Xa ukhetha isicwangciso sonyango lwe-distal tibial fractures, ukulungiswa kwangaphandle kungasetyenziselwa ukulungiswa kwesikhashana kweefractures kunye nokulimala okukhulu kwezicubu ezithambileyo.
Iimpawu:
"Ulawulo lomonakalo" ukulungiswa kwexeshana kweefractures kunye nokulimala okubonakalayo kwezicubu ezithambileyo, ezifana nezahlulo ezivulekileyo okanye iifractures ezivaliweyo kunye nokudumba okubonakalayo kwezicubu ezithambileyo.
Unyango oluqinisekileyo lokungcoliseka, iifractures ezosulelekileyo, okanye iifracture ezinokwenzakala okuthambileyo kwezicubu.
Examine:
Imeko yezihlunu ezithambileyo: ① Inxeba elivulekileyo;②Ukudumba kwezicubu ezithambileyo kakhulu.Jonga imeko ye-neurovascular kwaye urekhode ngononophelo.
Ukucinga: I-Anteroposterior kunye ne-lateral X-rays ye-tibia, kunye ne-anteroposterior, i-lateral kunye ne-ankle acupoints ye-ankle joint.Ukuba i-intra-articular fracture ikrokrelwa, i-CT scan ye-tibial vault kufuneka yenziwe.
Anatomy:·
I-anatomical "indawo ekhuselekileyo" yokubekwa kwepini yokulungisa yangaphandle ichazwe ngokwamanqanaba ahlukeneyo e-cross-section.
I-metaphysis esondeleyo ye-tibia ibonelela nge-220 ° indawo yokhuseleko lwangaphambili lwe-arc apho izikhonkwane zokulungiswa kwangaphandle zingafakwa.
Ezinye iindawo ze-tibia zibonelela ngendawo yokufaka inaliti ekhuselekileyo ye-anteromedial kuluhlu lwe-120 ° ~ 140 °.
Subuchule botyando
Isikhundla: Isigulana silala phantsi kwi-X-ray yetafile yokusebenza ebonakalayo, kunye nezinye izinto ezifana ne-cushion okanye i-shelf zibekwe phantsi kwelungu elichaphazelekayo ukunceda ukugcina isikhundla.Ukubeka i-pad phantsi kwe-hip ye-ipsilateral ijikeleza umlenze ochaphazelekayo ngaphakathi ngaphandle kokujikeleza kwangaphandle okugqithisileyo.
Asondela
Kwiimeko ezininzi, izithintelo ezincinci zenziwa kwi-tibia, i-calcaneus, kunye ne-metatarsal yokuqala ukubeka izikhonkwane zokulungiswa kwangaphandle.··
Iifractures zeFibula zilungiswa ngokulula ukusuka kumda ocacileyo we-lateral subcutaneous.
Ukuqhekeka kwe-vault ye-tibial ebandakanya ukudibanisa kunokulungiswa nge-percutaneously.Ukuba iimeko zezicubu ezithambileyo zivumela, kwaye ukuba kuyimfuneko, indlela eqhelekileyo ye-anterolateral okanye i-medial ingasetyenziselwa ukulungiswa.Ukuba ukulungiswa kwangaphandle kusetyenziswa kuphela njengendlela yokulungiswa kwesikhashana, indawo yokungena inaliti apho inaliti yokulungiswa kwangaphandle icwangciswe ukuba ibekwe kufuneka ibe kude nendawo yokugqibela yokulungiswa kwesikhonkwane ukukhusela ukungcoliswa kwezicubu ezithambileyo.Ukulungiswa kwangaphambili kwe-fibula kunye ne-intra-articular fragments iququzelela ukulungiswa okuchanekileyo okulandelayo.
Ukulumkela
Lumkela umkhondo wepini wokulungisa wangaphandle wokulungiswa okucacileyo okulandelayo kwendawo yotyando, njengoko izicubu ezingcolisekileyo ziya kukhokelela kwiingxaki zasemva kotyando.Iindlela eziqhelekileyo ze-anterolateral okanye ze-medial kunye nokudumba okubonakalayo kwezicubu ezithambileyo kunokukhokelela kwiingxaki ezinzulu zokuphulukisa amanxeba.
Ukunciphisa kunye nokulungiswa kweefractures ze-fibula:
Nanini na xa iimeko zeethishu ezithambileyo zivuma, iintsinga zophuka zinyangwa kuqala.I-fibular fracture iyancitshiswa kwaye igxininiswe ngokusebenzisa i-fibular ye-lateral incision, ngokuqhelekileyo kunye ne-3.5mm lag screws kunye ne-3.5mm l / 3 i-tube plate, okanye i-3.5mm i-LCDC plate kunye nezikrufu.Emva kokuba i-fibula iyancipha i-anatomically kwaye ilungiswe, ingasetyenziselwa njengomgangatho wokubuyisela ubude be-tibia kunye nokulungisa ukukhubazeka okujikelezayo kwe-fracture ye-tibial.
Ukulumkela
Ukudumba okubonakalayo kwezicubu ezithambileyo okanye inxeba elivulekileyo elibi kakhulu kunokuthintela ukulungiswa okuphambili kwefibula.Qaphela ukuba ungalungisi i-proximal fibular fractures kwaye uqaphele ukulimaza i-nerve proximal superficial peroneal.
IiFractures zeTibial: Ukunciphisa kunye nokulungiswa kwangaphakathi
I-intra-articular fractures ye-tibial vault kufuneka incitshiswe phantsi kombono othe ngqo ngokusebenzisa i-anterolateral okanye i-medial approach ye-distal tibia, okanye ngokunciphisa incwadi engathanga ngqo phantsi kwe-fluoroscopy.
