Serie de plaque de blocage - Plaque de coupe de locage de compression tibial distal
Distal tibial Pilon karilenw man teli ka kɛ, o bɛ kɛ sababu ye ka senkɔni lamini karilenw 10% dɔgɔya. Farikolo nɔgɔlen minnu bɛ senkɔni yɔrɔjan na, olu tɛ se ka muɲu kosɛbɛ farikolo yɔrɔ nɔgɔlenw datugucogo ɲuman na, o bɛ dɔ fara kari furakɛli gɛlɛya kan. Pilon karilenw dɔnna ni a sɔgɔli ye, a bɛ kɛ sababu ye ka farikolo yɔrɔ dɔw wuli, ani ka farikolo yɔrɔ nɔgɔlenw jogin. K’a sababu kɛ kolotugudaw ka ɲɔgɔndɛmɛ ni farikolo yɔrɔw labɛncogo yeli ye, kari fanba ka kan ka kɛ ni opereli ye. Opereli furakɛli dafalen ka kan ka kɛ ka kɛɲɛ ni kari suguya kɛrɛnkɛrɛnnenw ye, farikolo yɔrɔ nɔgɔlen joginw, ani banabagatɔw. Opereli furakɛli waati bɛnnen de ye ɲɛtaa kun ye.
Anatomie (banakisɛw) cogoyaw
Pilon karilenw bɛ kɛ ni metafisiki yɔrɔw ye, ani tuma dɔw la, diaphyse karilenw fana. Joli degun ni karilenw fana bɛ yen. Kolotuguda jɔnjɔn saba bɛ yen tuma bɛɛ: ɲɛfɛla yɔrɔ, cɛmancɛla kolotuguda ani kɔfɛla yɔrɔ.
Joli bɛ kɛ yɔrɔ saba ye minnu bɛ kɛ cogoya la: Kɛrɛfɛla sɔgɔli bɛ kɛ ɲɛfɛla ni kɔfɛla yɔrɔw cɛ, a ka ca a la a bɛ gɛrɛ fibula la. Cɛmancɛ sɔgɔli bɛ se ka kɛ kolotugudaw hɔrɔnyalenw ye walima kɔfɛla yɔrɔ degun. Medial comminution bɛ tali kɛ cɛmancɛ yɔrɔ dɔ la walima degun min bɛ cɛmancɛla malleolus kɛrɛfɛ.
A ka c’a la, sɔgɔsɔgɔninjɛ bɛ kɛ yɔrɔ min na kari siraw bɛ ɲɔgɔn cɛ. Kari yɔrɔba saba kelen-kelen bɛɛ bɛ se ka tigɛtigɛ ani kari sira wɛrɛw bɛ u la. A nafa ka bon ka senkɔniw joli siraw lakana. Farikolo nɔgɔlenw ka kan ka minɛ ka ɲɛ ani ka u kɔsegin dɔrɔn ni a mago bɛ a la walasa ka joginda - kɛnɛyali gɛlɛyaw bali. Karilen yɔrɔw bɔli kojugu ka kan ka kɛ walasa ka a yɔrɔw sɔgɔsɔgɔninjɛ bali ka bɔ joli siraw la.
Joginw kɛcogo
Jogin minnu fanga ka bon: A bɛ bin ka bɔ sanfɛ, ski, mobili kasaara, a ɲɔgɔnnaw Jogin minnu fanga ka dɔgɔn: A bɛ bin yɔrɔ fla kan.
Fariya sira: Axiale compression; Yɛlɛma-yɛlɛma fanga min bɛ tigɛli kɛ; Varus ka sɛgɛn fanga; Valgus ka fanga min bɛ tigɛ.
Varus force violence : A ka ca funankɛninw na, ni joginda jugumanba bɛ u la ani jogin minnu fanga ka bon. Kari sira bɛ sagittal plane kɔnɔ, wa a ka ca a la fibula bɛ to a cogo la.
Valgus force violence : A ka ca mɔgɔkɔrɔbaw la, ni joginda jugumanba tɛ u la ani jogin minnu fanga ka dɔgɔn. Kari sira bɛ koronawirisi plan na wa a ka ca a la a bɛ tali kɛ fibula kari la.
