Indlela ye-Suprapatellar yindlela yokuhlinzwa eguquliwe ye-Tibial intramentary nail endaweni esezingeni elinwetshiwe. Kunezinzuzo eziningi, kepha futhi zibubi, ukwenza izipikili zomculo we-tibia ngendlela ye-suprapatellar endaweni yeHallux Valgus. Abanye odokotela abahlinzayo bajwayele ukusebenzisa i-SPN ukuphatha konke ama-tibial fractures ngaphandle kokuphazamiseka okwengeziwe kwe-1/3 yeTibia.
Izinkomba ze-SPN yilezi:
1. I-Deminal noma i-Segtal Fractives yesiqu seTibial. 2;
2. Ukuqhekeka kwe-distal tibial metaphysis;
3. Ukuqhekeka kwe-hip noma idolo ngokukhawulelwa okukhona kwangaphambilini kokuguquguquka (isib
I-4. Ukuqhekeka kweTibial kuhlangene nokulimala kwesikhumba e-infrapatellar tendon;
I-5
Inzuzo ye-Semi-enwentsonde isikhundla seTibial Technique ye-Intramengrary Nail Technique yokwelashwa kwedayidi eliphakathi ne-tibial kanye ne-distal tibial fractures lilele ekubuyiseleni kabusha kanye nokukhululeka kwe-fluoroscopy. Le ndlela ivumela ukusekelwa okuhle kakhulu kobude obugcwele be-tibia kanye nokuncishiswa kwe-sagittal okulula kokuqhekeka ngaphandle kwesidingo sokukhohlisa (izibalo 1, 2). Lokhu kuqeda isidingo somsizi oqeqeshiwe ukusiza ngenqubo ye-intramedullary yezipikili.
Umdwebo 1: Isikhundla esijwayelekile sendlela ye-intramedullary nak testique ye-infrapatellar indlela: Idolo lisesimweni esiguquguqukayo ku-tripodoscopically angenayo. Kodwa-ke, lesi sikhundla singandisa ukuqondanisa kabi kwe-fracture block futhi kudinga amasu angeziwe wokunciphisa ukuncishiswa kwe-fracture.
Umdwebo 2: Ngokuphambene nalokho, isikhundla esinwetshiwe sedolo ku-Foam Ramp sisiza ukulungiswa kwe-Fracture Block kanye nokukhohlisa okwalandela.
Amasu okuhlinza
Ithebula / Isikhundla Isiguli sisendaweni ephakeme embhedeni we-fluorooscopic. Ithrebishi eliphansi elingaphansi lingenziwa, kepha alidingekile Kodwa-ke, imibhede eminingi yokuhlaziya noma imibhede ye-fluoroscopic ayinconywa ngoba ayifanelekile indlela ye-suprapatellar indlela ye-tibial inteil.
I-Padding the Ipsilateratel Thigh isiza ukugcina umkhawulo ophansi endaweni ejikelezwe ngaphandle. I-RELILE FOAM REMP isetshenziselwa ukuphakamisa umlenze othintekile ngaphezulu kohlangothi lwamakhompiyutha ukuze lube khona-ke, bese kuthi isimo se-hip esiguqukayo nesikhundla sibuye sikwazi ukuqondisa i-PIN kanye nokubekwa kwe-intrametundary nail. I-angle efanelekile ye-knee flexion angle isaphikiswa, ngeBeltran et al. Ukuphakamisa i-10 ° Knee Flexion kanye ne-Kubiak ephakamisa i-30 ° amadolo. Izazi eziningi ziyavuma ukuthi ama-knee flexion angel ngaphakathi kwalezi zigameko ayamukelekile.
Kodwa-ke, i-Eastman et al. Kutholakale ukuthi njengoba i-Knee Flexion Angle ekhuphuke kancane kancane yasuka ku-10 ° kuya ku-50 °, umphumela we-tenon sowesifazane ngemuva kokungena kwensimbi yensimbi wancishiswa. Ngakho-ke, i-engela enkulu ye-knee flexion iyosiza ekukhetheni isikhundla esifanele sokungena isipikili se-intrametuuntary kanye nokulungisa ukonakala kwe-angular endizeni ye-sagittal.
Fluoroscopy
Umshini we-C-ARM kufanele ubekwe ngakolunye uhlangothi lwetafula kusuka emlenzeni othintekile, futhi uma udokotela ohlinzayo emi ngakwehla kwedolo elithintekile, ukuqapha kufanele kube ekhanda lomshini we-C-arm futhi asondele ngo. Lokhu kuvumela udokotela ohlinzayo nodokotela we-radiologist ukuze abheke kalula i-Monitor, ngaphandle kwalapho kufakwa isipikili esiphezulu esivuthayo. Yize kungaphoqelekile, ababhali bancoma ukuthi i-C-ARM ihanjiswe ohlangothini olufanayo nodokotela ohlinzayo ngakolunye uhlangothi lapho kuqhutshwa isikulufa se-medial extlocking. Ngenye indlela, umshini we-C-arm kufanele ubekwe ohlangothini oluthintekile ngenkathi udokotela ohlinzayo enza inqubo ngohlangothini lwamalungu (Umdwebo 3). Le yindlela esetshenziswa kakhulu ngababhali ngoba igwema isidingo sodokotela ohlinzayo ukuthi basuke ohlangothini lwe-medial liye ohlangothini olungaphansi lapho beshayela isipikili esikhiyiwe.
