Mizere iwiri ya ndakatulo "kudula ndi kuyika kukhazikika kwamkati, kutsekedwa kwa intramedullary nailing" kumasonyeza bwino maganizo a madokotala ochita opaleshoni ya mafupa pa chithandizo cha distal tibia fractures. Mpaka lero, akadali nkhani yamalingaliro ngati zomangira mbale kapena misomali ya intramedullary ndizabwinoko. Mosasamala kanthu za zomwe zili bwino kwambiri pamaso pa Mulungu, lero tipanga mwachidule maupangiri opangira opaleshoni ya intramedullary misomali ya distal tibial fractures.
Preoperative "tayala lopatula".
Ngakhale kukonzekera preoperative sikofunikira, tikulimbikitsidwa kukhala ndi zotsalira za zomangira ndi mbale ngati zinthu zosayembekezereka (mwachitsanzo, chobisika fracture mzere kumalepheretsa kuyika kwa zomangira zotsekera, kapena kulakwitsa kwa anthu kuti aggravates fracture ndi kupewa immobilization, etc.) zomwe zingabwere chifukwa ntchito intramedullary misomali.
Maziko 4 oyikanso bwino
Chifukwa cha oblique anatomy ya distal tibial metaphysis, kukopa kosavuta sikungakhale kothandiza kuchepetsa bwino. Mfundo zotsatirazi zithandizira kuwongolera kuchuluka kwabwino kwa kuyikanso:
1. tengani preoperative kapena intraoperative orthopantomograms ya chiwalo chathanzi kuti mufanizire ndi kudziwa kuchuluka kwa kuchepa kwa fracture pa mbali yomwe yakhudzidwa.
2.gwiritsani ntchito mawondo opindika pang'ono kuti athandize kuika misomali ndi fluoroscopy
3.gwiritsani ntchito retractor kuti musunge nthambi pamalo ndi kutalika kwake
4.Place Schanz screws mu distal ndi proximal tibia kuti athandize kuchepetsa fracture.
7 Tsatanetsatane wa Kuchepetsa Thandizo ndi Kusasunthika
1. Ikani pini yolondolera molondola mu distal tibia pogwiritsa ntchito chipangizo choyenera chothandizira kapena kupotoza nsonga ya pini yotsogolera musanayike.
2. gwiritsani ntchito nsonga zotsitsimutsa khungu kuti muyike misomali ya intramedullary mu fractures yozungulira ndi oblique (Chithunzi 1)
3. gwiritsani ntchito mbale yolimba yokhala ndi monocortical fixation (tabular kapena compression plate) pochepetsa poyera kuti muchepetse mpaka msomali wa intramedullary utayikidwa.
4. Kuchepetsa kwa njira ya intramedullary misomali pogwiritsa ntchito zomangira zomangira kuti ziwongolere kung'ung'udza ndi njira kuti zithandizire bwino pakuyika kwa misomali (Chithunzi 2)
5. kutengera mtundu wa fracture, sankhani ngati mugwiritse ntchito zomangira zomangira ndi kutsekereza kwakanthawi kotsekereza ndi zikhomo za Schnee kapena Kirschner.
6. kupewa fractures atsopano pamene ntchito kutsekereza zomangira odwala osteoporotic
7. konzani fibula poyamba ndiyeno tibia pa nkhani ya fracture yophatikizika ya fibula kuti muthandize kukonzanso kwa tibial
Chithunzi 1 Percutaneous Weber clamp repositioning Oblique view (Zizindikiro A ndi B) zikuwonetsa kuthyoka kosavuta kwa tibia komwe kumapangitsa kuti pakhale minyewa yakuthwa yapamphuno yomwe imawononga pang'ono minofu yofewa.
Chithunzi cha 2 Kugwiritsa ntchito zomangira zotsekera Chithunzi A chikuwonetsa kuphulika kwakukulu kwa distal tibial metaphysis kutsatiridwa ndi kusinthika kwapambuyo kwa angulation, ndi zotsalira zotsalira zowonongeka pambuyo pa kukhazikitsidwa kwa fibular ngakhale kukonzedwa kwa sagittal posterior angulation deformity (Fig. C) (Fig. C) (Fig. B) (Fig. fracture (Fig. B ndi C), ndi medullary dilatation pambuyo poyika zikhomo zowongolera kuti apititse patsogolo kusinthika kwa coronal (Mkuyu. D), ndikusunga sagittal equilibrium (E)
6 mfundo za intramedullary fixation
- Ngati fupa la distal la fracture liri ndi mafupa okwanira, msomali wa intramedullary ukhoza kukhazikitsidwa mwa kuyika zomangira 4 m'makona angapo (kupititsa patsogolo kukhazikika kwa nkhwangwa zambiri), kuti apititse patsogolo kukhazikika kwapangidwe.
- Gwiritsani ntchito misomali ya intramedullary yomwe imalola zomangira zomwe zidalowetsedwa kuti zidutse ndikupanga chotchinga chokhazikika.
- Gwiritsani ntchito zomangira zokhuthala, zomangira zingapo, ndi ndege zingapo zoyika wononga kuti mugawire zomangira pakati pa malekezero otalikirana ndi opindika a chosweka kuti mulimbikitse kukhazikika kwa msomali wa intramedullary.
- Ngati msomali wa intramedullary umayikidwa patali kwambiri kotero kuti pre-bent guidewire imalepheretsa kufalikira kwa distal tibial, ndiye kuti palibe chowongolera kapena distal non-expansion chingagwiritsidwe ntchito.
- Pitirizani kutsekereza msomali ndi mbale mpaka kuthyokako kuchepetsedwa, pokhapokha ngati msomali wotsekereza umalepheretsa msomali wa intramedullary kuti usafalitse fupa kapena mbale ya unicortical imawononga minofu yofewa.
- Ngati misomali ya intramedullary ndi zomangira sizipereka kuchepetsedwa kokwanira ndi kukonza, mbale ya percutaneous kapena screw ikhoza kuwonjezeredwa kuti muwonjezere kukhazikika kwa misomali ya intramedullary.
Zikumbutso
Zoposa 1/3 za distal tibia fractures zimaphatikizapo mgwirizano. Makamaka, kupasuka kwa distal tibial tsinde, spiral tibial fractures, kapena kugwirizana kwa spiral fibular fractures ziyenera kufufuzidwa chifukwa cha fractures ya intra-articular. Ngati ndi choncho, fracture ya intra-articular iyenera kuyang'aniridwa mosiyana musanayike msomali wa intramedullary.
Nthawi yotumiza: Oct-31-2023
