Pakusarudza chirongwa chekurapa kukuvara kwetibial iri kure, kugadziriswa kwekunze kunogona kushandiswa sekugadzirisa kwenguva pfupi kukuvara kwakakomba kwenyama yakapfava.
Zviratidzo:
"Kudzora kukuvara" kugadzika kwechinguvana kwemapfupa akatyoka nekukuvara kwakakura kwenyama yakapfava, senge kutyoka kwakavhurika kana kutyoka kwakavharwa nekuzvimba kwakakura kwenyama yakapfava.
Kurapa kwakasimba kwemavanga ane utachiona, kana mavanga ane utachiona, kana kuti mavanga ane kukuvara kwakapfava kwakanyanya.
Examine:
Mamiriro enyama yakapfava: ①Ronda rakavhurika; ②Kukuvara kwakanyanya kwenyama yakapfava, kuzvimba kwenyama yakapfava. Tarisa mamiriro etsinga dzeropa wonyora pasi nokungwarira.
Kufungidzira: Kuongororwa kweX-rays dzemuchiuno chetibia, uye nzvimbo dzemuchiuno chetibia dziri pamberi, dzemuchiuno nedzemumakumbo. Kana paine chifungidziro chekuti pane kutyoka kwemudumbu, CT scan yemudumbu wetibia inofanira kuitwa.
Anatomi:·
"Nzvimbo yakachengeteka" yekuisa pini yekunze yakatsanangurwa zvichienderana nemazinga akasiyana echikamu chakasiyana.
Kuchinja kweproximal kwetibia kunopa nzvimbo yekuchengetedza yakaita searc yakatarisana ne 220° uko mapini ekugadzirisa ekunze anogona kuiswa.
Zvimwe zvikamu zvetibia zvinopa nzvimbo yakachengeteka yekuisa tsono panzvimbo iri pakati pe120°~140°.
Snzira yekuvhiya
Chinzvimbo: Murwere anorara akarara patafura yekuvhiyira inoonekera yeX-ray, uye zvimwe zvinhu zvakaita sechishongo kana sherufu zvinoiswa pasi pegumbo rakabatwa kuti zvibatsire kuchengetedza chinzvimbo chacho. Kuisa padhi pasi pechiuno cheipsilateral kunotenderedza gumbo rakabatwa mukati pasina kutenderera kwekunze kwakanyanya.
Anzira
Kazhinji, kucheka kudiki kunoitwa mu tibia, calcaneus, uye first metatarsal kuti paiswe mapini ekunze ekugadzirisa.··
Kutyoka kwefibula kunogadziriswa zviri nyore kubva pamucheto wepasi peganda unonzwikwa.
Kutyoka kwenzvimbo yetibial vault ine chekuita nejoini kunogona kugadziriswa neparutivi. Kana mamiriro enyama yakapfava achibvumira, uye kana zvichidikanwa, nzira yenguva dzose ye anterolateral kana medial inogona kushandiswa pakugadzirisa. Kana kugadzirisa kwekunze kuchingoshandiswa senzira yekugadzirisa kwenguva pfupi, nzvimbo yekupinda netsono panofanirwa kuiswa tsono yekunze inofanira kunge iri kure nenzvimbo yekupedzisira yekugadzirisa nzara kudzivirira kusvibiswa kwenyama yakapfava. Kugadzirisa kwekutanga kwefibula nezvidimbu zvemukati mearticular kunobatsira kugadzirisa kwacho kunotevera.
Zvekungwaririra
Chenjerera nzira yekunamira kwekunze kwenzvimbo yekuvhiyiwa, sezvo nyama ine utachiona ichizokonzera matambudziko mushure mekuvhiyiwa. Maitiro enguva dzose epamberi penzira kana pakati penzvimbo ine kuzvimba kwakanyanya kwenyama yakapfava anogonawo kukonzera matambudziko akakomba mukupora kweronda.
Kuderedza uye kugadzirisa kuputsika kwe fibula:
Kana paine mapfupa akapfava, fibula fractures inotanga yagadziriswa. Kupwanyika kwefibular kunoderedzwa uye kunogadziriswa uchishandisa lateral fibular incision, kazhinji ne3.5mm lag screws uye 3.5mm l/3 tube plate, kana 3.5mm LCDC plate uye screws. Mushure mekunge fibula yaderedzwa uye yagadziriswa, inogona kushandiswa senzira yekudzoreredza hurefu hwetibia uye kugadzirisa kutenderera kwekupwanyika kwetibial.
Zvekungwaririra
Kuzvimba kwakapfava kwenyama kana ronda rakavhurika zvakanyanya zvinogonawo kudzivirira kugadzika kwe fibula pakutanga. Chenjerera kuti usagadzirise kutyoka kwe proximal fibular uye chenjerera kukuvadza tsinga yepamusoro pe proximal peroneal.
