Locking Plate Series - Distal Tibial Compression Locking Bone Plate
Distal tibial Pilon fractures ke ntho e sa tloaelehang, e ikarabellang ka tlase ho 10% ea fractures ho pota leqaqailaneng. Li-tissue tse bonolo ho distal tibia li na le mamello e fokolang ea ho se koahele lisele tse bonolo, e leng ho eketsang bothata ba phekolo ea fracture. Li-fractures tsa pilon li tsejoa ka ho ts'oara, ho falla ha karolo ea articular, le likotsi tsa lisele tse bonolo. Ka lebaka la liphetoho tse amanang le ho lumellana ha lenonyello le ho tsamaisana le maoto le matsoho, ho robeha ho hongata ho hloka ho lokisoa ha opereishene. Kalafo e tiileng ea ho buoa e lokela ho ikamahanya le mefuta e itseng ea fracture, likotsi tsa lisele tse bonolo le bakuli. Nako e loketseng ea phekolo ea ho buuoa ke senotlolo sa katleho.
Likarolo tsa Anatomical
Ho robeha ha pilon ho kenyelletsa likaroloana tsa metaphyseal, 'me ka linako tse ling likhechana tsa diaphyseal hape. Ho boetse ho na le ho tepella maikutlong ha manonyeletso le ho robeha ho sa feleng. Kamehla ho na le likaroloana tse tharo tsa motheo tsa masapo: sekhechana sa anterolateral, sekhechana sa malleolar se bohareng, le sekhechana sa posterolateral.
Ho na le libaka tse tharo tse tloaelehileng tsa kopano e kopanetsoeng: Ho kopana ha morao ho etsahala pakeng tsa likaroloana tsa anterolateral le posterolateral, hangata li haufi le fibula. Central comminution e ka hlahisa e le likhechana tsa masapo tse sa lefelloeng kapa khatello ea sekhechana sa posterolateral. Phatlalatso e bohareng e kenyelletsa karolo ea sekhechana sa medial kapa compression e bapileng le malleolus e bohareng.
Comminution hangata e etsahala moo mela ea fracture e kopanang teng. E 'ngoe le e' ngoe ea likarolo tse tharo tse ka sehloohong tsa fracture e ka 'na ea fokotsoa' me ea ba le mela e meng ea ho robeha. Ho bohlokoa ho sireletsa methapo ea mali ea maqaqailana. Li-tissue tse bonolo li lokela ho tšoaroa ka hloko 'me li khutlisetsoe morao ha ho hlokahala ho qoba mathata a pholiso. Ho tlosoa ho feteletseng ha likhechana tsa ho robeha ho lokela ho qojoa ho thibela necrosis ea avascular ea likaroloana.
Mekhoa ea Kotsi
Likotsi tse phahameng tsa matla: Ho oela ho tloha bophahamong, ho thellelisa, likotsi tsa koloi, joalo-joalo. Likotsi tsa matla a tlase: Ho khoptjoa sebakeng se bataletseng.
Tataiso ea pefo: Axial compression; Matla a ho kuta a potolohang; Varus ho kuta matla; Valgus ho kuta matla.
Varus e qobella pefo: E atile haholo ho bacha, ba nang le ts'oaetso e matla le likotsi tse matla tsa matla. Mohala oa fracture o sefofaneng sa sagittal, 'me hangata fibula e lula e tiile.
Pefo ea Valgus: E atile haholo ho batho ba tsofetseng, ba nang le ts'oaetso e nyane haholo le likotsi tse fokolang tsa matla. Mohala oa fracture o sefofaneng sa coronal 'me hangata o amahanngoa le ho robeha ha fibula.
Litlhahlobo tsa ho Etsa Litšoantšo
Mokhoa o tloaelehileng oa pono ea anteroposterior, lateral, le mortise X - mahlaseli a leqaqailaneng a nkuoa. X-ray e tletseng bolelele ba tibia e ka bontša ho tsamaisana le lengole ka holimo. Bakeng sa bakuli ba bang ba nang le fractures e rarahaneng haholoanyane, X - mahlaseli a leoto la contralateral a nkoa ho fana ka tlhaloso bakeng sa ho tsosolosoa ha fracture le ho lemoha phapang e teng pele ho anatomical kapa congenital.
Mokhoa oa kotsi o ka boleloa esale pele ho tloha mofuteng oa ho robeha ha fibula ka X - mahlaseli 'me o aroloa e le: Pefo e hatellang (valgus deformity), Tensile pefo (varus), Axial loading (fibula e tsitsitseng). Haeba fibula e ntse e tiile, hangata ke kotsi e tebileng ea 'intra-articular' (Mofuta oa B). Likotsi tsa Axial loading ha li bake ho falla ho hongata empa li etsa hore ho be le palo e kholo ea axial loading ho distal tibia, e nang le likaroloana tse ngata tse nyenyane tsa holim'a li-articular le ho fokola ha boemo bo tlaase ho khatello ea lefufuru la articular. Tataiso ea phallo ea sekhechana e ka boleloa esale pele ho tsoa ho X-ray ea morao e bonts'ang mofuta oa phallo ea talar (hangata ho falla ha pele).
