Mazano mashanu ekugadzirisa zvipikiri zveDistal Tibial Fractures muIntramedullary

Mitsetse miviri yenhetembo inoti “cut and set internal fixation, closed set intramedullary nailing” inoratidza mafungiro evanachiremba vemapfupa panyaya yekurapa kuputsika kwetibia iri kure. Nanhasi, zvichiri nyaya yekufunga kuti zvipikiri zveplate kana zvipikiri zveintramedullary zviri nani here. Pasinei nekuti ndezvipi zviri nani mumaziso aMwari, nhasi tichaongorora mazano ekuvhiya ekuputsika kwetibia iri kure kure.

Seti ye "tairi rekuchengetedza" risati raitwa kuvhiyiwa

Kunyange hazvo kugadzirira nguva dzose usati wavhiyiwa kusiri madikanwa, zvinokurudzirwa kuva neseti yezvimwe zvezvikururu nemaplate kana paine mamiriro ezvinhu asingatarisirwi (semuenzaniso, mutsetse wakavanzika wekutyoka unodzivirira kuiswa kwezvikururu zvinokiya, kana kukanganisa kwevanhu kunowedzera kutyoka uye kudzivirira kusafamba-famba, nezvimwewo) zvinogona kuitika nekuda kwekushandisa intramedullary nailling.

Zvina zvekubudirira kugadzirisa nzvimbo

Nekuda kwechimiro che distal tibial metaphysis chakaonda, kudhonza nyore nyore kunogona kusaita kuti munhu aderedze mafambiro ake. Zvinhu zvinotevera zvichabatsira kuvandudza mwero wekubudirira kwekudzoreredza mafambiro ake:

1. Tora orthopantomograms yegumbo rine hutano usati wavhiyiwa kana kuti usati wavhiyiwa kuti uenzanise uye uone kuti kukuvara kwacho kwaderera sei padivi rakakuvara.

2. Shandisa nzvimbo yebvi rakapfava kuti zviite kuti nzara igare zvakanaka uye kuti fluoroscopy ishande zvakanaka.

3. shandisa chinodzosera kumashure kuti gumbo rirambe riri panzvimbo yaro uye rakareba

4. Isa zvikuro zveSchanz mutibia iri kure nepedyo kuti zvibatsire kuderedza kutsemuka.

7 Tsanangudzo dzeRubatsiro rweKuderedza uye Kusagona Kufamba

1. Isa pini yekutungamira nemazvo mutibia iri kure nekushandisa mudziyo wekubatsira wakakodzera kana nekukombamisa muromo wepini yekutungamira usati waisa.

2. Shandisa forceps yekuisa nzara mukati memedullary mumakumbo akatsemuka neakaonda (Mufananidzo 1)

3. Shandisa plate yakasimba ine monocortical fixation (tabular kana compression plate) mu open reduction kuti urambe uchideredza kusvika nzara yemukati medullary yapinzwa

4. Kutetepa kwenzira yembambo yemukati memedullary uchishandisa masikuruu eblock kugadzirisa angulation uye nzira yekuvandudza kubudirira kwekuisa mbambo yemukati memedullary (Mufananidzo 2)

5. Zvichienderana nerudzi rwekutyoka, sarudza kana uchishandisa masikuruu ekugadzirisa uye kugadzirisa kwechinguvana kwekuvhara nepini dzeSchnee kana Kirschner.

6. kudzivirira kutsemuka kutsva kana uchishandisa zvikuro zvinovhara varwere vane osteoporosis

7. tanga wagadzirisa fibula wozotevera tibia kana fibula yatyoka pamwe chete kuti zvive nyore kuisa tibial panzvimbo yayo.

Mufananidzo 1 Kugadziriswazve kwechikamu cheWeber chePercutaneous Maonero eOblique (Mufananidzo A naB) anoratidza kutyoka kuri nyore kwetibia yedistal uko kunozvibvumira kugadziriswazve kwechikamu che fluoroscopic chepercutaneous chinovanza zvishoma nezvishoma sharp-nosed clamp uko kunokonzera kukuvara kudiki kwenyama yakapfava.

Mufananidzo 2 Kushandiswa kwezvikururu zvinovhara Mufananidzo A unoratidza kutyoka kwakanyanya kwe distal tibial metaphysis zvichiteverwa nekukanganisika kweposterior angulation, nekukanganisika kwe residual inversion mushure mekugadziriswa kwe fibular pasinei nekugadziriswa kwe sagittal posterior angulation deformity (Mufananidzo C) (Mufananidzo B), ne blocking screw imwe yakaiswa kumashure uye imwe yakanongedza kumucheto kwe distal kwekutyoka (Mufananidzo B na C), uye medullary dilatation mushure mekuisa guide pins kugadzirisa coronal deformity (Mufananidzo D), uku uchichengetedza sagittal equilibrium (E)
Mapoinzi matanhatu ekugadzirisa intramedullary

1. Kana pfupa rekumashure repakaputsika rakasimba zvakakwana, nzara yemukati memudullary inogona kugadziriswa nekuisa screws ina mumakona akasiyana-siyana (kuvandudza kugadzikana kwemaaxes akawanda), kuitira kuti pave nekusimba kwechimiro.
2. Shandisa zvipikiri zvemukati memedullary zvinobvumira masikuruu akaiswa kuti apfuure nepakati uye kugadzira chimiro chinokiya chine kugadzikana kwekona.
3. Shandisa masikuruu akakora, masikuruu akawanda, uye nzvimbo dzakasiyana-siyana dzekuisa masikuruu kuti uparadzire masikuruu pakati pemagumo ekure nekure ekutyoka kwetsandanyama kuti usimbise simba rekugadzirisa nzara yemukati memedullary.
4. Kana nzara yemukati memudullary yakaiswa kure zvakanyanya zvekuti waya yekufambisa yakakombama isati yambopinda mutibhi, saka waya yekufambisa isina kukotama kana kuti isina kukotama inogona kushandiswa.
5. Chengeta nzara neplate zvinovhara kusvika kukuvara kwadzikira, kunze kwekunge nzara inovhara ichidzivirira nzara yemukati memedullary kuti isapararire pfupa kana kuti plate ye unicortical ichikuvadza nyama yakapfava.
6. Kana nzara ne screws zvemukati memedullary zvikasaita kuti pave nekudzikama kwakakwana, plate kana screws zvinogona kuwedzerwa kuti zviwedzere kugadzikana kwembambo dzemukati memedullary.

Zviyeuchidzo

Kupfuura chikamu chimwe muzvitatu chemapfupa etibia ekudistal anosanganisira majoini. Kunyanya, kutyoka kwetsinde retibial rekudistal, kutyoka kwetibial yespiral, kana kutyoka kwefibular kwakabatana kunofanirwa kuongororwa kuti uone kutyoka kwemukati mearticular. Kana zvakadaro, kutyoka kwemukati mearticular kunofanira kugadziriswa kwakasiyana usati waisa nzara yemukati memedullary.