Kana uchisarudza kuronga kurapwa kwehurongwa hwechiitiko che distal
Zviratidzo:
"Kukuvadzwa Kudzora" Kugadziriswa Kwechinguva chidiki kwekukuvara kwakakura uye zvakarukwa zvidimbu zvakarukwa kana zvakavhurika zvikanganiso kana zvakavharwa zvidimbu zvine hunyanzvi hwekuzvimba.
Kutenderwa kurapwa kwekusvibiswa, hutachiona hwakakanganisika, kana kuti zvikamu nezvakanyanya zvakapfava zvakapfava.
EXamine:
Nyoro nyoro mamiriro: ①Open ronda; ②Sevenere zvinyoro-nyoro tishu mufungidziro, nyoro nyoro tishu kuzvimba. Tarisa uone neurovascular mamiriro uye kunyatso nyora.
Kufungidzira: anteroposter uye yakazotevera X-ray yeTibia, uye anteroposter Kana iyo Intra-Artular Bracture inofungidzirwa kuti, iyo CT Scan yeTibial imba yekutonga inofanira kuitwa.
ANatomy:·
Iyo Anatomical "yakachengeteka Zone" yeExptery Equipment Pin Kugadziriswa kwakatsanangurwa zvinoenderana nemazinga akasiyana echikamu-chikamu.
Iyo proximal metaphysis yeTibia inopa iyo 220 ° anterior arc-yakavezwa yekuchengetedza nzvimbo iyo yekugadzirisa yekugadzirisa pini inogona kuiswa.
Zvimwe zvikamu zveTibia zvinopa anteomarial yakachengeteka sindano yekuisa nzvimbo munzvimbo yegumi nenomwe ° ~ 140 °.
SUrgical maitiro
Chinzvimbo: Nhema dzevarwere supine pane X-ray yakajeka tafura yekuvhiya, uye zvimwe zvinhu zvakadai secushion kana pasherufu zvakaiswa pasi pemumambo wakakanganisika kubatsira kuchengetedza chinzvimbo. Kuisa pad pasi pevhu ripilateral hip inotenderera iyo yakakanganisika inomuka mukati isina kuwandisa kwekunze kutenderera.
Approach
Kazhinji, zvidiki zvidiki zvinoitwa muTibia, Calcaneus, uye yekutanga metatarsal kuisa mapini ekunze ekugadzirisa.
FuBula Fractures inogadziriswa nyore nyore kubva kune iyo yakajeka inodambuka subcutaneous muganho.
Fractures yeTibial valt inosanganisira iyo yakabatanidzwa inogona kugadziriswa pwere. Kana zvinyoro nyoro mamiriro ezvinhu mvumo, uye kana zvichidikanwa, nguva dzose anteerolateral kana medial maitiro anogona kushandiswa kuti gadziriswe. Kana gadziriso yekunze inongoshandiswa seyakagadziriswa kwenguva pfupi, iyo sindano yekupinda nzvimbo iyo iyo yekugadzirisa tsono yakarongerwa kuti ibviswe kure neyekupedzisira zvipikiri zvekudzivirira. Kugadziriswa kwekutanga kweiyo fibula uye intra-lates zvidimbu zvinofambisa zvinotevera zvakajeka kugadzirisa.
Zvekungwaririra
Iva anochenjera gadziriro yekunze pini yePin yekutevera yakajeka kugadziriswa kweiyo shiri yemunda, sekusvibiswa tishu kuchatungamira kumanzwiro ekupedza. Kugara uchiita basa rekutora
Kuderedza uye kugadziriswa kweFibula Fractures:
Pese painenge yakapfava mamiriro emamiriro ezvinhu anobvumirwa, Fabula Fractures anotanga kubatwa. Iyo fralar yakavhiringidzika inoderedzwa uye yakagadziriswa uchishandisa iyo inotevera fibular incision, kazhinji ne 3.5mmm lag screws uye 3.5mm l / 3 tube ndiro, kana 3.5mm lcdc ndiro uye screws. Mushure mekunge FuBuLE is anatomically yakaderedzwa uye yakagadziriswa, inogona kushandiswa seyakagadziriswa yekudzoreredza kureba kweTibia uye kugadzirisa hurema hwekutenderera kweiyo tibi.
Zvekungwaririra
Yakakosha nyoro tishu kuzvimba kana ronda rakapedzisira riripo rinogona zvakare kudzivirira kugadziriswa kwekutanga kweiyo fibula. Chenjera kuti urege kugadzirisa proximal fralar fractures uye chenjera kuti ukukuvadza iyo proximal suphoficiken peroneal nerve nerve.
Tibial fractures: kuderedzwa uye kugadziriswa kwemukati
Intra-artular Fractures yeTibial imba yeTibi inofanirwa kuderedzwa pasi pechiratidzo chakananga kuburikidza neyeMukati mehukama hweTibia tibia, kana kuburikidza neanoreva zvisina kujairika kuderedzwa pasi peFluoroscopy.
