I-Locking Plate Series - I-Distal Tibial Compression Locking Bone Plate
I-distal tibial Pilon fractures ayivamile, ibalwa ngaphansi kwe-10% yokuphuka ezungeze iqakala. Izicubu ezithambile ku-distal tibia zinokubekezelelana okungalungile kokungatholakali kwezicubu ezithambile, okwandisa ubunzima bokwelashwa kokuphuka. Ukuphuka kwe-pilon kwaziwa ngokuqala, ukususwa kwendawo ye-articular, nokulimala kwezicubu ezithambile. Ngenxa yezinguquko ekuhambisaneni kwamalungu kanye nokuqondisa kwezitho, ukuphuka okuningi kudinga ukulungiswa kokuhlinzwa. Ukwelashwa okuqondile kokuhlinzwa kufanele kuhambisane nezinhlobo ezithile zokuphuka, ukulimala kwezicubu ezithambile, kanye neziguli. Isikhathi esifanele sokwelashwa kokuhlinzwa siyisihluthulelo sempumelelo.
Izici ze-Anatomical
I-Pilon fractures ihilela izingcezu ze-metaphyseal, futhi ngezinye izikhathi izingcezu ze-diaphyseal. Kukhona futhi ukucindezeleka kwamalunga kanye nokuphuka okungapheli. Kukhona njalo izingcezu ezintathu eziyisisekelo zamathambo: i-anterolateral fragment, i-medial malleolar fragment, ne-posterolateral fragment.
Kunezindawo ezintathu ezijwayelekile zokuhlangana okuhlangene: Ukuhlangana kwe-lateral kwenzeka phakathi kwezingcezu ze-anterolateral kanye ne-posterolateral, ngokuvamile eduze ne-fibula. I-Central comminution ingase iveze njengezingcezu zamathambo zamahhala noma ukucindezelwa kwe-posterolateral fragment. Ukukhishwa okuphakathi kuhilela ingxenye yocezu oluphakathi nendawo noma ukucindezelwa okuseduze ne-medial malleolus.
Ukuhlanganiswa kuvame ukwenzeka lapho imigqa yokuphuka ihlangana khona. Ngayinye yezingcezu ezintathu eziyinhloko zokuphuka ingase isuswe futhi ibe nemigqa eyengeziwe yokuphuka. Kubalulekile ukuvikela imithambo yegazi eqakaleni. Izicubu ezithambile kufanele ziphathwe ngokucophelela futhi zihoxiswe kuphela uma kunesidingo ukuze kugwenywe izinkinga zokuphola kwesilonda. Ukukhishwa ngokweqile kwezingcezu zokuphuka kufanele kugwenywe ukuvimbela i-avascular necrosis yezingcezu.
Izindlela Zokulimala
Ukulimala kwamandla aphezulu: Ukuwa endaweni ephakeme, ukushushuluza, izingozi zezimoto, njll. Ukulimala kwamandla aphansi: Ukukhubeka endaweni eyisicaba.
Isiqondiso sobudlova: Ukucindezelwa kwe-Axial; Amandla okugunda okujikelezayo; I-Varus shear force; I-Valgus shear force.
I-Varus force violence: Ivame kakhulu entsheni, enokulimala okukhulu kanye nokulimala okukhulu kwamandla. Umugqa wokuphuka usendizeni ye-sagittal, futhi i-fibula ivamise ukungaguquki.
I-Valgus force violence: Ivame kakhulu kubantu asebekhulile, abanokulimala okuncane kakhulu kanye nokulimala okuncane kwamandla. Umugqa wokuphuka usendizeni ye-coronal futhi uvame ukuhlotshaniswa nokuphuka kwe-fibular.
Imaging Examinations
Ukubuka okujwayelekile okujwayelekile kwe-anteroposterior, lateral, kanye ne-mortise X - ray yeqakala iyathathwa. I-X-ray enobude obugcwele ye-tibia ingabonisa ukuqondanisa kanye nokuhlangana kwedolo ngenhla. Kwezinye iziguli ezinokuphuka okuyinkimbinkimbi kakhulu, ama-X - ray wesitho esiphambene athathwa ukuze anikeze ireferensi yokwakhiwa kabusha kokuphuka kanye nokuthola ukuhluka okukhona kwangaphambili kwe-anatomical noma kokuzalwa.
Indlela yokulimala ingabikezelwa kusukela ohlotsheni lwe-fibular fracture ku-X - ray futhi ihlukaniswa ngokuthi: Udlame olucindezelayo (ukukhubazeka kwe-valgus), udlame oluqinile (varus), ukulayisha kwe-Axial (i-fibula eqinile). Uma i-fibula ingaguquki, ngokuvamile ukulimala kwe-intra - articular (Uhlobo B) okunzima kakhulu. Ukulimala kokulayisha kwe-axial akubangeli ukufuduka okuningi kodwa kubangela inani elikhulu lokulayisha i-axial ku-distal tibia, enezingcezu eziningi ezincane ze-articular surface kanye ne-prognosis embi yesibili ekucindezelweni kwe-articular cartilage. Isiqondiso sokugudluka kocezwana lungabikezelwa kusukela ku-X - ray engasemuva ebonisa uhlobo lokususwa kwe-talar (imvamisa ukufuduka kwangaphambili).
Ukwakhiwa kabusha kwe-CT okunezinhlangothi ezimbili nantathu kubalulekile. Bangahlinzeka ngolwazi oluhlanganisa izinga lokuphuka kokuphuka, indawo kanye nenombolo yezingcezu zamathambo, kanye nesiqondiso sokusuka.
