Maonero: 0 Munyori: Saiti Edhita Nguva Yekuburitsa: 2025-07-07 Mavambo: Site
Iyo tibial shaft imwe yenzvimbo dzakajairika dzekuputsika, inoverengera 13.7% yezvose zvakaputsika mumuviri. Iyo distal tibia ine anatomical hunhu hwakadai sekushaya muripo wekupa ropa uye kushoma kwenyama yakapfava yekuvhara. Kana pakatyoka, kukuvara kwenyama yakapfava uye kukanganiswa kweropa remunharaunda kunogona kuwedzera kuoma kwekuporeswa kwekutyoka. Uyezve, mukana wepamusoro wekuputsika kwefibular panguva imwechete uye kusagadzikana kunoita kuti kusarudzwa kwemaitiro akakodzera ekuvhiya kuve kwakakosha.
Muchinjikwa-chikamu chepakati-kusvika-kumusoro tibial shaft ine triangular, nepo yezasi yechitatu ine quadrilateral. Kusangana kwepakati nepakati pezvitatu kwakatetepa uye kunomiririra shanduko muchimiro, zvichiita kuti ive nzvimbo yakajairika yekutsemuka.
Iyo anterior yetatu yetibia inofukidzwa chete neganda pasina kufukidzwa kwemhasuru, zvichiita kuti ive nyore kuvhurika tyoka apo zvidimbu zvebhonzo zvinobaya ganda. Kunyangwe mukuputsika kwakavharwa, kuputika kwetibial kwakawanda kunoperekedzwa nekukuvadzwa kweganda uye subcutaneous tishu. Iyo yepakati-tibia haina mhasuru yekuvhara, uye kune ina fascial compartments yakatenderedza tibia uye fibula. Chiitiko checompartment syndrome chakakwirira mune tibial fractures kana ichienzaniswa nedzimwe kuputsika.
Iyo AO/OTA Arabic numeral classification inoratidzira tibial shaft fractures se 4 (tibia) 2 (shaft). Rudzi rweA runoenderana nekutsemuka kwakapfava nemutsara mumwechete wekutyoka, inova ndiyo yakajairika mhando. Type B dzakatsemuka dzine chimedu chepakati chakaita weji. Rudzi rweC C fractures inokonzerwa ne-high-energy trauma uye inotumirwa segmental fractures.
Type I: Kureba kweronda kushoma masendimita 1, kazhinji ronda rekuboorwa rinenge rakachena rine bhonzo rinobuda nemuganda. Kukuvara kwenyama yakapfava kudiki, pasina kukuvara kwekupwanya. Kutyoka kuri nyore, kuchinjika, kana kupfupi oblique, pasina comminution.
Rudzi rwechipiri: Ronda rinopfuura 1 cm, riine kukuvara kwakanyanya kwenyama yakapfava asi pasina kuvhuvhuta kana kuumbwa kweflap. Zvinyoro zvinyoro zvinoratidzira zvakapfava kusvika pakati pekupwanya kukuvara, kusvibiswa kuri pakati nepakati, uye zvine mwero comminuation yekutyoka.
Rudzi rwechitatu IIIA: Pasinei nekukuvara kwakakura kwekuputika kana kuumbwa kwekuputika, kana kushungurudzika kwepamusoro-simba pasinei nehukuru hwemaronda, pane zvakakwana zvinyoro zvinyoro zvakavharwa pamusoro pekuputsika.
Type IIIB: Yakawedzera nyoro yakapfava kukuvadzwa uye kurasikirwa, ine periosteal kubviswa uye pachena pfupa, inoperekedzwa nekusvibiswa kwakanyanya.
Rudzi IIIC: Yakabatana nekukuvara kwearteri inoda kugadziriswa.
Mishonga isiri-yekuvhiya yetibial fractures inosanganisira braces, plaster kunze kwekugadzirisa, traction, manual reduction, uye kushandiswa kwekunze kwekugadzirisa mafaira. Sarudzo dzekuvhiya dzinosanganisira yakakiyiwa ndiro yemukati kugadzirisa uye intramedullary nailing, pakati pevamwe.
