Iyo suprapetallar nzira yakagadziridzwa nzira yekuvhiya yekuvhiya yeTibial Intrameduutery Chikamambo muiyo hafu-yakawedzera ibvi nzvimbo. Pane zvakawanda zvakanakira, asiwo zvakashata, kuita zvipikiri zvemukati zveTibia kuburikidza neSuprapetallar Kusvikira muHallgux Valgus chinzvimbo chinzvimbo. Vamwe vanachiremba vanojaira vachishandisa iyo SPN kurapa miti yese tibial fractures kunze kwekuwedzera-mhizha-fungidziro yeiyo proximal 1/3 yeTibia.
Zviratidzo zveSpn nde:
1. Kubika kana segmistal fractures ye tibial stem. 2;
2. Fractures yeiyo distal tibial metaphysis;
3
4
5. Kuvhiringidza kwechiTibi mumarara ane nguva yakareba (iyo proximal kupera kweTibia kazhinji kwakaoma kuona pasi peFluoroscopy kana kureba kweTibia kufuro kweiyo trehorcop inogona kupfuura iyo fluoroscopy.
Kubatsira kweiyo hafu-yakawedzera ibvi kuTibial intramedullary zvipikiri zvechisimba zvechirongwa cheMid-tibial diephysis Iyi nzira inobvumira kutsigirwa kwakanyanya kwehurefu hwakazara hweTibia uye nyore Sagittal kuderedzwa kwejira pasina kudiwa kwekunyengera (mifananidzo 1, 2). Izvi zvinobvisa kudiwa kwemubatsiri akadzidziswa kubatsira neiyo intramellary zvipikiri zvechipikiri.
Mufananidzo 1: Koshesa chinzvimbo cheIntramedudullary zvipikiri zvechisimba zvehunyanzvi hwekushandisa Nekudaro, chinzvimbo ichi chinogona kuwedzeredza kusarongeka kwekubhururuka kwekuvhiringidza uye kunoda mamwe maitiro ekudzikisira ekudzikisira kudzikisira.
Mufananidzo 2: Mukupesana, iyo yakawedzera mabvi nzvimbo pane foam ramp fialitates brack block crack alignment uye inotevera manipulation.
Kuvhiya Maitiro
Tafura / chinzvimbo murwere ari mu supine chinzvimbo pane mubhedha wefuma. Rudzi rwekuzadzikisa runogona kuitwa, asi haruna madikanwa. Nekudaro, zvakanyanya kupwanyika kurongedza mibhedha kana maFluoroscopic mibhedha haina kukurudzirwa sezvo vasina kukodzera kuti suprapatellar kusvika tibial intramealary mbambo.
Padding iyo ipstilateral chiuno chinobatsira kuchengetedza iyo yakadzika mhedziso munzvimbo inotenderera kunze kwenzvimbo. A sterile foam ramp inobva yasimudza ruoko rwakakanganisika pamusoro pesimba rekudzivirira kwePritalateral Fluoroscopy. Iyo yakaringana ibvi yekubhururuka kona ichiri kunetswa, neBeltran et al. Kupa zano 10 ° iyo ibvi yekubhururuka uye Kubiak ichiratidza makumi matatu ° ibvi yekubhururuka. Vakawanda nyanzvi vanobvuma kuti mabvi lexion angles mukati meaya marangi anogamuchirwa.
Nekudaro, kumabvazuva et al. Wakawana kuti sezvo ibvi rinobhururuka rakapfuura zvishoma nezvishoma kubva pagumi ° kusvika makumi mashanu Naizvozvo, mabvi makuru anokona angle inobatsira pakusarudza iyo chaiyo intramedy intramedullary chipikiri chekupinda chinzvimbo uye kururamisa maAgular deformities mune imwe sagittal.
Fluoroscopy
Iyo C-ARM Machine inofanira kuiswa kune rimwe divi retafura kubva kune yakakanganisika makumbo, uye kana chiremba wekuvhiya akamira padivi pebvi rakakanganisika, mutambi anofanirwa kunge ari mumusoro weC-ruoko muchina uye padyo ne. Izvi zvinobvumira chiremba anovhiya uye radiologist kuti aone nyore nyore kutarisa, kunze kwekunge chipikiri chakabatanidzwa chichiiswa. Kunyangwe zvisiri zvekumanikidza, vanyori vanokurudzira kuti C-ruoko ngakufambirwe kune rumwe rutivi uye chiremba anovhiya kune rimwe divi rakatarisana kana iyo medial yekubatanidza screw ndeyekutyaira. Nenzira imwe chete, muchina weC-ruoko unofanirwa kuiswa pamusuwo wakakanganisika apo chiremba anovhiya anoita maitiro ari pane contralateral side (Mufananidzo 3). Iyi ndiyo nzira inowanzo shandiswa nevanyori nekuti inodzivirira kudiwa kweiyo chiremba anovhiya kuti asageza kubva kune imwe divi rekodhi paunotyaira iyo distal yekuvhara mbambo.
