Ukulungiswa kwangaphambi kokuhlinzwa kanye nesimo njengoba kuchazwe ngaphambilini ukuze kulungiswe uhlaka lwangaphandle lwe-transarticular.
Ukumiswa kabusha kwe-Intra-articular fracture nokulungiswa:
Kusetshenziswa ukuncishiswa kwe-incision kanye nokulungiswa okulinganiselwe. Ukuphuka kwe-articular surface engaphansi kungase kubonakale ngokuqondile ngokusebenzisa izimbobo ezincane ze-anteromedial kanye ne-anterolateral kanye nokusika kwe-lateral kwe-capsule ehlangene ngaphansi kwe-meniscus.
Ukudonswa kwesitho esithintekile kanye nokusetshenziswa kwemigqa ukuze kuqondiswe izingcezu ezinkulu zamathambo, futhi ukuminyanisa okuphakathi kungase kusethwe kabusha ngokuyichoboza nokuhlwithwa.
Naka ukubuyisela ububanzi bethafa le-tibial, futhi uma kukhona ukukhubazeka kwethambo ngaphansi kwendawo ye-articular, yenza i-bone grafting ukusekela i-articular surface ngemva kokucubungula ukuze usethe kabusha i-articular surface.
Naka ukuphakama kwamapulatifomu aphakathi nendawo, ukuze kungabikho isinyathelo se-articular surface.
Ukulungiswa kwesikhashana nge-clamp yokusetha kabusha noma iphinikhodi ye-Kirschner kusetshenziselwa ukugcina ukusetha kabusha.
Ukubekwa kwezikulufu ezingenalutho, izikulufu kufanele zihambisane nendawo ye-articular futhi zibekwe ethanjeni le-subchondral, ukuze kwandiswe amandla okulungisa. I-X-ray fluoroscopy ye-intraoperative kufanele yenziwe ukuze kuhlolwe izikulufu futhi ungalokothi ushayele izikulufu endaweni ehlangene.
Ukumiswa kabusha kwe-Epiphyseal fracture:
Ukudonsa kubuyisela ubude kanye ne-eksisi esebenzayo yelunga elithintekile.
Ukunakekelwa kuthathwa ukuze kulungiswe ukugudluka okujikelezayo kwesitho esithintekile ngokuthinta i-tuberosity ye-tibial nokuyiqondisa phakathi kwezinzwane zokuqala nezesibili.
Ukubekwa Kwendandatho Eseduze
Ububanzi bezindawo eziphephile zokubekwa kwentambo ye-tibial plateau tension wire:
I-popliteal artery, i-popliteal vein kanye ne-tibial nerve igijima ngemuva kwe-tibia, futhi i-peroneal nerve evamile igijima ngemuva kwekhanda le-fibular. Ngakho-ke, kokubili ukungena nokuphuma kwenaliti kufanele kwenziwe ngaphambili ethafeni le-tibial, okungukuthi, inaliti kufanele ingene futhi iphume inaliti yensimbi yangaphambili emngceleni ophakathi we-tibia nangaphambili ukuya emngceleni wangaphambili we-fibula.
Ehlangothini lwe-lateral, inaliti ingafakwa kusukela emaphethelweni angaphambili we-fibula futhi idluliselwe ohlangothini lwe-anteromedial noma kusukela ohlangothini oluphakathi; indawo yokungena ephakathi ngokuvamile isemaphethelweni aphakathi kwethafa le-tibial kanye nohlangothi lwayo lwangaphambili, ukugwema ucingo olucindezelayo ukuze ludlule izicubu eziningi zemisipha.
Kuye kwabikwa ezincwadini ukuthi indawo yokungena yocingo olucindezelayo kufanele okungenani ibe ngu-14 mm ukusuka endaweni ye-articular ukuvimbela ucingo lwe-tension ukuthi lungangeni ku-capsule ehlangene futhi lubangele isifo samathambo esithathelwanayo.
Beka intambo yokuqala ye-tension:
Iphinikhodi ye-olive ingase isetshenziswe, edluliswa ephinikhodi yokuphepha esiphethe iringi, ishiye ikhanda lomnqumo ngaphandle kwephini lokuphepha.
Umsizi ugcina indawo yomphathi weringi ukuze ihambisane nendawo ye-articular.
Gcoba iphini lomnqumo ngezicubu ezithambile futhi ngokusebenzisa ithafa le-tibial, uqaphele ukulawula isiqondiso salo ukuze uqinisekise ukuthi amaphuzu okungena nokuphuma asendizeni efanayo.
Ngemva kokuphuma esikhumbeni ohlangothini lwe-contralateral qhubeka uphuma inaliti kuze kube yilapho ikhanda lomnqumo lithinta iphini lokuphepha.
