Kukiya Plate Series - Distal Tibial Compression Locking Bone Plate
Distal tibial Pilon fractures haiwanzo, inoverengera isingasviki 10% yekuputsika kwakatenderedza chitsitsinho. Matishu akapfava ari distal tibia ane kushivirira kwakashata kune kusakwana kwakapfava kwenyama yakapfava, izvo zvinowedzera kuoma kwekutyoka kurapwa. Pilon fractures inozivikanwa nekufambisa, kutamiswa kweiyo articular pamusoro, uye kukuvara kwenyama yakapfava. Nekuda kwekuchinja kwekubatana kwekubatana uye kurongeka kwemakumbo, kuputsika kwakawanda kunoda kugadziriswa kwekuvhiya. Definitive kurapa kwekuvhiya kunofanirwa kuenderana nemhando dzakaputsika, kukuvara kwenyama yakapfava, uye varwere. Nguva yakakodzera yekurapa kwekuvhiya ndiyo kiyi yekubudirira.
Anatomical Features
Pilon fractures inosanganisira metaphyseal zvidimbu, uye dzimwe nguva diaphyseal zvidimbu zvakare. Kunewo majoint depression uye comminuted fractures. Kune nguva dzose zvitatu zvakakosha mapfupa emapfupa: anterolateral fragment, medial malleolar fragment, uye posterolateral fragment.
Kune nhatu dzakajairwa nzvimbo dzekubatana kwekubatana: Lateral comminution inoitika pakati peanterolateral uye posterolateral zvidimbu, kazhinji padyo nefibula. Central comminution inogona kuunza semahara emapfupa zvimedu kana kumanikidza kweiyo posterolateral fragment. Medial comminution inosanganisira chikamu chepakati chidimbu kana compression iri padyo nemedial malleolus.
Comminution inowanzoitika apo mitsara yekutsemuka inopindirana. Chimwe nechimwe chezvimedu zvitatu zvakakosha zvekuputsika zvinogona kuderedzwa uye kuva nemitsara yekuwedzera. Zvakakosha kuchengetedza tsinga dzeropa. Iwo matishu akapfava anofanirwa kubatwa nekungwarira uye chete kudzoserwa kana zvichidikanwa kudzivirira maronda - matambudziko ekuporesa. Kunyanya kubviswa kwezvimedu zvekuputsika kunofanira kudziviswa kudzivirira avascular necrosis yezvimedu.
Kukuvadza Nzira
Kukuvara kwepamusoro-simba: Kudonha kubva pakakwirira, skiing, tsaona dzemotokari, etc. Low - kukuvara kwesimba: Kutsika panzvimbo yakati sandara.
Nhungamiro yechisimba: Axial compression; Rotational shear force; Varus shear force; Valgus shear simba.
Varus kumanikidza mhirizhonga: Yakanyanya kuwanda muvechidiki, vane kukuvara kwakanyanya uye kukuvara kwakanyanya kwesimba. Mutsara wekutyoka uri mundege yesagittal, uye fibula inowanzogara yakasimba.
Valgus simba rechisimba: Yakanyanya kuwanda kune vakweguru, ine kukuvara kwakanyanya uye kuderera - kukuvara kwesimba. Mutsara wekuputsika uri mu coronal plane uye inowanzobatanidzwa ne fibular fracture.
Imaging Examinations
Routine standard anteroposterior, lateral, uye mortise maonero X - maranzi echidzitiro anotorwa. Iyo yakazara-yakareba X-ray yetibia inogona kuratidza kurongeka uye mabvi akabatanidzwa kumusoro. Kune vamwe varwere vane zvimwe zvakaputsika zvakaoma, X -mwaranzi yegumbo re contralateral inotorwa kuti ipe chirevo chekuvakazve kwekutyoka uye kuona pre - iripo anatomical kana congenital kusiyana.
Iyo nzira yekukuvara inogona kufanotaurwa kubva kurudzi rwefibular fracture pa X - rays uye inorongedzerwa se: Compressive violence (valgus deformity), Tensile violence (varus), Axial loading (inact fibula). Kana iyo fibula isina kurongeka, kazhinji kukuvara kwakakomba kwechikamu chemukati (Rudzi B). Kukuvadzwa kweAxial loading hakukonzeri kutama kwakawanda asi kunokonzera kuwanda kweaxial loading pane distal tibia, ine maduku akawanda articular surface fragments uye hurombo husina kunaka hwechipiri kune articular cartilage compression. Iyo nzira yekutyoka chimedu kutamiswa inogona kufanotaurwa kubva kune lateral X - ray inoratidza rudzi rwetalar displacement (kazhinji anterior displacement).
Maviri-dimensional uye matatu-dimensional CT reconstruction akakosha. Vanogona kupa ruzivo runosanganisira dhigirii rekutyoka comminution, chinzvimbo uye nhamba yemapfupa zvimedu, uye kutungamira kwekutama.