Mufananidzo 3: Chiremba wekuvhiya anomira pane rimwe divi reTibia rakakanganisika kuitira kuti mboor yekubatanidza screw inogona kutungamirwa nyore. Iko kuratidzwa kwacho kwacho kwacho kwakawanikwa kwakatarisana neanovhiya, kumusoro kweC-ruoko.
Zvese anteroposter uye medial-inotevera fluoroscopic maonero anowanikwa pasina kufambisa iyo yakakanganisika. Izvi zvinodzivirira kutamiswa kwenzvimbo yakatsemuka iyo yakagadzirwazve isati yaputsika isati yazara. Pamusoro pezvo, mifananidzo yehurefu hwakazara yeTibia inogona kuwanikwa pasina kurongedza c-ruoko nenzira yakatsanangurwa pamusoro apa.
Ganda incision zvese zviri zviviri zvisingagumi zviitiko zvakakodzera. Iyo percutaneous suprapatellar nzira yekunamatira zvipikiri zvakavakirwa pane kushandiswa kwe3-cm incision yekufambisa mbambo. Zvizhinji zvezviitiko izvi zvekuvhiya mitezo Mufananidzo 4 unoratidza zvakasiyana zviitiko.
Mufananidzo 4: Mufananidzo weKuvhiya Kwekuvhiya Kwekuvhiya Kwayedza.1- Suprapatellar Transpatellar Stident; 2- parapatellar nzira yeLighent; 3- Medial Limited Incision ParapateLlar Ligment Tolay; 4- Mialial kwenguva refu Incision Parapatellar Ligament Tolay; 5- gare gare parapatellar ligament nzira. Iko kuratidzwa kwakadzika kweiyo parapatellar nzira yekunyora inogona kunge iri kuburikidza nejoini kana kunze kweiyo Joint Bursa.
Kuratidzwa kwakadzika
Iyo percutaneusture suprapatellar maitiro anoitwa nekureba kupatsanurana quadriceps Tendon kusvikira iyo gwara racho rinogona kugadzirisa ndima dzezviridzwa senge zvipikiri zvemukati. Iyo Parapatellar Ligment Stackent, iyo inopfuura pedyo neiyo quadriceps mhasuru, inogona zvakare kuratidzwa zvakare yeTibial intramedenllary zvipikiri zvechipikiri. A blunt trocar tsono uye cannula anopfuura nepadyofelaferal Joint, maitiro anonyanya kutungamira anterior-yepamusoro yekupinda nzvimbo yeTibial intramedullary chipikiri kuburikidza neyechikadzi trocar. Kamwe chete iyo trocar yakamiswa nenzira kwayo, inofanira kuchengetedzwa munzvimbo yekudzivirira kukuvara kune iyo articular cartilage yebvi.
Iyo yakakura inoshandisika incision nzira inogona kushandiswa mukubatana ne hyperexteension parapatellar ganda incision, ine chero misial kana yakazotevera nzira. Kunyangwe vamwe vanovhiya vasingachengeti baundi rakapinda, Kubiak et al. tenda kuti bursa inofanirwa kuve yakachengetedzwa nzvimbo dzakasimba uye dzakawedzera-dzekuzvinyora dzinofanira kuve dzakaratidzwa zvakakwana. Zvinonzwisisika, izvi zvinopa dziviriro yakanakisa yebvi rakabatanidzwa uye rinodzivirira kukuvara kwebvi kutapukirwa.
Maitiro anotsanangurwa pamusoro apa anosanganisirawo hemi-dislocation yePatella, iyo inoderedza kudzvinyirira kwekunyepedzera pane iyo yekunyepedzera nzvimbo kune imwe nhanho. Kana zvikaoma kuita patellofural yekuongorora nekadiki kadiki uye yakanyanya kuwanda ibvi yekuwedzera Iyo Median inoburitsa incision, kune rumwe rutivi, inodzivirira kukuvadza kune iyo inotsigira ligaments, asi zvakaoma kuita zvinobudirira kupfugama kukuvara kugadzirisa.
