Sida Loo Doorto Mid Ku HabboonCiddiyaha Intramedullary ee Femoral-ka?
Xulashada mid ku habboonfakhlaaqeednxanuunwaxay u baahan tahay qiimeyn dhammaystiran oo ku saabsan nooca jabka bukaanka, qaab-dhismeedka jirka, tayada lafaha, habka qalliinka, iyo doorbidyada farsamo ee dhakhtarka qalliinka, taasoo horseedaysa go'aan gaar ah. Shuruudaha qiimaynta ugu muhiimsan waa sidan soo socota:
I. Xulashada iyadoo lagu saleynayo goobta iyo nooca jabka (Tilmaamaha)
Jabka bowdada ee proximal (intertrochanteric iyo transcervical):
Heerka Caadiga ahgudaha medullary cidiyaha(sida PFNA-da caadiga ah): Waxaa loogu talagalay jabka intertrochanteric (sida nooca 31-A1, 31-A2), jabka intertrochanteric ee gadaal u jeeda (nooca 31-A3), iyo jabka heerka sare ah (32-A1). Qaabka caadiga ah lama hagaajin wuxuuna ku habboon yahay bukaanada leh tayo lafo oo wanaagsan iyo jabka deggan.
Ciddiyaha gudaha medullary ee la dheereeyay (sida PFNA oo la dheereeyay): Waxaa loogu talagalay jabka hoose ee subtrochanteric, jabka leh xariiqda jabka oo ka baxsan dhammaadka fog ee acetabulum-ka yar oo ka badan 3 cm, jabka ipsilateral acetabular, jabka badan, jabka cudurada, ama bukaanada lafo-beelka. Noocyada dheeraadka ah waxay u baahan yihiin in la xidho waxayna bixin karaan hagaajin dherer buuxa oo wanaagsan iyo xasillooni ka hortagta wareegga.
Noocyo kale (sida InterTan,Ciddiyaha Gamma): InterTan (ciddiyaha labanlaabka ah oo lagu daray fiilo) waxay ku habboon tahay jabka aadka u daran ee u baahan cadaadis; ciddiyaha Gamma waxaa loogu talagalay jabka fudud, xasilloon ama jabka hoose.
Jabka usha bowdada (dhexda): Doorashada la door bidayo waa ciddiyaha intramedullary ee qufulan ee anterograde. Dhexroorka iyo dhererka saxda ah ee ciddiyaha intramedullary waa in la doortaa iyadoo lagu saleynayo ballaca godka medullary iyo heerka isku-darka jabka.
Jabka femoral-ka ee fog (condylar sare/intercondylar): Daaweynta la doorbidayo waa ciddiyaha intramedullary ee dib u qufulan, kuwaas oo ku habboon jabka sare ee condylar, jabka intercondylar ee ku lug leh dusha sare ee kala-goysyada, ama jabka ka hooseeya trochanter-ka femoral-ka.
II. Iyada oo ku saleysan Meesha Laga Galayo iyo Habka Qalliinka
Barta laga galo ee ugu sarreysa trochanter-ka weyn (habka antegrade): Ku habboon bukaanada cayilan (farsamo ahaan toos ah, waqti gaaban oo qalliin ah, fluoroscopy yar) iyo jabka joogtada ah ee intertrochanteric. Si kastaba ha ahaatee, waa in taxaddar la sameeyaa si looga fogaado dhaawac soo gaara murqaha afduubka.
Barta daloolka sanka ee Pyriform (jihada hore): Ku habboon jabka caadiga ah ee intertrochanteric, laakiin booska ayaa cidhiidhi ah. Way adag tahay in lagu shaqeeyo bukaanada cayilan waana in taxaddar la sameeyaa si looga fogaado waxyeelada dhiigga ee qoorta femoral ama madaxa femoral.
