Ngwa ntu Tibia zuru ụwa ọnụ 2025 kacha ọhụrụ ọhụrụ

Distal Tibial intramedullary ntu (DTN)

Suprapatellar nso Tibial Intramedullary Nail

Ọkachamara Tibia intramedullary Ntu

1.Proximal Oblique Cut

Mbelata oblique nke ihu na njedebe dị nso na-egbochi mgbakasị ahụ na ligamenti patellar.

2. Ekebe mkpọchi dị elu

Nhazi mkpọchi dị nso na-abawanye nkwụsi ike achọrọ maka iberi dị nso.

3. Mkpọchi oblique distal

Nhọrọ mkpọchi oblique nke dị anya iji gbochie mmebi anụ ahụ dị nro ma welie nkwụsi ike nke mpekere dị anya.

4. Ugboro abụọ eriri ịghasa

Mkpọchi nke ejiri eriri ụzọ abụọ emebere maka ntinye dị mfe.

Usoro mkpọchi

Mkpọchi imewe maka nrụzi siri ike, belata nbibi nbibi gachara.

Nkwado ọtụtụ ihe

Otutu isi ihe ndozi na-enye nkwụsi ike n'akuku yana nkwado kwụsiri ike maka tibial palteau.

Usoro mkpakọ

Ngwaọrụ na-egosipụta ọrụ ngbanwe mgbanwe, yana mgbanwe ọdịdị ọdịdị ya nke egosiri na ihe atụ n'okpuru ma tupu mkpakọ (ọnọdụ rụrụ arụ) na ọnọdụ mkpakọ (nke dabara nke ọma).

Ndozi nso-Distal

Usoro ndozi ọtụtụ site na nso na distal, na-egosi mgbaji tibial dị nso na nke dị anya.

Ekebere Flat maka ntinye dị mfe

Ogologo njedebe nke ntu isi nwere nhazi dị larịị, na-eme ka ntinye dị mfe n'ime oghere medullary.

Mkpọchi akpọchi angular

Mkpọchi mkpọchi akụkụ abụọ na njedebe dị nso na-egbochi ntụgharị na ngbanwe nke akụkụ mgbawa.

Anatomical curvature

Ọkpụkpọ ahụ pụrụ iche na-eme ka ntu isi guzobe nke ọma n'ime oghere medullary.

Mkpọchi mkpọchi akụkụ na-emekọrịta ihe

Ihe nkedo mkpọchi akụkụ atọ na-ejikọta ọnụ na njedebe dị anya na-enye nkwado na ndozi dị irè.

Ntughari:

Kwesịrị ekwesị maka ọtụtụ mgbaji ọkpụkpụ tibial (midshaft na ụfọdụ mgbawa distal/proximal fractures), ebe ụdị ndị ọzọ (dịka, DTN ma ọ bụ Ntu Ọkachamara) ka emebere maka mpaghara anatomical kpọmkwem ma ọ bụ mgbagwoju anya.

Usoro ịwa ahụ tozuru oke:

Usoro ọkọlọtọ (parapatellar ma ọ bụ transpatellar) na-agbaso usoro guzosiri ike nke ọma yana usoro mmụta dị ala, ebe ụzọ pụrụ iche (dịka ọmụmaatụ, suprapatellar) chọrọ ọzụzụ ọrụ nka ọzọ.

Ọnụ-arụmọrụ:

Tụnyere mbọ aka pụrụ iche dị ka Ntu Ọkachamara ma ọ bụ DTN, mbọ intramedullary tibial ọkọlọtọ na-adịkarị ọnụ ọnụ, na-eme ka ha dabara maka ikpe oge niile.

Ndakọrịta dị ukwuu nke ịkụnye:

Dakọtara na ngwa zuru ụwa ọnụ (dịka ọmụmaatụ, screws, ezubere iche ngwaọrụ), ebe ntu pụrụ iche (dịka ọmụmaatụ, Ntu ọkachamara nwere sistemu mkpọchi ọtụtụ ụzọ) nwere ike ịchọ ngwa ọrụ.

1. Nkwadebe tupu ịwa ahụ

Nlele onyonyo: X-ray/CT tupu arụọ ọrụ iji kwado ụdị mgbaji, dayameta na ogologo ọwara mmiri, yana nha tibia na-emegide ya dị ka ntụaka.

Ndokwa: Ọnọdụ dị n'azụ na mgbatị ikpere 90 °-120 ° na ntinye ntanye úkwù (iji belata mgbatị akwara patellar). Igwe rediolucent triangular nwere ike ịkwado fossa popliteal maka traction.

