Indlela yokukhetha iphakheji efanelekileyoI-Femoral Intramedullary Nail?
Ukukhetha inketho efanelekileyofiimvakalelo ezibuhlungunulwandlekufuna uvavanyo olupheleleyo lohlobo lokwaphuka kwesigulana, ukwakheka komzimba, umgangatho wamathambo, indlela yotyando, kunye nezinto ezikhethwa ngugqirha wotyando, nto leyo ekhokelela ekwenzeni izigqibo zomntu ngamnye. Iikhrayitheriya eziphambili zovavanyo zezi zilandelayo:
I. Ukukhetha ngokusekelwe kwindawo yokwaphuka kunye nohlobo (Iimpawu)
Ukuqhekeka kwe-femoral ekufutshane (ephakathi kwe-trochanteric kunye ne-transcervical):
Umgangathongaphakathi kwe-medullary uzipho(njenge-PFNA eqhelekileyo): Iboniswe kwiimfanta ezingaphakathi kwetrochanteric (ezifana nohlobo lwe-31-A1, 31-A2), iimfanta ezingaphakathi kwetrochanteric ezingasemva (uhlobo lwe-31-A3), kunye neemfanta ezikwinqanaba eliphezulu (32-A1). Imodeli eqhelekileyo ayilungiswanga kwaye ifanelekile kwizigulana ezineethambo ezisemgangathweni kunye neemfanta ezizinzileyo.
Iinzipho ezandisiweyo ngaphakathi kwe-medullary (ezifana ne-PFNA eyandisiweyo): Iboniswa ukwaphuka okuphantsi kwe-subtrochanteric, ukwaphuka okunomgca wokuqhekeka odlula ngaphaya kwesiphelo se-distal se-acetabulum encinci ngaphezu kwe-3 cm, ukwaphuka kwe-acetabular kwi-ipsilateral, ukwaphuka okuninzi, ukwaphuka kwe-pathological, okanye izigulane ze-osteoporotic. Iintlobo ezandisiweyo zifuna ukunqunyulwa kwaye zinokubonelela ngokulungiswa okungcono kobude obupheleleyo kunye nokuzinza okuchasene nokujikeleza.
Ezinye iintlobo (ezifana ne-InterTan,Uzipho lweGamma): I-InterTan (izikhonkwane eziphindwe kabini kunye nentambo) ifanelekile kwiingozi eziqhekekileyo ezifuna ukucinezelwa; izikhonkwane zeGamma ziboniswe kwiingozi ezilula nezizinzileyo okanye iingozi ezingaphantsi kwetrochanteric.
Ukuqhekeka kwe-femoral shaft (midsection): Ukhetho olukhethwayo luzipho oluvala ngaphakathi kwe-anterograde. Ububanzi obufanelekileyo kunye nobude bezipho ezivala ngaphakathi kufuneka kukhethwe ngokusekelwe kububanzi bomngxuma we-medullary kunye nomlinganiselo wokuphela kokuqhekeka.
Ukuqhekeka kwe-distal femoral (condylar upper/intercondylar): Unyango olukhethwayo kukufumana iinzipho ze-intramedullary ezivalekayo, ezifanelekileyo kwii-condylar upper comminuted fractures, ii-intercondylar fractures ezibandakanya umphezulu wamalungu, okanye ii-fractures ezingaphantsi kwe-femoral trochanter.
II. Ngokusekelwe kwindawo yokungena kunye nendlela yotyando
Indawo yokungena encotsheni ye-trochanter enkulu (indlela ye-antegrade): Ifanelekile kwizigulane ezityebileyo (indlela elula, ixesha elifutshane lotyando, i-fluoroscopy encinci) kunye nokuqhekeka rhoqo kwe-intertrochanteric. Nangona kunjalo, kufuneka kuthathwe unonophelo ukuze kuthintelwe ukwenzakala kwemisipha ye-abductor.
Indawo yokubhoboza i-sinus ye-Pyriform (icala eliya phambili): Ifanelekile kwiintlobo ze-fractures eziqhelekileyo ze-intertrochanteric, kodwa indawo ekuyo incinci. Kunzima ngakumbi ukuyihlinza kwizigulane ezityebileyo kwaye kufuneka kuthathwe unonophelo ukuze kuthintelwe ukonakala kwegazi lentamo ye-femoral okanye intloko ye-femoral.
