Ko ngā whati o te femur proximal e kitea whānuitia ana i roto i ngā whara haumanu e puta mai ana i te whara kaha nui. Nā ngā āhuatanga anatomical o te femur proximal, he maha ngā wā ka tata te rārangi whati ki te mata hononga, ā, ka toro atu pea ki roto i te hononga, ka kore e pai mō te whakapiri i ngā whao intramedullary. Nō reira, he nui tonu ngā take e whakawhirinaki ana ki te whakapiri mā te whakamahi i te pūnaha pereti me te tīwiri. Heoi, ko ngā āhuatanga koiora-ā-tinana o ngā pereti whakapiri eccentric he nui ake te mōrearea o ngā raruraru pēnei i te korenga o te whakapiri pereti taha, te pakaru o te whakapiri ā-roto, me te tango tīwiri. Ahakoa he whai hua te whakamahinga o te āwhina pereti medial mō te whakapiri, he ngoikoretanga o te nui haere o te whara, te roa o te wā pokanga, te nui haere o te mōrearea o te mate i muri i te pokanga, me te taumahatanga pūtea tāpiri mō ngā tūroro.
I runga i ēnei whakaaro, kia tutuki ai he taurite i waenga i ngā ngoikoretanga koiora-ā-tinana o ngā pereti takitahi taha me te whara pokanga e pā ana ki te whakamahinga o ngā pereti takirua taha me te taha, kua whakamahia e ngā tohunga o tāwāhi tētahi tikanga e uru ana ki te whakapiri pereti taha me te whakapiri tīwiri kiri tāpiri ki te taha waenga. Kua whakaatuhia e tēnei huarahi he hua haumanu pai.
I muri i te rongoā whakangote, ka whakanohoia te tūroro ki te tūranga takoto kau.
Hipanga 1: Te whakaiti i te whati. Whakauruhia he ngira Kocher 2.0mm ki roto i te ngongo tibial, tōia hei tautuhi anō i te roa o te peka, ā, whakamahia he papa turi hei whakatika i te nekehanga o te papa sagittal.
Hipanga 2: Te whakatakotoranga o te pereti maitai taha. Whai muri i te whakaiti taketake mā te kukume, whakatata tika atu ki te femur taha tawhiti, whiriwhiria he pereti maukati roa e tika ana hei pupuri i te whakaiti, ka whakauru i ngā tīwiri e rua ki ngā pito tata me ngā pito tawhiti o te whati hei pupuri i te whakaiti whati. I tēnei wā, he mea nui kia mōhio ko ngā tīwiri tawhiti e rua me whakanoho kia tata ki mua kia kore ai e pā ki te whakatakotoranga o ngā tīwiri waenga.
Hipanga 3: Te whakatakotoranga o ngā tīwiri pou waenga. Whai muri i te whakau i te whati ki te pereti maitai taha, whakamahia he wiri 2.8mm e ārahihia ana e te tīwiri hei tomo mā roto i te condyle waenga, me te pito ngira kei waenganui, kei muri rānei o te poraka femur distal, whakarara ki waho, ki runga hoki, e wero ana i te wheua cortical kei tērā taha. Whai muri i te whakaiti fluoroscopy pai, whakamahia he wiri 5.0mm hei hanga kōhao, ka whakauru i te tīwiri wheua cancellous 7.3mm.
He hoahoa e whakaatu ana i te tukanga whakaiti me te whakatika i te whati. He wahine 74-tau te pakeke me te whati hononga-roto o te femur distal (AO 33C1). (A, B) Ngā whakaahua X-ray taha i mua i te pokanga e whakaatu ana i te nekehanga nui o te whati femur distal; (C) Whai muri i te whakaiti whati, ka whakauruhia he pereti taha o waho me ngā tīwiri e mau ana i ngā pito proximal me distal; (D) Whakaahua fluoroscopy e whakaatu ana i te tūranga pai o te waea arataki medial; (E, F) Ngā whakaahua X-ray taha me te anteroposterior i muri i te pokanga i muri i te whakaurunga o te tīwiri pou medial.
I te tukanga whakaitiiti, he mea nui kia whai whakaaro ki ngā āhuatanga e whai ake nei:
(1) Whakamahia he waea ārahi me te tīwiri. He whānui te whakaurunga o ngā tīwiri pou waenga, ā, mā te whakamahi i te waea ārahi kāore he tīwiri ka puta he koki teitei i te wā e keri ana i roto i te condyle waenga, ka ngawari ai te paheke.
(2) Mena ka hopukina pai e ngā tīwiri o te pereti taha te uho taha engari kāore e taea te whakau i te uho taha rua, whakatikatikahia te ahunga o te tīwiri ki mua, kia taea ai e ngā tīwiri te uru ki te taha o mua o te pereti taha kia pai ai te whakau i te uho taha rua.
(3) Mō ngā tūroro e pāngia ana e te osteoporosis, mā te whakauru i tētahi mīhini horoi me te tīwiri pou waenga ka ārai i te tīwiri kei tapahi ki roto i te wheua.
(4) Tērā pea ka āraia te whakaurunga o ngā tīwiri pou waenga e ngā tīwiri i te pito tawhiti o te pereti. Mēnā ka tūpono he ārai i te tīwiri i te wā e whakauruhia ana te tīwiri pou waenga, whakaarohia te tango, te neke rānei i ngā tīwiri tawhiti o te pereti taha, me te aro nui ki te whakatakotoranga o ngā tīwiri pou waenga.
Take 2. Tūroro wahine, 76 tau te pakeke, he whati hononga-waho o te femur. (A, B) Ngā hihi-X i mua i te pokanga e whakaatu ana i te nekehanga nui, te koki koki, me te nekehanga o te papa koronari o te whati; (C, D) Ngā hihi-X i muri i te pokanga i ngā tirohanga taha me mua o te pokanga e whakaatu ana i te whakapiringa me te pereti taha o waho i honoa ki ngā tīwiri pou waenga; (E, F) Ngā hihi-X whai muri i te 7 marama i muri i te pokanga e whakaatu ana i te whakaora pai o te whati me te kore he tohu o te korenga o te whakapiringa o roto.
Take 3. Tūroro wahine, 70 tau te pakeke, he whati poroporo huri noa i te tākai femur. (A, B) Ngā hihi-X i mua i te pokanga e whakaatu ana i te whati poroporo huri noa i te tākai femur i muri i te pokanga turi katoa, me te whati i waho o te hononga me te whakapiringa poroporo pumau; (C, D) Ngā hihi-X i muri i te pokanga e whakaatu ana i te whakapiringa me te pereti taha o waho i honoa ki ngā tīwiri pou waenga mā te huarahi tāpiri-hono; (E, F) Ngā hihi-X whai muri i te 6 marama i muri i te pokanga e whakaatu ana i te whakaora pai o te whati, me te whakapiringa o roto kei te wāhi.
Wā tuku: Hanuere-10-2024
