Pehea e koho ai i kahi kui Intramedullary Femoral kūpono?

Pehea e koho ai i kahi kūponoKui Intramedullary Femoral?

Ke koho ʻana i kahi kūponofmanaʻo pononʻehapono ka loiloi piha ʻana i ke ʻano haki o ka mea maʻi, ke ʻano o ke kino, ka maikaʻi o ka iwi, ke ʻano hana ʻoki kino, a me nā makemake loea o ke kauka ʻoki kino, e alakaʻi ana i ka hoʻoholo pilikino. Eia nā pae loiloi nui:

I. Koho ʻana ma muli o ka wahi a me ke ʻano o ka haki (Nā Hōʻailona)

Nā haki femoral proximal (intertrochanteric a me transcervical):
Kūlana Maʻamauintramedullary kui(e like me ka PFNA maʻamau): Hōʻike ʻia no nā haki intertrochanteric (e like me ke ʻano 31-A1, 31-A2), nā haki intertrochanteric hoʻohuli (ʻano 31-A3), a me nā haki kiʻekiʻe (32-A1). ʻAʻole i hoʻoponopono hou ʻia ke kumu hoʻohālike maʻamau a kūpono no nā poʻe maʻi me ka maikaʻi o ka iwi a me nā haki paʻa.
ʻO ke kui intramedullary i hoʻonui ʻia (e like me ka PFNA i hoʻonui ʻia): Hōʻike ʻia no nā haki subtrochanteric haʻahaʻa, nā haki me ka laina haki e hoʻolōʻihi ana ma ʻō aku o ka hopena distal o ka acetabulum liʻiliʻi ma mua o 3 cm, nā haki acetabular ipsilateral, nā haki he nui, nā haki pathological, a i ʻole nā ​​​​maʻi osteoporosis. Pono nā ʻano i hoʻonui ʻia i ka cannulation a hiki ke hāʻawi i ka hoʻopaʻa piha piha a me ka paʻa anti-rotation.
ʻO nā ʻano ʻē aʻe (e like me InterTan,Kui Gamma): ʻO ke InterTan (kui pālua i hui pū ʻia me ke kaula) he kūpono ia no nā haki i ʻoki nui ʻia e pono ai ke kaomi; ua hōʻike ʻia ke kui Gamma no nā haki maʻalahi, paʻa a i ʻole nā ​​​​haki subtrochanteric.
Nā haki o ke koʻokoʻo femoral (midsection): ʻO ke koho makemake ʻia ʻo ia ke kui intramedullary anterograde locking. Pono e koho ʻia ke anawaena kūpono a me ka lōʻihi o ke kui intramedullary ma muli o ka laulā o ka lua medullary a me ke kekelē o ka comminution o ka haki.
Nā haki femoral distal (condylar luna/intercondylar): ʻO ka lāʻau lapaʻau makemake nui ʻia he reverse locking intramedullary nails, kūpono ia no nā haki condylar luna comminuted, nā haki intercondylar e pili ana i ka ʻili hui, a i ʻole nā ​​haki ma lalo o ka femoral trochanter.

II. Ma muli o ke kiko komo a me ke ʻano hana ʻoki kino

Wahi komo ma ka piko o ka trochanter nui (ʻano hoʻokokoke mua): Kūpono no nā poʻe maʻi momona (ʻano hana maʻalahi, manawa ʻoki pōkole, fluoroscopy liʻiliʻi) a me nā haki intertrochanteric maʻamau. Eia nō naʻe, pono e mālama pono ʻia e pale aku i ka hōʻeha ʻana i ka ʻiʻo abductor.
Wahi ʻoki sinus Pyriform (kuhikuhi i mua): Kūpono no nā haki intertrochanteric maʻamau, akā he haiki ke kūlana. He ʻoi aku ka paʻakikī o ka hana ʻana no nā maʻi momona a pono e mālama pono ʻia e pale aku i ka hōʻino ʻana i ke kahe koko o ka ʻāʻī femoral a i ʻole ke poʻo femoral.
Wahi puncture retrograde (ma o ka fossa intercondylar): Kūpono no nā haki femoral distal. Pono e mālama pono ʻia e pale aku i ka hōʻino ʻana i ke kumu o ka ligament cruciate posterior.

