Malangizo 5 Othandizira Kukonza Misomali Yamkati mwa Mafupa a Distal Tibial Fractures

Mizere iwiri ya ndakatulo yakuti “cut and set internal fixation, closed set intramedullary nailing” ikuwonetsa bwino momwe madokotala a opaleshoni ya mafupa amaonera chithandizo cha kusweka kwa tibia yakutali. Mpaka lero, nkhani ikadali yokhudza maganizo a anthu ngati zomangira za mbale kapena misomali ya intramedullary ndi zabwino. Mosasamala kanthu kuti ndi iti yomwe ili yabwino kwambiri pamaso pa Mulungu, lero tipereka chidule cha malangizo a opaleshoni yosweka kwa tibia yakutali mkati mwa medullary.

Seti ya "tayala lowonjezera" lisanachitidwe opaleshoni

Ngakhale kukonzekera kwanthawi zonse musanachite opaleshoni sikofunikira, tikukulimbikitsani kukhala ndi zomangira ndi mbale zina ngati pachitika zinthu zosayembekezereka (monga mzere wobisika wosweka womwe umaletsa kuyika zomangira zokhoma, kapena zolakwika za anthu zomwe zimawonjezera kusweka ndikuletsa kulephera kuyenda, ndi zina zotero) zomwe zingachitike chifukwa chogwiritsa ntchito misomali yamkati mwa intramedullary.

Maziko anayi osinthira bwino malo

Chifukwa cha kapangidwe kake ka oblique ka distal tibial metaphysis, kukhudza kosavuta sikungapangitse kuti nthawi zonse kuchepetse bwino. Mfundo zotsatirazi zithandiza kupititsa patsogolo kupambana kwa malo osinthira:

1. tengani ma orthopantomogram a mwendo wathanzi musanachite opaleshoni kapena mkati mwa opaleshoni kuti muyerekezere ndikupeza kuchuluka kwa kusweka kwa mbali yokhudzidwayo.

2. Gwiritsani ntchito bondo lopindika pang'ono kuti muzitha kuyika misomali ndi fluoroscopy

3. Gwiritsani ntchito chobwezera kuti mwendo ukhale pamalo ake komanso kutalika kwake

4. Ikani zomangira za Schanz mu tibia yakutali ndi yoyandikana nayo kuti zithandize kuchepetsa kusweka kwa mafupa.

Tsatanetsatane 7 wa Kuchepetsa ndi Kuletsa Kuyenda

1. Ikani pini yotsogolera bwino mu tibia yakutali pogwiritsa ntchito chipangizo choyenera chothandizira kapena kupotoza nsonga ya pini yotsogolera musanayiyike.

2. Gwiritsani ntchito forceps yokonzanso pamwamba yokhala ndi nsonga ya khungu kuti muike misomali yamkati mwa medullary m'mafupa ozungulira ndi oblique (Chithunzi 1)

3. Gwiritsani ntchito mbale yolimba yokhala ndi chogwirizira chimodzi (tabular kapena compression plate) mu open reduction kuti musunge reduction mpaka msomali wa intramedullary utalowetsedwa

4. kuchepetsa njira ya msomali ya intramedullary pogwiritsa ntchito zomangira zomangira kuti akonze mawonekedwe ake ndi njira kuti ziwongolere bwino malo oikira msomali wa intramedullary (Chithunzi 2)

5. kutengera mtundu wa kusweka, sankhani ngati mugwiritse ntchito zomangira zomangira ndi zomangira zomangira kwakanthawi ndi ma pini a Schnee kapena Kirschner.

6. Pewani kusweka kwatsopano pogwiritsa ntchito zomangira zotsekera mwa odwala osteoporosis

7. Konzani fibula poyamba kenako tibia ngati fibula yasweka pamodzi kuti muthandize kusintha malo a tibia

Chithunzi 1 Kuyikanso clamp ya Percutaneous Weber Mawonekedwe a Oblique (Zithunzi A ndi B) zikusonyeza kusweka kosavuta kwa tibia komwe kumadzipangitsa kukhala ndi fluoroscopic percutaneous minimally invasive sharp-nosed clamp reposition yomwe siiwononga minofu yofewa.

Chithunzi 2 Kugwiritsa ntchito zomangira zotchingira Chithunzi A chikuwonetsa kusweka kwakukulu kwa distal tibial metaphysis kutsatiridwa ndi kusokonekera kwa posterior angulation, ndi kusokonekera kotsalira kwa inversion pambuyo pa fibular fixation ngakhale kukonza sagittal posterior angulation deformity (Chithunzi C) (Chithunzi B), ndi screw imodzi yotchingira yomwe yayikidwa kumbuyo ndi ina kumbali ya distal kumapeto kwa kusweka (Zithunzi B ndi C), ndi kufalikira kwa medullary pambuyo poyika ma guide pini kuti akonzenso coronal deformity (Chithunzi D), pamene akusunga sagittal equilibrium (E)
Ma point 6 oti muyike intramedullary fixation

1. Ngati fupa lakutali la fupa loswekalo lili ndi mafupa okwanira, msomali wa intramedullary ukhoza kukhazikika poika zomangira zinayi m'makona osiyanasiyana (kuti ziwongolere kukhazikika kwa nkhwangwa zingapo), kuti ziwongolere kulimba kwa kapangidwe kake.
2. Gwiritsani ntchito misomali ya intramedullary yomwe imalola zomangira zomwe zayikidwa kuti zidutse ndikupanga kapangidwe kotseka kolimba.
3. Gwiritsani ntchito zomangira zokhuthala, zomangira zingapo, ndi malo angapo oyika zomangira kuti mugawire zomangirazo pakati pa malekezero akutali ndi oyandikira a fracture kuti mulimbikitse mphamvu yokhazikika ya msomali wa intramedullary.
4. Ngati msomali wa intramedullary wayikidwa patali kwambiri kotero kuti waya wotsogolera womwe unapingiritsidwa kale ulepheretse kukula kwa tibial yakutali, ndiye kuti waya wotsogolera womwe sunapingiritsidwe kale kapena wosapingirizidwa wakutali ungagwiritsidwe ntchito.
5. Sungani msomali wotsekereza ndi mbale mpaka kuswekako kuchepe, pokhapokha ngati msomali wotsekerezawo uletsa msomali wa intramedullary kufalikira kwa fupa kapena mbale ya unicortical ikuwononga minofu yofewa.
6. Ngati misomali ndi zomangira zamkati mwa medullary sizikupereka kuchepetsa ndi kukhazikika kokwanira, mbale kapena zomangira zamkati mwa medullary zitha kuwonjezeredwa kuti ziwonjezere kukhazikika kwa misomali yamkati mwa medullary.

Zikumbutso

Kupitirira 1/3 ya kusweka kwa tibia ya distal kumakhudza cholumikizira. Makamaka, kusweka kwa tsinde la tibial ya distal, kusweka kwa tibial yozungulira, kapena kusweka kwa spiral fibular komwe kumagwirizana nako kuyenera kufufuzidwa kuti mudziwe ngati pali kusweka kwa intra-articular. Ngati ndi choncho, kusweka kwa intra-articular kuyenera kuyang'aniridwa padera musanayike msomali wa intramedullary.