Amathiphu ama-5 okulungiswa kwezipikili ze-Intramedullary ze-Distal Tibial Fractures

Imigqa emibili yenkondlo ethi “cut and set internal fixation, closed set intramedullary nailing” ibonakalisa kahle isimo sengqondo sodokotela abahlinzayo bamathambo ngokwelashwa kokuphuka kwe-tibia ekude. Kuze kube namuhla, kuseyindaba yombono ukuthi izikulufo zepuleti noma izinzipho ze-intramedullary zingcono yini. Kungakhathaliseki ukuthi yikuphi okungcono kakhulu emehlweni kaNkulunkulu, namuhla sizokwenza umbono ophelele wamathiphu okuhlinzwa okuphambuka kwe-tibial ekude ngaphakathi kwe-medullary.

Isethi "yethayi eliyisipele" ngaphambi kokuhlinzwa

Nakuba amalungiselelo avamile ngaphambi kokuhlinzwa engadingeki, kunconywa ukuthi kube nesethi eyengeziwe yezikulufo namapuleti uma kwenzeka izimo ezingalindelekile (isb., umugqa wokuphuka ofihliwe ovimbela ukufakwa kwezikulufo ezikhiyayo, noma iphutha lomuntu elenza ukuphuka kube kubi futhi kuvimbele ukungasebenzi, njll.) okungase kuvele ngokusebenzisa ukubethela ngaphakathi kwe-medullary.

Izisekelo ezine zokushintsha indawo ngempumelelo

Ngenxa yokwakheka kwe-oblique kwe-distal tibial metaphysis, ukubamba okulula kungase kungabi njalo okuholela ekunciphiseni okuphumelelayo. Amaphuzu alandelayo azosiza ekuthuthukiseni izinga lempumelelo lokushintsha indawo:

1. thatha i-orthopantomogram ngaphambi kokuhlinzwa noma ngaphambi kokuhlinzwa kwesitho esiphilile ukuze uqhathanise futhi unqume izinga lokuncipha kokuphuka ohlangothini oluthintekile.

2.Sebenzisa isikhundla sedolo esigoqekile kancane ukuze kube lula ukubeka izinzipho kanye ne-fluoroscopy

3.Sebenzisa i-retractor ukugcina umlenze usendaweni yawo futhi ubude bawo buqinile

4. Beka izikulufo ze-Schanz ku-tibia ekude neseduze ukuze usize ekunciphiseni ukuqhekeka.

Imininingwane engu-7 Yokunciphisa Okusizwayo Nokuvinjelwa Kokuhamba

1. Faka iphini yokuqondisa kahle ku-tibia ekude ngokusebenzisa idivayisi yokusiza efanele noma ngokugoba ingcipho yephini yokuqondisa ngaphambi kokubeka.

2. sebenzisa i-forceps yokuvuselela ubuso eneziqongo zesikhumba ukuze ubeke izinzipho zangaphakathi kwe-medullary eziqhekekeni ezijikelezayo nezigobile (Isithombe 1)

3. sebenzisa ipuleti eliqinile eline-monocortical fixation (ipuleti lethebula noma i-compression) ekuncipheni okuvulekile ukuze ugcine ukunciphisa kuze kube yilapho uzipho lwangaphakathi lufakwa

4. ukuncishiswa kwesiteshi sezinzipho sangaphakathi kwe-medullary kusetshenziswa izikulufo zamabhulokhi ukulungisa i-angulation kanye nesiteshi ukuze kuthuthukiswe impumelelo yokubekwa kwezinzipho zangaphakathi kwe-medullary (Isithombe 2)

5. kuye ngohlobo lokuphuka, nquma ukuthi uzosebenzisa yini izikulufo zokuqinisa kanye nokuqinisa okwesikhashana kokuvimba ngezikhonkwane zeSchnee noma zeKirschner.

