Umusumari wa Tibial Distal: Intambwe mu kuvura imvune ya Tibial Distal

Kuvunika kwa tibial kure birasanzwe, kandi kuvura gakondo bifite aho bigarukira

Ivunika rya tibial intera ni ubwoko busanzwe bwo kuvunika ingingo. Ubuvuzi gakondo nko gufunga amasahani hamwe na antegrade imisumari yimisumari buriwese afite ibibi. Gufunga amasahani birashobora gutera indwara zanduye nyuma yo kubagwa cyangwa niyoroshe ya tissue yoroheje, gukira igihe kirekire; nubwo imisumari ya antegrade idashobora kwibasirwa cyane, irashobora kwangiza ingingo yivi, igatera ububabare, kandi igatwara ibyago byo gukosorwa bidahagije cyangwa kurwara nabi, bikabuza gukira.

Igisubizo gishya: Umusumari wa Tibial Distal (DTN)

Uburyo bushya bwo kuvura - Nail Tibial Nail (DTN) - butanga icyerekezo gishya cyo gucunga imvune ya tibial intera hamwe nigishushanyo cyihariye cya retrograde.

Guhitamo abarwayi no gutegura kugabanya

Umurwayi ashyirwa mumwanya mwiza. Ivunika ryimuwe rigomba kugabanywa intoki; nibiba ngombwa, koresha imbaraga zo kugabanya kugirango ufashe mbere yo kwinjiza DTN. Niba hari kuvunika kwa fibular guherekeza, guhuza neza fibular birashobora gufasha kugabanya tibial. Ivunika rya fibre irashobora guhagarikwa hamwe n imisumari yimbere. Kuvunika kuzengurutse akaguru, kugabanya anatomique no gukosora fibula bigomba kubanziriza kugabanuka kwa tibial kugirango wirinde kurwara nabi. Mu kuvunika gukinguye hamwe nibisanzwe byo hanze, umusumari urashobora kwinjizwamo mugihe ukomeza gukosora kugirango ugabanye kugabanuka.

Uburebure bwa cm 2-33 bukozwe hejuru ya malleolus yo hagati kugirango yerekane ligamenti ya deltoid. Imiyoboro ngenderwaho yinjizwa cyangwa hagati gato kugeza hejuru ya malleolus (Igishusho 2a), mm 4-5 uvuye hejuru ya arctular. Kurebera kuruhande byerekana kwinjiza ukoresheje intercondylar groove (Igishusho 2b), wirinda kwangirika kwimitsi yinyuma ya tibialis. Tandukanya ligamenti yimbere ya deltoid, hanyuma ukoreshe reamer kugirango wagure umuyoboro wa medullary kugeza mukarere ka metafhyseal (Ishusho 2c). Kuraho igufwa rya kanseri hafi ya cortex yegeranye yo hagati kugirango ushiremo umusumari (Ishusho 2d). Shyiramo umusumari wo kugerageza kwemeza ingano ya DTN (Ishusho 2e). Irinde inyundo cyangwa kugoreka cyane kugirango wirinde kuvunika kwa iatrogène. Hindura ubujyakuzimu bw'imisumari kugirango umenye neza ko imigozi ya kure itinjira mu kibanza cy'amaguru cyangwa kuvunika. Gukosora bigerwaho hamwe no guhuza imigozi hafi kandi kure.

Ako kanya imigeri ihuriweho hamwe no guhuza ibirenge kugeza hasi biremewe nyuma yo
kubagwa Kutagira uburemere bwibyumweru 4-6
Gutera imbere kubyibuha byuzuye hagati yibyumweru 8-12, mugihe ukurikirana imiterere ya callus nububabare.

Igikorwa cyo guhuza imigeri gitangira ako kanya nyuma yo kubagwa

Irinde kwikorera ibiro mu byumweru 4-6

Buhoro buhoro kwimura ibiro byuzuye mubyumweru 8-12

Gukurikirana abarwayi 10

Ubushakashatsi bwakurikiranye abarwayi 10 (Imbonerahamwe 1). Mugihe cy'amezi 3 nyuma ya op, imanza 7 zimaze gukira; abarwayi bose bagezeho gukira mumezi 6. Urubanza rumwe buri varus na recurvatum deformations zabaye. Nta gihombo cyo kugabanuka, kwandura, ingorane ziterwa no guterwa, cyangwa ibikomere bya iatrogène byagaragaye (Imbonerahamwe 2).