Faka isilayidi se-wire clamp ohlangothini lwe-contralateral bese udlulisa iphinikhodi ye-olive kusilayidi se-clamp yocingo.
Qaphela ukuthi ugcine i-tibial plateau phakathi nendawo yohlaka lwendandatho ngaso sonke isikhathi ngesikhathi sokusebenza.
Ngomhlahlandlela, intambo yesibili yokudonsa ibekwa ngokuhambisana, futhi ngakolunye uhlangothi lwesilayidi se-clamp clamp.
Beka intambo yesithathu yokudonsa, kufanele ibe sebangeni eliphephile ngangokunokwenzeka ngesethi yangaphambili ye-tension wire cross ibe engeli enkulu kunazo zonke, ngokuvamile amasethi amabili ocingo lwensimbi angaba i-engeli engu-50 ° ~ 70 °.
Ukulayisha kuqala kusetshenziswe intambo ye-tension:Cindezela ngokugcwele isiqinisi, dlulisa ichopho lentambo ye-tension kusiqinisi, cindezela isibambo, sebenzisa ukulayisha kuqala okungenani okungu-1200N kuntambo ye-tension, bese usebenzisa ilokhi yesibambo sika-L.
Ukusebenzisa indlela efanayo yokulungiswa kwangaphandle edolweni njengoba kuchazwe ngaphambili, faka okungenani izikulufu ezimbili ze-Schanz ku-distal tibia, unamathisele isilungisi sangaphandle esihlome esisodwa, futhi usixhume ku-fixator yangaphandle eyindilinga, futhi uqinisekise kabusha ukuthi i-metaphysis ne-tibial stem. ziku-eksisi kamishini evamile kanye nokuqondanisa kokuzungeza ngaphambi kokuqeda ukulungisa.
Uma kudingeka ukuzinza okwengeziwe, uhlaka lwendandatho lungaxhunywa engalweni yokulungisa yangaphandle ngenduku yokuxhuma.
Ukuvala isikwele
I-incision yokuhlinzwa ivaliwe isendlalelo ngongqimba.
Ipheshana yenaliti livikelwe nge-alcohol gauze wraps.
Ukuphathwa kwangemva kokuhlinzwa
I-Fascial syndrome kanye nokulimala kwezinzwa
Kungakapheli amahora angama-48 ngemuva kokulimala, ukunakekelwa kufanele kuthathwe ukuze kubhekwe futhi kunqunywe ukuba khona kwe-fascial compartment syndrome.
Qaphela ngokucophelela imizwa yemithambo yesitho esithintekile. Ukunikezwa kwegazi okukhubazekile noma ukulahleka kwemizwa okuqhubekayo kufanele kulawulwe ngendlela efanele njengesimo esiphuthumayo.
Ukuvuselelwa okusebenzayo
Ukuzivocavoca okusebenzayo kungaqalwa ngosuku lokuqala lwangemva kokuhlinzwa uma kungekho okunye ukulimala kwesayithi noma ukugula. Isibonelo, ukufinyela kwe-isometric kwe-quadriceps kanye nokunyakaza okungahambi kahle kwamadolo nokunyakaza okusebenzayo kweqakala.
Inhloso yemisebenzi yokuqala esebenzayo kanye ne-passive iwukuthola ububanzi obukhulu bokunyakaza kwedolo elihlangene isikhathi esifushane ngangokunokwenzeka ngemva kokuhlinzwa, okungukuthi, ukuthola uhla oluphelele lokunyakaza kwedolo elihlangene ngangokunokwenzeka ku-4 ~ 6 amasonto. Ngokuvamile, ukuhlinzwa kukwazi ukufeza inhloso yokwakhiwa kabusha kokuqina kwamadolo, okuvumela kusenesikhathi
umsebenzi. Uma izivivinyo ezisebenzayo zibambezeleka ngenxa yokulinda ukuvuvukala ukuthi kunciphe, lokhu ngeke kuvumele ukululama kokusebenza.
Ukuthwala isisindo: Ukuthwala isisindo kusenesikhathi ngokuvamile akukhuthazwa, kodwa okungenani amaviki angu-10 kuya kwangu-12 noma kamuva ukuze kuklanywe ukuphuka kwe-intra-articular.
Ukuphola kwesilonda: Bukisisa ukuphola kwesilonda phakathi namaviki ama-2 ngemva kokuhlinzwa. Uma ukutheleleka kwesilonda noma ukuphulukiswa ukubambezeleka kwenzeka, ukungenelela kokuhlinzwa kufanele kwenziwe ngokushesha ngangokunokwenzeka.
Isikhathi sokuthumela: Aug-16-2024
