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Global Advanced Tibia Tibia Zviridzwa Zita 2025 Pamusoro 6 Ruvatidzo

Views: 0     Munyori: Waiti Editor Shirt Rehishi Nguva: 2025-07-07 mavambo: Saiti

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Tibial fractures

Iyo tibial shaft ndeimwe yezvinhu zvinowanzoitika kuti zvidimbu zvibodzwa, worseing kwe13.7% yezvese zvikamu mumuviri. Iyo Distal Tibia ine Anatomical maitiro akadai seyakaipa yeropa mari yekupa uye mashoma akapfava tishusu. Kamwe kukanganisika kunoitika, kupfava kwetemberi kukuvadzwa uye kwakarongedzwa ropa reropa kunogona kuwedzera kuomarara kwekupora. Pamusoro pezvo, iyo yakakwira mukana wechiitiko chechidimbu fractures uye kusagadzikana kuita sarudzo yeiyo yakakodzera yekuvhiya maitiro akakosha.

Iyo muchinjiko-chikamu cheiyo yepakati-kusvika-yepamusoro tibial shaft yakatsemuka, nepo yepazasi yechitatu ndeye quadrilateral. Iyo jimi yepakati uye yakaderera muzvitatu zvakamanikidzwa uye zvinomiririra shanduko muchimiro, ichiita kuti ive nzvimbo yakajairika kuti zvidimbu.

Iyo anterior chetatu yeTibia yakafukidzwa chete neganda pasina tsandanyama yekuvhara, ichiita kuti iite kuti ive yakavhurika mapundu apo zvidimbu zvinobaya ganda. Kunyangwe mumakaruki akavharwa, manyatidziro mazhinji emifananidzo anoperekedzwa nekukuvara kweganda uye subcutaneous tishu. Iyo yepakati-tibia inoshayikwa yekuvhara, uye kune mana emhando yemakamuri akapoteredza Tibia naFibla. Iko kuitika kweiyo compartment syndrome yakakwira mu tiili fractures zvichienzaniswa nezvimwe zvidimbu.

Kuputsika kuiswa

AO / OTA Bracture dislocation kutsaura

Iyo AO / OTA Arabic Numeral Clautificificificiation inosarudza Tibial Shaft Fractures se4 (Tibia) 2 (SHAFT). Nyora inoenderana nezvakareruka mapundu nemutsara mumwe chete, ndechipi chinonyanya kukosha mhando. Type B Fractures ine yepakati yemhando-yakaumbwa chidimbu. Nyora c fractures inokonzerwa nekukwirisa-simba kushungurudzika uye zvinofambidzana zvikamu zvezvikamu zvezvikamu.

Gustilo Classification yeVabvaruka Akavhurika:

  • Nyora i: ronda kureba kupfuura 1 cm, kazhinji yakachena puncture ronda neine pfupa tip inobuda kuburikidza neganda. Nyoro tishu kukuvara kushoma, pasina kukuvara kupwanya. Iyo bracture iri nyore, inoburitsa, kana ipfupi oblique, pasina commuti.

  • Type II: ronda rinodarika 1 cm, ine yakawanda yakawedzera nyoro tishu kukuvadza asi pasina mutambi kana flap yekuumbwa. Nyoro tishu inoratidza nyoro kune zvine mwero kupwanya kukuvara, kusvibiswa zvine mwero, uye kuongorora zvine mwero kwekupwanya.

  • Type III: Yakakura yakapfava tishu kukuvadza inosanganisira mhasuru, ganda, mitsipa yeropa, uye mutsipa, nekumanikidzwa kukuru.

    • Type Iia: Pasinei nekukuvara kukuru kwekutambisa kana kuumbwa kwekunyepedzera, kana yakakwirira-simba kushungurudzika zvisinei nekukura kweronda, pane zvakakwana zvinyoro-nyoro tissue yekuvhara pamusoro pekupwanya.