Draping Sterile: Ọkọlọtọ sterilization na draping, na-ahụ na ngagharị C-ogwe aka.

2. Mbelata mgbaji

Usoro Mbelata emechiri emechi

Ntugharị akwụkwọ ntuziaka: Enyemaka na-etinye traktị ogologo oge ebe dọkịta na-awa ahụ na-akụ tibial crest na elu anteromedial iji dozie nhazi (ogologo, ntụgharị, angulation).

Ngwa-enyere aka:

• Usoro Joystick: skru Schanz etinyere n'ime mpekere dị nso/distal maka mbelata lever.

• Mkpọgide Percutaneous: Mmagide mbelata ntụnyere maka mgbaji agbaji.

• Ihe ndọpụ uche: Nnukwu ihe ndọpụ uche na-edobere coronally (ihe nkedo Schanz skru yiri tibial plateau, pin distal na talus ma ọ bụ distal tibia) iji kwado ogologo.

3. Nhazi ebe ntinye

Akara ala:

• Ebe ntinye 1cm n'ebe dị anya gaa n'ihu tibial plateau ọnụ ọnụ, kwekọọ na axis medullary.

• Nkwenye fluoroscopic: nlele AP dabara na crest tibial, anya mpụta yiri axis tibial.

Ngwa mmeghe:

• Mkpọpu mmiri n'elu guidewire (ya na aka nchekwa) ma ọ bụ awl ​​siri ike gbagọrọ agbagọ.

• Reamers aka (6-8mm) maka mgbaji agbaji nwere oghere ọwa mmiri.

4. Ntinye Guidewire & Reaming

Ndobe Guidewire: Ntuzi aka nwere bọọlụ gbajiri 10-15mm n'ọnụ maka ụzọ mgbaji. Nkwenye Fluoroscopic na anya physeal distal (etiti nkwonkwo ụkwụ).

Usoro nhazigharị:

• Ndị na-agbanwe agbanwe na-amalite na 8mm, na-abawanye 0.5mm ruo mgbe cortical 'chatter' (na-abụkarị 1-1.5mm> dayameta ntu).

• Mara: Mwepụ na-adịte aka na-ekpochapụ irighiri ihe; zere necrosis thermal.

5. Ntinye ntu

Mkpebi ogologo:

• Mmetụta intraoperative: Guidewire overlap method ma ọ bụ onye na-achị fluoroscopic (ebe ntinye aka na nkwonkwo ụkwụ).

• Gbaa mbọ hụ na ntu ntu ruru n'apa physeal na-enweghị proximal protrusion.

Usoro ntinye:

• Ọbu-aka-n'iru n'elu ndu; gbanwee mbelata ma ọ bụrụ na nguzogide emee.

• Debe mbelata n'oge ngafe maka mgbaji dị anya.

6. Ndozi ihe nkedo na-ejikọta ọnụ

Usoro Usoro

• Ọkpụkpụ gbajie kwụsiri ike ogologo: Mkpọchi dị nso na mbụ (otu skru na-enye ohere ịmegharị ya).

• Ogologo-adịghị akwụsi ike/mgbajiri agbaji: Mkpọchi nke anya na-ebute ụzọ wee bụrụ 'backslap' iji mpikota onu.

Mkpọchi dị nso

• ≥2 kposara site n'iji ngwaọrụ (multidirectional for proximal fractures).

Mkpọchi dị anya

• Usoro fluoroscopic: Central beam perpendicular ka ịghasa oghere ('okirikiri zuru oke'), mkpọpu ihe n'ụdị.

• ≥2 kposara maka mgbaji dị anya (nwere ike ijikọ AP/oblique orientations).

7. Usoro ikpeazụ

Okpu ngwụcha: Ntinye nhọrọ (na-egbochi ọkpụkpụ ọkpụkpụ), hụ na ọ nweghị nkwalite nkwonkwo.

Mmechi ọnya: Nrụzi akwara patellar nwere akwa akwa na suture subcutaneous rụrụ arụ.

8. Nlekọta nke postoperative

Ndozi mmalite:

• Mbuli ụkwụ; Nyochaa maka akụkụ ahụ syndrome n'ime awa 24.

• Bido mkpokọta nkwonkwo na-arụsi ọrụ ike (nfuli nkwonkwo ụkwụ, ngbanwe ikpere) na POD 1-2.

Protocol ibu ibu:

• Ibu obere ibu maka izu isii (doziri kwa nkwụsi ike), na-aga n'ihu ruo n'uju mgbe oku pụtara.

Nsoso: Nyocha ụlọ ọgwụ / redio na 2, 6, na 12 izu.