Elastically stabilized intramedullary nails (ESINs) inzira yakajairika yekuvhiya kugadzika kwekutsemuka kwepfupa refu muvana. Inoshandiswa zvakanyanya kurapa kusagadzikana kuputsika kweradius, ulna, femur, uye dzimwe nguva tibia uye humerus. Inoshandiswawo kurapa pathological kuputsika kwemapfupa marefu muvana. ESIN inopa yakavharwa kuputsika kwekugadzirisa pasina kuvhura nzvimbo yekuputsika, matatu-point kugadzikana, uye kuchengetedza kureba uye kutenderera mukuchinjika, mapfupi oblique fractures. Sekuremerwa-kugovera kudyara, inobvumira kufamba kwekutanga kwenhengo. Kazhinji, elastically yakagadzikana intramedullary misumari inobviswa mushure mekupwanyika kuporeswa.
Kutyoka kwechikadzi
Zviratidzo zveESIN mukuputsika kwevakadzi ndezvi: makore pakati pe4 ne14 makore uye kuputika kwevakadzi mukati mekutambudzika kwakawanda.
Murwere anoiswa patafura yemapfupa emapfupa, uye ukuru hwebhoti hunofananidzwa nehukuru hwegumbo remwana. Iyo fluoroscope inodiwa pakuwana antero-posterior (AP) uye latero-lateral (LL) maonero echidya chakakanganiswa uye inoiswa kuitira kuti ibvumire kuonekwa kwechikadzi kubva muhudyu kusvika kumabvi. Kuwana kwekudzikisa kunotariswa mune ese AP uye LL maonero, uye kutenderera kunosimbiswa zvakare.
Sarudzo yezvipikiri Iyo dhayamita yembambo inofanirwa kucherechedza mutemo mukuru wekusarudza zvipikiri. Iyo inotevera kupatsanurwa inogona kushandiswa seimwe mutsauko, inofambirana nezera remwana:
- 6-8 makore: 3 mm dhayamita;
- 9-11 makore: 3.5 mm dhayamita;
- 12-14 makore: 4 mm dhayamita.
Kureba kwezvipikiri kwakaenzana nechekure kubva kune distal growth cartilage kusvika kune yakakura trochanter growth cartilage .
Diaphyseal fractures
The proximal uye yepakati chetatu Muchiitiko chekuputsika kwediaphyseal muchidimbu nechepakati chechitatu, nzira yeC-yakaita, ine misumari inoiswa retrograde kuburikidza ne distal metaphysis, inosarudzwa. Panyaya yekutsemuka kwepedyo, muromo wembambo wezvipikiri wakakotama, nepo pakati pe-diaphyseal fractures, pakati pembambo yakakombama. Pakupera kwekushanda, munyaya yezvipembenene zvakaputika, zvimedu zvinogadziriswa kuitira kuti zvidzivirire kukanganiswa kwakasara, izvo zvinogona kuva nemhosva yehurefu husina kuenzana hwemakumbo ezasi. Panyaya ye oblique kana comminuted fractures, iyo distal tip inokotama uye inobata mubhonzo kudzivirira telescoping yezvidimbu uye kutama kwezvipikiri.
Maitiro echisikigo ezvimedu izvi ndezvekuita kupfupisa 5-10 mm pakarepo mushure mekushanda, iyo ichabhadharwa nekukurudzira kukura panguva yekubatanidzwa kwekuputsika.
Tibial fractures
Kuisa uye kugadzirira kwemurwere Murwere anoiswa patafura yemapfupa kuitira kuti abatsire kuderedza. Kuvapo kwefluoroscope kunosungirwa kune intraoperative control. Munda wekushanda unofanira kusanganisira ibvi .
Kuiswa kwezvipikiri
Zvipikiri zve elastic zvinogara zvakaiswa antegrade mune proximal metaphysis, pane antero-lateral uye anteromedial nzvimbo.
Kureba kwembambo kunosiyana pakati pe2.5 ne4 mm, zvichienderana nezera remurwere. Kushandiswa kwesando kufambisira mberi zvipikiri kunobvumirwa asi kunofanira kushandiswa nokungwarira.
Unhu hwekudzikisa hunosimbiswa nehupamhi hwembambo uye chiyero chekukotama.
