I-Humerus Intramedullary Nail: Isixazululo Esiphumelelayo Sokwelapha Ama-Humeral Fractures

Ukuphuka kwe-humerus, ithambo elisengalo engenhla, kungaba nomthelela omkhulu emisebenzini yomuntu yansuku zonke kanye nezinga lempilo. Ukwelapha lokhu kuphuka kudinga ukucatshangelwa ngokucophelela kwezici ezihlukahlukene, okuhlanganisa uhlobo lokuphuka, indawo, nezici zesiguli. Enye inketho yokuhlinzwa ethole ukuthandwa eminyakeni yamuva nje ukusetshenziswa kwe-humerus intramedullary nail. Lesi sihloko sihlola izinzuzo, indlela yokuhlinzwa, izingozi, nokuvuselelwa okuhlobene nale ndlela yokwelapha.

Isingeniso

Uma ukuphuka kwenzeka ku-humerus, kungabangela ubuhlungu obukhulu, ukuhamba okulinganiselwe, nokukhubazeka kokusebenza. Izindlela zokwelapha zendabuko, ezifana nokuphonsa noma ukucwenga, zinemikhawulo yazo, futhi ukucinga izixazululo eziphumelelayo kwaholela ekuthuthukisweni kwe-humerus intramedullary nail.

Iyini i-Humerus Intramed ullary Nail?

I-humerus intramedullary nail iyisisetshenziswa sezokwelapha esiklanyelwe ukuzinzisa nokukhuthaza ukuphulukiswa kwama-fractures ku-humeral shaft. Iqukethe induku ende yensimbi efakwa phakathi nendawo engenalutho yethambo, ihlinzeka ngokuzinza nokusekelwa ngesikhathi sokuphulukiswa. Uzipho luvamise ukwenziwa nge-titanium noma insimbi engagqwali futhi lufika ngosayizi abahlukahlukene ukuze kufakwe i-anatomi yesiguli.

Izinkomba ze-Humerus Intramedullary Nail

Izinzipho ze-Humerus intramedullary zivame ukusetshenziselwa ukwelashwa kwe-midshaft kanye ne-proximal humeral fractures. Zisebenza kahle kakhulu ekuqhekekeni okudinga ukulungiswa okuzinzile, njengokuphuka okungapheli noma ukuphuka okuhambisana nokugudluzwa okubalulekile. Ukwengeza, le nqubo ifanele iziguli ezinekhwalithi ephansi yamathambo noma lapho kufunwa isimo esingathwali isisindo.

Indlela Yokuhlinza ye-Humerus Intramedullary Nail

Ukuhlela Kwangaphambi Kokuhlinzwa

Ngaphambi kokuhlinzwa, ukuhlela kahle ngaphambi kokuhlinzwa kubalulekile. Lokhu kuhlanganisa ukuhlolwa okuphelele kwephethini yokuphuka, impilo evamile yesiguli, nanoma yikuphi ukulimala okuhlobene. Ama-X ray, ama-CT scan, noma i-MRI ingase isetshenziswe ukuze kuqondwe ngokucacile izici zokuphuka nokuhlela indlela yokuhlinzwa ngokufanele.

Ukuma Kwesiguli

Ngesikhathi sokuhlinzwa, isiguli sivamise ukubekwa esihlalweni solwandle noma i-lateral decubitus position. Okukhethwa kukho kuncike ekuthandeni kodokotela ohlinzayo kanye nendawo yokuphuka. Ukuma kahle kuqinisekisa ukufinyelela okuphelele endaweni ephukile futhi kusiza ukufakwa kwezipikili.

Ukusika kanye Nokufinyelela

Kusikwa indawo yokuhlinzwa ukuze kufinyelelwe ithambo eliphukile. Ubude nendawo ye-incision incike ohlotsheni lokuphuka kanye nendawo yalo eduze kwe-humerus. Ukuphatha izicubu ezithambile ngokucophelela kubalulekile ukuze kuncishiswe ukuhlukumezeka nokunciphisa ingozi yokutheleleka.

Ukufakwa Kwezinzipho

Ngemva kokudala indawo yokungena, udokotela ohlinzayo ufaka i-humerus intramedullary nail emseleni we-humeral. Isiqondiso se-Fluoroscopic sisetshenziselwa ukuqinisekisa ukubeka nokuqondanisa okunembile. Uzipho luthuthukisiwe ngethambo, luhlanganisa kabusha noma yiziphi izingcezu ezisusiwe, futhi lubuyisela i-anatom efanele.

