Xauv Phaj Series - Distal Tibial Compression Xauv Pob Txha Phaj
Distal tibial Pilon pob txha pob txha yog qhov tsawg, suav txog tsawg dua 10% ntawm pob txha pob txha. Cov ntaub so ntswg ntawm tus tibia distal muaj kev ua siab ntev rau cov ntaub so ntswg tsis txaus, uas ua rau muaj kev nyuaj ntawm kev kho pob txha. Pilon fractures paub txog kev sib txuas, kev txav ntawm cov pob txha pob txha, thiab cov nqaij mos raug mob. Vim muaj kev hloov pauv ntawm kev sib koom ua ke thiab kev sib haum xeeb ntawm cov ceg, feem ntau cov pob txha yuav tsum tau kho phais. Kev kho mob phais yuav tsum tau kho kom haum rau tej hom pob txha, cov nqaij mos raug mob, thiab cov neeg mob. Lub sijhawm tsim nyog ntawm kev kho mob phais yog tus yuam sij rau kev ua tiav.
Anatomical nta
Pilon fractures koom nrog metaphyseal fragments, thiab qee zaum diaphyseal fragments thiab. Kuj tseem muaj kev nyuaj siab sib koom ua ke thiab comminuted fractures. Ib txwm muaj peb cov pob txha pob txha: cov anterolateral fragment, qhov nruab nrab malleolar fragment, thiab posterolateral fragment.
Muaj peb qhov chaw ntawm kev sib koom ua ke: Lateral comminution tshwm sim ntawm cov anterolateral thiab posterolateral fragments, feem ntau ze rau lub fibula. Central comminution tej zaum yuav tshwm sim raws li cov pob txha dawb los yog compression ntawm posterolateral fragment. Medial comminution suav nrog ib feem ntawm cov khoom nruab nrab lossis cov compression nyob ib sab ntawm cov medial malleolus.
Kev sib txuas feem ntau tshwm sim qhov twg cov kab tawg sib tshuam. Txhua qhov ntawm peb qhov tseem ceeb ntawm cov pob txha tawg yuav raug txiav thiab muaj cov kab tawg ntxiv. Nws yog ib qho tseem ceeb los tiv thaiv cov hlab ntsha hauv pob taws. Cov ntaub mos muag yuav tsum tau ua tib zoo saib xyuas thiab tsuas yog thim rov qab thaum tsim nyog kom tsis txhob muaj qhov txhab - kho teeb meem. Kev tshem tawm ntau dhau ntawm cov pob txha tawg yuav tsum zam kom tsis txhob muaj avascular necrosis ntawm cov khoom tawg.
Kev raug mob Mechanisms
Kev raug mob ntawm lub zog siab: ntog los ntawm qhov siab, caij skiing, tsheb sib tsoo, thiab lwm yam. Tsawg - lub zog raug mob: Tripping ntawm ib qho chaw tiaj tus.
Kev taw qhia ntawm kev nruj kev tsiv: Axial compression; Rotational shear quab yuam; Varus shear quab yuam; Valgus shear quab yuam.
Varus quab yuam kev nruj kev tsiv: Feem ntau tshwm sim hauv cov tub ntxhais hluas, nrog kev raug mob hnyav dua thiab raug mob siab zog. Cov kab tawg yog nyob rau hauv lub dav hlau sagittal, thiab fibula feem ntau tsis zoo.
Valgus quab yuam kev nruj kev tsiv: Ntau tshaj nyob rau hauv cov neeg laus, nrog tsawg heev raug mob thiab tsis muaj zog - raug mob. Cov kab tawg yog nyob rau hauv lub dav hlau coronal thiab feem ntau cuam tshuam nrog cov pob txha pob txha.
Kev kuaj pom
Cov txheej txheem niaj hnub anteroposterior, lateral, thiab mortise saib X - rays ntawm pob taws yog noj. Tag nrho ntev X-ray ntawm tibia tuaj yeem pom qhov sib dhos thiab lub hauv caug sib koom ua ke saum toj no. Rau qee cov neeg mob uas muaj kev puas tsuaj ntau dua, X - rays ntawm lub caj dab contralateral raug coj los muab cov ntaub ntawv siv rau kev txhim kho pob txha thiab txhawm rau txheeb xyuas qhov kev hloov pauv ntawm lub cev los yog lub hauv paus.
Cov txheej txheem raug mob tuaj yeem kwv yees los ntawm hom fibular pob txha ntawm X - rays thiab cais raws li: Compressive kev nruj kev tsiv (valgus deformity), Tensile kev nruj kev tsiv (varus), Axial loading (zoo fibula). Yog hais tias lub fibula tsis zoo, feem ntau nws yog ib feem ntawm qhov intra-articular (Hom B) raug mob. Axial loading raug mob tsis ua rau muaj kev hloov pauv ntau, tab sis ua rau muaj qhov loj ntawm axial loading ntawm lub distal tibia, nrog rau ntau qhov me me ntawm cov pob txha pob txha thiab qhov tsis zoo ntawm cov pob txha mos. Kev taw qhia ntawm kev tawg tawg tawg tuaj yeem kwv yees los ntawm lateral X - ray qhia txog hom talar hloov chaw (feem ntau yog anterior hloov chaw).
