Iingcebiso ezi-5 zokulungisa izipikili ze-Intramedullary ze-Distal Tibial Fractures

Imigca emibini yembongo ethi “cut and set internal fixation, closed set intramedullary nailing” ibonisa ngokufanelekileyo isimo sengqondo soogqirha bamathambo malunga nonyango lwe-distal tibia fractures. Nanamhlanje, kusengumbandela woluvo lokuba ingaba ii-plate screws okanye ii-intramedullary nails zingcono na. Nokuba yeyiphi engcono emehlweni kaThixo, namhlanje siza kwenza isishwankathelo seengcebiso zotyando lwe-intramedullary nailing of distal tibial fractures.

Iseti "yetayara elingasetyenziswanga" ngaphambi kotyando

Nangona amalungiselelo esiqhelo ngaphambi kotyando engafunekiyo, kuyacetyiswa ukuba kubekho iseti eyongezelelweyo yezikrufu kunye neepleyiti xa kukho iimeko ezingalindelekanga (umz., umgca ofihlakeleyo wokuqhekeka othintela ukufakwa kwezikrufu ezitshixayo, okanye impazamo yomntu eyenza ukwaphuka kube mandundu kwaye kuthintele ukungasebenzi, njl.njl.) ezinokubangelwa kukusetyenziswa kwezipikili zangaphakathi.

Iziseko ezi-4 zokutshintsha indawo ngempumelelo

Ngenxa ye-anatomy ethe tyaba ye-distal tibial metaphysis, ukutsala okulula kusenokungasoloko kubangela ukuncipha okuphumelelayo. La manqaku alandelayo aya kunceda ukuphucula izinga lempumelelo yokutshintsha indawo:

1. thatha ii-orthopantomograms ngaphambi kotyando okanye ngaphambi kotyando lwelungu eliphilileyo ukuze uthelekise kwaye ubone ubungakanani bokuncipha kokuqhekeka kwethambo kwicala elichaphazelekayo.

2.Sebenzisa indawo yedolo egobileyo ukuze kube lula ukubeka iinzipho kunye ne-fluoroscopy

3.Sebenzisa i-retractor ukugcina ilungu lisendaweni yalo nobude balo

4. Beka izikrufu zeSchanz kwi-tibia ekude neyangasecaleni ukuze uncede ekunciphiseni ukwaphuka.

Iinkcukacha ezi-7 zoNcedo lokuNcitshiswa kunye nokuQhoma

1. Beka iphini yesikhokelo ngokuchanekileyo kwi-tibia ekude ngokusebenzisa isixhobo sokuncedisa esifanelekileyo okanye ngokugoba incam yephini yesikhokelo ngaphambi kokuba uyibeke.

2. Sebenzisa i-forceps yokubuyisela ubuso enencam yesikhumba ukubeka iinzipho zangaphakathi kwi-spiral kunye ne-oblique fractures (Umfanekiso 1)

3. Sebenzisa ipleyiti eqinileyo ene-monocortical fixation (itafile okanye ipleyiti yokucinezela) kwi-open reduction ukugcina i-reduction ide ifakwe isikhonkwane se-intramedullary

4. ukucuthwa komjelo wezipikili ngaphakathi kwe-medullary kusetyenziswa izikrufu zebhloko ukulungisa i-angulation kunye nomjelo ukuphucula impumelelo yokubekwa kwezipikili ngaphakathi kwe-medullary (Umfanekiso 2)

5. kuxhomekeke kuhlobo lokwaphuka, gqiba ekubeni usebenzise izikrufu zokubopha kunye nokubopha okwethutyana ngeSchnee okanye iKirschner pins.

