Intramedullary nailingyog ib qho kev siv orthopedic sab hauv kho cov txheej txheem uas rov qab mus rau xyoo 1940s.Nws yog dav siv nyob rau hauv kev kho mob ntawm cov pob txha pob txha ntev, tsis yog koom haum, thiab lwm yam kev raug mob.Cov txheej txheem muaj xws li ntxig ib tus ntsia thawv intramedullary rau hauv nruab nrab kwj dej ntawm cov pob txha kom ruaj khov ntawm qhov chaw tawg.Hauv cov ntsiab lus yooj yim, tus ntsia thawv intramedullary yog cov qauv ntev nrog ntau yamxauv ntsia hlauqhov ntawm ob qhov kawg, uas yog siv los kho qhov sib thooj thiab qhov kawg ntawm qhov tawg.Nyob ntawm lawv cov qauv, cov ntsia hlau intramedullary tuaj yeem faib ua cov khoom, tubular, lossis qhib-section, thiab siv los kho cov neeg mob sib txawv.Piv txwv li, cov ntsia hlau intramedullary muaj qhov zoo dua tiv thaiv kab mob vim lawv tsis muaj qhov chaw tuag.
Dab tsi ntawm cov pob txha puas tsim nyog rau cov ntsia hlau intramedullary?
Intramedullary ntsia thawvyog ib qho zoo tagnrho cog rau kev kho mob diaphyseal fractures, tshwj xeeb tshaj yog nyob rau hauv lub femur thiab tibia.Los ntawm cov txheej txheem minimally invasive, tus ntsia thawv intramedullary tuaj yeem muab kev ruaj ntseg zoo thaum txo cov nqaij mos puas hauv thaj tsam pob txha.
Qhov txo qis thiab intramedullary nailing fixation phais muaj cov txiaj ntsig hauv qab no:
Kaw txo thiab intramedullary nailing (CRIN) muaj qhov zoo ntawm kev zam qhov kev txiav ntawm qhov chaw tawg thiab txo qhov kev pheej hmoo ntawm kev kis kab mob.Nrog rau kev txiav me me, nws tsis txhob siv cov ntaub so ntswg ntau thiab kev puas tsuaj rau cov ntshav ntawm cov pob txha, yog li txhim kho tus nqi kho mob ntawm pob txha.Rau cov hom tshwj xeeb ntawmproximal pob txha fractures, CRIN tuaj yeem muab kev ruaj ntseg pib txaus, tso cai rau cov neeg mob pib sib koom ua ke thaum ntxov;Nws kuj tseem muaj txiaj ntsig zoo dua nyob rau hauv cov nqe lus ntawm kev coj tus kheej axial kev nyuaj siab piv rau lwm txoj hauv kev kho eccentric nyob rau hauv cov nqe lus ntawm biomechanics.Nws tuaj yeem tiv thaiv kom tsis txhob xoob ntawm kev kho sab hauv tom qab phais los ntawm kev ua kom thaj chaw sib cuag ntawm cov pob txha thiab cov pob txha, ua rau nws tsim nyog rau cov neeg mob pob txha.
Applied rau tibia:
Raws li pom nyob rau hauv daim duab, txoj kev phais yuav ua rau ib tug me me incision ntawm 3-5 cm tsuas yog saum toj no lub tibial tubercle, thiab ntxig 2-3 locking screws los ntawm incisions ntawm tsawg tshaj li 1 cm nyob rau hauv proximal thiab distal kawg ntawm lub sab ceg.Piv nrog rau kev qhib kev txo qis thiab kev txhim kho sab hauv nrog lub phaj steel, qhov no tuaj yeem hu ua cov txheej txheem tsawg kawg nkaus.
Siv rau femur:
1.Interlocking muaj nuj nqi ntawm femoral xauv intramedullary ntsia thawv:
Hais txog nws lub peev xwm los tiv thaiv kev sib hloov los ntawm kev xauv lub tshuab ntawm tus ntsia thawv intramedullary.
2.Classification ntawm cov ntsia hlau xauv intramedullary:
Nyob rau hauv cov nqe lus ntawm muaj nuj nqi: txheem xauv intramedullary ntsia thawv thiab reconstruction xauv intramedullary ntsia thawv;Feem ntau txiav txim siab los ntawm kev ntxhov siab ntawm kev sib kis ntawm lub duav mus rau lub hauv caug sib koom tes, thiab seb qhov nruab nrab ntawm cov rotators (hauv 5cm) yog qhov ruaj khov.Yog tias tsis ruaj khov, kev tsim kho ntawm lub duav kev nyuaj siab yog xav tau.
Hais txog qhov ntev: luv, proximal, thiab ncua hom, feem ntau xaiv raws li qhov siab ntawm qhov chaw tawg thaum xaiv qhov ntev ntawm tus ntsia thawv intramedullary.
2.1 Txheem interlocking intramedullary ntsia thawv
Lub luag haujlwm tseem ceeb: axial stress stabilization.
Indications: Fractures ntawm femoral ncej (tsis muaj feem xyuam rau subtrochanteric fractures)
2.2 Reconstruction interlocking intramedullary ntsia thawv
Lub luag haujlwm tseem ceeb: Kev ntxhov siab ntawm lub duav mus rau lub femoral ncej tsis ruaj khov, thiab kev ruaj ntseg ntawm kev ntxhov siab hauv ntu no yuav tsum tau rov tsim dua.
Cov lus qhia: 1. Subtrochanteric fractures;2. Fractures ntawm lub caj dab femoral ua ke nrog femoral ncej fractures ntawm tib sab (bilateral fractures nyob rau tib sab).
PFNA kuj yog ib hom kev kho dua tshiab-hom intramedullary ntsia thawv!
2.3 Distal xauv mechanism ntawm intramedullary ntsia thawv
Lub distal locking mechanism ntawm intramedullary rau tes nws txawv nyob ntawm seb cov chaw tsim khoom.Feem ntau, ib qho zoo li qub locking ntsia hlau yog siv rau cov ntsia hlau femoral intramedullary, tab sis rau femoral ncej fractures los yog lengthened intramedullary rau tes, ob los yog peb static locking screws nrog dynamic locking feem ntau yog siv los txhim kho kev sib hloov stability.Ob leeg femoral thiab tibial lengthened intramedullary rau tes yog tsau nrog ob lub ntsuas phoo.
Post lub sij hawm: Mar-29-2023
