Ulungiselelo lwaphambi kotyando kunye nesikhundla njengoko kuchaziwe ngaphambili ukulungiswa kwesakhelo sangaphandle se-transarticular.
I-intra-articular fracture repositioning kunye nokulungiswa:
Ukunciphisa okuncinci kunye nokulungiswa kusetyenziswa. Ukuqhekeka kwe-articular surface engaphantsi kunokubonwa ngokuthe ngqo ngokusebenzisa i-anteromedial encinci kunye ne-anterolateral incision kunye ne-lateral incision ye-capsule edibeneyo phantsi kwe-meniscus.
Ukutsalwa kwelungu elichaphazelekayo kunye nokusetyenziswa kwe-ligaments ukulungisa amaqhekeza amakhulu amathambo, kunye nokunyanzeliswa okuphakathi kunokusetwa ngokutsha ngokucofa kunye nokuhlutha.
Nika ingqalelo ekubuyiseleni ububanzi be-plateau ye-tibial, kwaye xa kukho isiphene samathambo ngaphantsi kwendawo ye-articular, yenza i-bone grafting ukuxhasa i-articular surface emva kokucoca ukusetha kwakhona indawo ye-articular.
Nika ingqalelo ukuphakama kweqonga eliphakathi kunye necala, ukwenzela ukuba kungabikho nyathelo lomphezulu we-articular.
Ukulungiswa kwexeshana kunye ne-reset clamp okanye i-Kirschner pin isetyenziselwa ukugcina ukusetha kwakhona.
Ukubekwa kwezikhonkwane ezingenanto, izikrufu kufuneka zihambelane ne-articular surface kwaye zibekwe kwithambo le-subchondral, ukwenzela ukwandisa amandla okulungisa. I-Intraoperative X-ray fluoroscopy kufuneka yenziwe ukujonga izikrufu kwaye ungaze uqhube izikhonkwane kwindawo edibeneyo.
Ukubekwa kwakhona kwe-Epiphyseal fracture:
I-Traction ibuyisela ubude kunye ne-axis yomatshini yelungu elichaphazelekayo.
Ukunyamekela kuthathwa ukulungisa ukujikeleza okujikelezayo kwelungu elichaphazelekayo ngokucofa i-tuberosity ye-tibial kunye nokuyiqhelanisa phakathi kweenzwane zokuqala nezesibini.
Ukubekwa kweRingi ekufutshane
Uluhlu lweendawo ezikhuselekileyo zokubeka i-tibial Plateau tension wire placement:
Umthambo we-popliteal, i-popliteal vein kunye ne-tibial nerve ihamba ngasemva kwi-tibia, kwaye i-peroneal nerve eqhelekileyo ihamba ngasemva kwentloko ye-fibular. Ngoko ke, zombini ukungena kunye nokuphuma kwenaliti kufuneka kwenziwe ngaphambili kwi-plateau ye-tibial, oko kukuthi, inaliti kufuneka ingene kwaye iphume kwinaliti yensimbi ngaphambili ukuya kumda we-medial we-tibia nangaphambili ukuya kumda wangaphambili we-fibula.
Kwicala elisecaleni, inaliti inokufakwa ukusuka kumda wangaphambili we-fibula kwaye idluliselwe kwicala le-anteromedial okanye ukusuka kwicala eliphakathi; indawo yokungena ephakathi idla ngokuba kumgca we-medial we-tibial plateau kunye necala layo langaphambili, ukuphepha ucingo loxinzelelo ukuba ludlule kwizicubu ezininzi ze-muscle.
Kuye kwaxelwa kwiincwadi ukuba indawo yokungena yocingo lwentambo kufuneka ibe ubuncinane ubuncinane be-14 mm ukusuka kwi-articular surface ukukhusela ucingo loxinzelelo ukuba lungene kwi-capsule edibeneyo kwaye ibangele isifo samathambo.
Beka intambo yokuqala yoxinzelelo:
Iphini lomnquma linokusetyenziswa, eligqithiswa kwiphini lokhuseleko elikwisibambi seringi, lishiye intloko yomnquma ngaphandle kwephini lokhuseleko.
Umncedisi ugcina indawo yomphathi wendandatho ukwenzela ukuba ihambelane nomgangatho we-articular.
Gcoba isikhonkwane somnquma ngokusebenzisa izicubu ezithambileyo kunye ne-plateau ye-tibial, unakekele ukulawula ulwalathiso lwayo ukuqinisekisa ukuba iindawo zokungena kunye nokuphuma zikwindiza efanayo.
Emva kokuphuma kwesikhumba kwicala le-contralateral qhubeka uphuma kwinaliti de intloko yomnquma idibane nepini yokhuseleko.