Distal Lateral Fibular Locking Plate
VA Distal Medial Tibia Locking Plate
Classification
AO/OTA Kutsemuka - Dislocation Classification
Kuwedzera - articular Type A fractures inowanzoita seyakapusa asi inogona kuve yakabatana nekukosha kwekukuvara kwenyama. Yakajairika partial intra - articular Type B mafractures anosanganisira articular comminution uye inoda buttress mahwendefa kuderedza intra - articular zvidimbu. Complete intra - articular Type C fractures inoratidza yakakwirira - kukuvara kwesimba kunobatanidza nekuuya kwetibio - talar joint, kukuvadzwa kune distal tibio - fibular syndesmosis, fibular fractures, uye tibial metaphyseal fractures, uye inowanzobatanidzwa nekukuvara kwakanyanya kwetishu.
Ruedi - Allgower Classification
Nyora I: A 'T' - kutsemuka kwakapatsanuka kwakaumbwa pasina kutamiswa kwakakosha.
Rudzi rwechipiri: Kupatsanurwa kweiyo articular pamusoro nekutama kuri pachena kwemutsara wekutyoka uye zvine mwero comminution.
Rudzi rwechitatu: Kuputsika kwakanyanya uye kudzvinyirira kwe distal tibial articular surface uye metaphysis.
Kwete - Kuvhiya Kurapa
Kusina-kuvhiya kurapwa kwe distal tibial Pilon fractures hazviwanzo. Zviratidzo zvacho zvidiki zvekutyoka marudzi uye varwere vane comorbidities izvo zvinowedzera njodzi yekuvhiyiwa kurapwa. Kuwedzera - articular fractures ine zvishoma shanduko mune yakazara tibial alignment inogona zvakare kurapwa nepurasita immobilization pasina kuvhiyiwa. Mutsindo unotanga kushandiswa kusvikira kuzvimba kwapera, uye ipapo pakaiswa plaster. Kuchinja kwakanyanya muhutano hwetibial kana articular surface kunogona kutungamirira kumatambudziko nekugadzirisa kwemakumbo uye kugadzikana. Kuenderera mberi X-ray bvunzo kwakakosha kuti uve nechokwadi chekubatana pamwe uye kurongeka kwemakumbo.
Selective intra - articular fractures inogonawo kurapwa kwete - kuvhiyiwa. Kune intra - articular fractures ine isingasviki 2 mm yekutyoka kwekutamisa uye isingasviki 3 mm yenhanho - kure, isiri - yekuvhiya kurapwa inogona kutariswa kune varwere vane yakaderera kushanda zvinodiwa.
Kuvhiya Zviratidzo
Articular pamusoro nhanho - kureba kupfuura 2 mm.
Valgus angulation yakakura kupfuura 5 °.
Chero varus angulation.
Vhura mafractures.
Compartment syndrome.
Vascular kukuvara.
Kukuvara kwakawanda.
Kuvhiya Nguva
(1) Emergency treatment: Kuderedza uye kugadzirisa kwekuparadzanisa; Open fractures; Associated vascular kukuvara; Compartment syndrome.
(2) Chekutanga - nhanho (Kudzoreredzwa kwekureba kwenhengo uye kurongeka): Calcaneal traction; External fixation; Kuderedza uye kugadziriswa kwemukati kwefibular fractures, kuderedza kuderedzwa kwakazaruka uye kugadziriswa kwemukati kwemashure ekupedzisira tibial malleolar fractures; Kudzivirira thrombus.
(3) Chechipiri - nhanho: Inenge 10 - 14 mazuva gare gare, kuzarura kuderedza uye kugadziriswa kwemukati kwetibial fracture.
(4) Mamiriro enyama akapfava echipiri - kuvhiyiwa kwedanho ndeaya: Kutorwa kwehematoma panzvimbo yekuvhiyiwa, kuvandudzwa kwe epidermal payakatsemuka mablister, kuporeswa kweronda rekutsemuka pasina hutachiona, kudzikira kwezvinyoro zvinyoro edema, uye kuunyana kweganda.
Nzira dzokuvhiya
(1) Kurisa kuratidzwa kwemutsara wekutsemuka.
(2) Gadzirisa kutsemuka kwese nemaitiro mashoma ekuvhiya.
(3) Dzivisa nzvimbo dzisina kunaka dzakapfava.
(4) Funga nezvemaitiro ekukuvadza.
(5) Funga nezvenzvimbo yekuisa ndiro.
Nokuda kwekuputsika ne-varus deformity, ndiro yepakati yepakati inosarudzwa, uye anteromedial approach inoshandiswa.
Nokuda kwekuputsika ne valgus deformity, lateral buttress plate inosarudzwa, uye anterolateral approach inoshandiswa.
Kureba pakati pematanho maviri kunofanirwa kunge kuri 5 - 7 cm.
CZMEDITECH Zvigadzirwa