Jaa Sɛgɛsɛgɛliw
Routine standard anteroposterior, lateral, ani mortise view (senkɔni ɲɛfɛla, kɔfɛla, ani mortise view X - rays) bɛ kɛ senkɔni na. Senkɔniw ka X - ray dafalen bɛ se ka ɲɔgɔndɛmɛ ni gɛnɛgɛnɛ jogincogo jira sanfɛ. Banabagatɔ dɔw la minnu ka kari ka gɛlɛn kosɛbɛ, u bɛ kɛ ni senkɔni kɛrɛfɛla la walasa ka ɲɛfɔli kɛ kariw jɔcogo kura kan ani ka farikolo yɔrɔw walima bangekɔlɔsi fɛn caman dɔn minnu tun bɛ yen ka kɔrɔ.
Jogincogo bɛ se ka fɔ ka ɲɛ ka bɔ fiɲɛ kari suguya la X - rays kan, wa a bɛ jate nin cogo la: Fariyako min bɛ kɛ ni degun ye (valgus deformité), Fariyako min bɛ kɛ ni sɛgɛn ye (varus), doni axial (fibula intact). Ni fibula ma tiɲɛ, a ka ca a la, o ye joginda jugumanba ye min bɛ kɛ joli yɔrɔ dɔ la (Type B). Axiale doni joginw tɛ kɛ sababu ye ka jiginni caman kɛ nka a bɛ na ni axial doni caman ye senkɔni yɔrɔjan kan, ni aksidan yɔrɔ misɛnnin caman bɛ sɔrɔ ani ka ɲɛfɔli jugu kɛ min bɛ kɛ filanan ye ni bolokɔniw degun ye. Kari yɔrɔ jiginni sira bɛ se ka fɔ ka bɔ kɛrɛfɛla la min bɛ talar jiginni suguya jira (a ka c’a la, ɲɛfɛla jiginni).
CT labɛnni kura minnu bɛ kɛ ni yɔrɔ fila ye ani yɔrɔ saba ye, olu nafa ka bon. U bɛ se ka kunnafoniw di i n’a fɔ kolo karilenw tigɛcogo, kolotugudaw jɔyɔrɔ ni u hakɛ, ani u jiginni sira.
Plaque de blocage fibular latéral distal
VA Tibia Medial Distal Plaque de blocage
Daɲɛw danfara
AO/OTA kari - Dislocation Classification
A ka ca a la, A suguya A karilenw bɛ i n’a fɔ u ka nɔgɔn nka u bɛ se ka kɛ sababu ye ka farikolo yɔrɔ nugulamaw jogin kosɛbɛ. A ka ca a la, joli yɔrɔ dɔw karilen suguya B bɛ kɛ ni bolokɔniw tigɛcogo ye, wa u bɛ kɛ ni buttress plates ye walasa ka joli kɔnɔna yɔrɔw dɔgɔya. Joginni dafalen minnu bɛ kɛ senkɔniw kɔnɔ suguya C, olu bɛ fanga caman joginw jira minnu bɛ tali kɛ senkɔniw - talar joli tiɲɛni na, joginni minnu bɛ sɔrɔ senkɔniw yɔrɔjan - fibular syndesmose la, fibulu karilenw, ani senkɔniw karilenw karilenw, ani a ka ca a la u bɛ tali kɛ farikolo yɔrɔ nɔgɔlenw joginni jugumanw na.
Ruedi - Allgower ka danfara
Sugu fɔlɔ : 'T' - cogoya tilalen karilen don ni a ma wuli kosɛbɛ.
Sugu filanan : Articulaire surface tilali ni kari sira jiginni jɛlen ye ani comminution moyenne.
Sugu sabanan : Tibial articular surface distal ani metaphysis karilen jugumanba minnu bɛ kɛ ni sɔgɔsɔgɔninjɛ ni degun ye.