Faka isilayidi socingo olubambezelayo kwicala elichaseneyo kwaye ugqithise isikhonkwane somnquma kwisilayidi socingo olubambezelayo.
Qaphela ukugcina i-plateau ye-tibial kumbindi wesakhelo sendandatho ngamaxesha onke ngexesha lokusebenza.
Ngesikhokelo, ucingo lwesibini lwe-tension lubekwe ngokunxuseneyo, kwakhona ngapha kwelinye icala lesilayidi socingo olubambezelayo.
Beka ucingo lwesithathu loxinzelelo, kufuneka lube kuluhlu olukhuselekileyo kangangoko kunokwenzeka kunye neseti yangaphambili yocingo lwentambo yomnqamlezo kwi-engile enkulu, ngokuqhelekileyo iiseti ezimbini zocingo lwentsimbi zinokuba yi-engile ye-50 ° ~ 70 °.
Ukulayisha kwangaphambili kufakwe kwintambo yoxinzelelo: Uxinzelelo olupheleleyo lwe-tensioner, dlula incam yocingo lwe-tension kwi-tensioner, cinezela isiphatho, faka ukulayisha kwangaphambili okungenani kwe-1200N kucingo lwe-tension, uze usebenzise isitshixo se-L-handle.
Ukusebenzisa indlela efanayo yokulungiswa kwangaphandle emadolweni njengoko kuchazwe ngaphambili, faka ubuncinane izikrini ezimbini ze-Schanz kwi-distal tibia, unamathisele i-fixator yangaphandle exhobileyo enye, kwaye uyidibanise ne-circumferential fixator yangaphandle, kwaye uqinisekise kwakhona ukuba i-metaphysis kunye ne-tibial stem zikwi-axis eqhelekileyo yomatshini kunye nokulungelelaniswa okujikelezayo ngaphambi kokugqiba ukulungiswa.
Ukuba kufuneka uzinzo olongezelelweyo, isakhelo sendandatho sinokudityaniswa kwingalo yokulungiswa kwangaphandle ngentonga yokudibanisa.
Ukuvala indawo yokusika
Uqhaqho lotyando luvalwe umaleko ngokomaleko.
Uluhlu lwenaliti lukhuselwe nge-alcohol gauze wraps.
Ulawulo lwasemva kotyando
I-Fascial syndrome kunye nokulimala kwenzwa
Ngaphakathi kwe-48h emva kokulimala, kufuneka kuthathelwe ingqalelo kwaye kuchongwe ubukho be-fascial compartment syndrome.
Qaphela ngokucophelela i-vascular nerves yelungu elichaphazelekayo. Ukunikezelwa kwegazi okungahambi kakuhle okanye ukulahleka kwe-neurological okuqhubekayo kufuneka kulawulwe ngokufanelekileyo njengemeko engxamisekileyo.
Ukuvuselela okusebenzayo
Ukuzivocavoca okusebenzayo kunokuqalwa ngosuku lokuqala emva kokusebenza ukuba akukho nzakeleyo yesayithi okanye i-comorbidities. Ngokomzekelo, i-isometric contraction ye-quadriceps kunye nokunyakaza kwe-passive yamadolo kunye nokunyakaza okusebenzayo kwe-ankle.
Injongo yemisebenzi yokuqala esebenzayo kunye ne-passive kukufumana uluhlu oluphezulu lokuhamba kwedolo elihlangeneyo ixesha elifutshane kangangoko kunokwenzeka emva kokuhlinzwa, oko kukuthi, ukufumana uluhlu olupheleleyo lokunyakaza kwamadolo kangangoko kunokwenzeka kwii-4 ~ 6 iiveki. Ngokuqhelekileyo, utyando luyakwazi ukufezekisa injongo yokwakhiwa kwakhona kwamadolo, ukuvumela kwangaphambili
umsebenzi. Ukuba ukuzivocavoca okusebenzayo kulibazisekile ngenxa yokulinda ukuvuvukala kuyancipha, oku akuyi kuba luncedo ekubuyiseleni ukusebenza.
Ukuthwala ubunzima: Ukuthwala ubunzima bokuqala ngokuqhelekileyo akukhuthazwa, kodwa ubuncinane i-10 kwiiveki ze-12 okanye kamva kwi-fractures ye-intra-articular eyilwe.
Ukuphola kwenxeba: Jonga ngokusondeleyo ukuphiliswa kwenxeba kwiiveki ezi-2 emva kotyando. Ukuba ukusuleleka kwesilonda okanye ukulibaziseka ukuphulukiswa kwenzeka, ukungenelela kokuhlinzwa kufuneka kwenziwe ngokukhawuleza.
Ixesha lokuposa: Aug-16-2024
