Ukulungiselela kanye nesikhundla njengoba kuchazwe ngaphambilini ngokulungiswa kohlaka lwangaphandle kwangaphandle.
I-Intra-articular fracture repoposition kanye nokulungisa:
Ukuncishiswa okulinganiselwe okulinganiselwe kanye nokulungiswa kusetshenziswa. Ukuqhekeka kwendawo yokuhlobisa engaphansi kungabonakala ngokuqondile ngokufakwa okuncane kwe-antentemial kanye ne-anterelateral kanye nokuvela kwamuva kwe-capsule ehlanganisiwe ngaphansi kwama-meniscus.
Ukutholwa komlenze othintekile kanye nokusetshenziswa kwama-ligaments ukuqondisa izingcezwana ezinkulu zamathambo, kanye nokucindezelwa okuphakathi kungasetha kabusha ngokuphrinta nokuhlwitha.
Naka ukubuyisela ububanzi bethafa leTibial, futhi lapho kunenkinga yamathambo ngaphansi kobuso be-articular, yenza ukuthathwa kwamathambo ukusekela indawo ye-articular ngemuva kokusetha kabusha indawo enobuhlakani.
Naka ukuphakama kwamapulatifomu aphakathi nendawo nawasemuva, ukuze kungabikho sinyathelo se-articular angaphezulu.
Ukulungiswa kwesikhashana nge-reset clamp noma i-kirschner pin isetshenziselwa ukugcina ukusetha kabusha.
Ukubekwa kwezikulufa eziyize, ama-screws kufanele abe ngokufana nendawo enobuhlakani futhi atholakala ethanjeni le-subchondral, ukuze andise amandla okulungiswa. I-Intraoperative X-ray Fluoroscopy kufanele yenziwe ukuze ihlole izikulufa futhi ungalokothi ushayele izikulufa ungene ekuhlanganiseni.
Ukuphakanyiswa kwe-Epiphyseeal Fracture:
I-Traction ibuyisa ubude kanye ne-eksisi emishini yemthonjeni othintekile.
Ukunakekelwa kuthathwa ukuze kulungiswe ukuthunyelwa okuguqukayo kwemthonjeni ethintekile ngokuhambisana ne-tibial Tuberoluty futhi uzinikeze phakathi kwezinzwane zokuqala nezesibili.
Ukubekwa Kwendandatho Ye-Proximal
Ububanzi bezindawo eziphephile zokubekwa kwentambo ye-tibial plateau:
I-popliteal artery, i-popliteal vein kanye ne-tibial nerve run ngemuva kwe-tibia, kanye ne-peponeal nerve ejwayelekile iqhuba ngemuva kwekhanda le-fibular. Ngakho-ke, kokubili ukungena nokuphuma kwenaliti kufanele kwenziwe ngethafa le-tibial, okusho ukuthinalitha kufanele ungene futhi uphume ngentambo yensimbi ye-tibia kanye ne-anterior emngceleni we-fibula.
Ngaseceleni kwamuva, inaliti ingafakwa emaphethelweni angaphandle kwe-fibula bese iphuma ohlangothini lwe-anteremedial noma ohlangothini lwe-medial; Iphuzu lokungena le-Medial livame ukuba umphetho we-medial wethafa le-tibial kanye nehlangothi lalo elingaphandle, ukugwema ucingo lokungezwani ukuze udlule izicubu zemisipha eziningi.
Kubikwe ezincwadini ukuthi iphuzu lokungenayo le-testy wire kufanele okungenani libe yi-14 mm ukusuka endaweni yezimangaliso ukuvikela ucingo lokuxabana kusuka ekungeneni i-capsule ehlangene nokudala isifo samathambo.
Beka i-test youre yokuqala:
I-PIN ye-Olive ingahle isetshenziswe, edluliswa nge-PIN yezokuphepha esikhwameni sendandatho, ishiye ikhanda le-olive ngaphandle kwe-PIN yezokuphepha.
Umsizi ugcina isikhundla somnikazi wendandatho ukuze ahambisane nobungqayizivele.
Hlanganisa i-PIN ye-Olive ngokusebenzisa izicubu ezithambile nangotshani beTibial, unakekela ukulawula indlela yawo ukuze uqinisekise ukuthi amaphuzu okufakwayo kanye nokuphuma endizeni efanayo.
Ngemuva kokuphuma esikhunjeni kusuka ohlangothini lwamakhompiyutha kuyaqhubeka ukuphuma ngenaliti kuze kube yilapho ikhanda lomnqumo lixhumana ne-PIN yezokuphepha.
