I-Tibial Intramedullary Nail: Isisombululo esithembekileyo seTibial Fractures

I-Tibial fractures, echaphazela i-shinbone, inokuchaphazela kakhulu ukuhamba kunye nemisebenzi yemihla ngemihla. Ukunyangwa kwezi fractures kufuna uqwalaselo ngononophelo lwemiba eyahlukeneyo, kubandakanywa uhlobo lokwaphuka, indawo, kunye neempawu zesigulana. Olunye ukhetho lotyando oluye lwabonakala lusebenza kwiminyaka yakutshanje kukusetyenziswa kwesikhonkwane se-tibial intramedullary. Eli nqaku liphonononga izibonelelo, ubuchule botyando, imingcipheko, kunye nokuchacha okuhambelana nale ndlela yonyango.

Intshayelelo

Ukuqhekeka kwe-tibia kunokuphazamisa, kubangela intlungu, ukungazinzi, kunye nobunzima bokuhamba. Izindlela zonyango zendabuko, ezifana nokuphosa okanye ukulungiswa kwangaphandle, zinezithintelo, ezikhuthaza ukuhlolisiswa kwezisombululo eziphezulu ezifana ne-tibial intramedullary nail.

Yintoni iTibial Intramedullary Nail?

Isikhonkwane se-tibial intramedullary sisixhobo sonyango esenzelwe ukuzinzisa nokukhuthaza ukuphulukiswa kweefractures kwi-shaft tibial. Iqukethe intonga yensimbi efakwe kwiziko elingenalutho lethambo, inika uzinzo kunye nenkxaso ngexesha lenkqubo yokuphulukisa. Isikhonkwane senziwe nge-titanium okanye intsimbi engenastainless kwaye iza ngobukhulu obahlukeneyo ukuze ikwazi ukwamkela izigulana ezahlukeneyo.

Iimpawu zeTibial Intramedullary Nail

Izikhonkwane ze-Intramedullary ze-Tibial zisetyenziswa ngokuqhelekileyo kunyango lwe-tibial shaft fractures. Zisebenza ngokukodwa kwiifractures ezifuna ukulungiswa okuzinzile, ezifana nokufuduka okanye ukuphulwa kwe-comminuted fractures. Obu buchule bukwafaneleke kumatyala anomgangatho ophantsi wamathambo okanye xa kufuneka ukuthwala ubunzima kwangoko.

Ubuchwephesha boTyando lwe-Tibial Intramedullary Nail

UCwangciso lwaphambi kokuSebenza

Ucwangciso olucokisekileyo lwangaphambi kotyando lubalulekile kuqhaqho oluyimpumelelo lwe-tibial intramedullary nail. Oku kubandakanya uvandlakanyo olubanzi lwepateni yokwaphuka, impilo yesigulane ngokubanzi, kunye naluphi na ukonzakala okuhambelanayo. Iindlela zokucinga ezifana ne-X-rays, i-CT scans, okanye i-MRI ingasetyenziselwa ukuvavanya iimpawu zokuphuka kunye nesikhokelo sokwenziwa kwesigqibo sotyando.

Ukubekwa kwesigulane

Ngexesha lotyando, isigulane ngokuqhelekileyo sibekwe phezulu kwitafile yokusebenza. Umlenze ochaphazelekayo ulungiselelwe kwaye ugxothwe ngendlela eyinyumba. Ukumisa okufanelekileyo kubalulekile ukuvumela ukufikelela ngokufanelekileyo kwindawo yokuphuka kunye nokuququzelela ukufakwa kwezikhonkwane.

Ukusika kunye noFikelelo

Ukusikwa kwenziwa phezu kwendawo yotyando ukufikelela kwithambo elaphukileyo. Ubude kunye nendawo ye-incision ixhomekeke kuhlobo lokuphuka kunye nendawo yalo kunye ne-tibia. Ukuphatha iithishu ezithambileyo ngononophelo kubalulekile ukunciphisa umonzakalo kunye nokunciphisa umngcipheko wosulelo.

