Indlela Yokukhetha Isipho EsifaneleUzipho lwe-Femoral Intramedullary?
Ukukhetha inketho efanelefimizwa yothandoni-ailkudinga ukuhlolwa okuphelele kohlobo lokuphuka kwesiguli, ukwakheka komzimba, ikhwalithi yamathambo, indlela yokuhlinzwa, kanye nezintandokazi zobuchwepheshe zikadokotela ohlinzayo, okuholela ekwenzeni izinqumo zomuntu ngamunye. Izindlela zokuhlola eziyinhloko yilezi ezilandelayo:
I. Ukukhetha okusekelwe endaweni yokuphuka kanye nohlobo (Izinkomba)
Ukuphuka kwe-femoral okuseduze (okuphakathi kwe-trochanteric kanye ne-transcervical):
Okujwayelekilei-intramedullary uzipho(njenge-PFNA ejwayelekile): Kuboniswe ukuphuka kwe-intertrochanteric (njengohlobo 31-A1, 31-A2), ukuphuka kwe-intertrochanteric okuphambene (uhlobo 31-A3), kanye nokuphuka kwezinga eliphezulu (32-A1). Imodeli ejwayelekile ayilungiswanga futhi ifanele iziguli ezinekhwalithi enhle yamathambo kanye nokuphuka okuzinzile.
Uzipho olunwetshiwe lwangaphakathi kwe-medullary (njenge-PFNA enwetshiwe): Kuboniswa ukwaphuka okuphansi kwe-subtrochanteric, ukwaphuka komugqa wokuphuka odlula ingxenye ekude ye-acetabulum encane ngaphezu kuka-3 cm, ukwaphuka kwe-acetabular kwe-ipsilateral, ukwaphuka okuningi, ukwaphuka kwe-pathological, noma iziguli ze-osteoporotic. Izinhlobo ezandisiwe zidinga ukunqunywa futhi zinganikeza ukulungiswa okungcono kobude obugcwele kanye nokuqina kokulwa nokujikeleza.
Ezinye izinhlobo (njenge-InterTan,Uzipho lwe-gamma): I-InterTan (izinzipho ezimbili ezihlanganiswe nekhebula) ifanelekela ukwaphuka okubuhlungu kakhulu okudinga ukucindezelwa; isinzipho seGamma siboniswa ukwaphuka okulula, okuzinzile noma ukwaphuka okungaphansi kwe-trochanteric.
Ukuphuka komgodi we-femoral (phakathi nendawo): Okuthandwayo ukukhetha uzipho oluvala ngaphakathi kwe-anterograde. Ububanzi obufanele kanye nobude be-intramedullary kufanele kukhethwe ngokusekelwe ebubanzini bomgodi we-medullary kanye nezinga lokuguquka kokuphuka.
Ukuphuka kwe-distal femoral (condylar upper/intercondylar): Ukwelashwa okuthandwayo yizinzipho ze-intramedullary ezikhiywayo ezingemuva, ezifanele ukuphuka kwe-condylar upper comminuted, ukuphuka kwe-intercondylar okubandakanya ubuso bamalunga, noma ukuphuka okungaphansi kwe-femoral trochanter.
II. Ngokusekelwe endaweni yokungena kanye nendlela yokuhlinzwa
Indawo yokungena esicongweni se-trochanter enkulu (indlela ye-antegrade): Ifanele iziguli ezikhuluphele kakhulu (indlela elula, isikhathi esifushane sokuhlinzwa, i-fluoroscopy encane) kanye nokuqhekeka okuvamile kwe-intertrochanteric. Kodwa-ke, kufanele kuqashelwe ukugwema ukulimala kwemisipha ye-abductor.
Indawo yokubhoboza i-sinus ye-Pyriform (indlela eya phambili): Ifanelekela ukuphuka okuvamile kwe-intertrochanteric, kodwa indawo yokuma incane. Kunzima kakhulu ukuyihlinza ezigulini ezikhuluphele kakhulu futhi kufanele kuqashelwe ukugwema ukulimaza ukugeleza kwegazi entanyeni ye-femoral noma ekhanda le-femoral.
