Uma ukhetha uhlelo lokwelapha ukwaphuka kwe-tibial ekude, ukulungiswa kwangaphandle kungasetshenziswa njengokulungiswa kwesikhashana kwakwaphuka okunokulimala okukhulu kwezicubu ezithambile.
Izinkomba:
"Ukulawulwa komonakalo" ukumiswa kwesikhashana kokuqhekeka okunokulimala okukhulu kwezicubu ezithambile, njengokuqhekeka okuvulekile noma ukuqhekeka okuvaliwe okunokuvuvukala okukhulu kwezicubu ezithambile.
Ukwelashwa okuqondile kokuqhekeka okungcolile, okuthelelekile, noma ukuqhekeka okunokulimala okukhulu kwezicubu ezithambile.
Ei-xamine:
Isimo sezicubu ezithambile: ①Inxeba elivulekile; ②Ukudumba okukhulu kwezicubu ezithambile, ukuvuvukala kwezicubu ezithambile. Hlola isimo semithambo yegazi bese uqopha ngokucophelela.
Ukuthwebula izithombe: Ama-X-ray angaphambili nangaseceleni e-tibia, kanye nama-acupoints angaphambili, angaseceleni kanye nangaseqakaleni e-ankle joint. Uma kusolwa ukuthi kukhona ukuphuka kwangaphakathi kwe-articular, kufanele kwenziwe i-CT scan ye-tibial vault.
Ai-natomy:·
“Indawo ephephile” yokwakheka kokwakheka kokubekwa kwephini yokubopha yangaphandle ichazwe ngokwamazinga ahlukene esigaba esiphambeneyo.
I-metaphysis eseduze ye-tibia inikeza indawo yokuphepha enjenge-arc yangaphambili engu-220° lapho kungafakwa khona izikhonkwane zokubopha zangaphandle.
Ezinye izingxenye ze-tibia zinikeza indawo yokufaka inaliti ephephile ngaphambi kwe-antermedial ebangeni elingu-120°~140°.
Sinqubo yokwelapha
Indawo: Isiguli silala silele etafuleni lokuhlinzwa elibonakalayo le-X-ray, kanti ezinye izinto ezifana nomcamelo noma ishalofu zifakwa ngaphansi kwesitho esithintekile ukuze kusizwe ekugcineni indawo. Ukubeka iphedi ngaphansi kwesinqe esingezansi kuzungeza isitho esithintekile ngaphakathi ngaphandle kokujikeleza kwangaphandle ngokweqile.
Aindlela yokusondela
Ezimweni eziningi, kwenziwa imicu emincane ku-tibia, calcaneus, kanye ne-metatarsal yokuqala ukuze kubekwe izikhonkwane zokulungisa zangaphandle.··
Ukuphuka kwe-fibula kulula kakhulu ukukulungisa kusukela emngceleni ongaphansi kwesikhumba ozwakalayo.
Ukuphuka kwe-tibial vault ehilela ilunga kungalungiswa nge-percutaneously. Uma izimo zezicubu ezithambile zivuma, futhi uma kudingeka, indlela evamile ye-anterolateral noma ye-medial ingasetshenziswa ukuze kuqiniswe. Uma ukuqina kwangaphandle kusetshenziswa kuphela njengendlela yokulinganisa yesikhashana, indawo yokungena kwenaliti lapho inaliti yokubopha yangaphandle ihlelwe khona kufanele ibe kude nendawo yokugcina yokubopha izinzipho ukuze kuvinjelwe ukungcoliswa kwezicubu ezithambile. Ukuqina kwasekuqaleni kwezingcezu ze-fibula kanye ne-intra-articular kwenza kube lula ukuqina okulandelayo.
Izinyathelo zokuzivikela
Qaphela ithrekhi yephini yokubopha yangaphandle ukuze uthole ukuqina okuqondile kwensimu yokuhlinzwa, njengoba izicubu ezingcolile zizoholela ezinkingeni zangemuva kokuhlinzwa. Izindlela ezivamile zangemuva noma zangaphakathi ezinokuvuvukala okukhulu kwezicubu ezithambile nazo zingaholela ezinkingeni ezinkulu ekupholeni kwenxeba.
Ukunciphisa nokulungisa ukuqhekeka kwe-fibula:
Noma nini lapho izimo zezicubu ezithambile zivuma, kuqala ukwelashwa ngokuphuka kwe-fibula. Ukuphuka kwe-fibula kuyancishiswa futhi kulungiswe kusetshenziswa i-lateral fibular incision, ngokuvamile ngezikulufo ze-lag ezingu-3.5mm kanye ne-3.5mm l/3 tube plate, noma i-3.5mm LCDC plate kanye nezikulufo. Ngemva kokuba i-fibula incishisiwe futhi ilungiswe ngokwesimo somzimba, ingasetshenziswa njengendinganiso yokubuyisela ubude be-tibia nokulungisa ukukhubazeka kokujikeleza kokuphuka kwe-tibial.
Izinyathelo zokuzivikela
Ukuvuvukala okukhulu kwezicubu ezithambile noma isilonda esivulekile esinzima kungavimbela ukunamathela kokuqala kwe-fibula. Qaphela ukuthi ungalungisi ukuphuka kwe-proximal fibular futhi uqaphele ukuthi ungalimazi i-proximal superficial peroneal nerve.
