Preoperative kugadzirira uye chinzvimbo sezvakatsanangurwa kare kune transarticular yekunze furemu fixation.
Intra-articular fracture repositioning uye kugadzirisa:
Yakaganhurirwa incisional kuderedza uye kugadzirisa kunoshandiswa. Kutyoka kweiyo yakaderera articular surface inogona kuonekwa zvakananga kuburikidza nediki anteromedial uye anterolateral incision uye lateral incision yejojo capsule pasi pe meniscus.
Kudhonza kwenhengo yakakanganisika uye kushandiswa kwemarunda kutwasanudza zvidimbu zvakakura zvemabhonzo, uye kudzvanya kwepakati kunogona kugadzikiswa zvakare nekuchera nekudzura.
Chenjerera kudzoreredza hupamhi hwetibial plateau, uye kana paine chirema chepfupa pasi peiyo articular surface, ita pfupa grafting kuti utsigire articular surface mushure mekutsvaga kugadzirisa zvakare articular surface.
Nyatsoteerera kureba kwepakati uye lateral mapuratifomu, kuitira kuti hapana articular pamusoro nhanho.
Kugadzirisa kwenguva pfupi nereset clamp kana Kirschner pin inoshandiswa kuchengetedza reset.
Kuiswa kwehollow screws, screws inofanirwa kuenderana neiyo articular surface uye iri mu subchondral bone, kuitira kuwedzera simba rekugadzirisa. Intraoperative X-ray fluoroscopy inofanira kuitwa kuti itarise screws uye usambotyaira masiruu mujoinhi.
Epiphyseal fracture repositioning:
Kudhonza kunodzosera kureba uye mechanical axis yenhengo yakabatwa.
Kuchengetedza kunotorwa kugadzirisa kutenderera kutenderera kwegumbo rakakanganisika nekupuruzira iyo tibial tuberosity uye kuitungamira pakati pekutanga neyechipiri zvigunwe.
Proximal Ring Kuiswa
Range yenzvimbo dzakachengeteka dzetibial plateau tension wire kuiswa:
Iyo popliteal artery, popliteal vein uye tibial nerve inomhanya kumashure kune tibia, uye iyo inowanzo peroneal nerve inomhanya kumashure kune fibular musoro. Nokudaro, kupinda nekubuda kwetsono kunofanira kuitwa mberi kune tibial plateau, kureva kuti, tsono inofanira kupinda uye kubuda mutsono yesimbi yepamberi kusvika kumuganhu wepakati wetibia uye mberi kusvika kumuganhu wepamberi wefibula.
Padivi reparutivi, tsono inogona kuiswa kubva kumucheto wepamberi wefibula uye yakapfuura kubva kune anteromedial side kana kubva kudivi remukati; iyo yepakati pekupinda poindi kazhinji iri pamucheto wepakati wetibial plateau uye yayo anterior side, kudzivirira tension waya kuti ipfuure nepakati pemasumbu akawanda.
Izvo zvakataurwa mumabhuku kuti nzvimbo yekupinda yetambo yekumanikidza inofanira kunge iine 14 mm kubva kune articular surface kudzivirira tambo yekumanikidza kuti ipinde mujojo capsule uye inokonzera hutachiona hwearthritis.
Isa yekutanga tension waya:
Pini yemuorivhi inogona kushandiswa, iyo inopfuudzwa nepapini yekuchengetedza iri pachibatiso chemhete, ichisiya musoro wemuorivhi kunze kwepini yekuchengetedza.
Mubatsiri anochengetedza nzvimbo yemubati wemhete kuitira kuti ienderane kune articular surface.
Dhonza pini yemuorivhi kuburikidza nemucheka wakapfava uye kuburikidza netibial plateau, uchichenjerera kudzora kutungamira kwayo kuve nechokwadi chekuti yekupinda nekubuda nayo iri mundege imwechete.
Mushure mekubuda ganda kubva kudivi re contralateral ramba uchibuda tsono kusvika musoro wemuorivhi wabata pini yekuchengetedza.
