Paunosarudza chirongwa chekurapa kwe distal tibial fractures, kugadzirisa kwekunze kunogona kushandiswa sekugadzirisa kwenguva pfupi kwekuputsika nekukuvara kwakanyanya kwezvinyoro zvinyoro.
Zviratidzo:
"Kudzora kukuvadza" kugadzirisa kwekanguva kwezvimedu zvine kukuvara kwakapfava kwetishu, senge mafracture akavhurika kana akavharwa mafracture ane zvakakosha zvinyoro zvinyoro kuzvimba.
Kunyatso rapwa kweakasvibiswa, akatyoka ane utachiona, kana kutyoka nekukuvara kwakanyanya kwetishu.
Examine:
Mamiriro enyama akapfava: ① Ronda rakavhurika;②Yakanyanya kupfava matishu contusion, nyoro kuzvimba.Tarisa uone neurovascular mamiriro uye kunyatsorekodha.
Kufananidza: Anteroposterior uye lateral X-rays yetibia, uye anteroposterior, lateral uye ankle acupoints yejojo yemakumbo.Kana intra-articular fracture ichifungidzirwa, CT scan yetibial vault inofanira kuitwa.
Anatomy:·
Iyo anatomical "nzvimbo yakachengeteka" yekumisikidzwa kwepini yekunze yakatsanangurwa zvinoenderana neakasiyana mazinga emuchinjiko-chikamu.
Iyo proximal metaphysis yetibia inopa 220 ° anterior arc-shaped security zone uko kunze kwekugadzirisa pini kunogona kuiswa.
Zvimwe zvikamu zvetibia zvinopa anteromedial yakachengeteka yekuisa tsono nzvimbo muhuwandu hwe120 ° ~ 140 °.
Surgical technique
Position: Murwere anorara akatsikitsira patafura yeX-ray iri pachena yekushanda, uye zvimwe zvinhu zvakaita secushion kana sherufu zvinoiswa pasi pegumbo rakabatwa kuti ribatsire kuchengetedza chinzvimbo.Kuisa padhi pasi peipsilateral hip inotenderera nhengo yakakanganiswa mukati pasina kutenderera kwekunze kwakanyanya.
Aswedera
Muzviitiko zvakawanda, zvimedu zviduku zvinogadzirwa mu tibia, calcaneus, uye metatarsal yekutanga kuisa mapini ekugadzirisa kunze.··
Fibula fractures inogadziriswa nyore nyore kubva palpable lateral subcutaneous border.
Kuputsika kwetibial vault kunosanganisira mubatanidzwa kunogona kugadziriswa percutaneously.Kana mamiriro enyama akapfava achibvumira, uye kana zvichidikanwa, nzira yenguva dzose yeanterolateral kana yepakati inogona kushandiswa kugadzirisa.Kana kugadziriswa kwekunze kuchishandiswa chete sechiyereso chekugadzirisa kwechinguva, nzvimbo yekupinda tsono apo tsono yekunze yakarongerwa kuiswa inofanira kunge iri kure nenzvimbo yekupedzisira yezvipikiri kudzivirira kusvibiswa kwenyama yakapfava.Kugadziriswa kwekutanga kwefibula uye intra-articular zvidimbu zvinogonesa kunotevera kujekesa kugadzirisa.
Zvekungwaririra
Iva nehanya nekunze kwepini yepini yekumisikidza kunotevera kwekupedzisira kugadziridzwa kwenzvimbo yekuvhiya, sezvo tishu dzakasvibiswa zvinozotungamira kune postoperative matambudziko.Nguva dzose anterolateral kana yepakati nzira ine yakakura yakapfava kuzvimba kwenyama inogona zvakare kutungamirira kumatambudziko akakomba mukupora kweronda.
Kuderedza uye kugadzirisa kwefibula fractures:
Pese kana mamiriro enyama akapfava achibvumira, fibula fractures inorapwa kutanga.Iyo fibular fracture yakaderedzwa uye yakagadziriswa uchishandisa lateral fibular incision, kazhinji ine 3.5mm lag screws uye 3.5mm l/3 tube plate, kana 3.5mm LCDC ndiro uye screws.Mushure mokunge fibula yakaderedzwa uye yakagadziriswa, inogona kushandiswa seyero yekudzorera kureba kwetibia uye kugadzirisa kushanduka kwekutenderera kwetibial fracture.
Zvekungwaririra
Kuzvimba kwenyama yakapfava kwakakosha kana ronda rakasimba rakavhurika rinogona kudzivirira kugadzirisa kwekutanga kwefibula.Chenjerera kuti usagadzirise proximal fibular fractures uye chenjera kukuvadza iyo proximal superficial peroneal nerve.
Tibial Fractures: Kuderedza uye Kugadziriswa Kwemukati
Intra-articular fractures yetibial vault inofanira kuderedzwa pasi pechiratidzo chakananga kuburikidza ne anterolateral kana nzira yepakati ye distal tibia, kana kuburikidza nekuderedza kusinganzwisisiki kwebhuku pasi pe fluoroscopy.
