Mazano mashanu eIntramedullary zvipikiri zvipikiri zve distal tibial fractures

Mitsetse miviri yemitemo "yakatemwa uye isa chimiro chemukati, yakavharwa sethlalary zvipikiri" nenzira yakakodzera kuratidza mafungiro ekuvhiya kweOrthopedic ekurapa kweKrisimasi Tibia. Nanhasi, ichiri nyaya yemafungiro ingangoita mapuranga kana zvipikiri zvemukati zviri nani. Pasinei nezviri nani mumeso aMwari, nhasi tichagadzira matipi emazwi ekuvhiya ekuvhenekerwa kwemukati memuromo we distal tibial fractures.

Preeperative "spare tire" set

Nepo mafambiro ekugadzirira gadziriro zvisingadere, zvinokurudzirwa kuve neshure kwemasero uye mahwendefa okusarongeka anowedzera kupwanyika uye anodzivirira kusarudzika uye etc.) izvo zvinogona kubva mukushandiswa kwekushandiswa kwemukati.

Zvigadziko zvina zvekubudirira kudzoreredza

Nekuda kweiyo oblique anatomy yeiyo distal tibial metaphysis, tsika yakapusa inogona kunge isingawanzo kuguma nekudzikiswa kwakabudirira. Pfungwa dzinotevera dzichabatsira kugadzirisa huwandu hwekubudirira kwekudzoreredza:

1. Tora preoperative kana IntrapernantOperotomographomogrammamo ane hutano kuenzanisa uye kuona huwandu hwekudzikisira kudzikisira padanho rakakanganisika.

2.Seuse nzvimbo yechidimbu-yakachinjika ibvi kuti ifambise zvepikiri neti-fluoroscopy

3.Seuse retsanga kuti urambe uine humbo munzvimbo uye urefu

4.Place SChanz screws mu distal uye proximal tibia yekubatsira mukudzikisira.

7 Zvinyorwa zveKubatsiro Kugadziriswa uye Kureba

1. Isa iyo gwara pini nenzira kwayo muTistil Tibia uchishandisa mudziyo wakabatsira kana pre-kukotama iyo tipiti yePini yekufambisa isati yaiswa.

2. Shandisa ganda-rakaputirwa ramutsu yekuisa mukati memukati zvipikiri mune spiral uye oblique fractures (Mufananidzo 1)

3. Shandisa righti yakaomeswa neye monocortical gadziriso (tabular kana compression plate) mukudzikiswa kwekudzikama kuchengetedza kudzikisira kusvikira iyo intramedulary chipikiri chakaiswa

4

5. Zvichienderana nerudzi rwepakungwa, sarudza kuti ushandise gadziriso screws uye kwenguva pfupi kuvharira kugadziriswa neSchnee kana Kirschner Pins.

6. Dzivirira zvipenga zvitsva paunenge uchishandisa kuvhara zviyero muOsteoporotic varwere

7. Gadzirisa iyo fiBula kutanga uye ipapo iyo tibia mune iyo yakaiswa fibula yakabatanidzwa kuti ifambise tibial repositioning

Mufananidzo 1 Percutane Weber Clamp Kuongorora Oblique Views (Viini A uye B) Rinorevesa Disoroscopic Pervasive Sperp

Fig. Kushandiswa kwekuvhara screws fig. A runyararo rwakanyanya kweiyo Distial Tibiel Dailymotion Pashure peSagittal (Fig. B) .
6 mapoinzi eIntramedullary Fixation

1. Kana iyo distal pfupa rekupwanya rakakwana, chipikiri chakaringana chinogona kugadziriswa nekuisa 4 screws mumakona mazhinji (kuti uvandudze kugadzikana kwemahara), kuitira kuti uvandudze kuomarara kwechimiro.
2. Shandisa intramedullary zvipikiri zvinobvumidza iyo yakaiswa screws kuti ipfuure nepamhepo yekuvhara kugadzikana kwe angular.
3. Shandisa gobvu screws, akawanda screws, uye mitezo yakawanda yeScrew kugovera zviyero pakati peiyo discal uye proximal magumo ekusimbisa maitiro ekugadziriswa kweiyo intramedullary.
4. Kana iyo intramedudullary mbichana yakaiswa zvakanyanya kuitira kuti iyo pre-bent bittingwire inotadzisa distal tibial kuwedzera, saka isiri-pre-pre-but-bent buttingwire kana kusawedzera kusashandiswa.
5. Chengetedza zvipikiri zvinovhara uye ndiro kusvika kupwanya kupfupika, kunze kwekunge zvipikiri zvinovhara zvinodzivirira chipikiri chakaparadzaniswa kuti uparadze pfupa kana iyo isina kusarudzika plate inokuvadza iyo nyoro.
6. Kana iyo intramedyy nails uye screws hairevi kuderedzwa kwakaringana uye kugadziriswa, ndiro yeiyo percutaneous kana screw inogona kuwedzerwa kuti uwedzere kugadzikana kweiyo intrameduutery zvipikiri.

Zviyeuchidzo

Kupfuura 1/3 ye distal tibia fractures inosanganisira kubatana. Kunyanya. Kana zvirizvo, iyo Intra-Artular Fracture inoda kutarisirwa zvakasiyana usati waiswa chikamu chegomarara.