Nzira yekubvisa sei intramedullary nail?

Kubviswa kwezvipikiri zve intramedullary inzira yenguva dzose, sezvo mugadziri wega wega anopa maturusi akakodzera ekubvisa. Nekudaro, iyo chaiyo inoda kubvisa iyo yakazara intramedullary chipikiri haiwanzo. Kana iyo intramedullary chipikiri ichitsemuka, mamiriro acho anova akanyanya kuoma. Panguva ino, zviridzwa zvakakosha uye matekiniki anodiwa kuti abvise intramedullary mbambo.

Universal intramedullary kubviswa kwezvipikiri uye yakatyoka mbambo yekubvisa seti inowanikwa pamusika, uye seti idzi dzinogona kubatsira kugadzirisa matambudziko ari pamusoro. Nekudaro, kuvhiyiwa kwebofu hakukurudzirwe pasina maturusi ehunyanzvi.

Kurongeka uko iyo intramedullary nail inobviswa yakakosha. Usati wabvisa kugadzirisa kwemukati, muswe unofanirwa kuwanikwa uye kubatwa. Iyo muswe chivharo dzimwe nguva yakaoma kuziva paX-rays, uye nekuda kwechikonzero ichi, vamwe vanachiremba havakurudziri kushandisa muswe chivharo kunze kwekunge ichiwedzera kureba kwekushanda kwembambo ye intramedullary. Mushure mekubvisa chivharo chemuswe, shandisa ruoko rwemutungamiri kuti ubate intramedullary nail, uye wozoenderera mberi nekubviswa kwembambo yekuvhara. Zvinofanira kuchengetwa mupfungwa kuti mapini ese ekukiya anofanira kubviswa asati aedza kubvisa pini huru. Kana mugadziri we intramedullary mbambo asingakwanisi kuzivikanwa, zvinodikanwa kunyatso buritsa caudal end of intramedullary mbambo kuti ijekese mabatiro ayo ekubata, kusanganisira mhando yeshinda uye saizi, uye kusarudza yakakodzera yekubvisa chishandiso. Kana mutambo wakakwana usingaite, sarudzo yekushandisa tapered yekubvisa chishandiso inogona kubatsira kubata muswe we intramedullary chipikiri. Kana bhonzo richipinda mugomba rembambo kana pamusoro pembambo ichifungidzirwa, chipikiri chinogona kuroverwa mukati mamirimita mashoma nesando inotsvedza isati yabviswa.

Zvakasiyana-siyana zvinotsanangurwa zvemuswe zvivharo zvakagadzirirwa kufambisa intraoperative kusarudzwa uye kuve nechokwadi chekubvisa intramedullary chipikiri.

Vanachiremba vanoverengeka vane ruzivo vakapfupikisa nhamba huru yeakatyoka intramedullary mbambo yekubvisa maitiro. Kana iyo yakaputsika mugumo wekuputsika inoda kuvhurwa kuti icheneswe uye kuderedzwa, iyo intramedullary nail inogona kubviswa kuburikidza neyakaputsika. Pazasi, isu tichazivisa muchidimbu dzimwe nzira dzekubvisa dzisingadi kuratidzwa kwekupedzisira kwakatsemuka.

• Nzira yekubvisa sei yakaputsika cannulated intramedullary chipikiri?

Kazhinji, hazvina kuoma zvakanyanya kubvisa iyo proximal chikamu cheyakaputsika intramedullary chipikiri. Kana iyo proximal chikamu chabviswa, zvinova zvinonetsa kuti ungabvisa sei distal chikamu pasina kuvhura fracture fragment. Kudzorera iyo proximal medullary canal nemamirimita mashoma kunogona kuita kuti kure kure kubviswa kwembambo.

Uchishandisa nucleus refu kana laparoscopic forceps, iyo distal chikamu dzimwe nguva inogona kubatwa uye kubudirira kubviswa. Zvisinei, marefu maforce haapi kubata kwakasimba, uye kubviswa kwakabudirira kunoenderana nekuti distal chikamu chakasununguka.

Kutyaira mbambo yakatetepa intramedullary kana bhuku reamer mune distal yakaputsika chipikiri zvakare dzimwe nguva kunobatsira kuibvisa. Panguva yekutyaira, pini yekuvhara yedistal inofanira kuchengetwa kuti irege kuenderera mberi kweiyo distal chikamu panguva yekutyaira. Kana iyo yakaonda intramedullary chipikiri kana manual reamer yawana kuita kwakasimba neiyo distal segment, bvisa distal yekuvhara chipikiri wobva wagogodza kumashure kuti ubvise distal chikamu chakatyoka.