III. Ma muli o ka lōʻihi o ke kui o ka Titanium Femor

Kui pōkole (170–200 mm): Hōʻike ʻia no nā poʻe maʻi me kahi kahawai medullary femoral haiki, nā haki paʻa, a me ka cortex femoral proximal lateral i hoʻopaʻa ʻia. Hoʻopōkole ia i ka manawa hana, akā pono ka akahele e pale aku i ka lawa ʻole o ke kūpaʻa rotational i nā poʻe maʻi me nā kahawai medullary ākea.
Kui lōʻihi waena (235–240 mm): Kūpono ma ke ʻano he koho ʻē aʻe no nā kui pōkole, a i ʻole no nā haki intertrochanteric haʻahaʻa, kahi e pono ai ke mālama ʻia nā lua laka distal akā ʻaʻole hiki ke hoʻohana ʻia nā kui lōʻihi.
Kui lōʻihi (260–480 mm): Kūpono no nā poʻe maʻi me nā kahawai medullary femoral ākea, osteoporosis, nā haki pathological, nā kīnā cortical proximal, nā laina haki e hoʻolōʻihi ana, a i ʻole ka poʻe e pono ai ka hoʻopaʻa piha ʻana. Eia nō naʻe, e hoʻonui iki ʻia ka manawa hana a me ke kahe koko.

IV. Ma muli o ke Anawaena a i ʻole ka Mānoanoa o ke Kui Hana Hou

Kumumanaʻo koho anawaena: Pono e hoʻohālikelike ʻia e like me ka ʻāpana haiki loa o ka lua medullary o ka mea maʻi (a i ʻole ka lua medullary i manaʻo ʻia) e hāʻawi i ka ikaika paʻa lawa (press-fit fixation) a pale i nā haki iatrogenic.
Kui i hoʻonui ʻole ʻia: E koho i kahi kui he 1mm ka liʻiliʻi ma mua o ke anawaena o ka lua medullary (no ka laʻana, inā he 10mm ke anawaena o ka lua medullary, e koho i kahi kui 9mm).
Kui i hoʻonui ʻia (no ka laʻana, inā he 11mm ke anawaena o ke kahawai i hoʻonui ʻia, koho i nā kui me ke anawaena o 9-10mm).
Pae maʻamau: ʻO ke anawaena maʻamau no nā pākeke he 9-11mm, ʻoiai no nā keiki he 4-6mm.

V. Koho ʻana ma muli o ke kūlana o ka iwi a me ke kūlana o ka mea maʻi

Nā maʻi me ka osteoporosis: He mea kūpono ke koho i nā ʻano mānoanoaʻOkioki Kui (press-fit fixation) a i ʻole nā ​​mea i hoʻolōʻihi ʻia e pale aku i ka ʻoki ʻana o nā kui poʻo a i ʻole ka hāʻule ʻana o ka hoʻopaʻa ʻana i loko ma muli o ka lawa ʻole o ka ikaika paʻa.
ʻŌpio/nā maʻi me ke kūlana iwi maikaʻi: Hiki ke koho ʻia nā kui intramedullary lahilahi e mālama i ke kahe koko o ka lua medullary a hōʻemi i ka pilikia o ka necrosis ischemic thermal i hoʻokumu ʻia e ka hoʻonui ʻana o ka iwi iwi.

Nānā: ʻO ke koho hope loa oHoʻoponopono hou ʻana i nā kui femoralpono i kahi hoʻoholo piha e pili ana i nā ana kiʻi pololei ma mua o ke ʻoki ʻana (X-ray/CT), nā kūlana fluoroscopy intraoperative, a me ke akamai o ka mea hoʻohana.