Paʻa Paʻa Paʻa - Paʻa Iwi Paʻa Paʻa ʻO Tibial Compression
He kakaikahi ka haʻihaʻi ʻana o ka tibial Pilon ma lalo o 10% o nā haʻi a puni ka kuʻekuʻe wāwae. ʻAʻole ʻae maikaʻi nā ʻiʻo palupalu i ka tibia ākea i ka uhi ʻole ʻana o ka ʻiʻo palupalu, kahi e hoʻonui ai i ka paʻakikī o ka mālama ʻana. ʻIke ʻia nā haʻihaʻi Pilon no ka comminution, ka neʻe ʻana o ka ʻili articular, a me nā ʻeha ʻili palupalu. Ma muli o ka hoʻololi ʻana i ka congruity hui a me ka alignment lālā, ʻo ka hapa nui o nā haʻihaʻi e koi i ka hoʻoponopono ʻana. Pono e hoʻopaʻa ʻia i nā ʻano haʻihaʻi kikoʻī, nā ʻeha ʻili palupalu, a me nā maʻi. ʻO ka manawa kūpono o ka lāʻau lapaʻau ke kī i ka holomua.
Nā hiʻohiʻona Anatomical
ʻO nā haʻihaʻi Pilon e pili ana i nā ʻāpana metaphyseal, a i kekahi manawa he ʻāpana diaphyseal pū kekahi. Aia kekahi puʻuwai hui a me nā haʻihaʻi comminuted. ʻEkolu mau ʻāpana iwi kumu: ka ʻāpana anterolateral, ka ʻāpana malleolar medial, a me ka ʻāpana posterolateral.
ʻEkolu mau ʻāpana maʻamau o ka hui pū ʻana: ʻO ka hoʻololi ʻana ma waena o nā ʻāpana anterolateral a me posterolateral, kokoke i ka fibula. Hiki ke hōʻike ʻia ka ʻāpana waena ma ke ʻano he ʻāpana iwi manuahi a i ʻole ke kaomi ʻana o ka ʻāpana posterolateral. ʻO ka hoʻokuʻu ʻia ʻana o ka medial e pili ana i kahi ʻāpana o ka ʻāpana medial a i ʻole ke kaomi ʻana e pili ana i ka medial malleolus.
Hoʻomaka pinepine ʻia ka hoʻohui ʻana ma kahi e hui ai nā laina haʻihaʻi. Hiki ke hoʻopili ʻia kēlā me kēia o nā ʻāpana haʻi nui ʻekolu a loaʻa nā laina haʻi hou. He mea nui ka pale ʻana i nā kīʻaha koko kuʻekuʻe wāwae. Pono e mālama pono ʻia nā ʻiʻo palupalu a hoʻihoʻi wale ʻia inā pono e pale aku i nā pilikia hoʻōla. Pono e pale ʻia ka wehe ʻana i nā ʻāpana haʻi i mea e pale ai i ka necrosis avascular o nā ʻāpana.
Mechanism Poino
Nā ʻeha kiʻekiʻe - ka ikehu: Hāʻule mai kahi kiʻekiʻe, ka ski, nā ulia kaʻa, a me nā mea ʻē aʻe.
Ke kuhikuhi o ka hana ʻino: Axial compression; ʻO ka ikaika shear rotational; ʻO ka ikaika shear Varus; ʻO ka ikaika shear Valgus.
Varus force violence: ʻOi aku ka maʻamau i ka poʻe ʻōpio, me ka ʻeha nui a me nā ʻeha kiʻekiʻe - ikehu. Aia ka laina haʻihaʻi ma ka mokulele sagittal, a paʻa pinepine ka fibula.
ʻO ka ikaika o Valgus: ʻoi aku ka maʻamau i ka poʻe ʻelemakule, me ka ʻeha liʻiliʻi a me nā ʻeha haʻahaʻa. Aia ka laina haʻihaʻi i loko o ka mokulele coronal a pili pinepine me ka haʻihaʻi fibular.
