Xa ukhetha isicwangciso sonyango lwezaphuko ze-tibial ezikude, ukufakelwa kwangaphandle kungasetyenziswa njengokufakelwa okwethutyana kwazaphuko ezineengozi ezinkulu zezicubu ezithambileyo.
Iimpawu:
"Ulawulo lomonakalo" lulungiso lwexeshana lwezaphuko kunye nokulimala okukhulu kwezicubu ezithambileyo, njengokuqhekeka okuvulekileyo okanye ukwaphuka okuvaliweyo kunye nokudumba okukhulu kwezicubu ezithambileyo.
Unyango oluchanekileyo lwamathambo angcolileyo, asulelekileyo, okanye amathambo aqhekekileyo aneengozi ezinkulu zezicubu ezithambileyo.
Euxamine:
Imeko yezicubu ezithambileyo: ①Inxeba elivulekileyo; ②Ukudumba okukhulu kwezicubu ezithambileyo, ukudumba kwezicubu ezithambileyo. Jonga imeko yemithambo-luvo kwaye ubhale phantsi ngononophelo.
Imifanekiso: Ii-X-reyi ze-anteroposterior nezecala ze-tibia, kunye nee-anteroposterior, lateral kunye nee-ankle acupoints ze-ankle joint. Ukuba kurhanelwa ukuba kukho ukwaphuka kwangaphakathi kwe-articular, kufuneka kwenziwe i-CT scan ye-tibial vault.
Ai-natomy:·
"Indawo ekhuselekileyo" ye-anatomical yokubeka iiphini zokubopha zangaphandle ichazwe ngokwamanqanaba ahlukeneyo e-cross-section.
I-metaphysis ekufutshane ye-tibia inika indawo yokhuseleko enjenge-arc yangaphambili engama-220° apho iiphini zokubopha zangaphandle zinokubekwa khona.
Ezinye iindawo ze-tibia zibonelela ngendawo ekhuselekileyo yokufaka inaliti ngaphambi kwe-antermedial kumgama we-120°~140°.
Subuchule bokunyanga
Indawo: Isigulana silala silele etafileni yokusebenza ecacileyo ye-X-ray, kwaye ezinye izinto ezifana nomqamelo okanye ishelufu zifakwa phantsi kwelungu elichaphazelekayo ukunceda ukugcina indawo. Ukubeka iphedi phantsi kwe-ipsilateral hip kujikeleza ilungu elichaphazelekayo ngaphakathi ngaphandle kokujikeleza okugqithisileyo kwangaphandle.
Aindlela yokusondela
Kwiimeko ezininzi, kwenziwa imingxunya emincinci kwi-tibia, calcaneus, kunye ne-metatarsal yokuqala ukuze kubekwe iiphini zokulungisa zangaphandle.··
Ukuqhekeka kwe-fibula kulula ukuyilungisa ukusuka kumda ongaphantsi kwesikhumba ocacileyo osecaleni.
Ukwaphuka kwe-tibial vault ebandakanya ilungu kunokulungiswa ngecala. Ukuba iimeko zezicubu ezithambileyo ziyavuma, kwaye ukuba kuyimfuneko, indlela eqhelekileyo ye-anterolateral okanye ye-medial ingasetyenziselwa ukuqinisa. Ukuba ukuqinisa kwangaphandle kusetyenziswa kuphela njengendlela yokulinganisa okwethutyana, indawo yokungena kwenaliti apho inaliti yokuqinisa yangaphandle icetywayo kufuneka ibe kude nendawo yokugqibela yokuqinisa iinzipho ukuthintela ukungcola kwezicubu ezithambileyo. Ukuqinisa kwangethuba i-fibula kunye neziqwenga zangaphakathi kwe-articular kwenza kube lula ukuqinisa okulandelayo.
Ukulumkela
Lumka nge-external fixation pin track ukuze ufumane i-external fixation field, njengoko izicubu ezingcolisiweyo ziya kukhokelela kwiingxaki emva kotyando. Iindlela eziqhelekileyo ze-anterolateral okanye ze-medial ezine-soft tissue dumbe kakhulu nazo zinokubangela iingxaki ezinkulu ekuphilisweni kwenxeba.
Ukunciphisa kunye nokulungiswa kwezaphuko ze-fibula:
Nanini na xa iimeko zezicubu ezithambileyo zivuma, ukwaphuka kwe-fibula kuqala kuyanyangwa. Ukwaphuka kwe-fibula kuyancitshiswa kwaye kulungiswe kusetyenziswa i-lateral fibular incision, ngesiqhelo ngee-screws ze-3.5mm lag kunye ne-3.5mm l/3 tube plate, okanye i-3.5mm LCDC plate kunye nee-screws. Emva kokuba i-fibula incitshisiwe kwaye ilungisiwe ngokwe-anatomiki, ingasetyenziswa njengomgangatho wokubuyisela ubude be-tibia kunye nokulungisa ukukhubazeka kokujikeleza kwe-tibial fracture.
Ukulumkela
Ukudumba okukhulu kwezicubu ezithambileyo okanye inxeba elivulekileyo kakhulu kunokuthintela ukunamathela kwe-fibula ekuqaleni. Lumka ungalungisi ukwaphuka kwe-proximal fibular kwaye lumka ungalimazi i-proximal superficial peroneal nerve.
