Ngā Pūrongo - Te Tukanga Whakamau ā-roto o te Pereti Femur

E rua ngā momo tikanga pokanga, arā, ko ngā tīwiri pereti me ngā pine intramedullary, ko te tuatahi kei roto ko ngā tīwiri pereti whānui me ngā tīwiri pereti kōpeketanga pūnaha AO, ā, ko te tuarua kei roto ko ngā pine retrograde kua kati me ngā pine tuwhera kua hoki whakamuri, kua hoki whakamuri rānei. Ko te kōwhiringa kei runga i te wāhi me te momo whati motuhake.
He pai ngā painga o te whakapiringa o te pine intramedullary, arā, he iti te kitea, he iti te tango, he pumau te whakapiringa, kāore e hiahiatia he whakapiringa o waho, me ētahi atu. He pai mō te whati o te 1/3 o waenganui, te whati o te femur 1/3 o runga, te whati maha-wāhanga, te whati pathological. Mō te whati o te 1/3 o raro, nā te nui o te kōhao medullary me te maha o ngā wheua cancellous, he uaua ki te whakahaere i te hurihanga o te pine intramedullary, ā, kāore te whakapiringa i te mau, ahakoa ka taea te whakapakari ki ngā tīwiri, engari he pai ake mō ngā tīwiri pereti maitai.

Te Whakatikatika Tuwhera-ā-roto mō te Whati o te Tūāpapa Femur me te Whao Intramedullary
(1) Tapahi: Ka tapahia te taha o te femur ki te taha, ki muri rānei, ki waenganui o te wāhi whati, he 10-12 cm te roa, ka tapahia mā roto i te kiri me te whānui o te fascia, ka hurahia te uaua femur ki te taha.
Ka tapahia te taha ki te rārangi i waenganui i te trochanter nui me te condyle taha o te femur, ā, he rite tonu, he paku muri rānei te tapahi kiri o te tapahi taha o muri, ko te rerekētanga matua ko te tapahi taha ka wehea te uaua vastus lateralis, ko te tapahi taha o muri ka uru ki te mokowā o muri o te uaua vastus lateralis mā roto i te uaua vastus lateralis. (Pikitia 3.5.5.2-1, 3.5.5.2-2).

Ko te tapahi anterolateral, i tētahi atu taha, ka mahia mā te rārangi mai i te tuaiwi iliac o mua ki runga ki te taha o waho o te patella, ā, ka uru atu mā te uaua femoral taha me te uaua rectus femoris, ka whara pea i te uaua femoral waenga me ngā peka io ki te uaua femoral taha me ngā peka o te uaua rotator femoris externus, nō reira he onge, he kore rānei e whakamahia (Pikitia 3.5.5.2-3).

