Te whao i roto i te medullaryhe tikanga whakatikatika ā-roto orthopedic e whakamahia whānuitia ana i te tekau tau atu i 1940. He whānuitia te whakamahinga hei rongoā i ngā whati wheua roa, ngā whara kore-hononga, me ētahi atu whara e pā ana. Ko te tikanga he whakauru i tētahi whao intramedullary ki roto i te awaawa pokapū o te wheua hei whakau i te wāhi whati. I roto i ngā kupu ngāwari, he hanganga roa te whao intramedullary me ngā mahatīwiri rakahe kōhao kei ngā pito e rua, e whakamahia ana hei whakatika i ngā pito tata me ngā pito tawhiti o te whati. I runga i tō rātou hanganga, ka taea te whakarōpū i ngā whao intramedullary hei totoka, hei ngongo, hei wāhanga tuwhera rānei, ā, ka whakamahia hei rongoā i ngā momo tūroro rerekē. Hei tauira, he pai ake te ātete o ngā whao intramedullary totoka ki te mate nā te kore o te wāhi mate o roto.
He aha ngā momo whati e tika ana mō ngā whao intramedullary?
Whao intramedullaryHe mea tino pai te whakatō hei rongoā i ngā whati diaphyseal, inā koa i roto i te femur me te tibia. Mā roto i ngā tikanga iti rawa te whakaekenga, ka taea e te whao intramedullary te whakarato i te pumau pai me te whakaiti i te kino o ngā kiko ngohengohe i te rohe whati.
Ko ngā painga o te pokanga whakaiti kati me te pokanga whakapiri whao intramedullary e whai ake nei:
Ko ngā painga o te whakaiti kati me te whao intramedullary (CRIN) he karo i te tapahi i te wāhi whati, me te whakaiti i te tūponotanga o te mate. Mā te tapahi iti, ka karohia te tapahi kiko ngohengohe nui me te kino ki te rere o te toto i te wāhi whati, ā, ka pai ake te tere whakaora o te whati. Mō ngā momo motuhake ongā whati wheua tata, ka taea e te CRIN te whakarato i te pumau tīmatanga e ranea ana, e āhei ai ngā tūroro ki te tīmata wawe i te nekehanga o ngā hononga; he pai ake hoki mō te kawe i te ahotea tuaka ki te whakaritea ki ētahi atu tikanga whakapiri eccentric mō te koiora. Ka taea e ia te ārai pai ake i te wetekina o te whakapiri ā-roto i muri i te pokanga mā te whakanui ake i te wāhi pa i waenga i te implant me te wheua, kia pai ake ai mō ngā tūroro e pangia ana e te osteoporosis.
Ka whakamahia ki te tibia:
E ai ki te pikitia, ko te tikanga pokanga he tapahi iti noa iho i te 3-5 cm i runga ake i te tibial tubercle, ā, ka whakaurua kia 2-3 ngā tīwiri maukati mā roto i ngā tapahi iti iho i te 1 cm i ngā pito proximal me te distal o te waewae o raro. Ki te whakatauritea ki te whakaiti tuwhera tuku iho me te whakapiri ā-roto me te pereti maitai, ka taea te kī he tikanga tino iti rawa te whakaekenga.
Ka whakamahia ki te femur:
1. Te mahi honohono o te whao intramedullary kua maukati te femur:
E pā ana ki tōna kaha ki te ātete i te hurihuri mā te tikanga raka o te whao intramedullary.
2. Te whakarōpūtanga o te whao intramedullary kua maukati:
Mō te mahi: te whao raka-roto-roto paerewa me te hanga anō i te whao raka-roto-roto; ko te nuinga o te wā ka whakatauhia e te tuku ahotea mai i te hononga hope ki te hononga turi, me te mea kei te pumau ngā wāhanga o runga me raro i waenganui i ngā hurihuri (i roto i te 5cm). Mena he kore pumau, me hanga anō te tuku ahotea hope.
Mō te roa: ngā momo poto, tata, me te roa, ko te nuinga ka whiriwhiria i runga i te teitei o te wāhi whati i te wā e tīpakohia ana te roa o te whao intramedullary.
2.1 Whao hononga-roto paerewa
Mahi matua: te whakau i te ahotea tuaka.
Ngā tohu: Ngā whati o te kakau femur (kāore e pā ki ngā whati subtrochanteric)
2.2 Te hanga anō i te whao raka-roto-upoko
Mahi matua: Kāore i te pumau te tuku ahotea mai i te hope ki te kakau femur, ā, me hanga anō te pumau o te tuku ahotea i tēnei wāhanga.
Ngā Tohu: 1. Ngā whati o te kaki o te femur; 2. Ngā whati o te kaki o te femur me ngā whati o te kakau femur i te taha kotahi (ngā whati taha rua i te taha kotahi).
He momo whao intramedullary anō hoki te PFNA, he momo hanga anō!
2.3 Te tikanga raka tawhiti o te whao intramedullary
He rerekē te tikanga raka o ngā whao intramedullary i runga i te kaihanga. I te nuinga o te wā, ka whakamahia he tīwiri raka tūmau kotahi mō ngā whao intramedullary femur proximal, engari mō ngā whati o te kakau femur, ngā whao intramedullary roa rānei, e rua, e toru rānei ngā tīwiri raka tūmau me te raka hihiri hei whakarei ake i te pumau hurihuri. Ka whakaukia ngā whao intramedullary roa femur me te tibial ki ngā tīwiri raka e rua.
Wā tuku: Maehe-29-2023
