6da Hal-abuur ee ugu Sarreysa ee Tibia Magaca 2025

Ciddi Tibial Intramedullary Distal (DTN)

Suprapatellar Approach Tibial Intramedullary Ciddida

Khabiir Tibia cidiyaha intramedullary

1. U-dhow Goynta Oblique

Goynta hore ee ku-meel-gaadhka ah ee dhamaadka u dhow waxay ka hortagtaa xanaaqa seedaha patellar.

2. Naqshad Quful sare leh

Naqshadaynta qufulka horudhaca waxay kordhisaa xasilloonida la rabo ee jajabka u dhow.

3. Qufulka fog

Ikhtiyaarka qufulka fog ee qufulka si looga hortago dhaawaca unugyada jilicsan iyo kordhinta xasilloonida jajabka fog.

4. Isku-xidhka Laba-jibbaaran

Furaha qufulka oo loogu talagalay dunta rasaasta oo laba jibaaran si fudud loo geliyo.

Habka Qufulka

Naqshad quful si loo hagaajiyo adag, yareyso kala-baxa qalliinka kadib.

Taageero-dhibcood badan

Qodobbo badan oo hagaajin ah ayaa bixiya xasillooni xagal iyo taageero xasilloon oo tibial palteau ah.

Marxalada cadaadiska

Qalabku waxa uu leeyahay hawl la qabsi la qabsi ah, iyada oo isbeddelkeeda qaab-dhismeed ee lagu muujiyay sawirada hoos yimaada labadaba cadaadis-ka-hor (xaalad dabacsan) iyo xaaladaha cadaadiska ka dambeeya (si adag u rakiban).

Ku-hagaajinta fogaanta

Habka hagaajinta badan ee u dhow iyo fog, waxay muujinayaan ugu dambeeya iyo jabka tibial ee fog.

Naqshad siman oo loogu talagalay Gelida Fudud

Dhamaadka fog ee ciddiyaha ugu weyn wuxuu leeyahay naqshad siman, oo fududeyneysa gelinta fudud ee godka medullary.

Furayaasha Quful xagasha

Laba xagal quful ah oo ku yaal dhamaadka u dhow ayaa ka hortagaya wareegga iyo barokaca qaybta jabka.

Curvature Anatomical

Qallooc gaar ah oo anatomical ah ayaa hubinaya in ciddiyaha ugu weyn uu si wanaagsan u dhex jiro daloolka medullary.

Xagalka Qufulka ee Is-goysyada

Saddex xagal oo isgoysyada ah oo xidhidhiyeyaasha xagasha ee cidhifka fog ayaa bixiya taageero iyo hagaajin wax ku ool ah.

Kala duwanaansho:

Ku habboon inta badan jabka tibial-jabka (dharka dhexe iyo qaar ka mid ah dillaacyada fogaanta/dhowrka), halka noocyada kale (tusaale, DTN ama Ciddida Khabiirka) loogu talagalay gobollo gaar ah oo anatomical ah ama dillaacyo adag.

Farsamada Qalliinka ee Qaan-gaadhka ah:

Habka caadiga ah (parapatellar ama transpatellar) ayaa raacaya habraac si wanaagsan loo aasaasay oo leh qalooca waxbarashada hoose, halka hababka gaarka ah (tusaale, suprapatellar) ay u baahan yihiin tababar farsamo oo dheeraad ah.

Waxtarka Kharashka:

Marka la barbar dhigo ciddiyaha gaarka ah sida Cidida Khabiirka ama DTN, ciddiyaha tibial intramedullary caadiga ah waa kuwo la awoodi karo, taasoo ka dhigaysa inay ku habboon yihiin kiisaska caadiga ah.

Waafaqsanaanta Maqaarka Ballaaran:

La jaanqaadi kara qalabaynta caalamiga ah (tusaale, furayaasha qufulka, aaladaha la beegsanayo), halka cidiyaha gaarka ah (tusaale, Cidiyaha Khabiirka leh nidaamyada qufulka jihooyin badan) ay u baahan karaan qalab gaar ah.

1. Diyaarinta qalliinka ka hor

Qiimaynta Sawirka: Raajo/CT-ga hore ee qalliinka ka hor si loo xaqiijiyo nooca jabka, dhexroorka kanaalka medullary iyo dhererka, iyadoo la cabbirayo tibia iska soo horjeeda tixraac ahaan.

Meelaynta: Booska dhabarka oo leh jilbaha jilbaha 90 °-120 ° iyo miskaha yar oo la isku dhejiyo (si loo yareeyo kacsanaanta jilicsanaanta patellar). Fireemka radiolucent saddex xagal ah ayaa laga yaabaa inuu taageero fossa popliteal si loo jiido.

