Yadda Ake Zaɓar Wanda Ya DaceKusa ta Intramedullary ta Femoral?
Zaɓar wani abu da ya dacefhalin ɗabi'anrashin lafiyayana buƙatar cikakken kimantawa game da nau'in karyewar majiyyaci, yanayin jikinsa, ingancin ƙashi, hanyar tiyata, da kuma fifikon fasaha na likitan tiyata, wanda ke haifar da yanke shawara ta musamman. Babban sharuɗɗan tantancewa sune kamar haka:
I. Zaɓi bisa ga wurin da karaya ta faru da nau'in (Alamun)
Karyewar ƙashi a cikin ƙugu (intertrochanteric da transcervical):
Daidaitacceintramedullary ƙusa(kamar PFNA na yau da kullun): An nuna shi ga karaya tsakanin trochanteric (kamar nau'in 31-A1, 31-A2), karaya tsakanin trochanteric (nau'in 31-A3), da karaya mai matakai masu girma (32-A1). Tsarin da aka saba amfani da shi ba a gyara shi ba kuma ya dace da marasa lafiya da ke da ingancin ƙashi mai kyau da karyewar da ta yi daidai.
Fatar da aka tsawaita a cikin farce (kamar PFNA mai tsawo): Ana nuna ta ga ƙananan karyewar ƙasa, karyewar layin karyewar da ya wuce ƙarshen ƙaramin acetabulum da fiye da santimita 3, karyewar acetabular acetabular a cikin ipsilateral, karyewar da yawa, karyewar cututtuka, ko marasa lafiya da ke fama da osteoporosis. Nau'ikan da aka tsawaita suna buƙatar cannulation kuma suna iya samar da ingantaccen gyarawa mai tsayi da kwanciyar hankali na hana juyawa.
Sauran nau'ikan (kamar InterTan,Kusa da Gamma): InterTan (ƙusa biyu tare da kebul) ya dace da karyewar da ta yi tsanani wanda ke buƙatar matsewa; an nuna ƙusa ta Gamma don karyewar da ta yi sauƙi, ko kuma ta yi karyewar da ba ta da ƙarfi.
Karyewar ƙashin ƙugu (tsakiyar sashe): Zaɓin da aka fi so shine ƙusa mai kullewa a cikin medullary. Ya kamata a zaɓi diamita da tsawon ƙusa mai dacewa bisa ga faɗin ramin medullary da kuma matakin haɗakar karyewar.
Karyewar ƙashi a cikin femoral (condylar sama/intercondylar): Maganin da aka fi so shine ƙusoshin intramedullary masu lanƙwasa baya, waɗanda suka dace da karyewar ƙashi a saman condylar, karyewar haɗin gwiwa da ta shafi saman haɗin gwiwa, ko karyewar da ke ƙasa da trochanter na femoral.
II. Dangane da Wurin Shiga da Hanyar Tiyata
Wurin shiga a saman babban trochanter (hanyar antegrade): Ya dace da marasa lafiya masu kiba (hanyar da ta dace da sauƙi, gajeren lokacin tiyata, ƙarancin fluoroscopy) da kuma karyewar jijiyoyin jini na yau da kullun. Duk da haka, ya kamata a yi taka-tsantsan don guje wa rauni ga tsokar da aka sace.
Wurin huda hancin Pyriform sinus (alkiblar gaba): Ya dace da karyewar jijiyoyin tsakiya na yau da kullun, amma wurin da aka sanya shi kunkuntar ne. Yana da wahalar yin aiki ga marasa lafiya masu kiba kuma ya kamata a yi taka-tsantsan don guje wa lalata kwararar jinin wuyan cinya ko kan cinya.
Wurin huda baya (ta cikin intercondylar fossa): Ya dace da karyewar cinyar da ke nesa. Ya kamata a yi taka-tsantsan don guje wa lalata asalin jijiyar giciye ta baya.
III. Dangane da Tsawon Kusa da Femur na Titanium
Gajeren farce (170–200 mm): An nuna shi ga marasa lafiya da ke da kunkuntar hanyar medullary ta femoral, karyewar da ta yi daidai, da kuma cortex na gefen proximal femoral. Yana rage lokacin tiyata, amma ana buƙatar taka tsantsan don hana rashin isasshen kwanciyar hankali na juyawa ga marasa lafiya da ke da manyan hanyoyin medullary.
Kusa mai tsayin matsakaici (235–240 mm): Ya dace a madadin gajerun ƙusoshi, ko kuma don ƙananan karyewar tsakanin ƙusoshi, inda ake buƙatar a riƙe ramukan kullewa na nesa amma ba za a iya amfani da dogayen ƙusoshi ba.
Dogon farce (260–480 mm): Ya dace da marasa lafiya da ke da faffadan hanyoyin farce, osteoporosis, karyewar fata, lahani na cortical, layukan karyewa masu faɗi, ko waɗanda ke buƙatar gyarawa gaba ɗaya. Duk da haka, lokacin tiyata da asarar jini zai ƙaru sosai.
IV. Dangane da Sake Ginawa Diamita ko Kauri na Farce
Ka'idar zaɓin diamita: Ya kamata a daidaita shi bisa ga mafi kunkuntar ɓangaren medullary na majiyyaci (ko kuma kimanin ramin medullary) don samar da isasshen ƙarfin riƙewa (matsawa-fit fixation) da kuma guje wa karyewar iatrogenic.
Kusa mara faɗaɗawa: Zaɓi ƙusa da ta fi ƙanƙanta da diamita na ramin medullary (misali, idan diamita na ramin medullary shine 10mm, zaɓi ƙusa mai 9mm).
Faɗaɗa ƙusa (misali, idan diamita na magudanar ruwa mai faɗi shine 11mm, zaɓi ƙusa masu diamita na 9-10mm).
Matsakaicin diamita: Girman diamita da aka fi amfani da shi ga manya shine 9-11mm, yayin da ga yara shine 4-6mm.
V. Zaɓi bisa ga yanayin ƙashi da kuma yanayin majiyyaci
Marasa lafiya da ke fama da osteoporosis: Yana da kyau a zaɓi mai kauriKashin baya Ƙusa (gyaran da aka matse) ko waɗanda aka tsawaita don guje wa yanke farce ko gazawar gyarawa ta ciki saboda rashin ƙarfin riƙewa.
Matasa/marasa lafiya masu kyakkyawan yanayin ƙashi: Ana iya zaɓar kusoshi masu siriri a cikin farce na ciki don kiyaye wadatar jinin ramin medullary da kuma rage haɗarin kamuwa da cutar thermal ischemic necrosis da ke faruwa sakamakon faɗaɗa ƙashi.
Lura: Zaɓin ƙarshe naSake Gina Kusoshin Hannuyana buƙatar cikakken hukunci bisa ga ma'aunin hoton X-ray/CT kafin tiyata, yanayin fluoroscopy a lokacin tiyata, da kuma ƙwarewar mai aikin.
Lokacin Saƙo: Satumba-16-2026