Nānā Kiʻi
Lawe ʻia nā kukui maʻamau o ka anteroposterior, ka ʻaoʻao, a me ka mortise. Hiki i ka X - ray piha piha o ka tibia ke hōʻike i ka alignment a me ka hui kuli ma luna. No kekahi poʻe maʻi me nā haʻihaʻi paʻakikī, lawe ʻia nā kukuna X o ka lālā contralateral e hāʻawi i kahi kuhikuhi no ke kūkulu hou ʻana i ka haʻihaʻi a me ka ʻike ʻana i nā ʻano anatomical a i ʻole congenital.
Hiki ke wānana ʻia ke ʻano ʻeha mai ke ʻano o ka haʻihaʻi fibular ma nā kukuna X a ua helu ʻia ʻo ia: Compressive violence (valgus deformity), Tensile violence (varus), Axial loading (intact fibula). Inā paʻa ka fibula, ʻo ia ka maʻamau he ʻeha ʻeha intra-articular (Type B). ʻAʻole nui ka hoʻoneʻe ʻana i nā ʻeha hoʻouka axial akā ka hopena i ka nui o ka hoʻouka ʻana axial ma ka tibia distal, me nā ʻāpana liʻiliʻi liʻiliʻi liʻiliʻi a me ka prognosis maikaʻi ʻole i ke koʻikoʻi o ka cartilage articular. Hiki ke wānana ʻia ka ʻaoʻao o ka hoʻoneʻe ʻana o nā ʻāpana haʻihaʻi mai ka ʻaoʻao X - ray e hōʻike ana i ke ʻano o ka neʻe ʻana o ka talar (maʻamau ka neʻe ʻana i mua).
He mea nui ka hana hou ʻana o ka CT ʻelua a me ʻekolu. Hiki iā lākou ke hāʻawi i ka ʻike me ke kiʻekiʻe o ka haʻihaʻi ʻana, ke kūlana a me ka helu o nā ʻāpana iwi, a me ke kuhikuhi o ka neʻe ʻana.
Papa Laka Lateral Lateral Fibular
ʻO VA Distal Medial Tibia Laka Pā
Hoʻokaʻawale
Haʻihaʻi AO/OTA - Hoʻokaʻawale Hoʻokaʻawale
ʻIke maʻalahi nā haʻihaʻi ʻano ʻano A ʻokoʻa akā pili paha me nā ʻeha ʻili palupalu nui. ʻO nā haʻihaʻi maʻamau intra-articular Type B e pili ana i ka hoʻopiʻi articular a koi i nā papa kumu no ka hōʻemi ʻana i nā ʻāpana intra-articular. Hōʻike ʻia nā haʻihaʻi intra-articular Type C i nā ʻeha kiʻekiʻe e pili ana i ka hoʻopau ʻana o ka hui tibio - talar, ʻeha i ka tibio distal - fibular syndesmosis, nā ʻeha fibular, a me nā tibial metaphyseal fractures, a pili pinepine me nā ʻeha kino palupalu.
Ruedi - Allgower Classification
ʻAno I: A 'T' - ʻano haʻihaʻi māhele me ka hoʻoneʻe nui ʻole.
ʻAno II: Māhele o ka ʻili ʻili me ka neʻe ʻana o ka laina haʻihaʻi a me ka comminution haʻahaʻa.
ʻAno III: ʻO nā haʻihaʻi koʻikoʻi i hoʻopaʻa ʻia a hoʻopaʻa ʻia o ka ʻili o ka tibial articular a me ka metaphysis.