Duubista Madhalayska ah: Nadiifinta addimada caadiga ah iyo xoqidda, hubinta dhaqdhaqaaqa C-gac.

2. Dhimista jabka

Farsamooyinka dhimista xiran

Jiidashada gacanta: Kaaliyaha ayaa quseeya jiidista dhererka halka takhtarka qalliinka uu calaacinayo crest tibial iyo oogada anteromedial si uu u hagaajiyo toosinta (dhererka, wareega, xagasha).

Qalabka-La Caawiyay:

• Farsamada Joystick: Kaashashka Schanz ayaa la geliyey jajabyo u dhow/fog si loo yareeyo kabaalka.

• Isku-duubni Jilicsan: Xoog-dhimista tilmaamaya ee jabka ku-meel-gaadhka ah/spiraal.

• Distractor: Wayn wax leexiya oo la dhigo si wadajir ah (udhow Schanz screw oo barbar socda taagga tibial, pin fog ee talus ama tibia fog) si loo ilaaliyo dhererka.

3. Meelaynta Goobta Gelitaanka

Astaamaha

• Barta galitaanka 1cm fogaan ah ilaa cidhifka tibial ee hore, oo la siman dhidibka dhexdhexaadka ah.

• Xaqiijinta fluoroscopic: Aragtida AP waxay la jaanqaadaysaa cirifka tibial, aragtida dambe waxay la mid tahay dhidibka tibial.

Qalabka Furitaanka:

• Daloolin qasacadaysan oo korka haga-wire ah (oo leh gacmo ilaalin) ama cawl adag oo qaloocan.

• Gacmaha reamers (6-8mm) ee jabka duqoobay ee leh xidhidh kanaalka.

4. Gelida Guidewire & Reaming

Meelaynta Guidewire: Tilmaamaha kubbad-caaradku waxay leexsadeen 10-15mm caarada si loo maro jabka. Xaqiijinta fluoroscopic ee nabarta physeal ee fog (xarunta canqowga).

Hab-maamuuska Reaming:

• Reamers dabacsan oo ka bilaabma 8mm, kordhinaya 0.5mm ilaa kortical 'chatter' (sida caadiga ah 1-1.5mm> dhexroor ciddiiyaha).

• Fiiro gaar ah: Ka-noqoshada joogtada ah waxay nadiifisaa qashinka; iska ilaali necrosis kulaylka.

5. Cidiyaha la galiyo

Go'aaminta Dhererka:

• Cabbirka qalliinka gudaha: Habka isku-dhaafka ah ee Guidewire ama mastareeyaha fluoroscopic (barka gelitaanka ilaa wadajirka canqowga).

• Hubi in cididu ay gaadho nabarka jidhka oo aan u soo bixin.

Farsamada Gelida:

• Gacmo-horumar ka badan guidewire; hagaajin dhimis haddii caabbi dhaco.

• Joogtaynta dhimista inta lagu jiro marinka jabka fog.

6. Isku-xidhka Isku-xidhka Isku-hagaajinta

Istaraatiijiyada taxanaha ah

• Jeexitaanka joogsan dhererka: Qufulka u dhow marka hore (kaliyadu waxay ogolaataa firfircooni).

• Dhererka-aan xasiloonayn/go'ay jabka: Xiritaanka fog ee marka hore waxaa ku xiga 'dib-u-dhac' si loo cadaadiyo.

Quful dhow

• ≥2 boolal iyada oo loo marayo aalad ujeedo (jaho badan oo jabka u dhow).

Quful fog

• Farsamada Fluoroscopic: Dhuxul dhexe oo toosan oo godadka maroojiya ('goobo qumman'), dalool dalool ah.

• ≥2 boolal loogu talagalay jabka fog (waxaa laga yaabaa inay isku daraan jihaynta AP/jiheeyaha).

7. Habka ugu dambeeya

Koofida Dhamaadka: Gelida ikhtiyaarka ah (waxay ka hortagtaa abuurka lafaha), hubi inaysan soo bixin wadajir.

Xiritaanka Dhaawaca: Dayactirka seedaha patellar ee lakabka leh oo leh tolmo ka hooseeya oo dabacsan.

8. Maareynta Qalliinka Kadib

Baxnaaninta Hore:

• Kor u qaadista addimada; la soco si loo ogaado cilladda qaybta 24saac gudahood.

• Ku billow abaabulka wadajirka ah ee firfircoon (bambooyin canqowga ah, jilibka jilicsan) ee POD 1-2.

Hab-maamuuska Miisaanka:

• Qayb miisaan-qaadid ah oo ah 6 toddobaad (lagu hagaajiyay xasillooni kasta), horumarka si buuxda marka callus u muuqdo.

Dabagalka: Qiimaynta kiliinikada/radioloji ee 2, 6, iyo 12 toddobaad.