Intramedullary nailing fixation inofarirwa nevazhinji vanovhiya mabhonzo ekukuvadza nekuda kwemaitiro ayo akareruka ekuvhiya, diki diki, kukuvara kudiki, uye nyore kubviswa kwembambo mushure mekutyoka kuporeswa. Inopa kugadzirisa kwakasimba kwemukati, kubvumira kutanga kwemashure ekushanda kwekuita basa uye kudzivisa matambudziko emunharaunda uye systemic. Izvi zvakanakira zvinoenderana neAO misimboti yekurapa.
Anterior oblique cutting in proximal end inodzivirira kutsamwa kune patellar ligament.
Advance proximal yekuvhara dhizaini inowedzera iyo inodiwa kugadzikana kweiyo proximal fragment.
Distal oblique locking sarudzo yekudzivirira yakapfava kukuvara kwetishu uye kuwedzera kugadzikana kweiyo distal fragment.
Locking screw yakagadzirwa nekaviri lead thread kuti inyore nyore.
Kukiya dhizaini yekusimbisa yakasimba, kuderedza postoperative fragment dislocation.
Mapoinzi akawanda ekugadzirisa anopa kugadzikana kweangular uye yakatsiga rutsigiro rwetibial palteau.
Chigadzirwa chacho chinoshandisa kushandiswa kwekugadzirisa basa, nekushandura kwayo morphological kunoratidzwa mumifananidzo pasi pese-pre-compression (yakasununguka mamiriro) uye post-compression (yakanyatsogadzirirwa) mamiriro.
Multi fixation nzira kubva kuproximal uye distal, inoratidza yekupedzisira proximal uye distal tibial fractures.
Mugumo wekure kure wembambo huru ine dhizaini yakapfava, inofambisa kupinza nyore mu medullary cavity.
Maviri angular ekukiya screws kumagumo eproximal anodzivirira kutenderera uye kutamiswa kwechikamu chekutyoka.
Yakakosha anatomical curvature inova nechokwadi chekuti mbambo huru yakamira zvakanaka mukati me medullary cavity.
Matatu matatu anopindirana ekona yekuvhara screws kumagumo ekupedzisira anopa tsigiro inoshanda uye kugadzirisa.
Inokodzera akawanda tibial shaft fractures (midshaft uye mamwe distal / proximal fractures), nepo mamwe marudzi (semuenzaniso, DTN kana Nyanzvi Nail) akagadzirirwa chaiwo anatomical matunhu kana yakaoma fractures.
Nzira yakajairwa (parapatellar kana transpatellar) inotevera nzira yakanyatsogadziriswa ine yakaderera yekudzidza curve, nepo nzira dzehunyanzvi (semuenzaniso, suprapatellar) dzinoda kumwe kudzidziswa kwehunyanzvi.
Kuenzaniswa nezvipikiri zvehunyanzvi seNyanzvi Chipikiri kana DTN, yakajairwa tibial intramedullary zvipikiri zvinowanzo tengeka, zvichiita kuti ive yakakodzera kumatare emazuva ese.
Inoenderana nezviridzwa zvepasirese (semuenzaniso, kukiya screws, kunanga zvishandiso), nepo zvipikiri zvehunyanzvi (semuenzaniso, Nyanzvi Nail ine akawanda-directional yekukiya masisitimu) ingangoda midziyo yevaridzi.
| Nyora | Zvakanakisa Zvinoratidza | Core Advantages |
|---|---|---|
| Nyanzvi Nail | Complex shaft fractures, osteoporosis | Multi-planar kukiya, kugadzikana kwepamusoro |
| Suprapatellar Nail | Proximal fractures, varwere vakafuta | Suprapatellar nzira, inoderedza anterior ibvi matambudziko |
| DTN | Distal fractures (padyo nejojo remakumbo) | Multi-directional distal locking, inopikisa kupfupisa |
| Standard Nail | Mid-shaft nyore kuputsika | Kushanda kuri nyore, kusingadhuri |
Drilling Instruments : Inosanganisira mabhiti ekudhirowa, reamers, uye mamwe maturusi anoshandiswa zvakananga pakuchera mapfupa.
