokuqala yezipikili ze-intramedullary.

Nakuba kungekho zinkomba eziphelele zokubethelwa kwe-femoral intramedullary nailing, izinkomba eziningi zesihlobo zichaziwe. Lokhu kufaka phakathi iziguli ze-polytrauma, iziguli ezikhuluphele ngokweqile, iziguli ezikhulelwe, i-femoral stem fractures, i-ipsilateral femoral stem kanye ne-acetabular/pelvic fractures noma i-femoral neck fractures, kanye ne-ipsilateral femoral stem kanye ne-tibial fractures. Eziningi zalezi zinkomba zihlobene nokukhululeka kokuma kwesiguli kanye nokuvimbela amanxeba amaningi okuhlinzwa eduze.

Ngakolunye uhlangothi, ukuphikisana okuphelele ekubuyiseleni kabusha isipikili se-femoral intramedullary kufaka phakathi ukuvinjwa kwesiteshi se-intramedullary esibuyisela emuva ngokufakelwa okugciniwe kanye nokuqhekeka okuvulekile kwe-distal femur. Ukuphikisana okuhlobene ukuphuka okuphakathi kuka-5 cm we-trochanter encane, ubunzima bokufinyelela iphuzu elifanele lokungena ngenxa yokugoba kwedolo okungaphansi kwama-degree angu-45, ukutheleleka kwangaphambi kwamadolo okungase kubangele engozini yokusabalala esiqwini se-femoral, ukulimala okunzima kwezicubu ezithambile edolweni, kanye nokuphuka kwe-intra-articular kanye ne-polex pole disfetal.

Izinkinga: Iningi lezinkinga zokubethelwa kwe-femoral retrograde zihlobene nokuphatha okungafanele, ikakhulukazi ukubekwa okungalungile kwendawo yokungena. Endizeni ye-sagittal, indawo yokungena engaphambili kakhulu izoholela ekuhumushweni kokuphuka kwangemuva, ukulimala kwe-articular surface, futhi ngokunokwenzeka nokufaka izinzipho ku-patella lapho idolo ligobeka. Ngakolunye uhlangothi, uma indawo yokungena ibekwe ngendlela engafanele endaweni engemuva, lokhu kungase kubangele ingozi enkulu yokulimala emthonjeni we-posterior cruciate ligament kanye nokufuduka kwangaphambili kwendawo yokuphuka.

Hutchinson et al. kuchazwe izinkinga ezihlobene nezindawo zokungena ezingafanele zendiza ye-coronal. Bathole ukuthi indawo yokungena emaphakathi kakhulu ibangele ukukhubazeka kwe-posterolateral ngokuhumusha kokuphuka kwe-posterolateral, kanti okuseceleni ngokweqile kubangele ukukhubazeka okumaphakathi nokuhumusha okuphakathi.Sanders et al. libike ukuthi ukukhetha indawo yokuqala ephakathi okwakungu-2 cm noma ngaphezulu ku-axis ephakathi kubangele ukuphuka kwe-cortical yangaphakathi okwakungaxhunywanga ngenxa yomzuzu wokugoba we-isthmic wangemuva wokuphuka okuholela ekunciphiseni okubi kwe-posterolateral.

Ezinye izinkinga ezihlotshaniswa ne-retrograde femoral follower nailing zihlanganisa ubuhlungu bedolo, ukuqina, i-heterotopic knee ossification, kanye nokwakheka komzimba wamadolo ngaphandle kwe-intra-articular.

Phetha

Nakuba indlela ngayinye yokubethela izipikili ye-intramedullary inenkomba ehambisanayo, ukukhetha ukuthi iyiphi indlela yokubethela yezipikili ye-intramedullary ezosetshenziswa ekwelapheni ukuphuka kwesiqu sesifazane ngokuvamile kuncike ekukhetheni udokotela ohlinzayo. Lapho wenza i-intramedullary nailing of the femur, ukuthola indawo efanelekile yokungena yohlobo lwezipikili ezisetshenziselwa ukulungiswa kuyadingeka ukuze kube nomphumela ophumelelayo. Ulwazi lwe-anatomy yendawo nokusebenza kwesithombe kuzosiza udokotela ohlinzayo enze inqubo eyanele ngokobuchwepheshe kuyilapho enciphisa ubungozi bezinkinga ezihambisanayo. Ukwengeza, ezinqubweni zokubethelwa kwe-intramedullary, ukugcinwa kokunciphisa kuyisici esibalulekile ekuvimbeleni i-malunion kanye ne-malunion noma ukungavumelani kokuphuka.