5 Mazano eIntramedullary Nail Fixation yeDistal Tibial Fractures

Mitsara miviri yenhetembo "cheka uye kuisa kugadziriswa kwemukati, yakavharwa yakavharwa intramedullary nailing" inonyatsoratidza mafungiro evanovhiya majoka kune kurapwa kwe distal tibia fractures.Kusvika nanhasi, ichiri nyaya yekufunga kana ndiro screws kana intramedullary zvipikiri zviri nani.Hazvinei kuti ndezvipi zviri nani mumeso aMwari, nhasi tichaita muchidimbu matipi ekuvhiya ekurovererwa kwe intramedullary ye distal tibial fractures.

Preoperative "spare tire" set

Nepo gadziriro dzenguva dzose dzekutanga kuvhiya dzisiri madikanwa, zvinokurudzirwa kuve neseti yezvikafu nemapureti kana paine mamiriro asingatarisirwe (semuenzaniso, yakavanzika yekutyoka mutsara inodzivirira kuiswa kwekuvhara screws, kana kukanganisa kwevanhu kunowedzera kutyoka uye kudzivirira kusafamba, nezvimwe, nezvimwe. ) izvo zvinogona kubva mukushandiswa kwe intramedullary nailing.

Iwo 4 mabhesi ekubudirira repositioning

Nekuda kweiyo oblique anatomy ye distal tibial metaphysis, nyore traction inogona kusagara ichiguma nekubudirira kuderedzwa.Aya mapoinzi anotevera anozobatsira kuvandudza mwero webudiriro yekumisikidza:

1. tora preoperative kana intraoperative orthopantomograms yehutano hwehutano kuti uenzanise uye uone kuwanda kwekuputsika kwekuderera kune rumwe rutivi rwakakanganiswa.

2.shandisa semi-flexed knee position kuti ubatsire kuiswa kwembambo uye fluoroscopy

3.shandisa retractor kuchengetedza nhengo panzvimbo uye kureba

4.Isa Schanz screws mu distal uye proximal tibia kuti ibatsire mukuderedza kuputsika.

7 Details of Assisted Reduction and Immobilization

1. Isa pini yemutungamiri nenzira yakarurama mu distal tibia uchishandisa chigadziro chakakodzera chekubatsira kana nekufanokotamisa muromo wepini yemutungamiri usati waiswa.

2. shandisa ganda-tipped resurfacing forceps kuti uise intramedullary misumari mu spiral uye oblique fractures (Mufananidzo 1)

3. shandisa ndiro yakaoma ine monocortical fixation (tabular kana compression plate) mukudzikisa pachena kuchengetedza kuderedza kusvika intramedullary chipikiri chaiswa.

4. kutetepa kweiyo intramedullary chipikiri chiteshi uchishandisa block screws kugadzirisa angulation uye chiteshi kuvandudza budiriro yekuisa intramedullary chipikiri (Mufananidzo 2)

5. zvichienderana nerudzi rwekutsemuka, sarudza kana kushandisa zvigadziriso zvekugadzirisa uye kugadzirisa kwechinguva chekuvhara neSchnee kana Kirschner pini.

6. kudzivirira kuputsika kutsva paunoshandisa kuvhara zvivharo muvarwere vane osteoporotic

7. gadzirisa fibula kutanga uye ipapo tibia munyaya yekubatanidza fibula fracture kuitira kuti tibial repositioning.

Mufananidzo 1 Percutaneous Weber clamp repositioning Oblique maonero (Figures A uye B) anoratidza zviri nyore distal tibia fracture inokweretesa kune fluoroscopic percutaneous zvishoma invasive inopinza-nosed clamp repositioning iyo inokonzeresa kukuvara kudiki kune nyoro.

Fig. 2 Kushandiswa kwekuvhara screws Fig. A inoratidza kuparara kwakanyanya kwe distal tibial metaphysis inoteverwa ne posterior angulation deformity, ine residual inversion deformity mushure mekugadzirisa fibula pasinei nekugadziriswa kwesagittal posterior angulation deformity (Fig. C) (Fig. B), ine imwe inovharira screw yakaiswa kumashure uye imwe nechemberi kumucheto kure kwekuputsika (Figs. B uye C), uye medullary dilatation mushure mekuisa mapini emutungamiri kuti awedzere kugadzirisa coronal deformity (Fig. D), uchichengetedza sagittal. kuenzana (E)
6 mapoinzi ekugadzirisa intramedullary

1. Kana iyo distal bone yekuputsika iine bony yakakwana, iyo intramedullary nail inogona kugadziriswa nekuisa 4 screws mumakona akawanda (kunatsiridza kugadzikana kweaxes akawanda), kuitira kuvandudza kusimba kwechimiro.
2. Shandisa zvipikiri zve intramedullary zvinobvumira zvipikiri zvakaiswa kuti zvipfuure uye ugadzire chimiro chekukiya chine angular kugadzikana.
3. Shandisa masiruu akakora, screws dzakawanda, uye ndege dzakawanda dzekuisa screw kugovera screws pakati pe distal uye proximal magumo ekutyoka kusimbisa kugadzirisa kweiyo intramedullary chipikiri.
4. Kana iyo intramedullary mbambo yakaiswa kure zvakanyanya kuitira kuti pre-bent guidewire inodzivirira distal tibial kuwedzera, ipapo isina-pre-bent guidewire kana distal isiri-kuwedzera inogona kushandiswa.
5. Chengetedza chipikiri chinovharira nendiro kusvika kutsemuka kwadzikira, kunze kwekunge mbambo inovharira ichidzivirira intramedullary chipikiri kubva pakuparadzira bhonzo kana unicortical plate inokuvadza nyama yakapfava.
6. Kana iyo intramedullary misumari uye screws isingapi kuderedzwa kwakakwana uye kugadzirisa, percutaneous plate kana screw inogona kuwedzerwa kuwedzera kugadzikana kwe intramedullary misumari.

Zviyeuchidzo

Kupfuura 1/3 ye distal tibia fractures inosanganisira kubatana.Kunyanya, kuputsika kweiyo distal tibial stem, spiral tibial fractures, kana kubatanidzwa kwe spiral fibular fractures kunofanira kuongororwa kune intra-articular fractures.Kana zvakadaro, iyo intra-articular fracture inoda kutarisirwa zvakasiyana isati yaiswa intramedullary chipikiri.