Kev tshem tawm ntawm cov ntsia hlau intramedullary yog ib txoj kev niaj hnub, raws li txhua lub chaw tsim khoom muab cov cuab yeej tshem tawm tsim nyog. Txawm li cas los xij, qhov xav tau tiag tiag kom tshem tawm cov ntsia hlau ua tiav intramedullary yog qhov tsawg. Thaum tus ntsia thawv intramedullary ruptures, qhov teeb meem no yog tshwj xeeb tshaj yog tsis yooj yim sua. Lub sijhawm no, cov cuab yeej tshwj xeeb thiab cov tswv yim yuav tsum tau tshem tawm cov ntsia hlau intramedullary.
Universal intramedullary ntsia thawv tshem tawm thiab tawg cov ntsia thawv tshem tawm muaj nyob rau hauv kev ua lag luam, thiab cov txheej txheem no tuaj yeem pab daws cov teeb meem saum toj no. Txawm li cas los xij, kev phais qhov muag tsis pom zoo tsis muaj cov cuab yeej tshwj xeeb.
Qhov kev txiav txim uas tus ntsia thawv intramedullary raug tshem tawm yog qhov tseem ceeb. Ua ntej tshem tawm cov kev txhim kho sab hauv, tus Tsov tus tw yuav tsum nyob thiab tuav. Tus Tsov tus tw yog qee zaum nyuaj los txheeb xyuas ntawm X-rays, thiab vim li no, qee tus kws kho mob tsis pom zoo kom siv lub hau npog tshwj tsis yog tias nws ua rau qhov ntev ntawm cov ntsia hlau intramedullary. Tom qab tshem tus Tsov tus tw, siv daim ntawv qhia caj npab los tuav tus ntsia thawv intramedullary, thiab tom qab ntawd mus rau kev tshem tawm ntawm tus ntsia thawv xauv. Nws yuav tsum tau nco ntsoov tias tag nrho cov xauv pins yuav tsum tau muab tshem tawm ua ntej sim tshem tawm tus pin tseem ceeb. Yog tias tus neeg tsim khoom ntawm tus ntsia thawv intramedullary tsis tuaj yeem txheeb xyuas tau, nws yog qhov tsim nyog yuav tsum tau nthuav tawm kom pom qhov kawg ntawm tus ntsia thawv intramedullary kom paub meej nws cov cuab yeej tuav, suav nrog xov hom thiab qhov loj me, thiab xaiv cov cuab yeej tsim nyog. Yog tias qhov kev sib tw zoo meej tsis tuaj yeem ua tau, qhov kev xaiv siv cov cuab yeej rho tawm tapered tuaj yeem pab tuav tus Tsov tus tw ntawm tus ntsia thawv intramedullary. Yog hais tias cov pob txha ingrowth mus rau hauv tus ntsia thawv qhov los yog nyob rau saum npoo ntawm tus ntsia thawv yog xav tias, tus ntsia thawv yuav tapping rau hauv ob peb millimeters nrog ib tug zawv zawg rauj ua ntej tshem tawm.
Ntau yam kev qhia tshwj xeeb ntawm tus Tsov tus tw lub kaus mom yog tsim los pab txhawb kev xaiv intraoperative thiab xyuas kom meej intramedullary ntsia thawv tshem tawm.
![intramedullary ntsia thawv cap]()
Ntau tus kws kho mob uas paub txog tau sau tseg ntau ntawm cov txheej txheem tshem tawm cov ntsia hlau tawg hauv lub cev. Yog tias qhov tawg ntawm qhov tawg yuav tsum tau qhib rau kev ntxuav thiab txo qis, cov ntsia hlau intramedullary tuaj yeem raug tshem tawm los ntawm qhov kawg tawg. Hauv qab no, peb yuav qhia luv luv txog qee txoj kev rho tawm uas tsis tas yuav raug cuam tshuam ntawm qhov kawg tawg.
