Izinzipho ze-intramedullary eziqinisiwe (Elastically stabilized intramedullary (ESINs) ziyindlela evamile yokuqiniswa kokuhlinzwa kokuphuka kwamathambo amade ezinganeni. Isetshenziswa kabanzi ukwelapha ukuqhekeka okungazinzile kwe-radius, ulna, femur, futhi ngezikhathi ezithile i-tibia ne-humerus. Ibuye isetshenziselwe ukwelapha i-pathological fractures yamathambo amade ezinganeni. I-ESIN ihlinzeka ngokulungiswa kokuqhekeka okuvaliwe ngaphandle kokuvula indawo yokuphuka, ukuzinza kwamaphuzu amathathu, nokugcinwa kobude nokujikeleza ekuqhekekeni okuguquguqukayo, okufushane kwe-oblique fracture. Njengokufakelwa kokwabelana ngomthwalo, ivumela umnyakazo wangaphambi kwesikhathi welungu. Ngokuvamile, izipikili ze-intramedullary ezizinzile ziyasuswa ngemva kokuphulukiswa kokuphuka.
Ukuphuka kwabesifazane
Izinkomba ze-ESIN ekuqhekekeni kwe-femal yilezi: ubudala obuphakathi kweminyaka emi-4 neyi-14 kanye nokuphuka kwe-femal ngaphakathi kokuhlukumezeka okuningi .
Isiguli sibekwe etafuleni le-orthopedic traction, futhi ubukhulu bebhuthi buvumelaniswa nobukhulu bomlenze wengane. I-fluoroscope iyadingeka ukuze kutholwe ukubukwa kwe-antero-posterior (AP) kanye ne-latero-lateral (LL) yethanga elithintekile futhi ibekwe ukuze kuvunyelwe ukubonwa kwe-femur kusukela ku-hip kuya ezingeni lamadolo. Ukutholwa kokuncishiswa kuhlolwa kukho kokubili ukubukwa kwe-AP ne-LL, futhi ukuzungezisa nakho kuqinisekiswa.
Ukukhethwa kwezipikili Ububanzi be-nail kufanele bugcine umthetho ojwayelekile wokukhetha izipikili. Izigaba ezilandelayo zingasetshenziswa njengenye indlela ehlukile, ehlotshaniswa neminyaka yengane:
- 6-8 iminyaka: 3 mm ububanzi;
- 9-11 iminyaka: 3.5 mm ububanzi;
- 12-14 iminyaka: 4 mm ububanzi.
Ubude bezinzipho bulingana nebanga ukusuka ku-cartilage yokukhula okude kuya ku-cartilage enkulu yokukhula kwe-trochanter.
I-Diaphyseal fractures
I-proximal ne-middle third Endabeni ye-diaphyseal fractures engxenyeni yesithathu eseduze naphakathi, indlela efana ne-C, enezinzipho ezifakwe ukubuyisela emuva ngokusebenzisa i-distal metaphysis, ikhethiwe. Endabeni yokuphuka okuseduze, iphoyinti eliseduze lezipikili ligobile, kuyilapho ukuhlukana kwe-diaphyseal maphakathi, phakathi nendawo ye-nail igobile. Ekupheleni komsebenzi, esimweni sokuphuka okuphambene, izingcezu ziyathinteka ukuze kugwenywe ukuphazamiseka okusele, okungaba nesibopho sobude obungalingani bemilenze ephansi. Endabeni yokuphuka kwe-oblique noma okuhamba kancane, ithiphu ye-distal igobile futhi ithinteke ethanjeni ukuze kugwenywe i-telescoping yezingcezu kanye nokufuduka kwezipikili.
Ukuthambekela kwemvelo kwalokhu kuphuka kuwukwenza ukufinyezwa kwe-5-10 mm ngokushesha ngemva kokuhlinzwa, okuzonxeshezelwa ngokukhuthazwa kokukhula ngesikhathi sokuhlanganiswa kokuphuka.
I-Tibial fractures
Ukuma nokulungiswa kwesiguli Isiguli sibekwe etafuleni lamathambo ukuze kube lula ukunciphisa. Ukuba khona kwe-fluoroscope kuyisibopho sokulawulwa kwe-intraoperative. Inkambu yokusebenza kufanele ifake idolo .
Ukufakwa kwezinzipho
Izinzipho ezinwebekayo zihlala zifakwe i-antegrade ku-proximal metaphysis, ezindaweni ezi-antero-lateral kanye ne-anteromedial.
Ububanzi bezinzipho buhluka phakathi kuka-2.5 no-4 mm, kuye ngeminyaka yesiguli. Ukusetshenziswa kwesando ukuze kuthuthukiswe izipikili kuvunyelwe kodwa kufanele kusetshenziswe ngokuqapha.
Izinga lokunciphisa liqinisekiswa ububanzi bezinzipho kanye nezinga lokugoba.
Izinzipho akufanele zithinteke ethanjeni elikhansela le-distal metaphysis ngaphambi kokuba ukunciphisa kuphelele; uma kungenjalo, izinqubo zokulungisa zingase ziphazamise i-osteosynthesis.