Mabhuku akawanda anoshuma pamusoro pekushandiswa kwezviridzwa zvakakodzerwa kubvisa chikamu che distal che cannulated mbambo dzakaputsika. Iyo hollow mhango ye intramedullary mbambo inogona kuzadzwa neakawanda dhairekitori waya dzakafanana pamwe negwara rehoko yekubvisa kudzivirira kudhirowa panguva yekubvisa. Iyo yakawanda inotungamira waya yekurongedza tekinoroji zvakare dzimwe nguva imwe nzira yekubvisa machira.

Chekupedzisira, kana ese ari pamusoro apa proximal ekubvisa maitiro asina kubudirira, distal kubviswa kwe intramedullary chipikiri kunogona kuedzwa. Semuenzaniso, chikamu chakatyoka distal chikamu chefemoral intramedullary chipikiri chinobviswa kuburikidza nepakazaruka mu distal femur kuburikidza nemabvi akabatanidzwa. Chibooreso chakanangidzirwa kumucheto kwechipikiri che intramedullary, uye kuvhura kwakakura zvekukwanisa kugarira waya yemuorivhi-inopinza ine gasket. Waya yekutungamira inodzokororwa yakapfuura nepaburi rembambo ye intramedullary uye inobuda kubva pakuvhurwa kweproximal femur, uye musoro wemuorivhi une spacer unogona kuburitsa distal yakatsemuka chipikiri kunze kweiyo proximal femur. Imwe nzira yakafanana inogona kushandiswa kune tibia, nekuisa retrograde yekuvhura distal yewaya yekutungamira pane medial malleolus. Dzimwe nguva, waya yeSteiner inopinzwa nepaburi repaburi ndokurovera pachipikiri chakatyoka kumagumo ekupedzisira, kuitira kuti chipikiri chakatyoka chifambe zvishoma, izvo zvinobatsira pakudzoreredza kupinza tsono yegwaro uye kubviswa kwembambo yakatyoka.

• Nzira yekubvisa sei yakaputsika yakasimba intramedullary chipikiri?

Zvipikiri zvakasimba zve intramedullary zvinowanzonetsa kubvisa pane cannulated intramedullary misumari. Maitiro ekubvisa ayo anosanganisira kudzoreredza kweiyo proximal medullary cavity uye kubata kunoshanda kweiyo distal yakatyoka chipikiri. Laparoscopic claw hooks inogona kushandiswa kubata zvipikiri zvakaputsika. Mabhuku akashumawo yakakosha kubata simba rakapoteredza muswe wembambo. Zvisinei, kushandiswa kwezvishandiso zvakasiyana-siyana kunogona kusakwanisa kunyatsobata distal yakaputsika mbambo. Muchiitiko ichi, mbambo yakaputsika inofanira kugogodzwa kubva kune rumwe rutivi rwefupa. Iyo yehunyanzvi nheyo yakafanana neye cannulated intramedullary nail. Shandisa maturusi akadai sezvibooreso zvakapfava uye mapini akaomarara ekutungamira kugogodza kunze zvipikiri zvakaputsika zvakanangana kumagumo.

• Nzira yekubvisa sei yakatyoka inopindirana intramedullary chipikiri?

Musoro kana chikamu chepamusoro chekona yakavharira kazhinji inogona kubviswa uchishandisa screwdriver inoenderana. Dzimwe nguva tambo dzescuruu yakavharirana dzinogona kutsvedzerera mukati mebhonzo, zvinoda kukwenya kutenderedza musoro wesiruu nechisimba nescrewdriver kuti usunungure. Yakakuvadzwa screw misoro ingangoda maturusi akakosha ekubvisa, senge mukati mekugadzirisa makiti ekubvisa senge counter-shinda drills. Iyo distal chikamu cheyakaputsika screw dzimwe nguva yakasunungurwa zvachose, iyo isingakanganise kubviswa kweiyo screw huru, uye inogona kusara mumuviri kana ikasakanganisa kunotevera kurapwa. Zvisinei, dzimwe nguva mbambo yakaputsika inogona kukonzera iatrogenic kuputsika kana mbambo huru yabviswa, uye inofanirwa kuibvisa. Iyo inonyanya kushandiswa nzira ndeyekusundira-kunze kweiyo screw, ndiko kuti, screw huru inodzoserwa panzvimbo yayo yepakutanga, kuitira kuti gomba rekupura pamusoro pebhonzo riri mumutsetse wakafanana negomba rekuvhara re intramedullary nail, uye screw yakaputsika inobviswa nekushandisa Steiner's wire, diki malleus tsvimbo kana screwdriver. Pini inosundirwa kunze nepaburi repini mune contralateral cortex uye yobviswa kuburikidza neakacheka akaparadzana.

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