Yuav ua li cas tshem tawm ib tug tawg cannulated intramedullary ntsia thawv?
Feem ntau, nws tsis yog qhov nyuaj heev los tshem tawm qhov sib thooj ntawm cov ntsia hlau tawg intramedullary. Thaum qhov sib thooj raug tshem tawm, nws dhau los ua qhov kev sib tw yuav ua li cas tshem tawm qhov distal yam tsis qhib qhov tawg tawg. Reaming tus kwj dej medullary los ntawm ob peb millimeters tuaj yeem pab tshem tawm cov ntsia hlau distal.
Siv lub nucleus ntev lossis laparoscopic forceps, qhov feem cuam tshuam tau qee zaum raug muab tshem tawm thiab ua tiav. Txawm li cas los xij, ntev forceps tsis muab lub zog tuav, thiab kev tshem tawm tau zoo nyob ntawm seb qhov distal puas tau loosened.
Tsav ib tug nyias intramedullary ntsia thawv los yog phau ntawv reamer rau hauv lub distal tawg tus ntsia thawv kuj qee zaum pab tshem tawm nws. Thaum lub sij hawm tsav tsheb, lub distal locking pin yuav tsum tau muab khaws cia kom tsis txhob txav mus ntxiv ntawm qhov distal thaum tsav tsheb. Thaum cov ntsia hlau nyias intramedullary los yog phau ntawv reamer tau ua tiav kev koom tes ruaj khov nrog ntu ntu, tshem tawm cov ntsia hlau distal thiab tom qab ntawd khob rov qab kom tshem tawm qhov tawg ntu.
Ntau cov ntaub ntawv qhia txog kev siv cov cuab yeej hooked kom tshem tawm qhov distal ntawm cannulated tawg rau tes. Lub hollow kab noj hniav ntawm tus ntsia thawv intramedullary tuaj yeem sau nrog ntau cov lus qhia nyob ntawm qhov sib npaug ntawm cov kev taw qhia ntawm kev rho tawm nuv kom tsis txhob decoupling thaum lub sij hawm extraction txheej txheem. Cov txheej txheem ntau txoj kev xaim ntim cov txheej txheem kuj yog qee zaum lwm txoj hauv kev rho tawm hooks.
![Txhaum cannulated intramedullary ntsia thawv tshem tawm]()
Thaum kawg, yog hais tias tag nrho cov saum toj no proximal tshem tawm cov tswv yim ua tsis tiav, distal tshem tawm ntawm tus ntsia thawv intramedullary yuav sim. Piv txwv li, ib feem ntawm qhov tawg ntawm cov ntsia hlau femoral intramedullary raug tshem tawm los ntawm kev qhib hauv qhov distal femur los ntawm lub hauv caug sib koom. Lub laum yog taw mus rau qhov kawg ntawm qhov kawg ntawm tus ntsia thawv intramedullary, thiab qhov qhib yog loj txaus kom haum rau cov txiv ntseej-tipped qhia hlau nrog lub gasket. Cov kev taw qhia hlau yog retrogradely dhau los ntawm lub hollow ntawm tus ntsia thawv intramedullary thiab protrudes los ntawm qhov qhib ntawm lub proximal femur, thiab cov txiv ntseej taub hau nrog lub spacer tuaj yeem nqa cov ntsia hlau distal tawg tawm ntawm lub femur proximal. Cov txheej txheem zoo sib xws tuaj yeem siv rau tibia, nrog rau kev nkag mus rau qhov chaw ntawm qhov chaw qhib ntawm cov ntawv qhia xaim ntawm medial malleolus. Qee lub sij hawm, Steiner's hlau yog ntxig los ntawm qhov qhib thiab khob tawm tsam cov ntsia hlau tawg ntawm qhov kawg ntawm qhov kawg, kom cov ntsia hlau tawg tuaj yeem txav mus deb me ntsis, uas yuav pab tau rau retrograde insertion ntawm tus taw qhia koob thiab tshem tawm cov ntsia hlau tawg.
