Kugadzirira kugadzirira uye chinzvimbo sezvakambotsanangurwa kune transarticular kunze kwekunze frame gadziriso.
Intra-Articular Fracture inokwereta uye kugadziriswa:
Kushoma incisional kuderedzwa uye kugadziriswa kunoshandiswa. Kuvhiringidzika kweiyo yakaderera yekunyepedzera pamusoro inogona kuvonekwa zvakananga kuburikidza nediki antengedial uye anteerolateral incisional incisilu capsile pazasi peVarume.
Kuedza kweiyo yakakanganisika nhengo uye kushandiswa kwe ligaments kururamisa zvidimbu zvepfupa, uye kumanikidzwa kwepakati kunogona kugadzirwazve ne pling uye kutanha.
Teerera kudzoreredza upamhi hweiyo tibial clateau, uye kana paine pfupa kuremara pazasi, ita pfupa dzichiita kuti utsigire iyo yekunyorera mushure mekushanduka-shanduka.
Teerera kumusoro kwekureba kwemu medial uye unotevera mapuratifomu, zvekuti hapana chimiro chehunyanzvi.
Kugadziriswa kwechinguvana neyakagadziridza Clamp kana Kirschner Pin inoshandiswa kuchengetedza reset.
Kuiswa kwehombodo yehombodo, zviyero zvinofanirwa kufanana neyenzi yemazano uye iri munzvimbo yepazasi, kuti uwedzere simba rekugadzirisa. Intraoperative x-ray fluoroscopy inofanira kuitwa kuti iitarise iyo screws uye usambofa uchityaira zvigunwe mubatanidzwa.
Epiphyseal Fracture inokwereta:
Kutsvagira kwakadzoreredza urefu uye mechancal axis yemberi yakakanganisika.
Chenjera chinotorwa kururamisa kuturika kwekutenderera kwegumbo rakakanganisika nekuvhara tibial tuborisity uye kutumirana pakati pezvigunwe zvekutanga uye zvechipiri.
Proximal Mhete Nzvimbo
Mhando yezvinhu zvakachengeteka zve tiial plateau tension waire kuiswa:
Iyo popliteal artery, popliteal vein uye tibial nerve runomhanya posterior kuTibia, uye yakajairika peroneal nerve inomhanya mumusoro wemba. Naizvozvo, kupinda kwetsono kunofanirwa kuitwa anterior kuTibial Plateau, ie, tsono inofanira kupinda uye kubuda muganho weTibia uye anterior kumuganho weiyo fibla.
Padivi rizere, tsono inogona kuiswa kubva kumucheto wemucheto weiyo fibulu uye wakapfuura kubva parutivi rwe anteromodial kana kubva kudivi rezvinyorwa; Iyo medial yekupinda pfungwa inowanzo pamucheto wepamhepo yeTibial Plateau uye yayo anterior divi, kudzivirira waya yekushushikana kuti ipfuure nepakati pehuswa.
Izvo zvataurwa mumabhuku okupinda kweiyo nguva yekunetseka inofanirwa kunge iri gumi nematanhatu kubva kuyaya yekunyepedzera yekunetseka yekubatanidza capsule uye ichikonzeresa arthritis.
Isa waya yekutanga yekunetseka:
Pini yemiorivhi inogona kushandiswa, iyo inopfuura nepini yekuchengetedza pini pamurwere, ichisiya musoro wemuorivhi kunze kwenzvimbo yekuchengetedza.
Mubatsiri anochengetedza chinzvimbo cheiyo mhete inobata kuitira kuti yave kufanana kune iyo yekunyepedzera nzvimbo.
Dhizaini yemiorivhi pini kuburikidza neyekupfava tishu uye kuburikidza neTibial Plateau, kutora hanya kudzora kutungamira kwayo kuti uone kuti iyo yekupinda uye yekubuda mapoinzi ari mune imwe ndege.
Mushure mekubuda ganda kubva kune contralateral ride rinoramba kubuda tsono kusvikira iyo memuorivhi afare pini yekuchengetedza.
Isa iyo waya clamp inotsvedza pane iyo Contralateral Side uye Pass iyo Olive Pin kuburikidza neWire Clamp Slide.
Chenjera kuti uchengetedze iyo tibial clateau pakati peiyo mhete pane nguva dzese panguva yekushanda.
Kuburikidza neiyo gwara, wechipiri wakaipa waya inoiswa kufanana, zvakare kuburikidza nedivi rakatarisana neye waya clamp slide.
Isa iyo yechitatu tension waya, inofanira kunge iri mune yakachengeteka kusvika kune yakachengeteka neyakagadziriswa yedambudziko rewire kuyambuka mukona
Preload yaishandiswa kune tension waya: Pfupi zvakakwana, kupfuudza tension waya kuburikidza neyekubata, shandisa iyo waya ye waya inosvika 1200n kune iyo wire waya, wobva washandisa iyo l-blable kukiya.
Kunyorera nzira imwechete yekugadzirisa kunze kwebvi sezvakanyorwa sezvakamboita screator yekunze, uye kuibatanidza neyekunze yekunze uye tibier stem mune yakajairika mechancal axis uye kutenderera kusati kwatanga kupedzisa kugadziriswa.
Kana kumwe kugadzikana kunodiwa, iyo mhete inokwanisa kusungirirwa kune yekunze yekugadzirisa ruoko neyakabatanidza tsvimbo.
Kuvhara Incision
Iyo yekuvhiya yekuvhiya yakavharwa denderedzwa ne layer.
Turakiti retsvanyiriri rinodzivirirwa nedoro gauze mapepa ekuputira.
Postoperative Management
Fascial syndrome uye nerve kukuvara
Mukati
Nyatso tarisa tsinga dzevarwo dzesumbu rakakanganisika. Yakaremara ropa yekupa kana kufambira mberi kurasikirwa kwemutsipa kunofanirwa kuve kwakadzoserwa nenzira kwayo kunge mamiriro emergency.
Inoshanda kugadzirisa
Inoshanda maekisesaizi inogona kutangwa pazuva rekutanga rekushanda kana pasina imwe saiti kukuvara kana comorbidities. Semuenzaniso, isometric contraction ye quadriceps uye inopfuura kufamba kwebvi uye kushandira kufamba kwegwenzi.
Chinangwa chemabasa ekutanga uye anongoerekana zvawana huwandu hwekufamba kwebvu hwebvu hwebvu sepfupi kwenguva pfupi mushure mekuvhiyiwa kwebvi remubvu zvakanyanya sezvinobvira mune 4 ~ mavhiki matanhatu. Kazhinji, kuvhiya kunokwanisa kuzadzisa chinangwa chebvi kugadzikana kwekuvakazve, kubvumira mangwanani
chiitiko. Kana mashandiro ekushanda anononoka nekuda kwekumirira kuzvimba kuti upedze, izvi hazvizoite kuti zvinyore kupora.
Kurema-kuremerwa: Kutanga kuremerwa-kutakura hakuwanzo kutsigirwa, asi anosvika gumi kusvika pamavhiki gumi nemaviri kana gare gare kune yakagadzirwa intra-articular fractures.
Kuporesa kwonda: Kunyatsotarisa kupora kwonda mukati memavhiki maviri mushure mekuvhiyiwa. Kana kutapukirwa kwakawanda kana kunonoka kupora kunoitika, kupindira kwekuvhiya kunofanira kuitwa nekukurumidza sezvinobvira.
Kutumira Nguva: Aug-16-2024
