Maitiro Ekusarudza YakakodzeraChipikiri cheIntramedullary cheFemoral?
Kusarudza gwaro rakakodzerafhunhu hwepabondenmurwizvinoda kuongororwa kwakazara kwerudzi rwekutyoka kwemurwere, maumbirwo emuviri wake, mhando yemapfupa ake, nzira yekuvhiya, uye zvinodiwa nachiremba wezvekurapa, zvichitungamira pakusarudza munhu mumwe nemumwe. Zvinodiwa zvikuru zvekuongorora ndeizvi:
I. Kusarudzwa kwakavakirwa panzvimbo yakatyoka uye rudzi rwayo (Zviratidzo)
Kutyoka kwechiuno chepamberi pechikadzi (kupatsanuka kwemukati memusana nepakati pechizvaro):
Zvakajairikamukati memedullary nzara(senge PFNA yakajairwa): Inoratidzwa kune mapfupa akatyoka pakati petrochanteric (senge rudzi rwe31-A1, 31-A2), mapfupa akatyoka pakati petrochanteric (rudzi rwe31-A3), uye mapfupa akatyoka epamusoro (32-A1). Muenzaniso wakajairika hauna kugadziriswa uye wakakodzera varwere vane mapfupa akanaka uye mapfupa akatyoka akasimba.
Nzara dzakareba dzemukati memudullary (dzakadai sePFNA dzakareba): Zvinoratidzwa kune mapfupa asina kusimba, mapfupa ane mutsetse wakatsemuka unopfuura mugumo weacetabulum mudiki neanopfuura 3 cm, mapfupa eipsilateral acetabular, mapfupa akawanda, mapfupa ane chirwere, kana varwere vane osteoporotic. Mhando dzakareba dzinoda kucheneswa uye dzinogona kupa kugadziriswa kuri nani kwenguva refu uye kugadzikana kwekudzivirira kutenderera.
Mamwe marudzi (akadai seInterTan,Nzara yeGamma): InterTan (nzara mbiri dzakasanganiswa netambo) yakakodzera kune dzakatyoka zvakanyanya zvinoda kudzvanywa; nzara yeGamma inoratidzwa kune dzakatyoka dziri nyore, dzakagadzikana kana dzakatyoka dziri pasi petrochanteric.
Kutsemuka kwemubato wemukadzi (pakati pechikamu): Sarudzo inosarudzwa ndeye anterograde locking intramedullary nail. Dhayamita yakakodzera uye kureba kwembambo yemukati memedullary zvinofanirwa kusarudzwa zvichienderana nehupamhi hwemukati memedullary uye mwero wekutsemuka kwemubato.
Kutsemuka kwechiuno chemusana (condylar upper/intercondylar): Kurapa kunonyanya kufarirwa ndekwekukiya nzara dzemukati memedullary, dzakakodzera kutsemuka kwechiuno chemusana, kutsemuka kwechiuno chemusana, kana kutsemuka kuri pasi pechifuva chemusana.
II. Zvichibva paNzvimbo Yokupinda uye Nzira Yokuvhiya
Nzvimbo yekupinda pamusoro pe greater trochanter (nzira yekutangira): Yakakodzera varwere vakafuta (nzira iri nyore, nguva pfupi yekuvhiya, fluoroscopy shoma) uye kutyoka kwemapfupa nguva dzose pakati petrochanteric. Zvisinei, kungwarira kunofanira kuitwa kudzivirira kukuvara kwetsandanyama dzeabductor.
Nzvimbo yekuboorwa kwe sinus yePyriform (kumberi): Yakakodzera kutyoka kwemukati metrochanteric, asi nzvimbo yacho yakamanikana. Zvakaoma kuvhiya varwere vakafuta uye kungwarira kunofanira kuitwa kudzivirira kukuvadza ropa rinobuda mumutsipa we femoral kana musoro we femoral.
Nzvimbo yekuboorwa kwemapfupa (kuburikidza ne intercondylar fossa): Yakakodzera kutyoka kwechiuno che distal. Kungwarira kunofanira kuitwa kudzivirira kukuvadza posterior cruciate ligament kwakabva.
III. Zvichibva pahurefu hwezvipikiri zveTitanium Femor
Nzara pfupi (170–200 mm): Inoratidzwa kune varwere vane femoral medullary canal yakamanikana, vane mapfupa akatsemuka zvishoma nezvishoma, uye lateral proximal femoral cortex isina kukuvadzwa. Inoderedza nguva yekuvhiyiwa, asi kungwarira kunodiwa kudzivirira kusagadzikana kwakakwana kwekutenderera kwemuviri kune varwere vane denderedzwa rakakura remedullary canal.
Nzara dzakareba pakati nepakati (235–240 mm): Dzakakodzera panzvimbo penzara pfupi, kana kuti dzakatyoka zvishoma pakati petrochanteric, uko maburi ekukiya ari kure anofanirwa kuchengetwa asi nzara refu hadzigone kushandiswa.
Nzara refu (260–480 mm): Yakakodzera varwere vane mapfupa akafara emudumbu, osteoporosis, mapfupa akatyoka, zvikanganiso zveproximal cortical, mitsetse yakatyoka yakareba, kana avo vanoda kugadziriswa kwenguva refu. Zvisinei, nguva yekuvhiyiwa uye kurasikirwa neropa zvichawedzera zvakanyanya.
IV. Zvichibva paKuvakazve Chipikiri kana Ukobvu
Nheyo yekusarudza dhayamita: Inofanira kuenzaniswa zvichienderana nechikamu chakamanikana chegomarara remusana remurwere (kana gomarara remusana rinofungidzirwa) kuti ripe simba rakakwana rekubata (kusunga-kukwana) uye kudzivirira kuputsika kweiatrogenic.
Nzara isina kukura: Sarudza nzara iri diki ne1mm pane dhayamita yemukana wepakati (semuenzaniso, kana dhayamita yemukana wepakati iri 10mm, sarudza nzara ye9mm).
Nzara yakakurisa (semuenzaniso, kana dhayamita yemugero wakakurisa iri 11mm, sarudza nzara dzine dhayamita ye9-10mm).
Rudzi rwakajairika: Dhayamita inowanzo shandiswa kuvanhu vakuru i9-11mm, nepo kuvana iri 4-6mm.
V. Kusarudzwa kwakavakirwa pamamiriro emapfupa uye mamiriro emurwere
Varwere vane osteoporosis: Zvinokurudzirwa kusarudza gobvuMushonga wemapfupa Nzara (kugadzika-kusimba) kana dzakareba kudzivirira kucheka nzara dzemusoro kana kutadza kugadzika mukati nekuda kwekushaya simba rakakwana rekubata.
Varwere vadiki/vane mapfupa akanaka: Nzara dzakatetepa dzemukati memedullary dzinogona kusarudzwa kuchengetedza ropa riri mumedullary cavity uye kuderedza njodzi ye thermal ischemic necrosis inokonzerwa nekukura kwemapfupa.
Cherechedza: Sarudzo yekupedzisira yeKuvakazve Nhambo dzeFemoralinoda kutonga kwakazara zvichibva pakuyera kwakarurama kwemifananidzo yepamberi pekuvhiyiwa (X-ray/CT), mamiriro e fluoroscopy panguva yekuvhiyiwa, uye hunyanzvi hwemushandi.
Nguva yekutumira: Gunyana-16-2026