    • Type IIB: Yakakura yakapfava tishu kukuvara uye kurasikirwa, ne perieventeal kukanda uye yakafumurwa pfupa, inoperekedzwa nekutsamwiswa kwakanyanya.

    • Type IIC: Yakabatana nekukuvara kwekuwedzera kunoda kugadziriswa.

Sarudzo dzekurapa

Zvisingarapike zvisingaiti zve tibial fractures zvinosanganisira mabhureki, plaster yekunze gadziriso, traction, bhuku retsiva, uye kushandiswa kwekugadziriswa kwemafiramu ekunze. Sarudzo dzekuvhiya dzinosanganisira yakakiiwa ndiro yemukati yekugadzirisa uye intramedullary mbichana, pakati pevamwe.

Intramedullary Nailing Fixation

Intramutery Nailing Kugadziriswa kwakafarirwa neyakawanda traupence kuvhiya nekuda kwekuita kwayo kwekuvhiya, zvidiki, kushungurudzika kushoma, uye kubviswa kwakakwana kwechipikiri kupora. Iyo inopa kugadziriswa kwakasimba kwemukati, kubvumira kutanga kwekushanda kwebasa rekushandisa uye kudzivirira matambudziko emuno uye systemic. Izvi zvakanakira kuenderana neye AO nheyo dzekurapa.

Czmeditech tibial intramedullary mbiri mhinduro mhinduro

Nyanzvi Tibia Intramedullary Chishamiso & Chiridzwa Set

1.Proximal oblique akacheka

Anterior oblique kucheka muProximal mugumo anodzivirira kutsamwiswa kweiyo patelar ligrament.

2. Yepamberi yekuvhara dhizaini

Kufambira mberi Proximal Kuregedza maitiro anowedzera kugadzikana kwaunoda kuti chidimbu chigadzikiso.

3. Distal oblique kukiya

Disal oblique Locking Sarudzo yekudzivirira zvakapfava matishu kukuvara uye kuwedzera kugadzikana kweiyo distal chidimbu.

4. Double Thread Screw

Kuvhiya screw yakagadzirirwa neyakaendisa tambo yekuisa nyore nyore.

SuprapAnellar Kusvira Tibial Intramedullary Chiverengero chacho & chiridzwa chakaiswa

Locking Mechanism

Kuvhara dhizaini yekugadziriswa kwakasimba, kuderedza kupatsanurana kwechidimbu.

Multi-Point rutsigiro

Nhamba dzemuwani dzegadziriro dzinopa kugadzikana kwekutadza uye kutsigirwa kweTibial Palteau.

Connection photos

Chishandiso chinoenderana nebasa rekuchinja, neyakaoma morphological shanduko mumifananidzo pasi pezvese pre-compression (yakasununguka nyika) uye kutumira-kumanikidzwa (kwakasimba) mamiriro.

Proximal-Distal Fixation

Multi gadziriso nzira kubva proximal uye distal, inoratidza yekupedzisira proximal uye distal tibial fractures.

Disal Tibial Intramealry Chemari (DTN) & Chiridzwa Set

Dhizaina dhizaini yekuisa nyore

Iko kupera kweiyo mbambo huru ine dhizaini yefaira, kufambisa zviri nyore kuisa mukati medumbu.

Angurar anovhara zviyero

Maviri angu ekuvhara masaga ezvikamu proximal anodzivirira kutenderera uye kutamiswa kwechikamu chakaputsika.

Anatomical curvature

Iyo yakakosha Anatomical curvature inosimbisa iyo hombe mbambo yakamisikidzwa mukati meiyo medullary cavity.

Interssecting angle kuvhara zviyero

Nhatu dzinopindirana dzinonaka dzinovhara zviyero pakupera kwe distal kupa rubatsiro runoshanda uye kugadziriswa.

Tibial intramedullary zvipikiri & chiridzwa chakaiswa

Kuedza:

Inokodzera yakawanda tibial shaft fractures (midhaft uye imwe distal / proximal fractures), nepo mamwe marudzi (eg, dnten chipikiri) zvakananga matunhu emidziyo kana akaomarara.

