Ku tshoveka ka tibial, thekiniki ya suprapatellar intramedullary nailing

Intramedullary tibial nailing: ku fikelela na ku ringanisiwa, ku vava ka matsolo ya le mahlweni

Endlelo ra vuhandzuri ro belela swipikiri endzeni ka medullary ya tibial fractures i ra nkoka leswaku ku nghenisiwa xipikiri xa intramedullary hi ndzhawu leyinene yo nghena, ku hunguta ku onhaka eka swivumbeko swa matsolo ya intra-articular, na ku fikelela ku vekiwa nakambe ka ku tshoveka lokunene na ku nghena kahle ka swipikiri.

Maendlelo ya classic ya tibial stem fractures i maendlelo ya infrapatellar median kumbe infrapatellar parapatellar. Hambileswi maendlelo lawa ya kombisiweke eka ku tshoveka ka xiphemu xa le xikarhi, ku tshoveka ka valgus endzhaku ka vuhandzuri, ka le mahlweni kumbe loku hlanganisiweke ku tala ku humelela eka ku tshoveka ka le kusuhi swinene.

Xivangelo lexikulu xa mallignment eka proximal tibial fractures i deformity leyi vangiwaka hiku koka ka quadriceps tendon hi nkarhi wa knee flexion xikan’we naku lwisana ka michini exikarhi ka nail tip na posterior tibial cortex hi nkarhi wa implant insertion. Patella yitlhela yi sivela ku nghena ka axial nail eka sagittal plane (Fig. 1a, b). Hikokwalaho, ndlela yin’wana leyi tolovelekeke yo fikelela ndzhawu leyi i hiku tsemiwa ka parapatellar exikarhi, leswi yisaka eka ku nghenisiwa nyana ka swipikiri exikarhi kuya eka tlhelo (Figs. 1c na 2). Loko xipikiri xi nghena eka intramedullary canal distal to fracture, xiphemu xa proximal xi rhetela xiva valgus (Xifaniso 2). Eku heteleleni, ku tsana ka ku wisa ka misiha ya xiyenge xa ​​le mahlweni ku hoxa xandla nyana eka valgus (Xifaniso 3).

Xifaniso 1 a,b Hi ku tirhisa endlelo ra ntolovelo ra infrapatellar, patella yi sivela ku nghena ka axial ka xipikiri, leswi endlaka leswaku ku va na ku onhaka loku tolovelekeke ka anterior apical sagittal alignment na valgus coronal alignment. c Ku tirhisa endlelo ra parapatellar eka ku ringanisiwa ka swipikiri swa intramedullary.

Xifaniso 2 Ku tshinela eka ndzhawu yo nghena hi ku tirhisa medial parapatellar incision swi yisa eka ku nghenisiwa ka swipikiri exikarhi nyana kuya eka tlhelo. Loko xipikiri xi nghena eka medullary canal leyi nga ekule ni ndhawu leyi tshovekeke (a), xiphemu xa le kusuhi xi rhetela xi va valgus (b) .

Xifaniso 3 Ku nonoka ka ku wisa eka xiyenge xa ​​misiha ya le mahlweni ( a ) ku humesa lunghiselelo leri nga vonakiki ra le handle ka mbeleko ( b ) .

Ku pin tibia eka xiyimo lexi andlariweke swinene swi pfuneta ku papalata swiphiqo leswi fambelanaka na ku olovisiwa lokukulu ka matsolo loko ku endliwa vuhandzuri. thekiniki leyi yi hlamuseriwile hi Gelbke, Jakma et al. hi 2010 naswona yi sungule ku duma swinene emalembeni ya sweswinyana hikuva ku pin tibia eka xiyimo lexi lavaka ku va xi olovile swi olovisa ku cinca-cinca ka ku tshoveka ni ku yi veka nakambe. Fluoroscopy yi sungule ku olova ku yi endla hi tlhelo ra xithekiniki. Minkarhi ya fluoroscopy ya suprapatellar nailing yivikiwile kuva yi koma swinene kutlula ya infrapatellar nailing. Ku engetela kwalano, angle ya ku nghenisiwa ka swipikiri (eka sagittal plane) yi fambelana swinene na longitudinal axis ya tibia eka endlelo leri kutlula eka infrapatellar nail; leswi swi sivela ku lwisana ka michini exikarhi ka nhloko ya xipikiri na cortex ya le ndzhaku, xisweswo swi olovisa ku hunguta ku tshoveka.

