Elastically stabilized intramedullary nails (ESINs) i ndlela leyi tolovelekeke ya vuhandzuri byo tiyisisa ku tshoveka ka marhambu yo leha eka vana. Yi tirhisiwa ngopfu ku tshungula ku tshoveka loku nga tshamisekangiki ka radius, ulna, femur, naswona minkarhi yin’wana tibia na humerus. Yitlhela yitirhisiwa ku tshungula ku tshoveka ka marhambu yo leha eka vana. ESIN yi nyika ku khomiwa ka ku tshoveka loku pfalekeke handle ko pfula ndzhawu ya ku tshoveka, ku tshamiseka ka tinhla tinharhu, na ku hlayisiwa ka ku leha na ku rhendzeleka eka ku tshoveka loku tsemakanyaka, ko koma ka oblique. Tanihi xirho lexi avelanakaka ndzhwalo, xi pfumelela ku famba-famba ka xirho ka ha ri ni nkarhi. Hi ntolovelo, swipikiri swa intramedullary leswi tiyeke hi ndlela ya elastic swi susiwa endzhaku ka ku hola ka ku tshoveka.
Ku tshoveka ka swirho swa le ndzeni
Swikombiso swa ESIN eka ku tshoveka ka khwiri hi leswi: malembe ya le xikarhi ka 4 na 14 wa malembe na ku tshoveka ka khwiri endzeni ka ku vaviseka ko tala .
Muvabyi u vekiwa etafuleni ro koka marhambu, naswona mpimo wa xihuku wu fambisana ni mpimo wa nenge wa n’wana. Fluoroscope ya laveka ku kuma mavonelo ya antero-posterior (AP) na latero-lateral (LL) ya xirho lexi khumbekaka naswona yi vekiwa leswaku yita pfumelela ku vonakala ka femur kusuka eka xirhendze kuya eka levele ya matsolo. Ku kumiwa ka ku hungutiwa ku kamberiwa eka mavonelo ya AP na LL, naswona ku rhendzeleka na kona ku tiyisisiwa .
Ku hlawula swipikiri Diameter ya swipikiri yifanele ku landzelela nawu wo angarhela wo hlawula swipikiri. Ku hlawuriwa loku landzelaka ku nga tirhisiwa tanihi muxaka wun’wana, lowu fambelanaka na malembe ya n’wana:
- 6–8 wa malembe: 3 mm hi vukulu;
- 9–11 wa malembe: 3.5 mm hi vukulu;
- 12–14 wa malembe: 4 mm hiku anama.
Ku leha ka swipikiri ku ringana na mpfhuka ku suka eka distal growth cartilage ku ya eka greater trochanter growth cartilage .
Ku tshoveka ka diaphyseal
Xiphemu xa vunharhu xa le kusuhi na xa le xikarhi Eka xiyimo xa ku tshoveka ka diaphyseal eka xiphemu xa vunharhu xa le kusuhi na xa le xikarhi, ku hlawuriwa endlelo ra xivumbeko xa C, na swipikiri leswi nghenisiweke endzhaku hi ku tirhisa metaphysis ya le kule. Eka xiyimo xa proximal fractures, proximal tip ya swipikiri yi govekile, kasi eka mid-diaphyseal fractures, xikarhi xa nail xi govekile. Eku heleni ka vuhandzuri, eka xiyimo xa transverse fractures, swiphemu swa khumbeka leswaku ku papalatiwa ku kavanyeteka loku saleke, leswi nga vaka na vutihlamuleri eka ku leha loku nga ringaniki ka swirho swa le hansi. Eka xiyimo xa oblique kumbe comminuted fractures, distal tip ya goveka naswona yi khumbeka eka marhambu ku papalata ku telescoping ka swiphemu na ku rhurha ka swipikiri.
Ntshikelelo wa ntumbuluko wa ku tshoveka loku i ku hlohlotela ku koma ka 5–10 mm hi ku hatlisa endzhaku ka vuhandzuri, leswi nga ta hakeriwa hi ku hlohloteriwa ka ku kula hi nkarhi wa ku tiyisisiwa ka ku tshoveka .
Ku tshoveka ka tibial
Ku vekiwa na ku lunghiselela muvabyi Muvabyi u vekiwa etafuleni ra marhambu leswaku ku ta olovisa ku hunguta. Ku va kona ka fluoroscope swa boha eka vulawuri bya le ndzeni ka vuhandzuri. Nsimu ya vuhandzuri yi fanele ku katsa matsolo .
Ku nghenisiwa ka swipikiri
Ti elastic nails ti tshama ti nghenisiwa antegrade eka proximal metaphysis, eka tindzhawu ta antero-lateral na anteromedial .
Diameter ya nail yihambana exikarhi ka 2.5 na 4 mm, kuya hi malembe ya muvabyi. Ku tirhisiwa ka hammer ku yisa emahlweni swipikiri swa pfumeleriwa kambe swifanele kutirhisiwa hi vukheta.
Khwalithi ya kuhunguteka yitiyisisiwa hi diameter ya nail xikan’we na degree ya ku gombonyoka.