Ukwaphuka kweTibial: Ukunciphisa kunye nokulungiswa kwangaphakathi
Ukuqhekeka kwamathambo ngaphakathi kwe-tibial vault kufuneka kuncitshiswe phantsi kombono othe ngqo ngendlela ye-anterolateral okanye ye-medial ye-distal tibia, okanye ngokunciphisa ngesandla ngokungathanga ngqo phantsi kwe-fluoroscopy.
Xa uqhuba isikrufu sokulaxaza, iqhekeza lesaphuko kufuneka lilungiswe ngocingo lweKirschner kuqala.
Ukunciphisa nokulungisa kwangethuba ukwaphuka kwangaphakathi kwethambo kuvumela iindlela ezingafunekiyo zokungenelela kunye nokuguquguquka okukhulu ekulungiseni kwesibini okuqinisekileyo. Iimeko ezingathandekiyo zezicubu ezithambileyo ezifana nokudumba okubonakalayo okanye umonakalo omkhulu wezicubu ezithambileyo zinokuthintela ukuqina kwangethuba kwezicubu zangaphakathi kwethambo.
Ukuqhekeka kweTibial: Ukulungiswa Kwangaphandle kweTransarticular
Isixhobo sokuqinikisa sangaphandle esidibanisa amalungu ahlukeneyo singasetyenziswa.
Ngokweemfuno zendlela yokulungisa inqanaba lesibini, iiphini ezimbini zokulungisa zangaphandle ze-5mm ezinemisonto engaphelelanga zafakwa ngecala okanye ngokusebenzisa imingxunya emincinci kumphezulu we-medial okanye we-anterolateral we-tibia kwisiphelo esikufutshane sokwaphuka.
Okokuqala qhekeza umphezulu wethambo ngokungqalileyo, uze ukhusele izicwili ezijikelezileyo ngesingxobo esithambileyo sokukhusela izicwili, uze ubhoboze, ucofe, uze uqhube isikrufu ngesingxobo.
Izikhonkwane zokulungisa zangaphandle kwisiphelo esikude sesaphuko zingafakwa kwiqhekeza le-tibial elikude, i-calcaneus kunye ne-first metatarsal, okanye intamo ye-talus.
Iiphini zokulungisa zangaphandle ze-Transcalcaneal mazibekwe kwi-calcaneal tuberosity ukusuka kwi-medial ukuya kwi-lateral ukuthintela umonakalo kwizakhiwo ze-medial neurovascular.
Iphini yokulungisa yangaphandle ye-metatarsal yokuqala kufuneka ibekwe kumphezulu we-anteromedial wesiseko se-metatarsal yokuqala.
Ngamanye amaxesha iphini yokubambelela yangaphandle inokufakwa ngaphambili nge-tarsal sinus incision.
Emva koko, i-distal tibia yaphinda yalungiswa kwaye umgca wamandla walungiswa nge-intraoperative fluoroscopy, kwaye kwahlanganiswa i-external fixator.
Xa ulungisa i-fixator yangaphandle, khulula i-connecting clip, yenza i-longitudinal traction, kwaye wenze i-hand reduction ethambileyo phantsi kwe-fluoroscopy ukuze ulungise indawo ye-fracture fracture. Emva koko umqhubi ugcina indawo ngelixa umncedisi eqinisa ii-connecting clips.
Minqaku le-ain
Ukuba ukufakelwa kwangaphandle akuyondlela ichanekileyo yonyango, umzila wenaliti yokufakelwa kwangaphandle kufuneka ugcinwe kude nendawo yokufakelwa echanekileyo ngexesha locwangciso lokusebenza, ukuze kungangcolisi intsimi yokusebenza yexesha elizayo. Uzinzo lokufakelwa kwangaphandle lungandiswa ngokwandisa isithuba seepini zokufakela kwindawo nganye yokuqhekeka, ukwandisa ububanzi beepini, ukwandisa inani leepini zokufakela kunye neentambo zokudibanisa, ukongeza amanqaku okufakela kwi-ankle joint, kunye nokwandisa iplani yokufakela okanye ukusebenzisa i-ring external fixator. Ukulungelelaniswa okufanelekileyo kokulungisa kufuneka kuqinisekiswe ngezigaba zangaphambili-zangasemva kunye nezasecaleni.
Ukuqhekeka kweTibial: ukulungiswa kwangaphandle okungenaspan-articular
Ngamanye amaxesha kukho ukhetho lokufaka i-external fixator engadluli kwi-joint. Ukuba i-distal tibial fragment inkulu ngokwaneleyo ukuba ikwazi ukufaka ii-half-thread external fixation pins, i-external fixator elula ingasetyenziswa. Kwizigulane ezine-metaphyseal fracture fractures ezincinci, i-hybrid external fixator equlathe i-proximal semi-threaded external fixation pin kunye ne-distal fine Kirschner wire iluncedo njengendlela yonyango yexeshana okanye ecacileyo. Kufuneka kuqatshelwe xa kusetyenziswa i-non-span-articular external fixators kwii-fractures ezine-soft tissue contamination. Ukususwa kwesi tissue singcolisiweyo, ukususwa kwendlela yenaliti, kunye nokuvalwa kwe-end of the cast de kube kufuneka ukuphiliswa kakuhle kwenxeba ngaphambi kokuba kwenziwe i-insulation ecacileyo.
I-Sichuan ChenAnHui Technology Co., Ltd
Uqhagamshelwano: Yoyo
I-WhatsApp:+8615682071283
Email: liuyaoyao@medtechcah.com
Ixesha lokuthumela: Feb-10-2023