Likarolo tse ncha tsa CT tse mahlakore a mabeli le a mararo li bohlokoa. Ba ka fana ka tlhahisoleseling ho kenyelletsa tekanyo ea ho robeha ha fracture, boemo le palo ea likhechana tsa masapo, le tataiso ea ho falla.
Letlapa la ho notlela la Distal Lateral Fibular Locking
VA Distal Medial Locking Plate
Karolelano
AO/OTA Fracture - Phapang ea Phallo
E eketsehileng - articular Type A fractures hangata e bonahala e le bonolo empa e ka amahanngoa le likotsi tse kholo tsa lisele tse bonolo. Ho robeha ha karolo e itseng ka hare ho articular mofuta oa B ho kenyelletsa ho ts'oaroa ka mokhoa o hlakileng 'me ho hloka lipoleiti tsa buttress ho fokotsa likaroloana tsa intra-articular. Li-fractures tse feletseng tsa mofuta oa C tsa intra-articular li bontša likotsi tse phahameng - matla a matla a amanang le comminution ea tibio - talar joint, kotsi ho distal tibio - fibular syndesmosis, fibular fractures, le tibial metaphyseal fractures, 'me hangata li amahanngoa le likotsi tse matla tsa lisele tse bonolo.
Ruedi - Allgower Classification
Mofuta oa I: A 'T' - ho robeha ha sebopeho se nang le sebopeho ntle le ho falla ho hoholo.
Mofuta oa II: Ho aroloa ha sebaka sa articular se nang le phallo e hlakileng ea mohala oa fracture le ts'ebetso e itekanetseng.
Mofuta oa III: Ho robeha ho matla le ho hatelloa ha sebaka sa distal tibial articular surface le metaphysis.
Non - Kalafo ea ho buoa
Kalafo e sa buuoeng bakeng sa distal tibial Pilon fractures ke ntho e sa tloaelehang. Lipontšo ke mefuta e fokolang ea ho robeha le bakuli ba nang le li-comorbidities tse eketsang kotsi ea phekolo ea ho buuoa. E eketsehileng - articular fractures le liphetoho tse fokolang ka kakaretso tibial lolamisiwa ka boela a phekoloa ka samente immobilization ntle ho buuoa. Qalong ho sebelisoa splint ho fihlela ho ruruha ho kokobela, ebe ho kenngoa samente. Liphetoho tse matla ho tibial kapa articular surface alignment li ka lebisa mathateng a ho tsamaisana le maoto le botsitso. Litlhahlobo tse tsoelang pele tsa X-ray lia hlokahala ho etsa bonnete ba ho lumellana ha litho le maoto le matsoho.
Li-fractures tse ikhethileng tsa intra-articular le tsona li ka phekoloa ntle le ho buuoa. Bakeng sa fractures ea intra-articular e nang le ka tlaase ho 2 mm ea ho falla ha fracture le ka tlase ho 3 mm ea mohato - ho tloha, phekolo e seng ea ho buoa e ka nkoa ho bakuli ba nang le litlhoko tse tlaase tsa ts'ebetso.
Lipontšo Tsa ho Buoa
Mohato oa Articular holim'a metsi - ho feta 2 mm.
Valgus angulation e kholo ho feta 5°.
Mofuta ofe kapa ofe oa varus.
Maqeba a bulehileng.
Syndrome ea likarolo.
Kotsi ea methapo.
Likotsi tse ngata.
Nako ea ho Buoa
(1) Kalafo ea tšohanyetso: Ho fokotsa le ho lokisoa ha li-dislocations; fractures e bulehileng; Likotsi tse amanang le vascular; Syndrome ea likarolo.
2 Ho lokisa ka ntle; Ho fokotsa le ho lokisa ka hare ho fractures ea fibula, ho fokotseha ho fokolang ho bulehileng le ho lokisa ka hare ho fractures ea posterior tibial malleolar; Thibelo ea thrombus.
(3) Ea bobeli - sethaleng: Hoo e ka bang matsatsi a 10 - 14 hamorao, ho fokotseha ho bulehileng le ho lokisa ka hare ho fracture ea tibial.
(4) Maemo a linama tse bonolo bakeng sa opereishene ea bobeli - ea sethaleng ke: Ho monya ha hematoma sebakeng sa ho buuoa, ho tsosolosoa ha epidermal nakong ea marako a robehileng, ho fola ha leqeba la maqeba a bulehileng ntle le tšoaetso, ho fokotseha ha edema ea lisele tse bonolo, le ho sosobana ha letlalo.
Mekhoa ea ho Buoa
(1) Eketsa ho pepeseha ha mohala oa fracture.
(2) Rarolla fractures tsohle ka mekhoa e fokolang ea ho buuoa.
(3) Qoba libaka tse nang le maemo a fokolang a linama tse bonolo.
(4) Nahana ka mochine oa kotsi.
(5) Nahana ka boemo ba ho beha poleiti.
Bakeng sa ho robeha ha varus deformity, ho khethiloe poleiti ea medial buttress, 'me mokhoa oa anteromedial o sebelisoa.
Bakeng sa fractures e nang le valgus deformity, ho khethoa poleiti ea lateral buttress, 'me mokhoa oa anterolateral o sebelisoa.
Sebaka pakeng tsa likarolo tse peli e lokela ho ba bonyane 5 - 7 cm.
Lihlahisoa tsa CZMEDITECH
