Icyuma gifunga
Kuvunika kwa tibial Pilon kuvunika ni gake, bingana munsi ya 10% yimvune zikikije akaguru. Uturemangingo tworoheje kuri tibia ya kure dufite kwihanganira nabi kwifata ryoroshye ridahagije, ibyo bikaba byongera ingorane zo kuvura kuvunika. Ivunika rya pilon rizwiho gukomeretsa, kwimura hejuru ya arctular, no gukomeretsa ingirangingo. Bitewe nimpinduka zifatanije hamwe no guhuza ingingo, kuvunika kwinshi bisaba gukosorwa kubagwa. Ubuvuzi busobanutse bwo kubaga bugomba guhuzwa n'ubwoko bwihariye bwo kuvunika, ibikomere byoroheje, n'abarwayi. Igihe gikwiye cyo kuvura kubaga nurufunguzo rwo gutsinda.
Ibiranga Anatomical
Ivunika rya pilon ririmo ibice bya metafhyseal, kandi rimwe na rimwe ibice bya diaphyseal. Hariho no kwiheba hamwe no kuvunika. Hama hariho ibice bitatu byibanze byamagufwa: igice cyimbere, igice cya malleolar yo hagati, nigice cyinyuma.
Hano haribice bitatu bisanzwe byo guhuriza hamwe: Gukomeretsa kuruhande bibaho hagati yimpande zinyuma ninyuma, mubisanzwe hafi ya fibula. Hagati ya komisiyo irashobora kwerekana nkibice byamagufwa yubusa cyangwa kwikuramo igice cyinyuma. Kwiyegereza hagati bikubiyemo igice cyo hagati cyangwa kwikuramo byegeranye na malleolus yo hagati.
Ubusanzwe ubusanzwe bubaho aho imirongo yamenetse ihurira. Buri kimwe mu bice bitatu byingenzi byavunitse birashobora kugabanywa kandi bifite imirongo yinyongera. Ni ngombwa kurinda imiyoboro y'amaraso. Uturemangingo tworoshye tugomba gukemurwa neza kandi tugasubira inyuma mugihe bibaye ngombwa kugirango twirinde igikomere - ibibazo byo gukiza. Kwiyambura cyane ibice byavunitse bigomba kwirindwa kugirango wirinde necrosis avasulaire yibice.
Uburyo bwo Gukomeretsa
Gukomeretsa cyane - gukomeretsa ingufu: Kugwa kuva murwego rwo hejuru, gusiganwa ku maguru, impanuka zimodoka, nibindi. Gukomeretsa imbaraga - Gukandagira hejuru.
Icyerekezo cyihohoterwa: Kwikuramo Axial; Imbaraga zo gukata; Varus yogosha; Imbaraga zo gukata.
Varus ihatira urugomo: Bikunze kugaragara cyane mu rubyiruko, hamwe n’ihungabana rikomeye ndetse n’imvune nyinshi. Umurongo wavunitse uri mu ndege ya sagittal, kandi fibula akenshi iba idahwitse.
Valgus ihatira urugomo: Bikunze kugaragara cyane mu bageze mu za bukuru, bafite ihahamuka ridakabije ndetse no gukomeretsa imbaraga. Umurongo wavunitse uri mu ndege ya coronale kandi akenshi ujyana no kuvunika kwa fibular.
Kwerekana Ibizamini
Inzira isanzwe ya anteroposterior, kuruhande, na mortise kureba X - imirasire yamaguru. Byuzuye - uburebure X - imirasire ya tibia irashobora kwerekana guhuza hamwe n ivi hejuru. Ku barwayi bamwe bafite imvune zigoye cyane, X - imirasire yingingo zinyuranye zifatwa kugirango zitange ibisobanuro byokwubaka kuvunika no kumenya mbere na mbere gutandukana kwa anatomique cyangwa kuvuka.
Uburyo bwo gukomeretsa bushobora guhanurwa uhereye ku bwoko bwavunitse bwa fibular kuri X - kandi bugashyirwa mu byiciro: Ihohoterwa rikabije (valgus deformity), urugomo rukabije (varus), imizigo ya Axial (fibula idasobanutse). Niba fibula idahwitse, mubisanzwe ni igice gikomeye cyimbere - igikomere (Ubwoko B). Gukomeretsa kwa Axial ntabwo bitera kwimuka cyane ahubwo bivamo ubwinshi bwimitwaro ya axial kuri tibia ya kure, hamwe nuduce duto duto duto twa arctular nuduce duto twa prognoz ya kabiri kugeza kwikuramo karitsiye. Icyerekezo cyo kuvunika ibice byavunitse birashobora guhanurwa uhereye X - ray yerekana ubwoko bwimuka ya talar (mubisanzwe kwimura imbere).