Ku vava ka matsolo ya le mahlweni endzhaku ka vuhandzuri i xiphiqo lexi fambisanaka na xona. Ku vava ka matsolo yale mahlweni swivikiwile eka 50-70% wa vavabyi lava tshovekeke, laha kungana ntsena 30% wa vavabyi lava kumaka ku hunguteka ka switlhavi endzhaku ko susiwa ka ximilani xale ndzeni. Ku ringanyetiwa leswaku ku vumbiwa ka swivati ​​leswi fambelanaka na ku fikelela patellar tendon na Hoffa fat pad i xihlovo lexi nga vaka kona xa ku vava ka matsolo endzhaku ka vuhandzuri. Ku engetela kwalaho, endlelo ra suprapatellar ri papalata ku tsemiwa ka ndhavuko ka rhavi ra rhavi ra patellar ra saphenous nerve, xisweswo ku papalata ku pfimba ka matsolo ya le mahlweni na ku pfimba ka switwi (Xifaniso 4). Ku hundzisa xipikiri hi le ka quadriceps tendon, xisweswo ku siya patellar tendon yi nga onhakanga, swi vonaka swi hunguta swinene mpimo wa ku vava ka matsolo endzhaku ka vuhandzuri.

Hikwalaho ka mbuyelo lowunene wa ku tshoveka ka le kusuhi, swikombiso eka matirhelo ya tliliniki swi andlariwile eka ku tshoveka hinkwako.

Xana xipikiri xa suprapatellar intramedullary xi fanele ku tirhisiwa rini?

Swipfuno swa kona

• Semi-extended knee position yi hlohletela fracture manipulation na repositioning hiku olovisa matimba ya misiha xikan’we naku khomiwa hinkarhi wa ku nghenisiwa ka swipikiri

• Khombo ra le hansi ra ku tshoveka endzhaku ka vuhandzuri ka ku tshoveka ka le kusuhi, ka xiphemu na le kule loko ku pimanisiwa na tithekiniki ta ntolovelo

• Ntirho wo belela hi tlhelo ra xithekiniki swa olova ku wu endla

• Ku nghenisiwa ka swipikiri swa koteka tanihi 'ndlela ya dokodela un'we wa vuhandzuri'.

• Ku hungutiwa ka nkarhi wa fluoroscopy

• Ku hava ku onhaka eka patellar tendon na ku hunguteka ka ku vava ka matsolo ya le mahlweni endzhaku ka ku stapling

• Swi olova ku swi endla eka endlelo ra swipano swo tala, tanihi le ka ku vaviseka ko tala

  
  

Swikombiso

• Ku tshoveka ka xirho xa le handle ka xirho xa le kusuhi xa tibia (muxaka wa AO 41A) .

• Ku tshoveka ko olova loku tshovekeke ka tibial diaphysis (muxaka wa AO 42A-C) .

• Ku tshoveka ka xiphemu xa tibial diaphyseal (muxaka wa AO 42C) .

• Ku tshoveka ka distal tibial extra-articular na ku tshoveka ko olova ka intra-articular distal extension (tinxaka ta AO 43A na C1) .

• Matsolo lama papamalaka

• Ku va na marhambu ya patellar na ku va na marhambu ya patellar tendon

• Xilondza lexi thyakeke eka levele ya patellar tendon

Ndlela Yo Xava Switirhisiwa Swa Marhambu Ni Switirhisiwa Swa Marhambu!

Swa CZMEDITECH , hi na layini ya swikumiwa leyi heleleke swinene ya switirhisiwa swa vuhandzuri bya marhambu na switirhisiwa leswi fambelanaka, swikumiwa ku katsa ku nghenisiwa ka nkolo, swipikiri swa le ndzeni ka medullary, pulati ya khombo, ku pfala pulati, cranial-maxillofacial ya xikandza, xirho xa xitekela, switirhisiwa swa gezi, switirhisiwa swo khoma swilo swa le handle, ku kamberiwa ka marhambu, nhlayiso wa swifuwo na tisethi ta switirhisiwa swa vona swo seketela.

Ku engetela kwalaho, hi tiyimiserile ku ya emahlweni hi hluvukisa switirhisiwa leswintshwa na ku ndlandlamuxa milayeni ya swikumiwa, leswaku hi ta fikelela swilaveko swa vuhandzuri swa madokodela na vavabyi vo tala, na ku tlhela hi endla leswaku khamphani ya hina yi phikizana swinene eka indasitiri hinkwayo ya misava hinkwayo ya switirhisiwa swo nghenisa marhambu na switirhisiwa.

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