Lapho ukhetha uhlelo lokwelashwa lokuqhekeka kwe-distal tibial fractures, ukulungiswa kwangaphandle kungasetshenziswa njengokulungiswa kwesikhashana kokulimala kwezicubu ezithambile ezithambile.
Izinkomba:
"Ukulawulwa komonakalo" Ukulungiswa kwesikhashana kwama-fractures ngokulimala okuthe xaxa kwezicubu ezithambile, njengokuqhekeka okuvulekile noma ukuvalwa okuvaliwe ngokuvuvukala kwezicubu eziphakeme.
Ukwelashwa okuchazayo kokuqhekeka okungcolile, okuthelelekile, noma ukuphazamiseka ngokulimala kwezicubu ezithambile.
EI-Xamine:
Isimo sezicubu esithambile: isilonda se-①open; I-②Seeverse Ukukhungatha kwezicubu ezithambile, ukuvuvukala kwezicubu ezithambile. Bheka isimo se-neurovascular futhi urekhode ngokucophelela.
Ukulingisa: I-Anteropostereor and Lateral X-Rays of Tibia, kanye ne-Anteroposterander, i-acupoints ethambile ne-acupoints ye-ankle Joint. Uma kusolwa ukwaphuka kwe-Intra-articular, ukuskena kwe-CT ye-Tibial Vault kufanele kwenziwe.
ANATOMY:·
"Indawo ephephile" ye-anatomical "yokubekwa kwe-PIN yangaphandle kwachazwa ngokuya ngamazinga ahlukene wesigaba sesigaba.
I-proximal metaphysis yaseTibia ihlinzeka ngezindawo zokuphepha ezibunjiwe ezingama-220 ° lapho kufakwa khona izikhonkwane zokulungiswa kwangaphandle.
Ezinye izingxenye zeTibia zinikeza indawo yokufaka inaliti yokufaka i-antentemial enanini elingu-120 ° ~ 140 °.
Sisu eliphuthumayo
Isikhundla: Isiguli sikhona i-sudine etafuleni elisebenzayo le-X-ray esobala, nezinye izinto ezifana ne-cushion noma eshalofini zibekwa ngaphansi komlenze othintekile ukusiza ukugcina isikhundla. Ukubeka i-pad ngaphansi kwe-ipsilateral hip kujikeleza umlenze othintekile ngaphakathi ngaphandle kokujikeleza okwedlulele kwangaphandle.
Aiproach
Ezimweni eziningi, ukwenziwa okuncane kwenziwa eTibia, i-calcAneus, kanye ne-metatarsal yokuqala ukubeka izikhonkwane zangaphandle.
UFibula Fracties uhlelwe kalula emngceleni we-palpable lateral subcutaneous.
Ama-fractures we-tibial vault ehilela ukuhlangana angahlelwa ngenhla. Uma izimo zezicubu ezithambile zivuma, futhi uma kunesidingo, kungasetshenziselwa indlela ejwayelekile ye-antenter noma ye-medial ukuthola ukulungiswa. Uma ukulungiswa kwangaphandle kusetshenziswa kuphela njengesilinganiso sokulungiswa kwesikhashana, inaliti yokungena yenaliti lapho inaliti yokulungiswa kwangaphandle ihlelwe ukuthi ibekwe kude nendawo yokugcina yezipikili ukuvikela ukungcoliswa kwezipikili kokugcina. Ukulungiswa kusenesikhathi kwe-Fibula nezingcezwana ze-Intra-articular kusiza ukulungiswa okuchazayo okulandelayo.
Izinyathelo zokuzivikela
Qaphela ngethrekhi ye-PIN ye-PIN yangaphandle yokulungiswa okuhlosiwe okulandelayo kwensimu yokuhlinza, njengoba izicubu ezingcolile zizoholela nakanjani ezinkingeni ezisebenzayo. Izindlela ezijwayelekile ze-anterelantatal noma izindlela zokuvuvukala kwezicubu ezithambile ezithambile nazo zingaholela ezinkingeni ezinkulu ekuphulukeni kwamanxeba.
Ukuncishiswa nokulungiswa koFibula Fractures:
Noma nini lapho izimo ezithambile zezicubu ezithambile, ama-fibula fracties aphathwa kuqala. Ukuqhekeka kwe-fubular kuncishisiwe futhi kulungiswe kusetshenziswa i-lateral fibular incisusion, imvamisa ngezikulufo ezi-3.5mm ze-lag kanye ne-3.5mm l / 3 tube Plate nezikulufo. Ngemuva kokuthi i-fibula incishiswe futhi ilungiswe, ingahle isetshenziswe njengendinganiso yokubuyisela ubude be-tibia futhi ilungise ukonakala kokushintshana kokuqhekeka kwe-tibial.
Izinyathelo zokuzivikela
Ukuvuvukala okuthe xaxa kwesicubu esithambile noma isilonda esivulekile esivulekile kungavimba nokulungiswa okuyisisekelo kwe-fibula. Qikelela ukuthi ungalungisi ukuqhekeka kwe-Fibular Fribulal futhi uqaphele ukulimaza i-peponeal nerve ye-prother ephezulu.
Ama-Tibial Fractures: Ukuncishiswa kanye nokulungiswa kwangaphakathi
Ukuqhekeka kwe-Intra-Aticular kwe-Tibial Vault kufanele kuncishiswe ngaphansi kombono oqondile nge-anterelateral noma indlela ye-medial ye-dibia dibia, noma ngokuncishiswa kwesandla okungaqondile ngaphansi kwe-fluoroscopy.