Faka i-Wire Clamp Slide ohlangothini lwamakhompiyutha bese udlula iphini le-olive ngokusebenzisa isilayidi se-wire clamp.
Nakekela ukugcina ithafa le-tibial enkabeni yefreyimu yendandatho ngaso sonke isikhathi ngesikhathi sokusebenza.
Ngokusebenzisa umhlahlandlela, ucingo lwesibili lwengxabano lubekwe ngokufana, futhi ngakolunye uhlangothi lwe-wire clamp slide.
Beka i-wire yesithathu yengxabano, kufanele ibe ebangeni eliphephile ngangokunokwenzeka ngesethi yangaphambilini yocingo lwe-wire wire ungene endaweni enkulu kunazo zonke, imvamisa amasethi amabili ensimbi angaba yi-angle ka-50 ° ~ 70 °.
I-Preload isetshenziswa kwi-Tempension Wire: Ukungezwani okugcwele, kudlulise isicucu socingo lwengxabano ngokusebenzisa isicucu, kucindezela isibambo, faka indawo okungenani engu-1200n ku-testy wire, bese ufaka ilokhi ye-L-HATT.
Ukusebenzisa indlela efanayo yokulungiswa kwangaphandle ngaphesheya kwedolo njengoba kuchaziwe phambilini, beka okungenani izikulufo ezimbili ze-schanz e-dibia yangaphandle, bese uzixhumanisa ne-mechaphs esihlokweni sangaphandle, futhi uphinde uqinisekise ukuthi i-mechafysis kanye nokuqondanisa okujwayelekile ngaphambi kokuqedela ukulungiswa.
Uma kudingeka ukuqina okwengeziwe, ifreyimu yendandatho inganamathiselwa engalweni yokulungiswa kwangaphandle ngenduku yokuxhuma.
Ukuvala I-incision
I-incision yokuhlinzwa ivaliwe ungqimba.
Ipheshana lenaliti livikelekile ngotshwala be-gauze ukugoqa.
Ukuphathwa kwe-postoperative
I-Fascial Syndrome nokulimala kwezinzwa
Ngaphakathi kwe-48h ngemuva kokulimala, kufanele kuthathwe ukunakekelwa kokubheka nokunquma ukubakhona kwe-Fakisial Ticial Syndrome.
Gcina ngokucophelela izinzwa zemithambo yemthonjeni othintekile. Ukuhlinzekwa kwegazi okulimazayo noma ukulahleka kwemizwa okuqhubekayo kufanele kulawulwe ngendlela efanele njengesimo esiphuthumayo.
Ukuvuselelwa Okusebenzayo
Ukuzivocavoca okusebenzayo kungaqalwa ngosuku lokuqala lwe-postoperative uma kungekho okunye ukulimala kwesayithi noma ama-comorbidities. Isibonelo, ukwakheka kwe-isometric kwama-quadriceps nokuhamba nje kwedolo nokuhamba okusebenzayo kwe-ankle.
Inhloso yemisebenzi yokuqala esebenzayo nengenamikhawulo ukuthola uhla oluphezulu lokuhamba kokuhlanganiswa kwedolo isikhathi esifushane ngangokunokwenzeka ngemuva kokuhlinzwa, okungukuthi, ukuthola uhla oluphelele lokuhamba kwedolo ngokuhlanganiswa ngangokunokwenzeka kumaviki ama-4 ~ 6. Ngokuvamile, ukuhlinzwa kuyakwazi ukufeza inhloso yokwakhiwa kabusha kwamadolo, okuvumela kusenesikhathi
umsebenzi. Uma izivivinyo ezisebenzayo zibambezeleka ngenxa yokulinda ukuvuvukala ukuncipha, lokhu ngeke kulungele ukululama okusebenzayo.
Ukuthwala isisindo: Ukuthwala isisindo kusenesikhathi akuvunyelwe, kepha okungenani amaviki ayi-10 kuye kwayi-12 noma kamuva kwenzelwe ukuqhekeka kwe-intra-articular fractures.
Ukuphulukiswa okulimazayo: Bheka eduze ukwelashwa ngamanxeba kungakapheli amasonto ama-2 ngemuva kokuhlinzwa. Uma ukutheleleka kwesilonda noma ukuphulukiswa okubambezelekile kwenzeka, ukungenelela okuhlinzayo kufanele kwenziwe ngokushesha okukhulu.
Isikhathi sePosi: Aug-16-2024
