Ukususwa kwezipikili ze-intramedullary kuyindlela evamile, njengoba umkhiqizi ngamunye ehlinzeka ngamathuluzi afanele okususa. Kodwa-ke, isidingo sangempela sokususa isipikili esiphelele se-intramedullary asivamile. Uma isipikili se-intramedullary siqhuma, isimo siba nzima kakhulu. Kuleli qophelo, amathuluzi akhethekile namasu adingekayo ukuze kukhishwe isipikili se-intramedullary.
Ukukhishwa kwendawo yonke yezinzipho ze-intramedullary kanye namasethi okususa izinzipho eziphukile ayatholakala emakethe, futhi lawa masethi angasiza ekuxazululeni izinkinga ezingenhla. Kodwa-ke, ukuhlinzwa okuyimpumputhe akunconywa ngaphandle kwamathuluzi akhethekile.
Ukuhleleka kokukhishwa kwe-intramedullary nail kubalulekile. Ngaphambi kokukhipha ukulungiswa kwangaphakathi, umsila kufanele utholakale futhi ubambe. Ikepisi lomsila ngezinye izikhathi kunzima ukulibona kuma-X-ray, futhi ngenxa yalesi sizathu, abanye odokotela abancomi ukusebenzisa isivalo somsila ngaphandle uma kwandisa ubude bokusebenza be-intramedullary nail. Ngemva kokukhipha isivalo somsila, sebenzisa ingalo yomhlahlandlela ukuze ubambe isipikili se-intramedullary, bese uqhubekela ekukhipheni isipikili sokukhiya. Kumele kukhunjulwe ukuthi zonke izikhonkwane zokukhiya kufanele zikhishwe ngaphambi kokuzama ukukhipha iphinikhodi eyinhloko. Uma umkhiqizi wezipikili ze-intramedullary engakwazi ukukhonjwa, kuyadingeka ukuveza ngokwanele ukuphela kwe-caudal ye-intramedullary nail ukuze kucaciswe indlela yayo yokubamba, okuhlanganisa uhlobo lwentambo nosayizi, nokukhetha ithuluzi elifanele lokukhipha. Uma ukufanisa okuphelele kungenakwenzeka, inketho yokusebenzisa ithuluzi lokukhipha elicijile ingasiza ekubambeni umsila we-intramedullary nail. Uma kusolwa ukungena kwethambo embotsheni yezipikili noma ngaphezulu kwesipikili, isipikili singagxivizwa ngaphakathi ngamamilimitha ambalwa ngesando esishelelayo ngaphambi kokususwa.
Ukucaciswa okuhlukahlukene kwama-tail caps kuklanyelwe ukwenza lula ukukhethwa kwe-intraoperative nokuqinisekisa ukukhishwa kwe-intramedullary nail.
![intramedullary nail cap]()
Odokotela abaningana abanolwazi baye bafingqa inani elikhulu lezindlela zokususa izinzipho ze-intramedullary eziphukile. Uma ukuphela okuphukile kwe-fracture kudinga ukuvulwa ukuze kuhlanzwe futhi kuncishiswe, isipikili se-intramedullary singasuswa ngokusebenzisa ukuphela okuphukile. Ngezansi, sizokwethula kafushane ezinye izindlela zokukhipha ezingadingi ukuvezwa kwesiphetho esiphukile.
Ungasusa kanjani isipikili se-intramedullary esiphukile?
Ngokuvamile, akunzima kakhulu ukususa ingxenye eseduze ye-nail intramedullary ephukile. Uma ingxenye eseduze isusiwe, kuba inselele ukuthi ungayisusa kanjani ingxenye ekude ngaphandle kokuvula ucezu oluphukile. Ukuvuselela i-proximal medullary canal ngamamilimitha ambalwa kungase kusize ukususwa kwezinzipho ezikude.
Ngokusebenzisa i-nucleus ende noma i-laparoscopic forceps, ingxenye ekude ingabanjwa futhi isuswe ngempumelelo. Kodwa-ke, ama-forceps amade awanikezi ukubamba okuqinile, futhi ukususwa okuphumelelayo kuncike ekutheni ingxenye ye-distal ikhululiwe.
Ukushayela uzipho oluncane lwe-intramedullary noma i-reamer manual ku-nail ephukile ye-distal nakho kuyasiza ngezinye izikhathi ukuyisusa. Ngesikhathi sokushayela, iphinikhodi yokukhiya i-distal kufanele igcinwe ukuze kugwenywe ukugudlulwa okwengeziwe kwengxenye ekude ngesikhathi sokushayela. Uma uzipho oluncane lwe-intramedullary noma i-reamer manual seluzuze ukusebenzelana okuqinile nengxenye ye-distal, susa isikhonkwane sokukhiya i-distal bese ubuyisela emuva ukuze ususe ingxenye ephukile ye-distal.