Paunenge uchityaira iyo Lag Screw, iyo Fracture Fragment inofanirwa kugadziriswa neKiriviri Wire kutanga.
Kuderedzwa kwekutanga uye kugadziriswa kweIntra-articular Fractures inobvumira kune zvishoma kusanzwisisika maitiro uye kushanduka kukuru mukugadziriswa kwechipiri. Nzvimbo dzisina kunaka dzakapfava dzakasarudzika senge dzakarongedzwa dzakakuvara kana dzakapfava-tishu kukuvara kunogona kudzivirira kutanga kwekutanga kwezvidimbu zvemhando yepamusoro.
Tibial fractures: transarticular yekunze kugadzirisa
Muchinjiko-mubatanidzwa wekunze fixator inogona kushandiswa.
Zvinoenderana nezvinodiwa zvechipiri-stage dixicixication nzira, maviri mashanu-yakagadzirirwa yekugadzirisa yekugadzirisa pini yakaiswa pini kana neyakagadzirirwa mikana yeTibia yeTibia kuProximal mugumo wekupwanya.
Chekutanga kupokana nepafupa pamusoro, wobva wadzivirira matombo akapoteredzwa neakapfava tishu dziviriro sleeve, uye wobva wadya, tinya, uye utyaira screw kuburikidza ne sleeve.
Pini dzekunze dzekugadzirisa pakupera kwekupedzisira kwekupwanya kunogona kuiswa pane iyo distal tibial chidimbu, iyo calcaneus chidimbu, yekutanga metatarsal, kana mutsipa weTalus.
Transcalcaneal Ekunze Kugadziriswa Pini Inofanirwa kuiswa kuCalcaneal Tubenity kubva kuModial kuRekutanga kuti udzivise kukuvadzwa kune mical neurovascular zvimiro.
Iyo yekunze yekugadzirisa pini yeiyo yekutanga metatarsal inofanira kuiswa pane iyo anteromarial pamusoro pechikamu cheiyo yekutanga metatarsal.
Dzimwe nguva iyo yekugadzirisa yekugadzirisa pini inogona kuiswa anterolateraly kuburikidza neTarsal Sinus Incision.
Zvadaro, iyo Distal Tibia yakagadzirwazve uye mutsara wemauto wakagadziridzwa kuburikidza neyakaipisisa fluoroscopy, uye iyo yekunze fantator yakaunganidzwa.
Paunenge uchigadzirisa iyo yekunze fixator, sunungura clip yekubatanidza, ita tambo refuitudinal, uye ita zvinyoro-nyoro manyoka kuderedzwa pasi peFluoroscopy kugadzirisa chinzvimbo chechidimbu chakapwanyika. Anoshanda anobva atadza chinzvimbo apo mubatsiri akasimbisa zvikamu zvinobatanidza.
Main point
Kana iyo yekunze gadziriso haisi kurapwa kwetsika, iyo yekugadzirisa yekugadzirisa track inofanirwa kuchengetwa kure neiyo chaiyo gadziriso nzvimbo panguva yekuronga kwekushanda, kuti arege kusvibisa ramangwana rekushanda. Kugadzikana kwekugadziriswa kwekunze kunogona kuwedzerwa nekuwedzera kwekugadziriswa kwemapipi pane pini, kuwedzera mapoinzi ekugadzirisa, kuwedzera ndege yekugadzira, uye kuwedzera iyo ndege yekugadzirisa kana kushandisa ring rekunze ficha. Yakarongeka yekugadzirisa inokodzera inofanirwa kuve yakavimbiswa kuburikidza neyenzi-posterior uye yakazotevera zvikamu.
Tibial fractures: isina-span-articular yekunze kugadzirisa
Dzimwe nguva isarudzo yekushandisa iyo yekunze fixator iyo isingasvike mubatanidzwa. Kana iyo distal tibial chidimbu chakakura zvakakwana kuti ugare hafu-tambo yekunze yekugadzirisa mapini, iyo yakapusa yekunze ficha inogona kushandiswa. Kune varwere vane diki metaphyseal zvidimbu zvidimbu, hybrid yekunze ficha ine proximal semi Kuchenjerera kunofanirwa kuve kwakanyengedzwa kana uchishandisa isiri-yekunyepedzera yekunze yekuvhara kune mapundu ane zvakapfava zvine mutsindo. Kubviswa kweizvi zvakasvibiswa tishu, kushomeka kwesimbi yetsozi, uye kusagadzikana kwemugumo mune yakakwenenzverwa kusvika pakurapa kwakanaka nguva kazhinji isati yaitika kusarudzika kunogona kuitwa.
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Bata: Yoyo
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Email: liuyaoyao@medtechcah.com
Kutumira nguva: Kukadzi-10-2023