Targeting Devices : Midziyo yekumisikidza uye kutungamira kuchera kana kuisa kuisa, senge waya dzekutungamira, maoko ekutungamira, uye midziyo yekunangisa.
Fixation Instruments : Zvishandiso zvinoshandiswa kubatanidza, kukiya, kana kugadzirisa maimplants, senge majoini epasi rose, mawrench, screws, uye sando.
Kuyera Zvishandiso : Zvishandiso zvekuyera kudzika, kumisa, kana kubatsira mukuvhiya, senge majeji akadzika, simba rekudzikisa, uye mapfupa emapfupa (AWL).
Imaging Evaluation: Preoperative X-ray / CT kusimbisa rudzi rwekuputsika, medullary canal diameter uye kureba, nechiyero che contralateral tibia sekutaura.
Positioning: Supine nzvimbo ine mabvi flexion 90 ° -120 ° uye zvishoma hip adduction (kuderedza patellar tendon tension). A triangular radiolucent frame inogona kutsigira popliteal fossa yekudhonza.
Sterile Draping: Yakajairwa sterilization yemakumbo uye kudonhedza, kuve nechokwadi cheC-ruoko kufamba.
Manual Traction: Mubatsiri anoshandisa longitudinal traction apo chiremba anovhiya palpates tibial crest uye anteromedial pamusoro kugadzirisa kurongeka (kureba, kutenderera, angulation).
Chiridzwa-Kubatsirwa:
Joystick Technique: Schanz screws akaiswa mune proximal / distal zvimedu zvekudzikisa lever.
Percutaneous Clamping: Yakanongedza kuderedza forceps ye oblique/spiral fractures.
Distractor: Hombe distractor yakaiswa coronally (proximal Schanz screw parallel to tibial plateau, distal pin in talus kana distal tibia) kuchengetedza urefu.
Nzvimbo:
Entry point 1cm kureba kune anterior tibial plateau edge, yakabatana ne medullary axis.
Fluoroscopic simbiso: AP maonero anowirirana netibial crest, lateral view inofanana netibial axis.
Zvishandiso zvekuvhura:
Chibooreso chemugaba pamusoro peguidhiwaya (ine sleeve yekudzivirira) kana curved solid awl.
Mawoko reamers (6-8mm) ekare akatyoka ane canal occlusion.
Guidewire Placement: Bhora-tipped guidewire yakabhenda 10-15mm pamuromo wekupwanyika. Fluoroscopic kusimbiswa kune distal physeal vanga (ankle centre).
Reaming Protocol:
Flexible reamers inotangira pa8mm, ichiwedzera 0.5mm kusvika cortical 'chatter' (kazhinji 1-1.5mm > dhayamita yembambo).
Cherechedza: Kubvisa nguva nenguva kunobvisa marara; kudzivisa thermal necrosis.
Kusarudza Urefu:
Intraoperative kuyerwa: Guidewire overlap nzira kana fluoroscopic mutongi (yekupinda pajoinhi rechidzitiro).
Ita shuwa kuti chipikiri chinosvika physeal vanga pasina proximal protrusion.
Insertion Technique:
Hand-advance over guidewire; gadzirisa kuderedza kana kushorwa kuchiitika.
Chengetedza kuderedzwa panguva yekupfuura kune distal fractures.
Sequence Strategy
Kureba-yakagadzika mafractures: Proximal kukiya kutanga (single screw inobvumira dynamization).
Hurefu-husina kugadzikana/yakaputsika: Distal locking inotanga kuteverwa ne 'backslap' kumanikidza.
