Sunan Nailing Nailing Tibia Na Duniya 2025 Manyan Ƙirƙirar Ƙira 6

Distal Tibial Intramedullary Nail (DTN)

Suprapatellar Approach Tibial Ƙusa na intramedullary

Kwararre Tibia intramedullary Nail

1.Proximal Oblique Cut

Yanke na gaba a cikin kusanci yana hana fushi ga ligament na patellar.

2. Ƙirar Kulle Na Ci gaba

Ƙirar kulle kusa da gaba tana ƙara kwanciyar hankali da ake so don guntun kusa.

3. Kulle Oblique na nesa

Zaɓin kulle nisa don hana lalacewar nama mai laushi da ƙara kwanciyar hankali na guntun nesa.

4. Biyu Zare Dunƙule

Kulle sukuro an tsara shi tare da zaren gubar guda biyu don sauƙin shigarwa.

Kayan aikin Kulle

Ƙirar kullewa don ƙaƙƙarfan gyare-gyare, rage raguwar ɓarna bayan aiki.

Multi-point Support

Makiyoyi masu yawa na gyarawa suna ba da kwanciyar hankali na kusurwa da goyan baya ga tibial palteau.

Matakan Matsi

Na'urar tana fasalta aikin daidaitawa, tare da sauye-sauyen yanayin halittar sa da aka nuna a cikin zane-zane a ƙarƙashin duka pre-compression (yanayin sako-sako) da yanayin matsawa (daidaitacce).

Ƙarfafawar Kusa-Distal

Hanyar gyare-gyare da yawa daga kusanci da nesa, suna nuna karayar kusanci da nisa na tibial.

Zane Flat don Sauƙaƙen Shiga

Ƙarshen ƙarshen babban ƙusa yana da ƙirar ƙira, yana sauƙaƙe shigarwa cikin rami na medullary.

Angular Kulle sukurori

Kusurwoyi guda biyu Kulle sukurori a kusa da ƙarshen yana hana juyawa da matsewar ɓangaren karaya.

Curvature na Anatomical

Curvature na musamman na jikin mutum yana tabbatar da cewa babban ƙusa yana da kyau a matsayinsa a cikin rami na medullary.

Matsakaicin Matsakaicin Kulle sukurori

Ƙungiya mai haɗin kai guda uku Kulle sukurori a ƙarshen nesa yana ba da tallafi mai tasiri da gyarawa.

Yawanci:

Ya dace da mafi yawan ɓangarorin tibial (midshaft da wasu karaya mai nisa/kusa da kusa), yayin da wasu nau'ikan (misali, DTN ko Ƙararren Ƙwararru) an tsara su don takamaiman yankuna na jiki ko ɓarna.

Balagagge Dabarar Tiya:

Daidaitaccen tsarin (parapatellar ko transpatellar) yana biye da ingantaccen tsari tare da ƙananan tsarin ilmantarwa, yayin da hanyoyi na musamman (misali, suprapatellar) suna buƙatar ƙarin horo na fasaha.

Tasirin Kuɗi:

Idan aka kwatanta da kusoshi na musamman kamar Nail na Kwararre ko DTN, daidaitattun kusoshi na intramedullary na tibial yawanci sun fi araha, yana sa su dace da lokuta na yau da kullun.

Faɗin Dacewar Dasawa:

Mai jituwa tare da kayan aiki na duniya (misali, Kulle sukurori , na'urori masu niyya), yayin da ƙusoshi na musamman (misali, Ƙararren Ƙwararru tare da tsarin kulle manyan hanyoyi) na iya buƙatar kayan aikin mallakar mallaka.

1. Shiri Na Farko

Ƙimar Hoto: X-ray/CT da aka riga aka yi don tabbatar da nau'in karaya, diamita na canal da tsayi, tare da auna tibia mai cin karo da juna a matsayin tunani.

Matsayi: Matsayin baya tare da ƙwanƙwasa gwiwa 90 ° -120 ° da ɗan ƙarar hip (don rage tashin hankali na patellar). Firam ɗin rediyolucent mai kusurwa uku na iya tallafawa fossa popliteal don jan hankali.

Bakararre Draping: Daidaitaccen haifuwar gaɓoɓi da ɗigo, yana tabbatar da motsin C-hannu.