Umusaza w'imyaka 69

Ibyerekana kuri DTN

Ubu bushakashatsi bwarimo kuvunika AO 43-A na C1; C2 nayo yasuzumwe. DTN iraboneka muburebure bwa mm 7 na mm 8, bigena ishyirwa ryimigozi yegeranye. Ivunika riri kuri cm 2-9 hejuru yubuso bwa arctular ni abakandida beza kugirango DTN ikosorwe. Ibimenyetso birashobora kwaguka kugeza kuri AO 42.

Ibinyabuzima bihamye

Imisumari ya retrograde ifite imbaraga zo hejuru no kuzunguruka ugereranije no gufunga ibyuma byo hagati hamwe n imisumari ya antegrade. Greenfield n'abandi. yakoze ibizamini bya biomehanike yerekana ko gukoresha imigozi ibiri ya kure muri DTN yageze kuri 60-70% yo kwikomeretsa no 90% bya torsional gukomera ugereranije ninshuro eshatu. DTN yagabanije ibice byavunitse bigenda munsi yumutwaro. Mu bihe 3 bitarakize mu mezi 3, ibintu birimo kwangirika kwinyama zoroshye, kwaguka kwa medullary, aho yavunitse, na osteoporose. Kubera ko DTNs ziza mubunini butatu gusa kandi gukosora kure bigarukira kumirongo itatu, birashobora gutanga umutekano udahagije mumigezi yagutse cyangwa amagufwa ya osteoporotic. Kuzamura ibiro hakiri kare bigomba kwiyegereza witonze mubihe nkibi.

Ibyiza bya DTN

Ugereranije no gufunga amasahani, imisumari yimbere itera kwangirika kwinyama zoroheje, cyane cyane kubarwayi bageze mu zabukuru ndetse nabafite ibikomere byoroheje byimitsi biturutse ku ihahamuka ryinshi. Muri ubu bushakashatsi, DTNs zinjijwemo ibice bitandatu gusa, nta ngorabahizi zoroshye. Inzira ntisaba guhindagurika kw'ivi, kugabanya ibyago byo gutakaza igabanuka no gukora neza kubarwayi bafite ivi rito (urugero, arthrite yo mu ivi cyangwa nyuma ya TKA).

Ingaruka zo kubaga no kwirinda

Ingaruka zirimo gukomeretsa imitsi yinyuma ya tibialis hamwe no kuvunika kwa malleolar. Ivunika rya malleolar yo hagati irashobora kuvurwa hakoreshejwe insinga ya bande, isahani, cyangwa gukosorwa hanze.
Ugomba kwitonda kugirango wirinde kwinjirira muri fibular notch. Igikoresho gihagaze gishobora gutera kuzenguruka inyuma ya DTN kubera uburemere bwayo; hindura umugozi wa kabiri kugirango werekeza kuri fibula (Ishusho 4c).

Kugereranya kwa Clinical

Igipimo cyo kudahuza no kudahuza imisumari ya antegrade ni 0-25% na 8.3-50%; yo gufunga amasahani, 0-17% na 0-17%. Muri ubu bushakashatsi, ibibazo byose byageze ku bumwe, kandi 20% bonyine ni bo bari bafite ubumuga> 5 °, ugereranije n’uburyo gakondo. kwandura cyane ni 0-23% na 0-8.3%. Ubu bushakashatsi bwatangaje ko nta ngorane zoroshye zoroshye, ziruta ubundi buryo bwombi. Amanota y'imikorere:

Muri make, DTN itanga ibyiza kuruta gufunga amasahani hamwe na antegrade yimisumari kandi byerekana igisubizo cyiza cyo kuvura imvune za tibial kure.

DTN igaragaramo invasiveness ntoya, ituze ryinshi, hamwe no gukira vuba

Nuburyo bwingenzi bwo kuvura gakondo kandi bukwiye kuzamurwa