Ukuphuka Kwe-Tibial: Ukunciphisa Nokulungiswa Kwangaphakathi
Ukuqhekeka kwangaphakathi kwe-tibial vault kufanele kuncishiswe ngaphansi kokubona okuqondile ngokusebenzisa indlela ye-anterolateral noma ye-medial ye-distal tibia, noma ngokunciphisa ngesandla okungaqondile ngaphansi kwe-fluoroscopy.
Uma ushayela isikulufu sokulaxaza, ingxenye yokuqhekeka kufanele ilungiswe ngentambo kaKirschner kuqala.
Ukunciphisa kanye nokubopha kwasekuqaleni kokuphuka kwamathambo ngaphakathi kwe-articular kuvumela amasu angangeni kakhulu kanye nokuguquguquka okukhulu ekubambeni kwesibili okuqinisekile. Izimo ezingathandeki zezicubu ezithambile njengokuvuvukala okuphawulekayo noma umonakalo omkhulu wezicubu ezithambile zingavimbela ukubopha kwasekuqaleni kwezingcezu zamathambo ngaphakathi kwe-articular.
Ukuphuka Kwe-Tibial: Ukulungiswa Kwangaphandle Kwe-Transarticular
Kungasetshenziswa i-cross-joint external fixator.
Ngokwezidingo zendlela yokulungisa yesigaba sesibili, izikhonkwane ezimbili zokulungisa zangaphandle ezingama-5mm ezinentambo eyingxenye zafakwa nge-percutaneously noma ngokusebenzisa ukusikeka okuncane ebusweni be-medial noma be-anterolateral be-tibia ekugcineni kwe-proximal kokuqhekeka.
Okokuqala hlikihla izicubu ngokungenaphutha uye endaweni yamathambo, bese uvikela izicubu ezizungezile ngesivikelo sezicubu ezithambile, bese ubhoboza, uthinta, bese ushayela isikulufu ngesivikelo.
Izikhonkwane zokulungisa zangaphandle ekugcineni kwe-fracture zingafakwa ku-distal tibial fragment, i-calcaneus kanye ne-first metatarsal, noma intamo ye-talus.
Izikhonkwane zokulungisa zangaphandle ze-transcalcaneal kufanele zibekwe ku-tuberosity ye-calcaneal kusukela ku-medial kuya ku-lateral ukuvimbela umonakalo ezakhiweni ze-medial neurovascular.
Iphini yokuqinisa yangaphandle ye-metatarsal yokuqala kufanele ibekwe ebusweni be-anteromedial besisekelo se-metatarsal yokuqala.
Ngezinye izikhathi iphini yokuqinisa yangaphandle ingafakwa ngaphambili ngokusebenzisa i-tarsal sinus incision.
Ngemuva kwalokho, i-tibia ekude yaphinde yahlelwa kabusha futhi umugqa wamandla walungiswa nge-fluoroscopy yangaphakathi kokuhlinzwa, kwathi i-fixator yangaphandle yahlanganiswa.
Uma ulungisa i-fixator yangaphandle, khulula i-linking clip, yenza i-longitudinal traction, bese wenza i-hand reduction ethambile ngaphansi kwe-fluoroscopy ukuze ulungise indawo ye-fracture fracture. Umqhubi ube esegcina indawo ngenkathi umsizi eqinisa i-connecting clips.
Miphuzu le-ain
Uma ukubopha kwangaphandle kungeyona indlela eqondile yokwelapha, ithrekhi yenalithi yokubopha yangaphandle kufanele igcinwe kude nendawo yokubopha eqondile ngesikhathi sokuhlela ukusebenza, ukuze kungangcolisi insimu yokusebenza yesikhathi esizayo. Ukuqina kokubopha kwangaphandle kungandiswa ngokwandisa isikhala sezikhonkwane zokubopha endaweni ngayinye yokuqhekeka, ukwandisa ububanzi bezikhonkwane, ukwandisa inani lezikhonkwane zokubopha kanye nezintambo zokuxhuma, ukwengeza amaphuzu okubopha kulo lonke iqakala, nokwandisa indiza yokubopha noma ukusebenzisa i-ring external fixator. Ukulungiswa okwanele kokulungisa kufanele kuqinisekiswe ngezigaba zangaphambili-zangemuva kanye neze-lateral.
Ukuphuka kwe-tibial: ukulungiswa kwangaphandle okungeyona i-span-articular
Ngezinye izikhathi kuyindlela yokusebenzisa i-fixator yangaphandle engadluli ijoyinti. Uma i-distal tibial fragment inkulu ngokwanele ukufaka ama-half-thread external fixation pin, i-external fixator elula ingasetshenziswa. Ezigulini ezinezingcezu ezincane ze-metaphyseal fracture, i-hybrid external fixator equkethe i-proximal semi-threaded external fixation pin kanye ne-distal fine Kirschner wire iwusizo njengendlela yokwelapha yesikhashana noma eqondile. Kufanele kuqashelwe uma kusetshenziswa ama-non-span-articular external fixators ukuze kwaphuke ama-fracture anokungcola kwezicubu ezithambile. Ukususwa kwalesi zicubu esingcolile, ukungcoliswa kwendlela yenaliti, kanye nokuvimbela ukunyakaza komlenze entanjeni kuze kube yilapho kuphola kahle inxeba ngaphambi kokuba kwenziwe ukuvimbela ukunyakaza okuqondile.
I-Sichuan ChenAnHui Technology Co., Ltd
Xhumana: Yoyo
I-WhatsApp:+8615682071283
Email: liuyaoyao@medtechcah.com
Isikhathi sokuthunyelwe: Feb-10-2023