Ob-dimensional thiab peb-dimensional CT reconstructions yog qhov tseem ceeb. Lawv tuaj yeem muab cov ntaub ntawv suav nrog qib ntawm kev sib tsoo pob txha, txoj hauj lwm thiab tus naj npawb ntawm cov pob txha tawg, thiab cov kev taw qhia ntawm kev txav chaw.
Distal Lateral Fibular Xauv Phaj
VA Distal Medial Tibia Xauv Phaj
Kev faib tawm
AO/OTA Fracture - Dislocation Classification
Ntxiv - articular Type A fractures feem ntau tshwm sim yooj yim tab sis tej zaum yuav cuam tshuam nrog kev raug mob ntawm cov nqaij mos tseem ceeb. Ib feem ntawm qhov intra - articular Type B fractures koom nrog articular comminution thiab yuav tsum tau daim hlau buttress kom txo cov intra - articular fragments. Ua tiav intra - articular Type C fractures qhia siab - lub zog raug mob cuam tshuam nrog kev sib koom ua ke ntawm tibio - talar sib koom ua ke, raug mob rau lub distal tibio - fibular syndesmosis, fibular fractures, thiab tibial metaphyseal fractures, thiab feem ntau yog txuam nrog mob hnyav cov nqaij mos.
Ruedi - Allgower Classification
Hom I: A 'T' - zoo li cov pob txha tawg tsis muaj qhov cuam tshuam loj.
Hom II: Split ntawm articular nto nrog pom tseeb txav ntawm txoj kab tawg thiab nruab nrab comminution.
Hom III: Mob hnyav thiab compressive pob txha ntawm lub distal tibial articular nto thiab metaphysis.
Kev kho tsis yog phais
Kev kho tsis yog phais rau cov pob txha ntawm tibial Pilon yog qhov tsawg. Cov lus qhia yog qhov tsawg kawg ntawm cov pob txha tawg thiab cov neeg mob uas muaj cov kab mob sib kis uas ua rau muaj kev pheej hmoo ntawm kev phais mob. Ntxiv - articular fractures nrog cov kev hloov me me ntawm tag nrho tibial kev sib raug zoo kuj tuaj yeem kho nrog plaster immobilization yam tsis muaj kev phais. Ib tug splint yog pib siv kom txog thaum lub o tuaj, thiab tom qab ntawd siv plaster cam khwb cia. Kev hloov pauv loj ntawm tibial lossis articular nto alignment tuaj yeem ua rau muaj teeb meem nrog kev sib haum xeeb thiab kev ruaj ntseg. Kev kuaj X-ray txuas ntxiv yog tsim nyog los xyuas kom muaj kev sib koom ua ke thiab kev sib haum xeeb ntawm cov ceg.
Selective intra - articular fractures kuj tuaj yeem kho tsis yog phais. Rau intra - articular fractures nrog tsawg dua 2 hli ntawm cov pob txha tawg thiab tsawg dua 3 hli ntawm cov kauj ruam - tawm, kev kho tsis yog phais tuaj yeem txiav txim siab rau cov neeg mob uas muaj kev ua haujlwm tsawg.
Kev phais mob
Articular nto kauj ruam - tawm ntau dua 2 hli.
Valgus angulation ntau dua 5 °.
Txhua yam angulation.
Qhib pob txha.
Compartment Syndrome.
Kev raug mob hlab ntsha.
Ntau qhov raug mob.
Sijhawm phais
(1) Kev kho mob thaum muaj xwm ceev: txo thiab kho qhov kev puas tsuaj; Qhib pob txha; Associated vascular raug mob; Compartment Syndrome.
(2) Thawj - theem (Rov kho ntawm limb ntev thiab sib dhos): Calcaneal traction; Sab nrauv fixation; Kev txo qis thiab txhim kho sab hauv ntawm cov pob txha pob txha, txwv qhib txo thiab sab hauv kho ntawm cov pob txha tibial malleolar pob txha; Kev tiv thaiv thrombus.
(3) Thib ob - theem: Kwv yees li 10 - 14 hnub tom qab, qhib qhov txo qis thiab kho sab hauv ntawm tibial pob txha.
(4) Cov ntaub so ntswg mos rau qhov thib ob - theem phais yog: nqus ntawm hematoma ntawm qhov chaw phais, epidermal regeneration ntawm pob txha pob txha, kho lub qhov txhab ntawm pob txha qhib tsis muaj kab mob, cov ntaub so ntswg edema, thiab wrinkling ntawm daim tawv nqaij.
Txoj Kev phais
(1) Maximize qhov raug ntawm kab tawg.
(2) daws tag nrho cov pob txha pob txha nrog kev phais tsawg tshaj plaws.
(3) Zam cov cheeb tsam uas muaj cov ntaub so ntswg tsis zoo.
(4) Xav txog kev raug mob mechanism.
(5) Xav txog qhov chaw ntawm lub phaj.
Rau cov pob txha nrog varus deformity, xaiv lub phaj nruab nrab ntawm lub taub hau, thiab siv txoj hauv kev anteromedial.
Rau cov pob txha nrog valgus deformity, xaiv ib lub phaj phaj sab nraud, thiab siv txoj hauv kev anterolateral.
Qhov kev ncua deb ntawm ob qhov kev txiav yuav tsum yog tsawg kawg 5-7 cm.
CZMEDITECH cov khoom