Zvipikiri hazvifanirwe kukanganiswa mukati mekanzura pfupa reiyo distal metaphysis isati yadzikiswa yakwana; kana zvisina kudaro, nzira dzekugadzirisa dzinogona kukanganisa osteosynthesis.
Pamberi pekubatana, kutenderera kwezvimedu kunotariswa uye, kana pane kuvapo kwezvakasara varus deformity, izvi zvinogadziriswa nekukotama kwakanyanya kwembambo. Pakupera kwekushanda, kudhonza kunozorora uye zvidimbu zvinokanganiswa.
Panyaya yekutyoka kwakapetwa, matipi ezvipikiri akasara kunze kwebhonzo akakotama pa90 ° uye akabatwa mu cortical bone kudzivirira telescoping yezvidimbu.
Humeral fractures
Zviratidzo zveESIN muhumeral fractures zvinosiyana zvichienderana nenzvimbo yekuputsika: iyo proximal metaphysis kana diaphysis. Mukuputsika kwemutsipa wekuvhiya wehumerus, ESIN inoratidzwa nokuti inoderedza nguva yekudzivirira inodiwa munyaya yekurapa kwekuchengetedza.
Munyaya ye diaphyseal fractures, kushandiswa kwezvipikiri zve elastic kunoratidzwa pasinei nekuvapo radial nerve maronda.
Kuiswa kwezvipikiri Zvipikiri zvinopinzwa uchishandisa nzira yekudzorera. Mapoinzi ekuisa anowanikwa pamucheto weparutivi rwenzvimbo yesupracondylar, ine postero-lateral direction uye proximal inclination. Mapoinzi ekupinda anogadzirwa pachishandiswa chibooreso nekuti bhonzo recortical munzvimbo iyi rakaoma kwazvo. Iyo dhayamita yezvipikiri inosiyana pakati pe2.5 ne3.5 mm, uye ivo vakakotama zvakafanana. Zvipikiri zvinopinzwa ne vertical manual pressure uye kutenderera kutenderera. Kana kuputsika munzvimbo yeproximal metaphyseal hakugone kuderedzwa zvakakwana, kutenderera kwe1800 kwezvipikiri kunobatsira kuderedza uku. Kana, zvakadaro, kudzikisira kusingagoneke, Kirschner gwara-waya inoiswa muchikamu chepamusoro chisati chadzikiswa. Muchiitiko che oblique diaphyseal fractures, zvakakosha kuti udzivise zvipikiri zvichisiya medullary canal uye kutamira kumashure kune radial nerve sulcus. Mushure mekunge zvipikiri zvese zvayambuka nzvimbo yekutyoka, zvinokanganiswa mupfupa rinodzima reproximal metaphysis.
Forearm fractures
Kurapa kweOrthopedic mukutyoka kweruoko kunogamuchirwa, asi miganhu inotenderwa yekungoerekana yagadziridzwa angulation inozivikanwa. Kana iyi miganhu yakapfuudzwa kana munyaya yekutadza kurapwa kwemapfupa, kuvharwa kuderedzwa uye ESIN inoratidzwa mukuputsika kwepamberi.
Operative technique Murwere anoiswa mudorsal decubitus, neruoko rwakakanganiswa patafura yeradiotransparent.
Iyo dhayamita yezvipikiri inoshandiswa inosiyana pakati pe2.5 ne3 mm. Chipikiri chepamusoro chinenge chakatwasuka, ukuwo chipikiri cheradial chine mucherechedzo wakakotama kuitira kudzoreredza curve yeradius.
Kugadzirisa kunowanzotanga nepfupa iyo iri nyore kuderedza. Kuredhiyo, nzvimbo yekupinda inowanikwa mu distal metaphysis, pamusoro pe distal growth cartilage, pakati pematanho ehurefu uye mapfupi extensors echigunwe. Iyo cortical bone inoratidzwa kuburikidza nediki incision uye gomba rinoboorwa, iro rinowedzerwa nekufamba kwedenderedzwa. Chipikiri chinopinzwa mukati memedullary canal kusvika panzvimbo yakatsemuka. Kudzikiswa kwekutsemuka kunoitwa uye chipikiri chinokwidziridzwa mukati mechikamu chepamusoro pasi pefluoroscopic control.
Nzira yakafanana inoitwa kune ulna, uchishandisa nzira yeantegrade, ine nzvimbo yekupinda pamucheto wepakati weolecranon.
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