Kuphulika kwa Tibial, njira ya suprapatellar intramedullary nailing

Intramedullary tibial misomali: kupeza ndi kuyanjanitsa, kupweteka kwapambuyo kwa bondo

Njira yopangira opaleshoni ya misomali ya intramedullary ya tibial fractures ndiyofunikira kuti mulowetse msomali wa intramedullary polowera polowera, kuchepetsa kuwonongeka kwa mawondo a intra-articular, komanso kuti akwaniritse bwino fracture repositioning ndi kulowa msomali woyenera.

Njira zachikale za kuphulika kwa tsinde la tibial ndi njira ya infrapatellar median kapena infrapatellar parapatellar. Ngakhale kuti njirazi zimasonyezedwa kuti ziphwanyike pakati pa gawo, postoperative valgus, anterior, kapena concomitant deformities zimachitika kawirikawiri fractures proximal.

Chifukwa chachikulu cha kusalongosoka kwa proximal tibial fractures ndi kupunduka komwe kumachitika chifukwa cha kukoka kwa tendon ya quadriceps panthawi ya mawondo a mawondo ndi mkangano wamakina pakati pa nsonga ya msomali ndi posterior tibial cortex panthawi yoika implants. Patella imalepheretsanso kulowa kwa msomali wa axial mu ndege ya sagittal (Mkuyu 1a, b). Choncho, njira ina yodziwika bwino yopezera mfundoyi ndi kudzera muzitsulo zapakati pa parapatellar, zomwe zimatsogolera pang'onopang'ono kuyika msomali wotsatira (mkuyu 1c ndi 2). Pamene msomali umalowa mu intramedullary canal distal mpaka fracture, gawo loyandikana nalo limalowa mu valgus (Chithunzi 2). Potsirizira pake, mpumulo wa minyewa yam'kati mwa chipinda cham'mbuyo imathandizira pang'ono ku valgus (Chithunzi 3).

Chithunzi 1 a, b Pogwiritsa ntchito njira yodziwika bwino ya infrapatellar, patella imalepheretsa kulowa kwa axial kwa msomali, zomwe zimapangitsa kuti pakhale kusinthika kofanana kwa anterior apical apical sagittal alignment ndi valgus coronal alignment. c Kugwiritsa ntchito njira ya parapatellar pakulumikiza misomali ya intramedullary.

Chithunzi 2 Kuyandikira polowera kudzera pakatikati pa parapatellar incision kumabweretsa kulowera pang'ono kwa msomali wam'mbali. Pamene msomali umalowa mu ngalande ya medullary mpaka kuthyoka (a), gawo loyandikana nalo limalowera ku valgus (b)

Chithunzi 3 Kupumula kwa mkangano mu chipinda cham'mbuyo cha minofu (a) kumapanga dongosolo la ectopic (b)

Kuyika tibia pamalo otalikirapo kumathandiza kupewa zovuta zomwe zimagwirizanitsidwa ndi kupindika kwambiri kwa mawondo. Njirayi idafotokozedwa ndi Gelbke, Jakma et al. mu 2010 ndipo yakhala yotchuka kwambiri m'zaka zaposachedwa chifukwa kukanikiza tibia pamalo olunjika kumapangitsa kuti fracture ikhale yosavuta ndikuyikanso. Fluoroscopy yakhala yosavuta kuchita mwaukadaulo. Nthawi za fluoroscopy za kukhomerera kwa suprapatellar zanenedwa kuti ndi zazifupi kwambiri kuposa za misomali ya infrapatellar. Kuonjezera apo, ngodya ya kuyika misomali (mu ndege ya sagittal) imakhala yofanana kwambiri ndi kutalika kwa tibia mu njira iyi kusiyana ndi msomali wa infrapatellar; izi zimalepheretsa mikangano yamakina pakati pa nsonga ya msomali ndi kotekisi yakumbuyo, potero zimathandizira kuchepetsa kusweka.

Kupweteka kwapambuyo kwa bondo pambuyo pa opaleshoni ndi vuto lofanana. Kupweteka kwapambuyo kwa mawondo kumanenedwa mu 50-70% ya odwala othyoka, ndi 30% yokha ya odwala omwe amamva kupweteka pambuyo pochotsa chomera chamkati. Akuti kupangika kwa zipsera komwe kumalumikizidwa ndi mwayi wopita ku patellar tendon ndi Hoffa fat pad ndizomwe zimayambitsa kupweteka kwa bondo pambuyo pa opaleshoni. Kuphatikiza apo, njira ya suprapatellar imapewa kudulidwa kwachikhalidwe kwa nthambi ya nthambi ya patellar ya mitsempha ya saphenous, potero kupewa dzanzi la mawondo am'mbuyo komanso kufooka kwamalingaliro (Chithunzi 4). Kudutsa msomali kudzera mu quadriceps tendon, motero kusiya patellar tendon, kumawoneka kuti kumachepetsa kwambiri ululu wa pambuyo pa opaleshoni ya bondo.

Chifukwa cha zotsatira zabwino za kupasuka kwapakatikati, zisonyezo muzochita zachipatala zafalikira ku fractures zonse.

Kodi misomali ya suprapatellar intramedullary iyenera kugwiritsidwa ntchito liti?

Ubwino wake

• Bondo lotalikirapo pang'onopang'ono limalimbikitsa kusintha kwa fracture ndikuyikanso popumula mphamvu ya minofu ndi kusungidwa pakuyika misomali.

• Chiwopsezo chochepa cha kusuntha kwapambuyo kwapang'onopang'ono, magawo ndi distal fractures poyerekeza ndi njira wamba.

• Nailing ntchito mwaukadaulo yosavuta kuchita

• Kuyika misomali ndizotheka ngati 'njira ya opaleshoni imodzi'

• Kuchepetsa nthawi ya fluoroscopy

• Palibe kuwonongeka kwa tendon ya patellar komanso kutsika kwapang'onopang'ono kwa mawondo am'mbuyo

• Zosavuta kuchita m'magulu angapo, monga momwe zimakhalira ndi zoopsa zingapo

  
  

Zizindikiro

• Kuphulika kwapadera kwa proximal tibia (mtundu wa AO 41A)

• Kuphulika kosavuta kwa tibial diaphysis (mtundu wa AO 42A-C)

• Segmental tibial diaphyseal fracture (mtundu wa AO 42C)

• Distal tibial extra-articular fractures ndi zosavuta za intra-articular distal extension fractures (AO 43A ndi C1 mitundu)

• Bondo loyandama

• Patellar ossification ndi patellar tendon ossification

• Chilonda choipitsidwa pamlingo wa tendon ya patellar

Kodi Mungagule Bwanji Ma Implant a Orthopedic ndi Orthopedic Zida?

Za CZMEDITECH , tili ndi mzere wathunthu wa mankhwala opangira opaleshoni ya mafupa ndi zida zofanana, zomwe zimaphatikizapo implants za msana, misomali ya intramedullary, trauma plate, mbale yotsekera, cranial-maxillofacial, prosthesis, zida zamagetsi, okonza kunja, arthroscopy, chisamaliro cha ziweto ndi zida zawo zothandizira.

Kuphatikiza apo, tadzipereka kupitiliza kupanga zinthu zatsopano ndikukulitsa mizere yazogulitsa, kuti tikwaniritse zosowa za maopaleshoni a madokotala ndi odwala ambiri, ndikupangitsanso kampani yathu kukhala yopikisana pamakampani onse apadziko lonse oyika mafupa ndi zida zamagetsi.

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