Ukutshixa i-Plate Series-Distal Tibial Compression Locking Bone Plate
I-distal tibial Pilon fractures ayinqabile, ibala ngaphantsi kwe-10% yeefractures ezijikeleze i-ankle. Izicubu ezithambileyo kwi-distal tibia zinonyamezelo olungeluhle lokungakhuseleki kwezicubu ezithambileyo, oko kwandisa ubunzima bonyango lokwaphuka. I-Pilon fractures iyaziwa ngokuba yi-comminution, ukufuduka kwendawo ye-articular, kunye nokulimala kwezicubu ezithambileyo. Ngenxa yotshintsho kwi-congruity edibeneyo kunye nokulungelelaniswa kwemilenze, ezininzi iifractures zifuna ukulungiswa kokuhlinzwa. Unyango oluchanekileyo lotyando kufuneka lulungelelaniswe kwiintlobo ezithile zokuphuka, ukulimala kwezicubu ezithambileyo, kunye nezigulane. Ixesha elifanelekileyo lonyango lotyando lungundoqo kwimpumelelo.
Iimpawu zeAnatomical
I-Pilon fractures ibandakanya amaqhekeza e-metaphyseal, kwaye ngamanye amaxesha amaqhekeza e-diaphyseal ngokunjalo. Kukwakho ukudakumba kwamalungu kunye nokwaphuka kwamalungu. Kukho amacandelo amathathu asisiseko amathambo: i-anterolateral fragment, i-medial malleolar fragment, kunye ne-posterolateral fragment.
Kukho iindawo ezintathu eziqhelekileyo zokuhlangana ngokubambisana: Ukuhamba kwe-lateral kwenzeka phakathi kwe-anterolateral kunye ne-posterolateral fragments, ngokuqhelekileyo isondele kwi-fibula. I-Central comminution ingabonisa njengamaqhekeza amathambo akhululekile okanye ukunyanzeliswa kweqhekeza le-posterolateral. Ukuhanjiswa okuphakathi kubandakanya inxalenye yeqhekeza eliphakathi okanye ukunyanzeliswa okufutshane ne-malleolus ephakathi.
Ukudibanisa ngokuqhelekileyo kwenzeka apho imigca yokuphuka idibana. Nganye kwiinqununu ezintathu eziphambili zokuqhekeka zinokuthi zihanjiswe kwaye zibe nemigca eyongezelelweyo yokuqhekeka. Kubalulekile ukukhusela imithambo yegazi ye-ankle. Izicubu ezithambileyo kufuneka ziphathwe ngononophelo kwaye zihoxiswe kuphela xa kuyimfuneko ukuphepha iingxaki zokuphilisa inxeba. Ukugqithisa ngokugqithiseleyo iinqununu zokuphuka kufuneka kugwenywe ukukhusela i-avascular necrosis yamaqhekeza.
IiNdlela zoKwenzakala
Ukulimala kwamandla aphezulu: Ukuwa ukusuka kumphakamo, ukutyibilika, iingozi zemoto, njl njl. Ukulimala okuphantsi: Ukukhubeka kwindawo ethe tyaba.
Isikhokelo sobundlobongela: Uxinzelelo lwe-Axial; Amandla okucheba ajikelezayo; Varus shear amandla; Valgus shear amandla.
I-Varus force violence: Ixhaphake kakhulu kubantu abancinci, kunye nokwenzakala okukhulu kunye nokulimala okuphezulu kwamandla. Umgca wokuqhekeka ukwindiza ye-sagittal, kwaye i-fibula ihlala ilungile.
Ubundlobongela be-Valgus: buxhaphake kakhulu kubantu abadala, kunye nokwenzakala okuncinci kunye nokulimala okuphantsi kwamandla. Umgca wokuqhekeka ukwinqwelomoya ye-coronal kwaye ihlala idibaniswa ne-fibular fracture.
Ukufanekisa iiMviwo
I-routine standard anteroposterior, lateral, and mortise view X - imitha ye-ankle ithathwa. I-X-ray epheleleyo ye-tibia ingabonisa ukulungelelaniswa kunye nedolo elihlangeneyo ngasentla. Kwezinye izigulane ezinobunzima obunzima, i-X-rays ye-contralateral limb ithathwa ukubonelela ngereferensi yokwakhiwa kwakhona kwe-fracture kunye nokufumanisa kwangaphambili ukuhluka kwe-anatomical okanye kokuzalwa.
Indlela yokulimala inokuqikelelwa ukusuka kuhlobo lwe-fibular fracture kwi-X-rays kwaye ihlelwa njenge: Ubundlobongela obucinezelayo (i-valgus deformity), ubundlobongela obuxinzelelekileyo (varus), ukulayishwa kwe-Axial (i-fibula ecacileyo). Ukuba i-fibula yonakele, idla ngokuba kukwenzakala okubukhali kwe-intra-articular (Uhlobo B). Ukulimala kwe-axial akubanga ukufuduka okukhulu kodwa kubangele ubuninzi be-axial yokulayisha kwi-distal tibia, kunye neengcezu ezincinci ze-articular surface kunye ne-prognosis embi yesibini kwi-articular cartilage compression. Isalathiso sokufuduswa kweqhekeza leqhekeza sinokuqikelelwa kwi-X esecaleni ebonisa uhlobo lokufuduswa kwe-talar (ngokuqhelekileyo ukufuduswa kwangaphambili).