2. Rage Karya

Dabarun Rage Rufe

Gargaɗi na Manual: Mataimaki yana amfani da tsinkayar tsayin daka yayin da likitan fiɗa ya ƙwanƙwasa crest tibial da kuma saman anteromedial don daidaita jeri (tsawon, juyawa, angulation).

Kayan aiki-Taimakawa:

• Fasahar Joystick: An saka screws na Schanz a cikin guntu na kusa/tsayi don rage lefa.

• Ƙunƙarar Maɗaukaki: Ƙarfin ƙarfi mai nuni don karyewar ɓarna.

• Mai watsawa: Babban mai karkatar da hankali wanda aka sanya shi a hankali (kusanci Schanz dunƙule daidai da tibial plateau, distal fil in talus ko distal tibia) don kiyaye tsayi.

3. Matsalolin Shiga

Alamomin ƙasa:

• Wurin shigarwa 1cm mai nisa zuwa gefen tibial plateau na gaba, daidaitacce tare da axis medullary.

• Tabbatar da fluoroscopic: Ra'ayin AP ya yi daidai da tibial crest, ra'ayi na gefe daidai da axis tibial.

Kayan Buɗewa:

• Gwangwani mai gwangwani a kan guidewire (tare da hannun riga mai karewa) ko lankwasa ƙaƙƙarfan awl.

• Reamers na hannu (6-8mm) don tsofaffin karaya tare da rufewar canal.

4. Shigar Guidewire & Reaming

Wurin Wuta Guidewire: Wire mai kambun ƙwallo ya lanƙwasa 10-15mm a tip don raƙuman karaya. Tabbatar da fluoroscopic a tabo mai nisa na physeal (cibiyar idon ƙafa).

Ka'idar Reaming:

• Masu sassaucin ra'ayi suna farawa daga 8mm, suna ƙara 0.5mm har zuwa cortical 'chatter' (yawanci 1-1.5mm> diamita na ƙusa).

• Lura: Janyewar lokaci-lokaci yana share tarkace; kauce wa thermal necrosis.

5. Cikar farce

Tsawon Tsawon:

• Ma'aunin intraoperative: Hanyar zoba ta Guidewire ko mai sarrafa fluoroscopic (maganin shiga zuwa haɗin gwiwa).

• Tabbatar cewa titin ƙusa ya kai tabo a jiki ba tare da kusanci ba.

Dabarar Shigarwa:

• Hannun gaba akan jagora; daidaita raguwa idan juriya ya faru.

• Kula da raguwa yayin wucewa don karaya mai nisa.

6. Haɗin kai Screw Gyara

Dabarun Jeri

• Karye-tsaye mai tsayi: Makullin kusa da farko (ƙuƙuma ɗaya yana ba da damar haɓakawa).

• Tsawon-wanda ba shi da kwanciyar hankali/ya ƙare karaya: Makullin nesa da farko yana biye da 'baya baya' don damfara.

Kulle Kurkusa

• ≥2 sukurori ta hanyar na'urar da aka sa ido (multidirectional for proximal fractures).

Kulle nesa

• Fasahar Fluoroscopic: Tsakiyar katako mai tsayin daka zuwa dunƙule ramuka ('cikakkiyar da'irar'), hakowa ta percutaneous.

• ≥2 sukurori don karaya mai nisa (na iya haɗawa da AP/daidaitacce daidaitacce).

7. Tsarin Karshe

Ƙarshen Ƙarshen: Saka zaɓi na zaɓi (yana hana haɓakar ƙashi), tabbatar da rashin haɓakar haɗin gwiwa.

Rufe Raunin: Gyaran jijiyoyi mai rufi tare da sako-sako da sutures na subcutaneous.

8. Gudanar da Bayan aiki

Gyaran Farko:

• Girman gaɓa; saka idanu don ciwon sashe a cikin sa'o'i 24.

• Ƙaddamar da haɗakar haɗin gwiwa mai aiki (famfon ƙafar ƙafa, ƙwanƙwasa gwiwa) akan POD 1-2.

Ka'idar ɗaukar nauyi:

• Wani sashi mai ɗaukar nauyi na makonni 6 (daidaita kowace kwanciyar hankali), yana ci gaba zuwa cikakke lokacin da kiran kira ya bayyana.

Bi-biye: Ƙimar asibiti/Radiological a makonni 2, 6, da 12.