Ukufakwa Kwezikhonkwane

Emva kokudala indawo yokungena kwi-proximal tibia, ugqirha ufaka ngokucophelela i-tibial intramedullary nail kwi-medullary canal. Isikhokelo seFluoroscopic sisetyenziselwa ukuqinisekisa ukubekwa okuchanekileyo kunye nokulungelelaniswa. Isikhonkwane sihamba phambili ngethambo, silungelelanisa nawaphi na amaqhekeza asusiweyo kunye nokubuyisela ukulungelelaniswa okufanelekileyo kwe-anatomical.

Ukutshixa izikrufu zokubeka

Nje ukuba isikhonkwane sibekwe kakuhle, izikrufu zokutshixa zifakwa ukuze kukhuseleke isikhonkwane ngaphakathi kwethambo. Ezi zikrini zibonelela ngokuzinza okongeziweyo kunye nokuthintela ukunyakaza okujikelezayo okanye kwe-axial yeeqhekeza zokuphuka. Inani kunye nokubekwa kwezikrufu kuxhomekeke kwipateni yokwaphuka kunye nokukhethwa ngugqirha wotyando.

Ukuvalwa Kwenxeba

Emva kokuqinisekisa ukulungelelaniswa okufanelekileyo kunye nokulungiswa, i-incision ivaliwe ngokusebenzisa i-sutures okanye i-staples. Ukuvalwa kwamanxeba kwenziwa ngobunono ukukhuthaza ukuphiliswa kunye nokunciphisa umngcipheko wosulelo. Kufakwe isinxibo esingenazintsholongwane, kwaye indawo yotyando ikhuselekile.

Izinto eziluncedo zeTibial Intramedullary Nail

Ukusetyenziswa kwesikhonkwane se-tibial intramedullary kunika iingenelo ezininzi kwiindlela zonyango zendabuko. Ezinye zezibonelelo eziphambili ziquka:

1. Ukulungiswa okuzinzile: Isikhonkwane sibonelela ngokuzinza ngokuzinzile, ukuvumela ukulungelelaniswa okufanelekileyo kunye nomanyano lweziqhekeza zokuphuka.

2. Ukuhlanganiswa kwangethuba: Isikhonkwane sibonelela ngokuhlanganisa kwangethuba, okwenza ukuba izigulane ziqale ukuthwala ubunzima kunye nokuzivocavoca umzimba ngokukhawuleza xa kuthelekiswa nezinye iindlela zonyango.

3. Ukulondolozwa konikezelo lwegazi: Ngokusebenzisa umjelo we-intramedullary, ubuchule be-tibial intramedullary nail bunciphisa ukuphazamiseka kunikezelo lwegazi lwethambo, olubalulekileyo ukuphiliswa kokwaphuka.

4. Iziphumo eziphuculweyo zokusebenza: Ngokulungiswa okuzinzile kunye nokuhlanganiswa kwangaphambili, izigulane ezenza utyando lwe-tibial intramedullary nail zihlala zifumana iziphumo eziphuculweyo zokusebenza kunye nokubuyela ngokukhawuleza kwimisebenzi yemihla ngemihla.

5. Ukunciphisa umngcipheko weengxaki zezicubu ezithambileyo: Xa kuthelekiswa neendlela zokulungiswa kwangaphandle, ubuchule be-intramedullary nail bubandakanya ukuchithwa okuncinci kunye nokunciphisa ukuphazamiseka kwezicubu ezithambileyo, okubangelwa umngcipheko ophantsi weengxaki zezicubu ezithambileyo kunye nokusuleleka.

   
   

Iingxaki kunye nemingcipheko

Ngelixa utyando lwezikhonkwane lwe-tibial intramedullary lukhuselekile kwaye lusebenza kakuhle, kukho iingxaki ezinokubakho kunye neengozi ezinxulumene nenkqubo. Kubalulekile ukuzazi ezi zinto zinokwenzeka phambi kokuba ufumane unyango. Ezinye zeengxaki ziquka:

Usulelo

Njengayo nayiphi na inkqubo yotyando, kukho umngcipheko wokosuleleka. Nangona kunjalo, ngobuchule obufanelekileyo bobuchwephesha, i-antibiotic prophylaxis, kunye nokhathalelo lwasemva kotyando, umngcipheko wokosuleleka unokuncitshiswa.