Indawo yokubhoboza emuva (ngokusebenzisa i-intercondylar fossa): Ilungele ukwaphuka kwe-distal femoral. Kufanele kuqashelwe ukugwema ukulimaza umsuka we-posterior cruciate ligament.
III. Kusekelwe kubude bezipikili ze-Titanium Femor
Uzipho olufushane (170–200 mm): Kuboniswe iziguli ezine-femoral medullary canal encane, ama-fracture azinzile, kanye ne-lateral proximal femoral cortex engashintshi. Kufinyeza isikhathi sokuhlinzwa, kodwa kudingeka ukuqaphela ukuvimbela ukuzinza okunganele kokujikeleza ezigulini ezine-wide medullary canal.
Izinzipho ezinobude obuphakathi (235–240 mm): Zifaneleka esikhundleni sezinzipho ezimfushane, noma ukuphuka okuphansi kwe-intertrochanteric, lapho izimbobo ezikhiyayo ezikude zidinga ukugcinwa khona kodwa izinzipho ezinde zingasetshenziswa.
Uzipho olude (260–480 mm): Lufanele iziguli ezinemisele emikhulu ye-femoral medullary, i-osteoporosis, ukwaphuka kwe-pathological, amaphutha e-proximal cortical, imigqa yokuphuka ende, noma lezo ezidinga ukulungiswa ubude obugcwele. Kodwa-ke, isikhathi sokuhlinzwa kanye nokulahlekelwa yigazi kuzokhula ngokulinganisela.
IV. Ngokusekelwe kububanzi noma ukujiya kwezipikili zokwakhiwa kabusha
Umgomo wokukhetha ububanzi: Kufanele uhambisane nengxenye encane kakhulu yomgodi we-medullary wesiguli (noma umgodi we-medullary olinganiselwe) ukuze unikeze amandla okwanele okubamba (ukuqina kokucindezela) futhi ugweme ukuqhekeka kwe-iatrogenic.
Uzipho olunganwetshwanga: Khetha uzipho oluncane ngo-1mm kunobubanzi bomgodi ophakathi nendawo (isibonelo, uma ububanzi bomgodi ophakathi nendawo bungu-10mm, khetha uzipho olungama-9mm).
Uzipho olunwetshiwe (isibonelo, uma ububanzi bomsele onwetshiwe bungu-11mm, khetha izinzipho ezinobubanzi obungu-9-10mm).
Ububanzi obujwayelekile: Ububanzi obuvame ukusetshenziswa kubantu abadala bungu-9-11mm, kanti kubantwana bungu-4-6mm.
V. Ukukhetha okusekelwe esimweni sethambo kanye nesimo sesiguli
Iziguli ezine-osteoporosis: Kunconywa ukukhetha okujiyileUdokotela Wamathambo Izipikili (ukuqina kokucindezela) noma ezinde ukuze kugwenywe ukunqunywa kwezinzipho zekhanda noma ukwehluleka kokuqina kwangaphakathi ngenxa yokunganele kwamandla okubamba.
Iziguli ezisencane/ezinesimo esihle samathambo: Izinzipho ezincane kakhulu zangaphakathi kwe-medullary zingakhethwa ukuze kulondolozwe ukugeleza kwegazi kwe-medullary cavity futhi kuncishiswe ingozi ye-thermal ischemic necrosis ebangelwa ukwanda komnkantsha wamathambo.
Qaphela: Ukukhetha kokugcina kweUkwakhiwa kabusha kwezinzipho ze-Femoralkudinga isahlulelo esibanzi esisekelwe ekulinganisweni okunembile kwezithombe zangaphambi kokuhlinzwa (i-X-ray/CT), izimo ze-fluoroscopy zangaphakathi kokuhlinzwa, kanye nekhono lomqhubi.
Isikhathi sokuthunyelwe: Septhemba 16-2026