Kutyoka kwenzvimbo yepakati pechidya chemudumbu (intertrochanteric region) yefemur kunokonzera 50% yekutyoka kwechiuno uye ndiyo mhando inonyanya kupararira yekukuvara kwechiuno muvarwere vakwegura. Kugadziriswa kwezvipikiri mudumbu (Intramedullary nail fixing) ndiyo nzira yakanakisisa yekurapa kutyoka kwechiuno mudumbu. Vanachiremba vemapfupa vanobvumirana kuti vadzivise "mhedzisiro ye" shorts effect nekushandisa nzara refu kana pfupi, asi parizvino hapana kubvumirana pakusarudza pakati penzara refu nepfupi.
Mukufunga, nzara pfupi dzinogona kupfupisa nguva yekuvhiyiwa, kuderedza kurasikirwa neropa, uye kudzivirira kusvetuka-svetuka, nepo nzara refu dzichipa kugadzikana kuri nani. Munguva yekupinza nzara, nzira yakajairika yekuyera kureba kwembambo refu ndeyekuyera kudzika kwepini inotungamirwa yakaiswa. Zvisinei, nzira iyi kazhinji haisi chaiyo, uye kana paine kutsauka pakureba, kutsiva nzara yemukati memedullary kunogona kukonzera kurasikirwa neropa rakawanda, kuwedzera kukuvara kwekuvhiyiwa, uye kuwedzera nguva yekuvhiyiwa. Naizvozvo, kana kureba kunodiwa kwembambo yemukati memedullary kuchigona kuongororwa usati wavhiyiwa, chinangwa chekuisa nzara chinogona kuzadzikiswa kamwe chete, kudzivirira njodzi dzekuvhiyiwa.
Kuti vagadzirise dambudziko iri rekurapa, nyanzvi dzekune dzimwe nyika dzakashandisa bhokisi rekurongedza nzara mukati memedullary (Box) kuti vaongorore hurefu hwenzara mukati memedullary vasati vavhiyiwa pasi pe fluoroscopy, inonzi "Box technique". Mhedzisiro yekushandiswa kwekiriniki yakanaka, sezvakagoverwa pazasi:
Kutanga, isa murwere pamubhedha wekudhonza uye ita zvekudzivirira zvakavharwa uchidhonza. Mushure mekudzikisa zvinogutsa, tora nzara yemukati memedullary isina kuvhurwa (kusanganisira bhokisi rekurongedza) woisa bhokisi rekurongedza pamusoro pefemur yegumbo rakakanganiswa:
Nerubatsiro rwemuchina weC-arm fluoroscopy, chinangwa chekutarisa nzvimbo yeproximal ndechekuenzanisa magumo eproximal enzipi yemukati memedullary necortex iri pamusoro pemutsipa wefemoral uye woiisa panzvimbo inopinzwa nzara yemukati memedullary.
Kana nzvimbo yepedyo yakwana, chengetedza nzvimbo yepedyo, wobva wasundidzira ruoko rweC kumucheto wekure woita fluoroscopy kuti uwane maonero chaiwo egumbo. Nzvimbo yekure inotarisa nzvimbo yepakati pemabvi ndiyo notch yepakati pemabvi. Dzorera nzara yemukati memedullary nehurefu hwakasiyana, nechinangwa chekusvika kure pakati pemucheto wekure wembambo yemukati memedullary nenotch yepakati pemabvi yemukati memadhiyamita 1-3 embambo yemukati memedullary. Izvi zvinoratidza hurefu hwakakodzera hwembambo yemukati memedullary.
Pamusoro pezvo, vanyori vakatsanangura zvinhu zviviri zvinoratidza kuti nzara yemukati memedullary yakareba zvakanyanya:
1. Mugumo wekure wembambo yemukati memedullary unopinzwa muchikamu chehafu chechikamu chejoini repatellofemoral (mukati memutsetse muchena uri pamufananidzo uri pazasi).
2. Mugumo wekure wembambo yemukati memedullary unopinzwa mutriangle yakagadzirwa nemutsetse weBlumensaat.
Vanyori vakashandisa nzira iyi kuyera hurefu hwezvipikiri zvemukati memedullary muvarwere makumi maviri nerimwe uye vakawana mwero wekururama we95.2%. Zvisinei, panogona kunge paine dambudziko nenzira iyi: kana chipikiri chemukati memedullary chikaiswa munyama yakapfava, panogona kunge paine mhedzisiro yekuwedzera panguva ye fluoroscopy. Izvi zvinoreva kuti hurefu chaihwo hwechipikiri chemukati memedullary chinoshandiswa hunogona kudikanwa kupfupika zvishoma pane chiyero chepamberi pekuvhiya. Vanyori vakaona chiitiko ichi muvarwere vakafuta zvakanyanya uye vakataura kuti kune varwere vakafuta zvakanyanya, hurefu hwechipikiri chemukati memedullary hunofanira kupfupikiswa zvine mwero panguva yekuyera kana kuve nechokwadi chekuti daro riri pakati pemagumo ekure kwechipikiri chemukati memedullary nepakati pechinongedzo chefemur riri mukati me 2-3 dhayamita yechipikiri chemukati memedullary.
Mune dzimwe nyika, nzara dzemukati medullary dzinogona kuputirwa imwe neimwe uye kupiswa nemajekiseni kare, asi kazhinji, hurefu hwakasiyana hwembambo dzemukati medullary hunosanganiswa pamwe chete uye kupiswa nemajekiseni pamwe chete nevagadziri. Nekuda kweizvozvo, zvingasakwanisika kuongorora hurefu hwembambo dzemukati medullary usati wapiswa nemajekiseni. Zvisinei, maitiro aya anogona kupedzwa mushure mekunge machira ekuchenesa aiswa.
Nguva yekutumira: Kubvumbi-09-2024