Lapho ushayela isikulufa se-lag, isiqephu se-fracture kufanele silungiswe nge-kirschner wire kuqala.
Ukuncishiswa kwangaphambi kwesikhathi nokulungiswa kokuqhekeka kwe-Intra-articular fractures kuvumela amasu amancane ahlaselayo nokuguquguquka okukhulu kokulungiswa okuchazayo kwesibili. Izimo ezingezinhle ezithambile ezifana nokuvuvukala okumakiwe noma ukulimala okuthambile kwezicubu ezithambile kungavimba ukulungiswa kwangaphambi kwezingcezu ze-intra-articular.
Ama-Tibial Fractures: Ukulungiswa kwangaphandle kwangaphandle kwe-Transarticular
I-Finator ehlanganisiwe yangaphandle ehlanganayo ingasetshenziswa.
Ngokwezidingo zendlela yokulungiswa kwesigaba sesibili, izikhonkwane zokulungiswa zangaphandle ezi-5mm ezihlanganisiwe zafakwa ngobuhlakani noma ngokulimala okuncane endaweni ye-tibia noma ye-anteraletal ye-tibia ekugcineni kwe-fracture.
Okokuqala distecly dise prove to the bone ebusweni, bese uvikela izicubu ezizungezile ngekhono elithambile lokuvikela izicubu, bese ushayela, uthephe bese ushayela isikulufa ngomkhono.
Izikhonkwane zokulungiswa kwangaphandle ekugcineni kwe-fracture zingafakwa kwi-distal tibial Fragment, i-calcaneus kanye ne-metatarsal yokuqala, noma intamo ye-talus.
Izikhonkwane zokulungiswa kwangaphandle zangaphandle kufanele zibekwe kwi-calcaneal tuberoty kusuka ekulaleni ukuze kucacele ukuvikela ukulimala kwezakhiwo ze-neurovascularcularcular.
I-PIN yokulungiswa kwangaphandle ye-metatarsal yokuqala kufanele ibekwe phezu kwe-anteromedial engaphezulu kwesisekelo se-metatarsal yokuqala.
Kwesinye isikhathi iPIN yangaphandle yokulungiswa ingabekwa i-antolaterally ngokusebenzisa i-tarsal sinus incision.
Ngemuva kwalokho, kwahlelwa kabusha iTibia futhi umugqa wamandla waguqulwa nge-fluoroscopy ye-intraperative, kanye nokulungiswa kwangaphandle kwaqoqeka.
Lapho ulungisa i-Finator yangaphandle, ukhulule isiqeshana sokuxhuma, wenze i-hangitudinal traction, futhi wenze ukuncishiswa kwencwajana emnene ngaphansi kwe-fluoroscopy ukulungisa isimo se-Fracture Fragment. I-opharetha bese igcina isikhundla ngenkathi umsizi eqinisa iziqeshana zokuxhuma.
Miphuzu le-ain
Uma ukulungiswa kwangaphandle akuyona ukwelashwa okucacisiwe, ithrekhi yenaliti yokulungiswa kwangaphandle kufanele igcinwe kude nendawo yokulungiswa ngesikhathi sokuhlela ukusebenza, ukuze ingangcolisi insimu yokusebenza okuzayo. Ukuqina kokulungiswa kwangaphandle kungakhushulwa ngokwandisa izikhala zezikhonkwane zokuluma endaweni ngayinye, okwandisa inani lezikhonkwane zokulungisa kanye nokufaka ama-struts ahlangene, nokwandisa iplanethi yokulungiswa noma ukusebenzisa i-Finator yangaphandle. Ukuqondaniswa okwanele kokulungisa kufanele kuqinisekwe ngezigaba zangemuva ezingemuva nangemuva.
Ama-Tibial Fractures: Ukulungiswa kwangaphandle okungekho emzimbeni
Kwesinye isikhathi kuyindlela yokusebenzisa i-Finator yangaphandle engapheli ukuhlanganiswa. Uma isiqephu se-distal tibial sikhulu ngokwanele ukuze sikwazi ukuhlalisa izikhonkwane zangaphandle zenhlamvu zangaphandle, kungasetshenziswa i-fixilator elula yangaphandle. Ezigulini ezinezingcezwana ze-metaphyeeal fracture ezincane, i-hybrid yangaphandle yangaphandle equkethe i-prop yokulungiswa yangaphandle ye-semi-threaded yangaphandle kanye ne-diate kirschner wire ilusizo njengendlela yesikhashana yokwelashwa noma eqondile yokwelashwa. Ukuqapha kufanele kusetshenziswe lapho kusetshenziswa ama-Finators angaphandle angewona ama-span-acticular wokuqhekeka ngokungcola kwezicubu ezithambile. Ukususwa kwalezicubu ezingcolile, ukungcola kwepheshana lenaliti, kanye nokungasebenzi kahle kwamakhawundeli asontayo kuze kube yilapho ukuphulukiswa kwamanxeba kuvame ukudingekile ngaphambi kokuvinjwa okucacile kungafuneki.
I-Sichuan Chenanhui Technology Co, LTD
Xhumana: UYoyo
I-WhatsApp: +8615682071283
Email: liuyaoyao@medtechcah.com
Isikhathi sePosi: Feb-10-2023