Xa uqhuba i-screw ye-lag, i-fragment fragment kufuneka ilungiswe nge-Kirschner wire kuqala.
Ukunciphisa kwangaphambili kunye nokulungiswa kweefractures ze-intra-articular kuvumela ubuchule obuncinci obungenabuqhetseba kunye nokuguquguquka okukhulu kwisigxina sesibini esicacileyo.Iimeko ezingathandekiyo zezicubu ezithambileyo ezifana nokudumba okuphawulweyo okanye umonakalo omkhulu wezicubu ezithambileyo zinokuthintela ukulungiswa kwangaphambili kwamaqhekeza e-intra-articular.
Ukuqhekeka kweTibial: Ukulungiswa kwangaphandle kwe-Transarticular
I-cross-joint fixator yangaphandle ingasetyenziswa.
Ngokweemfuno zenqanaba lesibini elichanekileyo lokulungisa izikhonkwane ze-5mm zesiqingatha-ezifakwe ngaphandle zifakwe nge-percutaneously okanye ngeendlela ezincinci kwi-medial okanye i-anterolateral surface ye-tibia ekupheleni kwe-fracture.
Qala ucazulule ngokucacileyo kumphezulu wethambo, emva koko ukhusele izicubu ezijikelezileyo ngomkhono wokukhusela izicubu ezithambileyo, emva koko ubhora, ucofe, kwaye uqhube isikrufu ngomkhono.
Izikhonkwane zokulungiswa kwangaphandle ekupheleni kwe-distal ye-fracture zingafakwa kwi-distal tibial fragment, i-calcaneus kunye ne-metatarsal yokuqala, okanye intamo ye-talus.
Izikhonkwane zokulungiswa kwangaphandle ze-Transcalcaneal kufuneka zibekwe kwi-tuberosity ye-calcaneal ukusuka kwi-medial ukuya ngasecaleni ukukhusela umonakalo kwizakhiwo ze-neurovascular medial.
Iphini yokulungisa yangaphandle ye-metatarsal yokuqala kufuneka ibekwe kwindawo ye-anteromedial yesiseko se-metatarsal yokuqala.
Ngamanye amaxesha i-pin yokulungisa yangaphandle inokufakwa kwi-anterolaterally ngokusebenzisa i-tarsal sinus incision.
Emva koko, i-distal tibia yabuyiselwa kwaye umgca wamandla walungiswa nge-fluoroscopy ye-intraoperative, kwaye i-fixator yangaphandle yahlanganiswa.
Xa ulungelelanisa i-fixator yangaphandle, khulula ikliphu yokudibanisa, yenza i-longitudinal traction, kwaye wenze ukunciphisa ngesandla ngokuthambileyo phantsi kwe-fluoroscopy ukulungelelanisa indawo yeqhekeza leqhekeza.Umsebenzisi ke ugcina indawo ngelixa umncedisi eqinisa iziqeshana zokuqhagamshela.
Mingongoma
Ukuba ukulungiswa kwangaphandle akulona unyango oluchanekileyo, umkhondo wenaliti yokulungiswa kwangaphandle kufuneka ugcinwe kude nommandla ochanekileyo wokulungisa ngexesha lokucwangciswa komsebenzi, ukuze ungangcolisi intsimi yokusebenza kwexesha elizayo.Ukuzinza kokulungiswa kwangaphandle kunokunyuswa ngokunyusa isithuba sezikhonkwane zokulungisa kwindawo nganye yokuphuka, ukwandisa ububanzi bezikhonkwane, ukwandisa inani lezikhonkwane zokulungisa kunye ne-struts yokudibanisa, ukongeza amanqaku okulungisa kwi-ankle joint, kunye nokwandisa ukulungiswa. inqwelo-moya okanye ukufaka umsesane wangaphandle wokulungisa .Ukulungelelaniswa kokulungiswa okufanelekileyo kufuneka kuqinisekiswe ngezigaba zangaphambili-ngasemva nangemva.
Ukuqhekeka kweTibial: ukulungiswa kwangaphandle kwe-non-span-articular
Ngamanye amaxesha kukhetho lokusebenzisa i-fixator yangaphandle engagqithisiyo.Ukuba i-distal tibial fragment inkulu ngokwaneleyo ukuba ifake izikhonkwane ze-half-thread zangaphandle, i-fixator yangaphandle elula ingasetyenziswa.Kwizigulana ezinamaqhekeza amancinane e-metaphyseal fracture, i-hybrid fixator yangaphandle equka iphini yokulungisa yangaphandle ene-semi-threaded kunye ne-distal fine Kirschner wire iluncedo njengobuchule bonyango bexeshana okanye obuqinisekileyo .Isilumkiso kufuneka sisetyenziswe xa usebenzisa i-non-span-articular fixators yangaphandle ye-fractures kunye nokungcola kwezicubu ezithambileyo.Ukususwa kwesi sihlunu singcolisekileyo, ukuchithwa kwephecana yenaliti, kunye nokunyanzeliswa kwesiphelo kwi-cast de ukuphiliswa kakuhle kwenxeba ngokuqhelekileyo kuyimfuneko ngaphambi kokuba kuqhutywe ukukhutshwa okuqinisekileyo.
Sichuan ChenAnHui Technology Co., Ltd
Qhagamshelana: Yoyo
WhatsApp: +8615682071283
Email: liuyaoyao@medtechcah.com
Ixesha lokuposa: Feb-10-2023