Imibiko eminingi yezincwadi ngokusetshenziswa kwezinsimbi eziboshwe ukuze kukhishwe ingxenye ekude yezinzipho eziphukile ezifakwe amathini. Imbobo engenalutho ye-intramedullary nail ingagcwaliswa ngezintambo zomhlahlandlela eziningi ngokuhambisana eduze nendawo yehuku yokukhipha ukuze kugwenywe ukunqamuka phakathi nenqubo yokukhipha. Indlela yokupakisha izintambo eziningi ngezinye izikhathi ingenye yezindlela zokukhipha izingwegwe.
![Ukususwa kwezinzipho ze-intramedullary eziphukile]()
Okokugcina, uma zonke izindlela zokususa eziseduze ezingenhla zingaphumeleli, ukususwa kwe-distal kwe-intramedullary nail kungazanywa. Isibonelo, ingxenye ephukile ye-distal ye-femoral intramedullary nail ikhishwa ngembobo ye-distal femur ngejoyinti yedolo. I-drill iqondiswe ngasekugcineni okude kwesipikili se-intramedullary, futhi ukuvuleka kukhulu ngokwanele ukufaka intambo yomhlahlandlela enesihloko se-olive ene-gasket. Intambo yomhlahlandlela idluliswa ngokuhlehlela emuva ngembobo yesipikili se-intramedullary futhi iphuma ekuvulekeni kwe-proximal femur, futhi ikhanda lomnqumo eline-spacer lingakhipha isipikili esikude esiphukile ku-proximal femur. Indlela efanayo ingasetshenziswa ku-tibia, ngokufaka ukubuyisela emuva kokuvula okukude kwentambo yomhlahlandlela ku-malleolus ephakathi. Ngezinye izikhathi, ucingo luka-Steiner lufakwa ngembobo bese lushayelwa esikhonkosini esiphukile ekugcineni, ukuze isipikili esiphukile sikwazi ukuhamba kancane, okuwusizo ekufakweni kabusha kwenaliti yomhlahlandlela nokususwa kozipho oluphukile.
Ungasusa kanjani isikhonkwane esiqinile se-intramedullary?
Izinzipho eziqinile ze-intramedullary ngokuvamile zinzima kakhulu ukususa kunezinzipho ze-intramedullary ekheniwe. Izindlela zayo zokususa zihlanganisa ukuphinda kufakwe i-proximal medullary cavity nokubamba okusebenzayo kwe-distal nail ephukile. Izingwegwe ze-Laparoscopic claw zingasetshenziselwa ukubamba izinzipho eziphukile ezikude. Izincwadi ziphinde zabika nge-forcep ekhethekile yokubamba ezungeze umsila wesipikili. Kodwa-ke, ukusetshenziswa kwamathuluzi ahlukahlukene kungase kungakwazi ukubamba ngokuphumelelayo i-distal nail ephukile. Kulokhu, isipikili esiphukile kufanele sikhishwe komunye umkhawulo wethambo. Isimiso sobuchwepheshe sifana naleso sesipikili se-intramedullary ekheniwe. Sebenzisa amathuluzi afana nezikhonkwane ezithambile nezikhonkwane zegayidi eqinile ukuze ukhiphe izikhonkwane eziphukile ezikude ngqo ekupheleni okuseduze.
![susa isikhonkwane esiqinile se-intramedullary esiphukile]()
Ungasusa kanjani isipikili se-intramedullary esiphukile?
Ikhanda noma ingxenye eseduze yesikulufu esihlanganisiwe ngokuvamile ingasuswa kusetshenziswa isikrudrayiva esimeshayo. Kwesinye isikhathi imicu yesikulufu esixhumene ingashibilika phakathi kwethambo, idinge ukudonsa eduze kwekhanda lesikulufu ngama-forceps kanye ne-screwdriver ukuze isikulule. Amakhanda esikulufu awonakele angase adinge amathuluzi akhethekile okususwa, njengamakhithi okususa okulungisa angaphakathi njengama-drill anemicu ephikisayo. Ingxenye ekude ye-screw ephukile ngezinye izikhathi ikhululwe ngokuphelele, engathinti ukukhishwa kwesikulufa esikhulu, futhi ingashiywa emzimbeni uma ingathinti ukusebenza kokwelashwa okulandelayo. Kodwa-ke, ngezinye izikhathi i-nail distal ephukile ingabangela ukuphuka kwe-iatrogenic lapho isipikili esiyinhloko sisuswa, futhi kuyadingeka ukuyisusa. Indlela evame ukusetshenziswa kakhulu yindlela yokuphusha ngaphandle kwesikulufu, okungukuthi, isikulufu esikhulu sihoxiswa endaweni yaso yasekuqaleni, ukuze imbobo yesikulufu endaweni yethambo ibe emgqeni ofanayo nembobo yokukhiya yesipikili se-intramedullary, futhi isikulufu esiphukile sisuswa kusetshenziswa ucingo lukaSteiner, induku encane ye-malleus noma i-screwdriver. Iphinikhodi iphushelwa ngaphandle ngembobo yephini ku-contralateral cortex futhi ikhishwe ngokusika okuhlukile.
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