Intramedullary nailinginowanzoshandiswa kugadzirwa kwemapfupa mukati mekugadzirisa nzira inotangira kuma1940s.Inoshandiswa zvakanyanya mukurapa kwekuputsika kwepfupa refu, kusabatanidzwa, uye kumwe kukuvadzwa kwakabatana.Iyo nzira inosanganisira kuisa intramedullary mbambo mukati megeji repakati pebhonzo kudzikamisa nzvimbo yekutyoka.Mumashoko akareruka, intramedullary nail chimiro chakareba chine akawandakukiya sikurumaburi kumativi ose maviri, ayo anoshandiswa kugadzirisa magumo uye kureba kwekuputsika.Zvichienderana nechimiro chadzo, zvipikiri zvemukati medullary zvinogona kuiswa seyakasimba, tubular, kana yakavhurika-chikamu, uye inoshandiswa kurapa marudzi akasiyana evarwere.Semuyenzaniso, yakasimba intramedullary zvipikiri zvine kuzvidzivirira kuri nani kuhutachiona nekuda kwekushaikwa kwenzvimbo yakafa yemukati.
Ndeapi marudzi ekuputsika akakodzera kune intramedullary misumari?
Intramedullary chipikirindiyo yakanakira kudyara kurapa diaphyseal fractures, kunyanya mufemur uye tibia.Kuburikidza nemaitiro mashoma ekupinda, intramedullary mbambo inogona kupa kugadzikana kwakanaka uku ichideredza kukuvara kwenyama yakapfava munzvimbo yekutyoka.
Iyo yakavharwa kuderedza uye intramedullary nailing fixation kuvhiyiwa kune zvinotevera mabhenefiti:
Yakavharwa kuderedza uye intramedullary nailing (CRIN) ine zvakanakira kudzivirira kuvharwa kwenzvimbo yekuputsika uye kuderedza njodzi yehutachiona.Nekuchekwa kudiki, inodzivirira yakakura yakapfava tishu dissection uye kukuvadzwa kwekupihwa kweropa panzvimbo yekutyoka, nekudaro kuvandudza mwero wekuporesa wekutyoka.Kune chaiwo marudzi eproximal bone fractures, CRIN inogona kupa kugadzikana kwakakwana kwekutanga, kubvumira varwere kuti vatange kufamba pamwe chete nokukurumidza;iyo inobatsirawo zvakanyanya maererano nekutakura axial stress ichienzaniswa nedzimwe nzira dzekugadzirisa eccentric maererano ne biomechanics.Inogona kudzivirira zviri nani kusunungurwa kwekugadzirisa kwemukati mushure mekuvhiyiwa nekuwedzera nzvimbo yekubatana pakati pekuisa uye pfupa, zvichiita kuti zvive zvakakodzera kune varwere vane osteoporosis.
Inoshandiswa kune tibia:
Sezvinoratidzwa mumufananidzo, kuvhiyiwa kunosanganisira kuita diki diki 3-5 masendimita chete pamusoro petibial tubercle, uye kuisa 2-3 kukiya screws kuburikidza neakachekwa asingasviki 1 cm kumucheto uye kure kure kwegumbo rezasi.Kuenzaniswa neyakavhurika kuderedzwa kwechinyakare uye kugadzirisa kwemukati nendiro yesimbi, izvi zvinogona kunzi idi diki diki invasive tekinoroji.
Inoshandiswa kune femur:
1.Interlocking basa rechikadzi rakakiiwa intramedullary chipikiri:
Inoreva kugona kwayo kuramba kutenderera kuburikidza nekukiya nzira ye intramedullary chipikiri.
2.Kuronga kweiyo yakakiiwa intramedullary chipikiri:
Panyaya yebasa: chiyero chakakiyiwa intramedullary mbambo uye kuvakazve yakakiyiwa intramedullary chipikiri;kunyanya kutsanangurwa nekushungurudzika kwekufambisa kubva muhudyu kusvika kumabvi akabatanidzwa, uye kana zvikamu zvepamusoro uye nechepasi pakati pevanotenderera (mukati me5cm) zvakagadzikana.Kana isina kugadzikana, kuvakwazve kwehudyu kusagadzikana kutapurirana kunodiwa.
Mukutaura kwehurefu: mapfupi, proximal, uye akawedzerwa marudzi, anonyanya kusarudzwa zvichienderana nekukwirira kwenzvimbo yekuputsika pakusarudza urefu hwe intramedullary nail.
2.1 Yakajairwa yakavharira intramedullary chipikiri
Basa guru: axial stress stabilization.
Zviratidzo: Kuputsika kwechikadzi shaft (isingashandisi kune subtrochanteric fractures)
2.2 Kuvaka patsva kunopindirana intramedullary chipikiri
Basa guru: Kushungurudzika kwekufambisa kubva muhudyu kusvika kune femoral shaft hakuna kugadzikana, uye kugadzikana kwekushungurudzika kwekufambisa muchikamu ichi kunoda kugadziriswa.
Zviratidzo: 1. Subtrochanteric fractures;2. Kuputsika kwemutsipa wechikadzi kusanganiswa nekuputsika kwechikadzi shaft kune rumwe rutivi (bilateral fractures kune rumwe rutivi).
PFNA zvakare imhando yekuvakazve-mhando intramedullary chipikiri!
2.3 Distal yekuvhara nzira ye intramedullary nail
Iyo distal yekuvhara nzira ye intramedullary misumari inosiyana zvichienderana nemugadziri.Kazhinji, single static locking screw inoshandiswa kune proximal femoral intramedullary mbambo, asi kune femoral shaft fractures kana kureba intramedullary zvipikiri, maviri kana matatu static kukiya screws ane dynamic kukiya anowanzo shandiswa kuwedzera kutenderera kugadzikana.Zvose zvechikadzi uye tibial zvakarebesa intramedullary zvipikiri zvinogadziriswa nemakumbo maviri ekukiya.
Nguva yekutumira: Mar-29-2023