Umdwebo 3: Udokotela ohlinzayo umi ngakolunye uhlangothi lweTibia ethintekile ukuze isikulufa esihlangene se-Medial siqhutshwa kalula. Isibonisi sitholakala maqondana nodokotela ohlinzayo, ekhanda le-C-ARM.
Yonke imibono ye-fluoroscertereor ne-medial-lateral itholakala ngaphandle kokuhambisa umlenze othintekile. Lokhu kugwema ukufuduka kwesiza se-fracture esekwe kabusha ngaphambi kokuba ukuqhekeka kuxazululwe ngokuphelele. Ngaphezu kwalokho, izithombe zobude obugcwele ze-tibia zingatholakala ngaphandle kokulinganisa i-C-MEM ngendlela echazwe ngenhla.
Ukuvela kwesikhumba kokubili ukufakwa okulinganiselwe futhi okunwetshiwe kufanelekile. Indlela ye-Supcutaneal Suprapatellar ye-intrametullary nail isuselwa ekusetshenzisweni kwe-3-cm incision ukushayela isipikili. Iningi lalezi zinto ezihlinzayo, kodwa futhi zingaba nokuguquguquka, njengoba kunconywe nguDkt Morandi, kanye nokuvela okwengeziwe okusetshenziswa nguDkt Torntella kanti abanye baboniswa ezigulini ezihlangene noma ze-parapatellar ezihlangene. Umdwebo 4 ukhombisa ukungezwani okuhlukile.
Umdwebo 4: Umfanekiso wezindlela ezahlukene zokuhlinza incistsotions.1- suprapatellar transpatellar ligament, 2- Indlela yokuLigament ye-Parapatellar Ligament; Indlela yokugana enomkhawulo we-parapatellar ligance; 4- Indlela Ehlala Isikhathi Esingapheli Somhlaba I-Parapatellar Ligament; 5- Indlela yokuLigateral Ligamellar 5- I-Latapatellar Ligament. Ukuvezwa okujulile kwendlela ye-parapatellar ligament kungaba ngokusebenzisa okuhlanganisiwe noma ngaphandle kwe-bursa ehlanganisiwe.
Ukuvezwa okujulile
Indlela ye-Supcutaneal Suprapatellar yenziwa ngokuyinhloko ngokuhlukanisa ama-quadriceps tendon kuze kube yilapho igebe lingathola ukudlula kwezinsimbi ezifana nezinzipho zomhlaba. Indlela ye-parapatellar ligament, edlula eduze kwemisipha ye-quadriceps, nayo ingakhonjiswa ngeTibials Interial Neil Technique. Inaliti ye-blunt trocar ne-cannula idluliselwa ngokucophelela ngokuhlanganiswa kwe-patellofemaeral, inqubo eqondisa ngokuyinhloko iphuzu lokungena elingaphandle le-tibial-ancy of tibial in nail insiza yowesifazane. Lapho i-trocrar isekwe kahle, kufanele ivikelwe endaweni yokugwema ukulimala kwe-carticular ye-articular yedolo.
Indlela enkulu yokufaka umhumushi ingasetshenziswa ngokubambisana ne-hyperextension parapatellar yesikhumba incision, ngendlela ye-medial noma ye-lateral. Yize abanye odokotela abahlinzayo bengagcini iBursa invaoperaipeatively, Kubiak et al. Kholwa ukuthi iBursa kufanele igcinwe i-Interacting nezakhiwo ezengeziwe ze-acticular kufanele zivezwe ngokwanele. Ngokweqiniso, lokhu kunikeza ukuvikela okuhle kakhulu kwedolo ngokuhlangana futhi kuvimbela ukulimala okufana nokutheleleka kwamadolo.
Le ndlela echazwe ngenhla ibuye ifake ne-hemi-disloation ye-patella, enciphisa ingcindezi yokuxhumana ezindaweni ezizwakalayo ngezinga elithile. Lapho kunzima ukwenza ukuhlolwa okuhlangene kwe-PateloLofeemore nge-cavity encane ehlanganisiwe kanye nedivaysi elilinganiselwe elilinganiselwe, ababhali bancoma ukuthi i-patella ingahle ihlukaniswe yi-ligament ukuhlukaniswa kwe-ligament. Ngakolunye uhlangothi, i-incision ephakathi nendawo, igwema ukulimala kwama-ligaments asekelayo, kepha kunzima ukwenza ukulungiswa okulimazayo kwamadolo.
