Uma ukhetha uhlelo lokwelapha lwe-distal tibial fractures, ukulungiswa kwangaphandle kungasetshenziswa njengendlela yokulungisa okwesikhashana ama-fractures ngokulimala okukhulu kwezicubu ezithambile.
Izinkomba:
"Ukulawula umonakalo" ukulungiswa kwesikhashana kokuqhekeka okunokulimala okuphawulekayo kwezicubu ezithambile, njengokuphuka okuvulekile noma ukuphuka okuvaliwe okunokuvuvukala okubalulekile kwezicubu ezithambile.
Ukwelashwa okuqondile kokungcolile, ukuphuka okuthelelekile, noma ukuphuka okunokulimala okukhulu kwezicubu ezithambile.
Examine:
Isimo sezicubu ezithambile: ①Inxeba elivulekile;②Ukuqubuka kwezicubu ezithambile kakhulu, ukuvuvukala kwezicubu ezithambile.Hlola isimo se-neurovascular futhi urekhode ngokucophelela.
Ukucabanga: I-X-ray ye-Anteroposterior kanye ne-lateral ye-tibia, kanye ne-anteroposterior, i-lateral ne-ankle acupoints ye-ankle joint.Uma kusolwa ukuphuka kwe-intra-articular, i-CT scan ye-tibial vault kufanele yenziwe.
Ai-natomy:·
I-anatomical "indawo ephephile" yokubeka iphinikhodi yokulungisa yangaphandle yachazwa ngokuya ngamazinga ahlukene wesigaba esiphambene.
I-proximal metaphysis ye-tibia inikeza indawo yokuphepha engu-220 ° yangaphambili efana ne-arc lapho izikhonkwane zokulungisa zangaphandle zingabekwa khona.
Ezinye izingxenye ze-tibia zihlinzeka ngendawo yokufaka inaliti ephephile ye-anteromedial ebangeni lika-120 ° ~ 140 °.
Sinqubo yokuhlinza
Indawo: Isiguli silala sibheke etafuleni le-X-ray elibonisa ngale, futhi ezinye izinto ezifana nomcamelo noma ishalofu zifakwa ngaphansi kwesitho esithintekile ukusiza ukugcina isimo.Ukubeka iphedi ngaphansi kwe-hip ipsilateral kuzungeza isitho esithintekile ngaphakathi ngaphandle kokujikeleza kwangaphandle ngokweqile.
Asondela
Ezimweni eziningi, ukusika okuncane kwenziwa ku-tibia, calcaneus, kanye ne-metatarsal yokuqala ukubeka izikhonkwane zokulungisa zangaphandle.··
Ukuphuka kwe-fibula kulungiswe kalula ukusuka emngceleni obambekayo ongaseceleni ongaphansi.
Ukuphuka kwe-vault ye-tibial ehilela ukujoyina kungalungiswa nge-percutaneously.Uma izimo zezicubu ezithambile zivuma, futhi uma kunesidingo, indlela evamile ye-anterolateral noma ephakathi ingasetshenziselwa ukulungiswa.Uma ukulungiswa kwangaphandle kusetshenziswa kuphela njengesilinganiso sokulungiswa kwesikhashana, indawo yokungena yenaliti lapho inaliti yokulungisa yangaphandle ihlelwe ukuthi ibekwe kufanele ibe kude nendawo yokugcina yezipikili ukuvimbela ukungcoliswa kwezicubu ezithambile.Ukulungiswa kwangaphambi kwesikhathi kwe-fibula nezingcezu ze-intra-articular kusiza ukulungiswa okuqondile okulandelayo.
Izinyathelo zokuzivikela
Qaphela iphinikhodi yokulungisa yangaphandle ukuze uthole ukulungiswa okuqondile okulandelayo kwendawo yokuhlinza, njengoba izicubu ezingcolile zizoholela ezinkingeni zangemva kokuhlinzwa.Izindlela ezivamile ze-anterolateral noma ezimaphakathi ezinokuvuvukala okubalulekile kwezicubu ezithambile nazo zingaholela ezinkingeni ezinkulu ekwelapheni kwesilonda.
Ukunciphisa nokulungiswa kwe-fibula fractures:
Noma nini lapho izimo zezicubu ezithambile zivuma, ama-fibula fracture aphathwa kuqala.Ukuphuka kwefibula kuyancishiswa futhi kulungiswe kusetshenziswa i-lateral fibular incision, ngokuvamile enezikulufu ze-lag ezingu-3.5mm kanye nepuleti leshubhu elingu-3.5mm l/3, noma ipuleti le-LCDC elingu-3.5mm nezikulufu.Ngemuva kokuthi i-fibula incishiswe ngokuzenzakalelayo futhi ilungiswe, ingasetshenziswa njengendlela evamile yokubuyisela ubude be-tibia nokulungisa ukukhubazeka okujikelezayo kwe-tibial fracture.
Izinyathelo zokuzivikela
Ukuvuvukala okuphawulekayo kwezicubu ezithambile noma inxeba elivulekile elivulekile kungase futhi kuvimbele ukulungiswa okuyinhloko kwe-fibula.Qaphela ukuthi ungalungisi i-proximal fibular fractures futhi uqaphele ukulimaza i-proximal superficial peroneal nerve.
Ama-Tibial Fractures: Ukunciphisa kanye Nokulungiswa Kwangaphakathi
Ukuphulwa kwe-intra-articular ye-vault ye-tibial kufanele kuncishiswe ngaphansi kombono oqondile ngokusebenzisa indlela ye-anterolateral noma ye-medial ye-distal tibia, noma ngokunciphisa okungaqondile ngesandla ngaphansi kwe-fluoroscopy.