Furakɛli min tɛ opereli ye
Furakɛli min tɛ opereli ye, n’o ye distal tibial Pilon karilenw ye, o man teli ka kɛ. A taamasiɲɛw ye kari suguya minnu bɛ bɔ u nɔ na dɔɔnin dɔɔnin ani banabagatɔ minnu ka bana wɛrɛw bɛ u la minnu bɛ dɔ fara opereli furakɛli farati kan. Kɛrɛnkɛrɛnnenya la, bolokɔni kɔkanna karilenw ni fɛn caman tɛ yeli kɛ senkɔni bɛɛ lajɛlen na, olu fana bɛ se ka furakɛ ni pilatiri jɔli ye k’a sɔrɔ opereli ma kɛ. A daminɛ na, a bɛ kɛ ni fɛnɲɛnamafagalan ye fo funu ka nɔgɔya, o kɔ, aw bɛ pilatiri kɛ a la. Yɛlɛma juguman minnu bɛ kɛ senkɔni walima senkɔniw yɔrɔ labɛncogo la, o bɛ se ka kɛ sababu ye ka gɛlɛyaw lase senkɔniw labɛncogo ni u sabatili ma. Sɛgɛsɛgɛli minnu bɛ kɛ tuma bɛɛ, olu ka kan ka kɛ walasa ka a dɔn ko kolotugudaw bɛ bɛn ɲɔgɔn ma ani ka a dɔn ko u senw bɛ bɛn ɲɔgɔn ma.
Selective intra - articular fractures fana bɛ se ka furakɛ ni opereli tɛ. Ni bolokɔniw kɔnɔna karilenw karilen don ni u karilenw jiginni tɛ milimɛtɛrɛ 2 bɔ ani ni u senna-bɔn ka dɔgɔn milimɛtɛrɛ 3 ma, furakɛli min tɛ opereli ye, o bɛ se ka jateminɛ banabagatɔw la minnu ka baarakɛcogo man ca.
Opereli taamasiɲɛw
Articular surface step - off ka tɛmɛ milimɛtɛrɛ 2 kan.
Valgus angulation ka bon ni 5° ye.
Varus angulation suguya o suguya.
Kari dafalenw.
Syndrome de compartiment (banakisɛfagalan) min bɛ wele ko « syndrome de compartiment ».
Joli minnu bɛ kɛ joli siraw la.
Jogin caman.
Opereli waati
(1) Furakɛli kɔrɔtɔlen: Dislocations dɔgɔyali ani u jɔli; Kari dafalenw; Jogin minnu bɛ sɔrɔ joli siraw la minnu bɛ tali kɛ ɲɔgɔn na; Syndrome de compartiment (banakisɛfagalan) min bɛ wele ko « syndrome de compartiment ».
(2) Fɔlɔ - dakun (Bolo janya ni a labɛncogo seginni): Kɔnɔbara samali; Kɛnɛma fiyɛli; Fibulari karilenw dɔgɔyali ni u kɔnɔna jɔli, da wulilen dɔgɔyali danma ani kɔfɛla kɔfɛla karilenw kɔnɔna jɔli; Thrombus (banakisɛfagalan) kunbɛnni.
(3) Taabolo filanan : Tile 10 - 14 ɲɔgɔn o kɔfɛ, da wulilen dɔgɔyali ni senkɔni karilen kɔnɔna jɔli.
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Opereli kɛcogo minnu bɛ kɛ
(1) Aw bɛ kari sira jiracogo caya.
(2) Aw bɛ kari bɛɛ ɲɛnabɔ ni opereli kɛcogo fitininw ye.
(3) Aw bɛ aw yɛrɛ tanga yɔrɔw ma minnu farikolo yɔrɔ nɔgɔlenw man ɲi.
(4) Jogin kɛcogo jateminɛ.
(5) Aw ye plati bilayɔrɔ jateminɛ.
Ni kariw bɛ ni varus deformité ye, medial buttress plate bɛ sugandi, ka sɔrɔ ka anteromedial approach kɛ.
Ni kariw bɛ ni valgus deformité ye, a bɛ kɛ ka lateral buttress plate sugandi, ka sɔrɔ ka anterolateral approach kɛ.
Tigɛyɔrɔ fila ni ɲɔgɔn cɛ janya ka kan ka kɛ santimɛtɛrɛ 5 - 7 ye a dɔgɔyalenba la.
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