Babiri - ibipimo na bitatu - ibipimo bya CT kwiyubaka ni ngombwa. Barashobora gutanga amakuru harimo urwego rwo kuvunika, umwanya numubare wibice byamagufwa, hamwe nicyerekezo cyo kwimuka.
Intera ya kure Fibular Icyuma gifunga
VA Hagati ya Tibia Hagati Icyuma gifunga
Ibyiciro
Ivunika rya AO / OTA - Gutandukanya ibyiciro
Ibirenze - Ubwoko bwa articular Ubwoko bwavunitse mubisanzwe bigaragara byoroshye ariko birashobora kuba bifitanye isano nibikomere byoroshye byumubiri. Ibice bisanzwe byimbere - kuvunika Ubwoko B kuvunika birimo gutondeka neza kandi bisaba isahani ya buto kugirango igabanye imbere - ibice bya articular. Imbere yuzuye - ivunika ryubwoko bwa C ryerekana ibikomere byinshi - imbaraga zijyanye no gutangira tibio - talar gufatanya, gukomeretsa tibio ya kure - syndular ya fibular, kuvunika fibular, hamwe no kuvunika metafhyseal tibial, kandi mubisanzwe bifitanye isano no gukomeretsa bikabije byumubiri.
Ruedi - Ibyiciro byose
Ubwoko I: A 'T ' - kuvunika gucikamo ibice nta kwimuka gukomeye.
Ubwoko bwa II: Gutandukanya ubuso bwa arctular hamwe no kwimuka kugaragara kumurongo wavunitse no gutangira.
Ubwoko bwa III: Ivunika rikabije kandi rikomeretsa cyane rya tibial tibial articular surface na metaphysis.
Kuvura - kubaga
Kutavura - kubaga kubice bya tibial kure byavunitse Pilon ni gake. Ibimenyetso ni ubwoko bwimvune bwimuwe kandi abarwayi bafite ingaruka mbi byongera ibyago byo kuvurwa. Ibinyuranye - kuvunika kwa articular hamwe nimpinduka ntoya muburyo rusange bwo guhuza tibial irashobora kandi kuvurwa hamwe na immobilisation ya plaster nta kubaga. Igice cya mbere gikoreshwa kugeza igihe kubyimba bigabanutse, hanyuma hagashyirwaho plaster. Impinduka zikomeye muburyo bwa tibial cyangwa arctular guhuza bishobora gukurura ibibazo bijyanye no guhuza ingingo no gutuza. Ibizamini bikomeza X - ray birakenewe kugirango habeho guhuza hamwe no guhuza ingingo.
Intore zatoranijwe - kuvunika ingingo zishobora no kuvurwa bitari - kubagwa. Kuvunika imbere - kuvunika ingingo zifite munsi ya mm 2 zo kwimuka kwavunitse no munsi ya mm 3 zintambwe - kuzimya, kutavurwa kubagwa birashobora gufatwa kubarwayi bafite ubushobozi buke bwo gukora.
Ibimenyetso byo kubaga
Intambwe yubuso yintambwe - hejuru ya mm 2.
Indwara ya Valgus irenze 5 °.
Indwara iyo ari yo yose.
Fungura ibice.
Indwara ya syndrome.
Gukomeretsa kw'amaraso.
Ibikomere byinshi.
Igihe cyo kubaga
(1) Kuvura byihutirwa: Kugabanya no gukosora dislokasiyo; Gufungura kuvunika; Gukomeretsa kw'amaraso; Indwara ya syndrome.
(2) Icyambere - icyiciro (Kugarura uburebure bwigihimba no guhuza): Gukurura Calcaneal; Gukosora hanze; Kugabanya no gukosora imbere kuvunika kwa fibular, kugabanuka gukinguye no gukosora imbere imbere yimbere ya tibial malleolar; Kurinda Thrombus.
(3) Icyakabiri - icyiciro: Hafi yiminsi 10 - 14 nyuma, kugabanuka gufungura no gukosora imbere kuvunika kwa tibial.
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Uburyo bwo kubaga
(1) Kugwiza cyane kwerekana umurongo wavunitse.
(2) Gukemura ibice byose hamwe nuburyo buke bwo kubaga.
(3) Irinde ahantu hafite imiterere yoroheje yoroheje.
(4) Reba uburyo bwo gukomeretsa.
(5) Reba aho washyize isahani.
Kuvunika hamwe nubumuga bwa varus, hatoranijwe isahani yo hagati ya buto, kandi hakoreshejwe uburyo bwa anteromedial.
Kuvunika hamwe nubumuga bwa valgus, hatoranijwe isahani ya buttress, hanyuma hakoreshwa uburyo butandukanye.
Intera iri hagati yibice byombi igomba kuba byibura cm 5 - 7.
CZMEDITECH Ibicuruzwa