Indawo yokubhoboza emva (ngokusebenzisa i-intercondylar fossa): Ifanelekile kwiimfanta ze-femoral ezikude. Kufuneka kuthathwe unonophelo ukuze kungalimazi imvelaphi ye-posterior cruciate ligament.
III. Isekelwe kubude bezipikili ze-Titanium Femor
Uzipho olufutshane (170–200 mm): Iboniswe kwizigulana ezine-femoral medullary canal emxinwa, ezaphukileyo ezizinzileyo, kunye ne-lateral proximal femoral cortex engaguqukiyo. Iyanciphisa ixesha lotyando, kodwa kufuneka uqaphele ukuthintela ukuzinza okungonelanga kokujikeleza kwizigulana ezine-wide medullary canal.
Iinzipho ezinobude obuphakathi (235–240 mm): Zifanelekile endaweni yeenzipho ezimfutshane, okanye kwiingxaki zokuqhekeka okuphantsi kwe-intertrochanteric, apho imingxunya yokutshixa ekude kufuneka igcinwe kodwa iinzipho ezinde azinakusetyenziswa.
Uzipho olude (260–480 mm): Lufanelekile kwizigulana ezine-wide femoral medullary canal, i-osteoporosis, i-pathological fractures, i-proximal cortical defects, i-long-extended fracture lines, okanye ezo zifuna ukulungiswa ubude obupheleleyo. Nangona kunjalo, ixesha lotyando kunye nokulahleka kwegazi kuya kwanda ngokuthe ngqo.
IV. Ngokusekelwe kuBuchule boKwakha kwakhona uBukhulu beZipikili okanye ukutyeba kwazo
Umgaqo wokukhetha ububanzi: Kufuneka ihambelane nenxalenye encinci yomngxuma we-medullary wesigulana (okanye umngxuma we-medullary oqikelelweyo) ukuze inike amandla aneleyo okubamba (ukuqina kwe-press-fit) kwaye iphephe ukwaphuka kwe-iatrogenic.
Uzipho olungolulwanga: Khetha uzipho oluncinci nge-1mm kunobubanzi bomngxuma ophakathi (umzekelo, ukuba ububanzi bomngxuma ophakathi buyi-10mm, khetha uzipho oluyi-9mm).
Uzipho olukhutshiweyo (umzekelo, ukuba ububanzi bomjelo okhutshiweyo yi-11mm, khetha uzipho olunobubanzi obuyi-9-10mm).
Uluhlu oluqhelekileyo: Ububanzi obusetyenziswa kakhulu kubantu abadala yi-9-11mm, ngelixa kubantwana yi-4-6mm.
V. Ukukhethwa ngokusekelwe kwimeko yethambo kunye nemeko yesigulana
Izigulane ezine-osteoporosis: Kucetyiswa ukuba ukhethe okutyebileyoUgqirha wamathambo Isikhonkwane (ukulungiswa kwe-press-fit) okanye ezo zinde ukuze kuthintelwe ukunqunyulwa kwezinzipho zentloko okanye ukungaphumeleli kokulungiswa kwangaphakathi ngenxa yokungoneli kwamandla okubamba.
Abaselula/izigulana ezinesimo esihle samathambo: Izipikili ezibhityileyo zangaphakathi kwe-medullary zinokukhethwa ukuze kulondolozwe igazi kwi-medullary cavity kwaye kuncitshiswe umngcipheko we-thermal ischemic necrosis ebangelwa kukwanda komongo wethambo.
Qaphela: Ukhetho lokugqibela lweUkwakhiwa kwakhona kweenzipho ze-Femoralifuna isigqibo esipheleleyo esisekelwe kumlinganiselo ochanekileyo womfanekiso wangaphambi kotyando (i-X-ray/CT), iimeko ze-fluoroscopy zangaphakathi kotyando, kunye nobuchule bomqhubi.
Ixesha leposi: Sep-16-2026