Ukungahambi kakuhle okanye ukungahambi kakuhle

Kwezinye iimeko, iziqwenga eziqhekezayo azikwazi ukuphilisa ukulungelelaniswa okufunwayo okanye ukuhluleka ukuphilisa ngokupheleleyo. Izinto ezinjengokuncipha ngokwaneleyo, umgangatho ophantsi wamathambo, okanye ukuthwala ubunzima obugqithiseleyo kunokufaka isandla ekungalungelelani okanye ukungahambi kakuhle. Ukujongwa ngokusondeleyo kwaye, ukuba kuyimfuneko, ungenelelo olongezelelweyo olufana nokuhlinzwa ngokutsha kunokufuneka.

Iingxaki ezinxulumene nokufakelwa

Ngelixa ingaqhelekanga, iingxaki ezinxulumene nokufakelwa zinokuthi zenzeke, ezifana nokukhulula i-implant, ukwaphuka, okanye ukucaphuka. Le miba inokufuna ungenelelo olongezelelekileyo lotyando ukulungisa.

Ukwenzakala kwiNerve okanye kwiGazi

Ngexesha lotyando, kukho umngcipheko omncinci wokulimala kwemithambo-luvo okanye imithambo yegazi. Oogqirha botyando bathatha inyathelo lokunciphisa lo mngcipheko, kodwa izigulane kufuneka ziqaphele ukuba zinokwenzeka kwaye zixele ngokukhawuleza naziphi na iimpawu eziqhubekayo okanye ezisandayo.

Ukubuyisela kwisimo sangaphambili kunye noBuyiselo

Ukulandela utyando lwezikhonkwane lwe-tibial intramedullary, inkqubo yokubuyisela kwisimo sangaphambili ibalulekile ukuze uchache ngokugqibeleleyo. Isicwangciso esithile sokubuyisela kwimeko yesiqhelo sinokuhluka ngokuxhomekeke kubunzima bokuphuka, iimpawu zesigulane, kunye nesikhokelo sogqirha. Ukuzivocavoca kwangaphambili, ukuthwala ubunzima, kunye nonyango lomzimba ludlala indima ebalulekileyo ekubuyiseleni umsebenzi, ukuphucula amandla, kunye nokukhuthaza ukuphilisa amathambo.

Izifundo zeCase kunye neMpumelelo yamabali

Izigulana ezininzi ziye zafumana iziphumo eziyimpumelelo nge-tibial intramedullary nail surgery. Olunye uphando lubandakanya umntu oneminyaka engama-35 ubudala kunye ne-comminuted tibial shaft fracture. Emva kokwenza utyando nge-tibial intramedullary nail, isigulane siphumelele umanyano oluqinileyo lwefracture, saphinda safumana amandla okuthwala ubunzima, sabuyela kwinqanaba labo langaphambili lomsebenzi kwiinyanga ezintandathu.

Ukuthelekiswa nolunye uKhetho loNyango

Xa uqwalasela ukhetho lonyango lwe-tibial fractures, kubalulekile ukuthelekisa izibonelelo kunye nemida yendlela nganye. Ngelixa utyando lwezikhonkwane lwe-tibial lwe-intramedullary lubonelela ngeenzuzo ezininzi, ezinjengokulungiswa okuzinzile, ukuhlanganiswa kwangaphambili, kunye nokunciphisa iingxaki zezicubu ezithambileyo, akunakulungele yonke ipateni yokuphuka okanye isigulane. Iindlela ezizezinye, ezifana ne-plating okanye ukulungiswa kwangaphandle, kunokukhethwa kwiimeko ezithile. Ukubonisana nengcali yamathambo kuya kunceda ukumisela eyona ndlela ifanelekileyo yonyango ngokusekelwe kwiimeko zomntu ngamnye.

Ukuqukumbela

Ukuqukumbela, utyando lwezikhonkwane lwe-tibial intramedullary lukhetho oluthembekileyo nolusebenzayo lonyango lokuqhekeka kwe-tibial. Ubuchwephesha bubonelela ngolungiso oluzinzileyo, luvumela ukuhlanganisa kwangethuba, kwaye lubonelela ngeenzuzo ezininzi kwiindlela zesintu. Nangona kukho iingozi ezinokubakho kunye neengxaki ezinxulumene nenkqubo, ukucwangciswa ngononophelo kwangaphambi kotyando, ubuchule obuchanekileyo botyando, kunye nonyango olufanelekileyo lwasemva kotyando kunokunciphisa oku kukhathazeka.