I-Distal Lateral Fibular Locking Plate
I-VA Distal Medial Locking Plate ye-Tibia Locking
Ukwahlukanisa
Ukuphuka kwe-AO/OTA - Ukwahlukaniswa Kokuhlukaniswa
Ukuphuka kwe-articular Type A ye-articular ngokuvamile kubonakala kulula kodwa kungase kuhlotshaniswe nokulimala okuphawulekayo kwezicubu ezithambile. Ingxenye evamile yokuphuka kwe-intra - articular yoHlobo lwe-B lwe-articular ihlanganisa ukuguqulwa kwe-articular futhi idinga amapuleti e-buttress ukunciphisa izingcezu ze-intra - articular. Ukuhlukana okuphelele kohlobo C lwe-intra-articular kubonisa ukulimala okukhulu kwamandla okuhambisana nokuhamba kwe-tibio - i-talar joint, ukulimala kwe-distal tibio - i-fibular syndesmosis, i-fibular fractures, kanye ne-tibial metaphyseal fractures, futhi ngokuvamile ihlotshaniswa nokulimala okukhulu kwezicubu ezithambile.
I-Ruedi - I-Allgower Classification
Thayipha I: A 'T' - ukuhlukana okumise okwehlukana ngaphandle kokususwa okubalulekile.
Uhlobo II: Ukuhlukaniswa kwendawo ye-articular ngokugudluzwa okusobala komugqa wokuphuka kanye nokuqhubeka okumaphakathi.
Uhlobo lwe-III: Ukuqhekeka okukhulu okwenziwa futhi okucindezelayo kwe-distal tibial articular surface kanye ne-metaphysis.
Non - kuhlinzwa Ukwelashwa
Ukwelashwa okungahlinzeki kwe-distal tibial Pilon fractures kuyivelakancane. Izinkomba ziyizinhlobo zokuqhekeka ezisuswe endaweni encane kanye neziguli ezinezinkinga ezikhulisa ubungozi bokwelashwa ngokuhlinzwa. Ukwephulwa okwengeziwe - i-articular fractures enezinguquko ezincane ekuqondeni okuphelele kwe-tibial nakho kungaphathwa nge-plaster immobilization ngaphandle kokuhlinzwa. Kuqala kusetshenziswa i-splint kuze kuphele ukuvuvukala, bese kufakwa ukhonkolo. Izinguquko ezinzima ekuqondeni kwe-tibial noma i-articular surface zingase ziholele ezinkingeni zokuqondisa izitho nokuzinza. Ukuhlolwa kwe-X-ray okuqhubekayo kuyadingeka ukuze kuqinisekiswe ukuhlangana okuhlangene nokuhleleka kwezitho.
Ukuphuka kwe-intra-articular okukhethiwe nakho kungelashwa ngaphandle kokuhlinzwa. Ngokwaphuka kwe-intra - articular okungaphansi kuka-2 mm wokususwa kokuphuka kanye nangaphansi kuka-3 mm wesinyathelo - ukuvala, ukwelashwa okungahlinzeki kungacatshangelwa ezigulini ezinezidingo eziphansi zokusebenza.
Izinkomba Zokuhlinza
Isinyathelo se-Articular surface - singaphezu kuka-2 mm.
I-Valgus angulation enkulu kuno-5°.
Noma iyiphi i-varus angulation.
Vula ama-fracture.
I-Compartment syndrome.
Ukulimala kwemithambo.
Ukulimala okuningi.
Isikhathi Sokuhlinza
(1) Ukwelashwa okuphuthumayo: Ukunciphisa nokulungiswa kokuhlukaniswa; Ama-fracture avulekile; Ukulimala kwe-vascular okuhlobene; I-Compartment syndrome.
(2) Isiteji sokuqala (Ukubuyiselwa kobude nokuqondanisa kwezitho): Ukudonsa kwe-calcaneal; Ukulungiswa kwangaphandle; Ukunciphisa nokulungiswa kwangaphakathi kwe-fibular fractures, ukunciphisa okuvulekile okulinganiselwe nokulungiswa kwangaphakathi kwe-posterior tibial malleolar fractures; Ukuvimbela i-thrombus.
(3) Okwesibili - isigaba: Cishe izinsuku ezingu-10 - 14 kamuva, ukunciphisa okuvulekile nokulungiswa kwangaphakathi kwe-tibial fracture.
(4) Izimo zezicubu ezithambile zokuhlinzwa kwesigaba sesibili yilezi: Ukumuncwa kwe-hematoma endaweni okuhlinzelwa kuyo, ukuvuselelwa kwe-epidermal kumabhamuza aphukile, ukuphola kwenxeba lokuqhekeka okuvulekile ngaphandle kokutheleleka, ukubola kwezicubu ezithambile, kanye nokushwabana kwesikhumba.
Izindlela Zokuhlinza
(1) Khulisa ukuchayeka komugqa wokuphuka.
(2) Xazulula konke ukuphuka ngezindlela ezimbalwa zokuhlinzwa.
(3) Gwema izindawo ezinezicubu ezithambile ezingezinhle.
(4) Cabangela indlela yokulimala.
(5) Cabangela indawo yokubeka ipuleti.
Ngokuphuka kwe-varus deformity, ipuleti le-medial buttress likhethiwe, futhi indlela ye-anteromedial isetshenziswa.
Ngokuphuka kwe-valgus deformity, ipuleti le-lateral buttress likhethiwe, futhi indlela ye-anterolateral isetshenziswa.
Ibanga phakathi kwemigqa emibili kufanele okungenani libe ngu-5 - 7 cm.
Imikhiqizo ye-CZMEDITECH