6. vimbela ukuphuka okusha uma usebenzisa izikulufo ezivimbayo ezigulini ezine-osteoporosis

7. lungisa i-fibula kuqala bese kuba yi-tibia uma kwenzeka i-fibula ephukile ehlangene ukuze kube lula ukuphinda ubeke i-tibial endaweni yayo

Umfanekiso 1 Ukuhlelwa kabusha kwe-Percutaneous Weber clamp Ukubukwa kwe-Oblique (Izithombe A no-B) kusikisela ukuphuka kwe-tibia okulula okuvumelana nokuhlelwa kabusha kwe-clamp ebukhali enekhala elincane elihlaselayo elibangela umonakalo omncane ezicutshini ezithambile.

Isithombe 2 Ukusetshenziswa kwezikulufo ezivimbayo Isithombe A sibonisa ukuphuka okuncishisiwe kakhulu kwe-distal tibial metaphysis okulandelwa ukukhubazeka kwe-posterior angulation, kanye nokukhubazeka kwe-inversion okusele ngemva kokulungiswa kwe-fibular naphezu kokulungiswa kokukhubazeka kwe-posterior angulation ye-sagittal (Isithombe C) (Isithombe B), kanye nesikulufo esisodwa esivimbayo esibekwe ngemuva kanye nesinye esiseceleni ekugcineni kwe-distal yokuphuka (Izithombe B no-C), kanye nokwanda kwe-medullary ngemva kokubeka izikhonkwane zokuqondisa ukuze kulungiswe ukukhubazeka kwe-coronal (Isithombe D), ngenkathi kugcinwa ukulingana kwe-sagittal (E)
Amaphuzu ayi-6 okulungiswa kwe-intramedullary

1. Uma ithambo elikude lokuphuka linamathambo anele, uzipho lwe-intramedullary lungalungiswa ngokufaka izikulufo ezine ngama-engeli amaningi (ukuthuthukisa ukuzinza kwama-axes amaningi), ukuze kuthuthukiswe ukuqina kwesakhiwo.
2. Sebenzisa izipikili zangaphakathi kwe-medullary ezivumela izikulufo ezifakiwe ukuthi zidlule futhi zakhe isakhiwo sokukhiya esinokuqina kwe-angular.
3. Sebenzisa izikulufo ezijiyile, izikulufo eziningi, kanye nezindawo eziningi zokubeka izikulufo ukuze usabalalise izikulufo phakathi kwemikhawulo ekude neseduze yokuphuka ukuze uqinise umphumela wokuqina kwezinzipho zangaphakathi.
4. Uma uzipho lwe-intramedullary lubekwe kude kakhulu ukuze ucingo lokuqondisa olugobile ngaphambili luvimbele ukwanda kwe-tibial ekude, khona-ke ucingo lokuqondisa olungagobile ngaphambili noma ucingo olugobile kude lungasetshenziswa.
5. Gcina uzipho oluvimbayo kanye nepuleti kuze kube yilapho ukuphuka kunciphile, ngaphandle kokuthi uzipho oluvimbayo luvimbela uzipho lwangaphakathi kwe-medullary ekusakazeni ithambo noma ipuleti le-unicortical lonakalisa izicubu ezithambile.
6. Uma izinzipho nezikulufo ze-intramedullary zinganikezi ukunciphisa nokuqinisa okwanele, ipuleti noma isikulufo esingangenwa nge-percutaneous singangezwa ukuze kwandiswe ukuzinza kwezinzipho ze-intramedullary.

Izikhumbuzi

Ngaphezu kwengxenye eyodwa kwezintathu yokuqhekeka kwe-tibia ekude kuhilela ilunga. Ikakhulukazi, ukuqhekeka kwesiqu se-tibial ekude, ukuqhekeka kwe-tibial ejikelezayo, noma ukuqhekeka kwe-spiral fibular okuhlobene kufanele kuhlolwe ukuze kutholakale ukuqhekeka kwe-intra-articular. Uma kunjalo, ukuqhekeka kwe-intra-articular kudinga ukuphathwa ngokwehlukana ngaphambi kokufakwa kwe-intramedullary nail.