Isa wire clamp slide padivi re contralateral wopfuudza pini yemuorivhi kuburikidza newaya yekusungirira inotsvedza.
Chenjerera kuchengetedza tibial plateau iri pakati pemhete yemhete nguva dzese panguva yekushanda.
Kuburikidza negwara, kechipiri tension waya inoiswa muparallel, zvakare kuburikidza nedivi rakapesana newaya clamp slide.
Isai yechitatu tension waya, inofanira kunge iri munzvimbo yakachengeteka sezvinobvira neyakapfuura seti yekumanikidza waya muchinjikwa kupinda mukona huru, kazhinji seti mbiri dzesimbi waya inogona kuva kona ye50 ° ~ 70 °.
Preload yakaiswa kune tension wire: Yakazara tension the tightener, pfuudza muromo wetambo yetension kuburikidza neinosunga, dzvanya mubato, isa preload inokwana 1200N kune tension waya, wobva waisa L-mubato kiyi.
Uchishandisa nzira imwechete yekugadziriswa kwekunze pamabvi sezvakatsanangurwa kare, isa angangoita maviri Schanz screws mu distal tibia, batanidza imwe-yakashongedzerwa yekunze fixator, uye ichibatanidza kune inotenderera yekunze fixator, uye simbisazve kuti metaphysis uye tibial stem. vari mune yakajairika mechanical axis uye kutenderera kurongeka usati wapedza kugadzirisa.
Kana kumwe kugadzikana kuchidiwa, chindori chemhete chinogona kusungirirwa kune ruoko rwekunze rwekugadzirisa netsvimbo yekubatanidza.
Kuvhara kuchekwa
Iyo yekuvhiya incision yakavharwa layer by layer.
Iyo tsono turakiti inodzivirirwa nedoro gauze wraps.
Postoperative management
Fascial syndrome uye kukuvara kwetsinga
Mukati me48h mushure mekukuvara, kutarisirwa kunofanira kutorwa kutarisa uye kuona kuvapo kwefascial compartment syndrome.
Nyatsocherechedza tsinga dzevascular dzenhengo yakabatwa. Kusakanganiswa kweropa kana kurasikirwa kwetsinga kunofambira mberi kunofanirwa kutarisirwa zvakakodzera semamiriro ekukurumidzira.
Kushanda kugadzirisa
Maekisesaizi anoshanda anogona kutangwa pazuva rekutanga postoperative kana pasina kumwe kukuvara kwesaiti kana comorbidities. Semuenzaniso, isometric contraction ye quadriceps uye passive kufamba kwemabvi uye kushingaira kufamba kwechidzitiro.
Chinangwa chemabasa ekutanga ekushanda uye asingaiti ndezvekuwana huwandu hwakawanda hwekufamba kwemabvi akabatanidzwa kwenguva pfupi sezvinobvira mushure mekuvhiyiwa, kureva, kuwana huwandu hwakazara hwekufamba kwemabvi akabatanidzwa zvakanyanya sezvinobvira mu4 ~. 6 mavhiki. Kazhinji, kuvhiyiwa kunokwanisa kuzadzisa chinangwa chekugadzirisazve kugadzikana kwemabvi, kubvumira kare
chiitiko. Kana maekisesaizi ekushanda akanonoka nekuda kwekumirira kuzvimba kuderera, izvi hazvizokodzeri kupora kwekushanda.
Kutakura uremu: Kutakura uremu kwekutanga kazhinji hakukurudzirwe, asi angangoita 10 kusvika mavhiki gumi nemaviri kana gare gare kune yakagadzirirwa intra-articular fractures.
Kupora ronda: Nyatsocherechedza kupora kweronda mukati memavhiki maviri mushure mekuvhiyiwa. Kana utachiona hwemaronda kana kunonoka kupora kunoitika, kupindira kwekuvhiya kunofanira kuitwa nokukurumidza sezvinobvira.
Nguva yekutumira: Aug-16-2024