Ukukhiya Izikulufu Ukubekwa

Uma isipikili sesibekwe ngendlela efanele, izikulufo zokukhiya ziyafakwa ukuze kuvikeleke isipikili phakathi kwethambo. Lezi zikulufu zinikeza ukuzinza okwengeziwe futhi zivimbela ukunyakaza okujikelezayo noma kwe-axial kwezingcezu zokuphuka. Inombolo nokubekwa kwezikulufu kuncike kuphethini yokuphuka kanye nokuncamelayo kodokotela ohlinzayo.

Ukuvalwa Kwenxeba

Ngemuva kokuthi izinzipho nezikulufi zibekwe endaweni ngokuphephile, ukusika kuyavalwa kusetshenziswa ama-sutures noma ama-staples. Ukuvalwa kwenxeba ngendlela efanele kubalulekile ukuze kuthuthukiswe ukuphola nokunciphisa ingozi yokutheleleka. Indawo yokuhlinza ibe isigqokiswa, bese kufakwa ibhandishi eliyinyumba noma okokugqoka.

Izinzuzo ze-Humerus Intramedullary Nail

Ukusetshenziswa kwe-humerus intramedullary nail kunikeza izinzuzo eziningana kunezindlela zokwelapha zendabuko. Ezinye zezinzuzo ezibalulekile zifaka:

1. Ukuzinza nokuqondanisa: I-nail inikeza ukulungiswa okuzinzile, okuvumela ukuqondanisa kahle kwezingcezu zokuphuka, okukhuthaza ukuphulukiswa okuphelele.

2. Ukuphazamiseka okuncane kwezicubu ezithambile: Uma kuqhathaniswa nezindlela zokunamathisela, ukubethelwa kwe-intramedullary kuhilela ukusika okuncane kanye nokuphazamiseka kwezicubu ezithambile, okunciphisa ubungozi bezinkinga.

3. Ukuhlanganiswa kwangaphambi kwesikhathi: I-nail inikeza ukuzinza okwanele ukuvumela ukunyakaza kwangaphambi kwesikhathi nokuvuselelwa, ukukhuthaza ukululama okusheshayo nokubuyisela ukusebenza.

4. Ukuncipha kwengozi yokutheleleka: Indlela evaliwe yokubethela izipikili ngaphakathi kwe-intramedullary inciphisa ubungozi bokutheleleka endaweni yokuhlinzwa uma kuqhathaniswa nezindlela zokunciphisa okuvulekile nezindlela zokulungisa ngaphakathi.

Izinkinga Nezingozi

Ngenkathi ukuhlinzwa kwe-humerus intramedullary nail ngokuvamile kuphephile futhi kusebenza kahle, kunezinkinga ezingaba khona kanye nezingozi ezihlobene nenqubo. Kubalulekile ukuqaphela lawa mathuba ngaphambi kokwelashwa. Ezinye zezinkinga zihlanganisa:

Ukutheleleka

Noma iyiphi inqubo yokuhlinzwa inengozi yokutheleleka. Nakuba amazinga okutheleleka ephansi uma kuqhathaniswa ne-humerus intramedullary nailing, amasu afanele oyinyumba nokunakekelwa kwangemva kokuhlinzwa kubalulekile ukuze kuncishiswe le ngozi. Uma kwenzeka ukutheleleka, ukwelashwa okufanele kwama-antibiotic kanye nokungenelela okungenzeka kokuhlinzwa kungase kudingeke.

I-Malunion noma i-Nonunion

Kwezinye izimo, ukuphuka kungase kungaphili kahle, okuholela ku-malunion (ukuqondanisa okungalungile) noma ukungahambisani (ukuntuleka kokuphulukisa). Izinto ezifana nekhwalithi ephansi yamathambo, ukunganyakazi ngokwanele, noma ukunyakaza ngokweqile kungaba nomthelela kulezi zinkinga. Ukuqapha eduze, ukuvakasha okuvamile, nokungenelela okufika ngesikhathi kungasiza ukubhekana nalezi zinkinga uma zivela.

