Umusumari wa kure: Urugendo rwo kuvura imivurungano ya kure

Kuvunika kwa mubiri bya kure birasanzwe, kandi imiti gakondo ifite imbogamizi

Kuvunika imyanda ni ubwoko busanzwe bwo kuvunika ingingo yo hasi. Ubuvuzi gakondo nko gufunga hamwe na antegrade intterlary imisumari buri kimwe gikomoka. Isahani yo gufunga irashobora gutera indwara zo nyuma cyangwa tissue yoroshye necrosis, kuruhuka cyane; Nubwo imisumari ya antegrade iteye ubwoba, irashobora kwangiza ivi, itera ububabare, kandi itwara ibyago byo gukosorwa cyangwa gukinisha, kubangamira gukira.

Igisubizo gishya: Umusumari wa kure (DTN)

Umuyoboro wo kuvura udusimba-disal tibial (DTN) -ububiko bushya bwo gucunga indabyo za kure na recrograde yihariye ya retrograde.

Umwanya wo Kwitegura no Kwitegura Kugabanuka

Umurwayi ashyirwa mumwanya wo gutanga suptine. Kuvumburwa bigomba no kugabana intoki; Nibiba ngombwa, koresha imbaraga zo kugabanya mbere yo kwinjiza DTN. Niba hari intera iherekeza fibuland ya fibuland, guhuza fibular bikwiye birashobora gufasha kugabanuka. Ibiti bya fibular birashobora gutuzwa hamwe nimisumari. Kuvuka hafi yamaguru, kugabanuka kwa Anatolical no gukosora fibula bigomba kubanza kubanza kugabanuka kwa tibial kugirango birinde malabment. Mu miterere ifunguye hamwe no gukosorwa hanze, umusumari urashobora kwinjizwa mugihe ukomeje gukosora kugirango ugere ku kugabanya kugabanuka.

Uburyo bwo kwinjizamo DTN

Igice cya cm 2-3 kirekire gikorwa ku isonga rya Malleolus melleolus kugirango igaragaze ligamen eltoid. Igice cya PIN cyinjijwe kuri cyangwa meta gato kugeza ku isonga rya Mainleolus (Ishusho 2a), mm 4-5 kuva hejuru yuburinganire. Reba kuruhande yerekana kwinjiza ukoresheje Intercondylar Groove (Ishusho 2b), kwirinda kwangirika mumitsi yinyuma yinyuma. Tandukanya imvugo igaragara ya deltoid, hanyuma ukoreshe reamer kugirango wagure imfashanyinya kugeza aho akarere ka metaphyseal (FIG. 2c). Kuraho igufwa ryagata kuri kanseri hafi ya Cortex yo hagati ya Cortex kugirango ushiremo umusumari (Ishusho ya 2d). Shyiramo umusumari ugeragezwa kugirango wemeze ubunini bwa DTN (Ishusho 2e). Irinde inyundo cyangwa birenze urugero kugirango wirinde kuvunika amavuta yo hagati ya Iatrogenic. Hindura imisumari yimbitse kugirango umenye neza imigozi itandukana ntabwo yinjiza ankle hamwe nurubuga. Gukosora byagezweho hamwe no guhagarika imiyoboro neza kandi kure.

Ako Guhuza Ibirenge
kanya Ankle Kugenda
no

Igikorwa cya Ankle gitangira ako kanya nyuma yo kubagwa

Irinde kwitwaza ibiro ku byumweru 4-6

Buhoro buhoro kwimura ibiro byuzuye mubyumweru 8-12

Kurikirana abarwayi 10

Ubushakashatsi bwakurikiranye abarwayi 10 (imbonerahamwe 1). Mugihe cyamezi 3 nyuma ya OP, hakira imanza 7 zari zakize; Abarwayi bose bageze gukiza mumezi 6. Urubanza rumwe buri munyamaziburo na relurvatum cyabaye. Nta gutakaza kugabanuka, kwandura, ingorane zijyanye n'imikorere, cyangwa imvururu zagaragaye (imbonerahamwe 2).

