Tibial Intramedullary Nail: Mhinduro Yakavimbika yeTibial Fractures

Tibial fractures, inobata shinbone, inogona kukanganisa zvakanyanya kufamba uye mabasa ezuva nezuva. Kurapa kwezvimedu izvi kunoda kunyatsotariswa kwezvinhu zvakasiyana-siyana, kusanganisira rudzi rwekutsemuka, nzvimbo, uye hunhu hwemurwere. Imwe nzira yekuvhiya yakaratidza kushanda mumakore achangopfuura ndeye kushandiswa kwetibial intramedullary nail. Ichi chinyorwa chinoongorora mabhenefiti, maitiro ekuvhiya, njodzi, uye kupora zvine chekuita neiyi nzira yekurapa.

Nhanganyaya

Kuputsika kwetibia kunogona kukanganisa, kunokonzera marwadzo, kusagadzikana, uye kuoma mukufamba. Nzira dzechinyakare dzekurapa, dzakadai sekukanda kana kugadzirisa kwekunze, dzine zvisingakwanisi, zvichiita kuti kuongororwa kwemamwe mhinduro dzepamusoro senge tibial intramedullary nail.

Chii chinonzi Tibial Intramedullary Nail?

A tibial intramedullary nail inyanzvi yezvokurapa yakagadzirirwa kudzikamisa uye kukurudzira kuporeswa kwekuputsika mumuti wetibial. Iyo ine simbi yesimbi inoiswa mukati megomba pakati pebhonzo, ichipa kugadzikana uye kutsigirwa panguva yekupora. Iyo mbambo inowanzo gadzirwa netitanium kana simbi isina tsvina uye inouya muhukuru hwakasiyana kuti igare akasiyana evarwere anatomies.

Zviratidzo zveTibial Intramedullary Nail

Tibial intramedullary misumari inowanzoshandiswa pakurapa tibial shaft fractures. Izvo zvinonyanya kushanda kune zvimedu zvinoda kugadziriswa kwakagadzikana, zvakadai sekudzingwa kana comminuted fractures. Iyi nzira yakakodzerawo kumatare ane hurombo husina kunaka hwemapfupa kana kana pakarepo kurema-kutakura kunodiwa.

Kuvhiya Technique yeTibial Intramedullary Nail

Preoperative Planning

Kunyatsoronga preoperative kwakakosha pakubudirira tibial intramedullary nail kuvhiya. Izvi zvinosanganisira kuongororwa kwakazara kwemaitiro ekutyoka, hutano hwemurwere, uye chero kukuvara kwakabatana. Maitiro ekufungidzira akadai seX-rays, CT scans, kana MRI anogona kushandiswa kuongorora maitiro ekutyoka uye kutungamira sarudzo yekuvhiya.

Patient Positioning

Munguva yekuvhiyiwa, murwere anowanzoiswa supine patafura yekushandisa. Gumbo rakabatwa rakagadzirirwa uye rakaputirwa nenzira isina utachiona. Kumisikidzwa kwakakodzera kwakakosha kuti ubvumire kuwana kwakaringana kunzvimbo yekutyoka uye kufambisa chipikiri kupinza.

Incision uye Access

Incision inoitwa pamusoro penzvimbo yekuvhiya kuti uwane bhonzo rakatyoka. Kureba uye nzvimbo yekucheka kunoenderana nerudzi rwekutsemuka uye nzvimbo yaro pamwe netibia. Kunyatsobata matishu akapfava kwakakosha kuderedza kushungurudzika uye kuderedza njodzi yekutapukirwa.

Kupinza Kwezvipikiri

Mushure mekugadzira nzvimbo yekupinda mu proximal tibia, chiremba anovhiya anonyatsoisa tibial intramedullary nail mu medullary canal. Fluoroscopic nhungamiro inoshandiswa kuve nechokwadi chekuiswa uye kurongeka. Iyo mbambo inokwidziridzwa kuburikidza nebhonzo, ichigadzirisa chero zvimedu zvakatamiswa uye kudzoreredza kwakaringana anatomical kurongeka.

Locking Screws Placement

Kana chipikiri chaiswa zvakanaka, zvikwiriso zvekukiya zvinopinzwa kuchengetedza chipikiri mukati mebhonzo. Aya screws anopa kumwe kugadzikana uye kudzivirira kutenderera kana axial mafambiro ezvimedu zvekutsemuka. Nhamba uye kuiswa kwe screws zvinoenderana nepeteni yekutyoka uye zvaanoda chiremba wekuvhiya.

Kuvharwa Kwemaronda

Mushure mekuona kurongeka kwakakodzera uye kugadzirisa, iyo incision yakavharwa uchishandisa sutures kana staples. Kuvharwa kwemaronda kunoitwa zvine hungwaru kukurudzira kuporeswa uye kuderedza njodzi yehutachiona. Chipfeko chisina kuchena chinoiswa, uye nzvimbo yekuvhiya inodzivirirwa.

Zvakanakira Tibial Intramedullary Nail

Kushandiswa kwetibial intramedullary nail kunopa zvakati wandei zvakanakira pane echinyakare nzira dzekurapa. Mamwe emabhenefiti akakosha anosanganisira:

1. Kugadziriswa kwakagadzikana: Chipikiri chinopa kugadzirisa kwakadzikama, kubvumira kurongeka kwakakodzera uye kubatana kwezvimedu zvekuputsika.

2. Kuunganidza kwekutanga: Chipikiri chinopa kuunganidza kwekutanga, zvichiita kuti varwere vatange kutakura uremu uye maitiro ekugadzirisa maitiro nokukurumidza kana achienzaniswa nedzimwe nzira dzokurapa.