Barta daloolka dib u celi (iyada oo loo marayo fossa intercondylar): Ku habboon jabka femur-ka ee fog. Waa in taxaddar la sameeyaa si looga fogaado waxyeelada asalka seedaha dambe.
III. Iyada oo ku saleysan dhererka ciddiyaha Titanium-ka ee bawdada
Ciddiyaha gaaban (170–200 mm): Waxaa loogu talagalay bukaanada qaba kanaalka medullary ee bowdada oo cidhiidhi ah, jabka oo deggan, iyo kiliyaha bowdada ee dhinaca hore ee aan shaqaynayn. Waxay soo gaabinaysaa waqtiga qalliinka, laakiin taxaddar ayaa loo baahan yahay si looga hortago xasillooni wareeg oo aan ku filnayn bukaanada qaba kanaalka medullary ee ballaaran.
Ciddiyaha dhererka dhexe (235–240 mm): Ku habboon beddelka ciddiyaha gaaban, ama jabka hoose ee intertrochanteric, halkaas oo godadka qufulka fog loo baahan yahay in la hayo laakiin ciddiyaha dhaadheer aan la isticmaali karin.
Ciddiyaha dhaadheer (260–480 mm): Ku habboon bukaanada qaba kanaalada medullary ee ballaaran ee femoral, lafo-beelka, jabka cudurada, cilladaha cortical proximal, khadadka jabka ee fog, ama kuwa u baahan hagaajin dherer buuxa. Si kastaba ha ahaatee, waqtiga qalliinka iyo dhiig-baxa ayaa si isku mid ah u kordhi doona.
IV. Iyada oo ku saleysan Dib-u-dhiska Dhexroorka Ciddiyaha ama Dhumucda
Mabda'a xulashada dhexroorka: Waa in la waafajiyaa iyadoo loo eegayo qaybta ugu cidhiidhisan ee godka medullary ee bukaanka (ama godka medullary ee la qiyaasay) si loo helo xoog ku filan oo lagu hayo (riix-ku-hagaajinta) loogana fogaado jabka iatrogenic.
Ciddi aan la fidin: Dooro ciddi ka yar 1mm dhexroorka godka medullary (tusaale ahaan, haddii dhexroorka godka medullary uu yahay 10mm, dooro ciddi 9mm ah).
Ciddiyaha la ballaariyay (tusaale ahaan, haddii dhexroorka kanaalka la ballaariyay uu yahay 11mm, dooro ciddiyaha dhexroorkoodu yahay 9-10mm).
Kala duwanaanshaha caadiga ah: Dhexroorka caadiga ah ee dadka waaweyn loo isticmaalo waa 9-11mm, halka carruurtana ay tahay 4-6mm.
V. Xulashada iyadoo lagu saleynayo xaaladda lafaha iyo xaaladda bukaanka
Bukaanada qaba lafo-beelka: Waxaa lagugula talinayaa inaad doorato dhumuc weynLafaha Ciddiyaha (hagaajinta ku-habaynta riixista) ama kuwa dheer si looga fogaado jarista ciddiyaha madaxa ama cillad ku timaadda hagaajinta gudaha sababtoo ah awood ku filan oo hayn ah.
Bukaanada da'da yar/ee qaba xaalad lafo oo wanaagsan: Ciddiyaha intramedullary ee khafiifka ah ayaa la dooran karaa si loo ilaaliyo qulqulka dhiigga ee godka medullary loona yareeyo khatarta necrosis-ka ischemic ee kulaylka ah ee ay keento fidinta dhuuxa lafta.
Fiiro gaar ah: Xulashada kama dambaysta ah eeCiddiyaha Bowdada ee Dib-u-dhiskawaxay u baahan tahay go'aan dhammaystiran oo ku salaysan cabbiraadda saxda ah ee sawir-qaadista kahor qalliinka (X-ray/CT), xaaladaha fluoroscopy-ga qalliinka dhexdiisa, iyo aqoonta hawl-wadeenka.
Waqtiga boostada: Sebtembar-16-2026