Yuav ua li cas kom tshem tau ib tug tawg khoom intramedullary ntsia thawv?
Cov ntsia hlau intramedullary yog feem ntau nyuaj rau tshem tawm ntau dua li cov ntsia hlau intramedullary. Nws cov tswv yim tshem tawm muaj xws li reaming ntawm proximal medullary kab noj hniav thiab zoo grasping ntawm tus ntsia thawv distal tawg. Laparoscopic claw hooks tuaj yeem siv los tuav cov ntsia hlau distal. Cov ntaub ntawv kuj tau tshaj tawm ib qho tshwj xeeb tuav forceps nyob ib ncig ntawm tus ntsia thawv. Txawm li cas los xij, kev siv ntau yam cuab yeej yuav tsis tuaj yeem tuav tus ntsia thawv distal tawg. Hauv qhov no, tus ntsia thawv tawg yuav tsum tau muab tshem tawm ntawm lwm qhov kawg ntawm cov pob txha. Cov txheej txheem thev naus laus zis zoo ib yam li cov ntsia hlau cannulated intramedullary. Siv cov cuab yeej xws li cov thom khwm thiab cov pins tawv tawv kom tshem tawm cov ntsia hlau tawg ncaj qha mus rau qhov kawg.
![tshem tawm cov ntsia hlau intramedullary tawg]()
Yuav ua li cas tshem tawm ib tug tawg interlocking intramedullary ntsia thawv?
Lub taub hau lossis qhov sib thooj ntawm cov ntsia hlau sib txuas feem ntau tuaj yeem raug tshem tawm siv cov ntsia hlau sib txuam. Qee lub sij hawm cov xov ntawm cov ntsia hlau sib txuas tuaj yeem plam hauv cov pob txha, xav tau traction nyob ib ncig ntawm lub taub hau ntawm cov ntsia hlau nrog forceps thiab lub hau ntswj kom unscrew nws. Lub taub hau ntsia hlau puas tuaj yeem xav tau cov cuab yeej tshwj xeeb rau kev tshem tawm, xws li cov khoom siv kho qhov tshem tawm sab hauv xws li cov xov tooj sib tsoo. Lub distal ib feem ntawm cov ntsia hlau tawg yog qee zaum xoob tag, uas tsis cuam tshuam rau kev tshem tawm ntawm lub ntsiab ntsia hlau, thiab tuaj yeem tso rau hauv lub cev yog tias nws tsis cuam tshuam rau kev kho mob tom ntej. Txawm li cas los xij, qee zaum cov ntsia hlau tawg tuaj yeem ua rau iatrogenic puas thaum lub ntsiab ntsia hlau raug tshem tawm, thiab nws yuav tsum tau tshem tawm. Txoj kev siv ntau tshaj plaws yog cov txheej txheem thawb tawm ntawm cov ntsia hlau, uas yog, lub ntsiab ntsia hlau tau thim rov qab mus rau nws txoj haujlwm qub, kom lub qhov ntsia hlau ntawm cov pob txha nto nyob rau hauv tib txoj kab raws li qhov xauv qhov ntawm cov ntsia hlau intramedullary, thiab cov ntsia hlau tawg raug tshem tawm los ntawm kev siv Steiner's hlau, me me malleus pas nrig lossis lub hau ntswj. Tus pin raug thawb tawm los ntawm tus pin qhov nyob rau hauv lub contralateral cortex thiab tshem tawm los ntawm ib tug cais incision.
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Tsis tas li ntawd, peb tau cog lus los tsim cov khoom tshiab thiab nthuav dav cov khoom lag luam, txhawm rau ua kom tau raws li kev xav tau ntawm kev phais ntawm ntau tus kws kho mob thiab cov neeg mob, thiab tseem ua rau peb lub tuam txhab muaj kev sib tw ntau dua nyob rau hauv tag nrho lub ntiaj teb orthopedic implants thiab instruments kev lag luam.
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