Ulwakhiwo lweCT olunemilinganiselo emibini enemilinganiselo emithathu luyimfuneko. Banokubonelela ngolwazi olubandakanya iqondo lokuqhekeka kwe-fracture, indawo kunye nenani leeqhekeza zethambo, kunye nesalathiso sokufuduka.
I-Distal Lateral Fibular Locking Plate
I-VA Distal Medial Tibia yokutshixa iPlate
Ukuhlelwa
I-AO/OTA Fracture - Ulwahlulo lwe-Dislocation
I-articular Type A fractures idla ngokubonakala ilula kodwa inokudibaniswa nokulimala kwezicubu ezithambileyo. I-intraial partial intra - articular Type B fractures ibandakanya ukuhanjiswa kwe-articular kwaye ifuna iipleyiti ze-buttress ukunciphisa i-intra-articular fragments. Iifractures ezipheleleyo ze-intra-articular Type C zibonisa ukulimala okuphezulu kwamandla okuhambelana nokuhamba kwe-tibio - i-talar joint, ukulimala kwi-distal tibio - i-fibular syndesmosis, i-fibular fractures, kunye ne-tibial metaphyseal fractures, kwaye ngokuqhelekileyo idibene nokulimala okukhulu kwezicubu ezithambileyo.
Ruedi - Allgower Classification
Chwetheza I: A 'T' - ukuqhekeka okumilisekileyo okumile ngaphandle kokufuduswa okubalulekileyo.
Uhlobo lwe-II: Ukwahlula kwe-articular surface kunye nokufuduka okucacileyo komgca wokuphuka kunye nokuhamba okuphakathi.
Uhlobo lwe-III: Iifractures ezinzima kunye noxinzelelo lwe-distal tibial articular surface kunye ne-metaphysis.
Non - utyando Unyango
Unyango olungazenziyo lotyando lwe-distal tibial Pilon fractures lunqabile. Izibonakaliso ziintlobo zokuqhekeka okuncinci kunye nezigulane ezine-comorbidities ezonyusa umngcipheko wonyango lotyando. Eyongezelelweyo - i-articular fractures kunye neenguqu ezincinci kwi-alignment ye-tibial jikelele nayo ingaphathwa nge-plaster immobilization ngaphandle kokuhlinzwa. I-splint isetyenziswe ekuqaleni de ukudumba kuphele, kwaye emva koko kufakwe i-plaster cast. Utshintsho olunzima kwi-tibial okanye i-articular surface alignment ingakhokelela kwiingxaki zokulungelelanisa kunye nokuzinza. Iimviwo eziqhubekayo ze-X-ray ziyimfuneko ukuze kuqinisekiswe ukuhlangana okuhlangeneyo kunye nokulungelelaniswa kwelungu.
I-intra-articular fractures ekhethiweyo inokunyangwa ngaphandle kokuhlinzwa. Kwi-intra-articular fractures kunye ne-2 mm ye-fracture displacement kunye ne-3 mm yesinyathelo-off, unyango olungenalo utyando lunokuqwalaselwa kwizigulane ezineemfuno eziphantsi zokusebenza.
Iimpawu zoCando
Inyathelo lomphezulu we-Articular - ukusuka ngaphezulu kwe-2 mm.
I-angulation yeValgus ingaphezulu kwe-5 °.
Nayiphi na i-angulation ye-varus.
Vula iifractures.
I-compartment syndrome.
Ukwenzakala kwemithambo.
Ukwenzakala okuninzi.
Ixesha Lotyando
(1) Unyango olungxamisekileyo: Ukunciphisa kunye nokulungiswa kwe-dislocations; Ukuqhekeka okuvulekileyo; Ukulimala kwemithambo edibeneyo; I-compartment syndrome.
(2) Inqanaba lokuqala (Ukubuyiselwa kobude bomlenze kunye nokulungelelaniswa): I-calcaneal traction; Ukulungiswa kwangaphandle; Ukunciphisa kunye nokulungiswa kwangaphakathi kwee-fibular fractures, ukunciphisa okuvulekileyo okuncinci kunye nokulungiswa kwangaphakathi kwe-posterior tibial malleolar fractures; Ukuthintela i-thrombus.
(3) Okwesibini - isigaba: Ngokumalunga ne-10 - iintsuku ze-14 kamva, ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi kwe-tibial fracture.
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IiNdlela zoTyando
(1) Ukwandisa ukuvezwa komgca wokuphuka.
(2) Sombulula zonke iifractures kunye neendlela ezimbalwa zotyando.
(3) Ziphephe iindawo ezineemeko ezibuthathaka ezithambileyo.
(4) Qwalasela indlela yokulimala.
(5) Qwalasela indawo yokubeka ipleyiti.
Ukuphuka kwe-varus deformity, i-plate ye-buttress ye-medial ikhethiwe, kwaye i-anteromedial approach isetyenziswa.
Ukuphuka kwe-valgus deformity, i-lateral buttress plate ikhethiwe, kwaye i-anterolateral approach isetyenziswa.
Umgama phakathi kweendlela ezimbini zokuqhawula kufuneka ube ubuncinane ubuncinane be-5 - 7 cm.
Iimveliso ze-CZMEDITECH