Iyo SPN STONGLE yekupinda Pfungwa yakafanana neiyo yeiyo Infrapadellar Stop. Anterior uye akazotevera fluoroscopy panguva yekusagadzikana yekuisa anochengetedza kuti tsono yekuisa pfungwa ndeyechokwadi. Iyo yekuvhiya inofanirwa kuve nechokwadi chekuti tsono inotungamira haina kufambiswa zvakanyanya kumberi mune iyo proximal tibia. Kana ichitungamirwa zvakanyanya kumberi, inofanira kuiswa kuiswa nerubatsiro rwechipikiri chinovhara pasi peposeri coronal fluoroscopy. Mukuwedzera, kumabvazuva et al. Tenda kuti ichirovera iyo yekupinda pini mune yakadudzirwa yakarongedzwa ibvi
Kuderedza zvishandiso
Zvishandiso zvinoshanda zvekudzikiswa zvinosanganisira nzvimbo yekudzikisa nzvimbo yehukuru hwakasiyana, zvishandiso zvechikadzi, zvekunze zvigadzirwa, uye zvigadziko zvemukati zvekugadzirisa zvidimbu zvidiki zvidiki zvine hungwaru hwekora. Kuvhara zvipikiri zvinogona zvakare kushandiswa kune iyo yakataurwa pamusoro pekudzikisa maitiro. Kuderedza Hun Huns inoshandiswa kururamisa Sagittal anginglation uye kuendesa kudzikisira deformities.
Implants
Vazhinji vagadziri veOrthopedic vemukati vatambi vakagadzira vanoshandiswa vanoshandisa masisitimu kutungamira kuiswa kwechiitiko cheTibial intramealry zvipikiri. Inosanganisira ruoko rwakatambanudzwa ruoko, kutungamirirwa kwekutungamirirwa kwekureba kwekuyera mudziyo, uye medullary Explary Expander. Zvakakosha kuti trocar uye blunt trocar pini inochengetedza iyo intrameduutery chipikiri kuwana zvakanaka. Chiremba anovhiya anofanira kudzoreredza chinzvimbo cheCannula kuti kukuvara kune iyo PatelloFemaral Joint kana Pereiarticular Zvimiro nekuda kwekusvika padhuze neyekutyaira kwete.
Kuvhara zviyero
Chiremba anovhiya anofanira kuve nechokwadi chekuti nhamba yakakwana yekuvhara zviyero zvinoiswa kuchengetedza kuderedza kunogutsa. Kugadziriswa kwezvidimbu zvidiki zvinovhiringidza Iyo suprapatellar kusvika kune tibial intramedudullary zvipikiri zvechipikiri zvakafanana neiyo Infrapatellar Kusvikira Pfungwa dzeScrew Kutyaira maitiro. Kuvhara zviyero zvakanyatso kufambiswa pasi peFluoroscopy.
Kuvharwa kwevarungu
Kuyamwa neakakodzera kunze kwekunze kwekunze panguva yekudzika kunobvisa zvidimbu zvepfupa zvemahara. Maronda ese anoda kunyatso kudiridzwa, kunyanya iyo ibvi yekuvhiya nzvimbo. Iyo quadriceps tendon kana ligament layer uye iyo suture panzvimbo yeiyo kuputika inobva yavharwa, inoteverwa nekuvhara kweiyo dermis uye ganda.
Kubviswa kwechipikiri chemukati
Kunyangwe iyo tibial intrameduutery nail inotungamirirwa kuburikidza ne suprapetallar nzira inogona kubviswa kuburikidza nenzira dzakasiyana dzekuvhiya dzinoramba dzichinetseka. Maitiro anowanzozivikanwa ndeyekuti iyo transarticular suprapatellar maitiro ekubvunzurudzwa kwepamhepo. Iyi nzira inofumura chipikiri nekukwevera kuburikidza ne suprapatellar intramedullary zvipikiri zvechikiri kushandisa ma 5.5 mm Hollow Drill. Chishandiso chombo chinobvisa chinobva chanunurwa kuburikidza nechiteshi, asi iyi maneja anogona kuoma. Iyo parapatellar uye infantapatellar nzira inzira imwe nzira dzekubvisa zvipikiri zvemukati.
Njodzi panjodzi dzekuvhiya dzekutsigira kusvika kuTibial Intrameduutery Nail Carnilage kune Patella uye Chekurapa Kwemamwe Zvimiro zveMista Nekudaro, pane kushayikwa kwekuenderana kiriniki kesi mishumo. Varwere vane Chondromalacia ichave yakawanda yekunyora kumanikidza kukurudzira cartilage kukuvara. Kukuvadza kwekurapa kune patellar uye echikadzi kuchema kumeso kwechimiro chikuru kune vanachiremba vanovhiya vachishandisa iyi nzira yekuvhiya, kunyanya nzira yekuvhiya.
Kusvika parizvino, hapana chiratidzo chekiriniki chekiriniki pane zvakanakira nezvakanaka nezvakaipa zveiyo hafu-yekuwedzera tibial intramedullary zvipikiri zvechipikiri.
Kutumira Nguva: Oct-23-2023
