Amathiphu angu-5 Okulungisa I-Intramedullary Nail of Distal Tibial Fractures

Imigqa emibili yenkondlo "ukusika futhi usethe ukulungiswa kwangaphakathi, isethi evaliwe ye-intramedullary nailing" ibonisa kahle isimo sengqondo sabahlinzeki bamathambo maqondana nokwelashwa kwe-distal tibia fractures.Kuze kube namuhla, kusengumbono wokuthi izikulufi zamapuleti noma izinzipho ze-intramedullary zingcono.Kungakhathaliseki ukuthi yikuphi okungcono kakhulu emehlweni kaNkulunkulu, namuhla sizokwenza uhlolojikelele lwezeluleko zokuhlinza zokubethelwa kwe-intramedullary of distal tibial fractures.

Isethi yangaphambi kokusebenza "yesondo eliyisipele".

Nakuba amalungiselelo avamile ngaphambi kokuhlinzwa kungenasidingo, kunconywa ukuba kube nesethi eyisipele yezikulufu namapuleti uma kwenzeka izimo ezingalindelekile (isb., ulayini wokuphuka ofihlekile ovimbela ukubekwa kwezikulufu zokukhiya, noma iphutha lomuntu elenza ukuphuka kube kubi futhi livimbele ukungakwazi ukuhamba, njll. ) okungase kuvele ekusetshenzisweni kwezipikili ze-intramedullary.

Izisekelo ezi-4 zokubeka kabusha ngempumelelo

Ngenxa ye-oblique anatomy ye-distal tibial metaphysis, ukudonsa okulula kungase kungabi njalo ekunciphiseni okuphumelelayo.Amaphuzu alandelayo azosiza ekuthuthukiseni izinga lempumelelo lokubeka kabusha:

1. thatha ama-orthopantomograms ngaphambi kokuhlinzwa noma kwe-intraoperative yesitho esinempilo ukuze uqhathanise futhi unqume izinga lokunciphisa ukuphuka ohlangothini oluthintekile.

2.sebenzisa indawo yedolo eguquguqukayo ukuze kube lula ukubekwa kwezinzipho kanye ne-fluoroscopy

3.sebenzisa i-retractor ukugcina isitho sisendaweni nobude

4.Beka izikulufu ze-Schanz ku-distal ne-proximal tibia ukuze usize ekunciphiseni ukuphuka.

7 Imininingwane Yokuncishiswa Okusizwayo kanye Nokunganyakazi

1. Beka iphinikhodi ngendlela efanele ku-distal tibia ngokusebenzisa umsizi ofanele noma ngokugoba kusengaphambili ichopho lephinikhodi ngaphambi kokuyibeka.

2. sebenzisa i-forceps evuselelayo enesihloko sesikhumba ukuze ubeke izinzipho ze-intramedullary ekuqhekekeni okuvunguzayo kanye ne-oblique (Umfanekiso 1)

3. sebenzisa ipuleti eliqinile eline-monocortical fixation (i-tabular noma ipuleti lokucindezela) ekuncishisweni okuvulekile ukuze ugcine ukuncipha kuze kube yilapho kufakwa isipikili se-intramedullary.

4. ukufinyezwa kweshaneli yezinzipho ze-intramedullary kusetshenziswa izikulufu zebhlokhi ukuze kulungiswe i-angulation nesiteshi ukuze kuthuthukiswe impumelelo yokubeka izinzipho ku-intramedullary (Umfanekiso 2)

5. kuye ngokuthi hlobo luni lokuphuka, nquma ukuthi usebenzise izikulufu zokulungisa kanye nokulungisa okwesikhashana okuvinjiwe ngamaphinikhodi ka-Schnee noma e-Kirschner.

6. vimbela ukuphuka okusha lapho usebenzisa izikulufo zokuvimba ezigulini ezine-osteoporotic

7. lungisa i-fibula kuqala bese i-tibia esimweni sokuphuka kwe-fibula ehlangene ukuze kube lula ukuhlelwa kabusha kwe-tibial

Umfanekiso 1 I-Percutaneous Weber clamp ebeka kabusha ukubukwa okutshekile (Amanani A no-B) aphakamisa ukuphuka okulula kwe-distal tibia okuholela ekumiseni kabusha kwe-fluoroscopic percutaneous ehlasela kancane enekhala elibukhali elidala umonakalo omncane esicutshini esithambile.

Umfanekiso wesi-2 Ukusetshenziswa kwezikulufu ezivinjiwe Umfanekiso A ubonisa ukuphuka okwenziwe kakhulu kwe-distal tibial metaphysis elandelwa ukukhubazeka kwe-angulation yangemuva, nokukhubazeka okusele kokuguquguquka ngemva kokulungiswa kwe-fibular naphezu kokulungiswa kokukhubazeka kwe-sagittal posterior angulation (Fig. C) (Fig. B), ngesikulufu esisodwa sokuvimbela esibekwe ngemuva kanye nesisodwa ngaseceleni ekugcineni kwe-distal yokuphuka (Amakhiwane. B no-C), kanye nokunwetshwa kwe-medullary ngemva kokubeka izikhonkwane zomhlahlandlela ukuze kuthuthukiswe ukulungisa ukukhubazeka kwe-coronal (Fig. D), kuyilapho kugcinwa i-sagittal. ukulingana (E)
Amaphoyinti angu-6 wokulungiswa kwe-intramedullary

1. Uma ithambo elikude le-fracture liyithambo ngokwanele, isipikili se-intramedullary singalungiswa ngokufaka izikulufo ezi-4 kuma-engeli amaningi (ukuthuthukisa ukuzinza kwama-ax amaningi), ukuze kuthuthukiswe ukuqina kwesakhiwo.
2. Sebenzisa izipikili ze-intramedullary ezivumela izikulufu ezifakiwe ukuthi zidlule futhi zakhe isakhiwo sokukhiya esinokuqina kwe-angular.
3. Sebenzisa izikulufu eziwugqinsi, izikulufu eziningi, nezindiza eziningi zokubeka isikulufu ukuze usabalalise izikulufu phakathi kwamaphethelo akude kanye namaphethelo aseduze okuphuka ukuze uqinise umphumela wokulungisa wezipikili ze-intramedullary.
4. Uma isikhonkwane se-intramedullary sibekwe kude kakhulu ukuze i-pre-bent guidewire ivimbele ukunwetshwa kwe-distal tibial, khona-ke i-non-pre-bent guidewire noma i-distal non-expansion ingasetshenziswa.
5. Gcina isikhonkwane esivimbileyo nepuleti kuze kube yilapho ukuphuka kwehle, ngaphandle uma uzipho oluvimbayo luvimbela uzipho lwe-intramedullary ekusakazeni ithambo noma ipuleti le-unicortical lilimaza izicubu ezithambile.
6. Uma izinzipho nezikulufi ze-intramedullary zinganikezi ukuncishiswa nokulungiswa okwanele, ipuleti le-percutaneous noma isikulufu singase kwengezwe ukuze kwandiswe ukuqina kwezinzipho ze-intramedullary.

Izikhumbuzi

Ngaphezu kwe-1/3 ye-distal tibia fractures ihilela ukujoyina.Ikakhulukazi, ukuphuka kwe-distal tibial stem, i-spiral tibial fractures, noma i-spiral fibular fractures ehambisanayo kufanele kuphenywe ngenxa ye-intra-articular fractures.Uma kunjalo, ukuphuka kwe-intra-articular kudinga ukulawulwa ngokuhlukana ngaphambi kokubekwa kwesipikili se-intramedullary.