Ulungiselelo lwangaphambi kotyando kunye nesikhundla njengoko kuchaziwe ngaphambili ukulungiswa kwesakhelo sangaphandle se-transarticular.
I-intra-articular fracture repositioning kunye nokulungiswa:
Ukucuthwa okuncinci kokusika 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 kuchaziwe ngaphambili, beka ubuncinane izikrufu ezimbini ze-Schanz kwi-distal tibia, uqhoboshele i-fixator yangaphandle exhobileyo enye, kwaye uyidibanise kwi-circumferential fixator yangaphandle, kwaye uqinisekise kwakhona ukuba i-metaphysis kunye ne-tibial stem. zikwi-axis yomatshini eqhelekileyo kunye nokulungelelaniswa okujikelezayo ngaphambi kokugqiba ukulungiswa.
Ukuba kufuneka uzinzo olongezelelweyo, isakhelo sendandatho sinokudityaniswa kwingalo yokulungiswa kwangaphandle ngentonga yokudibanisa.
Ukuvala indawo yokusika
I-incision yotyando ivalwe 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 ixesha elifutshane emva kokuhlinzwa, oko kukuthi, ukufumana uluhlu olupheleleyo lokunyakaza kwamadolo kangangoko kunokwenzeka kwi-4 ~. Iiveki ezi-6. 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