Uma ushayela isikulufu se-lag, isiqeshana sokuphuka kufanele silungiswe ngentambo ye-Kirschner kuqala.
Ukuncishiswa ngaphambi kwesikhathi nokulungiswa kokuphuka kwe-intra-articular kuvumela amasu angavamisile kancane kanye nokuguquguquka okukhulu ekulungiseni okuqinisekile kwesibili.Izimo ezingezinhle zezicubu ezithambile ezifana nokuvuvukala okumakiwe noma ukulimala okukhulu kwezicubu ezithambile zingavimbela ukulungiswa ngaphambi kwesikhathi kwezingcezu ze-intra-articular.
Ama-Tibial Fractures: Ukulungiswa Kwangaphandle kwe-Transarticular
I-cross-joint fixator yangaphandle ingasetshenziswa.
Ngokwezidingo zendlela yokulungisa ecacile yesigaba sesibili, izikhonkwane ezimbili zokulungisa zangaphandle ezinengxenye engu-5mm ezinemicu yafakwa nge-percutaneously noma ngokusebenzisa izimbobo ezincane endaweni ephakathi nendawo noma e-anterolateral ye-tibia ekugcineni okuseduze kokuphuka.
Okokuqala hlinza endaweni yethambo, bese uvikela izicubu ezizungezile ngomkhono wokuvikela izicubu ezithambile, bese ubhoboza, uthephe, futhi uqhube isikulufu ngomkhono.
Izikhonkwane zokulungisa zangaphandle ekugcineni kwe-distal ye-fracture zingafakwa ku-distal tibial fragment, i-calcaneus ne-metatarsal yokuqala, noma intamo ye-talus.
Izikhonkwane zokulungisa zangaphandle ze-Transcalcaneal kufanele zibekwe ku-calcaneal tuberosity kusukela emaphakathi kuya ehlangothini ukuze kuvinjelwe ukulimala kwezakhiwo ze-neurovascular zangaphakathi.
Iphinikhodi yokulungisa yangaphandle ye-metatarsal yokuqala kufanele ibekwe endaweni ye-anteromedial yesisekelo se-metatarsal yokuqala.
Ngezinye izikhathi iphinikhodi yokulungisa yangaphandle ingafakwa i-anterolaterally ngokusebenzisa i-tarsal sinus incision.
Khona-ke, i-distal tibia yahlelwa kabusha futhi umugqa wamandla walungiswa nge-fluoroscopy ye-intraoperative, futhi i-fixator yangaphandle yahlanganiswa.
Lapho ulungisa i-fixator yangaphandle, khulula isiqeshana sokuxhuma, yenza i-longitudinal traction, futhi wenze ukwehlisa ngesandla okuthambile ngaphansi kwe-fluoroscopy ukuze ulungise ukuma kwesiqephu sokuphuka.Umsebenzisi ube esegcina indawo ngenkathi umsizi eqinisa iziqeshana zokuxhuma.
Miphuzu
Uma ukulungiswa kwangaphandle kungekona ukwelashwa okuqondile, ithrekhi yenaliti yokulungisa yangaphandle kufanele igcinwe kude nendawo eqondile yokulungisa ngesikhathi sokuhlela ukusebenza, ukuze ingangcolisi insimu yokusebenza kwesikhathi esizayo.Ukuzinza kokulungiswa kwangaphandle kungandiswa ngokukhulisa isikhala sezikhonkwane zokulungisa endaweni ngayinye yokuphuka, ukwandisa ububanzi bezikhonkwane, ukwandisa inani lezikhonkwane zokulungisa kanye nezintambo zokuxhuma, ukwengeza amaphuzu okulungisa kuwo wonke umhlanganiso we-ankle, nokwandisa ukulungiswa. indiza noma ukufaka isilungisi sangaphandle esiyindandatho .Ukulungiswa kokulungiswa okwanele kufanele kuqinisekiswe ngezigaba zangaphambili-ngemuva kanye nezigaba.
Ukuphuka kwe-Tibial: ukulungiswa kwangaphandle okungeyona i-span-articular
Ngezinye izikhathi kuyinketho yokufaka i-fixator yangaphandle engadluli ekuhlanganyeleni.Uma i-distal tibial fragment inkulu ngokwanele ukuze ikwazi ukufaka izikhonkwane zokulungisa zangaphandle ze-half-thread, i-fixator yangaphandle elula ingasetshenziswa.Ezigulini ezinezingcezu ezincane zokuphuka kwe-metaphyseal, isilungisi sangaphandle esiyingxubevange esihlanganisa iphinikhodi yokulungisa yangaphandle ene-semi-threaded kanye ne-distal fine Kirschner wire iwusizo njengendlela yokwelapha yesikhashana noma eqinisekile .Ukuqapha kufanele kusetshenziswe lapho kusetshenziswa izilungisi zangaphandle ezingezona-span-articular zokuqhekeka okunokungcola kwezicubu ezithambile.Ukususwa kwalesi sicubu esingcolisiwe, ukukhishwa kwepheshana yenaliti, kanye nokunganyakazi kwengxenye yomkhawulo ekhoneni kuze kube yilapho ngokuvamile kudingekile ukuphola kwenxeba ngaphambi kokuba kuqiniswe ngokuphelele.
I-Sichuan ChenAnHui Technology Co., Ltd
Othintana naye: Yoyo
WhatsApp: +8615682071283
Email: liuyaoyao@medtechcah.com
Isikhathi sokuthumela: Feb-10-2023