Kutyoka kweTibial: Kuderedza uye Kugadziriswa Kwemukati
Kutsemuka kwetsinga dzemusana dzinofanira kuderedzwa kana munhu achiona zvakananga kuburikidza ne anterolateral kana medial approach ye distal tibia, kana kuburikidza nekudzikisa tsinga nemaoko zvisina kunanga uchishandisa fluoroscopy.
Paunenge uchityaira sikuruu yekunonoka, chidimbu chekutyoka chinofanira kugadziriswa neKirschner wire kutanga.
Kudzikiswa nekugadzika kwemapfupa ari mukati memuviri wemunhu kunobvumira nzira dzisinganyanyi kupindira uye kuchinjika kukuru mukugadzirisa kwechipiri. Mamiriro asina kunaka enyama dzakapfava akadai sekuzvimba kwakajeka kana kukuvara kwakanyanya kwenyama dzakapfava zvinogona kudzivirira kugadzika kwezvidimbu zvemukati memuviri wemunhu.
Kutsemuka kweTibial: Kugadziriswa kwekunze kweTransarticular
Chinogadzirisa chekunze chinopindirana nejoini chinogona kushandiswa.
Zvichienderana nezvinodiwa nenzira yekusimbisa danho rechipiri, mapini maviri ekunze e5mm ane shinda yehafu akaiswa parutivi kana kuburikidza nekucheka kudiki pamusoro pepakati kana pamberi petibia pamucheto wepedyo wekutyoka.
Kutanga, cheka mapfupa zvakananga, wobva wachengetedza nyama yakakomberedza neruoko rwakapfava, wobva waboora, rova, wobva wapinza sikuruu neparuoko.
Mapini ekunze ekugadzika ari kumucheto kwepakaputsika anogona kuiswa pachidimbu chetibial chedistal, calcaneus ne first metatarsal, kana mutsipa wetalus.
Mapini ekugadzirisa ekunze eTranscalcaneal anofanira kuiswa pa calcaneal tuberosity kubva pa medial kusvika pa lateral kudzivirira kukuvara kwe medial neurovascular structures.
Pini yekunamira yekunze yemetatarsal yekutanga inofanira kuiswa pamusoro peantermedial yehwaro hwemetatarsal yekutanga.
Dzimwe nguva pini yekunamira yekunze inogona kuiswa pamberi pechifukidziro kuburikidza nekucheka kwe tarsal sinus.
Zvadaro, distal tibia yakadzorerwa patsva uye force line yakagadziriswa kuburikidza ne intraoperative fluoroscopy, uye external fixator yakaunganidzwa.
Paunenge uchigadzirisa chibatiso chekunze, sunungura chibatiso chekubatanidza, tora chibatiso chenguva refu, uye deredza zvinyoro nyoro uchishandisa fluoroscopy kuti ugadzirise nzvimbo yechidimbu chakatyoka. Mushandi anobva achengetedza nzvimbo yacho uku mubatsiri achisimbisa zvibatiso zvekubatanidza.
Mnzvimbo isina chinhu
Kana kugadziriswa kwekunze kusiri kurapwa kwakananga, nzira yekunamira tsono yekunze inofanira kuchengetedzwa kure nenzvimbo yekunamira chaiyo panguva yekuronga kushanda, kuitira kuti isasvibise nzvimbo yekunamira mune ramangwana. Kugadzikana kwekunamira kwekunze kunogona kuwedzerwa nekuwedzera nzvimbo yepini dzekunamira panzvimbo yega yega yakatyoka, kuwedzera dhayamita yepini, kuwedzera huwandu hwepini dzekunamira uye struts dzinobatanidza, kuwedzera nzvimbo dzekunamira pajoini regumbo, uye kuwedzera nzvimbo yekunamira kana kuisa rin'i yekunamira yekunze. Kurongeka kwakakwana kwekugadzirisa kunofanirwa kuve nechokwadi kuburikidza nematanho ekumberi-ekumashure uye epadivi.
Kutsemuka kwetsinga dzemudumbu: kugadzika kwekunze kusina span-articular
Dzimwe nguva isarudzo yekuisa chibatiso chekunze chisingapfuure joini. Kana chidimbu chetibial chedistal chakakura zvakakwana kuti chikwane mapini ekunze ehafu-thread, chibatiso chekunze chiri nyore chinogona kushandiswa. Kune varwere vane zvidimbu zvidiki zvemetaphyseal fractures, chibatiso chekunze chehybrid chine proximal semi-threaded external fixation pin uye distal fine Kirschner wire chinobatsira senzira yekurapa kwenguva pfupi kana yekupedzisira. Kungwarira kunofanirwa kushandiswa pakushandisa non-span-articular external fixators pakutyoka kune kusvibiswa kwenyama yakapfava. Kubviswa kwenyama iyi ine utachiona, kubviswa kwetsono, uye kudzivirira kufamba kwemucheto mu cast kusvika ronda rapora zvakanaka risati raitwa.
Sichuan ChenAnHui Technology Co., Ltd
Bata: Yoyo
WhatsApp:+8615682071283
Email: liuyaoyao@medtechcah.com
Nguva yekutumira: Kukadzi-10-2023
