Imigca emibini yombongo "ukusika kunye nokubeka ukulungiswa kwangaphakathi, isethi evaliweyo ye-intramedullary nailing" ibonakalisa ngokufanelekileyo isimo sengqondo soogqirha bamathambo ngokubhekiselele kunyango lwe-distal tibia fractures. Ukuza kuthi ga namhlanje, kusengumbandela woluvo ukuba ngaba izikrufu zeplate okanye izikhonkwane ze-intramedullary zingcono. Nokuba yeyiphi eyona nto ingcono emehlweni kaThixo, namhlanje siza kwenza ushwankathelo lweengcebiso zotyando zokubethelwa kwe-intramedullary ye-distal tibial fractures.
Iseti yangaphambi kotyando "ivili elisecaleni".
Nangona amalungiselelo esiqhelo angaphambi kokuhlinzwa ayimfuneko, kuyacetyiswa ukuba ube neseti esecaleni yezikrufu kunye neepleyiti kwiimeko ezingalindelekanga (umzekelo, umgca wokuqhekeka ofihliweyo othintela ukubekwa kwezikhonkwane zokutshixa, okanye impazamo yomntu eyenza kube mandundu ukuphuka kunye nokuthintela immobilization, njl. njl.) ezinokuvela ekusebenziseni izikhonkwane ze-intramedullary.
Iziseko ezi-4 zokubeka ngokutsha ngempumelelo
Ngenxa ye-oblique anatomy ye-distal tibial metaphysis, i-traction elula ayinakuhlala ibangela ukunciphisa ngempumelelo. La manqaku alandelayo aya kunceda ekuphuculeni izinga lempumelelo yokubekwa ngokutsha:
1. thatha i-orthopantomograms yangaphambili okanye i-intraoperative ye-othopantomograms yomlenze ophilileyo ukuthelekisa kunye nokugqiba ubungakanani bokunciphisa ukuphuka kwicala elichaphazelekayo.
2.sebenzisa i-semi-flexed knee position ukuze kube lula ukubeka izikhonkwane kunye ne-fluoroscopy
3.sebenzisa iretractor ukugcina ilungu kwindawo kunye nobude
I-4.Ifake i-Schanz screws kwi-distal kunye ne-proximal tibia ukuze uncede ekunciphiseni ukuphuka.
7 Iinkcukacha zokuNcitshiswa koNcedo kunye nokuPhuculwa
1. Beka ipini yesikhokelo ngokuchanekileyo kwi-distal tibia ngokusebenzisa isixhobo esifanelekileyo sokuncedisa okanye ngokugoba kwangaphambili incam yesikhonkwane sesikhokelo ngaphambi kokubekwa.
2. sebenzisa i-forceps ye-skin-tipped resurfacing forceps ukubeka izikhonkwane ze-intramedullary kwi-spiral kunye ne-oblique fractures (Umfanekiso 1)
3. sebenzisa ipleyiti eqinile kunye nokulungiswa kwe-monocortical (i-tabular okanye i-compression plate) ekunciphiseni okuvulekileyo ukugcina ukunciphisa kude kube kufakwe isikhonkwane se-intramedullary.
4. ukucuthwa kweshaneli ye-intramedullary nail usebenzisa izikrufu zebhloko ukulungisa i-angulation kunye neshaneli yokuphucula ukuphumelela kokubekwa kwe-intramedullary nail (Umfanekiso 2)
5. ngokuxhomekeka kuhlobo lokuphuka, thatha isigqibo sokuba usebenzise izikrufu zokulungisa kunye nokulungiswa kokuthintela okwethutyana kunye nezikhonkwane ze-Schnee okanye ze-Kirschner.
6. ukuthintela ukuqhekeka okutsha xa usebenzisa izikrufu zokuthintela kwizigulane ze-osteoporotic
7. lungisa i-fibula kuqala kwaye emva koko i-tibia kwimeko yokuqhekeka kwe-fibula edibeneyo ukuze kube lula ukubuyisela i-tibial
Umzobo 1 I-Percutaneous i-Weber clamp ibeka kwakhona iimbono ze-Oblique (Amanani A kunye no-B) acebisa ukwaphuka kwe-distal tibia ngokulula okuziboleka kwi-fluoroscopic percutaneous invasive minimally invasive sharp-nosed clamp repositioning ebangela umonakalo omncinci kwizihlunu ezithambileyo.
Umzobo we-2 Ukusetyenziswa kwe-screws yokuthintela Umzobo A ubonisa ukuphuka okuphezulu kwe-distal tibial metaphysis elandelwa yi-posterior angulation deformity, kunye ne-residual inversion deformity emva kokulungiswa kwe-fibular nangona ukulungiswa kwe-sagittal posterior angulation deformity (Fig. C) (Fig. C) (Fig. B) (Fig. ukuphuka (amaFig. B kunye no-C), kunye ne-medullary dilatation emva kokubeka izikhonkwane zesikhokelo ukuqhubela phambili ukulungisa i-coronal deformity (Umfanekiso D), ngelixa ugcina ukulingana kwe-sagittal (E)
Amanqaku ama-6 okulungiswa kwe-intramedullary
- Ukuba ithambo elikude le-fracture lanele ngokwaneleyo, isikhonkwane se-intramedullary sinokulungiswa ngokufaka i-screws ezi-4 kwii-angles ezininzi (ukuphucula ukuzinza kwee-axes ezininzi), ukwenzela ukuba kuphuculwe ukuqina kwesakhiwo.
- Sebenzisa izikhonkwane ze-intramedullary ezivumela ukuba izikrufu ezifakiweyo zidlule kwaye zenze isakhiwo sokutshixa ngokuzinza kwe-angular.
- Sebenzisa izikrufu ezingqindilili, izikrufu ezininzi, kunye neenqwelo-moya ezininzi zokubeka izikrufu ukuze usasaze izikrufu phakathi kweziphelo ezikude kunye nezisondeleleneyo zokwaphuka ukomeleza isiphumo sokulungisa isikhonkwane se-intramedullary.
- Ukuba isikhonkwane se-intramedullary sibekwe kude kakhulu ukwenzela ukuba i-guide-bent guidewire inqanda ukwandiswa kwe-distal tibial, ngoko i-guide-pre-bent guidewire okanye i-distal non-expansion ingasetyenziswa.
- Gcina i-nail yokuthintela kunye nepleyiti kuze kube yilapho i-fracture iyancipha, ngaphandle kokuba isikhonkwane sokuthintela sithintela isikhonkwane se-intramedullary ekusasazeni ithambo okanye i-unicortical plate iyonakalisa izicubu ezithambileyo.
- Ukuba izikhonkwane ze-intramedullary kunye ne-screws aziboneleli ngokunciphisa ngokwaneleyo kunye nokulungiswa, i-percutaneous plate okanye i-screw inokongezwa ukunyusa ukuzinza kwezipikili ze-intramedullary.
Izikhumbuzo
Ngaphezulu kwe-1/3 ye-distal tibia fractures ibandakanya ukudibanisa. Ngokukodwa, iifractures ze-distal tibial stem, i-spiral tibial fractures, okanye i-spiral fibular fractures ehambelana nayo kufuneka iphandwe nge-intra-articular fractures. Ukuba kunjalo, i-intra-articular fracture kufuneka ilawulwe ngokwahlukileyo ngaphambi kokubekwa kwesikhonkwane se-intramedullary.
Ixesha lokuposa: Oct-31-2023