Kukura Kwekuvhiya Kwekukura:

Iyo nzira yakajairwa (parapatellar kana transpatellar) inotevera maitiro akaomeswa neyakaderera yekudzidza, nepo nzira dzakasarudzika (semuenzaniso, Suprapetallar) inoda kuwedzera kwehunyanzvi hwekudzidziswa.

Mutengo-kushanda:

Kuenzaniswa nenishi dzakasarudzika senge nyanzvi yehunyanzvi

Yakakura Kupinza Kuenderana:

Zvinoenderana nechiridzwa cheunivhesiti (semuenzaniso, kukiya midziyo, zviripo zvipikiri zvakasarudzika)

Nyora zvakanakisa zviratidzo zvakanakira zvakanakira
Nyanzvi mbichana Yakaoma shaft fractures, osteoporosis Multi-planar kuvhara, yakakwirira kugadzikana
Suprapatellar mbambo Proximal Fractures, varwere vanonaka Suprapatellar nzira, inoderedza anterior knee matambudziko
Dnn Distal fractures (pedyo neAnkle Joint) Yakawanda-inotungamira distal kuvhara, inoramba ichipfupisa
Chidimbu chakajairika Mid-Shaft Yakareruka Fractures Kushanda kwakareruka, mutengo-unoshanda

Kuiswa kweTibia zvipenyu zviridzwa

  1. Kudhirowa Zviridzwa : Inosanganisira mabhedhi ekudhirowa, reamers, uye zvimwe zvishandiso zvakananga kuBone Drill.

  2. Targeting zvishandiso : zviridzwa zvekumisa uye zvinotungamira kuchera kana kuisa kuiswa kuiswa, sekutungamira waya waya, kutungamira marara, uye kuravirira mhandara.

  3. Zviridzwa Zvibatsiro : Zvishandiso zvinoshandiswa kubatanidza, kuvhara, kana kugadzirisa zvipembanyi, zvakadai seyngajini, madhiri, zviyero, uye nyundo.

  4. Kuyera zvishandiso : zviridzwa zvekuyera zvakadzama, zvichikonzera kudzika kwakadzika, kana kubatsira mukuvhiyiwa, kwakadai sekudzika kwegeji, kuderedza kweRoga, uye pfupa.

Zviridzwa
Kuridza zviridzwa
Maturusi ekuyera
Zvinangwa zvishandiso
    

Kuvhiya nhanho-ne-nhanho

1. Kugadzirira Kugadzirira

Kufungidzira kuongorora: preaperative x-ray / ct kuratidza fracture mhando, medullary canal diamita uye urefu, nekuyera kweContartlateral Tibia serevo.

Positioning: Supine chinzvimbo nebvi yekubhururuka 90 ° -120 ° uye zvishoma Hip Adduction (kuderedza patellar tension). Mutengo wedzinza radilucent ingatsigira iyo popliteal fossa yekutengesa.

Stile Drawing: Standard Limb Stalilization uye kuyerera, kunoita kuti C-ARM Movility.

2. Fracture kuderedza

Yakavharwa Dzinodzikisira Maitiro

Manual Traction: Mubatsiri anoshandisa traction refu

Chishandiso-chakabatsirwa:

  • Joystick Technique: SChanz Screw yakaisa muProximal / Distal zvidimbu zveLever kuderedzwa.

  • Percutaneous kuronga: Podhi Rinoring Rinzvimbo Forceps yeOblique / Spiral Fractures.

  • Inovhundutsa: Yakakura inokanganisa yakaiswa coronilly (Proximal Scongz Screw paTibial Plateau, Disal Pin muTalus kana Distal Tibia) Kuti uchengetedze urefu.

3. Kupinda Point Localization

Landmark:

  • Kupinda Point 1cm distal kuenda kuAnterior tibial Plateau endhudhudhudhudhudhudhudhe,

  • Fluoroscopic Simbiso: AP View inoenderana ne tibial crest, yakatevera maonero akafanana tibial axis.

