Distal tibial fractures yog ib hom kab mob qis qis. Kev kho mob ib txwm muaj xws li xauv daim hlau thiab antegrade intramedullary rau tes txhua tus muaj lawv qhov tsis zoo. Xauv daim hlau yuav ua rau muaj kab mob tom qab phais lossis cov nqaij mos necrosis, ncua kev rov zoo; Txawm hais tias cov ntsia hlau antegrade muaj qhov cuam tshuam me me, lawv tuaj yeem ua rau lub hauv caug sib koom ua ke, ua rau mob, thiab ua rau muaj kev pheej hmoo ntawm kev kho tsis zoo lossis tsis zoo, cuam tshuam kev rov qab los.
2Kev daws teeb meem tshiab: Distal Tibial Nail (DTN)
Ib qho kev xaiv kho tshiab-Distal Tibial Nail (DTN)-muab qhov kev xav tshiab rau kev tswj cov pob txha pob txha pob txha nrog nws cov qauv retrograde tshwj xeeb.
Daim duab 1: DTN retrograde insertion tsim
II. Kev phais mob
1Tus neeg mob qhov chaw thiab kev npaj txo qis
Tus neeg mob muab tso rau hauv lub supine txoj hauj lwm. Tshem tawm cov pob txha tawg yuav tsum tau txo qis manually; yog tias tsim nyog, siv qhov txo qis los pab ua ntej tso DTN. Yog tias muaj qhov sib txuam nrog cov pob txha pob txha, kev kho kom zoo ntawm cov nqaij mos tuaj yeem pab txo tibial.
Cov ntsiab lus tseem ceeb: Supine txoj hauj lwm, siv txo forceps yog tias xav tau. Ua ntej kev tswj fibular pob txha kom ntseeg tau tias tibial txo qis.
2DTN insertion txheej txheem
Ib tug 2-3 cm ntev incision yog ua nyob rau hauv lub ntsis ntawm lub medial malleolus kom nthuav tawm lub sab deltoid ligament. Ib daim ntawv qhia tus pin yog muab tso rau ntawm los yog me ntsis nruab nrab mus rau lub ntsis ntawm lub malleolus, 4-5 mm los ntawm articular nto.
Post-op: Tsuas yog 6 me me incisions, ua tiav kho tsis pub dhau 1 xyoos
Cov ntsiab lus kho mob
DTN implanted los ntawm me me incisions nrog zoo heev mos mos preservation. Fibular puas stabilized nrog intramedullary ntsia thawv. Tus neeg mob tau txais kev rov zoo tag nrho tsis muaj teeb meem.
Pre-op duab
Tam sim ntawd Post-op
3-hli kev soj ntsuam
1-xyoo Kho
VI. Kev sib tham
1Biomechanical Stability
Retrograde rau tes muaj superior axial thiab rotational nruj piv rau medial locking daim hlau thiab antegrade rau tes. Greenfield et al. Kev sim biomechanical qhia tau hais tias siv ob qhov ntsia hlau distal hauv DTN tau ua tiav 60-70% ntawm cov compressive txhav thiab 90% ntawm qhov torsional nruj piv rau peb cov ntsia hlau.
2Qhov zoo ntawm DTN
Muab piv rau cov ntawv xauv, cov rau tes intramedullary ua rau cov nqaij mos puas tsawg dua, tshwj xeeb tshaj yog rau cov neeg laus thiab cov neeg uas muaj cov nqaij mos raug mob hnyav los ntawm lub zog loj. Cov txheej txheem tsis tas yuav tsum tau lub hauv caug flexion, txo qhov kev pheej hmoo ntawm kev txo qis thiab ua kom haum rau cov neeg mob uas muaj kev txwv lub hauv caug.
3Kev sib piv
Qhov tsis zoo thiab qhov tsis zoo rau cov ntsia hlau antegrade yog 0-25% thiab 8.3-50%, feem; rau xauv daim hlau, 0-17% thiab 0-17%. Hauv txoj kev tshawb no, tag nrho cov xwm txheej tau ua tiav kev sib koom ua ke, thiab tsuas yog 20% muaj deformity> 5 °, piv rau cov txheej txheem ib txwm muaj.
Kev paub txog tus kheej ntawm kev tswj hwm tag nrho.
Lub vev xaib no siv cov ncuav qab zib thiab cov thev naus laus zis zoo sib xws ('cookies'). Raws li koj qhov kev pom zoo, yuav siv cov ncuav qab zib tsom xam los taug qab cov ntsiab lus twg koj nyiam, thiab cov ncuav qab zib ua lag luam los nthuav tawm cov paj laum raws li kev tshaj tawm. Peb siv cov neeg muab kev pabcuam thib peb rau cov kev ntsuas no, uas tuaj yeem siv cov ntaub ntawv rau lawv tus kheej lub hom phiaj.
Koj muab koj qhov kev tso cai los ntawm txhaj rau 'Accept all' los yog los ntawm kev siv koj tus kheej tej chaw. Koj cov ntaub ntawv kuj tseem tuaj yeem ua tiav hauv peb lub tebchaws sab nraud EU, xws li Asmeskas, uas tsis muaj cov ntaub ntawv tiv thaiv qib sib xws thiab qhov twg, tshwj xeeb, kev nkag mus los ntawm cov tub ceev xwm hauv zos yuav tsis muaj kev tiv thaiv zoo. Koj tuaj yeem tshem tawm koj qhov kev pom zoo tam sim ntawd thaum twg los tau. Yog tias koj nyem rau ntawm 'Reject all', tsuas yog cov ncuav qab zib uas tsim nyog yuav raug siv.