Paunenge uchityaira iyo lag screw, iyo fracture fragment inofanirwa kugadziriswa neKirschner waya kutanga.
Kudzikisira kwekutanga uye kugadzirisa kwemukati-articular fractures inobvumira maitiro mashoma ekupinda uye kuchinjika kukuru mune yechipiri definitive fixation.Mamiriro asina kunaka akapfava-matishu akadai seakazvimba kuzvimba kana kukuvara kwakanyanya kwetishu-nyoro kunogona kudzivirira kukurumidza kugadzirisa kwemukati-articular zvidimbu.
Tibial Fractures: Transarticular External Fixation
A cross-joint yekunze fixator inogona kushandiswa.
Maererano nezvinodiwa zvechikamu chechipiri chekugadzirisa nzira yekugadzirisa, mapini maviri e5mm hafu-yakaiswa kunze kwekugadzirisa akaiswa percutaneously kana kuburikidza nediki diki pachikamu chemukati kana anterolateral pamusoro petibia pamagumo ekupedzisira kwekuputsika.
Tanga wanyatsochekerera pabhonzo repamusoro, wobva wadzivirira matishu akatenderedza neruoko rwekudzivirira tishu, wozoboora, tap, uye dhiraivha sikuruu nepakati peruoko.
Mapini ekunze ekugadzirisa pamucheto wekuputsika anogona kuiswa pane distal tibial fragment, calcaneus uye yekutanga metatarsal, kana mutsipa wetalus.
Transcalcaneal external fixation pins inofanira kuiswa pa calcaneal tuberosity kubva pakati kuenda kune lateral kudzivirira kukuvadzwa kwepakati neurovascular structures.
Iko kunze kwepini yekugadzirisa yekutanga metatarsal inofanira kuiswa pane anteromedial pamusoro penheyo yekutanga metatarsal.
Dzimwe nguva pini yekugadzirisa yekunze inogona kuiswa anterolaterally kuburikidza ne tarsal sinus incision.
Zvadaro, distal tibia yakagadziridzwa zvakare uye mutsara wesimba wakagadziriswa kuburikidza ne-intraoperative fluoroscopy, uye iyo yekunze fixator yakaunganidzwa.
Paunenge uchigadzirisa chigadziriso chekunze, sunungura clip yekubatanidza, ita longitudinal traction, uye ita zvinyoro zvinyorwa zvinyorwa pasi pe fluoroscopy kuti ugadzirise nzvimbo yekuputsika fragment.Mushandisi anobva achengetedza nzvimbo apo mubatsiri anosimbisa ma clips ekubatanidza.
Main point
Kana kugadzirisa kwekunze kusiri kurapwa kwakajeka, iyo yekunze yekumisikidza tsono track inofanirwa kuchengetedzwa kure nenzvimbo yakatarwa yekugadziriswa panguva yekuronga kwekushanda, kuitira kuti isasvibisa remangwana rekushanda munda.Kugadzikana kwekugadziriswa kwekunze kunogona kuwedzerwa nekuwedzera kuparadzaniswa kwepini dzekugadzirisa pane imwe neimwe nzvimbo yekuputsika, kuwedzera dhayamita yepini, kuwedzera nhamba yepini dzekugadzirisa uye kubatanidza struts, kuwedzera mapeji ekugadzirisa kumativi ose echidzitiro, uye kuwedzera kugadzirisa. ndege kana kuisa chigadziriso chemhete chekunze .Kurongeka kwakakwana kwekugadzirisa kunofanira kuvimbiswa kuburikidza neanterior-posterior uye lateral phases.
Tibial fractures: kwete-span-articular kunze kwekugadzirisa
Dzimwe nguva isarudzo yekushandisa yekunze fixator iyo isingapfuure mubatanidzwa.Kana iyo distal tibial fragment yakakura zvakakwana kuti igare hafu-tambo yekunze mapini ekugadzirisa, nyore nyore kugadzirisa kwekunze kunogona kushandiswa.Kune varwere vane zvimedu zvidiki zvemetaphyseal fracture, yakasanganiswa yekunze fixator ine proximal semi-threaded yekunze yepini yekumisikidza uye distal fine Kirschner waya inobatsira senzira yenguva pfupi kana yechokwadi yekurapa.Kuchenjerera kunofanira kushandiswa paunenge uchishandisa zvisiri-span-articular zvekunze zvigadziriso zvekuputsika nehutachiona hwakapfava.Kubviswa kwenyama iyi yakasvibiswa, kusvibiswa kwemutsara wetsono, uye kusamira kwekupedzisira mukanda kusvikira kupora kwakanaka kweronda kuchiwanzodikanwa kusati kwaitwa immobilization.
Sichuan ChenAnHui Technology Co., Ltd
Contact: Yoyo
WhatsApp:+8615682071283
Email: liuyaoyao@medtechcah.com
Nguva yekutumira: Feb-10-2023
