I-Tibial fracture, i-suprapatellar intramedullary nailing technique

I-Intramedullary tibial nailing: ukufikelela kunye nokulungelelaniswa, intlungu yamadolo angaphambili

Indlela yokuhlinzwa kwi-intramedullary nailing of tibial fractures ibalulekile ukwenzela ukuba kufakwe isikhonkwane se-intramedullary ngendawo yokungena echanekileyo, ukunciphisa umonakalo kwizakhiwo zamadolo e-intra-articular, kunye nokufezekisa ukuchithwa kwe-fracture efanelekileyo kunye nokungena ngokufanelekileyo kwe-nail.

Iindlela zakudala zokuqhekeka kwe-tibial stem yi-infrapatellar median okanye infrapatellar parapatellar approach. Nangona ezi ndlela zibonakaliswe kwi-middle-segment fractures, i-valgus ye-postoperative, i-anterior, okanye i-deformities edibeneyo idla ngokuphindaphindiweyo kwi-fractures engaphezulu.

Isizathu esiphambili sokungahambi kakuhle kwi-proximal tibial fractures kukukhubazeka okubangelwa ukutsalwa kwe-tendon ye-quadriceps ngexesha lokuguqa kwamadolo kunye nokungqubuzana komatshini phakathi kwe-nail tip kunye ne-posterior tibial cortex ngexesha lokufakwa kokufakelwa. I-patella iphinda ithintele ukungena kwe-axial nail kwi-plane ye-sagittal (Umfanekiso 1a, b). Ngoko ke, enye indlela eqhelekileyo yokufikelela kwinqanaba ngokusebenzisa i-parapatellar incision medial, ekhokelela kwi-medial encinci yokufakwa kwe-nail lateral (Imifanekiso 1c kunye ne-2). Njengoko isikhonkwane singena kwi-intramedullary canal distal ukuya kwi-fracture, inxalenye esondeleyo idibanisa kwi-valgus (Umfanekiso 2). Ekugqibeleni, ukunyanzeliswa kokuphumla kwemisipha yecandelo langaphambili kuncedisa kancane kwi-valgus (Umfanekiso 3).

Umzobo we-1 a, b Ukusebenzisa indlela ye-infrapatellar eqhelekileyo, i-patella ivimbela ukungena kwe-axial yesikhonkwane, okubangelwa ukukhubazeka okuqhelekileyo kwe-anterior apical sagittal alignment kunye ne-valgus coronal alignment. c Ukusebenzisa indlela yeparapatellar ulungelelwaniso lwezikhonkwane ze-intramedullary.

Umfanekiso wesi-2 Ukusondela kwindawo yokungena ngokusebenzisa i-medial parapatellar incision ikhokelela ekufakweni kwe-nail esecaleni kancinane. Njengoko isikhonkwane singena kwi-medullary canal distal ukuya kukwaphuka (a), inxenye esondeleleneyo ityekela kwivalgus (b)

Umzobo 3 Ukuphumla koxinzelelo kwi-compartment ye-muscle yangaphambili (a) ivelisa ilungiselelo elifihlakeleyo le-ectopic (b)

Ukubethela i-tibia kwindawo eyandisiweyo kunceda ukuphepha iingxaki ezinxulumene nokuguqa kwedolo kwangaphakathi. ubuchule buchazwe nguGelbke, Jakma et al. ngo-2010 kwaye iye yanda kakhulu kwiminyaka yamuva nje ngenxa yokuba ukukhonkxa i-tibia kwindawo ephantse yathe tye yenza lula ukuqhekezwa kwe-fracture kunye nokubekwa ngokutsha. I-Fluoroscopy iye yaba lula ngobuchule ukwenza. Amaxesha e-Fluoroscopy e-suprapatellar nailing axelwe ukuba mafutshane kakhulu kune-infrapatellar nailing. Ukongezelela, i-angle yokufakwa kwezipikili (kwi-plane ye-sagittal) ihambelana ngakumbi ne-longitudinal axis ye-tibia kule ndlela kune-infrapatellar nail; oku kuthintela ukungquzulana komatshini phakathi kwencam yesikhonkwane kunye ne-cortex yangasemva, ngaloo ndlela kuququzelela ukunciphisa ukuphuka.