6. thintela ukwaphuka okutsha xa usebenzisa izikrufu ezivimbayo kwizigulana ezine-osteoporosis

7. lungisa i-fibula kuqala uze emva koko ulungise i-tibia xa kukho ukwaphuka kwe-fibula edibeneyo ukuze kube lula ukuphinda ubeke i-tibial endaweni yayo

Umfanekiso 1 Ukutshintshwa kwe-Percutaneous Weber clamp Iimbono ze-Oblique (Imifanekiso A kunye no-B) zibonisa ukwaphuka kwe-tibia elula evumela ukutshintshwa kwe-fluoroscopic percutaneous minimally invasive sharp-nosed clamp okudala umonakalo omncinci kwizicubu ezithambileyo.

Umzobo 2 Ukusetyenziswa kwezikrufu ezithintelayo Umzobo A ubonisa ukwaphuka okuxineneyo kwe-distal tibial metaphysis kulandelwa kukukhubazeka kwe-posterior angulation, kunye nokukhubazeka kwe-inversion okushiyekileyo emva kokulungiswa kwe-fibular nangona kulungiswe ukukhubazeka kwe-sagittal posterior angulation (Umzobo C) (Umzobo B), kunye nesikrufu esinye esithintelayo esibekwe ngasemva kunye nesinye ecaleni kwisiphelo se-distal sokuqhekeka (Umzobo B kunye no-C), kunye nokwanda kwe-medullary emva kokubeka ii-guide pin ukulungisa ngakumbi ukukhubazeka kwe-coronal (Umzobo D), ngelixa kugcinwa i-sagittal equilibrium (E)
Amanqaku ama-6 okulungiswa kwe-intramedullary

1. Ukuba ithambo elikude lesaphuko linamathambo aneleyo, isikhonkwane se-intramedullary sinokulungiswa ngokufaka izikrufu ezi-4 kwii-engile ezahlukeneyo (ukuphucula uzinzo lwee-axes ezininzi), ukuze kuphuculwe ubulukhuni besakhiwo.
2. Sebenzisa izikhonkwane ze-intramedullary ezivumela izikrufu ezifakiweyo ukuba zidlule kwaye zenze isakhiwo sokutshixa esinozinzo lwe-angular.
3. Sebenzisa izikrufu ezityebileyo, izikrufu ezininzi, kunye neendawo ezininzi zokubeka izikrufu ukuze usasaze izikrufu phakathi kweziphelo ezikude nezikufutshane zokuqhekeka ukuze uqinise isiphumo sokuqiniswa kwezipikili zangaphakathi.
4. Ukuba uzipho lwe-intramedullary lubekwe kude kakhulu ukuze ucingo olukhokelayo olugobileyo luthintele ukwanda kwe-tibial ekude, ngoko ucingo olukhokelayo olugobileyo okanye olugobileyo olukude lungasetyenziswa.
5. Gcina uzipho oluvimbayo kunye nepleyiti de kube kuncitshisiwe ukwaphuka, ngaphandle kokuba uzipho oluvimbayo luthintela uzipho olungaphakathi kwe-medullary ukuba lungasasazeki ithambo okanye ipleyiti ye-unicortical yonakalisa izicubu ezithambileyo.
6. Ukuba iinzipho kunye nezikrufu ze-intramedullary aziboneleli ngokunciphisa nokuqinisa okwaneleyo, ipleyiti okanye isikrufu esingena esikhumbeni singongezwa ukonyusa uzinzo lweenzipho ze-intramedullary.

Izikhumbuzo

Ngaphezulu kwe-1/3 yezaphuko ze-tibia ezikude zibandakanya ilungu. Ngokukodwa, ukwaphuka kwesiqu se-tibial esikude, ukwaphuka kwe-tibial ejikelezayo, okanye ukwaphuka kwe-spiral fibular okunxulumene noko kufuneka kuphandwe ukuze kufunyanwe ukwaphuka kwe-intra-articular. Ukuba kunjalo, ukwaphuka kwe-intra-articular kufuneka kulawulwe ngokwahlukeneyo ngaphambi kokubekwa kwenzipho ze-intramedullary.