Umurwayi w'imyaka 69

Ibimenyetso kuri DTN

Ubu bushakashatsi bwarimo AO 43-A na C1 kuvunika; C2 nabwo yasuzumwe. DTNS iraboneka muburebure bwa MM 7 na 8 mm, byerekana gushyiramo imigozi myiza yo guhuza. Kuvunika Iherereye hejuru yubuso bwa articular ni abakandida beza kuri DTN POCTION. Ibimenyetso birashobora kwagurwa kuri Ao 42 kuvunika.

Biomena

Gusubiramo imisumari isumba byose kandi izunguruka ugereranije na plaque yo muri metale hamwe nimisumari. Greenfield et al. Yakozwe ikizamini cyibinyabuzima yerekana ko ukoresheje imigozi ibiri ya kure muri DTN yageze kuri 60-70% yo gukomera no gukomera kwa 90% ugereranije na screw eshatu. DTN yagabanije gukandagira igice munsi yumutwaro. Mu manza 3 zidakira mu mezi 3, ibintu byari birimo ibyangiritse byoroheje, kwaguka kwa medullary, kuvunika ahantu, na Osteorezo. Kubera ko DTN iza mu bunini butatu gusa kandi ikosora igarukira kuri screw eshatu, zirashobora gutanga imitekano idahagije mu miyoboro yagutse cyangwa amagufwa ya osteoropotic. Hagomba kwitwaza ibirori hakiri kare bigomba kwegera byitonda mubihe nkibi.

Ibyiza bya DTN

Ugereranije no gufunga amasahani, imisumari yo mu ntambara ituma ibyangiritse byoroheje, bikwiranye nabarwayi bageze mu zabukuru hamwe nabafite ibikomere byoroshye biva mu mbaraga zingufu nyinshi. Muri ubu bushakashatsi, DTNs yinjijwe binyuze mu bice bitandatu gusa, nta kibazo cyoroshye cya tissuwe. Inzira ntabwo isaba guhindaho ivi, kugabanya ibyago byo gutakaza no gukora bikwiranye nabarwayi bafite ijisho rito (urugero, ivi rya arthritis cyangwa post-tka).

Ingaruka zo kubaga no kwirinda

Ingaruka zirimo gukomeretsa imitsi yinyuma ya tibialis hamwe na toclelar yo hagati. Kuvunika muri Malle-yo hagati birashobora kuvurwa hamwe na band band insinga, kwifotoza, cyangwa gukosorwa hanze.
Hagomba gufatwa kugirango wirinde kwinjira muri fibular. Igikoresho cyibibanza gishobora gutera inyuma ya DTN bitewe nuburemere bwayo; Hindura isegonda kugirango ugaragaze kuri fibula (Ishusho 4c).

Kugereranya kwa Clinical

Ibiciro bya Noninion na Malalignament ku misumari ya antegrade ni 0-25% na 8.3-50%; yo gufunga amasahani, 0-17% na 0-17%. Muri ubu bushakashatsi, imanza zose zageze mu bumwe, kandi 20% gusa zari zifite ubumuga> 5 °, ugereranije nuburyo gakondo.ibiciro bitagaragara ni 0-8.3% kumasahani ya 0-23% yo gufunga; Indwara ndende ni 0-23% na 0-8.3%. Ubu bushakashatsi bwatangaje ko nta kibazo cyoroshye cya Tissuwe, dukosora ubundi buryo bwombika.

Muri make, DTN itanga inyungu hejuru yo gufunga hamwe na antegrade intramedulllary imisumari kandi igereranya igisubizo cyiza cyo kuvura indwara zo mumurikagurisha.

DTN ibiranga guterana, gushikama cyane, no gukira byihuse

Nuburyo bwagaciro bwo kuvura gakondo kandi bikwiye guteza imbere

Yamakawa y, Uehara t, Shigemoto K, et al. Ibisubizo bibanza byo guhoberana bikabije bya Tibia bikabije hamwe nisumari ya kure: 'igiteganijwe imbere, Urukurikirane rwigihugu cyimyitozo ngororamubiri. Gukomeretsa, 2024: 111634.
创伤骨科智能科技创伤骨科智能科技. (2024 年 12月 31 日). 胫骨远端髓内钉突破胫骨远端骨折的治疗 [微信公众号文章]. 创伤骨科智能科技 智汇骨. https://mp.weixin.qq.com/s/9uqqv4eae4Bkzg2u4nq8q (yabonetse: 207日)