Amathiphu angu-5 wokulungiswa kwezipikili kwe-intrametundary of distal tibial fractures

Imigqa emibili yenkondlo "isikiwe futhi isetha ukulungiswa kwangaphakathi, ukuvalwa okuvaliwe kwe-intramenduvalling" kubonisa kahle isimo sodokotela abahlinza amathambo babheke ekwelapheni i-dibia dibia evuthayo. Kuze kube namuhla, kuseyindaba yombono wokuthi ngabe izikulufu zeplate noma izipikili zomculo zingcono. Kungakhathaleki ukuthi yikuphi okungcono kakhulu emehlweni kaNkulunkulu, namhlanje sizokwenza ukubukwa kwamathiphu wokuhlinza wokufaka izikhala zomhlaba ezihlaselwayo ze-distal tibial fractures.

Isethi "Spare Tire" isethi

Ngenkathi amalungiselelo e-coustine prepoperative akudingekile, kunconywa ukuba abe nesethi esetshenzisiwe yezikulufo namapuleti uma kungenzeka izimo ezingalindelekile (isib. Ukuphupha komugqa okudala ukubekwa futhi kuvimbela ukufakwa kwezinsimbi futhi kuvimbela ukugcwala kwezikhala zomhlaba.

Izisekelo ezi-4 zokuphinda ziphendule

Ngenxa ye-anatomy ye-oblique ye-distal tibial metaphysis, ukugcwala okulula kungenzeka kungahlali kuphumela ekunciphiseni okuphumelelayo. Amaphuzu alandelayo azosiza ukuthuthukisa inani lempumelelo yokuphindisela:

1. Thatha ama-orthopantocogragraphs e-preeperative noma ama-operaperative operative of the Healthy Limb ukuze uqhathanise futhi unqume ubukhulu bokuncipha kohlangothi oluthintekile.

Sebenzisa isikhundla se-semi-eguquguqukile ukulungiselela ukubekwa kwezipikili ne-fluoroscopy

3.Sebenzisa i-retractor yokugcina umlenze endaweni nobude

I-4.Place Schanz screws ku-Tibia ye-Distal and Proximal Tibia ukusiza ekunciphiseni kwe-Fracture.

Imininingwane engu-7 yokunciphisa okusizwayo kanye nokungasebenzi kahle

1. Beka isikhonkwane se-PIN nge-Distal Tibia ngokusebenzisa idivaysi efanelekile yokusizwa noma ngokugoba i-Tip ye-PIN Yesiqondisi ngaphambi kokubekwa.

2. Sebenzisa ama-forcepacing asungula isikhumba afakwe isikhumba ukubeka izipikili ezi-intramedullary e-Spiral and Oblique Fractique (Umdwebo 1)

I-3. Sebenzisa ipuleti eliqinile ngokulungiswa kwe-monocortical (i-tablor noma ipuleti ye-compress) ekunciphiseni okuvulekile ukuze ulondoloze ukuncishiswa kuze kufakwe isipikili se-intramengract

I-4. Ukuncishiswa kwesiteshi esinama-nalidractivary Nail usebenzisa ama-block screw ukuze ulungise uMongen kanye nesiteshi ukuze uthuthukise impumelelo yokubekwa kwezipikili kwe-intrametundary (Umdwebo 2)

5

6. Vikela ukuqhekeka okusha lapho usebenzisa ama-screws avimba ezigulini ze-osteoporotic

7. Lungisa i-fibula kuqala bese iTibia esimweni sokuphazamiseka kwe-fibula ehlanganisiwe ukwenza lula ukubuyiselwa kwe-tibial

Umdwebo 1 we-percutaneous weber clamp resopositionitionitioning oblique ukubukwa (amanani

I-Fig. 2 Ukusetshenziswa kokuvinjwa kwesikulufa C), kanye ne-medullary dilatation ngemuva kokubeka izikhonkwane zemihlahlandlela ukuze uqhubeke nokulungisa isimo se-coronal (umdwebo d), ngenkathi ugcina ukulingana kwe-sagittal (e)
Amaphoyinti ayi-6 wokulungiswa kwe-intrametundary

1. Uma ithambo le-distal lokuqhekeka lakhiwe ngokwanele, i-intrametuundary nail ingalungiswa ngokufaka izikulufa ezi-4 kuma-engeli amaningi (ukwenza ngcono ukuqina kwama-axes amaningi), ukuze kuthuthukiswe ukuqina kwamazembatho eziningi)
2. Sebenzisa izinzipho ze-intramenduvact ezivumela izikulufo ezifakiwe ukuthi zidlule futhi zakha isakhiwo sokukhiya ngokuqina kwe-angular.
3. Sebenzisa izikulufo eziwugqinsi, izikulufa eziningi, nezindiza eziningi zokubekwa kwesikulufa ukusabalalisa izikulufo eziphakathi nendawo okude nokuphela kokuphela kokuqhekeka kokuqinisa ukukhanyiswa kwezipikili.
4. Uma i-intramerary nail ibekwa kude kakhulu ukuze umhlahlandlela wangaphambi kwe-bent uvimbela ukwanda kwe-tibial distal tibial, khona-ke umhlahlandlela ongaphambi kokungaphambi kokungaphambi kokungasebenzisi noma ukunwebeka kungasetshenziswa.
5. Gcina isipikili esivinjiwe nepuleti kuze kube yilapho ukuqhekeka kuncishisiwe, ngaphandle kokuthi izipikili ezivinjelwe zivimbela inkatho eyimfihlo ekusakazeni ithambo noma ipuleti le-UNICordical lilimaza izicubu ezithambile.
6. Uma izipikili ezihlekisayo nezikulufa azinikezi ukuncishiswa okwanele nokulungiswa, ipuleti elihlanzekile noma isikulufa lingangezwa ukukhulisa ukuqina kwezipikili ze-intramerary.

Izikhumbuzi

Ngaphezu kwe-1/3 ye-distal tibia fractures ebandakanya ukuhlangana. Ikakhulu, ukuqhekeka kwe-distal tibial stem, i-spiral tibial fractures, noma ukuqhekeka okuhambisanayo okuvulekile kwe-fibular fractures kufanele kuphenywe ngokuqhekeka kwe-intra-articular fractures. Uma kunjalo, ukwaphuka kwe-Intra-articular kudinga ukuphathwa ngokwahlukana ngaphambi kokubekwa kwezipikili zomhlaba.