Intlungu yedolo yangaphambili ye-postoperative yingxaki ehambelanayo. Iintlungu zangaphambili zamadolo ziye zabikwa kwi-50-70% yezigulane zokuphuka, kunye ne-30% kuphela yezigulane ezifumana intlungu emva kokususwa kwesityalo sangaphakathi. Kuqikelelwa ukuba ukubunjwa kwamanxeba okuhambelana nokufikelela kwi-tendon ye-patellar kunye ne-Hoffa fat pad ngumthombo onokuthi ube ngumthombo weentlungu zamadolo emva kokuhlinzwa. Ukongezelela, indlela ye-suprapatellar igwema ukuchongwa kwendabuko yesebe lesebe le-patellar ye-nerve ye-saphenous, ngaloo ndlela igwema ukuguqa kwamadolo angaphambili kunye nobuhlungu boluvo (Umfanekiso 4). Ukugqithisa isikhonkwane kwi-tendon ye-quadriceps, ngaloo ndlela ishiya i-tendon ye-patellar ingaguquki, ibonakala inciphisa kakhulu izinga leentlungu zedolo emva kokuhlinzwa.

Ngenxa yeziphumo ezilungileyo zokwaphuka okusondeleyo, izibonakaliso ekusebenzeni kweklinikhi ziye zandiswa kuzo zonke iifractures.

Kufuneka kusetyenziswe nini i-suprapatellar intramedullary nail?

Iingenelo

• Isikhundla sedolo elongeziweyo elisezantsi likhuthaza ukuguqulwa kokuqhekeka kunye nokubekwa kwindawo ngokutsha ngokuphumza amandla emisipha kunye nokugcinwa ngexesha lokufakwa kwezipikili.

• Umngcipheko ophantsi wokususwa kwe-postoperative ye-proximal, i-segmental kunye ne-distal fractures xa kuthelekiswa neendlela eziqhelekileyo

• Ukusebenza ngezikhonkwane kulula ngobuchule ukwenza

• Ufakelo lwezikhonkwane luyenzeka 'njengenkqubo yotyando olunye'

• Ukunciphisa ixesha le-fluoroscopy

• Akukho monakalo kwi-tendon ye-patellar kunye nesiganeko esisezantsi se-post-stapling yangaphambili yeentlungu zedolo

• Kulula ukwenza kwinkqubo yamaqela amaninzi, njengakumothuko oluninzi

  
  

Iimpawu

• I-fracture eyongezelelweyo ye-tibia ye-proximal (uhlobo lwe-AO 41A)

• Ukuqhekeka okulula kwe-tibial diaphysis (uhlobo lwe-AO 42A-C)

• Ukuqhekeka kwe-segmental tibial diaphyseal (uhlobo lwe-AO 42C)

• I-distal tibial extra-articular fractures kunye ne-intra-articular distal extension fractures elula (i-AO 43A kunye neentlobo ze-C1)

• Idolo elidadayo

• I-Patellar ossification kunye ne-patellar tendon ossification

• Inxeba elingcolileyo kwinqanaba le-patellar tendon

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

Kuba I-CZMEDITECH , sinomgca wemveliso ogqityiweyo kakhulu wokufakelwa kotyando lwe-orthopedic kunye nezixhobo ezihambelanayo, iimveliso ezibandakanya ukufakelwa komqolo, iinzipho ze-intramedullary, ipleyiti yokwenzakala, ipleyiti yokutshixa, i-cranial-maxillofacial, iprosthesis, izixhobo zamandla, izilungisi zangaphandle, arthroscopy, ukhathalelo lwezilwanyana kunye neeseti zezixhobo ezixhasayo.

Ukongeza, sizibophelele ekuqhubekeni siphuhlisa iimveliso ezintsha kunye nokwandisa imigca yemveliso, ukuze sihlangabezane neemfuno zotyando zoogqirha abaninzi kunye nezigulana, kwaye senze inkampani yethu ikhuphisane ngakumbi kulo lonke ilizwe lehlabathi lokufakelwa kwamathambo kunye nezixhobo.

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