Iphoyinti lokungena nge-SPN inaliti liyafana naleso sendlela ye-infrapatellar. I-fluoroscopy ye-anterior ne-lateral ngesikhathi sokufaka inaliti kuqinisekisa ukuthi iphuzu lokufaka inaliti lilungile. Udokotela ohlinzayo kufanele aqinisekise ukuthi inaliti eqondisayo ayiqhutshwa kakhulu engcupheni ye-Tibia eProximal. Uma kuqhutshwa ngokujulile kusemuva kakhulu, kufanele kubekelwe ngosizo lwesipikili esivimba ngaphansi kwe-fluoroscopy yangemuva. Ngaphezu kwalokho, i-Eastman et al. Kholwa ukuthi ukumba i-PIN yokungena endaweni enezimo ezivelelekile ezicijinikile ekuphakamiseni kokuqhekeka okulandelayo endaweni ye-hyreexted.
Amathuluzi Okuncishiswa
Amathuluzi angokoqobo okuncishiswa afaka ama-FOIT Reculiction ForcePs of osayizi ahlukene, ama-lifters wesifazane, amadivaysi okulungiswa kwangaphandle, kanye nezifo zangaphakathi zokulungiswa kwezingcezu ezincane ze-cortical. Ukuvimba izinzipho kungasetshenziselwa futhi inqubo yokunciphisa okushiwo ngenhla. Izando zokunciphisa zisetshenziselwa ukulungisa i-sagittal monation kanye nokukhubazeka kwezithangami.
Ukufakwa
Abakhiqizi abaningi be-Orthopedic Focators bangaphakathi bathuthukise ukusetshenziswa kwezinsimbi ukuqondisa ukubekwa okujwayelekile kwezipikili ze-tibialntramentary. Kubandakanya ingalo eyengeziwe yokuma, idivaysi yokulinganisa ubude be-Pin ubude, kanye ne-medullary Exper. Kubaluleke kakhulu ukuthi izikhonkwane ze-trocrar kanye ne-blunt trocrar zivikela ukungena kwezikhala ezihlangene kahle. Udokotela ohlinzayo kufanele aqinisekise isikhundla se-cannula ukuze kulimaze i-patelofemoral okuhlangene noma izakhiwo ze-periarticular ngenxa yokusondela kakhulu kwidivayisi yokushayela akwenzeki.
Ukukhiya izikulufo
Udokotela ohlinzayo kufanele aqinisekise ukuthi inani elanele lezikulufo ezikhiyayo zifakwa ukuze zilondoloze ukuncishiswa okugculisayo. Ukulungiswa kwezingcezwana ze-fracture ezincane (i-proximal noma i-distal) kufezwa ngezikulufo ezi-3 noma ngaphezulu ezikhiyiwe phakathi kwezingcezwana ezisondelene, noma ngezikulufo ezihleliwe zodwa. Indlela ye-Suprapatellar eTibial Interial Neil Technique ifana nendlela ye-infrapatellar ngokuya ngenqubo yokushayela yesikulufa. Izikulufa ezikhiya ziqhutshwa kahle ngaphansi kwe-fluoroscopy.
Ukuvalwa kwenxelo
Ukumunca ngokuhambisana okufanele ngesikhathi sokuhlanza kususa izingcezwana zamathambo zamahhala. Onke amanxeba adinga ukuniselwa ngokuphelele, ikakhulukazi isiza sokuhliswa kwamadolo. Ingqimba ye-Quadriceps tendon noma i-ligament kanye ne-suture esizeni se-rapture bese kuvalwa, kulandelwe ukuvalwa kwe-dermis nesikhumba.
Ukususwa kwesipikili se-intramedullary
Ukuthi i-tibial intramentary nail eqhutshwa ngendlela ye-suprapatellar ingasuswa ngendlela ehlukile yokuhlinzwa ihlala iphikisana. Indlela ejwayelekile kakhulu indlela ye-transarticular suprapatellar yendlela yokususwa kwe-intrametundary yezipikili. Le ndlela iveza izipikili ngokumba ngesiteshi se-suprapatellar intramenduvary nail Channel usebenzisa i-5.5 mm hollow drill. Ithuluzi lokususa izipikili liqhutshwa ngesiteshi, kepha le mineuver ingaba nzima. Izindlela ze-parapatellar kanye ne-infrapatellar zingezona ezinye izindlela zokususa izipikili zomhlaba.
Zibeka engcupheni yokuhlinzwa yendlela ye-suprapatellar eTibials I-intramengractial Technique Nail Technicique ukulimala kwezokwelapha ku-Patella nasekulimaleni kwezokwelapha kwezinye izinhlaka zezokwelapha, ukutheleleka okuhlangene, kanye nemfucumfucu ye-Intra-articular. Kodwa-ke, kunokuntuleka kwemibiko ehambelana nemitholampilo ehambelana nemitholampilo. Iziguli ezine-chondromalacia zizoba zithambekele ekulimaleni okwelashwa ngezokwelapha. Ukulimala Kwezokwelapha ku-Patellar kanye nezakhiwo ze-teleral articular support kuyinto ekhathazayo enkulu odokotela abahlinzayo besebenzisa le ndlela yokuhlinza, ikakhulukazi indlela yokuhambisa.
Kuze kube manje, abukho ubufakazi bemitholampilo bezibalo ngezinzuzo nokubi kwenqubo yokungezelela kwezipikili ze-invaltial.
Isikhathi Sokuthumela: Oct-23-2023