Zviridzwa Kuvhura:

  • Cannulated kudhiraya pamusoro pekutapudza

  • Ruoko Reamers (6-8mm) yekare fractures ine canal occlusion.

4. Kutungamira Kuisa & Reaming

Kutungamirwa kwekutungamira: bhora-rakaputirwa bunduwire bent 10- Fluoroscopic Simbiso paDistal Physeal Scar (Ankle Center).

Kugadziridza Protocol:

  • Kuchinja kwezvinhu zvinotangira pa 8mm, kuwedzera 0.5mmmin kusvikira cortical 'Chatter ' (kazhinji 1-1.5mm> zvipikiri zvechipikiri).

  • Ongorora: Kubvisa kubvisa marara; Dzivisa Thermal Necrosis.

5. Nail Kuisa

Kutsunga Kureba:

  • IntrapaPerative Kuyera: Kutungamira nzira inodarika kana fluoroscopic mutongi (yekupinda nzvimbo kune ankle Joint).

  • Ita shuwa chipikiri chechipikiri chinosvika physeal vanga pasina proximal protrusion.

Kuisa maitiro:

  • Ruoko-kufambira mberi pamusoro pemutungamiriri; Rongedza kuderedzwa kana kuramba kukaitika.

  • Chengetedza kuderedzwa panguva yekufamba kweiyo distal fractures.

6. Kubatira Screw Kugadziriswa

Treace Trategy

  • Yakareba-yakagadzikana fractures: Proximal kukiya yekutanga (single screw inobvumira dynamization).

  • Kureba-kusagadzikana / kufambidzana fractures: distal kuvhara kutanga kuteverwa ne 'Backslap ' kuroverera.

Proximal kukiya

  • ≥2 Screws kuburikidza neAiming mudziyo (Multidirectional Frororal Fractures).

Kutadza kuvhara

  • Fluoroscopic maitiro: Central Beam perpendicular kuti screw holes ( 'denderedzwa renzvimbo '), percutaneous kudhiraivha.

  • ≥2 zviyero zve distal fractures (inogona kusanganisa AP / Oblique nyaya).

7. Maitiro ekupedzisira

End Cap: Inesarudzo yekuisa (inodzivirira Bony ingrowth), simbisa kuti hupombwe.

Kuvharwa kwevarungu: Yakavharirwa Patellar Tendon Kugadziriswa neRubtutaneous Sutures.

8. Postoperative Management

Kutanga kugadzirwazve:

  • Gumbo kukwirira; Monitor yeCompartment Syndrome mukati me 24hrs.

  • Kutanga Inoshanda Joint Moblilization (Ankle Pumps, Knee Flexion) paPOD 1-2.

Kuremerwa protocol:

  • Chikamu kuremerwa-kwemavhiki matanhatu (yakagadziridzwa pakugadzikana), kufambira mberi kuzere kana callus kuoneka.

Tevera-up: Clinical / radiological kuongororwa pa2, 6, uye mavhiki gumi nemaviri.

Brand-chaiyo misiyano


Depuy synthes (Johnson & Johnson)

Misorohwe: Raynham, Massachusetts, USA

Zvishongedzo Zvekushandisa:

  • Nyanzvi tibial chipikiri (etn) - yakagadzirirwa kugadzikana mune yakaoma tibial fractures.

  • T2 tibial nail - inopa inogadziriswa gadziriso uye kumanikidzwa.

ZVINOKOSHA ZVINOKOSHA: Yakasimba R & D, Global Kugovera, uye kuwirirana neTraumA Solutions.

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Depuy synthes (Johnson & Johnson)
Nyanzvi yeNailert Tibial Nail (ETN)
T2 Tibial Nail

Stryker

Misorohwe: Kalamazoo, Michigan, USA

Zvishongedzo Zvekushandisa:

  • T2 Tibial nail - Modular System yeTibial Shaft Fractures.