3. Kuchengetedzwa kweropa: Nekushandisa iyo intramedullary canal, iyo tibial intramedullary chipikiri nzira inoderedza kukanganisa kuropa kwebhonzo, izvo zvakakosha pakurapa kwekutyoka.

4. Kuvandudzwa kwemigumisiro yekushanda: Nekugadzirisa kwakadzikama uye kuunganidza kwekutanga, varwere vanovhiyiwa tibial intramedullary nail vanowanzoona migumisiro yakagadziridzwa yekushanda uye kukurumidza kudzokera kumabasa ezuva nezuva.

5. Kuderedzwa kwengozi yezvakapfava zvinyoro zvinyoro: Kuenzaniswa nekunze kwekugadzirisa nzira, intramedullary chipikiri nzira inosanganisira madiki ekucheka uye kuderedzwa kwakapfava kukanganiswa kwetishu, zvichikonzera njodzi yakaderera yezvakapfava zvinyama zvinetso uye hutachiona.

   
   

Matambudziko uye Njodzi

Nepo tibial intramedullary nail kuvhiyiwa kazhinji kwakachengeteka uye kunoshanda, pane zvinogona kunetsa uye njodzi dzine chekuita nemaitiro acho. Zvakakosha kuziva zvingangoitika izvi usati warapwa. Mamwe ematambudziko anosanganisira:

Utachiona

Sezvinongoita chero nzira yekuvhiya, kune njodzi yekutapukirwa. Zvisinei, neunyanzvi hwakakodzera hwokudzivirira utachiona, antibiotic prophylaxis, uye kutarisira pashure pokuvhiyiwa, ngozi yokutapukirwa inogona kuderedzwa.

Kusawirirana kana kuti Nonunion

Mune zvimwe zviitiko, zvimedu zvakaputsika zvingasapora mukurongeka kwaidiwa kana kutadza kupora zvachose. Zvinhu zvakadai sokusakwana kuderedza, hurombo husina kunaka hwemapfupa, kana kuwandisa uremu hunogona kuita kuti pave nekusawirirana kana kusabatana. Kunyatsotarisa uye, kana zvichidiwa, mamwe mapindiro akadai sekuvhiyiwa kwekudzokorora anogona kudiwa.

Matambudziko ane chekuita nekudyara

Kunyange zvisingawanzoitika, matambudziko ane chekuita nekudyara anogona kuitika, senge implant kusunungura, kutyora, kana kushatirwa. Nyaya idzi dzingada kumwe kupindira kwekuvhiya kugadzirisa.

Kukuvara Kwetsinga kana Ropa

Panguva yekuvhiya, pane njodzi diki yekukuvara kwetsinga kana yeropa. Vana chiremba vanovhiya vanotora matanho ekudzikisa njodzi iyi, asi varwere vanofanirwa kuziva mukana uye nekukasira kutaura chero zviratidzo zvinoramba zvichiitika kana kuwedzera.

Kudzorera uye Kudzorera

Kutevera tibial intramedullary nail kuvhiyiwa, chirongwa chakazara chekudzorera chakakosha pakugadzirisa kupora. Iyo chaiyo chirongwa chekudzorera chinogona kusiyana zvichienderana nekutyoka kuomarara, hunhu hwemurwere, uye kutungamira kwechiremba. Maekisesaizi ekutanga ekufambisa, kutakura uremu zvishoma nezvishoma, uye kurapwa kwemuviri kunoita basa rakakosha mukudzorera basa, kuvandudza simba, uye kukurudzira kuporeswa kwemapfupa.

Nyaya Dzidzo uye Nhau Dzakabudirira

Varwere vakawanda vakawana zvakabudirira netibial intramedullary nail kuvhiyiwa. Imwe nyaya yekudzidza yaisanganisira munhu ane makore makumi matatu nemashanu ane comminuted tibial shaft fracture. Mushure mekuvhiyiwa netibial intramedullary nail, murwere akawana mubatanidzwa wakasimba wekuputsika, akawanazve uremu hwakazara, uye akadzokera kune yavo yapfuura nhanho yebasa mukati memwedzi mitanhatu.

Kuenzanisa Nedzimwe Kurapa Sarudzo

Paunenge uchitarisa nzira dzekurapa dzetibial fractures, zvakakosha kuenzanisa zvikomborero uye zvisingakwanisi nzira imwe neimwe. Nepo tibial intramedullary nail kuvhiyiwa kunopa zvakati wandei zvakanakira, senge yakagadzika kugadzirisa, kukurumidza kuunganidza, uye kuderedzwa kwakapfava matishu matambudziko, inogona kunge isiri yakakodzera kune yega yekutyoka pateni kana murwere. Dzimwe nzira, senge plating kana yekunze kugadzirisa, inogona kufarirwa mune zvimwe zviitiko. Kubvunzana nenyanzvi yemapfupa kuchabatsira kuona nzira yakakodzera yekurapa zvichienderana nemamiriro emunhu.

Mhedziso

Mukupedzisa, tibial intramedullary nail kuvhiyiwa ndiyo yakavimbika uye inoshanda yekurapa sarudzo yetibial fractures. Iyo tekinoroji inopa yakagadzikana kugadzirisa, inobvumira kukurumidza kuunganidza, uye inopa akati wandei mabhenefiti pane echinyakare nzira. Kunyange zvazvo pane njodzi dzingangovapo uye zvinetso zvine chokuita nokuvhiyiwa, kunyatsoronga kufanovhiya, nzira yokuvhiya chaiyo, uye kutarisirwa kwakakodzera pashure pokuvhiyiwa kunogona kuderedza kunetseka uku.