（2） Te Whakaaturanga: Wehea, tōia te uaua femur taha ki mua, ka whakaurua ki roto i tōna wāhi wehe me te biceps femoris, tapahia tika rānei te uaua femur taha, engari he nui ake te toto. Tapahia te periosteum kia kitea ai ngā pito whati o runga me raro o te whati femur, ā, kia kitea ai te whānuitanga kia taea ai te tirotiro me te whakaora, ā, kia iti rawa te tango i ngā kiko ngohengohe.
（3）Te whakatika i te whakapiri ā-roto: Tāpirihia te peka e pāngia ana, whakaaturia te pito whati tata, whakauruhia te ngira puāwai paramu, te ngira intramedullary āhua-V rānei, ka ngana ki te ine mēnā he tika te matotoru o te ngira. Mēnā he whaiti te kōhao medullary, ka taea te whakamahi i te whakawhanui kōhao medullary hei whakatika me te whakawhanui tika i te kōhao, kia kore ai e taea te tomo me te kore e taea te unuhia. Whakamaua te pito whati tata ki te pupuri wheua, whakauruhia te ngira intramedullary ki muri, werohia te femur mai i te trochanter nui, ā, ina pana te pito o te ngira ki runga i te kiri, tapahia he iti 3cm ki te wāhi, ka haere tonu te whakauru i te ngira intramedullary kia kitea rā anō i waho o te kiri. Ka tangohia te ngira intramedullary, ka hurihia, ka tukuna mā roto i te foramen mai i te trochanter nui, kātahi ka whakauruhia ki te taha tata ki te papa o te whakawhiti-wāhanga. He iti ngā pito porowhita o ngā ngira intramedullary kua whakapaitia me ngā kōhao tango. Kātahi ka kore e hiahiatia te kukume me te whakarerekē i te ahunga, ā, ka taea te wero i te ngira ki waho, kātahi ka werohia kotahi ki roto. Tērā atu huarahi, ka taea te wero i te ngira ki muri mā te whakamahi i te pine ārahi, ā, ka whakaatuhia ki waho o te kokoti nui o te trochanteric, kātahi ka taea te wero i te pine intramedullary ki roto i te kōhao medullary.
Te whakaora anō i te whati. Ka taea te whakatutuki i te whakatikatika ā-tinana mā te whakamahi i te hiki o te pine intramedullary proximal me te hurihanga wheua, te kume, me te taupoki whati. Ka tutuki te whakapiringa mā te whakamahi i tētahi pupuri wheua, kātahi ka panaia te pine intramedullary kia anga whakamuri te kōhao tango o te pine kia rite ki te piko o te femur. Me tae te pito o te ngira ki te wāhanga tika o te pito tawhiti o te whati, engari kaua e puta mā te paparanga kiriuhi, ā, me waiho te pito o te ngira kia 2cm ki waho o te trochanter, kia taea ai te tango i muri mai. (Pikitia 3.5.5.2-4).

I muri i te whakapiringa, ngana ki te nekeneke mārire o te peka, me te tirotiro i te kore pumau. Mena e tika ana kia whakakapia te ngira matotoru o roto o te uaua, ka taea te tango me te whakakapi. Mena he iti te wetewete me te kore pumau, ka taea te tāpiri i te tīwiri hei whakapakari i te whakapiringa. (Pikitia 3.5.5.2-4).
I horoia te patunga, ā, i kapihia kia paparua. I whakakakahuria he pūtu paraikete ārai-hurihuri ki waho.
II Te Whakamautanga o roto o te Tīwiri Pereti
Ka taea te whakamahi i te whakapiri ā-roto me ngā tīwiri pereti maitai ki ngā wāhanga katoa o te kakau femur, engari ko te 1/3 o raro te mea pai ake mō tēnei momo whakapiri nā te whānui o te kōhao medullary. Ka taea te whakamahi i te pereti maitai whānui, te pereti maitai kōpeketanga AO rānei. He pakari ake tēnei, he pūmau ake, kāore he whakapiri o waho. Heoi, kāore e taea e tētahi o rāua te karo i te mahi a te huna i te ahotea me te whai i te kaupapa o te kaha ōrite, me whakapai ake.
He whānui ake te awhe tihore o tēnei tikanga, he nui ake te piri o roto, he pā ki te whakaora, ā, he ngoikoretanga anō hoki.
Ina kore he āhua o te titi o roto i te medullary, ka ngāwari ake te urutau ki te piko o te medullary whati tawhito, ki te wāhanga nui rānei o te whati kāore e taea te whiti me te 1/3 o raro o te whati.
(1) Tapahi taha o te femur, o muri rānei.
(2)(2) Te whakaatu i te whati, ā, i runga i ngā āhuatanga, me whakatikatika, me whakapiri ki roto mā te whakamahi i ngā tīwiri pereti. Me whakanoho te pereti ki te taha whakawhāiti taha, me haere ngā tīwiri mā roto i te kiriuhi i ngā taha e rua, ā, ko te roa o te pereti me 4-5 ngā wā o te whānui o te wheua i te wāhi whati. Ko te roa o te pereti he 4 ki te 8 ngā wā o te whānui o te wheua whati. E 6 ki te 8 ngā wā e whakamahia whānuitia ana ngā pereti kōhao i roto i te femur. Ka taea te whakapiri i ngā kongakonga wheua nui kua pakaru mā te whakamahi i ngā tīwiri tāpiri, ā, ka taea te whakanoho i te maha o ngā hononga wheua i te wā kotahi ki te taha waenga o te whati kua pakaru.（Pikitia 3.5.5.2-5）。