  • Gamma3 tibial nail - inosanganisa intramedullary mbiri nechisarudzo chekuvhara.

ZVINOKOSHA ZVINOKOSHA: Advanced Robotic (Mako), Mashoma Ashanje Mhinduro, uye STROUT Trauma Portfolio.

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Stryker
T2 Tibial Nail
Gamma3 tibial nail 

Smith & Nepew

Mahofisiquarer: London, UK

Zvishongedzo Zvekushandisa:

  • Trigen Tibial Nail - Yakagadzirirwa Kugadziriswa Kwekuisa uye Kugadzikana.

  • Im tibial nail - intramedullary gadziriso ye tibial fractures.

ZVINOKOSHA ZVINOKOSHA: Tarisa pane zvemitambo mushonga uye trauma, zvigadzirwa zvemitambo.

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Smith & Nepew
Trigen tibial nail
im tibial nail

Czivemech

Misorohwe: Changzhou, China

Zvishongedzo Zvekushandisa:

  • Disal tibial intramedudullary zvipikiri (DTN) - Yakagadziriswa kune distal fractures.

  • Nyanzvi Tibia Intramedullary Chikamambo - Yakakwira-simba Titanium Alloy Dhizaini.

  • Suprapatellar Kusvira Tibial Intramedullary Chikamambo - Mukomana Anonhuwirira Kuiswa.

  • Tibial intramellary zvipikiri - zvidziviriro zvesarudzo.

ZVINOKOSHA ZVINOKOSHA: Mhinduro dzinoshanda-zvinobatsira, zvichikura kuvapo kwepasi rose.

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Czivemech
Disl Tibial Intramealry Chemari (DTN)
Nyanzvi Tibia Intramedullary Chipikiri
SuprapetaLar Kusvitsa Tibial
Intramedullary zvipikiri zvechiTibalularary.

Zimmer biomet

Misorohwe: Warsaw, Indiana, USA

Zvishongedzo Zvekushandisa:

  • Znn tibial nail - anatomic dhizaini yekuvandudzwa yakakodzera.

  • Silivity zvipikiri zvechisimba

ZVINOKOSHA ZVINOKOSHA: STRELD MUBAINCAL COUNTETIONS, BIOLOGICS Kubatanidzwa, uye Mhinduro Dzakasarudzika.

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Zimmer biomet
Znn tibial zvipikiri
zvakasikwa zvipikiri system

Orthofifix

Misorohwe: Lewisville, Texas, USA

Zvishongedzo Zvekushandisa:

  • Lon Tibial Nail (Lateral Orthopedic Chikiri) - Yakagadzirirwa yezvekare yekupinda nzira.

ZVINOKOSHA ZVINOKOSHA: NEMAHARA MUFANANIDZO KUKUNDA KWEMAHARA , REMB DELFORFIT KUSANGANO.

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Orthofifix
Lon Tibial Nail (Lalteral Orthopedic Chikiri)

Mhedziso

CZMECECH inopa zviyero zvakaringana zvemukati zveProximal, zvisakwanirisa, zvine madhiri ekutungamira (semuenzaniso, kutungamira kwekutungamira kwezvinhu zvepasirese muBiomechanics uye kiriniki.

Mareferensi

[1]. 德康医疗. 德康医疗胫骨骨折解决方案 - 胫骨髓内钉. 德康医疗, 26 Gunyana 2024, https:/bs.mpixin.qs.com/s/g7pe8xfbxbluc9Q.

[2] .ao nheyo. (ND). Intramedullary Misumbu yeTibial Shaft Yakareruka Spiral Fracture [Surgical Technique]. AO Kuvhiya Reference. Kudzoserwa Chikunguru 10, 2024, kubva https://surgeryreellection.aoweddation.org/rthopedic-Tharthopedic-Tharments/Tiba-frax-frallation-Nailing icsearly=/searchurreservation

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