Proximal Locking
≥2 screws kuburikidza nechinangwa chekushandisa (multidirectional yeproximal fractures).
Distal Locking
Fluoroscopic technique: Central beam perpendicular to screw holes ('yakakwana denderedzwa'), percutaneous drilling.
≥2 screws ye distal fractures (inogona kusanganisa AP / oblique orientations).
End Cap: Optional kupinza (inodzivirira bony ingrowth), iva nechokwadi chekuti hapana kubatana kwakabatana.
Kuvharwa Kwemaronda: Yakaiswa patellar tendon kugadzirisa ine yakasununguka subcutaneous sutures.
Kugadziridza Kwepakutanga:
Limb elevation; tarisa kune compartment syndrome mukati me24hrs.
Tanga kushanda pamwe chete kuunganidza (ankle pumps, knee flexion) paPOD 1-2.
Weight-Bearing Protocol:
Chikamu chekutakura uremu kwemavhiki matanhatu (kugadziriswa pakugadzikana), kufambira mberi kusvika kuzere kana callus inoonekwa.
Kutevera-Up: Clinical / radiological evaluation pa2, 6, uye mavhiki e12.
Dzimbahwe: Raynham, Massachusetts, USA
Flagship Products:
Nyanzvi Tibial Nail (ETN) - Yakagadzirirwa kugadzikana mune yakaoma tibial fractures.
T2 Tibial Nail - Inopa yakagadziridzwa kugadzirisa uye kumanikidza.
Makiyi Masimba: Yakasimba R&D, kugovera kwepasirese, uye kubatanidzwa nezvinoshungurudza mhinduro.
Dzimba guru: Kalamazoo, Michigan, USA
Flagship Products:
T2 Tibial Nail - Modular system yetibial shaft fractures.
Gamma3 Tibial Nail - Inobatanidza intramedullary mbambo nekuvhara sarudzo.
Makiyi Masimba: Yepamberi marobhoti (Mako), zvishoma invasive mhinduro, uye yakasimba trauma portfolio.
Dzimba guru: London, UK
Flagship Products:
TRIGEN Tibial Nail - Yakagadzirirwa nyore kuisa uye kugadzikana.
IM Tibial Nail - Intramedullary kugadzirisa kune tibial fractures.
Makiyi Masimba: Tarisa pamushonga wemitambo uye kushungurudza, zvinhu zvitsva.
Dzimbahwe: Changzhou, China
Flagship Products:
Distal Tibial Intramedullary Nail (DTN) - Yakagadzirirwa kune distal fractures.
Nyanzvi Tibia Intramedullary Nail - High-simba titanium alloy dhizaini.
Suprapatellar Nzira yeTibial Intramedullary Nail - Minimally invasive insertion.
Tibial Intramedullary Nail - Yakasiyana-siyana yekugadzirisa sarudzo.
Makiyi Masimba: inodhura-inoshanda mhinduro, kuwedzera kuvepo kwepasirese.
Dzimba guru: Warsaw, Indiana, USA
Flagship Products:
ZNN Tibial Nail - Anatomic dhizaini yekuvandudza kukwana.
Natural Nail System - Imics echisikigo bhonzo mechanics.
Makiyi Masimba: Yakasimba mukuvakazve pamwe chete, biologics kubatanidzwa, uye yakasarudzika mhinduro.
Dzimba guru: Lewisville, Texas, USA
Flagship Products:
LON Tibial Nail (Lateral Orthopedic Nail) - Yakagadzirirwa lateral entry approach.
Key Strengths: Inyanzvi mukukurudzira kukura kwepfupa, kururamisa kwemakumbo.
CZMEDITECH inopa yakakwana tibial nailing mhinduro dzeproximal, distal, uye dzakaomarara mafractures, ane hunyanzvi magadzirirwo (semuenzaniso, kukiya-kwakawanda-kukiya, nzira yesuprapatellar) inofananidzwa nemhando dzepasi rose dzinotungamira mubiomechanics uye mhedzisiro yekiriniki.