Swipikiri aswifanelanga ku khumbeka eka cancellous bone ya distal metaphysis loko kuhunguteka kungase hetiseka; handle ka sweswo, maendlelo yo lulamisa ma nga ha endla leswaku osteosynthesis yi nga tshamiseki.
Loko kungase endliwa impaction, ku rhendzeleka ka swiphemu swa kamberiwa naswona, eka xiyimo xa vukona bya residual varus deformity, leswi swi lulamisiwa hiku gombonyoka ngopfu ka xipikiri. Eku heleni ka vuhandzuri, ku koka ku olovisiwa naswona swiphemu swa kona swa khumbeka.
Eka xiyimo xa comminuted fractures, ti proximal tips ta swipikiri letinga sala ehandle ka marhambu ti goveka eka 90° naswona ti khumbeka eka cortical bone ku sivela telescoping ya swiphemu.
Ku tshoveka ka humeral
Swikombiso swa ESIN eka ku tshoveka ka humeral swa hambana kuya hi ndzhawu ya ku tshoveka: proximal metaphysis kumbe diaphysis. Eka ku tshoveka ka nhamu ya vuhandzuri ya humerus, ESIN ya kombisiwa hikuva yi hunguta nkarhi wa ku nga fambi lowu lavekaka eka vutshunguri lebyi hlayisaka .
Eka xiyimo xa ku tshoveka ka diaphyseal, ku tirhisiwa ka swipikiri leswi olovaka swa kombisiwa ku nga khathariseki vukona bya swirhumbana swa misiha ya radial.
Ku nghenisiwa ka swipikiri Swipikiri swi nghenisiwa hi ku tirhisa ndlela ya retrograde. Tindhawu to nghenisa ti kumeka eka margin yale tlhelo ya ndzhawu ya supracondylar, tina tlhelo ra postero-lateral na proximal inclination . Tindzhawu to nghena ti lulamisiwa hiku tirhisa drill hikuva marhambu ya cortical eka ndzhawu leyi ya tika swinene. Diameter ya swipikiri yihambana exikarhi ka 2.5 na 3.5 mm, naswona yi govekile hindlela yofana. Swipikiri swi nghenisiwa hi ntshikelelo wa mavoko lowu yimisiweke na ku famba-famba loku rhendzelekaka. Loko ku tshoveka eka ndzhawu ya proximal metaphyseal kunga hungutiwi hindlela leyi ringaneleke, ku rhendzeleka ka 1800 ka swipikiri swi olovisa kuhunguteka loku. Loko, hambiswiritano, kuhungutiwa swinga koteki, Kirschner guide-wire yi vekiwa eka xiphemu xa proximal loko kungase hungutiwa loku pfulekeke. Eka xiyimo xa oblique diaphyseal fractures, swina nkoka ku papalata swipikiri leswi humaka eka medullary canal naswona swi rhurhela endzhaku kuya eka radial nerve sulcus. Endzhaku kaloko swipikiri leswi haswimbirhi swi tsemakanye ndzhawu leyi tshovekeke, swi khumbeka eka cancellous bone ya proximal metaphysis.
Ku tshoveka ka voko ra le mahlweni
Vutshunguri bya marhambu eka ku tshoveka ka mavoko ya le mahlweni bya amukeriwa, kambe swipimelo leswi pfumeleriweke swa angulation leyi pfuxetiweke hi ku tisungulela swa tiviwa swinene. Loko swipimelo leswi swi tlula kumbe eka xiyimo xa ku tsandzeka ka vutshunguri bya marhambu, ku hunguteka loku pfalekeke na ESIN swi kombisiwa eka ku tshoveka ka mavoko ya le mahlweni .
Thekiniki ya vuhandzuri Muvabyi u vekiwa eka dorsal decubitus, na voko ra le mahlweni leri khumbekaka eka tafula ra radiotransparent.
Diameter ya swipikiri leswi tirhisiwaka yihambana exikarhi ka 2.5 na 3 mm. Xipikiri xa ulnar xi lava ku kongoma, kasi xipikiri xa radial xina ku gombonyoka loku tivekaka leswaku kuta vuyiseriwa pronatory curve ya radius.
Ku khomiwa hi ntolovelo ku sungula hi marhambu lawa swi olovaka ku ma hunguta. Eka radius, ndzhawu yo nghena yi kumeka eka distal metaphysis, ehenhla ka distal growth cartilage, exikarhi ka ti tendons ta long na short extensors ya thumb. Marhambu ya cortical ya paluxiwa hiku tsemiwa lokuntsongo naswona ku boriwa khumbi, leri kurisiweke hiku famba famba ka xirhendzevutani. Xipikiri xi nghenisiwa eka medullary canal kuya fika laha xi tshovekeke kona. Ku hunguta ku tshoveka ka swipikiri ku endliwa naswona xipikiri xi yisiwa emahlweni eka xiphemu xa le kusuhi ehansi ka vulawuri bya fluoroscopic .
Endlelo leri fanaka ri endliwa eka ulna, hiku tirhisa thekiniki ya antegrade, laha ndzhawu yo nghena eka yona eka margin yale xikarhi ya olecranon.
Ndlela Yo Xava Switirhisiwa Swa Marhambu Ni Switirhisiwa Swa Marhambu!
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