Ukuhluleka kokufakelwa

Akuvamile, ukufakelwa okusetshenziselwa ukubethelwa kwe-intramedullary kungase kuhluleke. Lokhu kungenzeka ngenxa yokuqhekeka kokufakelwa, ukuxega, noma ukufuduka. Ukukhetha kahle izimila, indlela yokuhlinzwa, nokunakekelwa kwangemva kokuhlinzwa kunganciphisa ingozi yokwehluleka kokufakelwa.

Ukulimala Kwezinzwa

Ngesikhathi sokuhlinzwa, kunengozi encane yokulimala kwezinzwa, okungaholela ekulahlekelweni kwezinzwa noma kwezimoto. Odokotela abahlinzayo bathatha izinyathelo zokuphepha ukuze bagweme ukulimala kwezinzwa, njengokuhlakazeka ngokucophelela nolwazi olufanele lwe-anatomical. Noma yiziphi izimpawu ezihlobene nezinzwa kufanele zibikwe ngokushesha ethimbeni lezokwelapha ukuze lihlolwe futhi liphathwe.

Ukuvuselela kanye Nokubuyisela

Ngemuva kokuhlinzwa kwe-humerus intramedullary nail, uhlelo oluphelele lokuvuselela lubalulekile ukuze ululame kahle. Uhlelo oluthile lokuvuselela lungahluka kuye ngobunzima bokuphuka kanye nezici zesiguli. Ukuhlanganisa kwangaphambi kwesikhathi, ukuzivocavoca okuthambile kohlobo lokuhamba, kanye nokuzivocavoca okuqinisayo kwethulwa kancane kancane ukuze kubuyiselwe ukusebenza futhi kuthuthukise amandla emisipha. Izikhathi zokwelapha ngokomzimba, eziqondiswa umelaphi ochwepheshe, zidlala indima ebalulekile enqubweni yokululama.

Izibonelo Nezindaba Zempumelelo

Iziguli eziningi zithole imiphumela emihle ngokuhlinzwa kwe-humerus intramedullary nail. Ucwaningo olulodwa lwabandakanya umuntu oneminyaka engu-45 ubudala owaphuka i-humeral shaft fracture. Ngemva kokuhlinzwa ngozipho lwe-intramedullary, isiguli sathola ukuqondana okuhle kakhulu kokuphuka, saphinde sathola uhla oluphelele lokunyakaza, futhi sabuyela ezingeni laso langaphambi kokulimala phakathi nezinyanga eziyisithupha.

Ukuqhathanisa Nezinye Izinketho Zokwelashwa

Uma ucubungula izinketho zokwelapha zokuphuka kwe-humeral, kubalulekile ukuqhathanisa izinzuzo nemikhawulo yendlela ngayinye. Ngenkathi ukusetshenziswa kwe-humerus intramedullary nail kunikeza izinzuzo eziningi, njengokuzinza, ukuhlanganisa ngaphambi kwesikhathi, nokuphazamiseka okuncane kwezicubu ezithambile, kungase kungafaneleki kukho konke ukuphuka noma isiguli. Ezinye izindlela, ezifana nokucwenga noma ukulungisa kwangaphandle, zingakhethwa ezimweni ezithile. Ukubonisana nochwepheshe wamathambo kuzosiza ekunqumeni indlela yokwelapha efaneleke kakhulu ngokusekelwe ezimweni zomuntu ngamunye.

Isiphetho

Ekuphetheni, ukusetshenziswa kwe-humerus intramedullary nail kuye kwavela njengendlela yokwelapha ephumelelayo futhi enokwethenjelwa yokwelashwa kwe-humeral fractures. Le ndlela yokuhlinza inikeza ukulungiswa okuzinzile, ikhuthaza ukuhlanganisa kusenesikhathi, futhi inikeza izinzuzo eziningana kunezindlela zendabuko. Nakuba kunezingozi ezingaba khona kanye nezinkinga ezihlobene nenqubo, ukuhlela kahle ukuhlinzwa, indlela ecophelelayo, nokunakekelwa kwangemva kokuhlinzwa kungasiza ekunciphiseni lokhu kukhathazeka. Ngokuhlunyeleliswa okufanele nokuqapha ngokucophelela, iziguli zingathola ukululama okuphumelelayo futhi ziphinde zibuyisele amakhono azo okusebenza.