Lapaʻau ʻole ʻokiʻoki
ʻAʻole kaʻawale ka mālama ʻana i nā haʻihaʻi Pilon tibial distal. ʻO nā hōʻailona nā ʻano haʻihaʻi liʻiliʻi a me nā maʻi me nā comorbidities e hoʻonui i ka pilikia o ka mālama ʻana. Hiki ke mālama ʻia nā haʻihaʻi ʻokoʻa me ka liʻiliʻi liʻiliʻi o ka alignment tibial holoʻokoʻa me ka plaster immobilization me ka ʻole o ka ʻoki ʻana. Hoʻohana mua ʻia kahi splint a hiki i ka pau ʻana o ka pehu, a laila hoʻohana ʻia kahi pahu plaster. ʻO nā hoʻololi koʻikoʻi i ka tibial a i ʻole ka ʻili ʻana o ka ʻili o ke kino ke alakaʻi i nā pilikia me ka alignment lālā a me ke kūpaʻa. Pono nā hoʻokolohua X-ray mau e hōʻoia i ka hui like ʻana a me ka alignment lālā.
Hiki ke mālama ʻia nā haʻihaʻi intra-articular koho ʻole me ka ʻoki ʻana. No nā haʻihaʻi intra-articular me ka liʻiliʻi o 2 mm o ka neʻe ʻana o ka haʻihaʻi a ma lalo o 3 mm o ka haʻi ʻana, hiki ke noʻonoʻo ʻia ka lāʻau lapaʻau ʻole no nā maʻi me nā koi haʻahaʻa.
Nā hōʻailona hōʻailona
ʻOi aku ka lōʻihi ma mua o 2 mm.
ʻOi aku ka nui o ka angulation Valgus ma mua o 5°.
Kekahi varus angulation.
Nā haʻihaʻi hāmama.
maʻi ʻāpana.
ʻeha ʻeha.
Nā ʻeha lehulehu.
ʻO ka manawa ʻokiʻoki
(1) Hoʻoponopono pilikia: Hoʻemi a hoʻoponopono i nā dislocations; Nā hāmama hāmama; ʻO nā ʻeha pili i ka vascular; maʻi ʻāpana.
(2) ʻO ka mua - ka pae (Hoʻihoʻi hou i ka lōʻihi o ka lālā a me ka hoʻonohonoho ʻana): Ka huki ʻana o Calcaneal; Hoʻopili waho; ʻO ka hoʻohaʻahaʻa a me ka hoʻoponopono i loko o nā haʻihaʻi fibular, ka hoʻohaʻahaʻa haʻahaʻa i kaupalena ʻia a me ka hoʻopaʻa ʻana i loko o ka tibial malleolar fractures hope; Kāohi thrombus.
(3) Ka lua - ka pae: Ma kahi o 10 - 14 mau lā ma hope, wehe wehe a hoʻoponopono i loko o ka tibial fracture.
(4) ʻO nā kūlana o ka ʻiʻo palupalu no ka lua o ke kaʻina hana: ʻO ka lawe ʻana i ka hematoma ma ke kahua o ka ʻoki ʻana, ka hoʻōla hou ʻana o ka epidermal ma nā ʻōpala o ka haʻihaʻi, ka hoʻōla ʻana i ka ʻeha o nā haʻi hāmama me ka maʻi ʻole, ka emi ʻana o ka edema ʻili palupalu, a me ka wrinkling o ka ʻili.
ʻO nā ala ʻokiʻoki
(1) Hoʻonui i ka hōʻike ʻana o ka laina haʻihaʻi.
(2) E hoʻoholo i nā haʻihaʻi āpau me ka liʻiliʻi loa o ke kaʻina hana.
(3) Hōʻalo i nā wahi me nā kūlana palupalu palupalu.
(4) E noʻonoʻo i ka hana ʻeha.
(5) E noʻonoʻo i ke kūlana hoʻonoho pā.
No nā haʻihaʻi me ka deformity varus, koho ʻia kahi pā waena waena, a hoʻohana ʻia kahi ala anteromedial.
No nā haʻihaʻi me ka deformity valgus, ua koho ʻia kahi pā pani lateral a hoʻohana ʻia kahi ala anterolateral.
ʻO ka mamao ma waena o nā ʻāpana ʻelua he 5-7 cm ka liʻiliʻi.
Nā huahana CZMEDITECH