Ngaphambi kwe- impaction, ukujikeleza kwezingcezu kuyahlolwa futhi, uma kukhona ukukhubazeka kwe-varus esele, lokhu kulungiswa ukugoba ngokweqile kwesipikili. Ekupheleni komsebenzi, ukudonsa kuyaxegiswa futhi izingcezu ziyathinteka.
Endabeni yokuphuka okuphindaphindiwe, amathiphu asondelene ezinzipho ashiywe ngaphandle kwethambo agobe ku-90° futhi athinteke ethanjeni le-cortical ukuvimbela i-telescoping yezingcezwana.
Ama-humeral fractures
Izinkomba ze-ESIN ekuqhekekeni kwe-humeral ziyahlukahluka kuye ngokuthi indawo yokuphuka: i-proximal metaphysis noma i-diaphysis. Lapho kuphuka intamo yokuhlinzwa ye-humerus, i-ESIN iboniswa ngoba inciphisa isikhathi sokunganyakazi esidingekayo esimweni sokwelashwa okuvamile .
Endabeni ye-diaphyseal fractures, ukusetshenziswa kwezipikili ezinwebekayo kuboniswa kungakhathaliseki ukuthi kukhona izilonda ze-radial nerve.
Ukufakwa kwezinzipho Izinzipho zifakwa kusetshenziswa indlela yokubuyisela emuva. Amaphuzu okufaka atholakala emaphethelweni e-lateral yendawo ye-supracondylar, ene-postero-lateral direction kanye ne-proximal . Izindawo zokungena zilungiswa kusetshenziswa i-drill ngoba ithambo le-cortical kule ndawo linzima kakhulu. Ububanzi bezinzipho buhluka phakathi kuka-2.5 no-3.5 mm, futhi zigotshwe ngokufanayo. Izinzipho zifakwe ngokucindezela okuqondile kwe-manual kanye nokunyakaza okujikelezayo. Uma ukuphuka endaweni ye-metaphyseal eseduze akukwazi ukuncishiswa ngokwanele, ukujikeleza kwe-1800 kwezipikili kusiza lokhu kunciphisa. Uma, nokho, ukuncishiswa kungenakwenzeka, i-Kirschner guide-wire ifakwa esiqeshini esiseduze ngaphambi kokwehliswa okuvulekile. Endabeni ye-oblique diaphyseal fractures, kubalulekile ukugwema izipikili ezishiya i-medullary canal futhi zifuduke ngemuva kwe-radial nerve sulcus. Ngemuva kokuthi zombili izipikili ziwele indawo yokuphuka, zithinteka ethanjeni elikhansela le-proximal metaphysis.
Ukuphuka kwengalo
Ukwelashwa kwamathambo ekwaphukeni kwengalo yengalo kuyamukelwa, kodwa imikhawulo evunyelwe ye-angulation elungiswe ngokuzenzekelayo yaziwa kahle. Uma le mikhawulo yeqiwe noma esimweni sokwehluleka ukwelashwa kwamathambo, ukuncipha okuvalekile kanye ne-ESIN kuboniswa ekuqhekekeni kwengalo yengalo.
Indlela yokusebenza Isiguli sibekwe ku-dorsal decubitus, nengalo ethintekile phezu kwetafula eline-radiotransparent.
Ububanzi bezinzipho ezisetshenzisiwe buhluka phakathi kuka-2.5 no-3 mm. Uzipho lwe-ulnar lucishe luqonde, kuyilapho uzipho lwe-radial lunokugoba okumakiwe ukuze kubuyiselwe ijika le-pronatory ye-radius.
Ukulungiswa ngokuvamile kuqala ngethambo okulula ukulinciphisa. Ku-radius, indawo yokungena itholakala ku-distal metaphysis, ngaphezu kwe-distal growth cartilage, phakathi kwezintambo zama-extensors amade namafushane wesithupha. Ithambo le-cortical livezwa ngokusikwa okuncane futhi kubhobozwe imbobo, eyandiswa ukunyakaza okuyindilinga. Uzipho lufakwa kumsele we-medullary kuze kufike endaweni yokuphuka. Ukuncishiswa kokuphuka kwenziwa futhi isipikili sithuthukele esiqeshini esiseduze ngaphansi kokulawulwa kwe-fluoroscopic.
Inqubo efanayo iyenziwa ku-ulna, kusetshenziswa indlela ye-antegrade, nendawo yokungena emaphethelweni amaphakathi e-olecranon.
Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?
Ngoba I-CZMEDITECH , sinomugqa womkhiqizo ophelele kakhulu wezimila zokuhlinza amathambo nezinsimbi ezihambisanayo, imikhiqizo ehlanganisa izimila zomgogodla, izipikili ze-intramedullary, ipuleti lokuhlukumezeka, ipuleti lokukhiya, i-cranial-maxillofacial, izitho zokufakelwa, amathuluzi amandla, izilungisi zangaphandle, i-arthroscopy, ukunakekelwa kwezilwane kanye namasethi amathuluzi asekelayo.
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